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Fall 2021 | Volume 71 | Number 3

NJ PSYCHOLOGIST The Professional Journal of the New Jersey Psychological

Special Issue: Promoting Equity, Inclusion, and Social Justice in Professional Psychology

In this issue: CE ARTICLES Reaching the Underserved: A Primer on the Integrated Behavioral Health Model (1 CE) Racially-Adjusted Normative Data (RAND): A Current Discussion Informed by History and Neuropsychology (1.5 CE)

STUDENT AFFAIRS All Systems Affected: The Multidimensional Impact of the COVID-19 Pandemic on the Lives of Doctoral Psychology Students Diversity, Equity, & Inclusion (DEI): A Neuropsychological Update

“Painting the Ivory Tower:” Challenges and Opportunities in Diversifying Academia American Indian Mascots and the Ethical Duty of Psychologists Helping All Youth Achieve Their Potential Through Culturally Responsive Social-Emotional Learning

Experiences and Functioning of New Jersey College Students During the COVID19 Pandemic as Relevant to Psychology and Social Justice ...and more!

Contents 1

Editor's Note

Preparing a Realistic Vision for the Future of NJPA to Maximize Our Potential for Growth

President: Daniel Lee, PsyD President-Elect: Peter DeNigris, PsyD Past-President: Lucy Sant’Anna Takagi, PsyD Secretary: Mary Blakeslee, PhD Treasurer: Marc Gironda, PhD Parliamentarian: Joseph Coyne, PhD Members-At-Large Phyllis Bolling, PhD Aida Ismael-Lennon, PsyD Elio Arrechea, PhD Nicole J. Rafanello, PhD Aileen Torres, PhD Dan DaSilva, PhD APA Council Representative: Rhonda Allen, PhD

Shifting Gears in Private Practice

Continuing Education Section (2.5 CE)

American Indian Mascots and the Ethical Duty of Psychologists

Helping All Youth Achieve Their Potential Through Culturally Responsive Social-Emotional Learning (SEL)

Special Representatives: ECP Chair: Melany Rivera Maldonado, PhD NJPAGS Chair: Jared Hammond Affiliate Caucus Chair: Phyllis Bolling, PhD CODI Co-Chairs: Phyllis Bolling, PhD and Susan Herschman, PsyD Executive Director: Keira Boertzel-Smith, JD Director of Professional Affairs: Susan C. McGroarty, PhD

"Painting the Ivory Tower:" Challenges and Opportunities in Diversifying Academia

Experiences and Functioning of New Jersey College Students During the COVID-19 Pandemic as Relevant to Psychology and Social Justice

Student Affairs All Systems Affected: The Multidimensional Impact of the COVID-19 Pandemic on the Lives of Doctoral Psychology Students

Diversity, Equity, & Inclusion (DEI): A Neuropsychological Update

Book review: Wrongful Conviction in Sexual Assault: Stranger Rape, Acquaintance Rape, and IntraFamilial Sexual Assaults

Psychoanalytic Supervision A Book Discussion with Author Nancy McWilliams, PhD

Executive Board

Affiliate Organization Representatives: Northeast Counties Association of Psychologists: Nansie Ross, PsyD Essex/Union County Association of Psychologists: Sara Tedrick Parikh, PhD Mercer County Psychological Association: TBD Middlesex County Association of Psychologists: Tammy Dorff, PsyD Monmouth/Ocean County Psychological Association: Deirdre Waters, PsyD Morris County Psychological Association: TBD Somerset/Hunterdon/Warren County Psychological Association: Janie Feldman, PsyD South Jersey Psychological Association: TBD

Editor's Note academia. The two continuing education articles offered in this issue also delve into the potential roles and functions that neuropsychologists (Hammond, Hammond and Brooks) and primary care psychologists (Silverman, Clark, and Rothbaum) hold in advocating more inclusionary practices across psychology and throughout our wider society.

Introduction to the Special Issue: Promoting Equity, Inclusion, and Social Justice in Professional Psychology By Aaron Gubi, PhD Editor

Finally, the COVID-19 pandemic has brought forth a myriad of challenges for many people. However, during these difficult times we need to remember that health and economic disparities have not been experienced equally within our state or nation. Drs. Simon and Sinclair looks at the relative privilege psychologists have enjoyed while concurrently utilizing a “4 bins” analogy to assess the rapid changes occurring within our profession due to the pandemic. Christopher King and a group of graduate students within his research lab at Montclair State University (Pozzo, Bomysoad, Stratton, Morales, Wilson and Vasquez) look outward to contextualize these disparate outcomes, sharing initial research data that examines the impact of the pandemic among undergraduate college students in New Jersey. In contrast, Nouriman Gharary and a group of doctoral students in counseling psychology from Felician University (Driver, Taylor, Guarino, Hoo, Spieker and Parmanand) look inward, applying an intersectional lens to explore how diverse and minoritized graduate trainee identities continue to intersect with the fallout from the pandemic. Collectively, these manuscripts express the hardships, resiliency, humility and aspirations that comprise our unwavering resolve as a profession to advance social justice.

The evolving black lives movement, and increasing recognition of health and socioeconomic inequities during the COVID-19 pandemic, has brought equity and inclusion efforts to the forefront within many social spheres and professions. This special issue aims to examine research, training, and professional practices that highlight this social justice theme. As we try to advance social justice practices, it is imperative that we remember our past. It is the inscription on the monument to Martin Luther King in Washington, DC, that reminds us that, “the arc of the moral universe is long, but it bends toward justice.” Many contend that psychologists need to do more to become a purposeful force for social change. Dr. Steven J. Myers iteratively engages this theme as he analyzes the biases perpetuated through the use of mascots that depict Native American stereotypes and demonstrates how dedicated psychologists were able to collaborate with likeminded community stakeholders to end the use of a derogatory mascot within a local public school in New Jersey. Indeed, inclusion involves providing equal opportunity to all people to fully engage themselves in creating an environment whereby everyone and every group feels accepted, valued, and in possession of a sense of autonomy and agency. The application of such an aim is analyzed through the implementation of culturally responsive social-emotional learning interventions within the public schools (Yuan, Elias, and Leverett) and highlighted by Jayashankar and Foley in their manuscript that examines the rationale to support efforts to diversify

About the Author Aaron A. Gubi, PhD, is a licensed psychologist and an assistant professor at Kean University where he also serves as clinic director of Kean Psychological Services, a community-based psychology training clinic. He also works part-time as a psychologist within a residential treatment facility and has a small private practice. He is currently serving as editor of the NJ Psychologist.

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Preparing a Realistic Vision for the Future of NJPA to Maximize Our Potential for Growth: The Development of the 2023-2027 NJPA Strategic Plan

By, NJPA President, Dr. Daniel Lee and NJPA Executive Director, Keira Boertzel-Smith

The purpose of strategic planning is to set overall goals for NJPA and to develop a plan to achieve them. It involves stepping back from NJPA’s dayto-day operations and asking where NJPA is headed and what its priorities should be. The plan shapes our communication with members and external partners relating to the association’s advocacy, membership, continuing education, communications, and governance goals and the actions needed to achieve those goals. Our current NJPA strategic plan sunsets in December 2022. We are currently planning for the 2023-2027 strategic plan.

essential question; what does the association have to deny/to give up in order to create opportunities for the association’s future success? There are non-negotiable association management activities that require the Executive Board and Central Office’s attention to keep the association relevant and operational: membership, advocacy, continuing education, communications, and governance. In a survey, we asked our Executive Board to identify priorities and non-priorities related to these association management activities. In August, we asked NJPA chairs to identify the details of how the tactics will be completed; who will do the work, how this will be monitored and reviewed, and the process for assessing progress. They discussed ideas to encourage the longevity of committees, and attracting new members. In the following video. Dr. Randy White discusses involving more voices in the process.

The first step in developing the 2023-2027 plan is asking the NJPA Executive Board to articulate and consider our current reality; where are we going and how we are going to get there? We used the framework outlined by NJPA Strategic Planning Consultant, Dr. Randall White, as our

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At our September 17th Association Check-In, we discussed the strategic plan development and informed our members about a future opportunity for membership to provide feedback. The current strategic plan and strategic planning working document can be viewed online in the Members Only section under Governance. Our membership will be asked to participate in a survey to share their input. Below are some questions to ask ourselves for our planning. NJPA Membership: Maintain a growing, engaged membership base by delivering value NJPA is a member/volunteer driven association. NJPA membership dues account for the majority of incoming revenue. NJPA must maintain annual aggressive, widespread, and diverse retention and recruitment efforts to keep the association in existence. What activities can we build into our strategic plan to make this happen? NJPA Advocacy: Advance the science and profession of psychology through state and national relations NJPA must maintain a presence at both the state and national level to be a strong voice for psychology. Access to quality mental healthcare and health equity advocacy efforts are what keep the profession of psychology relevant and alive. What activities can we build into our strategic plan to make this happen? NJPA Continuing Education: Provide continuing education learning opportunities to promote excellence and professional development Providing a robust continuing education calendar each year provides psychologists with their mandatory continuing education credits, and contributes to the NJPA non-dues revenue needed to support the association. What activities can we build into our strategic plan to make this happen?

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NJPA Communications: Improve professional and public awareness of NJPA, and the science and profession of psychology To stay relevant, members and the public must see and hear about the great work of NJPA. This happens with year-round communications through NJPA multimedia channels. What activities can we build into our strategic plan to make this happen?

Congratulations to Our Newly Elected 2022 Executive Board Members! President-Elect: Aida Ismael-Lennon, PsyD

Secretary: Alexandra Miller, PsyD

(Affiliate) Member-At-Large: Deirdre Waters, PsyD

(Membership) Member-At-Large: Alexandra Gil, PsyD

NJPA Governance: Grow NJPA leadership to keep the association relevant NJPA must maintain good governance and association management to provide the vision and direction to ensure that NJPA is on the right path. What activities can we build into our strategic plan to make this happen?

Board members are leaders within NJPA who are recognized as having experience, insight, and thoughtful perspective on issues that are important to NJPA. It is the role of NJPA board members to actively participate in setting NJPA policy, developing goals and priorities, creating future initiatives, conducting strategic planning, and making proactive efforts to meet all the objectives set forth in NJPA's Mission Statement.

Below is a sample of our developing strategic plan goals

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Shifting Gears in Private Practice from insurance panels, or shifting the gears of private practice in other major ways, there is much to contemplate (Clay, 2020). The “Four Bins” is a useful strategy for approaching ethical issues. These “bins” include ethical, clinical, legal, and risk management content areas and can be helpful in sorting through the possible effects of any major change on one’s practice (Behnke, 2014). Considerations for those contemplating remote practice include (but are certainly not limited to) informed consent, abandonment, self-care, pitfalls, licensure, and more.

By, Jane Simon,PhD and Sandra Ackerman Sinclair, PhD The NJPA Ethics Education and Resource Committee

Though prompted by a global pandemic, telehealth has surfaced as a surprising tool for enhancing work-life balance. Tele-health has afforded flexibility for many, and for psychologists in particular. Psychologists, who often fill multiple professional and personal roles, can now use time previously spent traveling to and from the office to be present with family and attend personal events. While inperson sessions were/are certainly missed, remote sessions do not appear to have a negative impact on client progress. In fact, many clients have commented on the benefits of tele-health for balancing therapy time within their own schedules.

For new patients, it’s important to be clear from the outset about any unusual or new parameters of your practice. This may include the provision of exclusively virtual sessions, new policies on accepting only out-of-pocket payment, or the decision to allow your license to expire in some states. All relevant information should be included in your informed consent and then reviewed in an intake evaluation to be sure that all terms are clear and understood. It is prudent to review the guidelines for Informed Consent that are discussed throughout the Ethical Principles of Psychologists and Code of Conduct, specifically 3.10 and 10.01 (APA, 2017).

Initially skeptics wondered whether tele-therapy would be equally effective. But now that we have had opportunities to observe clients who began and terminated a complete psychotherapy journey via tele-health, the potential for positive outcomes achieved entirely through virtual treatment is clear. While tele-health might not be the best modality for all, many psychologists are contemplating the ramifications of providing only virtual sessions beyond the pandemic. Whether this might mean giving up an office for full-time tele-health, expanding one’s practice to more states, changing fees, removing oneself

A practice that becomes non-traditional in some way also requires enhanced screening of potential patients. Should you choose to terminate your contracts with insurance companies, it may become unrealistic for some patients to continue in treatment with you if it means paying out of pocket (Clay, 2020). In the event that your practice becomes permanently 100% virtual, you may find that not every case will be appropriate for remote therapy. For prospective patients who you deem 5

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inappropriate for your changed practice, or those wishing for something other than what you are offering, the ethical response is to provide them with a few referrals to practitioners who may provide what they seek. The situation becomes a bit more complicated with existing patients, who may react negatively to even slight changes in your practice. Of course, it’s crucial to remember our ethical obligation to refrain from abandoning our patients, to give patients ample time to process changes to our practice in a clinically sensitive manner, and again, to provide referrals for any patients who prefer not to adjust to these changes. At the same time, it’s also important to remember that we are entitled to make changes simply because they benefit us. While it’s common for psychologists (and others in such helping professions) to feel uncomfortable making decisions that benefit us rather than our patients, we also have an ethical obligation to practice self-care. Ignoring our own wants and needs will surely eventually have a negative impact, not only on us but on our patients, as we grow resentful and face burnout. It’s our duty to take proper care of ourselves so that we have the resources we need to do good clinical work for our patients (Knapp, Vandercreek & Fingerhut, 2017). Any major change involves some inherent risk. Should you choose to leave all of your insurance panels or shift to an exclusively virtual practice, you might lose a large percentage of your caseload. It’s also possible that some of your patients will find these changes inordinately distressing, to the point that you might be tempted to reconsider your plans. In addition to the ethical issues described above, remember to consider clinical, risk-management, and legal issues, especially when facing potentially unhappy and/or disgruntled patients.

honest as possible with your patients about the reasons for the changes to your practice, even if these changes are only of benefit to you. Clearly, it’s best to avoid any misguided attempts to mitigate risk by falsely suggesting that these changes are in your patients’ interest if in fact they are not. Such gaslighting may actually be counterproductive, increasing the risk of a board complaint or malpractice suit. Finally, always keep abreast of any regulatory changes that may impact your practice. Many regulations that were significantly relaxed at the onset of COVID19 were only temporary changes. Ultimately, though it may seem like a simple transition at first glance, switching to an exclusively teletherapy practice involves many considerations, particularly ethical ones. The traditional in-person therapy we have known and practiced is clearly not the only milieu for facilitating positive change and offering support. Those of us who have been skeptical of tele-health for years have been forced to recognize its value. The COVID-19 global pandemic has significantly impacted our field and broadened our perception of ways that we can effect great change. Tele-health, the change that prompted this discussion, has eliminated barriers to help-seeking for many. As you consider the role that you would like telehealth to play in your practice, ask yourself what would help you create the optimal balance so that you are even more present for your clients. References Furnished Upon Request The NJPA Ethics Education and Resource Committee offers free, confidential feedback, exclusively to NJPA members, concerning ethical questions that may arise in the course of their practice. The information provided by the Ethics Committee is designed to assist NJPA members to better understand ethical issues arising out of the practice of psychology in an educative and consultative manner. Ethics Committee consultations are available on weekdays. Note - The information provided by the Ethics Committee should not be relied on as legal advice, and is not a substitute for consultation with a licensed attorney.

It is ethically and clinically essential to be as 6

Continuing Education Homestudy Section The content of continuing education is the crucial component intended to maintain, develop, and increase conceptual and applied competencies that are relevant to psychological practice, education, and science.

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Reaching the Underserved: A Primer on the Integrated Behavioral Health Model (1 CE) Integrated Behavioral Health is Different than Specialty Mental Health Behavioral healthcare in integrated behavioral health includes “mental healthcare, substance abuse care, health behavior change, and attention to family and other psychosocial factors,” (Hunter et al, 2009). Across the nation, and in New Jersey, practitioners are using the integrated behavioral health model in primary care settings, hospitals, university counseling centers, and other locations to increase access to mental healthcare, especially among the underserved.

By, Dina Goldstein Silverman, PhD

By, Alexandra Miller Clark, PsyD

Primary care medicine has been the leading provider of mental health services in the United States for decades (Jacobs, Brieler, Salas, Betancourt, & Cronholm, 2018), before the SarsCov-2 pandemic. Research suggests that, in the past two decades, psychologists have been playing an increasingly larger role in primary care settings (Robinson, & Strosahl, 2009). At the same time, primary care medical settings have begun to transition from a strictly biomedical model to an increasingly holistic, biopsychosocial perspective (Bluestein, & Cubic, 2009). Family medicine residency programs have increasingly employed psychologists as core faculty involved in training resident physicians in assessment and treatment of anxiety and depression, as well as providing them with tools to increase medication adherence, compliance with appointments, and

By, Peggy A. Rothbaum, PhD

Abstract Integrated behavioral health is a system of mental healthcare that is increasingly being implemented across the nation and in New Jersey to enhance access to care for the underserved, reduce lengthy wait times in traditional mental health settings, reduce overall rates of depression and anxiety, and improve compliance with medical treatment. Benefits of integrated behavioral health are addressed, and options for psychologists’ involvement in this initiative are discussed. The authors also share local and nationwide opportunities for training, education, and involvement in integrated behavioral health. 8

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cessation of harmful behaviors by teaching residents motivational interviewing and equipping them with rudimentary counseling strategies (Jacobs, Brieler, Salas, Betancourt, & Cronholm, 2018).

their teams have written watershed books summarizing the current research on the best practices in integrated care, its clinical effectiveness, cost effectiveness, and legislative information on implementation and payment structures of this form of care (Blount, 2019; Ratzliff, Unutzer, Katon, & Stephens, 2016).

Behavioral health integration, a system of involving mental health professionals, including psychiatrists, psychologists, licensed clinical social workers, nurses, etc. in primary care clinics has repeatedly been shown to improve patient satisfaction, reduce costs, improve social function for patients, and increase access to care for vulnerable populations that traditionally struggle with limited resources, low socioeconomic status, and being underinsured or uninsured (Fisher, & Dickinson, 2014; Sadock, Perrin, Grinnell, Rybarczyk, & Auerbach, 2017; Solberg, Crain, Maciosek, et al., 2015; Woltmann, Grogan-Kaylor, Perron, George, Kilbourne, et al., 2012). Integrated Behavioral Health improves mental health outcomes in areas such as depression, anxiety, sleep, and substance use (Alexopoulos et al., 2009; Hunkeler et al., 2006, Krahn et al, 2006, Oslin et al., 2006). Krahn and colleagues (2006) found that more severe forms of depression should be sent to specialty mental health, but the effects of integrated behavioral health treatment were comparable for treatment of those with mild to moderate depression and dysthymia. Integrated behavioral health also improves physical health outcomes (Lanoye et al, 2016), and is especially helpful for those dealing with multiple co-morbidities (Bierman, 2019). Studies are also finding that treatment gains from integrated behavioral health are maintained at 18 month follow-ups (Saddock et al, 2017). The seminal study by Katon et al. addressed the evidence for clinical effectiveness of primary care integration in the treatment of depression extensively, spurring the growing trend and increased interest in this mode of practice. Both Wayne Katon and Alexander (“Sandy”) Blount and

Integrated Behavioral Health Increases Access to Care for the Underserved Integrated behavioral health reduces disparities in access to behavioral health for underserved populations, including People of Color, the elderly, and those living in rural settings. Integrated care, as a treatment for depression, has been shown to be as effective for Latinx and African-American patients as for White patients (Interian et al, 2012). Pre-pandemic, even with expanded health insurance coverage, it was found that there was less availability of behavioral health services in neighborhoods where the majority of people are African American (VanderWielen et al, 2016). A 2007 study examining a multi-site randomized controlled clinical trial (RCT), found that for African-American elders, integrated mental health and substance abuse service set in the context of primary care, as opposed to a specialty mental health clinic, was associated with increased utilization of outpatient mental health and substance abuse services (Ayalon, et al., 2007). Another study, demonstrated that Latinx adults with depressive symptoms who received integrated, culturally focused psychiatric consultation delivered in primary care experienced greater reduction in their depressive symptomology than those who received care in usual treatment settings (Bedoya et al, 2014). Integrated behavioral health, with the warm handoff by the physician in the same space, also makes it more likely that the elderly will get needed treatment as studies 9

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have shown that compared with younger adults, older primary care patients are at increased risk for inadequate treatment for mental health and are less likely to be referred to specialty mental health clinics (Lake, & Turner, 2017; Maust, Kales, & Blow, 2015). Lastly, Lanoye and colleagues (2017) found that integrated care prevents inpatient hospitalizations in at risk "frequent flyer" populations, those individuals that frequently visit the emergency room with routine concerns that otherwise could be handled within a primary care setting at a significant systemic cost savings. Current research focuses on provision of culturallyhumble, integrated behavioral health services that would increase access to care and retain patients in treatment, decreasing their symptomology and empowering patients to improve their lives. For instance, Rajaei & Jensen propose utilizing narrative family therapy as an empowering, culturally-humble and collaborative treatment in integrated behavioral health settings (2017). Mancini proposes training and development in core competencies of culturally humble integrated behavioral health to facilitate access to care for vulnerable populations, including strong interpersonal communication skills, collaboration and teamwork, informatics, effective screening and assessment, evidencebased interventions, care planning and coordination, a systems-oriented practice and practice-based learning, and quality improvement for providers to hone across disciplines (2021). In summary, behavioral health integration can help provide a continuity of services for many populations, particularly for those that, for reasons of racism, historical abuses towards People of Color in the mental health system, financial concerns, and societal stigma, may not seek traditional mental health services (Nilsson, Berkel, & Chong, 2019; Snowden, & Pingitore, 2002).

Integrated Behavioral Health Is An Ideal Setting for Trauma-Informed Care in the PostCOVID-19 Pandemic World To say that the COVID-19 pandemic has grossly affected mental health across the nation would be an understatement. According to the Stress in America 2020 report, 78% of American adults had indicated that pandemic stress has overwhelmed them, and Gen-Z teens (age 13-17) and Gen-Z adults (age 18-23) reported particularly high stress and symptoms of depression (APA, 2020). Worries about their own health and the health of their loved ones, grief for lives lost or impacted by SARS-Cov-2, job loss and prospects of lengthy unemployment, financial distress, and uncertainty about the future, were some of the factors contributing to the depressive symptomology. Complicating individual experiences of the pandemic, societal issues, including access to education and healthcare, concerns about mass shootings, climate change, immigration, rise in suicide rates, widespread sexual harassment and assault reports in the news, and the opioid/heroin epidemic contributed to American adults reports of increased stress and symptoms of depression (APA, 2020). In fact, 7 out of 10 Americans (71%) reported that that was the lowest point in our nation’s history that they could remember, as compared to 2019, when 56% of Americans shared that sentiment (ibid). Concurrently, as many as 20% of COVID-19 survivors, with no prior psychiatric history, are likely to be diagnosed with a mental illness within 14 - 90 days of recovery compared to other health events, such as influenza, other respiratory tract infections, skin infections, cholelithiasis, etc. (Taquet, Luciano, Geddes, & Harrison, 2021). Hazard ratios in this study were the highest for anxiety disorders, insomnia, and dementia (ibid).

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Healthcare workers taking care of patients battling Sars-Cov-2 are vulnerable to both, a higher risk of infection than the general population, and mental health problems, ranging from anxiety about their own illness or mortality or spreading the virus to their loved ones, posttraumatic stress symptoms, depression, and frustration (Xiang, Yang, Li, Zhang, Cheung, et al., 2020). Increased incidents of suicide, both in COVID-19 patients and healthcare providers, driven by social isolation, economic recession, fear of contagion, exposure to trauma, and social boycott and discrimination further imperil mental health (Thakur, & Jain, 2020).

health care settings, where multiple systems of care can work together as opposed to separately across multiple disciplines and organizations, can facilitate access to treatment and support for this particularly vulnerable population (Fortuna, Tolou-Shams, RoblesRamamurthy, & Porche, 2020). Addressing healthcare regulations, facilitating telehealth access, and working with stakeholders in the community to promote and structure prevention and collaboration strategies is one avenue where psychologists can make an enormous impact for Communities of Color due to psychologists’ skillset that includes understanding and utilization of research, program development and measurement, and evaluation and direct service delivery. Integrated care results in more efficient and effective delivery of culturally competent mental health treatment, facilitating access to care for all patients, including those that may have long-standing barriers to accessing traditional psychotherapy and those impacted directly by the COVID-19 pandemic.

In light of the COVID-19 pandemic and its significant impact on American mental health, it seems imperative to utilize behavioral health integration as a model to deliver swift, impactful mental health interventions to help stem the tide of anxiety, depression, and other mental illness. Psychologists are uniquely positioned to be on the forefront of developing timely short-term interventions to support frontline healthcare workers, assist hospitalized COVID-19 patients, and help facilitate support for a beleaguered and frightened general population. Current researchers are vested in developing more trauma-informed interventions for patients in primary care settings (Tomaz, & Castro-Vale, 2020), and psychologists have the unique skills to not only develop short-term trauma-informed interventions, but also to educate and train physicians and other healthcare providers in their implementation. Research has shown that the most vulnerable populations disproportionately affected by the COVID-19 pandemic are People of Color, who are already experiencing the profound impact of poverty, systemic racism, unemployment, crime, and lack of access to high-quality care. Provision of trauma-informed care in integrated behavioral

There are Many Options for Psychologists in Integrated Behavioral Health There are many options for how psychologists can be of service through integrated behavioral health. Psychologists can join a medical or other organization that already has integrated behavioral health and oversee the program, engage in further program development, provide measurement and evaluation of program efficacy, and provide clinical supervision and managerial oversight to behavioral health consultants, and psychologists can serve as behavioral health consultant themselves. A psychologist can also start a new integrated program within a primary care or other medical setting as an employee of the

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setting. In order to start a new program in a setting where it did not exist before, one will need to obtain a license for the program. A psychologist can outsource their own services per day to provide behavioral health in medical settings or create a company to outsource other Behavioral Health Consultants (BHCs) from his/her own practice to do the same.

room, where the patient has just met with the physician or another healthcare provider. Having the BHC enter the room is “understood” and made legitimate in the same way that other treatment team members may walk into the room to take the patient’s vitals. Especially with People of Color, who have a long-standing history of trauma and abuse in medical settings, this warm handoff helps establish trust with the BHC because often there is already a trusting relationship with the physician. Having the BHC in the same setting is also helpful for reaching underserved populations because there is less “hassle” with taking time off work and finding transportation for a separate mental health visit, as the BHC can evaluate and treat the patient in the same office. While integrated care can and is often provided in situations in which the BHC is in a separate building, it is then referred to as “co-located” care versus “truly integrated.”

Best practice psychologists are those who adapt their services to meet the needs of the medical team. Those psychologists, who attempt to bring traditional psychotherapy to a medical setting, tend to be less successful. Psychologists who understand the medical model and work collaboratively as a member of the medical team are most successful in an integrated setting. This finding was reiterated repeatedly by subject matter experts interviewed for NJPA’s Integrated Care Task Force that became the Integrated Care Committee in 2018. This finding was written about in Peggy Rothbaum’s (2006) article that encourages psychologists to learn how to better collaborate in teams.

In co-located settings, the referring physician’s office may reach out to the co-located BHC via a specialty referral, prompting the office where the BHC is located to contact the patient for scheduling and to clarify the nature of the patient’s concerns. In some settings, the referring physician’s office can even schedule the initial visit for the BHC, facilitating treatment access. While in the traditional referral model the referring provider often hands the patient a list of local mental health facilities, or may encourage the patient to contact their insurance company for an innetwork referral, many patients may become “lost to follow up” with that referral system. They may find it challenging to navigate the complexities of finding an in-network behavioral health provider, or become discouraged by the lengthy waitlists or response times, or they may simply feel too overwhelmed to tackle yet another scheduling hurdle.

Location and Collaboration Integrated behavioral health is different from specialty mental health primarily because of where the BHC is located. In a “truly integrated” setting, the BHC sits in the same setting as the health care team, including physicians, nurses, and medical assistants. The location of the BHC encourages a high degree of collaboration with other professionals simply because of the increase in human contact. A high degree of collaboration is further encouraged by using the same treatment plan and electronic health record. The team works together to address the biological, psychological, and social needs of the patient. There is a “warm handoff” from the physician to the BHC, often in the same exam

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Another method of care integration is care coordination that simply involves two or more providers working together to facilitate appropriate service delivery and exchange appropriate information to provide the best possible service to the patient (Gerrity, 2016). While care coordination is a vital component of behavioral health integration (Rothbaum, 2006; Rothbaum & Williams, 2006), and effective collaboration is an essential skill for a BHC, additional variables are crucial for a true integrative care model.

aspects of eating, or brief training in diaphragmatic breathing and progressive muscle relaxation that may decrease the anxiety symptoms that lead the patient to overeat. A third way in which BHC receives referrals is through the provider that may have just interviewed a distressed patient. If the BHC is not sure exactly why the physician has asked for this consultation, which is very likely to happen in this fast-paced environment, one may begin with a question such as, “What is most on your heart and mind today?” to quickly move to the problem. There will be moments of ambiguity in the fast-paced environment of a truly integrated setting and the BHC needs to be comfortable with their own authority and with taking charge doing a timely, skilled assessment through a decision tree of questions. At the first session, the BHC seeks to leave the patient with one tangible skill they can walk away with to help them with their mental and behavioral health needs. BHCs will often find themselves providing psychoeducation on sleep hygiene since sleep is integrally connected to behavioral health. For depression, BHCs will often promote behavioral activation. For anxiety BHCs will often find themselves beginning with psychoeducation on anxiety and teaching the patient four-square breathing that, in itself, can be life changing.

Timing and Identifying Patients Sessions with a BHC, in a truly integrated setting, are quite short compared to traditional specialty mental health session; most are 8 – 20 minute sessions versus 45-55 minute sessions. In addition, the expectation is that most patients in an integrated setting will receive two to three visits versus 15 plus visits in specialty mental health. For professionals just learning how to implement integrated behavioral health, it is an adjustment to learn how to shorten sessions to get to the heart of the matter quickly. Patients are identified in one of three ways. Screening measures, such as the GAD-7, the AUDIT-C, the PHQ-9 or the PHQ-2, are typically administered in the waiting area by medical assistants while triaging the patient prior to the appointment and are used to flag a patient that will receive a BHC consultation. Another method is for the BHCs to review electronic medical records (EMR’s) at the start of the day to identify patients in advance that might benefit from a behavioral health consultation. As an example, the BHC may look at the EMR and notice that at 2:00pm a patient is coming in who had previously been identified as pre-diabetic and whose sugar is continually on the increase. This patient may benefit from a discussion about the emotional and behavioral

How to Get Trained in New Jersey One potential resource for training in integrated primary care is the Center for Integrated Primary Care (CIPC) at the University of Massachusetts Medical School, under the direction and leadership of Dr. Alexander E. (“Sandy”) Blount, one of the founding fathers of integrated primary care and a pioneer in behavioral health integration. CIPC offers evidence-based training in primary care behavioral health integration using the

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curriculum developed by Dr. Blount and his colleagues across a variety of domains. A full certificate course is available, as are specialty courses in various topics, such as Pediatrics and Behavioral Health, Serious Mental Illness and Creating and Managing an Integrated Primary Care Practice. Continuing education coursework is also available, inclusive of advanced training using self-study modules and mentorship with senior faculty at the CIPC. The Center for Integrated Primary Care offers a comprehensive website, https://www.umassmed.edu/cipc/, that offers information on the multitude training opportunities available. Dr. Blount’s latest magnum opus on the subject, “Patient-Centered Primary Care: Going from Good to Great” is also available and provides the latest summative data on development in integrated care (Blount, 2019).

Addiction Agencies (https://www.njamhaa.org/integratedhealthcare-council). Several New Jersey organizations have been trained under the Cherokee Health System model in administering primary care integration under the grant from the Nicholson Foundation, and the leadership of Rutgers Health University Behavioral Healthcare, in seeking to create an education model and curriculum to train providers across disciplines in integrated behavioral health (https://www.njspotlight.com/2019/03/1903-27-state-seeks-to-fix-critical-issues-thathave-hindered-integrated-care/). Multiple hospital corporations across the state are involved in premiering this curricula and offer employment and leadership opportunities for psychologists interested in doing this work where a burgeoning BHC could learn on the job. Two of those sites, the Henry J. Austin Health Center in Trenton, NJ, a primary care center serving the predominantly under-insured or uninsured community of mostly AfricanAmericans, and at the Center for Health, Education, Medicine and Dentistry, a primary care serving the needs of the predominantly Orthodox-Jewish community of Lakewood, NJ, hired behavioral health providers that traveled to Tennessee for in-depth training in the Cherokee model (Buddi, Friedman, Alli, Randell, Kang, & Feuerstein, 2017) and were selected for their cultural humility, sensitivity, and experience with the unique populations of patients that they would engage. They were also trained in a unique CBT model and electronic medical record keeping and set up a workflow that would reduce wait-times for patients and allow the patients to receive brief interventions tailored to their specific needs (ibid). Their work has continued and expanded across other state

The University of Michigan also offers an online continuing education certificate course in integrated care with specializations in adult, pediatric, and combined tracks (https://ssw.umich.edu/offices/continuingeducation/certificate-courses/integratedbehavioral-health-and-primary-care), as does The Society for Health Psychology (https://societyforhealthpsychology.org/trainin g/integrated-primary-care-psychology/), The American Psychological Association (https://www.apa.org/education/grad/curricul um-seminar), and the National Register for Health Service Psychologists (https://www.nationalregister.org/educationtraining/ihts/). All the curricula are available digitally and include pre-recorded lectures, downloadable slides, self-assessments, and the latest evidence base on primary care behavioral health intervention. Additional training opportunities in New Jersey are available through the Integrated Care Council at the New Jersey Association of Mental Health and

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sites.

About the Authors

Lastly, for those desiring a more extensive education on the subject, the University of Arizona offers a Master’s program and a Graduate Certificate program in Integrated Primary Care with a Clinical and a Managerial track (https://chs.asu.edu/programs/graduate), and multiple post-doctoral residencies and predoctoral internship programs in clinical psychology and clinical health psychology across the state provide opportunities for recent graduates to train in integrated behavioral health, including Cooper University Healthcare, Rutgers University Behavioral Health, and the Veterans Health Administration, among others.

Dr. Dina Goldstein Silverman is a licensed psychologist in NJ and PA employed as an attending psychologist and Assistant Professor of Psychiatry and Psychology at Cooper University Healthcare and the Cooper Medical School of Rowan University. She is a fellowship-trained health psychologist involved in evaluation and treatment of bariatric patients, patients struggling with co-morbid medical and mental health concerns and adjustment to chronic illness, and those struggling with infertility, stillbirth, miscarriage, and early neonatal loss. She also teaches courses to psychiatry residents on evidencebased psychotherapies and is involved in the education and supervision of pre-doctoral psychology interns with the Cooper University Healthcare’s psychology internship program that is currently pursuing APA accreditation. An alumna of the University of Texas, Columbia University, and Temple University, she lives in southern New Jersey with her young family and enjoys spending all her spare time with them.

Summary The advent of integrated behavioral health offers many promising opportunities for psychologists to exercise their vast skill set to serve a variety of patient populations, collaborate with multidisciplinary treatment teams and hone their clinical skills in short-term, evidence-based interventions. Whereas traditional outpatient mental health services will always maintain a significant role in the pantheon of clinical psychology roles, integrated behavioral health provides a unique chance for New Jersey psychologists to expand their skill set and collaborate with our physician colleagues and other multidisciplinary medical team members and increase our reach to residents of our state, particularly vulnerable populations. Extensive educational opportunities are available for those who are interested in acquiring more training in integrated behavioral health. In addition to the benefits summarized above, integrated behavioral health also offers plentiful opportunities to develop psychologists’ multidisciplinary collaboration and communication skills.

Alexandra Miller Clark, PsyD, MSCP, has led the Integrated Health Committee for NJPA since 2019. She was part of a team that introduced and implemented an integrated program in four primary care settings in New Jersey that primarily serve an immigrant Latino population. She is also the founder of Live Well Psychology Center, LLC in Sparta, NJ and the host of the podcast Psychology America with Dr. Alexandra. Peggy A. Rothbaum PhD, LLC (drpeggyrothbaum.com) is a psychologist, writer, researcher and consultant in Westfield, New Jersey. She also does community service, creates art, and is a passionate advocate for non-human animals. She uses her art and writing to benefit the causes that matter to her.

References Furnished Upon Request Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

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Fall 2021

Racially-Adjusted Normative Data (RAND): A Current Discussion Informed by History and Neuropsychology (1.5 CE)

By, Jared Hammond, MA

By, Jaclyn Hammond, MA

With calls for social justice and antiracism, psychologists across the country have been sharing views and methods for dismantling systemic structures while researching and contributing to theories deconstructing racism and race. Ethical standards have been subsequently applied to these domains. Notwithstanding, there remains a looming question for psychologists that engage in assessment, whether they be neuropsychologists, forensic psychologists, or school psychologists, with regards to psychometrics: is the use of racial adjusted normative data (RAND) an act of racism? This article will examine the history of psychological assessment over the last century and how the past may be used to inform ethical applications and provide directions for future practice.

By, Jill Brooks, PhD

from such education. Many praised Binet’s genius in his work with the “feeble minded” (Yoakum & Yerkes, 1920). Once Binet published his finalized assessments in 1905, several revisions and adaptations emerged in America (e.g., Goddard Revision, Stanford Revision, Yerkes-Bridges Point Scale), the most prominent adaptation was released in 1916 by Lewis Terman from Stanford University. The Stanford-Binet assessment was marketed to schools where it received immediate popularity, especially in California (Croizet, 2013). This gained the interest of the US government, who contracted Terman to implement his psychological testing in the military during World War I. In 1917, Terman along with Yerkes, Whipple, and Goddard, the other developers of the revisions for Binet’s work, created Army Alpha (i.e., verbal) and Army Beta (i.e., nonverbal) tests for use in recruitment and assessment of soldiers. There was caution raised from several test developers against its use among civilians (Yoakum & Yerkes, 1920) and the lack of standardized scientific methodology and interpretation accounting for non-intelligence factors that could influence

Psychometrics is the measurement of psychological abilities and faculties. The first psychometric test of ability was developed in 1901 and published in 1905 in response to the French public school changes towards universal education. Binet was tasked with developing an assessment that would help determine which children would be admitted to traditional school settings and which lacked the ability to benefit 16

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performance (Atwell, 1934). Notwithstanding, psychometric assessment of ability gained popularity in the US; this was largely due to Terman, who owned many of the psychometric tests (full or partial authorship) and used his connections with the government for marketing and credibility to maximize profit (Croizet, 2013).

responsible for academic testing for schools (e.g., SAT, MCAT, LSAT), but also for the creation of early tracking, identification, and intervention for individuals of low ability to provide supports and prevent the eventual disappointment of pursuing something beyond their ability. The opposite was also true: to identify, track, and promote individuals of higher ability that were not suited for pursuits of “mediocre intelligence” (Croizet, 2013). He postulated intelligence was heritable and believed his research and others (Terman, 1919; Yoakum & Yerkes, 1920) confirmed the findings that White people had higher ability scores than Black people. As such, a racial divide was seemingly supported with neutral, dispassionate, scientific evidence. Garth (1925) was the first psychologist to conduct a review of race and came to the conclusion of white supremacy based on mental superiority. But this line of scientific study was quickly abandoned after several studies (Benedict, 1940; Klineberg, 1935; Montagu, 1942) demonstrated Black people raised and educated in the northern US had higher scores than either the White and Black people in previously collected normative data sets. Interestingly, these individuals were primarily raised and educated (if at all) in the southern US. And in spite of this, the scientific community neither confirmed nor denied the possibility of race as a construct or the superiority of White to Black people (Winston, 2020).

David Weschler released the Weschler-Bellevue Intelligence Scale (WBIS) in 1939 over his perceived shortcomings of the second edition of the Stanford-Binet, namely that the normative sample only included individuals aged 18 years or less, and thus, was actually a test for children and not appropriate for adult use especially given how aging can limit processing speed (Lawton, 1939). The WBIS was special for a few reasons. First, it challenged the psychometric test development and overall structure. Second, it was normed for use with adolescents and adults in a clinical context, the first assessment of its kind to consider people should be compared to others like themselves (Kaufman & Lichtenberger, 2006). Following the WBIS, Weschler released the more popular and wellknown Adult Scale of Intelligence (WAIS) in 1955 and with it the structure of the assessment, but it was not the superior psychometrics or philosophy that led to its popularity, but rather the perceived shortcomings of the “rushed” and “hurried” publication of the third edition of the Stanford-Binet. Terman died in 1956, and his long-time protégé, Maud Merril, who retired in 1954 and helped him release the second edition of the test, published the update in 1960. While Weschler was emboldened to challenge the monopoly controlled by Terman earlier, it is unclear how much sexism and male privilege contributed to his success over Merril.

At the beginning of the Civil Rights era in the US, the Supreme Court was hearing expert testimony from proponents and opponents of Terman’s eugenics theories with regards to racial desegregation (Croizet, 2013). Despite all the scientific evidence and testimony demonstrating the deleterious effects of segregation, the courts generally sided with the “neutral” view of the longstanding supporters of

It cannot be overstated how Terman (1919) moved the study of scientific racism through American history and culture. He is not only 17

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so-subtle allusions, to dangers of racial mixing akin to warnings by Cattel a few decades prior (Winston, 2020).

hereditability of intelligence. Notable is the fact that SCOTUS did not disavow these tests as psychometrically invalid or scientifically erroneous, but rather on the grounds that the constitutional rights of Americans had been violated. As such, the mismeasurement and mistreatment of Black Americans and other minority groups was allowed to continue. Renewed vigor was found in white supremacists bent on preventing “race mixing,” such as Henry Garrett (Tucker, 1994; 2002; Winston, 1998; 2020) who testified numerous times during the 1940s

Akin to other institutions in other domains in the US, psychological and neuropsychological assessment has a history of misapplication and systemic injustice. The topics of systemic racism and critical race theory cannot be ignored given the understanding of how environmental factors influence test performance. Díaz-Santos and Hough (2015) have reviewed and written about the extensive research with neuropsychological assessment of individuals from marginalized and/or underserved populations and how a variety of nonintelligence factors can influence performance, from culture to acculturation, education and education quality, and language and literacy proficiency, as well as stereotype threat and perceived racism (Ardila, 2002, 2005; Ardila et al., 2010; Bialystok & Feng, 2008; Brickman et al., 2006; Costa et al., 2008; Greenfield, 1997; Judd et al., 2009; Manly, 2005, 2006; Roth et al. 2001; Steele, 1997; Steel & Aronson, 1995). Neuropsychology is a critical and vital service for the treatment of various neurologic and psychiatric disorders and is especially prominent for detection of dementia and mild cognitive impairment.

and 1950s and even in Brown v BOE under the laurels of 30 years of racial research, the past presidency of APA, and head of Columbia University psychology department. He conspired with Nazi sympathizers and openly critiqued scientific work based on perceived racial identities (e.g., Jewish, Black), attacked students, and funded research by other scientists to support his views through the late 1960s (Winston, 2020). In 1979, California superior court ruled in Larry P v Riles that intelligence testing was biased toward Black Americans and could not be used for determination of special education.This was extended and upheld at various points in the 1980s to eventually ban the use of IQ testing for any aspect of education placement (Powers et al., 2004). The work of Gould in The Mismeasure of

There have been several arguments levied against the use and development of racially adjusted normative data (RAND). Pedraza and Mungas (2008) presented five main concerns. First, the use of RAND may “obscure” the underlying moderators and mediators contributing to perceived group discrepancies, which are most salient to proper interpretation and clinical use. Second, the use of RAND may unintentionally validate the notion that race is not a social construct, but a construct of scientific and biological merit. Third, the use of RAND may promote incorrect interpretation of

Man (1981) was utilized in these proceedings to show that the IQ tests in question had no psychometric value. Debate over psychological mismeasurement erupted again in 1994 when The Bell Curve (Herrnstein & Murray) was published, arguing that IQ validly measures intelligence across all groups equally, purporting the idea that intelligence is heritable, and this genetic passing of intelligence supports the superiority of White Americans over Black Americans. Although scientific racism had been largely debunked, it had been revived, with not18

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recently (Mindt et al., 2021). However, these RAND samples vary considerably. It becomes the ethical responsibility of the clinician to review the psychometric properties for the assessments being researched, as well as the research methodology and interpretation prior to selection, administration, and interpretation.

assessment datum and increase misunderstanding about the reasons for the observed discrepancy in neuropsychological performance between groups. Next, the use of RAND has theoretical limitations regarding generalizability and reliability outside of the geographic and cultural domains where they are collected (e.g., Southwest US versus Northeast US). Finally, the use of RAND may unintentionally result in a dangerous attitude toward affirming the discrepancies in assessment performance among culturally and ethnically diverse groups and increase the gap of misunderstanding. The authors noted that these concerns are a welcomed line of scientific inquiry because it moves “the discourse away from how much different one group is from another, to why these differences exist at all” (Pedraza & Mungas, 2010).

Test selection among psychologists can be a source of unethical practice when working with individuals from diverse groups (Wong, 2006). It is not only important to consider the psychometric properties of the tests (e.g., construct validity, reliability), but also the referral question for the client (Manly, 2005). Ethical decision-making models have been presented (Díaz-Santos & Hough, 2015; Manly & Echemendia, 2007; Romero et al., 2009; Wong, 2006) for test selection and the use of RAND. After an appropriate risk-benefit assessment, such demographic corrections could be useful for someone who meets the following criteria: (a) native of that country of assessment, (b) assumed normal neurodevelopment; (c) education without special intervention; (d) English as a first language. RAND may be helpful, but should be interpreted with caution for: (a) individuals who have not completed their education, namely adolescents and young adults; (b) adults with a mild neurodevelopmental disorder, such as ADHD or SLD; (c) English proficiency, whether it be English as a Second Language, bilingualism, and/or multiple language speakers; (d) individuals educated in another country.

The need for cross-cultural neuropsychology (Manly, 2005; 2006; 2008), as well as methods for increasing culturally competent assessment practices (Mindt et al., 2010), ethical test development (Manly & Jacobs, 2004) and interpretation (Avila et al., 2019) is well described. Case studies utilizing the example of hypertension to demonstrate the use of “cut-off” scores in medicine (e.g., high versus normal blood pressure) is different and not replicable in neuropsychological tests, thus the need for RAND and the benefits for treatment and outcomes in American minority groups (Manly & Echemendia, 2007). The use of RAND can be ethically and clinically relevant for early detection of areas for intervention for individuals who would otherwise not receive access to services (Manly, 2005). Ethical use of culturally derived normative samples is key for future multicultural humility and practice. There exist multiple RAND samples for ethnic and cultural minorities in the US both historically (Artiola i Fortuny et al., 1991; Heaton et al., 1991) and

When deciding whether or not to use RAND, it is important to remember specific and general ethical considerations outlined in the standards of the APA Code of Ethical Conduct (2016). It is important to know and maintain the individual levels of clinical competency (2.01, 2.03) by continuously reviewing the foundations, research, and methodology by which clinical 19

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graduate training and professional levels for critical analysis of reimagining evidenced-based practices and psychometric constructs, especially the notion of race.

decisions are derived (2.04). Services must be provided free from discrimination (3.01) and all forms of harassment and harm (3.02; 3.03; 3.04). Informed consent (3.10) is an excellent opportunity to manage clinical risk, but it is not always applied to assessment (9.03). There is an ethical responsibility to acknowledge the flawed historical bias in the use of assessments (9.01; 9.02), which is why selection of tests based on modern psychometric theories is critical (9.05). With this modern understanding of deconstruction of race, proper interpretation by qualified individuals will be key (9.06; 9.07; 9.10). Decisions based on assessment results can have significant consequences influencing an individual’s access to education or medical services.

References Furnished Upon Request About the Authors Jared B. Hammond, MA is a fifth year doctoral student at Kean University’s Combined PsyD program and aspires to be board certified in clinical neuropsychology. He has completed externships in clinical neuropsychology at Kessler Institute for Rehabilitation, Lenox Hill Hospital, and Livingston Public Schools while concurrently working as a neuropsychometrist for Head to Head Consultants. Jared is completing his internship in clinical neuropsychology at Denver Health Medical Center/University of Colorado School of Medicine with a focus on providing access to neuropsychological services for marginalized and underserved communities.

It is this ethical scientific mindedness (Sue, 2006) that will help reduce clinical work of preformed judgements and predictions based on demographic factors, and instead increase research of contextual factors over perceived elite and confirmatory statistical methods (Delis et al., 2004) and further quality discussion and understanding of how society and privilege may influence test use, development, and research. Corey (2021) has applied White privilege to neuropsychology, challenging individuals to examine and “unpack their privilege” using the metaphor of the knapsack from McIntosh’s original work (1989), and it has been largely read with praise. Recently, Byrd (2021) has pointed out that, despite the massive undertaking and huge contribution to the field, two major considerations were missing: how structural racism is the producer of White privilege and the need for measurable goals and action items within an executive plan. As such, Byrd has argued the study of White privilege, albeit important, is counter intuitive to decolonization efforts in psychometrics and neuropsychology to place whiteness at the center of the discussion, proposing that the path forward is to create a critical antiracist neuropsychology. This would include access and equity practices at the

Jaclyn B. Hammond, MA is a first-year doctoral student at Kean University’s Combined PsyD program with the pursuit of becoming a licensed clinical psychologist. She completed internships in mental health counseling at the Italian Home for Children and Brookview House, Inc. while concurrently working as a neuropsychological technician for Head to Head Consultants. Jaclyn received her Master’s degree at Lesley University in Clinical Mental Health Counseling and Expressive Therapies with a specialization in Art Therapy. For her capstone thesis, Jaclyn chose to complete a review on the use of mindfulness and art-based interventions for competitive athletes in treatment of sports-related injury. Dr. Jill Brooks is a clinical neuropsychologist who maintains a private practice, Head to Head Consultants, in Gladstone, New Jersey. Dr. Brooks received her undergraduate and graduate degrees in speech and language pathology from Northwestern University in Evanston, Illinois, and the University of WisconsinMadison, in Madison Wisconsin, respectively. She obtained her Doctor of Philosophy degree in Counseling Psychology at the University of Miami in Coral Gables, Florida. Dr. Brooks completed an internship in Clinical Neuropsychology at the University of Florida-Shands Medical Center in Gainesville, Florida, followed by a postdoctoral fellowship in Clinical Neuropsychology at the Center for Head Injuries at JFK Medical Center in Edison, New Jersey.

Earn 1.5 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

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American Indian Mascots and the Ethical Duty of Psychologists American Indian, and social psychologist. Her course covered topics related to cultural identity, stereotyping, and research on the negative psychological consequences of mascots. I left her course with a completely different perspective on the issue and a sense of responsibility. In 2010, I began working as a school psychologist at a Bergen county public high school. The mascot was the “Indian,” celebrated, revered, and considered by most, harmless. For years, prior to my arrival and thereafter, a small contingent of students would protest the mascot, pleading for its retirement, only to be met with an overpowering wave of school and community resistance. In June of 2020, however, a collaborative effort of educators, students, and community members with a firm rationale grounded in empirical psychological research contributed to the mascot’s retirement.

By, Steven J. Myers, PhD

Entering college in the mid 1990s, I hadn't given any thought as to whether Native-themed mascots were problematic. I attended a New Jersey high school with the “warrior” moniker; a noble, historic figure, without tribal association or identity, embroidered on the school's athletic apparel and painted on the gym walls. I never questioned its accuracy, since it was consistent with the images I saw in movies and I hadn't actually met a Native person before. That is how stereotypes operate; a generic mental representation intended to portray a group of people, reinforced by inaccurate images and assumptions. Some stereotypes are so pervasive in society that when I visited the Navajo Nation as a college senior, I was half expecting to see Navajo people living in teepees.

The controversy over the use of Native mascots is not just another branch of “cancel culture.” There are historical facts, psychological research, and ethical duties that call psychologists to action. The purpose of this article is to provide a brief summary of the psychological research conducted by Dr. Fryberg and others; the ethical duties of psychologists to take action against stereotyped mascots as a form of racial injustice, barriers and inroads to change, and finally some practical steps that psychologists can take to positively impact this change.

In 2004, I attended a graduate level social psychology course at the University of Arizona that transformed my understanding of the principles of stereotyping and how those principles influenced my (mis)perceptions of American Indian people and culture. My professor was Dr. Stephanie Fryberg, Tulalip

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Stereotype Threat and the Psychological

the relationship between stereotyped images on

Consequences of Mascots

the psychological well-being of American Indian and White high school students. The researchers

Stereotype threat refers to “being at risk of

found that exposure to stereotyped images

confirming, as a self-characteristic, a negative

(Disney’s Pocahontas and Chief Wahoo) was

stereotype about one's social group.” Steele and

associated with decreased self-esteem for

Aronson (1995) demonstrated the effect on African

American Indian youth when compared to a group

American college students who performed more

exposed to a written list of stereotypically

poorly on standardized tests than White students

negative outcomes associated with Native people

when their race was emphasized. For American

(i.e. statistics about dropout out rates, alcoholism,

Indians, stereotype threat is magnified by the

and suicide) and a control condition. Conversely,

relative invisibility of American Indians in

European American youth demonstrated

contemporary society and the narrow band of

increased levels of self-esteem after exposure to

traits and behaviors depicted in media, mascots,

stereotyped images and the stereotypically

and popular culture (Fryberg et al., 2008). In a key

negative outcomes when compared to a control

study, Fryberg and colleagues (2008) examined

group (Table 1).

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Follow up studies have also demonstrated that mascots have a negative effect on American Indian community efficacy and achievement-related possible selves. Scholars also argue that Native mascots not only cause psychological harm to Native people, but they also perpetuate negative associations of, and attitudes towards, Native Americans among non-Native American groups (Freng and Willis-Esqueda 2011; Chaney, Burke and Burkley, 2011). Moreover, it is particularly troubling that Native themed mascots are so prominent at institutions of education. Ethical Duties Among the Psychologists Code of Conduct (APA, 2017) is Principle E: Respect for People’s Rights and Dignity. This principle states: Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and selfdetermination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices. Dr. Fryberg’s research on the negative psychological consequences of mascots formed the basis for the APA to adopt a resolution in 2005 calling for the immediate retirement of all Native 24

mascots. The APA position statement recognizes that mascots limit the educational experience of all people, represent a form of discrimination and stereotype, and limit the ways in which American Indian Nations are able to accurately portray their culture. Furthermore, the APA calls for all psychologists to action against racial injustice, oppression, and discrimination, recognizing the mental health toll many racial and ethnic groups continue to face in our country and around the world. Barriers and Inroads Reclaiming Native Truth (2018) is a national effort to achieve equity, inclusion, and policy changes that will improve the lives of Native families and communities. This project includes an extensive body of research examining attitudes about Native people and Native issues, as well as a Guide for Allies. This guide provides data-based suggestions to help bring about societal changes in the attitudes of Americans around Native issues. In focus groups, Fryberg (2018) found that while the majority (4 out of 5) of Americans surveyed would feel uncomfortable calling a Native person a r**skin, 51% opposed the banning of Native themed mascots in athletics. The argument in support of Native-themed mascots appears to be based on sentiment about Native culture. Greenberg, Quinian, and Rosner (2018) reviewed and analyzed 4.9 million social media posts and found that most online users admired Native culture. Moreover, most survey respondents did not fully comprehend the issue surrounding Native-themed mascots, particularly when those mascots were seen as “respectful” and depicted “strength and bravery.” Education appears to be the key inroad to attitude and policy change on the use of mascots. Data compiled from the Reclaiming Native Truth Project indicate that 72% of Americans surveyed

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believed it is necessary to make significant changes to school curricula on Native history and culture. Linking accurate history with portrayals of contemporary Native people is key to achieving support for Native issues. Moreover, learning about systematic oppression and the research findings on the psychological harm of mascots were cited as important elements to shift support on Native-themed mascots (Fryberg, 2018). Action Native mascots are still visible across all levels of education and sport, with adamant supporters clinging to maintain the status quo. Equipped with the knowledge that mascots are harmful to the psychological well-being of Native people and the ethical duty to “not knowingly participate in or condone activities of others based on such prejudices,” what is a psychologist to do? Psychologists are well-positioned to influence change on this issue, and improve the narrative surrounding Native people. Refraining from wearing apparel or supporting the use of Nativethemed mascots, whether it be a school or sports franchises is a good first step for a psychologist. The second step involves actively educating others. Psychologists are uniquely capable of both understanding social science research and communicating the findings effectively, in a way that is objective, clear, and concise. However, psychologists also know that belief structures can be resistant to change. The Reclaiming Native Truth project found tying together four themes helped inspire a strong narrative that changed attitudes about Native people and issues. These include identifying a key issue or problem and including information about Native values, accurate history, a link to contemporary Native life, and a call to action. For

example, the project found that the following narrative on Native-themed mascots yielded a greater attitude change in respondents that heard the narrative over those who did not. Values - Our own culture and heritage are important parts of who we are and how we define ourselves. History - No one deserves to see their heritage insulted or ridiculed. Yet, for hundreds of years, Native Americans have been mocked and dehumanized by slurs and images in team mascots at every level, from elementary schools to professional sports. Visibility - While some people mistakenly believe that these mascots are harmless or even respectful, the mascots actually represent a continued dehumanization of Native peoples and do real psychological harm to Native children. Call to Action - It’s time to eliminate the use of Native American names, symbols and images as team mascots. References Furnished Upon Request About the Author Dr. Myers is a licensed psychologist in private practice in Oradell, New Jersey.With 14-years of experience in New Jersey public schools, Dr. Myers has an acute understanding of the legal obligations public schools have to equitably address the learning and mental health challenges of its students. In his practice, Dr. Myers provides psychotherapy services for adults, adolescents, children, and families, as well as, parent coaching and consultation. He conducts comprehensive psychological, psycho-educational, and neuropsychological assessments to assist in the treatment and remediation of mental health and learning challenges, as well as, to assist in legal proceedings. Dr. Myers also provides contracted psychological services to school districts including evaluations, consultation, supervision, and training.

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Helping All Youth Achieve Their Potential Through Culturally Responsive Social-Emotional Learning (SEL)

By, May Yuan, MS

By, Larry Leverett, EdD

By, Maurice J. Elias, PhD

The past year accentuated long existing inequities of the nation’s sociopolitical climate, fraught with political, racial, and social tensions that exist in schools and communities. At the core of the failures to create a fair and just society, many Black, Brown, and poor students have been historically underserved in schools, and denied the opportunities to succeed as capable learners. It is therefore urgent that we embrace the hard work of demonstrating respect, empathy, civility, and perspectivetaking across all classrooms and diverse communities in which students live. Educators and the learners they serve can only flourish in learning environments that are supportive, inclusive, and that embrace a “wall to wall” integration of social-emotional learning (SEL) and culturally responsive education (CRE). In the wake of the dual pandemics of COVID-19 and racial injustice, educators, researchers, and policymakers have recognized the importance of cultivating SEL and CRE in all aspects of teaching and learning. These are especially needed to ameliorate the adverse effects of these pandemics on the mental health of students in the classroom, and of the adults who are charged with meeting their needs. SEL and CRE competencies support the development of learners to help them successfully navigate their various social contexts, including school, family, community, workplace, and faith-based organizations. As the current generation of youth will become the next generation of educators, policymakers, and leaders, it is increasingly imperative to pay attention to the cultivation of SEL competencies in our youth in a 26

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systematic and culturally responsive manner. In our view, it is long overdue for our nation to develop learning environments with holistic, inclusive approaches - approaches that are essential to building the competencies of all learners to help them achieve successful school experiences and fulfilling life trajectories.

and CRE have unique potential to positively influence students in various aspects of their well-being. Additionally, CRE, when combined with SEL, allows students to effectively engage in and navigate difficult situations with empathy and compassion, and to embrace their own cultural identities while accepting and developing meaningful relationships with others that are different than themselves.

Indeed, although it is clear that we have become a diverse nation, and will be become more so over the next several decades, the United States of America has a long history of policies and practices that have not successfully recognized the benefits of diversity. There is an abundance of empirical evidence that traditional educational practices and mental health interventions have not been sufficiently successful in mitigating racialized disparities in many sectors of our society. Black and brown students, in particular, are likely to suffer from harmful stereotyping and bias alongside fewer socioeconomic resources and far less social capital (Murphy et al., 2020). Therefore, it is time that we assess our efforts to create inclusive environments that recognize the strengths of our increasingly diverse population.

SEL interventions consists of pedagogy based in social learning theory that underlies many evidence-based cognitive behavior therapy interventions (Davis et al., 2017). They focus on fostering social skills (i.e., social awareness and relationship skills), emotional competencies (i.e., self-awareness and self-management), and the effective utilization of both to make wise and responsible decisions (i.e., responsible decision-making). According to the Collaborative for Academic, Social, and Emotional Learning (CASEL), these aforementioned skills comprise the core SEL competencies that all students benefit from cultivating (CASEL, n.d.). When CRE and SEL are implemented effectively, systematically, and intentionally, SEL curricula in culturally responsive learning environments have been found to not only effectively increase the use of SEL competencies and improve students’ well-being, but also increase academic achievement; additionally, effective SEL implementation fosters greater feelings of safety, recognition of cultural competencies, and support within the school setting (Durlak et al., 2011; Zins & Elias, 2007). These findings are logical, as students that are pre-occupied with their safety, or who are not socially or emotionally well, often are less likely to be motivated to achieve academically. SEL curricula can both be implemented in preventative and universal settings by

To attempt to systematically counter these and related trends, recent scholars have called for culturally responsive and trauma-informed educational practices (e.g., Duane et al., 2021). Culturally responsive education (CRE) is defined as a pedagogy that equips students with the tools to embrace their cultural identities and treat others’ cultural identities with curiosity, respect, and humility, and provides students with the knowledge and tools to tackle social inequities and become vehicles of positive change (Simmons, 2019). As students spend the majority of their academic year in a school setting, school-based interventions and programming that have their foundations in SEL

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educators (i.e., Tier 1), as well as in more targeted interventional contexts by school support staff and mental health professionals (i.e., Tier 2 and Tier 3; Greenberg et al., 2017).

empathy and perspective-taking are critical skills that allow better understanding of, and dialogue between, different cultures and worldviews and more respectful and productive dialogue within classrooms. Emotional regulation and focus also are necessary for both students and educators to avoid making “snap” judgments and instant reactions, and to be better listeners of what is being communicated within the classroom (Elias & Leverett, 2022). At the intersection of SEL and CRE thus lies the possibility of helping all students give voice to systemic inequities and racial realities and to better respond to the lived experience, challenges, and potential traumas of children and youth of all backgrounds.

Although there has been some debate about the place of SEL and CRE in schools and their importance in academic settings, our current position, informed by decades of research, is that SEL and CRE are not only important, but essential for the well-being of students and the adults that serve them. Additionally, we believe that all students, regardless of race, background, or context, are capable of learning and building upon SEL skills and demonstrating cultural competencies. Educational equity, the idea that all students deserve to receive what they need to develop their full academic, social, and emotional potential, is also central to the integration between SEL and CRE (Elias & Leverett, 2022). At its core, SEL pedagogy that integrates CRE operates from a strengthsbased (rather than deficit-based) perspective, and when done well offers students from all backgrounds and ability levels the skills and self-efficacy to voice their beliefs, to reach towards their potential, and to achieve a positive, noble purpose (Hatchimonji et al., 2017).

Psychologists and educators who are responsible for the well-being of today’s students, who will eventually become tomorrow’s leaders and workforce, must examine our own biases and model and instill the SEL competency of selfawareness in students, including of our own resources and potential as agents of positive change. It is also increasingly necessary for educators and mental health providers to recognize and communicate about sources of trauma in children and adolescents, to become aware of the nuances of different cultures, and to teach and practice in a culturally responsive manner. Program evaluation research in SEL and CRE approaches must explicitly assess their educational equity and culturally responsive practices. Lastly, we urge that training guidelines in the fields of psychology and education require exposure to evidence-based SEL curricula and culturally responsive, trauma-informed perspectives, to provide a holistic education for the next generation of mental health professionals and educators working with students. Psychologists can lead the call for cross-disciplinary collaboration and encourage mutual consultation about best practices that both recognize and cultivate the full potential of

Bring Culturally Responsive and SEL Education into Schools Now Although structural inequities abound in our larger society, at the institutional level, schools and educational systems can be made more equitable and supportive for students of all backgrounds by incorporating culturally responsive SEL. For example, the explicit instruction and cultivation of self-awareness is necessary for students, educators, and practitioners to understand personal biases. Additionally, the “social awareness” skills of

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students of all backgrounds and contexts (Dutil, 2019). References Furnished Upon Request About the Authors May Yuan is a doctoral student in clinical psychology at Rutgers University, The State University of New Jersey. Her research broadly pertains to youth socio-emotional and character development, including ways to create a supportive school climate and culture, to enhance socialemotional skills in youth, and to reduce negative outcomes such as bullying and suicide. She is also currently an extern at The Haven, Piscataway School Based Mental Health. Dr. Larry Leverett’s career in education is driven by his passion for equity and social justice. From serving as a

teacher's aide for Head Start to serving as Assistant Commissioner of Urban Education in the New Jersey DOE, Dr. Leverett has worked as a principal, assistant superintendent, and superintendent in urban and suburban school districts. Dr. Leverett served ten years as the Executive Director of the Panasonic Foundation, and currently serves as the Managing Director for New Jersey Network of Superintendents (NJNS), a community of practice for superintendents. Maurice J. Elias, PhD, is a Professor of Psychology at Rutgers University and is Director, Rutgers SocialEmotional and Character Development Lab (www.SECDLab.org, @SECDLab) and Co-Director, Academy for Social-Emotional Learning in Schools (SELinSchools.org, sel.rutgers.edu, @SELinSchools). He is a licensed psychologist in New Jersey.

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“Painting the Ivory Tower:” Challenges and Opportunities in Diversifying Academia lower than overall percentage, with the American Psychological Association’s Center for Workforce Studies reporting that, as of 2019, only 17% of faculty identified as racial/ethnic minorities (Bichsel et al., 2019). This can be attributed, among many other factors, to limited hiring, as well as low retention rates, both within the field of psychology and other disciplines. Studies have identified several race-related challenges

Pamela Foley, PhD

affecting retention of faculty of color, placing extra barriers in their path through academia. Taking on teaching and mentorship roles where there is limited

Shruthi Jayashankar, MA

diversity among the student body and on campus, in

Department of Professional Psychology and Family Therapy, Seton Hall University

general, has been shown to adversely affect faculty of color in their connection with students and their motivation to advance in academia (Arnold et al., 2016).

In the context of the current highly publicized debate

Being one of a few, or the only faculty member of color in departments, has also been shown to pose barriers to tenure and promotions. Louis et al. (2016) noted that this

regarding critical race theory, and the initial denial of tenure to a highly regarded African American scholar in response to pressure from conservative activists (NAACP Legal Defense and Educational Fund, 2021), the

is due to faculty of color being overburdened with mentorship and service responsibilities, in addition to teaching, while balancing rigid research expectations and

challenges facing faculty of color have become more visible. Prior research (Zambrana et al., 2015; Harper, 2013) has shown the value in employing faculty of color that benefits both students and junior faculty of color. Historically, it has been found that faculty of color encourage their students to interact with diverse peer groups, foster attitudes of service, and more often facilitate conversations surrounding race, ethnicity, and gender (Knowles & Harleston, 1997). However, despite the attempts made to encourage diversity in organizations and institutions, the National Center for Educational Statistics (2020) indicated that as of Fall 2018, full-time faculty of color were still underrepresented, with Asian/Pacific Islander faculty making up 12%, Black and Hispanic faculty making up another 12% and, American Indian/Native Alaskan and those who identify as multiracial making up 1% of the professoriate. Within the field of professional psychology, the representation of faculty of color was

tenure timelines placed by their institutions. Faculty of color may also be discouraged from studying or publishing content that does not conform to “traditional” ideologies, or from employing non-traditional research methods, including qualitative methods (Settles et al., 2021). Another roadblock to the retention of faculty of color is the pervasiveness of invalidating messages or microaggressions that scholars of color may receive from senior faculty, whose mentorship serves as a crucial factor in retention (or lack thereof) among faculty of color (Davis et al., 2021; Freeman et al., 2019). Some examples of such messages include dismissing their research ideas, speaking in a patronizing tone towards mentees of color, as well as mentor’s demonstrating attitudes informed by harmful racial stereotypes such as the “angry Black man,” or the idea of emotional and difficult women of color (Davis et al., 2021). Unfortunately, such experiences have set up a pattern that needs to be broken if faculty of color

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are to succeed in academia.

practices in institutions is also beneficial. Studies examining strategies to patch the “leaky pipeline” in psychology, as well as other STEM fields, have called for the modification of faculty recruitment and hiring practices, such recruiting within communities of color, ensuring that employment advertising emphasizes their recognition of the value of multiculturalism and diversity on their campuses, as well as mandating bias and awareness trainings for those who conduct the interview process and make hiring decisions (Llamas et al., 2021; Liu et al., 2019).

The issues of retention discussed above can also affect the pipeline into the professoriate. Students of color are often not mentored by faculty of color, due to the demographics of most academic departments (Brunsma et al., 2017). This, along with the general racial climate on campus, can lead to students feeling unsupported and disenfranchised, resulting in lower GPAs among students of color, as well as greater dropout rates among potential graduates of color (Llamas et al., 2021). Even if they are fortunate enough to have a mentor of similar racial background, minority students are likely to observe the stressors faced by their faculty of color

The US Census Bureau (2021) reported, in August 2021, that those who identified themselves as only White dropped by 8.6% since 2010, to just under 62% of the US population, while the number of multiracial individuals in the US increased by 276% in the same period, to almost 19%. Though these changes are in part due to improved methods of counting, it is quite clear that the racial landscape in the US is becoming much more diverse. White Americans remaining the largest single racial group, with 204.3 million (61.6%). However, the population now includes 33.8 million (10.2%) individuals who identify as multiracial, 62.1 million (18.7%) Hispanic or Latino, and 35.3 million (17.9%) who identify as Asian, Native Hawaiian or other Pacific Islander, or Native American. If academia continues to remain nearly 80% White, institutions of higher education risk losing touch with the population they exist to serve.

that may discourage them from seeking a similar path. Further, in the same way that faculty mentors may be limited in their ability to pursue research that is meaningful to them, students of color may also face challenges in obtaining approval for dissertation research using newer methodologies or addressing possibly controversial topics that may feel critical to the entrenched academic hierarchy (Settles et al., 2021). With these core issues affecting the experiences and academic growth of both students and faculty of color, systemic change is needed. Among the strategies that have been found to be effective in improving the retention rates and academic success of both students and faculty of color are increasing not only the presence but the true inclusion of faculty of color on

References Furnished Upon Request

campus, updating and expanding curriculum to reflect

About the Authors Shruthi Jayashankar is a 3rd year Counseling Psychology PhD student at Seton Hall University. Shruthi is currently an extern at Newark Beth Israel Hospital’s Regional Diagnostic and Treatment Center. Shruthi’s research interests lie in higher education, multiculturalism in academia, and the STEM pipeline. Shruthi hopes to specialize in doing trauma healing with underserved minorities, including the incorporation of non-traditional therapeutic methods such as music therapy.

diversity in both a current and historic context, and developing programming and initiatives supporting a multi-racial campus community (Llamas et al., 2021; Banks & Dohy, 2019). A study by Gregus and colleagues (2020) investigating clinical psychology doctoral students’ perceptions of multiculturalism within their programs and campus climate found that students emphasized the need to integrate diversity training into the general curriculum, research and clinical/training opportunities . Procter and colleagues (2018) found that African American graduate students in school psychology programs emphasized accessibility of faculty, open lines of communication, as well as the upholding of cultural humility within student and faculty teaching and mentorship relationships as major factors influencing student retention and program completion. Similarly, researchers have noted that focus on improving faculty recruitment and hiring

Pamela F. Foley, PhD is the Training Director of the Counseling Psychology PhD program at Seton Hall University. Dr. Foley’s research interests are in workplace and career issues, multicultural issues, and the intersections between them. She also maintains a small psychology practice and acts as a consultant for Social Security Disability.

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Experiences and Functioning of New Jersey College Students During the COVID-19 Pandemic as Relevant to Psychology and Social Justice

Christopher King, JD, PhD

Jill Del Pozzo, MA

Rachel Bomysoad

Julia Stratton

Ivysmeralys Morales, MA

sexual minorities, and historically marginalized groups (Czeisler et al., 2020; Moore et al., 2021; O’Connor et al., 2020; Proto & Quintana-Domeque, 2021; Xionga et al., 2020). Younger adults, including college students, also evidenced increased mental health vulnerability (Copeland et al., 2021; Czeisler et al., 2020; Dennon, Caitlin Wilson

2021; Wang et al., 2020; Xionga et al., 2020).

Loumarie Vasquez

Consistent with expectations, researchers have found that the COVID-19 pandemic is negatively impacting the psychological functioning of the general population (Hossain et al., 2020; Vindegaard & Benros, 2020; Wu et al., 2021; Xionga et al., 2020). In addition to mental health symptoms like anxiety and depression, researchers also observed increases in substance use (Mallet et al., 2021), in part to cope with the numerous stressors beget by the pandemic (McKay & Asmundson, 2020). Relatedly, researchers have observed increased rates of family and intimate partner violence (Cappa & Jijon, 2021; Piquero et al., 2021). Also consistent with expectations, vulnerability for bearing such adverse outcomes has likely not been homogenous across the population. Although early findings have been mixed, some researchers observed higher rates of mental health symptoms among women,

Questions have also arisen about the utility of and access to telehealth that saw a substantial uptick during the pandemic, to alleviate such burdens. Early research suggests that telehealth has been a useful pandemic-time tool, though not a panacea (Appelton et al., 2021; Costa et al., 2021). Little research examined the psychosocial functioning and access to mental health care during the pandemic among New Jersey residents, specifically (for one exception, see Kecojevic et al., 2020). Thus, in this article, we report interim data concerning the psychosocial functioning of college students in New Jersey since the pandemic began, focusing on descriptive results for variables that we anticipate will be of particular interest to local psychologists. Method After receipt of Institutional Review Board approval,

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recruitment of adult English-speaking students and certain staff at a public university in New Jersey (interim N = 925; age: M = 19.77, SD = 2.69; 75% women;

racism, immigration status, and household changes in substance use, conflict, and violence (Table 2). Most participants reported having access to health insurance and the Internet. Many reported knowing about Internet-based mental health services and resources (i.e., telehealth, self-help, support groups) and slightly more than half of participants reportedly sought out mental health information online during the pandemic (Table 3).

61% non-White) began in June 2020 and is ongoing, including planned waves of follow-up data collection. Participants were via the undergraduate research participant pool maintained by the university’s psychology department, and email lists for psychology department graduate programs and members of a professional and technical engineers union.

An appreciable minority of participants had a mental health diagnosis and treatment history prior to the pandemic. Reports of stress and increased anxiety and depression symptoms were common during the pandemic, though current substance use levels were low risk for most participants. Only a minority of participants reported receipt of a mental health diagnosis and treatment during the pandemic, despite many feeling an increased need for mental health services. Among participants who received treatment during the pandemic, the most reported receipt of services were from a psychologist, followed by a psychiatrist or other type of mental health professional, and followed by peer, spiritual, and non-psychiatric medical support. The highest percentage of these participants reported slight changes to their access to care, with the next highest percentage group reporting no changes. About equal numbers reported receipt of more frequent or less frequent services (Table 4).

All participants completed an online Qualtrics survey examining psychosocial functioning during the COVID19 pandemic. The survey included both multiple choice and free response items, ad-hoc items, and several psychological measures (e.g., Alcohol Use Disorders Identification Test; Drug Abuse Screening Test). Participants were able to leave individual items blank when they preferred or when not applicable, resulting in variable numbers of responses to different items (see Tables 1–5). After cleaning the interim data, we used descriptive statistics (ns and percentages) to summarize preliminary results for select variables. Specifically, variables concerning demographics; certain stressors during the COVID-19 pandemic; access to healthcare and the Internet; prior and current mental health problems, including substance misuse; awareness of and utilization of mental health services, including

Sizable minorities of participants endorsed a range of barriers to seeking services for mental health services during the pandemic, including concerns about stigma. The barriers with the highest percentage of endorsements were wanting to solve problems on one’s own, not knowing where to go for care, not being able to afford care, preferring the support of family and friends, and anticipating that problems would go away on their own (Table 5).

telehealth; and barriers to seeking mental healthcare. Results Many participants completed the survey in Fall 2020, followed by Spring 2021, Winter 2020–2021, and Spring and Summer 2020. The largest portion of the sample was White, followed by Hispanic, African American or Black, multiracial, Asian, Native Hawaiian or Other Pacific, or other. Most participants were between 18 and 24 years old, and many identified as female, heterosexual, and being single. Many participants also reported average or below neighborhood and household incomes (Table 1).

Discussion Preliminary descriptive results concerning the psychosocial functioning of mostly young adult college students in New Jersey during the COVID-19 pandemic suggest that there is much for New Jersey psychologists to address with this population, and to investigate among other segments of the local population. Stressors appeared to extend beyond financial concerns for a fair number of participants,

A slight majority of participants reported financial hardship during the pandemic. Appreciable percentages of participants also reported experiencing other stressors: being laid off from work, ageism,

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About the Authors

including experiences of ageism, racism, immigrationrelated stress, and changes in household substance use and conflict. Many reported an increase in mental

Christopher M. King, JD, PhD, is an Assistant Professor of Psychology, the Associate Director of Clinical Training (PhD and MA Programs in Clinical Psychology), and the Director of the

health symptoms, and a sizable minority reported not receiving services despite many being aware of professional and non-professional supports during the pandemic, having health insurance and regular Internet access, and feeling an increased need for services.

Forensic Psychology Concentration (MA Program in Clinical Psychology) at Montclair State University. He also works in part-time private practice at Clinical & Forensic Psychological Consulting Services (CFPCS, LLC) / Morristown DBT. He teaches and conducts research related to adult and juvenile clinical-forensic psychology, correctional psychology, police and

Participants endorsed a variety of attitudinal and situational barriers to seeking services, including concerns about stigma.

public safety psychology, and mental health law, and his clinical specializations include forensic psychology and dialectical behavior therapy.

Although the current interim local sample was large and diverse in many respects, the fact that most participants were young adult college students raises

Jill Del Pozzo is a doctoral student in clinical psychology at Montclair State University. She is currently an intern at the New Jersey VA Health Care System and is examining risk factors

questions about the generalizability of results to other New Jersey citizens, including youth, young adults not attending college, and middle-aged and older adults.

for schizotypy for her dissertation. She hopes to specialize in neuropsychology.

Future research should sample these groups. Our focus on descriptive results for baseline cross-sectional data

Rachel Bomysoad is a doctoral student in clinical psychology at Montclair State University, with a focus in forensic psychology

also raises many questions for additional investigations with the current data set as it is finalized, such as potential associations among, and differential effects

research. She is currently an extern at the Baruch College Counseling Center.

for, demographic factors and psychosocial functioning variables.

Julia Stratton is a master’s student in clinical psychology at

Notwithstanding these and other limitations of the

to obtain a doctoral degree in the field of clinical psychology and specialize in personality psychology and forensic assessment.

Montclair State University. She is currently completing a research externship in forensic psychology at MSU. Julia hopes

current report, our preliminary results lend credence to the anticipated adverse psychosocial impacts of the COVID-19 pandemic on New Jersey residents. The

Ivysmeralys Morales is a former master's student at Montclair State University. She is currently a research assistant in Dr. Christopher King's research lab at MSU, and works as a

types of stressors and worsened mental health functioning reported within our sample reflect matters for local practitioners to assess in their work with young adults in college and university counseling centers, private practice, and other mental healthcare settings. In addition, there appears to be a continued need for local advocacy efforts toward overcoming the numerous endorsed barriers to accessing mental healthcare.

behavioral therapist with developmentally challenged children and adolescents. Her interests are in forensic psychology. Caitlin Wilson is a master's student in clinical psychology at Montclair University. She is currently a supervisor at CUNY Queens College CARA (College Access: Research & Action), ensuring first-generation college students, low-income students, and students of color have the knowledge and support necessary to enroll in and persist through college. She hopes to specialize in working with juvenile offenders to provide this population with a better support system.

References Furnished Upon Request

Loumarie Vasquez is a master’s student in clinical psychology at Montclair State University. She is currently a Crisis Intervention Specialist at the Center for Family Services, INC, assisting children and families with managing behavioral and mental health crises. Loumarie hopes to specialize in juvenile forensic psychology.

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Student Affairs All Systems Affected: The Multidimensional Impact of the COVID-19 Pandemic on the Lives of Doctoral Psychology Students disparities that make the fight with the pandemic difficult for many, unfortunately, we are also facing another virus, and that is the racism and its manifestation of violence against the Asian, and AsianAmerican communities.

By, Nouriman Ghahary, PhD, LPC Associate Professor, Director of Clinical Training - Doctorate in Counseling Psychology, Felician University

I want to emphasize that violence does not have a neutral affect, whether it is an overt attack on an individual, or it’s embedded within policies. In fact, structural violence is so insidious that it can blindside

Introduction

the inflicted, and make what is abnormal, and should A pandemic is defined as “an epidemic occurring

not be, seem normal.

worldwide, or over a very wide area, crossing international boundaries and usually affecting a large

Racism, discrimination, injustice, and social justice all

number of people” Merriam-Webster. (n.d.). But this definition includes nothing about population immunity, virology, or disease severity, and it does not include

have complex links to mental health. These concepts have direct links to our sense of self and to our sense of well-being. As counseling psychologists, we are in a

anything about how communities experience and cope with the multidimensionality of this catastrophe.

unique position to use our research, instruction, and clinical work to effectively enhance knowledge, address systemic inequities and bias, call attention to the disparities that affect marginalized groups, give voice to the unheard, and improve the human condition. The core principles and values of counseling psychology is indeed in line with social justice values and initiatives, and our ecological frame-work, our focus on the dialectical relations between people and their environment, and standards of diversity, inclusion, and equity are all of theoretical relevance to and the foundations of our social justice framework in counseling psychology.

The COVID-19 pandemic brought the world to a standstill and made many of us think about our mortality. We, indeed, faced a collective and ongoing traumatic event that was the size of the entire globe itself. At the same time, as the pandemic was gaining momentum and claiming the lives of many people, the circumstances it forced upon communities, allowed millions of people who were mandated to shelter in place to witness the blatant brutality of the killing of George Floyd on TV. This event put into motion a movement for justice in the United States and around the world.

It is with the aforementioned principles in mind that we set out to fulfill our professional, moral, and ethical responsibilities. While remaining realistic about not being able to completely eliminate all the injustices around us, we knew we could take a stance against

Today, as we are ever so slowly recovering and yet still dealing with sickness, death, and economic disparities resulting from the pandemic, and the economic

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inequalities, discriminations, and injustices in our society and make contributions to the field of psychology at the same time. Hence, in a conference focused on issues of diversity, and titled: Contributions of Psychology to Creating a Just Society: Diversity, Social Justice, and Resilience, we attempted to take a small step toward achieving this goal. In doing so, we took one more step in the direction of further educating ourselves about the concepts that are significant in gaining multicultural sensitivity, understanding social justice, and practicing equity and inclusion. As a part of this conference, a group of Counseling Psychology PsyD students from Felician University shared their personal experiences with the audience. The following articles are the works they presented. Through the sharing of their personal narratives, these students generously and candidly illustrated examples of adversity and resilience during the past year. They depicted how they had been affected by the multidimensions of the everyday life’s demands, privilege and prejudice, responsibilities as students and clinicians, and a deadly and isolating pandemic. These students not only talked about their own experiences, but they shed light on how their personal experiences had helped them grow and informed their work with their clients. The themes that unfolded in the students’ narratives included: Parenting and Strain on families, Social Justice, Racism, Privilege, Economic Vulnerability, Health Vulnerability, Loss and Trauma, and Coping and Resilience. About the Author Nouriman Ghahary, PhD, LPC, is a licensed psychologist. She is an associate professor of counseling psychology and the director of clinical training in the Doctorate in Counseling Psychology Program at Felician University. References Merriam-Webster. (n.d.). Pandemic. In MerriamWebster.com dictionary. Retrieved July 7, 2021, from https://www.merriamwebster.com/dictionary/pandemic

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My Personal Experience as an African American Woman

mother, an essential healthcare worker, took this especially hard. I went through a series of depressive episodes where I could not understand my feelings or bring myself to find the inspiration to fight for my life. I was angry for a long time. I was angry at myself for having a body that was working against me, but mostly angry at previous healthcare physicians whom I saw in regard to this lump on my body.

By Nia Driver, MS Second Year Counseling Psychology Doctoral Student, Felician University

Prior to being diagnosed, I saw two other doctors who assured me that I had nothing more than a benign fatty lump, known as lipoma that would go away over time, but was not a threat to my health if it didn’t. These practitioners never offered to remove, biopsy, or even provide a mere ultrasound. My persistent contacting my primary physician resulted in her referring me to a cancer specialist who could provide an ultrasound using top notch imaging. Upon receiving a screening, I was sent into next day surgery to remove and biopsy the lump, where I would later be labeled a cancer patient.

As an African American, middle-class, woman living amidst both a pandemic and racial war, my experience has been very unique. The consistent trauma I experienced through the loss of loved ones, loss of income, and decline in my own mental and physical health impacted my views on life as I knew it and granted me insight into what really matters to me in life. Like the majority of people during the pandemic, I was impacted financially. The loss of my job triggered my anxiety and caused confusion regarding how I was going to be able to provide for myself; however, the greatest decline in my life during this period was in my health.

I continue to think about how different my life could have been had I not been persistent with complaining about this lump. It saddens me to think of how many women of color experience this type of medical negligence from healthcare professionals. Research suggests that medical professionals harboring false beliefs about biological differences between Black and White people is associated with racial disparities in pain assessment thus affecting treatment recommendations (Hoffman et al., 2016). Medical professionals admitted to holding the belief that Black people have thicker skin. The “angry black woman” and “Black brute” stereotypes may also influence those beliefs. Black people are often perceived as strong, assertive, and animal-like in their abilities, thus there is a perception that we are less likely to feel pain, have weakness, or be vulnerable to sickness. This view from medical professionals has the ability to be detrimental to the lives of Black and Brown people with undiagnosed illnesses. This experience definitely created an immediate distrust for physicians and caused me to be very aggressive during the treatment process when it came to receiving tests, blood work, and medicines.

Cancer is a disease that holds the title of the second leading cause of death in the United States (Ogedegbe et al, 2005). In 2020, cancer affected a projected 1,806,590 Americans (Siegel, Miller, & Jemal, 2020). In March 2020, I was diagnosed with non-Hodgkin’s lymphoma. This diagnosis followed a biopsy of a tumor on my right abdomen. Following my diagnosis, I completed a series of reactive care where I received radiation treatment. Initially, I was diagnosed as being in stage two, and over time, cancer spread to my lungs and a second surgery was performed to remove three centimeters from my right lung to remove and prevent the further spread throughout my lungs. During this period, I lost a total of 35 pounds, my sense of taste, and majority of my hair, leading me to cut it to a short length. Going through this experience during a pandemic made it extremely hard to stay strong and keep faith that I would overcome my circumstances. I was unable to see my family and friends or even leave the house. I lived in a bubble essentially, trapped inside of four walls with monitors and a small television. My immediate family was barely able to interact with me and offer comfort, due to having contact with the outside world, and me being immunodeficient. My

Going through this during a time where the world was entering what could be perceived as a “race war” only amplified my feelings regarding how I was treated. The Black Lives Matter movement began in July 13, 2013 as a

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political response to the countless number of racially motivated deaths of Black people that occurred at the hands of law enforcement and the injustice victims receive in court. The movement sheds light on the effects of white supremacy and calls for police reform in attempts to yield the amount of violence inflicted on Black communities (BlackLivesMatter.com). This organization has increased in popularity over the years and has a presence throughout the nation, as well as internationally. Having to succumb to witnessing the lives of Black men and women, via constant replay on social media, traumatized me. It is draining, overwhelming, and extremely emotionally provoking to have these videos circulating throughout mainstream media for everyone to see.

The Social Justice of COVID-19

As a Black woman, I have had experiences with law enforcement, educators, and employers that I feel would have gone differently had I not been Black. It is very disheartening to see these bodies plastered across my television and phone screens. I fear for my Black siblings, friends, and colleagues. I felt that while the protests raised awareness and increased alliance, there was an abundance of blatant racist backlash that was also hard to endure. Still, I can recognize that these videos are of importance for evidence purposes and to expose the truth to those who may not have experienced such injustice.

and social economic results.

I believe it is especially important to recognize the importance of lives of those who are marginalized across all settings. This pandemic has opened my eyes to the harsh reality of the world in which we live. It has also lit a fire in me to ignite change in how I live my life. I am now consciously kinder to all people, including myself. I try to be more transparent in all of my relationships: intimate, platonic, familial, and professional. I’ve made the attempts to be more optimistic in life because I realized just how short it is. Above all, I am making a conscious effort to actively listen to those around me. I realized that, as a trained behavior therapist, I might have been unintentionally dismissive of the concerns of parents or clients, and my experience with my health and BLM made me realize that everyone deserves equality, and everyone deserves to be heard and cared for. I am appreciative for my experiences because they made me a better person.

The following inequalities are at the root of the disparate impacts of COVID-19 on racial-ethnic

By Marlene Taylor-Edghill, MA Fifth Year Counseling Psychology Doctoral Student, Felician University

COVID-19 has caused a disproportionate amount of disease and death in Black, Latino, and Native American communities and among the impoverished within the United States (US). This racial and social imbalance intensified during the pandemic with predicted consequences of reduced physical and mental health

While they are only 13% of the total US population, Black Americans are 34% of COVID-19 confirmed cases, with Latinos and Hispanics having comparable statistics. In the Center for Disease Control (CDC) reported cases, race and ethnicity are absent or not mentioned, while the “other” category includes Native Americans when counted. Consequently, the health impacts to communities of color are more serious than currently identified and reported.

minorities: a. Imbalance of healthcare availability due to economics; b. Susceptibility to chronic illnesses that lead to complications related to COVID-19; c. Inability to work from home due to job requirements, low wages, social distancing requirements not followed; d. No access to Internet or Wi-Fi, lacking technology hardware essential for online learning for children and telehealth services; e. More likely to live in urban areas in crowded or multifamily homes; f. Communities of color having lower rates of vaccination. (Fortuna, Tolou-Shams, Robles-Ramamurthy, & Porche, 2020).

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On November 4th, I breathed a sigh of relief only to have my anxiety return and increase until January 20th. Since re-engaging with my peers and professors and

The divisions in our country, with racism at its foundation, has led to the many inequities in our society. The COVID-19 pandemic revealed the many inequities in our society and showed the truth about marginalized people of color (POC). As the pandemic and the Black Lives Matter (BLM) movement dominated our daily news, my knowledge of the impact of racism on our country grew. Stories of POC who were frontline workers, and the circumstances they faced, increased my anxiety as I relived my own childhood experiences of living in poverty.

relying on my faith, I feel hopeful for our country’s future. I have again committed to my mission and desire to make a difference for people. My commitment is to help marginalized communities where I can provide services that include outreach, prevention, community service, and advocacy. We advance social justice when we remove barriers that people face because of gender, age, ethnicity, religion, culture, or disability.

The pandemic brought its own set of personal health concerns and isolation impacting my mental health. The last six months of 2020 were filled with anxiety, and at times depression, for me. I feared that we were on the verge of losing our democracy, due to the divisions in our nation, politically and racially. Our politics were full of divisive rhetoric that appeared to favor white supremacy. As a black woman, I felt vulnerable and afraid for the safety of myself and my family. My husband and I actively explored the options of moving out of the United States to escape the future we anticipated living in an authoritarian, racist country

In conclusion, counseling psychology needs to continue to evolve in social justice action at dismantling the systems of oppression that serve as the root cause of the inequities and individual-level suffering, and to make what is implicit in the identity of counseling psychology explicit in strategy. There is an opportunity to move our field forward as we deepen our commitment to action and influence other psychological disciplines to effectively reduce systemic oppression and promote equity and justice. Such advancement will require us to step outside of our comfort zones, open ourselves to being transformed by

At one point, I questioned my ability to work effectively with my clients and realized that no one is immune to influences that are out of their control. I recognized there is no shame or embarrassment in reaching out for help if you are a mental health professional. The increased time I had to be alone through the pandemic helped me to appreciate my life and the person I have become, and realize that my experience of anxiety and depression increased my ability to relate to my patients that where experiencing the same.

the process, broaden our perspectives, center our aims to serve those most affected by injustice, challenge areas of discomfort and bias that arise, and organize our efforts in tandem with multiple professional and community partners. We cannot shed the social privilege that has been afforded to us as professionals, but we can use it to serve in meaningful ways (DeBlaere, et al., 2019). References Furnished Upon Request

Even though the truth and recognition of oppressive environments has been a protracted part of the counseling psychology domain, social justice continues as a part of our education and action. My responsibility as a doctoral student of counseling psychology is to focus on ceasing oppression and to be aware of the possibility of misrepresenting main contributing factors of, and therefore solutions to, problems that compromise the welfare of marginalized communities (Ivey, 2003).

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Parenting During the Pandemic: Being Comfortable in an Uncomfortable Situation

As a mental health provider, doctoral student, and now, also a new parent, I faced the same questions and I was forced to adapt and change. I, myself, was challenged to not only shift the way I worked with my clients, but also to become creative in providing strategies to help them manage their daily stressors and uncertainties. Despite being able to reduce and manage my clients’ anxieties, my own worries continued to grow. Amongst the

By Brendan Guarino MA, LAC Fourth Year Counseling Psychology Doctoral Student, Felician University

period of initial lockdown, came isolation. My wife, my daughter, and I could not see our friends and families. We were isolated from socialization outside of our technology. My daughter was only a few days old, and we wanted to provide the best home environment possible. Scientific studies have shown that even children as young as two years of age are able to understand some of the changes around them

In today’s climate of uncertainty and restrictions, it is not uncommon for individuals to experience stress and anxiety. COVID-19 impacted the lives of millions, and it changed the world as we know it, from halting daily routines to claiming the lives of loved ones. The COVID-19 pandemic put a significant strain on many families, especially new parents. On March 12, 2020, my wife and I brought a beautiful baby girl into this world. We both were filled with a lot of different emotions and uncertainties. As we both were first time parents, taking care of our daughter was an adventure that was new and unfamiliar. Being a new parent, as well as doctoral student, is a major stressor and challenge, as well. As the year went on, stress accumulated and tensions began to rise. Figuring out a way to cope with the pandemic and nationwide lockdowns still remain a challenge for many. As the year moved along, my wife and I began to integrate ways of coping with the unfamiliarity of our new life.

(Johnson, 2020). Children need constant attention, and while I love being a parent, I found that bringing a newborn into the world during a pandemic is not ideal. Research has shown that parents should try to provide the most favorable environment at home to improve the physical, social, and emotional well-being of their children (Johnson, 2020). Ways in which parents manage stress has an impact on their families such as how they talk to their children and provide one-on-one time for them. Spending one-on-one time with children can be difficult, especially while trying to balance busy schedules. My wife and I have realized family time should be cherished, and despite our busy schedules, we try to spend as much time together, at the end of the day, as possible. Working together as a unit and providing support are the most important skills we have learned from these unfamiliar times. Both my wife and I were forced to adapt to uncomfortable situations. We were challenged to grow quickly and adjust to our new life with little outside support. It is important for parents of newborns, young children, and adolescents to be role models for their children. Parents are encouraged to model to their children positive behavior, such as regulating emotions, handling stress, problem-solving, and effective communication so as their children grow, they develop resiliency and hardiness in the face of adversity.

Stress can accumulate over time and can be a biproduct of multiple factors. Co-occurring stressors have adverse effects on families and may be in part due to the individual’s experiencing of these stressors. Parents of children, teenagers, and newborns are faced with stress and worry that are generated by today’s circumstances. Parents must develop ways to cope with internal and external stress in order to foster a positive family environment. In the presence of COVID-19, caregivers struggle to balance work and family, as well as their own psychological health. As families trek into a new year, they are faced with the question, how can we cope with all the demands forced upon us?

References Furnished Upon Request

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Do You See Me? Making the Invisible, Visible

declared the novel corona virus outbreak a pandemic. The Trump Administration used the terms “Kung Flu” and “Chinese Virus” during public appearances that led to an increase in xenophobia and racism towards Asian Americans (Levenson, 2020; Marquardt & Hansler, 2020; Schwartz, 2020). Media outlets reported numerous incidents of anti-Asian racism. In the United States, there was 1,135 cases of harassment and discrimination against Asian Americans within the first two weeks after Trump coined the term. (Asian Pacific Policy and Planning Council & Chinese for Affirmative Action, 2020).

By, Vanvian Hoo, LCSW Third Year Counseling Psychology Doctoral Student, Felician University

Working in Chinatown as a clinical social worker for 18 years has given me insight on how strong the mental health stigma is within in this community. One of the contributing factors that drives the mental health stigma is the fear of deportation/separation as a result of receiving services. Another factor relates to the cultural norm of “saving face” and viewing any form of mental weakness as a defect that brings shame to the person and their family. Not only do these cultural barriers decrease the willingness of Asians to seek mental health services, but it also increases invisibility of an already marginalized group.

In the past year and a half, I received a notable increase in referrals for therapy from Chinese-Americans. The increase in distress, fear for safety, and depressive symptoms were chief complaints. My existing patients reported an increase in discrimination, as well as incidents of microinvalidations. Microinvalidations are communications that exclude, negate, or nullify the psychological thoughts, feelings, or experimental reality of a person of color (Sue et al., 2007). Many patients recounted painful memories of feeling like the “alien in own land” and incidents in which they were asked “Where are you from” and “Do you speak English” despite being multi-generational native New Yorkers and New Jersey residents.

One way to combat the mental health stigma is to increase psychoeducation about mental health within this community and forming these services, not as a correction for defects, but as a tool for better understanding oneself in order to enhance one’s life and lives of those within the community. Over the years, I listened to my patients’ trauma narratives and their experiences of severe anxiety and depression resulting from the burden of being categorized as the “Model Minority.” They have been silent in their struggles of being invisible as they try to pursue academic, work, and life benchmarks that society predetermines for them. The harm of complimentary stereotypes is as detrimental as negative stereotypes. The Model Minority stereotype is dangerous because it tells Asian Americans how to behave. It is also used against other minority groups to silence claims of inequality. (Lee, 1996, p. 125). The Model Minority concept is dangerous because some Asian Americans use this as a measurement of self-worth. Feelings of incompetence and failure despite frequent achievements and success, in addition to not fitting in, were constant themes voiced by my patients while in treatment.

A 15-year-old Chinese-American male patient described an incident in which he was called racial slurs by an adult while playing basketball with his friends. Another Chinese-American female patient described the humiliation she felt when getting on the subway and other passengers backed away from her. These are just a few examples among the plethora of discriminatory incidents that I have heard in my clinical practice. In the counter transference, I felt the same anger and frustration as my patients and became aware on the parallel process of recollecting past discriminatory experiences and experiencing present microaggression and microassaults. Growing up in New York, a city filled with a diverse population, one could infer that a Chinese-American girl would fit in rather nicely. Unfortunately, that was not always the case. I, along with two of my fellow Asian classmates were, at times, targeted by bullies based on our physical appearances alone in a predominately white school.

In March 2020, the WHO (World Health Organization)

A major form of microinvalidation is colorblindness

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Health and Diversity

because it denies the racial and experimental reality of people of color and provides an excuse to White people to claim that they are not prejudiced (Helms, 1992; Neville’ Lilly, Duran, Lee & Browne, 2000 as cited by Sue et al., 2007). White people tend to prefer “colorblindness” to avoid an awareness of race and racism (Neville, Awad, Brooks, Flores, & Bluemel, 2013 as cited by Liu, Liu, Kim & Yeung, 2019).

By, Diana Spieker, MA, LAC Second Year Counseling Psychology Doctoral Student, Felician University

It was not until during the pandemic that my Caucasian husband fully understood the racial disparity between us after witnessing a microassault towards me. While on a walk during a cold March afternoon, I had a mask on and hood covering most of my facial features. Only by looking directly at me could someone identify me as Chinese. We passed by two random, mask-less neighbors on the opposite side of the street, and as a friendly gesture, they waved hello to my husband. As he waved back, I turned to greet them as well, and as I did, their response was startling. Upon making eye contact, they stopped waving, took out their masks, put them on, and picked up their pace down the street. It was in this moment that my husband witnessed how we were viewed and treated differently based on racial differences. My husband was extremely bothered at their response and dismayed that, even in our quiet little progressive town, racism is still present.

COVID-19 has been the central topic of discussion everywhere for the past year, and counting. The news channels, every website, social media, posters on every public place, tell us about it and how to take care of ourselves. Also available are the detail account of cases and the death toll in every country, state, county, and city. And of course, all kind of recommendations for home remedies that would cure or protect us from the virus. During the pandemic, in addition to the protective guidelines, Center for Disease Control (CDC) provided a list of high-risk populations. The list provided did not resonate with me even though my health conditions were listed. I knew about my vulnerability as a patient but was unable to identify with any other risk factors on that list. I was in denial of my own vulnerability and did not understand what high risk meant. It meant vulnerability to more serious conditions and to medical treatment outcomes, in general, and, in particular, to COVID-19. Overcoming high risk factors is related to access to medical and support systems and the understanding of the urgency to overcome those factors.

My patients often discuss their anger and frustration on being marginalized and oppressed. Despite the anger, their ability to self-regulate and control their impulsivity to perpetuate racial violence is quite impressive and admirable. Together, in session, we discuss strategies to address the social injustices and how they can implement self-advocacy. The impact of volunteering at non-profits that serve the Asian community and other marginalized groups, as well as attending various community activism events to help mobilize and give visibility and voice to those who cannot, are discussed. A Chinese-American patient remarked in session “I always felt invisible and that was my reality. But now people are seeing my reality and they feel my anger, too. I just want to be seen and be treated as an equal.” As a licensed clinical social worker and a psychologist in training, my patient’s comment sums up my own personal mission statement that I hope to fulfill it; to make the invisible visible and to give voice to the marginalized and the oppressed by teaching them to advocate for themselves so that they are seen and heard. References Furnished Upon Request

In 2013, I was diagnosed with Lupus and Rheumatoid Arthritis, both autoimmune diseases in which the person’s immune system mistakenly recognizes normal cells or organs of the body as intruders and attacks them as foreigners. These attacks result in symptoms that are incapacitating, and depending on the severity and progressive damage to organs, can result in death. Diagnoses takes time because the symptoms are shared with so many other diseases and it requires having access to medical resources, medical insurance, and a lot of advocacy for your cause. In the midst of it all, you are struggling with symptoms and trying to support yourself financially. Studies have shown that physical and psychological stress are implicated in the development of a disease,

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and the disease itself becomes a cause of significant stress, creating a vicious cycle. There is also research showing the influence of family and community support in positive treatment outcomes for patients with autoimmune diseases. For this reason, treatments should include stress management and behavioral intervention to prevent stress-related immune imbalance. Different stress reactions should be discussed with autoimmune patients, and obligatory questionnaires about trigger factors should include psychological stress in addition to infection, trauma, and other common triggers (Sojanovich and Marisavljevich, 2007).

Hydroxychloroquine, without sound research. Information was provided based on case studies protocols and quickly set in place as treatment for COVID-19. This medication is the basic treatment for autoimmune diseases, and because of the treatment campaign, the medication fell into shortage, creating panic among the vulnerable population. Only until October 2020, studies become available, and the FDA provided results regarding the use of the medication. Social distancing altered our lives and undeniably affected families, including mine. For children, their sense of security, and most of all, their relationships were disrupted. As a family, we made the decisions to put the children first and offered activities to them to strengthen the family relations, using our Colombian food as center of our gatherings. Through COVID-19, I learned that family activities reduce my stress, and my immune system gets rebooted sharing my cultural traditions, speaking Spanish, and laughing so hard that the belly hurts.

According to the Lupus Foundation and other researchers, autoimmune diseases affect Latino and black communities at a higher rate than other races. Dr. Spihlman (2020) provided data showing how Black and Latino populations were affected at disproportionately higher rates by COVID-19, and individuals with an immune compromised state were more vulnerable as the immune response determines the antiviral defense, the disease progression, severity, and clinical outcomes of COVID-19. Systemic lupus erythematosus also disproportionately afflicts Black and Hispanic populations. (Spihlman AP, at. al, 2020). “Nearly 60% of those with COVID-19 and lupus became sick enough to be hospitalized, and 10% were admitted to the intensive care unit. About 10% died.” (Shmerling, 2020).

COVID-19 is a challenge for us because it is touching our vulnerabilities at their core. The vaccination hope has not produced enough data regarding those with autoimmune diseases, and I do not feel ambitious enough to participate in human trials. This goes back to the vulnerability issue. COVID-19 has given me the space to face that vulnerability, and when I do that, I can be stronger, following protocols, following my treatment, and taking care of myself.

In general, I keep a strict medication regimen, practice self-care, and take precautions when I am around people, staying away from the sick. With the pandemic, I redoubled the efforts to create a protective environment for myself. That included, dropping off the laundry, going to the supermarket at 6:00 am, or finding a local market with a few patrons that would be following the CDC guidelines. To this day, I continue with these patterns.

Adding thoughts after I wrote for the conference: I tested positive for the virus. This was followed by a week in the hospital, knowing the odds were against me. But I survived it, and the rest would be a slow recovery that I would face as a warrior. My takeaway is that our clients must be seen from all aspects of their lives; all parts have relevance, and as professionals we need to encourage and empower them to advocate for themselves. I want to be the kind of professional that I found in my path to recovery, who took my symptoms seriously and saw me as a complete human being, not just parts of me.

The most important decision for my mental health was to filter any news or social media information regarding COVID-19. It may appear like a boring life, but it is not. Living with an autoimmune disease makes you appreciate more about what you can do and focus on that. During the pandemic, I learned to communicate through Zoom, new crochet stitches, new readings, study for my licensing exam, and pass it, and began the PsyD program. I even made some decorations for my home. A scary moment was the information regarding the treatment of COVID-19 with the medication

As mental health professionals we have the opportunity to exercise authority and leadership to promote accurate information, sound researches, treatment accessibility and advocacy for both mental and physical health. We have a responsibility to educate individuals about the importance of self-care and to help provide appropriate services to our communities.

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Recognizing My Privilege as a Social Justice Supporter

different minority groups, who have been historically marginalized, I would be remiss to ignore my privilege, particularly as I sit across from my patients. As a psychology doctoral student, the plethora of atrocities from this last year has signified the importance of recognizing my privilege particularly within the therapeutic relationship. The concept of recognizing one’s privilege was ratified in 2016 by psychologists Lauren Mizock and Konjit Page, who implored those in counseling psychology to also be social justice activists aware of the pervasiveness of privilege and oppression within their own identities.

By, Suryia Parmanand, MA, EdS Third Year Counseling Psychology Doctoral Student, Felician University

At the start of the lockdown initiated by the spread of the novel coronavirus, I nestled comfortably at home with an abundance of food, a steady income, and yes even a good supply of coveted household supplies. Shortly thereafter, a festering wound began to rupture here in the United States. First, the images of civil unrest, then the bellowing chants from the streets outside some of our homes. These were familiar scenes and chants of social activism that I had long ago seen and heard in a faraway country.

Furthermore, the challenges and limitations experienced by my patients affect not just their life outcomes but the life outcomes of those within and surrounding their nucleus. If we consider the nucleus as the powerhouse of the cell, therein lies the implication that each nucleus is fundamental to our collective well-being and existence. Standing on the periphery is unacceptable, my position of privilege can be used to amplify the voices of those who are downtrodden.

Months later the continued loss of life and subsequent hardship brought upon by the respective health and racism pandemics, were further amplified by food shortages, and disparities in access to health care, all fundamental to our existence and overall life outcomes. Interwoven throughout the tapestry of these calamities bellowed an oppressive narrative. And, here from the sanctuary of my home, I was sheltered from it all, my privilege ever-glaring.

References Mizock, L., & Page, K. V. (2016). Evaluating the ally role: Contributions, limitations, and the activist position in counseling and psychology. Journal for Social Action in Counseling & Psychology, 8(1), 17-33.

Upon my re-entry into the world, my privilege again glared with my quick and seamless access to COVID-19 tests, N-95 masks, and the much sought after COVID-19 vaccine. My privilege again illustrated, but this time as a doctoral-trainee at a well-funded hospital. I am well aware that some of the privileges to which I have been the beneficiary has not been afforded to all.

New Jersey Psychological Association Graduate Students (NJPAGS) Becoming a member of NJPAGS means keeping informed about the issues affecting the practice of psychology in New Jersey. It is a unique opportunity to network with local peers, and enjoy each others' support in addressing the challenges associated with graduate study in psychology. It gives students a chance to network with local professional psychologists and learn from their knowledge and experience.

Within the context of the therapeutic relationship, there also exists dimensions of privilege. My patients sit across from me: a doctoral student; someone, who has access to much of which they are restricted from. My patients are multifaceted individuals and families, many are immigrants, many are women, and many are people of color, many face limitations as a result of socioeconomic status, and some grapple with the conventional gender norms. Despite belonging to

Learn more about our graduate student organization!

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Diversity, Equity, & Inclusion (DEI): A Neuropsychological Update categories reflecting sex/gender and include more options for race/ethnicity. Second, full-time doctoral students in NJ are more likely to be white than any other group and account for more students than all marginalized groups measured combined. Third, individuals from Black, Latinx, Asian, Pacific Islander, and Native American groups continue to be underrepresented. Finally, a large group of individuals

By, Jared Hammond, MA Chair, NJPAGS

receiving doctoral education may be returning overseas or may not be guaranteed the opportunity to continue

As we approach the end of 2021, it is important to

to work in the US, suggesting a potential loss for including this diverse group of individuals into the workforce.

reflect upon the most salient topic of the last 18-20 months: diversity, equity, and inclusion. Although these are distinct concepts, they are often reflected with the acronym ‘DEI.’ This is important to consider because these three concepts exist as simultaneous processes.

This last point is an important factor to consider for psychology and neuropsychology. One of the main

Together, they create the opportunity for action rather than summarizing a trendy philosophy. We stand on the

missions of the American Academy of Clinical Neuropsychology (AACN) has been to address social inequities and systemic injustice in neuropsychology through action. In addition to the lack of diverse

precipice of committing to lasting and sustained DEI action in educational, professional, and clinical practice in both our state and nationwide, and our actions over the next few months will determine whether this work will become a lasting guiding aim.

representation in our professional field, they have estimated by the year 2050, almost 60% of the population in the US won’t be eligible (i.e., “untestable”) for neuropsychological evaluation due to nonspecific or a lack of culturally appropriate normative data (AACN,

According to the most recent data reported by the State of New Jersey, there were 18,439 full-time doctoral students enrolled in NJ public universities in 2018 (NJOHE). Of these doctoral students, 9% identified as Black, 10% identified as Hispanic, and 13% identified as Asian. Just under 2% of students identified as biracial/multiracial. Aside from white students, the next largest group were students who identified as ‘Alien’ status, which accounted for 22% of full-time doctoral students. Under current reporting, this suggests that these students are not US citizens or nationals, and their race/ethnicity is not recorded (IPEDS, 2021). The State only collected data for traditional gender categories of ‘male’ and ‘female’ and has not released new data in this domain in the last three years; however, the use of these categories persists.

2021). This means that individuals from Black, Latinx, Asian, and other marginalized communities may receive incomplete or inadequate services pertaining to many areas of psychological health, including neurodevelopmental (e.g., Autism, ADHD) and neurodegenerative (e.g., Alzheimer’s, Parkinson’s) processes. Access to these services currently can be challenging for marginalized groups, with diagnostic rates of Alzheimer’s disease worse among Black people compare to white people (Graves et al., 2021). For these marginalized individuals, representing more than half the US population, to be denied such access would be a catastrophic failure and major social injustice. As such, part of AACN’s Relevance 2050 Initiative is to focus primarily on recruitment of individuals from diverse cultural, socioeconomic, religious, and linguistic backgrounds into the field of neuropsychology, as well as the AACN leadership and membership. The eventual

This data seems to highlight a few things. First, the State should immediately consider altering the

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goal is to dismantle this distinction between ‘regular neuropsychology’ and ‘multicultural neuropsychology,’ recognizing that DEI work is not narrow in its relevance, but a broad and salient issue for all aspects of our profession, from training to research to clinical practice (Naugle, 2020).

Graves, L. V., Edmonds, E. C., Thomas, K. R., Weigand, A. J., Cooper, S., Stickel, A. M., … & Bondi, M. W. (2021). Diagnostic accuracy and differential associations between ratings of functioning and neuropsychological performance in non-Hispanic Black and White older adults. The Clinical Neuropsychologist. https://doi.org/10.1080/13854046.2021.1971766

In 2019, AACN’s journal The Clinical Neuropsychologist published 11 articles related to DEI research and work in neuropsychology (Hilsabeck & Rivera Mindt, 2020). In 2020, one less article was published (Hilsabeck & Rivera Mindt, 2021). This reflects how difficult it can be to publish DEI research despite targeted recruitment efforts. It only emphasizes how we must continue to incorporate DEI into every facet of our practice. In the upcoming special issue, along with my colleagues (Hammond et al., in press), we discuss the history of how psychometrics contributed to systemic racism in tandem with the ethical use of racially-adjusted normative data (RAND). This is a very relevant topic following the reporting of Black professional football players being denied financial compensation for CTE due to misuse of RAND. And these issues have persisted in neuropsychology historically in paper-and-pencil testing (Heaton et al., 1991) but also more recently in computerized assessment (Wallace et al., 2021). Implicit bias, in addition to psychometric considerations, may account for this finding of culturally skewed results in sports and medicine (Graves et al., 2021).

Hammond, J. B., Hammond, J. B., Brooks, J. (in press). Racially-adjusted normative data (RAND): A current discussion informed by history and neuropsychology. NJ Psychologist. Heaton, R. K., Grant, I., & Matthews, C. G. (1991). Comprehensive norms for an expanded HalsteadReitan Battery: Demographic corrections, research findings, and clinical applications. Psychological Assessment Resources. Hilsabeck, R. C., & Rivera Mindt, M. (2020). Editorial from the TCN department of culture and gender in neuropsychology: Updates, future directions, and next steps. The Clinical Neuropsychologist, 34(5), 863-872. Hilsabeck, R. C., & Rivera Mindt, M. (2021). A year of turmoil and change: Editorial from the TCN Department of Culture and Gender in Neuropsychology. The Clinical Neuropsychologist, 35(3), 481-489. Naugle, R. (2020). AACN president’s annual statement of the academy report. The Clinical Neuropsychologist, 35(1), 1-6.

Through this introspective process of examining our own implicit bias and unpacking privilege (Cory, 2021), we may begin to integrate DEI action not simply as a once-a-year training but a commonplace practice residing at the forefront of our minds. There are many ways to incorporate DEI action, from publishing research to academic learning to round-table discussion.

New Jersey Office of Higher Education. (2018). Full-time post-baccalaureate enrollment in NJ colleges by race/ethnicity and gender, Fall 2018. Retrieved from: https://www.state.nj.us/highereducation/documents /pdf/statistics/byrace/Enr2018RaceSex.pdf Wallace, J., Beidler, E., Covassin, T., Hibbler, T., & Schatz, P. (2021). Understanding racial differences in computerized neurocognitive test performance and symptom-reporting to deliver culturally competent patient centered care for sport-related concussion. Applied Neuropsychology: Adult. https://doi.org/10.1080/23279095.2021.1912047

References American Academy of Clinical Neuropsychology. (2021). Relevance 2050 initiative. Retrieved from: https://theaacn.org/relevance-2050/relevance2050-initiative/ Cory, B. (2021). White privilege in clinical neuropsychology: An ‘invisible knapsack’ in need of unpacking? The Clinical Neuropsychologist, 35(2), 206218.

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Book review: Wrongful Conviction in Sexual Assault: Stranger Rape, Acquaintance Rape, and Intra-Familial Child Sexual Assaults Johnson, M.B. (2021). New York, NY: Oxford Press.

are unquestionable, the academic study of this phenomenon has been disconcertingly sparse. Accordingly, Matthew Johnson’s (2021) Wrongful Conviction in Sexual Assault: Stranger Rape, Reviewed by, Anthony F. Tasso, PhD Fairleigh Dickinson University Professor and Deputy Director School of Psychology & Counseling

The images of violence and violent crimes often evoke strong visceral reactions in victims and nonvictims alike, arousing desires to punish current perpetrators along with the hope of preventing future crimes. Images of sexual crimes tend to be at the top of the list of abhorrent violent acts evoking such reactions. With more than 300,000 sexual assaults per year and the undeniable resultant acute and chronic physical and psychological sequelae, the short- and longer-term effects of sexual violence on individuals and families are nothing short of devastating.

Acquaintance Rape, and Intra-Familial Child Sexual Assaults is an essential addition to the professional literature. This book represents a consolidation and extension of both his work as an academic psychologist as well as his legislative advocacy, providing scientifically grounded information on the causal and countering factors pertaining to the problem of innocent people found guilty in a court of law. Johnson sets the stage for the book by using high profile case examples of wrongful sexual assault convictions. The author then delves into the history of rape laws as a means through which we can understand its failures. Wrongful Conviction chronicles the rather permissive sexual assault laws of the early 1900s through to the more aggressive persecutory times that started in the 1970s. Johnson highlights that while the public goal of weeding-out and punishing such violent perpetrators laudably facilitated a concerted focus on addressing sex crimes, it inadvertently facilitated an appreciable uptick of wrongful convictions. The book also contains a perusal of the literature suggesting mixed findings pertaining to successful prosecution as a result of the contemporary aggressive protocols. This approach has been, however, linked to a noticeable increase in false positive convictions; a concept that is interwoven throughout the text.

Despite the collective public wish to identify and discipline those who commit such heinous acts, accurate identification of the guilty is of paramount importance. However, this process is far from linear, and is burdened with significant methodological challenges. For example, emotions can color objectivity, hence, the motivation to convict can obfuscate appropriate attention being given to potentially exonerating evidence. Additionally, the inherent limitations with manufactured investigations (emblematic of many sexual assault situations) becomes fertile ground for procedural missteps. The results of these mistakes are unequivocally horrific, with the innocent charged and the guilty remaining free.

Wrongful Conviction then differentiates between the types of sexual assault, most notably stranger rape (when the assailant and victim have no preexisting

Although the disturbing effects of wrongful convictions

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relationship) and acquaintance rape (when the assailant and victim have a preexisting relationship). The author reports that stranger rape commonly elicits near equal

classmates) frequently consist of significant investigative challenges, such as parsing the history between the individuals and assessing the veracity of

outrage from both men and women, resulting in a more comprehensive, unequivocal desire to identify, convict, and punish offenders. Johnson notes that acquaintance rape typically results in varied degrees of outrage that fall along gender lines. Specifically, women tend to be

reporting. Wrongful Conviction also raises the issue of intra-familial rape and child sexual assault. Here, the author identifies how the emotionally charged nature of sexual predation against children is susceptible to problematic investigations, inaccurate information, as well as intentional or unintentionally false allegations. Once again, the book uses well-known examples (including the 1980s New Jersey daycare case) to illuminate the intricate, sensitive nature of these processes. Such vignettes are a true strength of the book.

more concerned by the prospect of sexual violation by a known individual, while men are more likely to question, challenge, or outright dismiss the veracity of reported acquaintance sex assaults.

Johnson describes several high profile wrongful convictions involving stranger rape (e.g., Central Park Five, Kurt Bloodsworth), reporting how aggressive investigative processes, inadvertent misidentifications, or intentionally false confessions resulted in wrongful convictions. The author also explains how the concepts of black box investigations (nontransparent inspective methods in the absence of objective data) and mistakenly characterizing an acquaintance rape for stranger rape are both sensitive to problematic investigations. This concern is illustrated by the overturned convictions in the cases presented in

Wrongful Conviction then progresses to the racial elements of sexual assault. First reporting on the disproportionate number of African Americans incarcerated in the United States, the author refers to pre-civil war eras and later to Jim Crow to highlight the ways in which racism manifested through the harsh legal treatment of Black Americans. The text places particular emphasis on the racial alterities in the conviction and charging of Black (compared to White) American sexual perpetrators. The book covers the historical ways in which lynching and castration were used for Black men charged with sexual assault, especially if the alleged victim was a white woman. Johnson then comprehensively reviews the evidence of racial bias (whether implicit or explicit) during investigative protocols, in addition to summarizing several landmark cases that demonstrate the severe and often questionable charges against Black men identified as sexual offenders.

Wrongful Conviction. Johnson further states that whether the victim/witness is alert and capable or incapacitated is a significant factor accounting for why stranger rapes are more likely to result in wrongful convictions. Specifically, the author reports on evidence suggesting that capable victims/witnesses (i.e., those who can assist in the investigative process) are more susceptible to false memories due to the emotionally charged nature of the incident. Conversely, incapacitated persons (i.e., those compromised in assisting in the investigative process) are more susceptible to false confessions. The author also provides detailed information on several high profile examples for illustrative purposes. Most notably of these is the New York City Central Park Jogger case, which is an example of a wrongful conviction with an incapacitated victim.

The book segues to serial rapists and wrongful convictions, with analyses suggesting common pathways to an inaccurate conviction. Specifically, the text once again underscores how incapacitated victim prosecutions can result in false confessions and capable victim prosecutions can incur misidentifications. It shows that additional factors can account for wrongful conviction. These include erroneous assessments of the relationships between the offender and rape victim and failures of criminal investigation teams when examining the frequency and patterns of rapes occurring within a particular geographical area.

Acquaintance/date rape accounts for approximately 75% of all sexual assaults in the United States. Johnson explains how acquaintance assaults (assaults perpetrated by past or current dating partners, friends,

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the book is most useful to forensic psychologists, I argue that any type of psychotherapist would benefit from understanding the subtle ways in which the different types of sexual assaults can be particularly vulnerable to wrongful convictions. While much of the text is necessarily dense with legal terminology, the author provides clear explanations of courtroom concepts (that may be unfamiliar to many psychologists) along with a user-friendly glossary.

Wrongful Conviction closes by accentuating the need for a comprehensive systematic approach to address this deleterious aspect of the US legal system. Johnson rests on the relevant literature highlighting the roles of crime control vis-à-vis due process (with the former believed more susceptible to wrongful convictions), characteristics of the offense (e.g., severity or nature of the victim’s relationship with the offender) and characteristics of the alleged offender (e.g., race, SES) deemed crucial in this process. The text also incorporates more classic psychological factors (e.g., signal detection theory, the Zeigarnik effect, tunnel vision) germane to the conviction of an innocent person. Johnson finishes by suggesting future directions for research with the goal of creating a much-needed springboard for countering this travesty of our legal system.

Wrongful Conviction is an excellent consolidation of Johnson’s robust body of previous work along with his demonstrated record of legislative success to provide a book easily comprehended and soundly applied. About the Reviewer: Anthony F. Tasso, PhD, ABPP is Professor of Psychology and Deputy Director of the School of Psychology & Counseling, Fairleigh Dickinson University. He also maintains a private practice in Whippany (Hanover Township), Morris County, NJ.

The value of Wrongful Conviction is extensive, with a clear utility for assessment, clinical work, and research addressing pretrial and trial evaluations, postconviction appeals, and public policy. Although

Member News Lise Deguire, PsyD is thrilled to announce that her book Flashback Girl was selected as the Nautilus Book Awards gold medal winner for Memoir. The mission of Nautilus Book Awards is to recognize books that help build a “better world.” This international competition (21 countries) selects “exceptional literary contributions” from books which are a “conscious catalyst for positive change.” Flashback Girl was among a record number of entries this year, each vying for recognition by this prestigious award program. Previous award winners of Nautilus Book Awards include Deepak Chopra, Barbara Kingsolver, Eckhart Tolle, Louise Erdrich, Desmond Tutu, and His Holiness the Dalai Lama. LiseDeguire.com

Ruth Lijtmaer, PhD presented the following papers: Contemporary Perspectives with Immigrants, Exiles and Refugees COVID and the Silence of Others, at the Manhattan Institute for Psychoanalysis 5-7-21 ON LINE; Black Mozart and the Sound of Race Discrimination Then and Now. at IFPE (International Forum for Psychoanalytic Education), Conference: (re) Vision. 5-15-21. ON LINE; Where are the women in classical music? Why are their voices silent? at IPA (International Psychohistory Association) 5-21-21.ON LINE. Peggy Rothbaum, PhD announces her recently published book: Help America Heal: A Story of Hope for Young People (https://www.amazon.com/Help-America-Heal-storypeople/dp/0988359219/ref=tmm_hrd_swatch_0?_encoding=UTF8&qid=&sr=) and article Trying to Bury Trauma Does Not Work available to read here: (https://www.kevinmd.com/blog/2021/05/trying-to-burytrauma-does-not-work.html). Dr. Rothbaum also participated in a virtual conference presenting Managing Stress and Avoiding Burnout for Adult Protective Services Professionals for World Elder Abuse Awareness Day, Arizona Department of Economic Security, June 16. In Memoriam Avanente Tamagnini, PhD | NJPA Member, 38 years Lois Goorwitz, PhD | NJPA Member, 14 years

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Psychoanalytic Supervision A Book Discussion with Author Nancy McWilliams, PhD (Guilford Press, September 2021)

literature on it. The empirical literature and the theoretical literature and just reflecting on my own experiences, both as a supervisee and as a supervisor. So, that's the origin of it. By, Anthony F. Tasso, PhD Fairleigh Dickinson University Professor and Deputy Director School of Psychology & Counseling

Anthony Tasso: You mentioned that you've been supervising for a long time. How has supervision changed over the course of your career? Nancy McWilliams: It's less informal than it once was. For example, the Board of Psychological Examiners, if you are training somebody on permit, asks for much more detail than they once did. There is more expected of supervisors, by professional organizations and by supervisees. Our supervisees are expected to evaluate us that wasn't true in in my early years. Certainly my program at Rutgers asks all of its students to evaluate their supervisory experiences. It’s a profoundly important relationship to people, whether done

Nancy McWilliams, PhD

Anthony Tasso: Why a book on supervision?

informally or scrupulously, and supervisees are very

Nancy McWilliams: Well, I'm of an age where there was

pleased to feel like they have a supervisor they can go to who can help them with their blind spots and

no such thing as training in supervision; we all sort of learned how to supervise by being supervised. But I think, with good reason, a lot of the mental health

support their good intuitions and their knowledge.

professions, certainly our APA, and psychiatry’s APA, and the ACSW, are asking that people be trained in supervision. I think they've been getting complaints from supervisees about the uneven quality of supervisors and from students wanting to know how to supervise, so there are now pressures on training programs to provide courses in supervision. That was one reason I thought I would write another textbook. I have supervised now for almost 50 years, and all over the world, and in all kinds of different situations: individual and group and for different kinds of patients. The immediate stimulus to my doing the book, though, was that one of my colleagues, Malin Fors of Norway, with whom I’ve long consulted in a supervisory way, suggested that I do a book on supervision. It's been running around my brain for a while, and it became my COVID project. I couldn't travel anywhere and do the teaching that I often do. So I got into reading the

Psychoanalytic Supervision align with your previous three?

Anthony Tasso: This is your fourth book. How does

Nancy McWilliams: Yeah, I thought I'd kind of covered the psychoanalytic territory with the other three. The first one, Psychoanalytic Diagnosis, was a reaction to the changes in the DSM in 1980. I began thinking about how the whole clinical tradition that had been predominantly psychoanalytic up until the 1970s, had formerly emphasized doing individual case formulations, thinking about people in complex ways, and seeing problems as dimensional and contextual rather than simply categorical. And, all of a sudden, we have this list of diseases with a kind of Chinese menu of symptomatic criteria: you either have the illness, or you don't. So I felt that reflective clinical practice was going to slowly be undermined by the DSM. I wanted to get the way that my psychoanalytic predecessors had worked put down 51

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on paper to preserve a certain kind of clinical knowledge. And then that book was more successful than I expected. And then I got a lot of questions about, “But what about conceptualizing the individual person rather than the personality categories?” and I realized there weren't a lot of books out there on case

communicator. I don't know where that went in psychoanalysis. I'm lucky. I had two very good high school teachers who taught me how to write really clearly. One had been the English composition teacher of the novelist John Updike. I really lucked out. They taught me clear writing, and it has benefited me all my life.

formulation. Both the way psychoanalytic people think diagnostically and the way they formulate cases hadn’t been widely systematized, so I wrote a book on that, Psychoanalytic Case Formulation. And I said that was gonna be my last one. My editor kept pressing me to

Anthony Tasso: Your book is called Psychoanalytic Supervision. How would the non-psychoanalytic therapist take to the book?

write a book on therapy, and I kept saying I didn’t want to write a book on therapy, because my whole shtick is

Nancy McWilliams: I hope they would be interested in it. I called it that just to be consistent with my other books and because I think I needed to represent a kind of “truth in advertising.” I am a psychoanalyst; that is how I think about things. I'm hoping that other people will find their way to the book and “translate” its ideas into their own clinical language. With the

that therapy should derive from the particular patient, the particular problem, and the particular match of patient and therapist. But then I thought, gradually, I began thinking of things that hadn't ever been covered in my own training on psychotherapy, and I slowly began putting together something on therapy, Psychoanalytic Psychotherapy. And I thought that was the end. But a book on supervision sort of rounds it all out in terms of my own career. That's kind of the order in which I learned things myself.

Psychodynamic Diagnostic Manual (2nd Edition) that I edited with Vittorio Lingiardi, we've been hearing a lot from non-psychoanalytic people saying, “You know? A lot of this make sense,” and “Thank you. We appreciate this.” I actually wanted to change the title in the

You know I used to devalue my own work, I thought:

second edition from the Psychodynamic Diagnostic

“I'm not a brilliant new theorist, I'm not a researcher, I'm an ordinary therapist. I know what it's like to be an

Manual to the Practitioner Diagnostic Manual or the Psychological Diagnostic Manual, but Guilford Publications rejected the idea because, you know, the first edition had established a “brand.” We had to stick with the brand.

ordinary therapist. I'm psychoanalytically oriented, I am a psychoanalyst, but I'm not an advocate for any particular kind of psychoanalytic intervention, and I like integrating what I do with other ways of thinking about people.” So I wasn't expecting that my books would make the impact that they have. But I think what I am good at, and I have come not to devalue my thinking so much now, I'm good at integrating, and I'm good at explaining things that are often talked about in very arcane jargon. So I think I found my niche, which is to try to pass on a certain kind of knowledge base.

Anthony Tasso: How do you feel now that they didn't let you change the name? Nancy McWilliams: I'm still a little bit disappointed, but on the other hand, there's so much crazy antipathy these days and misunderstanding of the psychodynamic tradition that it may not be the worst thing to stand for it unapologetically. There are people who believe that there's no empirical basis for anything psychodynamic. Or, that everything Freud said has been clinically disproven. Or that everybody psychoanalytic thinks that Freud’s never wrong about anything, which is bizarre. I am hoping my book will reach people beyond the analytic community. Psychoanalysts had been supervising for decades before other theoretical orientations arose, and we've learned a lot, often by making bad mistakes. It would seem a shame for people who are from newer

Anthony Tasso: You're writing is so accessible and makes your work particularly appealing. Nancy McWilliams: Well, it's a strange thing that’s happened to psychoanalytic writing. Freud was very accessible; that's one reasons he was so successful. Jung had equally important ideas, and so did a lot of other people, but Freud was really a great

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theoretical orientations to have to reinvent the wheel of some of the things that we've learned.

someone else. Especially if you have the legal responsibility, if you're teaching in a program that's training people. That's a huge responsibility, to try to discourage people who either don't have the talent, or who are unethical, from being in the profession. That's a real burden on the supervisor that doesn't exist with

Anthony Tasso: Along the lines of theoretical orientations, what do you see as unique to psychoanalytic supervision and what are supervisory concepts you see as relevant to most theoretical modalities?

being a therapist.

Nancy McWilliams: So, first, some more unique stuff, I'm not sure anything is totally unique, but

And we all share that it's much easier to consult, which means to supervise somebody who's voluntarily asking for your help, when the therapist asking for supervision

psychoanalysts are much more likely to construe supervision not so much as teaching knowledge and

is the person with the legal responsibility for the patient. I do a lot of that; people just voluntarily ask me

technique as facilitating professional and personal development supporting the already assumed intuitive skill of the therapist. It's not so much about teaching

to consult on their work with a patient or a range of patients. That's easier.

methods as it is about expanding knowledge and maturity. But again, I think everybody does that, to

When you're a supervisor in a psychoanalytic institute and you're going to credential somebody as an analyst,

some degree. I suppose that one of the more distinctive areas for psychoanalytic supervision is that most

or when you're in a graduate program and you're going to credential them as a psychologist or psychiatrist or a

psychoanalysts routinely ask their supervisees about their countertransference feelings: how they feel about the patient, what are their fantasies about the patient.

social worker or pastoral counselor, that's a burden, but you know the people in our field tend to be so conscientious and thoughtful. It's rare that you really

The supervisor might report their own feelings and fantasies about the people who are being presented.

are worried that the patient is getting bad treatment. Most therapists are, in my experience, too hard on

There's an assumption that a lot of therapeutic communication happens via the relationship and right-

themselves. We're pretty self-critical people. When therapists’ patients get better, they tend to credit the

brain-to-right-brain kinds of processes, and that you have to sort of open people to those. I was trained in the tradition of Theodor Reik, the guy who wrote

patient, and if a patient gets worse, it's their fault. So it's not frequent that we actually have to give really painful feedback to a supervisee. They’re already hard

Listening with the Third Ear, and he was a very intuitive kind of analyst, not one of the strict ego psychologists, you know, the type who tell supervisees you never answer a question, you always do this, you never do that, that kind of formulaic psychoanalysis was nothing that I was ever really exposed to. I have colleagues who got that from their own analyst or their own supervisor, and it's a lousy way to supervise. I don't think it's very common anymore, because the relational movement really opened up people’s sensitivity to the complexity of supervision and the emotional basis of supervision. So that's the specific stuff where psychoanalytic supervision probably has its own particular slant.

on themselves. But when we do, it's a different skill from even giving painful feedback to a patient. So much depends upon it if, for example, they're in an analytic institute. They want to join a whole community, and they have a certain vision of what their life is going to be like. If you tell them “I just don't think you're cut out to be an analyst,” it can really wreck their vision of their own future, so that weighs on people very heavily. But, I think it’s also true across theoretical orientations that it’s very hard for supervisors to give supervisees bad news. Anthony Tasso: How does psychoanalytic supervision incorporate multicultural factors?

Now, what we all have in common is that all supervisors feel this terrible sense of responsibility, and it's a strange responsibility to be concerned about the treatment of a patient who's in treatment with

Nancy McWilliams: If you went to a Division 39, Society for Psychoanalysis and Psychoanalytic Psychology of the American Psychological Association,

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meeting these days, that's all you hear people talking about. It’s a natural concern for psychodynamic professionals because so many issues related to culture or minority status of any kind, or vulnerable parts of identity, ethnicity, race, or sexual orientation, so many aspects of them, are unconscious. Many people think they have no racism. I don't think you can be a psychoanalyst and feel that it's possible in a culture like this to have absolutely no unconscious racist feelings whether you're Black or White, for that matter. I think

used to it now, but the shift was harder. With supervisees, not so much, and I'm not sure how to explain that. It may have something to do with the fact that I'm not trying to listen so hard for the transference. I'm basically talking to a colleague, and we're collaborating one-on-one on what's the best way to help the patient. It doesn't feel quite so artificial somehow, and of course it doesn't have the same anxieties. None of my supervisees are suicidal, but some of my patients have been on and off. And not

it's very unusual for anybody who has grown up with a minority sexual orientation not to have some

being in person with somebody who's talking about suicidal feelings feels to me like a torture. There's

internalized homophobia or self-doubt. So in a way, I think analysts are well positioned to help people with the implications of immigration or marginality. We are

nothing comparable with supervision.

used to looking at internalized and self-directed hostility up close.

this book?

Anthony Tasso: How would a supervisee benefit from

Dealing with privilege, on the other hand, I can't say the psychoanalytic community has done very well with

Nancy McWilliams: There's a whole chapter for supervisees. I got a lot of really nice responses to a couple of paragraphs I put in my book on therapy,

those issues. If you go to the American Psychoanalytic Association (APasA) meetings, it's still, for the most part, older white guys, presumably mostly heterosexual,

Psychoanalytic Psychotherapy, about what to do if you have a misfit with your supervisor. So I have a whole chapter on how to increase the probability that you'll

and there's now a lot of push-back to change that. That's a very, very alive part of contemporary struggles

get something good out of supervision. Even if you don't like your supervisor, there's something you can

with issues related to privilege and identity.

learn. If you keep having the same experience with several supervisors, you’ve got to look at yourself, but

Anthony Tasso: Much of mental health services have been virtual since the start of the pandemic. Can you comment on your observations of virtual supervision

sometimes it's just a bad fit. I changed the tone in that chapter, and I just started talking directly to the reader. You know if you're stuck in clinical situations like some

and consultation?

of our students at GSAPP are in, internships and highly stressed agencies, where nobody has any time to really help them with their cases and they get all the grunt work and no real supervision (except for “Did you fill in this form?” and that form? and the other form?). And they feel very disillusioned: this is not what they expected from a community of mental health professionals. I talked about the problem that, with the rapid turnover in those places, sometimes they're being supervised by people who know less than they do. They come out of a very thoughtful program, and that won't be the first time they will have to be supervised by somebody who may be throwing their weight around but doesn't appreciate what they know. And what do you do in that situation? How do you help yourself not to act out? And so on.

Nancy McWilliams: I guess I feel there is a bigger difference between virtual supervision and in-person supervision than there is between virtual therapy and face-to-face therapy. With my therapy patients, I really feel the difference seeing them on Zoom: I feel a kind of closing down of reverie. I'm staring at them in a way that I don't do when they're in the office. I miss their body language, and I get distracted by technical glitches and by my own image on the screen. For me, the only advantage of doing therapy virtually, aside from convenience, has been that I sometimes get to see people's kids, and sometimes I get to see their pets. It's interesting to see where they live. I've learned a little bit more about them that way. I find that this shift from in-person to virtual was pretty hard with patients, and at first, I felt much more tired, much more artificial. I'm

When many of my colleagues found out I was writing a

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book on supervision, they told me some horror story about their life as a supervisee. And the empirical literature is beginning to ask supervisees for data about the supervisory experience. It's been fairly new that supervisees are asked to talk about their experience, and they’re reporting that they rarely tell the whole

affect. We try to help them develop more realistic and reliable self-esteem, to mentalize other people, to reflect on themselves, to have some sense of vitality, to accept what can't be changed. So I wanted to write a book on those overarching goals of therapy. And I got three or four chapters done, and my editor sent it out

truth to supervisors, especially if they sense that the supervisor is narcissistically invested in a particular approach or understanding or technique. They learn to be very careful. It seems to me that the more you shut down what you can say, the less you're opening

to some colleagues to evaluate it. They all came back saying that it was too scholarly for a popular book and too popular for a scholarly book. I got kind of dispirited and demoralized and dropped that project, but I rehabilitated it for the supervision book. There's a

yourself up to learning. So, the first priority of supervisors should be to help the supervisee feel safer.

chapter in it about what analytic supervisors keep their eye on, and it's not the day-to-day ups and downs of symptoms, it's the more overarching vital signs of improvement in therapy. So that's what I did with that.

Anthony Tasso: The intimacy of supervision creates so much more vulnerability than in the classroom. Nancy McWilliams: Yeah. I remember, in my own

So now my editor is after me again, and at first, I thought I could write a book on grief, as I know a lot

supervision, feeling skinless, like I had no protective covering it all, and fearing that my very insightful

about grief. And I got kind of excited and inspired about that, but then I went out and read a lot of popular

supervisor was going to see through me and see all my flaws. It's a horrible experience to feel that dread.

books on grief. I found that there are some really good ones out there, and I found myself thinking, “I don't have anything to add to this.” So I dropped that. Now

Anthony Tasso: Your first three books, along with your co-edited Psychodynamic Diagnostic Manual, has clinicians as the target audience. Have you ever thought about a self-help book, a book geared towards the non-therapist?

she's asking “What about aging? You wrote a good article on aging.” And I'm thinking okay, so now I’m collecting popular books on aging and I'm reading them thinking, “Oh, I thought I would be saying that, and that it hadn't been said before, but Mary Pipher's written a good book that says most of what I would say . . .” so I don't know where I am with that.

Nancy McWilliams: It's funny that you ask. My editors have been trying to get me to write a popular book for years. And I'm open to it if I can get inspired. The first thing I was really inspired to do was to write a book on overall mental health. If you're a researcher, the way you can investigate how therapy helps is: Did the symptom go down? Did this person score better on the Beck Depression Inventory, for example. That makes perfect sense for researchers, but therapists think in larger terms than whether a symptom is temporarily worse or better. Because we know that when people are trying something new, their symptoms can temporarily get worse, or if they're grieving some loss they dealt with for decades with denial, they're going to look more depressed for a while. So we tend to think in terms of overall issues like helping people increase their attachment security, their sense of agency, their flexibility of coping mechanisms, the maturity of their defenses, their capacity to tolerate a whole range of

Anthony Tasso: Sounds like there's a lot of ideas percolating. Nancy McWilliams: Yeah, there are. I just have to get something that I can really run with without feeling like I'm just rehashing what other people have said. It doesn't have to be brilliant, but it has to be a new synthesis or something interesting. I'm almost 76, and sometimes I feel like maybe I don't want to spend the rest of my years writing books. But I do enjoy it, I really like writing.

Anthony Tasso: Is there anything else you would like to comment on about Psychoanalytic Supervision? Nancy McWilliams: Well, when I put the

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announcement out on the NJPA listserv, I was feeling a kind of gratitude to all the people in New Jersey, especially New Jersey psychologists, who have taught me important things for many years, starting in 1973 at what was then Rutgers Mental Health Center. I began doing supervision groups there for local therapists, and continued when I went into private practice. One woman left my Thursday night group about a year and a half ago who’d been in it since 1973. So these groups have a long life. Most participants stay in them for

About the Interviewer: Anthony F. Tasso, PhD, ABPP is Professor of Psychology and Deputy Director of the School of Psychology & Counseling, Fairleigh Dickinson University. He also has a psychotherapy practice in Whippany (Hanover Township), Morris County, NJ.

years, they deepen, we get to know each other well. For me, the nicest thing about group supervision is that I

The State University of New Jersey, and has a private practice in Lambertville, New Jersey. She is author of

always learn as much as I teach. I feel a deep gratitude to my colleagues. One of the things I wanted to encourage in this book was for supervisors and

Psychoanalytic Diagnosis, Psychoanalytic Case Formulation, Psychoanalytic Psychotherapy, and Psychoanalytic Supervision, and is co-editor of both

supervisees to get into groups of colleagues, where they can slowly feel safe talking about what they

editions of the Psychodynamic Diagnostic Manual. She is a past-president of the Society for Psychoanalysis and

actually said and did, and about what their own dynamics are. I don't try to move into people's dynamics; I feel that's not the place of a supervisor. But,

Psychoanalytic Psychology (Division 39 of the American Psychological Association), and is on the editorial board of Psychoanalytic Psychology. A graduate of the National

I am pleased when I've set a tone of enough safety that people start disclosing information about themselves. Like, “I was sexually abused when I was nine, so I get

Psychological Association for Psychoanalysis, Dr. McWilliams is also affiliated with the Center for Psychotherapy and Psychoanalysis of New Jersey and

triggered by sexual abuse patients.” I find it touching when people are able to do that. I don't go for it, but I

serves on the Board of Trustees of the Austen Riggs Center in Stockbridge, Massachusetts. She is the

try to create an atmosphere in which people feel increasingly okay to tell the truth about themselves,

recipient of honors including the Gradiva Award from the National Association for the Advancement of

their feelings toward their patients, their feelings toward the field, their worries about their own professional skills and development.

Psychoanalysis; the Goethe Scholarship Award from the Section on Psychoanalytic and Psychodynamic Psychology of the Canadian Psychological Association;

About the Author Nancy McWilliams, PhD, ABPP, teaches in the Graduate School of Applied and Professional Psychology at Rutgers,

the Rosalee Weiss Award from the Division of Independent Practitioners of the APA, the Laughlin Distinguished Teacher Award from the American Society of Psychoanalytic Physicians; the Hans H. Strupp Award from the Appalachian Psychoanalytic Society; and the International, Leadership, and Scholarship Awards from APA Division 39. Dr. McWilliams is an honorary member of the American Psychoanalytic Association, the Moscow Psychoanalytic Society, the Institute for Psychoanalytic Psychotherapy of Turin, Italy, and the Warsaw Scientific Association for Psychodynamic Psychotherapy. Her writings have been translated into 20 languages.

Anthony Tasso: Anything else? Nancy McWilliams: I guess I didn't say anything about the chapter on ethics, which I worked hard on. I'll be curious about people's reactions to it. I talked about how much more complicated ethical issues are than one would think from just mastering the APA code of ethics. I give some examples. In general, I think if I have to give a take-home message to supervisors, it would be: Don't underestimate how frightening and painful it can be for other people to show you their work; don't assume that because you're a nice, thoughtful person that they experience you as a nice, thoughtful person. They come in with a lot of fears about what you'll expose and how they will disappoint you. And don't forget that these are competent adults who are showing you their most vulnerable underside.