BC PsyChologist t h e j o u rn a l o f t h e b c psych o lo g i c a l a ss o ciati o n Vo lu m e 2 Issu e 4 â€˘ Fa l l 2013 Cu lt u re
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L e t te r f r o m t h e P r e s i d e n t
L e t te r f r o m t h e E xe c u t i v e D i r e c to r
Ad v o c a c y f o r E n h a n ce d Acce s s to P s y c h o lo g i c a l S e r v i ce s
L e t te r f r o m t h e A PA C o u n c i l Re p r e s e n t at i v e
B CPA N e w s B o a r d o f D i r e c to r s 2013 Ele c ti o n
Wo r k s h o p a n d AG M Re g i s t r ati o n
Fa i t h M at te r s : I m p l i c at i o n s o f Re l i g i o n a n d S p i r i t u a l i t y f o r P s y c h o lo g i s t s B y J ay e Wa l d , P h . D. , R . P s y c h .
O u tco m e s M o n i to r i n g a n d B r i t i s h C o lu m b i a P s y c h o te r a p i s t s B y Te r r a Ko w a ly k , B A , G a b r i e l a I o n i t a , B A , M A & M a r i ly n F i t z p at r i c k , B A , M . E d . , P h . D.
C o p i n g w i t h t h e S u b t le Ra c i s m: Client Handout B y Te d Alt a r, P h . D. , R . P s y c h .
T h e M at r i x Sy s te m o f M a n a g e m e n t : St r e n g t h s a n d N e e d s B y D o n H u tc h e o n , C . P s y c h o l . (U K), R . P s y c h .
mission statement The British Columbia Psychological Association provides leadership for the advancement and promotion of the profession and science of psychology in the service of our membership and the people of British Columbia.
EDITOR IN CHIEF Ted Altar, Ph.D., R. Psych. Assistant Editor Marian Scholtmeijer, Ph.D.
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PUBLISHER Rick Gambrel, B.Comm., LLB. ART DIRECTOR Inkyung Kang
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executive director Rick Gambrel, B.Comm., LLB.
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administrative director Eric Chu
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EXECUTIVE ASSISTANT Rukshana Hassanali
DISCLAIMER The opinions expressed in this publication are those of the authors, and they do not necessarily reflect the views of the BC Psychologist or its editors, nor of the BC Psychological Association, its Board of Directors, or its employees. Canada Post Publications Mail #40882588 COPYRIGHT 2013 © BC PSYCHOLOGICAL ASSOCIATION
BOARD OF DIRECTORS PRESIDENT Ted Altar, Ph.D., R. Psych. VICE-PRESIDENT Don Hutcheon, Ed.D., R. Psych. TREASURER Marilyn Chotem, Ed.D., R. Psych. DIRECTORS Michael Mandrusiak, Psy.D., R.Psych. Douglas Cave, MSW, RSW, Ph.D., R. Psych., MA, AMP, MCFP. Yuk Shuen (Sandra) Wong, Ph.D., R. Psych. Joachim Sehrbrock, Ph.D., R. Psych.
letter from the President t e d a lta r, ph . d. , r. p sych .
The President of the BC Psychological Association. Contact for the Board of Directors at firstname.lastname@example.org
D e a r M e m b e rs ,
I hope you have had some holidays this year or will soon be scheduled to do so. We know that people who take holidays have fewer health problems than those who do not. For example, in one study of some thirteen thousand middle-aged men with a risk for heart disease, those who did not take vacations for five consecutive years were found to be thirty percent more likely to have a heart attack. Even missing one year's vacation was associated with a higher risk of heart disease (Psychosomatic Medicine. 2000. 62:608â€“ 12). Of course, this relationship may not be causal but only predictive. Practicing what we preach, the Board did not meet for August, but we did have to meet in late July to finalize the hiring of the Executive Director. Normally, the board does not meet in July or August. We spent many hours searching and interviewing for the best person to serve as your Executive Director. We wanted someone who could do more than simply be a manager since we have a very competent staff who have proven that they can manage the office on their own. What we were hoping to find is someone who can also act as our advocate for Psychology in B.C. I certainly think we have that person and although he is not a Psychologist, he is a licensed lawyer. It is therefore my very great pleasure to announce that the BCPA Selection Committee has selected a candidate for the ED position and that their recommendation was approved by the Board. Our new Executive Director will be Rick Gambrel. Rick brings with him over 25 years of experience as a trial lawyer with a focus on personal injury and employment law. Besides his law degree and license to practice law in British Columbia, Rick has a Bachelor of Commerce from UBC and has a myriad of skills in business, finance and lobbying the government during the past thirty years. His extensive experience leading organizations such as the Trial Lawyers Association of BC (Executive Member
1998â€“2005, Vice President 2003, President 2004) and as
the current President of White Rock Concerts makes him a good fit for BCPA. Very important for us is his experience with government. For example, he participated as an executive member of the Trial Lawyers Association in the successful campaign for citizen rights of representation in automobile insurance claims. Rick assumed his responsibilities in August as Executive Director and we are very pleased and impressed with his political and organizational acumen. As a lawyer he will also help us with recommending some constitutional changes and changes in our Policy Manual. His legal background and knowledge will certainly be an asset. You will find Rick to be a very pleasant, energetic and enthusiastic person of good will and broad interests. He is certainly very keen on actively championing our causes and has some great ideas. He has always appreciated the role and importance of psychologists in his work with personal injury cases. His email address with BCPA is email@example.com I would also like to report that as of September 12 we had 18 new BCPA members sign up this year. We naturally want to warmly welcome these new members. With respect to the renewals this year as compared to the same time last year, we have so far the following: Members as of September 12, 2012
Members as of September 12, 2013
It has been an interesting year for the BCPA board. Some important changes in restructuring for greater efficiency and better board process have been implemented and we have asked the members to ratify some constitutional changes towards this greater end. Respectfully, Dr. Ted Altar
letter from the Executive Director Pl e a se a l low m e to in t r o d u ce m yse l f.
ri ck ga m b re l , b . Co m m . LLB .
I am Rick Gambrel, your new Executive Director of the BCPA. Who am I? My education is from UBC, first with a Bachelor of Commerce, and then a Law Degree. I come to the BCPA from a 28year career as a trial lawyer. During that time, I also acted as Managing Partner of a number of law firms, managing them as a business, as well as helping individuals in court. I was a Board member of the Trial Lawyers Association of British Columbia and ultimately had the honour to be elected President of the Association by 1400 of my peers. In that role I dealt with the media, lobbied government and sat on the Council of Presidents of the Association of Trial Lawyers of America. In addition, for the past twelve years, I served as President of, and managed, one of North America’s most successful classical music concert series, White Rock Concerts, which was named Canadian Arts Presenter of the Year in 2007. I received great joy from bringing beautiful music to sold-out houses of over 800 each season. I thoroughly enjoyed my legal career, but there came a time when I realized that I had accomplished all that I had set out to accomplish in law, so I had the luxury of being able to venture on to a new challenge. I had a number of options available to me and after meeting both the very impressive staff and the equally impressive Board, I chose BCPA, and, fortunately for me, you chose me. As an association management professional I hope to be able to bring some fresh ideas and a different perspective to BCPA, and work with the staff, the Board and the members to further the goals of this great organization. I look forward to meeting you at our Annual General Meeting on November 29th at the University Golf Club. On the same day, I invite you to attend the workshop, “Defining and Dealing with Addiction in the 21 st Century,” presented by Stanton Peele, Ph.D., J.D., one of the foremost authorities on Addiction in America. Thank you to Dr. Ted Altar and the BCPA Board for giving me the opportunity to serve this organization in this important role. I look forward to meeting all of you.
The Executive Director of the BC Psychological Association. Contact: firstname.lastname@example.org
Regards, Rick Gambrel B.Comm., LLB.
Advocacy for Enhanced Access to Psychological Services K a re n R . Co h e n , Ph . D. , C . Psych .
Chief Executive Officer Canadian Psychological Association Contact: email@example.com
Communities of psychology well understand that one of the greatest challenges faced when caring for the mental health of Canadians is the significant barriers to accessing mental health services. Despite the staggering statistic that one in five Canadians will experience a mental health problem in a given year, only one-third of those will receive the help they need. We have psychological treatments that work, and experts trained to deliver them. Yet the services of psychologists are not funded by provincial health insurance plans, which makes them inaccessible to most Canadians. When available, publically funded services are often in short supply and wait lists are long and steadily growing. In addition, the cost of mental illness in Canada is estimated at 51 billion dollars annually, so we must act now and be innovative in our approach. That is why the Canadian Psychological Association (CPA) recently released a commissioned report from a group of health economists who developed several models for enhanced access. The report ‘An Imperative for Change: Access to Psychological Services for Canada’ by David Peachey, Vern Hicks and Orvill Adams provides a business case for improved access to psychological services based on demonstrating positive return on investment and proposed service that yields desired outcomes. The proposed models were developed after an extensive review of national and international literature as well as focused interviews and surveys of a range of stakeholders from among government, insurance and health provider communities. To launch this exciting report, CPA issued a news release and delivered a speech at the Press Gallery on Parliament Hill. CPA’s advocacy activity for 2013/14 will
be to promote the report’s recommendations with other health stakeholders, key employers, insurers and the Federal Government in its areas of authority and as a large employer. CPA is working in concert with our provincial and territorial partners to meet with government, employers, and insurers to follow through on the report’s recommendations. To help facilitate this activity we have developed an advocacy tool kit that Canada’s associations of psychology can use to promote the report’s recommendations within their jurisdictions. The report suggests that the following measures could be taken to increase access to psychological services. The report details the costs, and cost offsets, of each of the measures: • Adapt the United Kingdom’s publicly funded model for Improved Access to Psychological Therapies (IAPT) in the provinces and territories. Under this program psychologists oversee the delivery of care for people with the most common mental health problems: depression and anxiety. • Integrate psychologists into primary care teams so that mental health problems are addressed at the right time, in the right place, by the right provider. • Include psychologists on specialist care teams in secondary and tertiary care facilities for health and mental health conditions. • Expand the public service private insurance coverage and promote employer support for psychological services. Canadian employers could expect to recover $6 to $7 billion annually with attention to prevention, early identification and treatment of mental health problems among their workforces. To find out more, or share your ideas about enhancing access to psychological services, contact firstname.lastname@example.org Karen R. Cohen, Ph.D., C. Psych. Chief Executive Officer Canadian Psychological Association
letter from the APA Council Representative At its meeting, the Council of Representatives adopted measures to promote quality in multiple levels of psychology education and revise certain elements of APA governance to make it more effective. G o o d G ov e rn a n ce Pr oj e c t
Following a three-year analysis, the council voted to approve the following: • Enhancing the use of technology to expand communication within APA and membership. • Developing the creation of a new pipeline for leadership in APA governance. • Creating a triage system, enabling more efficient governance. • Expanding the council’s scope to focus on directing and informing major policy issues. • Delegating responsibility for budget and internal policy matters to APA’s Board of Directors for a three-year trial period. • Changing composition of APA’s Board of Directors to be more representative of APA’s membership. Q ua l it y in P sych o lo gy Ed u c at i o n
The council adopted three measures to strengthen the teaching of psychology and training across the continuum of psychology education. At the undergraduate level, the council adopted revised guidelines for the psychology major, updating those the APA adopted in 2006. The new guidelines now include new teaching tools as well as student learning and benchmarking measures. Regarding graduate level training, the council adopted a resolution on accreditation for programs that prepare psychologists to provide health services. The APA policy now states that to practice as an independent health service psychologist, candidates must graduate from an APA/Canadian Psychological Association accredited doctoral program and internship or programs accredited by an accrediting body that is recognized by the U.S. Secretary of Education for the accreditation of education and training programs that prepare students for entry into professional practice. The resolution gives unaccredited graduate programs five years to become 8
Au g us t 2013
j e a n n e l e b l a n c Ph . D. , ABPP, R. Psych
The BCPA Representative to the APA’s Council of Representatives. Contact: email@example.com
accredited and internship programs seven years to gain accreditation. (This policy will not impact students currently in the pipeline and allows for grandparenting of those graduates from unaccredited programs who are now licensed providers.) Psych o lo g is t s’ wo rk in n ati o n a l se cu rit y se t tin gs
Also during the meeting, the council adopted a resolution that reconciles the APA’s policies against torture and other forms of cruel, inhuman or degrading treatment or punishment and those related to psychologists’ work in national security settings. The new APA resolution does not create new policy but makes existing policy in the area more internally consistent and comprehensive. This reconciled policy rescinds the report of the APA Presidential Task Force on Psychological Ethics and National Security (PENS) and retains the Association’s 2006 policy concerning torture and the 2008 member petition on psychologists’ work in national security settings. “APA’s policies in this area and the reconciled policy document are all grounded in the principle that torture is always a violation of human rights and a violation of the APA Ethics Code,” said Kathleen Dockett, EdD, a task force member. In ot h e r ac ti o n , t h e co u n cil :
• • • •
Recognized sleep psychology and police and public safety psychology as specialties in professional psychology. Adopted guidelines for the practice of telepsychology and psychological practice with older adults. Adopted revised standards for educational and psychological testing. Adopted a resolution on Counseling in HIV testing programs.
BCPA News u p co min g wo rk sh o p s
Defining and Dealing with Addiction in the 21st Century Presented by Stanton Peele, Ph.D. / November 29th, 2013 BCPA Annual General Meeting on November 29th, 2013 Please see page 25 or visit www.psychologists.bc.ca for more information and registration.
su b mit a r t i cl e s
co n tac t us
Want to write for us? We are always looking for writers for the BC Psychologist or the BCPA blog. The theme for the upcoming Winter 2014 issue is: Relationships with Animals. For further details, contact us at: firstname.lastname@example.org We publish notices regarding retirement, awards, and deaths of members. Please keep us informed about your career and life milestones. If you want a notice to be included in the publication (100 words maximum) contact us at: email@example.com
Board of Directors 2013 Election a special resolution to set the size of the BCPA Board to no less than 6 members and no more than 10 members has been presented. If the resolution does not pass, the current constitutional provisions will continue to apply, which provide that the number of directors shall be 12 or a greater or lesser number determined from time to time at the general meeting. t his y e a r,
This year, BCPA has received one nominee for the Board of Directors. As there are currently 6 members continuing on in their terms. Whether or not the amendment passes, the nominee shall be elected to the Board by acclamation. The new member of the Board is: Murray Ferguson. s tat e m e n t o f in t e n t f o r m u rr ay fe r g us o n
I completed my Doctorate in Clinical and Forensic Psychology at Monash University in Melbourne, Australia. I was a member of the National Executive of the Australian Psychological Societyâ€™s College of Forensic Psychologists from 2005 to 2007, and of the Victorian Branch from 2005 to 2011, the later 2 years as the Professional Development Officer. My desire to join the board of directors of the BCPA lies in my desire to help develop and strengthen the role of psychologists within the health care system of British Columbia, improving access for the public and those most in need of mental health care.
Faith Matters : Implications of Religion and Spirituality for Psychologists INTRO D UCTION
jay e wa l d, ph . d. , r. psych .
A substantial body of empirical research demonstrates the importance of religion and/or spirituality (R/S) in our culture (Pargament, 2013).1 As psychologists, we are likely to encounter clients of various R/S backgrounds and research has shown that how psychologists understand and respond to R/S issues can also impact our clinical effectiveness (Milstein, Manierre, & Yali, 2010; Saunders, Miller, & Bright, 2010; Worthington, Hook, Davis, & McDaniel, 2011). R/S can be a major determinant of a personâ€™s belief systems, values, sense of identity, and meaning-making. R/S can also influence a clientâ€™s presenting problems, coping strategies, relationships, and broader cultural context in a variety of ways (Baetz & Toews, 2009), and numerous studies have linked R/S with various psychological health variables (e.g., Koenig, 2009; Vieten, et al., 2013). Although still in its infancy, and not without significant debate, there is also increasing support on the efficacy of integrating R/S practices into psychological treatment (Hook et al., 2010; Saunders et al. 2010; Rosenfeld, 2011; Worthington et al., 2011). Furthermore, several studies have found that many clients would like to have their R/S considered as part of their psychological care, yet often face a range of barriers to having these needs met within this context (Baetz & Toews, 2009; Saunders et al., 2010; Vieten, et al., 2013). Furthermore, many psychologists are under-equipped to respond to the clinical and ethical issues related to working with R/S clients (Gonsiorek, Richards, Pargament, & McMinn, 2009; Rosenfeld, 2011; Vieten et al., 2013). We typically do not receive adequate education or training in this area of diversity and it continues to be largely neglected in graduate training programs (Vogel et al., 2013). Traditionally, psychologists have not commonly discussed R/S issues with clients for a variety of reasons, including lack of competence, concern about violating ethical codes, as well as negative biases towards R/S (Milstein et al., 2010; Saunders et al., 2013). According to the recent literature, there is still significant variation among our attitudes about R/S, as well as our comfort levels and the degree to which we address this issue in practice (Vieten et al., 2013). My primary aim in writing this article is to provide a reference tool to facilitate improved professional knowledge and practice in working with R/S clients. I first present an overview of the current demographic trends of R/S diversity in our society. Next, I briefly discuss the ethical guidelines
Dr. Jaye Wald started her career as a psychologist in research/academia at the University of British Columbia and then moved into the private sector to pursue her clinical interests in work disability and rehabilitation. Dr. Wald is also currently completing graduate courses at Carey Theological College to bridge her interests in faith and psychology and for professional development in working with clients and organizations in the Christian community. Questions, comments, or ideas for further dialogue on this topic can be emailed to firstname.lastname@example.org.
1 The terms religion (or religious) and (or) spirituality (or spiritual) as used in this article are based upon the commonly used definitions in the literature. Religion implies an affiliation with a religious denomination group, community, or belief system. The term spiritual most often refers to a connection to the transcendent or sacred, and often involves belief in a divine being and (or) a sense of ultimate reality or truth. Clients may identify themselves as only spiritual or only religious, or both. See Pargament (2013) and Vieten et al. (2013) for current discussions of these definitions.
Ackn ow l e d g e m e n t s
Dr. Wald would like to thank the individuals who kindly reviewed a draft of this article: Paddy Ducklow, Ph.D., R. Psych., Alex Kwee, Ph.D., R. Psych., Sharon Smith, Ph.D. (Rehabilitation Sciences), and Spencer Wade, Ph.D., R. Psych.
D is cl a im e r
The opinions expressed in this paper are solely of the author and do not reflect the views of her employer, or any affiliated organizations or academic institutions.
for working with R/S clients. Lastly, I summarize a set of R/S competencies proposed for psychologists. My hope is that this article promotes greater interest around this topic as well as creates further dialogue and collaboration among psychologists and R/S communities. D EMOGRAPHIC TREN DS OF RELIGIOUS/ SPIRITUAL D IV ERSITY
Several studies confirm that many individuals in our country are allied with, and engage in some form of R/S (Bibby, 2012; Clark & Schellenberg, 2006; Pew Research Group, 2013). Findings also reveal significant diversity in terms of formal R/S affiliations, participation in public and private R/S practices, and the degree of importance of R/S in peoples’ lives. There is also considerable variation within different R/S traditions and research suggests that this will become increasingly diverse. Trends further show that a growing number of people are not affiliated with a religion and a greater number of people are identifying themselves as spiritual, but not religious. Further shifts, including major restructuring of religious organizations in this country, are predicted over the next few decades, but overall, R/S will continue to play an important part in peoples’ lives (Bibby, 2012; Clark & Schellenberg, 2006). The main demographic trends of R/S diversity in Canada published by Pew Research Group (2013), which are based upon several data sources including the 2011 Canadian General Social Survey and the 2011 National Household Survey, are summarized below. • Approximately 2/3 of Canadians identify with the Christian faith (27% Catholic; 39% Protestant), 11% reported affiliation with other religions (Muslim, Hindu, Sikh, Buddhist, Judaic, Eastern Christian Orthodox), and 24% are not affiliated with a religion. • In British Columbia, approximately 44% identify with the Christian faith, 12% belong to other religions, and 44% are not affiliated with a religion. • Approximately 27% of Canadians and 17% of British Columbians attend religious services at least once a month. • Among the religiously unaffiliated Canadians, 33% say that R/S beliefs are still important to the way they live their lives and 18% engage in a faith practice (e.g., pray, meditate, or engage in other forms of worship) on their own at least once a month.
ETHICAL GUID ELINES FOR WORKING WITH RELIGIOUS/SPIRITUAL CLIENTS
In recent years, there has been a growing body of literature on the ethical issues in working with R/S clients, which has identified several unique concerns around respect for client values, informed consent (e.g., risks/ benefits, discussion of alternative treatments, inclusion of R/S interventions in psychotherapy, self-disclosure of the psychologist’s R/S orientation), competence, dual relationships, and conflict of interest (Gonsiorek et al., 2009; Rosenfeld, 2011). The ethical guidelines for working with R/S clients have been traditionally considered as a form of multicultural competency required by psychologists (American Psychological Association; APA, 2002; Canadian Psychological Association; CPA, 2000), yet in the past this population has been an under-represented diversity group (Vieten et al., 2013). Over the past decade or so, the APA (and APA Division 36: Society for the Psychology of Religion and Spirituality) has played an important role in recognizing R/S as a distinct aspect of individual and cultural diversity (e.g., Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists, APA, 2002 and the Resolution on Religious, Religion-Based and/or Religion-Derived Prejudice, APA, 2008). There are also ongoing efforts to advance awareness and educational resources on this topic to psychologists (e.g., Pargament, 2013). The CPA recognizes this aspect of diversity in its Code of Ethics (Principle I: Respect for the Dignity of Persons; CPA, 2000) and in the Guidelines for NonDiscriminatory Practice (CPA, 2001), and it has a special interest section on religion. Our Code of Conduct (College of Psychologists of British Columbia, CPBC; 2009) includes ‘Religion’ as a competency issue in Section 3.24 (Obtaining Needed Training for Special Situations), which requires us to obtain necessary experience, consultation, or supervision when working with this client group. PROPOSE D RELIGIOUS/SPIRITUAL COMPETENCIES FOR PSYCHOLOGISTS
Experts in this field (e.g., Milstein et al., 2010; Saunder et al., 2010; Worthington et al., 2011) are strongly advocating required basic R/S competencies for BC Psychologist
psychologists, and as minimal standards, we need to work with R/S clients using a collaborative, client-centered, and empirically-based approach. We also need to appreciate the inter-disciplinary nature of R/S issues and to convey respect and collaboration with other professions who have expertise in this area. However, there are still no agreed upon empirical and consensus-based R/S competencies and training guidelines for psychologists, although progress has recently been achieved. The following provides an overview of 16 consensus and empirically-based R/S competencies (based upon attitudes, knowledge, and skills) published by Vieten et al. (2013). These authors recognize that much more work is needed to further refine and implement
these competencies into graduate training programs and clinical practice. At tit u d e s . This competency reflects our ability to acknowledge that R/S is an important part of diversity and encourages us to communicate respect, appreciation, and sensitivity to clients about this issue. This competency also promotes self-awareness of our attitudes, beliefs, and values about R/S and their potential impact on clients and the treatment process. Kn ow l e d g e . This competency encompasses our knowledge of the R/S definitions and the different types of R/S traditions, beliefs, and practices as well as our understanding of the relationships between R/S and its impact on health, functioning, and human development.
American Psychological Association (2002/2010 Amendments). Ethical Principles of Psychologists and Code of Conduct. Washington, DC: Author. American Psychological Association. (2008). Resolution on religious, religion-based and/or religion-derived prejudice. American Psychologist, 63, 431–434. Baetz, M. & Toews, J. (2009). Clinical Implications of Research on Religion, Spirituality, and Mental Health. Canadian Journal of Psychiatry, 54, 292-301. Bibby, R. (April 8, 2012). Religion and Spirituality Remain Pervasive: Latest National Survey Findings. Project Canada Surveys Press Release. University of Lethbridge. Retrieved August 25, 2013 from http://www.reginaldbibby.com/images/PCS_Release_Religion_Spirituality_Remain_Pervasive_in_Canada_Easter_2012.pdf. Canadian Psychological Association. (2000). Canadian Code of Ethics for Psychologist. Third edition. Ottawa: Author. Canadian Psychological Association. (1996/2001). Guidelines for Non-Discriminatory Practice. Ottawa: Author. Clark, W., & Schellenberg, G. (2006). Who’s Religious? Canadian Social Trends (No. 81). Stats Can Report Cat #11-008. Retrieved August 25, 2013 from http://www.statcan.gc.ca/pub/11-008-x/2006001/pdf/9181-eng.pdf. College of Psychologists of British Columbia (2009). Code of Conduct. Author. Gonsiorek, J. C., Richards, P.S., Pargament, K.I., McMinn, M.R. (2009). Ethical Challenges and Opportunities at the Edge: Incorporating Spirituality and Religion Into Psychotherapy. Professional Psychology: Research and Practice, 40, 385–395 Hook, N. J., Worthington, E. L., Jr., Davis, D. E., Jennings, D. J., II, and Gartner, A. L. (2010), Empirically Supported Religious and Spiritual Therapies. Journal of Clinical Psychology, 66, 46-72. Koenig, H. G. (2009). Research on Religion, Spirituality, and Mental health: A review. Canadian Journal of Psychiatry. 54, 283–291. Milstein, G., Manierre, A., Yali, A. M. (2010). Psychological Care for Persons of Diverse Religions: A Collaborative Continuum. Professional Psychology: Research and Practice, 41, 371–381. Pargament, K. I. (Editor-in-Chief, 2013). APA Handbook of Psychology, Religion, and Spirituality. American Psychological Association. Abstract (and Table of Contents) retrieved on August 25, 2013 from http://www.apa.org/pubs/books/4311506.aspx. Pew Research: Religion and Public Life Project (June 27, 2013). Canada’s Changing Religious Landscape. Retrieved August 25, 2013 from http://www.pewforum.org/2013/06/27/canadas-changing-religious-landscape/. Rosenfeld, G.W. (2011). Contributions From Ethics and Research That Guide Integrating Religion Into Psychotherapy. Professional Psychology: Research and Practice, 42, 192–199. Saunders, S. M., & Miller, M. L., Bright, M. M. (2010). Spiritually Conscious Psychological Care. Professional Psychology: Research and Practice, 41, 355–362 Vieten, Cassandra; Scammell, Shelley; Pilato, Ron; Ammondson, Ingrid; Pargament, Kenneth I.; Lukoff, David. (2013). Spiritual and Religious Competencies for Psychologists. Psychology of Religion and Spirituality, 5, 129-144. Vogel, M. J., Mark R. McMinn, M. R., Peterson, M. A., & Gathercoal, K. A. (2013). Examining Religion and Spirituality as Diversity Training: A Multidimensional Look at Training in the American Psychological Association. Professional Psychology: Research and Practice. 44, 158–167. Worthington, E. L., Hook, J.N., Davis, D. E., McDaniel, M. A. (2011). Religion and Spirituality. Journal of Clinical Psychology: In Session, 67, 204-214.
a few additional resources
Association for Spiritual, Ethical and Religious Values in Counseling (2009): See also the Competencies for Addressing Spiritual and Religious Issues in Counseling (2009). Author. Retrieved August 10, 2013 from: http://www.aservic.org/wp-content uploads/2013/06/Competencies-for-Addressing-Spiritual-and-Religious-Issues-in-Counseling.pdf APA Psychotherapy Video Series on Spirituality: It includes seven different videos illustrating how to work with clients of diverse R/S traditions. Retrieved August 25, 2013 from http://www.apa.org/pubs/videos/browse.aspx?query=&fq=DocumentTypeFilt: %22Video%22%20AND%20SeriesFilt:%22Spirituality%22&sort=TitleSort%20asc Canadian Psychological Association Special Interest Section on Religion: http://cpa.ca/aboutcpa/cpasections/religion/ Society for the Psychology of Religion and Spirituality. Division 36. American Psychological Association: http://www.apadivisions.org/division-36/index.aspx
This competency also reminds us to be knowledgeable of ethical and legal issues that may occur during the provision of services to R/S clients. Skil l s . This competency encompasses a range of clinical skills such as: routinely assessing clientsâ€™ R/S backgrounds (including their beliefs, practices, importance of R/S in their lives) as part of clinical history-taking (see Milstein et al., 2010 and Saunders et al., 2010 for example questions); helping clients to explore, identify, and access their R/S needs, resources, and concerns (Saunders et al., 2010; Worthington et al., 2011); and knowing when it is appropriate to refer to, consult with, or collaborate with other professionals (e.g., possibly a psychologist who shares the same R/S tradition as a client, or clergy or other spiritual leaders; Milstein et al., 2010). This situation might be more
relevant with clients for whom R/S is very important or in cases in which clients are clearly struggling with R/S concerns (Worthington et al. 2010). It is also generally agreed that psychologists who are interested, or employ R/S interventions within their clinical practice, do so conservatively and cautiously, and will require more advanced education, training, and supervision to utilize those specific techniques (Gonsiorek et al. 2009; Hook et al. 2010; Rosenfield et al., 2011; Vivien et al., 2013). These skills require us to be able to identify our own limits of competence through ongoing self-evaluation. This competency also encourages us, as part of our ongoing professional development to be familiar with current R/S research and clinical practice issues as they continue to evolve.
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Outcomes Monitoring and British Columbia Psychotherapists How do we know when we are effective as psychotherapists? Do we wait for clients to tell us they are doing better? Do we use clinical judgment? Many professions have objective measures that evaluate success. For example, educators can point to the grades of students, physicians to symptom improvement, and courtroom lawyers to judicial decisions. Psychotherapists typically deal with ambiguous data and have a proud tradition of developing and refining clinical judgment to assess progress. In 2011, the Canadian Psychological Association (CPA) Task Force on Evidence-Based Practice of Psychological Treatments underlined the continuing importance of clinical judgment to evidence-based practice (EBP): “practitioners are required to exercise their professional judgment when providing treatment” (p.11; 2012). However, the CPA’s definition of EBP also includes the idea of progress monitoring (PM) and feedback. The Task Force called for “the monitoring and evaluation of services provided to clients throughout treatment” (p. 7). The developing emphasis on outcomes or progress monitoring (PM) can be traced to emerging evidence that clinical judgment is skewed toward what we want to see (Lambert, 2005). As clinicians, it is normal to want all our clients to benefit. However, clinicians are not skilled at identifying deteriorating clients. Hanson, Lambert and Forman (2002) looked at outcome rates of over 6,000 patients across a variety of settings, and found an average deterioration rate of 8.2%, from 3.2% to 14.1%. When comparing clinical judgment to a PM measure (the Outcomes Questionnaire-45 [OQ-45]; Lambert, 2004), Hannan and colleagues (2005) found that the empirical method correctly predicted 100% of clients who were reliably worse or deteriorated at termination; 86% were identified by only the third session. In comparison, clinicians using their subjective clinical judgment predicted that only 3 out of 550 clients would deteriorate at termination, and only 1 of these predictions was accurate. A further study by Hatfield, McCullough, Franz, and Krieger (2010) found that only 32% of therapists recorded patient deterioration in their case notes in situations where clients reported symptom worsening.
T e rr a Kowa ly k , B . A .
An M.A. candidate in the Counselling Psychology department at McGill University, under the supervision of Dr. Marilyn Fitzpatrick. Ga b rie l a I o nita , B . A . , MA .
A Ph.D. candidate in the Counselling Psychology department at McGill University, under the supervision of Dr. Marilyn Fitzpatrick. M a rily n Fit zpat ri ck , B . A . , M . e d. , ph . d.
An Associate Professor of Counselling Psychology and the Director of Training of the Counselling Psychology graduate program at McGill University.
au t h o r n ot e
Terra Kowalyk, Gabriela Ionita and Marilyn Fitzpatrick are from the Department of Educational and Counselling Psychology, McGill University. This research was supported in part by a grant from Fonds Québécois de la Recherche sur la Société et la Culture. Correspondence concerning this article should be addressed to Terra Kowalyk, Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec. E-mail: firstname.lastname@example.org
Not only do clinicians systematically fail to identify client deterioration, they tend to overestimate client improvement. Walfish, McAlister, O'Donnell, and Lambert (2012) asked 129 clinicians to rate their ability to help clients compared to the ability of other psychotherapists, and the extent to which they believe their clients improve, remain the same, or deteriorate. On average, clinicians viewed their skills to be at the 80th percentile (no respondents’ self-rating was below the 50th percentile). The majority believed that 77% of their clients improved as a result of their treatment and 3.66% deteriorated; almost half indicated that none of their clients regressed. These numbers defy statistical possibility (Dunning, Heath, & Suls,
2004). In the face of such positive self-assessment bias, the
need for empirical outcome measurement is clear. Pr o g re s s M o nito rin g M e a su re s
In psychotherapy, the focus is increasingly shifting to PM systems. The clinical utility of these systems has repeatedly been demonstrated to improve practice. For example, after the implementation of a tracking system, a centre for family services found that cancellation and no-show rates dropped by 40% and 25%, respectively, and the number of clients in long-term treatment who experienced little or no improvement fell by 80%. In one year, the centre saved nearly half a million dollars, money used to hire additional staff and provide more services (Claud et al., 2004). Another community health and counseling organization experienced similar reductions in cancellations and no-shows, and the average length of therapy decreased by 59% (Bohanske, Plum, Albert, & Haynes, 2006). A recent meta-analysis of outcome monitoring studies indicated that the effects of providing feedback on patients reduced distress symptoms, and increased chances of experiencing clinically significant change at termination, when compared to no feedback conditions. This was especially true for patients who were most at-risk (Shimokawa, Lambert & Smart, 2010). Overington and Ionita (2012) have provided an overview of PM instruments in areas such as domains assessed, target population, administration, cost, and training. The three main domains generally assessed are: 1. symptoms, 2. well-being, and 3. functionality. Different instruments have various strengths and features. For example, some instruments aid in diagnosis (e.g., Treatment Outcome Package [TOP]; Kraus, Seligman, & Jordan, 2005); others are used to facilitate discussion around therapy progress (e.g., Partners for Change Outcome Management System [PCOMs]; Duncan, 2012). In terms of administration and scoring, most are available in paper and computer versions and the shortest take as little as two minutes for clients to complete. Computer versions can be completed by clients on their own tablets in the waiting room and the results calculated and forwarded automatically to the therapist’s inbox in time for the session. The data from PM measures can also provide a means for evaluation at various levels including the organization, practitioners, and the clients — a practice
known as benchmarking (Lueger & Barkham, 2010). At the organizational level, PM measures can be used to compare the quality of services provided by each organization. They can also provide clinicians with a useful comparison with other practitioners to see where their clinical skills excel and where they need improvement. Clients can also be studied to see how they fare in regards to a benchmark created by the particular measure (Barkham et al., 2001). PM Usag e in C a n a da a n d B ritish Co lu m b ia
The McGill Psychotherapy Process Research Group (MPPRG) has been studying the use of PM measures in Canada. In 2012, Ionita conducted a nationwide survey of PM measure utilization. Of the 1668 clinicianrespondents, 1124 had not heard of PM measures, 242 knew of — but had never used — them, 101 clinicians had used them in the past, and only 201 clinicians (12%) were currently using a measure to track client progress in therapy. Across the provinces, there was a range of utilization from 4.8% to 24%, with 12% being the average. In other words, even in the province with the highest utilization rates, only one in four psychotherapists currently use some form of PM measure to track client change. British Columbia sits at the top with 23% of clinicians using PM measures. Ionita also examined the barriers to PM utilization. Canadian practitioners who were not using PM indicated that their top three barriers to utilization were: 1. Lack of training on the measures, 2. Limited access to training on the measures, and 3. Limited knowledge about the measures. One clinician who overcame her reluctance to use the measures told us, “I was noticing how the same fears and questions I had were being shared all the time by people using it all over the world. So I started thinking, ‘okay it’s not a problem with me; it’s normal to have those doubts’ and reading through how people dealt with and learned how to overcome the barriers... Like everyone does I suppose, we put up barriers when we are coming against something new but it’s just because it’s new.” We all want to help each client; PM measures can provide an objective measurement to help make this desire a reality. The practice of psychology in British Columbia is regulated under the Health Professions Act (HPA), which BC Psychologist
2013-2014 WORKSHOPS COMING TO BRITISH COLUMBIA
mandates a Continuing Competency Program (CCP) to promote high practice standards for all registrants of the College of Psychologists of BC. According to the CCP requirements, “Continuing competency activities should be sufficiently evidence-based so as to be seen by a majority of registrants to enhance the registrant’s practice of psychology” (College of Psychologists of British Columbia, 2012, section 5). One of the ways that BCPA members can comply with these requirements is to begin to monitor patient progress using a validated PM measure. Su rm o u n t in g t h e B a rrie rs
Since the biggest barriers to using PM measures appear to be lack of knowledge and lack of training, the MPPRG is currently developing an online tool to help clinicians access information, explore their doubts, and choose a PM measure suitable to their practice. It will include information from journal articles, video interviews with psychologists, testimonials from fellow clinicians, and interactive activities that provide an experiential understanding of what PM measures have to offer. We anticipate bringing you news and links to this tool in 2014. Watch for it in BC Psychologist.
DSM-5 Vancouver: October 25 & April 4 (9 am-12 pm) Victoria: October 31 & April 10 (1 pm-4 pm) With the release of the DSM-5 comes new diagnosis and changes to the way workshop is intended for doctors, psychologists, social workers, senior clinicians and
ANXIETY Vancouver: November 6 & March 20; Victoria: November 15 & March 27 it can become ‘disordered,’ including the link with panic, depression, trauma and accessible strategies to assist both adults and children in reducing anxiety.
TRAUMA Vancouver: November 7-8; Victoria: November 13-14; Kamloops: November 20-21 The impact of trauma can be far-reaching and enduring. This workshop provides an overview of the way trauma impacts a person through the brain and nervous system and how it can result in longer term symptoms at physical, psychological and principles are explored that apply to a diverse range of impacts in children, adolescents and adults.
coming to BRITISH COLUMBIA in 2013-2014.
ADDICTIONS AND MENTAL ILLNESS presents
Daniel Brown, PhD
- Working with Co-occurring Disorders
Prince George: December 4; Vancouver: December 5 & May 14 Nanaimo: December 12; Victoria: May 22; Kelowna: May 29
Integrating Hypnosis and Attachment Disorders Saturday, December 7th, 2013 - 9am – 5 pm
Doors open at 8:30am at the Paetzold Education Centre, Vancouver General Hospital, Vancouver, BC Dr. Brown is Director, Center for Integrative Psychotherapy, Newton MA, Associate Clinical Professor, Harvard Medical School; taught hypnotherapy for 41 years. His 14 books include 3 books on hypnosis style. He spent 40 years studying Buddhist meditation and contributed to 2 books of East-West dialogues in psychology with H.H. The Dalai Lama. His current research is on the contribution of early attachment to complex trauma.
Sophisticated assessment tools are available to identify attachment pathology in adults. Less attention, however, has been paid to the development of effective treatment protocols. This workshop is specifically about state-of-the-art, effective ways to treat insecure attachment pathology, primarily in personality and dissociative disorder patients. Teaching format: lecture, demonstration, and case presentation. Hypnosis training recommended but not required. To download registration form visit www.hypnosis.bc.ca Members - Early Bird $125, after Nov. 8th $150 Non-Members - Early Bird $150, after Nov. 8th $175 Students - $75
leading to both? This workshop provides a framework for working systemically with
STALKING - Assessment and Management Vancouver: December 12 & June 18
informal assessment tool to help in determining the level of risk of stalkers.
TO REGISTER OR FOR INFORMATION : www.ctrinstitute.com 204.452.9199 email@example.com
Canadian Society of Clinical Hypnosis (BC Division) 2036 West 15th Avenue, Vancouver, B.C. V6J 2L5 Phone: 604-688-1714 Fax: 604-683-6979 www.hypnosis.bc.ca Email: firstname.lastname@example.org
with Issues of Crisis and Trauma
Coping with the Subtle Racism : Client Handout t e d a lta r, ph . d. , r. p sych .
The President of the BC Psychological Association. Contact for the Board of Directors at email@example.com
W h at is Su b t l e R acism?
In some ways it is easier to deal with those situations where people openly voice racist beliefs or commit open acts of unsubtle discrimination. At least here we know what we are dealing with. Thanks to the hard earned advances of minorities, along with support from sympathetic members of the dominant majorities, blatant racism is now socially unacceptable. Although it still exists, few persons now openly state racist views, except maybe secretively on bathroom walls or openly when intoxicated. Subtle racism, however, is more hidden but can be just as effective in hurting individuals and suppressing the aspirations of minorities. Being ignored, ridiculed or unfairly treated can be subtle and, as a result, can more insidiously be taken to heart or internalized as indicating that something is wrong with oneself. While people of good intentions may unconsciously fall into subtle racism, good intentions are simply not good enough. Social Psychologists have been studying prejudice for almost a century and recent studies have focused on the new racism that is disguised both to the victims, and even to the perpetrator. Very often those guilty of this new racism are not aware of their negative attitudes and discriminatory behaviours. Many of the worst acts of injustice, discrimination and oppression have been blindly justified by “good” intentions. One only has to remember the long history of devaluation and de-acculturation that occurred when government officials and missionaries said that First Nations people are children who need to be saved from themselves. Social psychologists have observed numerous characteristic forms of subtle racism such as the following: 1. Denial. This takes the form of refusing to look at the evidence that there is continuing discrimination against minorities. One might hear the claim, “Discrimination against First Nations people is no longer a problem in Canada”. Even when the reality of discrimination
is acknowledged as still existing, it might then be minimized. For instance, “First Nations people don’t have it as bad as they did in the past”. Such platitudes don’t address current wrongs and in fact turn attention away from correcting current discriminations. Antagonism. Here we have the demands of minorities for equal rights, or some redress to their historical wrongs, being vigorously and heatedly opposed. For example, “First Nations people are getting too demanding in their Land Claims” or “They already have too many benefits and their problems are their own fault”. Another form of this is the disproportionate response to a mistake on the part of minorities. Minor mistakes are treated as cardinal offenses and used to justify an exaggerated negative reaction. Resentment. When there is at last some redress to the disadvantages of a minority group, or when there is an attempt to right in a small way the wrongs of the past, there is expressed resentment. For instance, “The government has given the Nisga’a too much in their Treaty!” When one understands the nature of the treaty and what little was begrudingly granted, a reasonable person would see that the real generosity occurred on the part of the Nisga'a. Tokenism. This consists in going a little way towards treating a target minority in a fair manner, but only to later resist a greater demand towards equality and fairness. The attitude here is that “I’ve done enough for those people already!” Reverse Discrimination. It sometimes occurs that belonging to a minority can be an advantage. Studies in the 1970’s in Vancouver indicated that if you were Black and needed to ask a passerby for a dime to make a phone call, you were more likely to get a helpful response than if you were White. This kind of leaning over backwards may at first appear to be a benefit, but it can also become another way of giving with one hand only to take away with the other. The attitude here is something like, “Hey, I’m not racist, look how much I’ve done for them”. For example, if a First Nations student were to be given an easy pass BC Psychologist
in a course, whether it be elementary school, high school, or college (I have had First Nations college students in Terrace complain to me about their high school grades being inflated), the long term effect is not to help the student but rather hold them back by not properly preparing them for the real demands of the world. This kind of attempt to help First Nations students is simply patronizing or condescending. The message is that First Nations students cannot do as well as White students. In many ways, the new racism is harder to deal with since it is not always so obvious. It is therefore easy to wrongly internalize this kind of discrimination as due to personal failure, as in the case where a person has been patronized in elementary and high school only to find out at college that they are behind in their learning. The tragedy here is that for many bright First Nations students, there is an automatic tendency to then think that they are not smart enough to succeed in college. As a result, we are all diminished as a society when good talent is held back and lost in this manner. Those who do succeed in college are sometimes held back or diminished by a patronizing attitude expressed by some White managers or professionals. A number of First Nations professionals have told me how it is sometimes very difficult working in companies or agencies where senior staff or management is predominantly non-First Nations. On the surface everybody is pleasant but when there is a disagreement on anything substantive, then the subtle racism appears. This can take the form of the First Nations voice not being taken seriously or being undermined by unfair comment. It is sometimes expressed by a refusal to objectively consider if the opinion that they disagree with would be so readily dismissed were it not for the fact that a visible minority was voicing it. Be aware, of course, of falling into the error of seeing racism where is does not exist. After all, other people are entitled to their differing opinions and they may simply not like you for other reasons, possibly legitimate ones. If you tend to be critical and negative, it is natural for people not to like you. This is a basic fact of social life. In general, it is always better to influence people the positive way by praising them for what they are doing right rather than needlessly criticizing them for doing something wrong. 18
S o m e Su g g e s ti o ns o n H ow to Co pe wit h Su b t l e R acism
Use your anger constructively, or don't get angry in the first place. The first person anger is going to hurt is yourself. Anger raises blood pressure, increases certain hormones like epinephrine and norepinephrine, and is a common trigger for self-injurious behaviours like drinking and smoking. Anger, especially when long lasting and frequent, is now being considered a major factor in heart disease. When we become embittered and angry, we tend to also become less patient and kind to others. Because of our negative reactions, other people in turn react even more negatively towards us. The resulting vicious circle is that the anger at the injustices one may feel results in the further injustice of being unkind to others who had nothing to do with the original cause of your anger. 2. Anger at the injustice of the world is to be used constructively, as for example through proper political protest or effective individual action. Donâ€™t just get mad, voice your objection calmly and rationally, organize a proper protest with others, or, simply write a fairminded letter to those who might be able to address your grievance. When voicing your protest, it is still important to treat others with respect even if they do not reciprocate or are disrespectful. Remember, nobody is a complete racist. Everybody, including those who might be treating you unfairly, is far more that just one or even a hundred of their acts. We are what we do and everybody has done millions of small acts in their life. It is therefore simply inaccurate and unfair to label a person only on the basis of just some of the things that person has done. Somebody may be guilty of a racist act, but it is unfair to label him or her totally as a racist. Two wrongs never make a right and just because somebody has treated you unfairly, that is no reason for you to become unfair in turn. 3. Walk away. Not all battles are worth fighting and not all pettiness is worth the consumption of your time and emotional energy. You cannot change other people, only influence them. Your strongest influence will be how you act and handle the frustrations of life, and this includes the fact that nobody is perfect and everybody has their moments of irrationality and even prejudicial thoughts. Accepting the imperfections of the world does not mean that you have to agree with 1.
those imperfections or condone them. Accepting means acknowledging the reality that we all have to cope with. Our duty to our loved ones and ourselves is not to add to the unfairness of the world by fighting the useless fight. Don’t react, rather weigh what is the best course of action and this often may mean simply walking away. 4. Give honest feedback if it will serve your purpose. If you realistically believe that it will serve your purpose, or you feel that you must make an honest statement for your own integrity, then try to do so in a fair and respectful manner. Your grievance is with a particular act, not with the whole person. You do not, and never will, know the whole person. Voice your complaint about the particular act and do not condemn the whole person. Behind all discriminatory behaviours lies both unfairness and irrationality. There is, therefore, no point in becoming unfair and irrational yourself. It is difficult to get people who have fallen into an act of subtle racism to now become objective and give serious reflection to the question, “would you be saying or doing what you are saying and doing now if my skin color were different?” As difficult as it may be, it is best to remain calm and speak slowly in a rational and fairminded manner. You may not be able to change their wrongheaded attitude, but that is no reason for you to get hotheaded and prejudicial in turn. 5. Stop ‘Shoulding’ on others and yourself. Stop saying to yourself that other people “should” not be racist. There is no “should” about it since the fact of the matter is that some people are going to be very unfair, and maybe all people, ourselves included, have on occasion been unfair with somebody. For me to shout and cry that on a rainy day “it should be sunny” is silly since I have no control over sunshine. Similarly, you cannot control such facts of the world as subtle racism. What you can do is not add to the unfairness of the world by demanding what is not in your control. All we can do is try to influence others positively, and that is best done
by setting a good example and confusing those who would be unfair by remaining in control through calmness and fairness on at least our part. 6. Use self-instructions. Part of being a visible minority is learning how to cope with subtle racism rather than letting it get to you and bring you down. What you say to yourself has a profound effect on how you feel and act. Control the thinking and you exert strong control over bad feelings and hurtful acts. One of the self-instructions I teach kids to say to themselves is simply, “When people call me names, that is their shame”. Is this not a true statement? Of course, it is, and it is a far more true and accurate statement than calling people names in turn. To remain in control, keep your thoughts accurate and fair and do not resort to swearing and namecalling. Here are some examples of the kinds of selfstatements that would help you to remain fair and calm in a difficult situation: Take it easy; this is not the end of the world. As long as I keep my cool, I’m the one who is in control. It is sad that some people are unfair, but that doesn’t stop me from being fair. It is regretful that some people are rude, but that doesn’t stop me from being respectful. 7. Be tolerant. Subtle racism may be a form of intolerance but that does not stop you from practicing tolerance. Remember, many people who fall into subtle racism do not wish or want to be racist in their thinking or acts. Due to living in a society that every day feeds old stereotypes, we should not be surprised by subtle racism from others, or even from ourselves. If you wish to have your rights of free agency respected, you must respect the agency of others to disagree with you. That does not mean that you have to agree with what is unfair and wrong.
Hopkins, N., Reicher, S. & Levine, M. (1997). On the parallels between social cognition and the „new racism“. British Journal of Social Psychology, 36, 305–329. Liz, E. (1995). The Invisible empire: Racism in Canada. Random House Miles, R. (1989). Racism. London: Routledge. Nielsen, L.B. (2002). Subtle, Pervasive, Harmful: Racist and Sexist Journal of Social Issues, Vol. 58, pp. 265–280 Reid, Landon D.; Foels, Rob; (2010).; The people doth protest too much: Explaining away subtle racism. .J. of Language & Social Psychology, Vol 29(4), Dec, 2010. pp. 478–490 BC Psychologist
The Matrix System of Management : Strengths and Needs Pre a m b l e
The definition of Matrix Management is a style of management where an individual has two reporting superiors (bosses) — one a functional expert, usually from administrative services, who manages everyone with the same functional specialty regardless of their project team assignments and the other, an operational expert, a project manager in charge of everyone assigned to the same project (Hatch, 2011). Since employees often possess a skill useful to more than one project team, they may be assigned to one or more projects and thus report to multiple project managers as well as a functional boss from administration. Matrix systems in organizations were designed to be fast and flexible when compared to other structural types of organizational designs, where change involves restructuring the whole organization (Hatch, 2011). As a consequence, matrix structures developed within organizations adapt well to rapidly changing environments. It would appear that the highly educated professionals typical of matrix structures can handle the greater complexity of working in an environment requiring them to juggle the demands of multiple managers and ever-changing work requirements. “Ah ha,” you say, “isn’t this tailor-made for the average Mental Health/Social Services organization with its highly educated cadre of staff, eager for flexibility and ongoing change to stimulate the drudgery of daily case work?” For the most part a big resounding YES — but only if the matrix system is effective. Please read on. To reiterate, matrix management superimposes layers of management over individualized projects thereby establishing a multiple command system. It is a type of organizational management in which people with similar skills are pooled for work assignments, resulting in more than one manager. Managers in the various functional areas supervise the talent pool for the project teams and determine the availability of skills for various projects. Team members may return to their functional specialities or transfer to new project teams when a project is completed. A political agenda may arise if the project leader, the team of committed subordinates and the demands of the project do not mesh well, or 20
D r. D o n a l d “ D o n ” H u tch e o n , C . Psych o l . (UK). , R. Psych .
The Vice-President of the BC Psychological Association.
the project’s functional manager is not qualified in the profession he/she is overseeing at the work site and does not comprehend the professional context communicated from another discipline’s point of view. This can and has caused numerous problems in Health Care/Social Services projects which have been the bastion of matrix management structures. To be effective the matrix system requires collaboration, openness, and effective problem solving rather than traditional “blaming” administrative approaches which tend to occur in dysfunctional organizations and the directive, command-style approach found in many functional, albeit imperfect organizations. An obvious point: the success of the matrix system is dependent on the sensitivity brought to bear in the quality of working relationships fostered between the employees, their ability to deal with conflict and work well within groups AND the commensurate communication skills to carry this off. The intrinsic ability to work through problems, admit mistakes and accept you were wrong (for once) and then get on WITH BUSINESS is a tough row for many to hoe! In the writer’s experience, cross functional (i.e., matrix systems) management requires leadership adept in critical thinking. Anything less is a recipe for disaster. Specifically, different philosophical camps often emerge in a matrix system during project development and implementation, an occurrence that often challenges even the most mild-mannered Mental Health/Social Service practitioners. What to do? First, let me digress and give you some background before we continue. Many years ago Argyris (1973) contrasted matrix management with the traditional hierarchical organization, the latter dependent on the administrative ladder. Specifically, as one goes up the ladder, power and control increases, availability of information increases, the scope of decisions made and the responsibilities involved increases. Conversely, implicit in the matrix system are
generally opposite tendencies. If the matrix system is to work successfully and at its fullest potential, it requires managers who have effective two-way communication, acknowledge employee vulnerability and have the ability to think outside of the box. The sine qua non of the matrix system’s working effectively is “active” engagement, a demonstrated concern about working relationships and mutual respect developed with and between colleagues. Ideally, a project team utilizing the matrix system requires intense collaboration and interdependence to be successful (Sargent, 1983). “Great,” you say, “we’re trained practitioners in the helping profession. This is as easy as falling off a log. What’s the problem?” It’s simply this: in practice the “soft” supportive, quasi-therapeutic approach required for a successful matrix system, frequently does not occur consistently enough in evolving projects because of the tight time lines and budgetary restraints. If management and the team lack sufficient training and fail to reinforce the ingredients required by the matrix system to work effectively, team members still tend to be competitive, trust issues arise and turf protection abounds. A desire for visible power and traditional top-down organizational behavior patterns begins to emerge or re-emerge, which can be detrimental to the project. This I believe is the crux of the problem. The level of power in matrices is often described as “strong”, “medium” or “weak” depending on the level of power of the project manager. Most importantly, for a matrix management style to be effective, the functional and operational managers must have equal weight in controlling the individuals in their Matrix. Generally, in real life application, the functional reporting relationship between the project manager and project workers is stronger, because the project manager controls the worker’s compensation and evaluations. Unfortunately, this can create problems with a functional manager who micro-manages, is not interested in an equal valence of power with the project manager and wants greater control of all aspects of the project/job areas. Specifically, problems tend to occur when the functional manager has a need for greater scrutiny and involvement in the day-to-day operation of the project, personally or through a designate. This intrusive behavior can undermine the vested authority of the project manager and increases the likelihood of a toxic work environment.
Problems occur in matrix systems when a worker is involved in several projects simultaneously and their time on a specific project is disputed and/or diluted as a result of the conflict between the functional manager and the project manager. KEEP THIS IN MIND as employees in the Mental Health/Social Services Industry may become collateral damage in these disputes, which occasionally result in messy, litigious outcomes — not always, but sometimes. We’ll talk about the three matrix levels (i.e., strong, medium, weak) later on For now, let’s précis the advantages/disadvantages of the matrix system. The advantages of the matrix system, especially for project management, include: Flexibility — individuals can be chosen according to the needs of the project. The use of a project team benefits from viewing problems in a different way, as specialists have been brought together in a new environment. Project managers are directly responsible for completing the project within a specific deadline and budget, allowing greater transparency and tighter quality control and quality improvement. The disadvantages of the matrix system for project management can include: A conflict of loyalty between project team practitioners/management designates and the project manager over the allocation of resources. This frequently occurs in the Mental Health/ Social Services Industry as resources are supplied by government for specific purposes. The interpretation of how to spend the project money and issues of the service provision, quality control and cost effectiveness are often debated, with little or no sensitivity to underlying philosophical perspectives from the various professional constituents. The outcome can be operational intransigence between conflicting philosophies/belief systems creating communication problems and the dreaded turf wars interfering with the project’s ongoing maintenance and functional lines of authority — let alone with getting the project completed on time! Projects can also be difficult to monitor if the turf wars between team members and management cause teams to seek, then request and receive too much independence. An extension of thought is required here. The matrix system requires flexibility, speed and efficiency to operate at an optimal level. If the concern is not
meeting the pre-arranged time lines, people go looking for flexible ways to problem solve the dilemma, which often includes increasing costs if more professionals are requested by the project teams once the project is underway. But why would they deplete a fixed budget by hiring more staff in these circumstances? A “more is better” mind-set can evolve regarding expansion of staffing. This is usually a result of infighting amongst the team members and management when the conflict is not carefully examined and resolved. One often observes a knee jerk reaction to resolve the dilemma(s) by hiring more people to get the job done within the time lines. If this happens the problem(s) can increase because of operating on a fixed budget, which can be depleted at an alarming rate, even exponentially in some cases. With each additional staff member hired, the pressure to perform may increase the error rate. It sounds like old fashioned “circular logic,” doesn’t it. Read on. The government work milieu is not “free enterprise” with private financing, but is instead played out within a strict economic boundary, cost wise. The infighting fireworks usually begin slowly and then proceed, if unresolved, with more passion and vitriol as the project continues and the money is drained. Specifically, the “Oops, the completion deadline is looming what do we do now” syndrome comes into play! People can “act out” unmercifully when dealing with highly educated bureaucrats promoted from the ranks who want to take over! Consequently, the project managers and professional team workers can find their opinions disregarded in very short order. NOW we’re dealing with ego, power, control and the final authority from a functional manager who oversees everyone and likes to crack the whip. Are you frightened just a little? You should be. If you’ve ever been ensnared in one of these “power plays,” it isn’t fun. Many a professional reputation has been stained in these circumstances and it’s tough making a comeback! Taken from a different slant and from an optimist’s point of view, the matrix system is a concept that initially has great appeal because it draws on the full potential of the human resource capabilities of the respective, imperfect organizations. In theory it frees up leadership for everyone concerned and does not rely on a few people who have positional power. HOWEVER, there are inherent problems with the matrix structure in 22
a single, multidisciplinary, or cross-functional team when a number of these cross-functional teams are working simultaneously, requiring people to relate to one another vertically, horizontally, and diagonally, all at the same time. In the Mental Health/Social Services Industry, the overriding concern about matrix management is how to make it work. At first blush, the matrix structure appears dynamic and innovative, but it requires both ability and willingness to serve more than one boss to derive any potential benefits and this may have more to do with culture and behavior than any intrinsic organizational design. Please keep that in mind. His to ri c a l Co n t e x t
Historically, the Matrix System was in vogue in the 1970’s and 80’s in such organizations as Xerox, Digital Equipment Corporation and Citibank which employed a two-boss matrix management structure, as they sought to maximise productivity and harness resources. The matrix approach appeared to keep organizations agile, but by the late 1980’s it was clear that it wasn’t such an easy task and corporate enthusiasm began to wane. Specifically, the structure was often too complex to be effective. What worked well in corporate free enterprise organizations did not translate easily in other, not for profit employment environments. Specifically, in the not for profit organizations people working in matrix teams seemed unable to negotiate satisfactorily over resource issues and cost allocations; individual team members and their managers couldn’t agree where responsibility should lie. As a result the early enthusiasts for the matrix system began to revert to simpler structures. By the 1990’s matrix management had developed into several modifications (i.e., subsets) which included (Reh, 2013): “virtual teams,” the focus being increasingly on customer service and speed of delivery; the “ad hoc” project team, where members often belonged to different departments but were loaned out to work for a period of time according to project need; the “cross-functional” team, which was comprised of people with different functional skills working towards a common goal such as gathering information, making decisions and generating support from stakeholders to achieve their objective; and lastly, the “selfdirected” team, which was empowered to make decisions and take actions to resolve day to day issues. “Self-directed” teams may consist of people within one function or across functions but they are driven more by initiative than corporate directive.
In the 1990’s it appeared the matrix system was still the most popular structure for product developers capitalizing on an organization’s ability to draw on the competence of the whole workforce, but realistically could this be consistently achieved? What characterizes the matrix’s strengths is how to get beyond hierarchy and how to get people in multi-disciplinary teams to work together effectively, allowing everyone coming together to brainstorm their ideas at the beginning of the project. In the Mental Health/Social Services Industry, this did create problems based on philosophical differences of service provision, as mentioned above. For instance, the “medical model” with a “top-down” hierarchical management approach and the rivalries between various professions (e.g., psychology vs. psychiatry, or nursing vs. other professions) often created challenges in changing the “mind-set” which had been inculcated for decades (the attitude that says, "this is the way things should be done for this project,; let’s do it my way"). This rigidity is not easy to change and many a “range war” developed as a result. In this working environment, the matrix system leaders were required to be influencers, facilitators and persuaders. The issue of who wields the power was still an obstacle in decision-making, especially when there were conflicting interests at stake. T h e Pr o b l e m in a N u t sh e l l
Generally speaking employers want to use teams which manifest co-ordination, co-operation and flexibility. This has been a hard nut to crack from the writer’s experience working in the field of Mental Health/Social Services Industry. How so? Here goes. The Matrix Model of Management identifies that organizations and industries in the private sector have vertical chains of command but also have people work horizontally, across their functional specialization. In theory, employers harness the services of employees irrespective of their function, to work collaboratively on key projects. On such projects the matrix manager can pool the necessary resources in order to achieve what, from the strategic objective, is the overriding priority. However, as you’ve probably picked up, in most organizations, functions are the number one way to do business within the organization and getting work done cross-functionally (i.e., matrix system) is difficult at best. In the not for profit, government-funded organizations during the past three decades (at least), organizations have tried to solve this problem by changing
the culture or by restructuring, but very little progress has been made. Functional “silos” still don’t cooperate with one another (e.g., psychology is still viewed as the “hand maiden” of psychiatry); operational processes are reworked and reworked to death and long cycle times to get projects achieved are the result. Keeping this in mind, how do you survive as a Mental Health/Social Service employee in the matrix system? H ow to Su rv iv e a s a n E m ploy e e in t h e M at rix Sys t e m o f M a n ag e m e n t
Before I go on, have I left anyone behind? If so, hang tight, be patient; this matrix thing should come together with time and careful review. Let’s continue, shall we. In the Mental Health/Social Services sector, the two basic reasons that cross-functional operations and projects aren’t working well entail a greater refinement of the horizontal dimension in those organizations using the matrix system of management. Refining the horizontal dimension involves alignment around the customers’ needs (i.e., patients, families) and how to best meet these identified needs within the staffing and operational budget available. When there is a token re-structuring within an organization, there is typically a rearrangement of reporting relationships — in effect, the vertical dimension of who reports to whom. HERE’S THE PROBLEM and it’s a great big one! The restructuring is often not affecting alignment in the horizontal dimension — the dimension which interfaces with the patients and their families. Structure is concerned with reporting relationships and alignment is about including everyone in the same direction to meet the strategic objectives and satisfy the patients and families. This can and has caused politics to rear its ugly head. Simply stated, in order to successfully achieve this alignment with the constituents, you have to address VERY CAREFULLY the horizontal dimension where the work gets done and include input/feedback from the constituents. How do we do this effectively? Carefully evaluating the type of matrix system subtype you work in will address most of the overriding issues Please read on. As mentioned above, there are three basic forms of matrix management (Reh, 2013). The “weak matrix” which entails the project manager's overseeing staff from different functions but still reporting to his/ her functional manager. Such a structure enhances the BC Psychologist
possibility for communication across functional areas, but it’s still hierarchical and for this reason retains most of the problems associated with a functional organization (beware of this one). The “strong matrix” entails the project manager's being independent of functional management. It is the role of functional managers to support the project by providing technical expertise and assigning resources as and when required. In this structure there is potential for conflict between the project manager and the functional manager over resource assignment and cost allocation — as a result excellent communication, strong relationships and a flexible working culture are required (evaluate the strengths of leadership between the project and functional leader and then decide, do I stay or do I transfer?). Lastly, in the “balanced matrix” power and accountability are shared equally by the project manager and functional manager. Not surprisingly this style of matrix management is the most difficult system to maintain because “power sharing” is tricky and emotional resilience on the part of those involved is essential and not always easy to maintain. The frequency of working in a balanced matrix is rare but if you do, please learn as much as you can about your respective managers and their respective philosophies both clinically and administratively. Whichever subset your current matrix structure entails, there are a number of matrix management challenges in those working milieus which have relatively weak accountability and influence and operate without appropriate authority. By the way and to reiterate, this has occurred frequently in the Mental Health/Social Services Industry which receives most of its revenue from the government. What to do about the matrix system in this situation? The Summary should clarify what you need to know.
Su m m a ry
According to Hall (2013) matrix managers need to make sure that team members comprehend the matrix working paradigm and change their behaviors accordingly to meet the needs of the team and the demands of the project (i.e., Context); A matrix system is intended to improve cooperation across professional disciplines, but it can easily lead to increased bureaucracy, more meetings and slower decisions where too many people are involved (i.e., Cooperation). The project leader needs to have competence in all aspects of management of the project, or risk becoming a hand maiden to the whims and fancies of the functional manager! Specifically, the matrix system is often dependent on “strangers” (i.e., program manager) who don’t have direct control but indirectly have incredible influence on the team’s morale (e.g., budgetary restraints). In this regard, there are many factors that can undermine trust (e.g., cross cultural differences between professional disciplines; miscommunication through technology) and when trust is undermined managers often increase control. Centralization can make the matrix slow and expensive to run in these circumstances, with high levels of cost escalation. It is imperative that matrix managers build trust in distributed and diverse teams and empower people, even though they may rarely get time to meet face-to-face, as described in the functional manager’s role (i.e., Control). Lastly, “Community” — the formal structure becomes less important when getting things done in a matrix system, so both the functional and project managers need to focus on the “soft structure” of networks, communities, teams and groups that need to be set up and maintained to get things done. If this is done competently in your imperfect organization, great. If not, think about options, including moving on.
Chris Argyris, “Today’s Problems with Tomorrow’s Organizations, “in Jong S. Jun & William B. S Storm, eds., Tomorrow’s Organizations: Challenges and Strategies, Glenview, Ill,: Scott, Foresman, 1973. Hall, K. (2013). Making the Matrix Work: How matrix managers engage people and cut through complexity. Nicholas Brealey Publishing. Hatch, J. (2011). Organizations: A very short introduction. Oxford University Press. Reh, F.J. (2013). Matrix Management. about. com. guide.
Defining and Dealing with Addiction in the 21st Century (in co nj u n c ti o n wit h t h e BCPA A nn ua l G e ne r a l Me e tin g 2013) Wor k s hop Pre s ented by Stanton Peele , Ph . D .
About the Workshop DSM-5 (a) avoids defining addiction (referring only to the generic “Substance Use Disorders”), (b) includes the following degrees of such disorders — mild, moderate, and severe, (c) expands the “addiction” umbrella for the first time to include non-substance (behavioral) addictions, beginning with gambling, (d) suggests the likelihood that other such addictions will soon be added (e.g., Internet, videos, sex, eating/obesity), (e) fields claims from important psychiatric figures that this document is not sufficiently rooted in neuroscience. Psychologists must be prepared for a new — but shifting — concept of addiction, so as to be true to psychological theory and evidence-based techniques, responsive to the range of clinical addictive problems clients may present, and make use of the soundest scientific concepts. Stanton Peele’s workshop will address these questions.
About the Presenter – Stanton Peele, Ph.D.
Stanton Peele has been at the forefront of thinking about addiction since the publication of his book (with Archie Brodsky), Love and Addiction, in 1975. That work showed, almost forty years before its recognition by the American Psychiatric Association, that addiction is not a side product of drugs, but is a direct result of powerful but negative experiences in which people become immersed. In eight books Dr. Peele has written since then — including The Meaning of Addiction, Diseasing of America, The Truth About Addition and Recovery, and 7 Tools to Beat Addiction — Dr. Peele has continued to pioneer concepts of harm reduction, life-functioning-oriented treatments, and purpose and values as beacons in recovery, while he has disputed the benefits of the disease concept of addiction. Dr. Peele has developed the Life Process Program for treating
addiction both residentially, and on-line. His next book (with Ilse Thompson) Recover! Stop Thinking Like an Addict, attacks the mind sets that cause addiction, while presenting a mindfulness-based treatment, The PERFECT Program(T).
Learning Objectives 1. To understand DSM-5 substance use disorder (SUD) definitions and their implications 2. To understand developments, current and likely in the future, in the definition and treatment of addiction 3. To understand concept, and primary examples of, evidence-based treatments 4. To understand application of addiction concept to nonsubstance-use activities 5. To understand meaning of harm reduction and range of HR applications 6. To understand relationship between psychological concepts and twelve-step Tx and AA 7. To understand developments in neuroscience, their limits, and their meaning and applicability to psychological Tx 8. To understand natural recovery and its implication for Tx 9. To understand the contours of addiction in coming decades and the social implications 10. To consider child-rearing in relationship to addiction, past, present, future
Friday November 29th, 2013
9:00AM – 4:00PM @ University Golf Club 5185 University Boulevard Vancouver, BC V6T 1X5
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Dealing with Addiction in the 21st Century
kin’s research focuses EarlyaBird Deadline Please include cheque for the correct amont, not postrd on understanding ! ends on August 23 dated, andSAVE made out to “BCPA” orof“BC Psychological the causes and co 12%! Please visit www. of disruptive Association”. If you prefer paying relates by credit card, please psychologists.bc.ca to register. behavior in children register online. Randy Salekin is a Professor and youth, parin the Department of Psy-
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sites including the Disruptive Behavior Clinic at the University of Alabama.
at the University of morning callous-unemotional Workshop chology fee includes handouts, & afternoon coffee, Alabama (UA). Dr. Salekin traits. He currently and lunch. also Freeserves Parking. Participant information is protected as the Director serves as the director of the DisruptiveInformation Behavior under the BC Personal Act. for treatment at three
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Deadline: November 22, 2013 Visit www.psychologists.bc.ca
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$270.90 BCPA Members Workshop & AGM
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About the Workshop
Continuing Education Credits
Psychologists must be prepared for a new — but shifting — concept of addiction, so as to be true to psychological theory and evidencebased techniques, responsive to the range of clinical addictive problems clients may present, and make use of the soundest scientific concepts. Stanton Peele’s workshop will address these questions.
Non-Members’ Rates (September 28th – November 22nd, 2013) q Early Bird Price (until Oct 31st) $246.75 (incl. GST) q Regular Price $270.90 (incl. GST) Meal requirements Regular meal Vegetarian meal Special needs or allergies (please include details)
Presented by Stanton Peele, Ph.D.
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