NJ Psychologist: Spring 2022

Spring 2022 | Volume 72 | Number 2

NJ PSYCHOLOGIST The Professional Journal of the New Jersey Psychological Association

Post-COVID Transformation and Changes to Professional Psychology

In this issue: CE ARTICLES Pandemic Acquired Risk Avoidance (PARA): Considerations for Clinical Application, Public Education, and Research (1 CE) COVID 19 and Psychologists: Strategies to Help Ourselves and Those We See (1 CE)

COVID and the Rapid Changes in the Landscape of Mental Health Services: What We Need to Know as Private Practitioners Some Ethical Considerations for Forensic Family Evaluations

The Impact of COVID-19 on Administering Standardized Assessments in Psychological Evaluations The NJPA Foundation Highlight 2020/2021 Social Advocacy Open Topic Dissertation Grant Recipient, Cindy Chang, PsyM Buffers Against the Effect of Discrimination on Mental Health in Sexual Minority Individuals Book Review: Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0 ..and more!

Executive Board President: Peter DeNigris, PsyD President-Elect: Briana Cox, PsyD Past-President: Daniel Lee, PsyD Secretary: Alexandra Miller Clark, PsyD Treasurer: Marc Gironda, PhD Parliamentarian: Bonnie Markham, PhD Members-At-Large: Elio Arrechea, PhD Daniel DaSilva, PhD Alex Gil, PsyD Sara Tedrick Parikh, PhD Aileen Torres, PhD Deirdre Waters, PsyD APA Council Representative: Rhonda Allen, PhD Special Representatives: ECP Chair: Anna Urbaniak, PhD NJPAGS Chair: Kristin Parente Affiliate Caucus Chair: Phyllis Bolling, PhD CODI Co-Chairs: TBD Executive Director: Justin Karmann Director of Professional Affairs: Susan C. McGroarty, PhD 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: Loraine Washton, PhD Middlesex County Association of Psychologists: Tammy Dorff, PsyD Monmouth/Ocean County Psychological Association: Deirdre Waters, PsyD Morris County Psychological Association: Sarah Dougherty, PsyD Somerset/Hunterdon/Warren County Psychological Association: Janie Feldman, PsyD South Jersey Psychological Association: Ange Puig, PhD Editorial Board: Editor: Aaron Gubi, PhD Homestudy CE Article Editor: Dennis Finger, EdD Editorial Board Members: Anthony Tasso, PhD Nathan McClelland, PhD Eric Herschman, PsyD Ashley Gorman, PhD Staff Liaison: Christine Gurriere

We're here to help!

Central Office: 8:30 am – 4:00 pm Phone: 973-243-9800 STAFF CONTACT INFORMATION Executive Director: Justin Karmann njpajk@psychologynj.org Communications: Christine Gurriere njpacg@psychologynj.org Membership/Foundation: Jennifer Cooper njpajc@psychologynj.org Continuing Education: Kaleigh White njpakw@psychologynj.org Director of Professional Affairs: Dr. Susan McGroarty Consultation Request (login required)

Contents 2

President's Message

3

Member News

4

Get Psyched! A Wellness Event

7

A Tribute to Raymond Hanbury, PhD

Continuing Education Articles

8

Introduction

9

COVID-19 and Psychologists: Strategies to Help Ourselves and Those We See (1 CE)

Pandemic Acquired Risk Avoidance (PARA): Considerations for Clinical Application, Public Education, and Research (1 CE) General Articles

13

19

The Impact of COVID-19 on Administering Standardized Assessments in Psychological Evaluations

22

Some Ethical Considerations for Forensic Family Evaluations

25

COVID and the Rapid Changes in the Landscape of Mental Health Services: What We Need to Know as Private Practitioners

27

The NJPA Foundation: 2020/2021 Social Advocacy Open Topic Dissertation Grant Recipient Highlight

29

Book Review: Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0

31

Classified Ad: Office Space

32

Join the NJPA Referral Network!

33

Welcome New Members!

34

Looking for your next career move?

Check out the NJPA Career Center!

NJ Psychologist

Spring 2022

President's Message

By Peter DeNigris, PsyD NJPA President At the time I wrote my article for the Winter issue of the

leadership, the Executive Board, or Central Office staff if

NJ Psychologist, the COVID variants were surging across the state and the country. Currently, the number of new

we can assist or support your wellness in any way.

cases in New Jersey has decreased, and our governor recently revoked the public health emergency. While

The aforementioned topics were at the forefront of APA’s Practice Leadership Conference, which was held

there are many positive indicators involving the COVID pandemic, our field is continuing to battle the second pandemic: the mental health crisis that has resulted

on March 3 and 4, 2022. While this conference was initially intended to be in-person in Washington, DC, the difficult decision was made to convert this to a virtual

from COVID-19. Private practitioners have unprecedented waiting lists that are thwarting people’s access to care. School psychologists are overwhelmed by

conference approximately one month prior given the recent surge in COVID variants. The second part of this conference, APA Services Advocacy Summit: Advancing

addressing the rapidly evolving mental health needs of

Health Equity and Access to Psychological Services, was

their students. Organizational psychologists are having pivotal roles in assisting corporations and employers with redefining the workplace environment. Much

held on March 27 and 28, 2022, and involved meetings between NJPA leadership and our legislative representatives on Capitol Hill. I had the pleasure of

uncertainty remains. It is still unclear exactly how COVID-19 will influence our society and our field in the long-term. While our field continues to learn more, our international society is faced with another crisis: the war and humanitarian crisis in Ukraine. This conflict between two countries is having a global impact. Once again, the services of psychologists are being called upon, and our field is responding in kind. Personally, I have been inspired by the conversations I have had with many of you regarding how you are responding to these two crises and helping the people whom you serve whether in private practices, schools, or other organizations. In many of these conversations, though, I am also hearing the words “exhausted,” “burnout,” and “overwhelmed.” I sincerely hope that each of you is ensuring that your mental and physical health needs are being met. Despite the enormous demands on our profession, as the saying goes, we cannot pour from an empty cup. Please do not hesitate to reach out to NJPA

participating in this conference with NJPA’s Executive Director, Justin Karmann, and several members of the Executive Board. One of the highlights for me was the opportunity to discuss these topics and other challenges to our field with our colleagues from across the country.

I would like to provide a brief summary of what was discussed, thus far, at this year’s conference.

First, leaders within APA emphasized the need for psychologists to employ adequate self-care measures in the face of the mental health crisis that we are facing.

They also highlighted some of the issues that they are currently addressing, such as mental health equity, the utilization of more technology in the practice of psychology, ensuring evidence-based practice in the areas of ethics and equity, diversity, and inclusion, and advocating for telehealth parity, including audio-only services, in all 50 states. Furthermore, APA announced that they have created the part-time position of Senior

2

NJ Psychologist

Spring 2022

Director for Independent Practice and are actively soliciting applicants.

field to adopt a “cultural humility” with a focus on stopping oppression, decolonizing psychology at the state level, and finding ways to “bring psychology to the people.”

They challenged state associations to conduct an internal audit of their EDI principles, assess their baseline of diversity, and make a commitment to develop pathways for students of color. APA is planning follow-up meetings related to these topics in the coming weeks and months, and NJPA is committed to having representatives present.

Second, we attended a presentation entitled, Using Foresight to Build Resilience and Agility in Uncertain Times, by Olivia Mastry, JD, MPH. This, again, highlighted the uncertainty caused by COVID-19, economic stressors, and multiple forms of social unrest during the past two years. She recommended focusing on the “five horizons” of resolve (addressing immediate emergencies), resilience (planning for near challenges), return (working for equilibrium and saying goodbye to what was normal), re-imagine (envisioning and reinventing new opportunities), and reform (organizing and influencing the future). Dr. Mastry defined strategic foresight as anticipating possible changes in the future in order to prepare. In brief, this involves anticipating change, interpreting the implications of the potential change, and creating an informed vision and strategic action.

Lastly, and of particular concern, NJPA learned that APA is seriously considering changing the manner in which APA is governed such that states would no longer have a voice on APA’s Council of Representatives and state associations would have limited ability to have any voice in APA affairs.

APA’s Policy and Planning Board is advocating for a new model of APA governance called The Assembly. In reviewing preliminary information about this proposed new model, state associations are not recognized as part of APA’s governance and decision-making. At the time of this writing, NJPA is gathering more information about this proposed change. Please be assured that NJPA is committed to working with other state associations to ensure that we continue to have an active and strong voice in APA affairs. More information will be shared with NJPA membership as this situation evolves.

Third, conference participants attended a panel presentation entitled, Inclusive Leadership: Translating Equity, Diversity, and Inclusion into Understandable Language and Action Steps, by Shirley Ann Higuchi, JD (APA Associate Chief of Professional Practice for Justice, Legal, & State Advocacy), Maysa Akbar, PhD, ABPP (APA Chief Diversity Officer), and Thema Bryant-Davis, PhD (APA President-Elect). The presenters advocated for our

As always, please do not hesitate to contact NJPA’s Central Office, Leadership Committee, and/or Executive Board with any questions or concerns. We look forward to seeing you at our upcoming events.

Member News Craig S. Fabrikant, PhD, a clinical and forensic psychologist in South Florida, is the 2022 president-elect of the Florida Psychological Association. Dr Fabrikant is also the past-president, Florida Chapter, of the Association of Family and Conciliation Courts.

Eric Herschman, PsyD has been awarded NJASP’s Jane Bostrum Service to School Psychology Award. This prestigious award is given in recognition of outstanding contributions to the profession of school psychology. Examples include an individual who has made noteworthy recent contributions to the field, an individual who has made contributions over a long period of time, an individual who has contributed to the professional literature, and an individual who has contributed to the state or national professional association, etc. Eric will be honored during the Spring 2022 conference on May 6th.

Eileen Kennedy Moore, PhD has a new children's book out titled Moody Moody Cars (Magination Press). In this quirky, joyful picture book, classic automobiles express a range of feelings, from excited to angry, to help kids find their way through the roadways of emotion. Learn more here!

Ruth Lijtmaer, PhD presented the paper: My name is nobody. I do not know what is my true self. Trauma of immigrants in the 21 St Century. Presented in Spanish as; Mi nombre es Nadie. No sé quién soy realmente. Trauma de la inmigración del siglo XXI. IARPP, Spain. 12-18-21. ON LINE. Anthony Tasso, PhD and Nesrin Hisli Sahin, PhD published the paper: COVID-19 Disruption on College Students: Academic and Socioemotional Implications. Psychological Trauma: Theory, Research, Practice, and Policy, 13, 1, 9-15. Tasso, A.F., Hisli Sahin, N. & San Roman, G.J. (2021). They recently learned that this article was the most downloaded 2021 article across all 89 APA journals and out of more than 5000 submissions. https://www.apa.org/monitor/2022/01/top-journal-articles.

In Memoriam: Ray Hanbury, PhD, NJPA Member 49 years; Ilene Kesselhaut, EdD, NJPA Member, 31 years; Rebecca Meyer, PhD, NJPA Member, 32 years.

3

NJ Psychologist

Spring 2022

A Message from the Executive Director

By Justin Karmann, MDiv Executive Director

Throughout my career, recruitment and engagement events have been my favorite activities to plan for a very specific reason: they work. Regardless of the cause, whether it be for social justice activism or fundraising, nothing generates more interest and attendance than an event with delicious food, adult beverages, and activities.

As we all know, socialization around a collective interest is often critical for human connection and engagement.

Arriving to an engagement with the confidence that you know people, and those individuals you may not know, will be in your same line of work provides a great comfort that there should be minimal awkwardness or uncertainty. In addition, you know the engagement has activities for the whole family, which further adds to the peace of mind and attractiveness to attend. Plainly speaking, events such as these pull people out of their routine and provide something to look forward to. NJPA is no different. Especially given the heavy toll that has been this past season of life, we as an organization and as individual members need something to recharge and refresh us.

food, adult beverages, networking, giant Jenga, other yard games, and ice cream (as well as non-dairy frozen treats)! If you choose to bring your family, there is a great playground to keep your younger ones occupied during the 11:00 am - 12:00 pm CE hour (supervision not provided).

We also have ulterior motives for wanting you to attend this fun event. NJPA is looking to grow as an organization and to bolster our committees and volunteer driven activities. We hope you consider inviting your colleagues and cohorts to attend whether they are members of NJPA or not. We also hope you join us during the networking hour to hear about all the amazing things our association has to offer while also meeting with our Central Office Staff and our Leadership team. Finally, all profits of the adult beverage purchases go to supporting our Foundation and the field of psychology.

For all of these reasons and more, we hope to see you on Sunday, June 26th from 10:30 am - 3:00 pm. If you cannot make the CE part, feel free to come at noon and join us for the afternoon. “Get Psyched!” will be a great time regardless of when you come or go.

For this iteration, we are hosting a Wellness Event called “Get Psyched.” And yes, we are psyched about this and we hope you are, too. The Central Office staff, especially Kaleigh White, and an amazing task force of volunteers have been planning this event for nearly five months.

The goal for “Get Psyched!” is for NJPA members to see one another in-person, some for the very first time. I am personally excited to meet so many of you that I have spoken to over the phone or via ZOOM. We also want “Get Psyched!” to be a rejuvenating time where you not only receive a Continuing Education credit centered around your own well-being as psychologists, but also a day filled with all the best activities: cornhole, yummy

See you soon at Brookside Park in Scotch Plains!

PS: If you are a musician and would like to play music during the latter part of the event, please contact me. I’d love to talk to you about this opportunity. njpajk@psychologynj.org

4

NJ Psychologist

Spring 2022

5

NJ Psychologist

Spring 2022

6

NJ Psychologist

Spring 2022

In Memoriam

A Tribute to Raymond Hanbury, PhD

By Joseph and Stephanie Coyne

Dr. Raymond Hanbury received his PhD from New York University in 1979 and continued to work in the field

For his long service to NJPA, he received both the Psychologist of the Year Award and the Lifetime Achievement Award.

While his professional achievements are stellar, all who knew Ray will particularly cherish their memories of who he was as person. Ray was a husband, father, and grandfather, friend, colleague, and psychologist. Easygoing and conservative, he was one of those rare people who never cursed and never said a bad word about anyone. He liked hamburgers and root-beer floats. He was a faithful church-goer and usher in his local church over decades of service. He was a devoted husband to his beloved wife, Pat, who also served as the office manager for his practice. He was a loving and proud father to his daughters, Amy and Kim, a loving father-in-law to Kim’s husband Joe, and a proud and adoring grandfather to his grandsons, Kai and “GG”. When you asked Ray for a favor, the usual response was: “No problem!”. We were privileged to call him our dear friend for many years. We spent many conferences and vacations together and there was always some story to tell about NJPA or APA or the hospital or his police work or the Disaster Response Network – Ray could leave you breathless wondering about how he was involved in all of these activities. This was his special talent – being enthusiastically engaged in his work which was always “other-oriented”. Along with a group of several other colleagues and friends, we celebrated New Year’s Eve together for over 15 years. We will never forget our friend and colleague and all the good times we’ve shared.

until the time of his death in March, 2022. It is difficult to summarize Dr. Hanbury’s numerous professional contributions and achievements during those 40 years He was the author or co-author of more than 60 publications including books, chapters, book reviews, and journal articles, held numerous editorial positions, gave over 90 professional presentations to various mental health and community associations, and was frequently interviewed on various media.

During his long career, Dr. Hanbury earned a Diplomate in Clinical Psychology from the American Board of Professional Psychology. In addition, he also received Diplomate status from the American Board of Forensic Examiners and the American Academy of Experts in Traumatic Stress. He was also made a Fellow of these associations. He was a long-term member of the American Psychological Association and received APA’s Presidential Citation for his outstanding service to the field of psychology and the mental health needs of the public. In addition, he served several terms as a Representative on APA Council from both NJPA and Division 50 (Society of Addiction Psychology). He was awarded Fellow status from APA and from APA Divisions 18 (Psychologists in Public Service), 22 (Rehabilitation Psychology), 31 (State and Provincial Psychology Associations), 38 (Health Psychology), 42 (Psychologists in Independent Practice), 50 (Society of Addiction Psychologists), and 56 (Trauma Psychology). Ray contributed to numerous special projects and grants, published numerous chapters and book reviews, as well as giving dozens of presentations and symposia over virtually all of his 40+ year career.

While we have highlighted his many professional accomplishments, perhaps the honor that most clearly tells us what Ray’s life was about is one that Pat recently shared with us.Many years ago, Ray treated a deeply traumatized Vietnam veteran. At the conclusion of treatment, this man wanted to share how much it meant to him to have his life back, and so he gave Ray his Purple Heart and told him he wanted him to keep it for him as a token of his healed wounds. To the honor of that soldier and with his gratitude and consent, that medal was placed at Ray’s casket during his wake.

Dr. Hanbury was a long-term active member of NJPA and served as NJPA President in 2000. He was NJPA’s liaison to the New Jersey Board of Psychological Examiners for 10 years. He was involved in many areas and was a long-time member of COLA and served as COLA Chair. He also served “behind-the-scenes” as an active member of the Council on Continuing Education and spent many hours reviewing proposed CE programs to ensure that they met APA requirements for continuing education.

Dr. Hanbury’s life was focused on service to others – his was a life that was truly well lived. He will be missed by all who knew him.

7

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.

Introduction It would be an understatement to say that the last two years have been tumultuous. The global pandemic, beginning in late winter 2020, has forever changed us, both as individuals and collectively, in myriad ways, many of which we barely are beginning to uncover. The challenge for psychologists in New Jersey now, in the spring of 2022, spans not only understanding the ways in which ourselves and the world have changed over the past two years, but also the ways our field has shifted into something different than it once was. The following articles in the special section of the present edition of the NJ Psychologist seek to shed some light on some of these areas. The first article, by Dr. Ralph Dell’Aquila, is a thoughtful discussion on the concept of grief as it relates to Covid-19, both on a personal and professional level. Different types of grief, the potential for growth, and adaptive coping strategies for psychologists moving through the pandemic are all addressed. In the second article, Laura Barbanel et al. discuss the phenomenon of Pandemic Acquired Risk Avoidance, a pattern of behavior identified via results from a survey-driven research study conducted in the spring of 2021.

Although we have been forever changed by the Covid-19 pandemic, it is our belief that the healing will continue, both for ourselves and those we serve. We hope these articles can contribute, in some small way, to that process.

Nathan McClelland, PhD Dr. Nathan McClelland is a psychologist with Morris Psychological Group, PA, in Parsippany, NJ, where he has worked since 2015.

His practice focuses primarily on the treatment of emerging adults struggling with the transition to young adulthood. He participates in various capacities with the New Jersey Psychological Association, as a member of the Committee for Continuing Education, the co-chair for the Homestudy Learning Committee, and the continuing education liaison for the NJ Psychologist. Dr. McClelland earned his PhD from St. John’s University in Queens, NY, in 2013, and completed his postdoctoral training at New York Presbyterian-Weill Cornell Medical Center in 2015.

7

NJ Psychologist

Spring 2022

COVID-19 and Psychologists: Strategies to Help Ourselves and Those We See (1 CE)

By Ralph D. Dell’Aquila, EdD Earn 1 CE credit when you read this article and successfully complete the post-test. Purchase this CE activity here.

Introduction Here are some statistics concerning COVID-19:

can help people positively reconstruct grief, and this

500,356,391 confirmed cases; 80,470,272 confirmed cases in the United States; 6,183,788 global deaths, and 986,198 deaths in the United States.

can lead towards a renewed sense of hope and posttraumatic growth.

(https://coronavirus.jhu.edu/, accessed on 3/28/22).

In addition to the physical aspects of the pandemic, the

The learning objectives of this article are as follows:

mental health component of the pandemic has been difficult as COVID-19 has caused societies around the

1. Distinguish between different types of grief: ambiguous loss, disenfranchised grief, and prolonged grief

world to question key coping mechanisms with respect to coping with grief. Over the period of the COVID-19 pandemic, people have been limited or deprived from

2. Identify sources of post-traumatic growth as it relates to the COVID-19 pandemic 3. Discuss adaptive coping strategies for

visiting/paying last respects to loved ones; in addition, mourning rituals were curtailed (Olafadewa et al., 2020).

psychologists relating to COVID-19 effects and residual effects of the COVID-19 Pandemic

Multiple stressors have been endured by many around the world, such as loss of work, distance from family/friends, and living with uncertainty (Diolauti et al., 2021; Kartsava & Kuzznetsova, 2020). Subtle losses in terms of our daily routines and lifestyle changes like wearing masks (at work and even out in public) are noteworthy. Younger people, as well as the elderly, who have missed out on opportunities to attend key events represent other sources of loss at the hands of COVID19.

Aspects of Grief Prior to COVID-19, friends and families followed established rituals to provide a foundation for events such as wakes, social gatherings, and physical consolation. The pandemic modified, curtailed, or stopped many rituals and social mores with respect to the death of loved ones (Govenas & Shear, 2020).

Technological advances, such as livestream funeral services and FaceTime for hospital visits (Ingravallo, 2020), have helped to ease the effects of the social distancing of COVID-19. However, disenfranchised grief can still appear in the case of families who were not able to grieve in a traditional way (Wallace et al., 2020).

Social distancing and limitations placed on people of all ages created some more subtle issues under the category of loss.

While the Center for Disease Control (CDC) mandates have been modified recently, the effects of the pandemic on grief are noteworthy and every country around the world has had aftereffects with respect to COVID-19.

Navigating COVID-19 grief is relevant for psychologists on both personal and professional levels. Psychologists

9

NJ Psychologist

Spring 2022

Ambiguous loss is another important aspect that can manifest in psychological and physical ways (Boss, 2021).

Boss (2021) noted examples of ambiguous loss related to COVID-19: loss of trust in the world as a fair place (psychological ambiguous loss), not being able to say final goodbye to a family member who suddenly died, and a parent with dementia who does not recognize family or is physically unable to attend a funeral for a loved one (physical ambiguous loss). Other examples of ambiguous loss: toddlers not being able to have play

unresolved issues that are connected to the various types of grief and loss to be reconciled. COVID-19 guidelines on social distancing, mask wearing, and travel restrictions caused everyone around the world to make various adjustments in our collective worldview and behavior. A sense of uncertainty has been present throughout the pandemic because of a sense of limited self-efficacy and no one is sure what the end game is going to look like. Walsh (2020) noted that people are facing a variety of losses such as: illness/deaths of

dates or share toys in daycare, finding new ways to balance work/home/caring for children, considering

friends/family, change in social network/physical connections, livelihoods, pre-crisis ways of life, and

working from home virtually, and young people having to adjust to virtual learning.

shattered assumptions about the world/future.

One theme that cuts across various aspects of grief vis-

Disenfranchised grief occurs when the loss is not recognized by others. One example of disenfranchised

`a-vis COVID- 19 is uncertainty. Uncertainty is defined by the presence of vague, multi-faceted, or

grief is when the bereaved, during the height of COVID19, were not able to provide the funeral that the deceased wanted because of restrictions (Ingravallo,

unpredictable situations and having insufficient tools to cope with them (Toro et al., 2019). Satici et al., (2020) studied 1772 Turkish people between ages 18 and 73.

2020). Such an experience can be very difficult to sort out because the criteria for honoring a family member who died could not be met during the pandemic.

They found that inability for subjects to tolerate uncertainty was connected to fear of COVID-19 and rumination.

Disenfranchised grief can occur when families are unable to grieve in traditional practices of funeral

Researchers in Argentina examined the effect of

services or being unable to attend the burial (Wallace et al., 2020). Other examples might be not being able to

uncertainty intolerance on 3,805 participants regarding anxious and depressive symptoms regarding COVID-19.

have a graduation ceremony or prom during the pandemic.

The study confirmed the connection between the intolerance of uncertainty and mental health symptoms (del Valle et al., 2020). Acceptance and Commitment

Prolonged Grief Disorder (PGD) represents a reaction to a death that does not appear to get better over time.

Therapy (ACT) was recommended by Kroska et al., (2020) to focus on internal thought processes,

PGD (F43.80) will be added to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5-TR). The DSM-5-TR edition is set to be released in March 2022 and PGD has been part of the ICD 11 (International Classification of Disease 11) since 2018 (Moran, 2021; Eisma et al., 2020). Persistent Complex Bereavement Disorder (PCBD) was listed in DSM-5 as a condition for further study. PGD is defined as distressing and disabling yearning for the deceased and or preoccupation with the deceased; in addition, this is accompanied by emotions such as guilt, anger, and other symptoms characteristic of emotional pain that last at least six months (Eisma et al., 2020).

emotions, values, and mindfulness in the context of COVID-19. ACT can help people to see the connections between difficult emotions and personal values, for example, sadness surrounding loss of a loved one.

Post- Traumatic Growth and COVID-19: While there are many research studies and media coverage about the adverse aspects of COVID-19, the other side of the proverbial coin lies in post-traumatic growth that helps people find meaning as they integrate trauma/loss associated with COVID-19. One strategy associated with post-traumatic growth is to examine personal perceptions associated with

Though it may seem that the pandemic is in the rearview mirror of our collective awareness, there are some

10

NJ Psychologist

Spring 2022

COVID-19; such analysis can provide important insights into current and future directions. Lack of control and unpredictability are common themes that have been encountered in different life contexts with respect to the pandemic.

Directions for Clinicians

Meaning-making is defined as how people conceptualize, connect, and make sense of the world around them (Park & Folkman, 1997). It is important to examine how people interpret COVID-19 challenges

Grief is a universal human experience because everyone faces grief at different points of life.

Psychologists, like other healthcare providers, have to negotiate their own losses/grief while at the same time helping others navigate their grief. The COVID-19 context seems unique in how it has manifested on a global level. All countries have been affected by COVID19 in terms of social distancing, wearing masks in

whether in our work as psychologists or on a personal level. Three dimensions of meaning, as they relate to

different contexts, concern about contagion, ability to treat those infected, and a general sense of uncertainty.

meaning-making, include: 1. Coherence: making sense of life, 2. Purpose: COVID-19 has interrupted activities that provide meaning/purpose, and 3. Significance: our

Identifying and discerning the various forms of loss and consequent grief may facilitate tailored prevention and treatment strategies (Varshey et al., 2021).

sense of meaning with respect to self/world (Martela & Steger, 2016).

Aafes-van Doom et al. (2020) did a study involving 339

In a three-wave longitudinal study, Yang et al. (2021) studied 2,364 college students three months before the

therapists with respect to their practice during the pandemic and vicarious trauma. The researchers found that 74.9% felt more fatigue, 63.7% reported moderate

pandemic, and during and after COVID-19 in China. Yang et al (2021) examined whether meaning-making in negative experiences (MINE) would result in better

vicarious trauma, as measured by the Vicarious Trauma Survey, however, 65.3% reported that the therapeutic relationship remained solid. It is important for

coping strategies. Those participants who reported positive meaning from the pandemic had less

psychologists to examine cumulative loss/grief on a personal and professional level to avoid

psychological distress. The ability to think through COVID-19 mental health concerns is important to

burnout/fatigue. Peer supervision and positive social support can go a long way to help reduce a sense of

examine. Yang et al. (2021) showed the value of reframing anxious and depressive thoughts and how this leads towards better adaptation and new found

isolation and recalibrating our expectations/thought processes.

meaning.

A study that addressed practitioners’ COVID-19 transition from office to working remotely from home

Matos et al. (2021) did an online survey concerning the role of social connection and post-traumatic growth relating to COVID-19. They studied 4,057 participants from 21 countries (Argentina 257, Australia 109, Brazil 299, Canada 115, Chile 282, China 77, Columbia 50, Cyprus 38, Denmark 141, France 115, Great Britain 268, Greece 145, Italy 160, Japan 522, Mexico 181, Poland 82, Portugal 394, Saudi Arabia 256, Slovakia 46, Spain 392, United States 128). The researchers determined that social compassion, as defined by compassion and social safeness, increased the likelihood of self-reports of participants in terms of post-traumatic growth. The value of social connections, even with the backdrop of the pandemic, was affirmed as a valued coping strategy.

Perceived social support and self-efficacy were correlated with post-traumatic growth during COVID19 (Zhai et al, 2021).

was done involving 92 psychotherapists, specifically two counselors, 16 psychologists and 74 social workers in New York and New Jersey (Shklarski et al., 2021).

Shklarski et al., (2021) found that most therapists had to make rapid transitions moving from in-office to remotely seeing patients. While most of the practitioners were able to make this transition from office to remote work reasonably well, others who work with children faced additional challenges because they did not have the same physical space for the games needed to make certain interventions. Lastly, the researchers made note of “Zoom fatigue” as a challenge faced by practitioners.

One takeaway from Shklarski et al., (2021) study is that flexibility of mind and adaptation can lead

11

NJ Psychologist

Spring 2022

others most effectively. Physical wellness, spirituality, and mindfulness can be good preventative strategies to help psychologists. Equally important is to practice psychological flexibility in terms of our personal and professional lives, which can help us to adapt proactively. Kroska et al., (2020) noted that psychological flexibility helps to reduce psychological distress in the context of COVID-19. One reason may be that psychological flexibility can counter aspects of uncertainty by adjusting expectations.

towards new opportunities even in challenging times.

The ability to provide secure telehealth services on a wide scale basis is helpful for practitioners as they can potentially reach more people, particularly those who may be home bound. Use of remote technology also provides for some additional flexibility for psychologists and more opportunities to interface with family as working remotely does not involve any commuting.

In terms of implications from the research noted, there are some strategies that may help promote resilience.

Self-care, in the form of reflecting upon the ways COVID-19 has had an impact professionally/personally, can be a positive experience. Professionally, peer support offers the opportunity to speak with one another more freely than with family because of the confidential nature of the issues psychologists face.

Further, peer support offers an opportunity to reflect upon the meaning of grief, personally and professionally, which can hopefully lead towards post-traumatic growth.

By making meaning, we practice the skills we will use to lay the groundwork for a satisfying life, even as the world changes around us (Steger, 2020). Managing personal expectations and assumptions about the world can provide us with ways to recalibrate our direction. A key predictor of post-traumatic growth is social support (Northfield & Johnson, 2021). The pandemic has been very challenging on many levels, but has hopefully helped us to grow as people and psychologists.

The ability to reframe grief is not easy especially as many psychologists have lost people close to them. Part of the reframing process is to acknowledge the loss and then to think of ways to integrate this loss into one’s life.

Worden’s Four Tasks of Mourning comes to mind; while not a stand-alone way of working through grief, it is a helpful conceptualization for psychologists and patients.

Worden (2018) included the following: 1. Accept reality of the loss, 2. Process pain of grief emotionally, cognitively, and spiritually, 3. Adjust to world without the deceased and, 4. Find enduring connection with the deceased in the midst of a new life.

References Furnished Upon Request About the Author For the past 17 years, Ralph D. Dell’Aquila, EdD has been a Sr. EAP Counselor for NJ Transit’s Employee Assistance Program. He also works in private practice. Dr. Dell’Aquila is a licensed psychologist and professional counselor in Washington, DC and New Jersey. He has had over 25 years of experience working in different clinical settings including private practice. He is the author of the article Addressing communication and rumination in physician/patient interactions: Implications for treatment compliance. Journal of Patient Care 2019, 5:1

Having a work/life balance also makes sense and enables psychologists to have the reserves to help

How do I know if a continuing education activity will be applicable to the NJ requirement?

All continuing education courses must be approved by one of the four organizations listed below, or by a provider approved by one of the four organizations listed below (i.e. NJPA is approved through APA. NJPA is now recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for NY licensed psychologists).

Approved Sponsors of NJ CE: 1. American Psychological Association; 2. National Register of Health Service Psychologists; 3. Association of State and Provincial Psychology Board; or 4. American Medical Association (ACCME is the facilitator of AMA approved content).

12

NJ Psychologist

Spring 2022

Pandemic Acquired Risk Avoidance (PARA): Considerations for Clinical Application, Public Education, and Research (1 CE)

Rosalind Dorlen, PsyD

Dorothy Cantor, PsyD

Bonnie Markham, PhD

Phyllis Tobin, PhD

Laura Barbanell, EdD

Zoe Verrico

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

Introduction

As the global crisis worsened, it became clear that the

The COVID-19 pandemic is a major health crisis that has

COVID-19 pandemic effects on mental health did not fit into existing models of post-traumatic stress disorder,

profoundly affected the world’s population and is associated with substantial outbreaks of disease and

generalized anxiety, social anxiety, or other traditional diagnostic categories. Those of us who were treating

adverse mental health consequences (WHO, 2020).

Since early in 2020, people have been bombarded with changing information and a great deal of misinformation

patients saw expressions of anxiety, fear, panic episodes, and fearful avoidance symptoms, which were not the initial presenting problems that caused them to

about the state of the virus, vaccines, treatments, and the efficacy of masking. According to the CDC (2020), rates of anxiety and depression among US adults were

seek psychotherapy. Our patients were expressing anxieties about their health, about returning to life as they previously experienced it, and demonstrating

about four times higher between April 2020 and August

phobic/avoidant responses facing that reality. In

2021 than they were in 2019. On January 6, 2021, Secretary of Health and Human Services, Xavier Becerra, reiterated the fact that a “public health emergency exists as a result of the continued consequences of the corona virus.”

response to these observations and early recognition of the mental health crisis, we decided to conduct a survey to understand more about how people were dealing with the evolving COVID-19 environment.

The researchers of this study also reported having many of the same feelings as their patients. This synchronicity was reminiscent of the period immediately after 9/11, when psychologists and other mental health professionals experienced many fears of terrorism and annihilation, just as their patients were.

Clearly, there were no useful existing models to describe patterns of avoidance and fears of connection or phobic responses to contemplating re-entry when the lockdown eased. To use DSM or ICD-10 nosology for these patients seemed to unnecessarily pathologize individuals whose personalities would not have predicted these responses. The phobic/avoidant

As a result of the lockdown, which had been imposed early in the pandemic, in-person psychotherapy was not possible and mental health services delivery consisted of using HIPAA compliant psychotherapy platforms with patients on a teletherapy screen. Five clinical psychologist colleagues began meeting as a peer group, once each week on a Zoom platform, for the purposes of helping each other learn more about practicing telemedicine, and sharing case material, observations, and experiences with a range of patients. The theoretical orientation of the psychologists was psychoanalyticallyinformed treatment, as well as cognitive/behavioral.

13

NJ Psychologist

Spring 2022

behavior appeared to represent a normal response to an unprecedented crisis.

healthcare, even when genuinely ill. At a broader societal level, health anxiety can lead to mistrust of public authorities and scapegoating of populations or groups (Sibley et al., 2020).

At the point in time in which the investigators conceptualized the research, re-entry to normal life was the primary pandemic-related issue because it appeared as if the pandemic was abating. Since then, the country has seen widespread, but not universal vaccination, several surges of different COVID-19 variants, mixed messaging from the CDC regarding masking and appropriate periods of isolation and with that, continued concern participating in activities outside of the home.

Many of the issues being explored during the Spring of 2021 are equally as pressing today as everyone navigates

In their study of the effects of the pandemic, the American Psychoanalytic Association COVID-19 Advisory Team (APsaA, 2021) reported on what they labeled Pandemic Trauma and Stress Experience (PTSE) and noted the deleterious effects the pandemic was having on individuals, families, and communities.

There is need for more evidence-based research into health anxiety/depression and its determinants, so that

the continued effects of the pandemic going forward.

valid individual and population-level strategies can be developed to minimize these in the face of the COVID19 pandemic. The mental health professions face both a

Literature Review

challenge and an opportunity; the challenge of Conceptual and empirical research on the psychological consequences of the COVID-19 pandemic is beginning to

addressing the numerous barriers and the limitations in obtaining quality mental health treatment, as well as

emerge (Rudolph et al., 2020; Sibley et al., 2020). Though

the opportunity to implement those suggestions or

there are few large-scale observational studies available to date, it has been evident that the COVID-19 pandemic

recommendations that are feasible at the local or regional level. The long-term mental health impact of

has led to a vigorous and multifaceted response from

COVID-19 may take quite a while to become fully

psychologists, psychiatrists, and allied professionals

apparent, and managing this impact requires concerted

(Rajkumar, 2020). Mental health is clearly being taken into consideration at multiple levels in the general

effort not just from licensed psychologists and other mental health professionals, but from the healthcare

population, among healthcare workers, and in vulnerable

system at large.

and underserved populations. Though evidence in the literature is not yet robust, there are numerous valuable

The current survey was developed to obtain data on

observations and suggestions for professionals working in this field, whether they are associated with independent practice, psychiatric or general hospitals, or agencies in the community.

how people, who reported greater levels of stress during the pandemic, were experiencing anxiety about complying with CDC recommended behaviors, and how avoidant behavior was demonstrated through increased reluctance to venture forth especially during the time period when the virus seemed to be receding and appeared to be safer.

As the number of patients affected by the pandemic increased, several researchers (Taylor et al., 2020; Jungmann & Witthoft, 2020) have discussed the mental health impact of COVID-19 from the perspective of health anxiety. Health anxiety arises from misinterpretation of perceived bodily sensations and changes and can be protective in everyday life (Hou et al., 2020; Lebel et al., 2020). However, during an outbreak of infectious disease, particularly in the presence of inaccurate or exaggerated information from the media and other data sources, health anxiety can become excessive. At an individual level, intensified health anxiety can manifest as maladaptive behavior, such as repeated medical consultation or avoidance of

Methodology The survey, What Has the COVID-19 Pandemic Meant to You? (See the survey here) was developed by the five clinical psychologists, with the assistance of a doctoral student (all authors of this article) in clinical psychology at the Rutgers Graduate School of Professional Psychology, and additional consultation with colleagues familiar with survey construction and design. The survey, using a Likert-style questionnaire (2012), was anonymous and distributed randomly by email

14

NJ Psychologist

Spring 2022

throughout the country to friends, associates, colleagues, neighbors, listservs, family, and community bulletin boards. Respondents were requested to distribute the survey widely among their various social networks and email addresses in their personal directories. The surveys were distributed and tabulated during the three-week period between March 24 and April 7, 2021. Nearly 800 respondents between the ages of 18 and 80 returned the completed survey from a wide swath of the US. Most responses included expository comments based on the question at the conclusion of the survey, “In the space below, please tell us about your concerns, if any, as you anticipate the end of the pandemic/resuming pre-pandemic

Overall, compliance with CDC recommendations was high among all age groups.

activities. There is no word limit, feel free to type as much as you would like.” These comments framed respondents’ subjective impressions and thoughts

reported that members of their family, or close circle, had died of COVID-19 by the time the study concluded.

about the lockdown and attitudes about re-entry and

To summarize the findings:

While it was anticipated that higher anxiety levels would be reported in the 60+ age group, a surprising finding was that while overall self-reports of anxiety increased during the pandemic, the highest stress levels reported were in the 20-40 age group, which comprised nearly 40% of the survey’s participants. In support of this finding, of the 5% of participants who self-reported being “very stressed and anxious” before the pandemic, the percentage jumped to 22% reporting feeling “very stressed and anxious” during the pandemic. Thirteen percent of total respondents

behaviors. By the time the questionnaire/survey was disseminated, many in the country had been initially

Overall, anxiety increased during the pandemic.

vaccinated and thus attitudes, as well as anxieties,

Self-reported stress levels of people were

about re-entry were uppermost in the media and in people’s minds.

reportedly higher and 38% of respondents, who reported being moderately stressed/anxious before the pandemic, were reporting themselves “more

Data analysis on the survey was accomplished using

stressed/anxious” during the pandemic. While only

Qualtrics, which enabled assessment and comparison of a number of variables and factors: self-reported

5% of participants self-reported being “very stressed and anxious” before the pandemic, the

levels of anxiety anticipating the resumption of pre-

percentage jumped to 22% of participants reporting

pandemic activities; relationship between self-reported stress and anxiety levels and compliance with CDC

that they were “very stressed and anxious” at the time they completed the survey.

recommended health-related restrictions; relationship between stress and anxiety levels related to riskavoidant behavior during the pandemic; gender differences; and vaccination status.

With reduced restrictions, there were increased self-reports of anxiety among younger (age 20-40) individuals. Given that some restrictions had been lifted, older respondents (age 61-80) regardless of gender, reported feeling “mildly stressed/anxious” and those in the 20-40 age groups were reporting greater stress about re-entry. Thus, an inverse correlation was noted between age and self-reports of anxiety, e.g., the older the respondent the less likely to report feeling moderately stressed and anxious about re-entry than those in the younger category.

The highest stress levels were reported in the “not yet vaccinated” group. Seventy-four percent of people, who reported feeling not “stressed and anxious” about re-entry, reported “having received or are planning to be vaccinated.” Those who reported feeling “stressed and anxious” about re-

Results A significant finding of this survey was the pervasiveness of re-entry anxiety associated with the return to pre-pandemic activities and normalcy. The researchers named this phenomenon, Pandemic Acquired Risk Avoidance (PARA), to distinguish it from the pathological anxiety disorders delineated in the ICD-10, or Pandemic Trauma and Stress Experience, the designation from the American Psychoanalytic Association COVID-19 Advisory Team. Fully 71% of the respondents self-reported feeling “stressed and anxious” about resumption of former activities while 21% reported feeling “not stressed or anxious at all.”

15

NJ Psychologist

Spring 2022

entry were less likely to be fully vaccinated or were anticipating their second dose and/or wanting an appointment, but having trouble finding one.

Overall women reported greater stress and anxiety than men. Men were more likely than women to report “less stress and anxiety” during the pandemic.

vaccination rates, better and more accurate information about transmission of the virus, declining rates of illness and death, and better public health messaging, it was predicted that the data would show that people would gradually return to their prepandemic level of functioning while incorporating some of the adjustments made to reduce risk.

Fifty percent of women respondents self-described as being “somewhat stressed/anxious” before the pandemic. This tendency of women to acknowledge or experience higher levels of stress than men has been acknowledged frequently in the literature (APA,

Unfortunately, we have yet to see the end of the pandemic. In fact, it has widened and increased, first with the Delta variant and more recently with Omicron.

While there have been fluctuations and reductions in

2010; Hou et al., 2020). Though they report similar average stress levels, women in the survey were

rates of transmission, our data indicates that many continue to perceive risk and uncertainty about venturing forth. During the transition from pandemic

more likely than men to acknowledge that their stress levels were on the rise.

There were gender differences in anxiety levels during the lockdown phase of the pandemic. While women reported greater anxiety about re-entry than

to endemic times there is likely to be continued risk and uncertainty around variants, surges, and other viruses that can be out of control. Issues remain

men, men tended to report greater anxiety during the lockdown phase of the pandemic.

including the need for continued vaccinations and boosters, the percentage of the population that needs

Respondents experienced loss of loved ones. In terms of loss, 13% of the total responded that members of their family or close circle had died of

to be vaccinated to reach community immunity (Barker et al., 2021) and clarifications of activities deemed to be safe.

COVID-19 since the pandemic began.

The anxiety individuals reported about returning to inDiscussion and implications The COVID-19 crisis had at least six key psychological

person activities, Pandemic-Acquired Risk Avoidance (PARA), was in response to the momentous global

challenges: Threats to health, for example, will I get sick, will someone in my family get sick?

public health crisis. Existential fears in the context of widespread political unrest, along with social isolation and the inability of many “to find a place and new

Uncertainty about the outcome, for example, if I or someone in my family gets sick, will we die or have long-haul symptoms?

Lack of control, for example, what if I lose my job or am unable to do my job?

Social isolation, including how long the isolation will continue, and particularly what isolation means to child development.

Loss of agency, including the feeling that one cannot do anything to change the course of the pandemic.

Loss and grief, as loved ones succumb to COVID-19.

friends” as one respondent wrote, is a daunting task.

Fears and other psychological symptoms of anxiety were reported across all age groups. The comments section of the study poignantly expressed the fears, hopes, and anxieties about venturing forth.

To cope with the psychological challenges ahead, many respondents shared that they had sought out psychological counseling and psychotherapy. PARA will likely subside as transmission rates decrease, however those continuing to experience significant anxiety and depression should consider reaching out for psychological help.

Each one of these challenges individually could cause people to become anxious and depressed. The researchers predicted equanimity in the face of all the stressors to be highly unlikely and, in fact, the data supported this prediction. As each of the stressors were reduced, such as, getting oneself vaccinated, increased

The important public education message that needs to be conveyed through the various media channels is that PARA may be a normal reaction on the path to a “return to life.” Thus, we hope to depathologize

16

NJ Psychologist

Spring 2022

lives and work lives to a greater extent than younger people. That may have also been a contributing factor.

In a report of a survey completed in January 2022, The New York Times (Leonhardt, 2022) reported that the 18-34-year-old respondents, a similar age group, are still feeling more anxious about personal risk.

reluctance to resume pre-pandemic activities and see it as a normal reaction to an abnormal set of circumstances rather than psychological dysfunction and pathology.

Importantly, since the pandemic started, there has been in an increased focus on mental health and various forms of mental health treatment. As we live through the pandemic and see its wide-spread psychological effects, mental disorders appear to be less stigmatized than they have been in the past, as indicated by myriad articles about stress, anxiety, and depression in the popular press and frequent television advertisements for mental health services.

Finally, there is the question of whether individuals who choose not to be vaccinated experience stress/anxiety in anticipation of being out in the world.

It would be important to compare their levels of anxiety to those people who are fully vaccinated and received a booster shot.

Treatment implications of the study for psychologists and other mental health professionals

Some survey respondents expressed gratitude about feelings of maturity and positive growth through the pandemic. Perhaps this is an example of post-traumatic growth (Collier, 2016; Tedeschi & Calhoun, 2016). Many respondents indicated they plan to rethink the workplace going forward and would like to embark on a hybrid model with a balance between work-at-home and at the office.

When individuals present for treatment of anxiety during and after the pandemic, it is important to distinguish between pathological anxiety and PARA. This would be akin to distinguishing between depression and expected grief in someone who has just experienced the loss of a loved one. Normalizing the grief helps the person tolerate it, knowing it will run a particular course. Normalizing PARA can have a similar

Clearly, there is need for further research to assess the scope of the pandemic’s impact on psychological wellbeing. It will be important for researchers to study the lasting psychological effects of having lived through such frightening times. We cannot know now what lingering anxiety or other symptoms will be evident.

effect. If patients aren’t worried about the fact that they are experiencing anxiety about what to do and not to do while the virus is prevalent, they will likely experience some relief.

How can the clinician ascertain whether this is PARA or a diagnosable anxiety disorder? These are some questions to consider as part of the initial intake.

This study focused on the variables of age and gender.

There is a need for further research into the mental health effects of the pandemic on varied population groups. In terms of the gender differences, which we observed between men and women, is there a relationship between women’s greater anxiety and the fact that more jobs were lost by women during the pandemic and that women had more childcare responsibility than men did (Pinho-Gomes et al, 2020)?

Have you experienced anxiety at other times in your life?

If so, under what circumstances?

If not, what is it about COVID-19 that causes you anxiety?

How has your anxiety impacted your behavior?

Do you have a way that you assess whether to participate in an activity? If so, tell me what it is. If not, can we devise a plan for evaluating risk?

What do you anticipate your anxiety level to be when the risk of COVID-19 has become less acute?

The results of this study indicated that the 20-40 age group experienced more stress and anxiety than older individuals. However, that may have been an artifact of the time period in which the study was done. Younger people were just becoming eligible for vaccination, and many had not yet been able to receive it. Once they were vaccinated, did their stress/anxiety levels diminish?

Additionally, that age group was disrupted in their social

If the patient is experiencing PARA, therapy may not be in order, particularly once there is a strategy in

17

NJ Psychologist

Spring 2022

place for evaluating risk. It will be up to the individual therapist and patient to make that determination. But what the treating psychologist should keep in mind is whether the presenting problem of PARA is the ticket

Leonhardt, D. (2022). Two COVID-19 Americas. New York Times, January 25, 2022. www.nytimes.com.

into therapy when there is actually some greater issue behind it.

Pinho-Gomes, A., Peters, S., Thompson, K., Hockham, C., Woodward, M., Carcal, C. (2020). Where are the women?

Likert Scales in Evaluation Survey Work - CDC https://www.cdc.gov › cb_february_14_2012.

Gender inequalities in COVID-19 research authorship. BMJ

Just as we are learning about long-haul cases of the disease, where physical manifestations are not resolving when the individual is no longer testing positive, there

Global Health, Vol 5, Issue 7. Http/dx.dol.org/10.1136bmigh2020-002922.

may well be long-haul psychological consequences both for those who did and did not actually have COVID-19.

the existing literature, Asian Journal of Psychiatry, 52, Article ID: 10266, https://dol.org/10.1016/J.ajp.2020. 102066.

Rajkumar, R.P. (2020) COVID-19 and mental health; A review of

Rudolph, C.W., Allan, B., Clarke, M., Hertel, G., Hirschi, A., Kunze, F., Zacher, H. (2020). Pandemics: Implications for research and practice in industrial and organizational psychology. Industrial and Organizational Psychology: Perspectives on Science and Practice. .http://dx.doi:org/10.31234/osf.lo/k8us2.

References American Psychoanalytic Association (2021). Resource Center for Psychoanalytic Education During COVID-19 (APsaA).

Pandemic Trauma and Stress Experience (PTSE) https://apsa.org/PTSE

Sibley, C.G., Greaves, L.M., Satherly, N., Wilson, M.S., Overall, N.C., Lee, C.H.J., Barlow, F. K (2020). Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward

American Psychological Association (2010). (https://www.apa.org/news/press/releases/stress/2010/ge nder-stress.pdf.

government and well-being. American Psychologist. Advance online publication. http://dx.doi.orgg/10.1037/amp//amp0000662.

Barker, P., Hartley, D., Beck, A.F., Oliver, G.H., Sampath, B. (2021). Rethinking Herd Immunity: Managing the COVID-19 Pandemic in a Dynamic Biological and Behavioral Environment.

NEJM Catalyst.

Taylor, S., Landry, C.A., Paluszek, Fergus, M.M., McKay, D., Asmundson, G. J. Gordon J.G., Asmundson, G.J.G.(2020)., Development and initial validation of the COVID-19 Stress Scales. Journal of Anxiety Disorders, May: 2020. Published online 2020 May 4. doi: 10.1016/j.janxdis.2020.102232.

Becerra, X. (2021). Renewal of Determination that a Public Health Emergency Exists April 15, 2021, Xavier Becerra, Secretary of Health and Human Services.

Tedeschi, R.T., Calhoun, L.G. (2016). Community-based

Center for Disease Control and Prevention. (2020). Coronavirus disease 2019 COVID-19) - Cases in US retrieved from https://www.cdc.gov/coronavirus/2019-ncov/casesupdates/cases-in-us.html.

laboratories for post deployment adjustment: A model. The Military Psychologist, 31, 6-10.

World Health Organization. (2020). WHO Director-General’s opening remarks at the media briefing on COVID-19 March 2020.

Collier, L. (2016). Growth after trauma. American Psychological Association, Vol 47, No 10. (https://www.apa.org/monitor 2016/11).

About the Authors

Hou, F., Bi, F., Jiao, R., Luo, D., Song, K. (2020). Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China: a cross-sectional

Rosalind Dorlen, PsyD is a board-certified licensed

study. BMC Public Health volume 20, Article number 1648 (2020).

Dorothy Cantor, PsyD is retired from clinical practice. She is a

psychologist/psychoanalyst in Summit, NJ. She is a former president of NJPA. former president of NJPA and APA.

Jungmann, S.M., Witthoft. M. (2020). Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic:

Bonnie Markham, PhD, PsyD is a licensed psychologist in

Which factors are related to coronavirus anxiety? Journal of

Phyllis Tobin, PhD is a licensed psychologist/psychoanalyst in

Anxiety Disorders. www.ncbi.nim.nih.gov.

Hillside, NJ.

Metuchen, NJ. She is a former treasurer of APA.

Laura Barbanel, EdD is a licensed psychologist/psychoanalyst

Lebel, S., Mutsaers, B., Timei, C. (2020). Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review of conceptualization, measurement, prevalence, course, and correlates. https://journals plos.org/plosona article journal.

in Brooklyn, NY. Zoe Verrico is a second-year graduate student at the Graduate School of Applied and Professional Psychology, Rutgers University.

18

NJ Psychologist

Spring 2022

The Impact of COVID-19 on Administering Standardized Assessments in Psychological Evaluations

Mariah Laster

Kai Primus-Dawson

David Brandwein, PsyD

Introduction

psychologist, is of vital importance. In order to

The COVID-19 pandemic has greatly impacted the

accomplish this vital goal, psychologists have turned to and depended on the COVID-19 guidelines issued by

psychological field, leading psychologists to face numerous challenges when providing services to their

the Center for Disease Control and Prevention (CDC).

clientele. While therapeutic modalities have been able to transition to virtual platforms (e.g., Zoom, doxy.me, etc.), the transition has been more fraught for psychological

The COVID-19 guidelines set forth by the Centers for Disease Control and Prevention (2022) have presented a unique set of challenges for psychologists that choose

evaluations. This includes, for some, psychological evaluations conducted in forensic contexts or other “high stakes” evaluations.

to administer assessments in-person. These guidelines include mask use, social distancing, screening tests, as well as in-depth cleaning and disinfecting protocols, which have caused difficulties involving both clinician

While conducting mental status examinations and interviews is certainly possible via virtual/telehealth platforms, psychologists who choose to administer standardized assessments as part of the evaluation process may decide against using virtual/telehealth platforms to administer these assessments. While assessment services such as Q-Global and PARiConnect permit psychologists to administer assessments via electronic means, psychologists may not want to truly give these assessments “remotely” (e.g., where the client is in one place and the psychologist is in another) due to concerns related to test security, the integrity of the assessment being administered, and the integrity of the psychological evaluation. However, if psychologists choose to administer in-person standardized assessments during this (or any future) pandemic, maximizing client and psychologist health, as well as the health of others associated with the client and the

and client accessibility, response clarity, and clinical judgment. The goal of this article is to discuss the challenges and limitations of in-person administration of standardized assessments during the COVID-19 pandemic and offer recommendations for best practice.

Accessibility Access to psychological assessments have decreased since the onset of the pandemic. Due to safety precautions and difficulties adhering to screening tests and cleaning and disinfecting protocols, many clinicians temporarily terminated in-person services and transferred to telehealth. Compared to therapy, assessments are not as feasible to conduct using an online platform. Many assessments require in-person interaction due to standardized administration procedures and practices, such as manipulation of

19

NJ Psychologist

Spring 2022

physical materials and clinical observation (Wright et al., 2020). While objective personality assessments typically require less interaction between the psychologist and the client due to the self-directed nature of these assessments and may be appropriate for remote administration, there are no evidence-based protocols for administering performance-based assessments, such as the Rorschach Inkblot Test, via telehealth. Also, cognitive and neuropsychological assessments are less feasible to administer via telehealth since they require the use of physical materials and face-to-face interaction. Farmer et al. (2020) reported that psychological assessments can be given via telehealth platforms and have reliable and valid results, yet it is important for these assessments to be normed or validated for an online format. While recent research suggests that some standardized assessments can be administered via an online format and offer results similar to those from in-person assessments, to the authors’ knowledge, none of these assessments have been normed or validated by the test publisher using an online format.

Response Clarity Rapport is an essential component of assessment procedures that requires response clarity. To build rapport, clinicians consciously engage in behaviors that most clients interpret as signs of interest and concern.

When done incorrectly, this technique is referred to as negative attending and reduces rapport (SommersFlanagan & Sommers-Flanagan, 2015). Due to mask mandates, clinicians may ask clients to repeat themselves more frequently because of muffled speech caused by masks. Asking clients to repeat responses could affect rapport due to negative attending. If a client is not comfortable with their clinician, they could feel awkward, nervous, or judged, which consequently may affect their ability to complete the evaluation in a valid fashion.

Additionally, clients may have trouble hearing clinicians clearly due to masks and social distancing. If clients cannot hear the clinician, this may result in the client having reduced engagement in the evaluation process and the evaluation not being a true reflection of the client’s psychological functioning. This is especially problematic if the assessment directs clinicians not to repeat items, such as during certain individually administered intelligence tests. Even if clinicians manage to speak clearly, clients who are hearing impaired could depend on lip-reading to communicate. Masks alter sounds and veil lips, significantly increasing communication challenges in

20

individuals with hearing complications while decreasing their willingness to engage (Saunders et al., 2021).

Clinical Judgment Clinical judgment pertains to analyzing presenting symptoms to determine appropriate treatment (American Psychological Association, n.d.), which is another domain that is affected by mask mandates. Wearing masks for long periods of time can increase restlessness, negative affect, and fidgeting. These attitudes and behaviors may not be typical for the client and impede accurate inferences from behavioral observations. Masks deny clinicians visual hints they use for more context (Ten Hulzen & Fabry, 2020), as well as reduce effectiveness of clinicians observing and interpreting clients’ facial expressions to assess affect. Moreover, if clients are mouthing or mumbling words, clinicians are unable to observe this due to the mouth being obscured. It is imperative for clinicians to maintain accurate records of relevant behavioral observations because these observations may be important to the overall findings from the evaluation. Clinical judgment is further disrupted by mask-use and social distancing, due to its potential impact on the reliability and validity of standardized assessments. As stated earlier, clients may not be able to fully hear or comprehend spoken directions, not only due to mask-wearing but also due to social distancing requirements. This would clearly affect validity of the standardized assessments due to the difference between the quality of the oral instructions offered to the examinee and the oral instructions that were offered during the standardization process. Finally, clinicians may also document inaccurate responses from clients due to failure to hear the client, which prevents the psychologist from completing an evaluation that presents the client’s true functioning level.

Emerging From the Pandemic Phase to the Endemic Phase, along with Suggestions for Best Practice At the time this article is being written, there have been many positive developments as it pertains to the COVID19 pandemic, both in New Jersey and elsewhere. After the surge involving the Delta and Omicron variants, there have been fewer cases and fewer deaths. Vaccines and boosters have been an immense help in this area, and the authors are thankful for the research and science that led to the development of these vaccines. Mask mandates have also been vanishing and, at the time this article is

NJ Psychologist

Spring 2022

being written, schoolchildren in New Jersey and other parts of the United States have been able to remove their masks while at school. These developments, as well as others not mentioned here, have enabled many psychologists to move back to full-time in-person practice. While some psychologists may require masks, others may not and it can start to feel like things are back to the way they were before the onset of the pandemic over two years ago. There certainly is reason for guarded optimism that society is in the process of transitioning from the pandemic phase of COVID-19 to the endemic phase of COVID-19.

For psychologists that can conduct psychological evaluations that involve standardized assessments, the authors suggest that these psychologists closely consider the risks and benefits of both telehealth/virtual evaluations and in-person evaluations. Psychologists and clients that are immune-compromised may hesitate to transition to in-person services and, as such, telehealth would be a reasonable and safe platform for these professionals and clients to meet to complete psychological evaluations.

Those psychologists that choose in-person services should consider the relevant points made by the authors as it pertains to mask-wearing and attempt to avoid any complications mask-wearing may present to completing a valid evaluation. For some, this may be reason, in and of itself, to move to an online platform to complete the evaluation.

References Furnished Upon Request About the Authors Mariah Laster is a first-year doctoral student at Kean University in the Combined School-Clinical Psychology PsyD Program. She aspires to become a forensic psychologist who specializes in civil ligation. Her research interests include psychology-law, personality assessment, and trauma.

Kai Primus-Dawson is a first-year doctoral student at Kean University in the Combined School-Clinical Psychology PsyD Program. She aspires to become a clinical psychologist who specializes in family dynamics. Her research interests include developmental disorders and interaction of family subsystems.

David Brandwein, PsyD is an associate professor at Kean University in the Department of Advanced Studies in Psychology and is the associate director of Clinical Training in the University's PsyD Program in Combined School-Clinical Psychology. He is also a licensed psychologist in New York and New Jersey and specializes in conducting evaluations in family court matters.

21

NJ Psychologist

Spring 2022

Some Ethical Considerations for Forensic Family Evaluations those affected by our professional actions. This includes the children in the family, as well as the opposing party. Further, Principle A tells us to be alert to and guard against personal, financial, and social factors that might lead us to misuse of our influence.

By Lidia D. Abrams, PhD NJPA Ethics Education and Resource Committee Member

Principle C tells us to have integrity, to be accurate, honest, and truthful in our professional work. The specialty guidelines for forensic psychology of the APA further tell us that forensic practitioners should strive to be unbiased and impartial, and avoid partisan presentation of unrepresentative, incomplete, or inaccurate evidence that might mislead finders of fact.

Finally, whether hired by plaintiff or defendant, New Jersey Court Rules (NJSA 5:3-3b) tell us that regardless of who hires us we should carry out nonpartisan evaluations, for the best interest of the child.

Psychologists serve a very important role in Family Court, performing forensic evaluations to determine the best interest of the children and families undergoing divorce and separation. In order to do this work, we should be familiar with the American Psychological Association’s Specialty Guidelines for Forensic Psychology (2011), with the Association for Family and Conciliation Courts’ Model Standards of Practice for Child Custody Evaluations (2006, under revision), and the New Jersey Administrative Code of the Board of Psychological Examiners, Subchapter 12 (2021).

Despite the legal and ethical expectations of our being unaffected by the interests of the side that hires us, attorneys and their clients, who have the option of using a shared or court-appointed evaluator, sometimes choose to hire their own expert, in the hopes likely, with the expectation that this expert will support their position. Research shows that experts in various settings do indeed tend to side with the party that hired them. Being hired by one parent fighting for custody puts us at risk for making biased assessments regarding the children’s best interests.

In the state of New Jersey, forensic evaluators may be court-appointed to carry out an evaluation, jointly chosen by the parties, or hired by one side, with another expert being hired by the opposing party. New Jersey is one of the last few states that allows parties going through a divorce to hire their own evaluator to help them gain custody of their children, rather than only using a court-appointed or jointly chosen psychologist.

This process, while maximizing the parties’ abilities to fight for their parental rights, also tends to complicate and lengthen the legal processes, often to the detriment of the children in the family. It further raises ethical issues for the professionals involved. This article will describe some of the ethical considerations of participating in this process.

In order to best fulfill the role of forensic psychologist, we should be aware of the research surrounding sources of bias in our work (guideline 2.01), and we should apply this knowledge to our professional activities (guideline 2.04).

Studies show that persons randomly assigned to Group A or Group B in various settings will tend to come to see their group and group members as better and more righteous than members of the other group and will make decisions biased in their own group’s favor. This

Although according to ethical Principle B, we are to maintain fidelity and responsibility to our client who hired us, Principle A, beneficence and nonmaleficence, tells us that our obligation to help and do no harm applies not only to the client who hired us but to all

22

NJ Psychologist

Spring 2022

has been conceptualized as role-induced bias (e.g. Eigen & Listokin, 2012; Engel & Glockner, 2013). More directly relevant to this topic, research with experts and with laypeople asked to play the role of experts hired by different sides of a case consistently show a robust effect of retention bias (Murrie et al., 2009; Murrie et al., 2013).

That is, the experts, as well as the subjects playing the role of experts, were significantly more likely to side with the party that they were told they were working for, even though they were randomly assigned to that side.

Financial incentives aside, study participants naturally aligned themselves with the group they were assigned to, their supposed retaining party, and this biased their interpretation of the facts in front of them in favor of their side.

The tendency of experts to favor their retaining party has been noted and recorded since the early 1900s (Hand, 1901). Experts hired by opposing sides are likely to interpret tests differently and diagnose persons differently, both to support their retaining side (e.g.

Murrie et al., 2009). This tendency has been explained through the adversarial mindset (Simon et al., 2020), in which the fact of being in an adversarial situation leads people to adopt biased views towards the situation and each other and make different decisions. The adversarial mindset involves a “my side bias,” in which we tend to have a favorable conception of our side, ourselves and others on the same side of the conflict, and an unfavorable conception of the opposing parties. We may develop hot, cognitive reactions to the situation and the parties on each side, involving positive feelings for our side and negative feelings and assessments of the opposing side, and, as a result of these processes, our judgments become skewed in ways that are self-affirming and self-serving for what we define as our side. This is accompanied by an “other side bias,” within which we view our counterpart’s position as biased about their own side and biased about the situation in the opposite way, towards supporting their own interests. The combination of the myside bias and otherside bias, existing on both sides, tends to escalate the adversariality of the situation.

This affects the parties in legal proceedings, and it has been shown to also affect the experts hired by each side.

The adversarial mindset primes us towards confirmation biases (Wason, 1960) in favor of the side that hires us. That is, we are likely to seek out, notice, and give more weight to facts in our client’s favor. Our client, or their attorney first approaching us, explaining the situation and putting their trust in us, tends to establish the primary

23

relationship. The anchoring effect tends to lead to us giving more weight to information we receive first (Friedlander & Stockman, 1983). This information lays the groundwork for a working hypothesis of the dynamics of the relationships in that family, from which point forward we will be at risk for confirmation bias, looking for information to support this initial hypothesis.

The opposing party being susceptible to the same adversarial mindset, may well play into our initial hypothesis of “our side” being the “better” side, as they may treat us with suspicion and maybe even hostility. This may lead us to dislike them and further work towards confirming our initial hypothesis in favor of the hiring party. Just as the feuding parties tend to have suspicion, hostility, and bias against each other, it appears difficult for experts to escape this strong human tendency to take sides.

Becoming aware of our potential biases will help us overcome them. Implicit biases are non-conscious, but they can be brought into consciousness with knowledge and honest self-reflection. If hired by one side or the other, ethically we must strive to be non-partisan.

Taking a step back to examine the goal of custody evaluations, it is not to dissect past mistakes of the parties, but rather to determine the best interest of the children moving forward. Research (Warshak, 2014; Braver & Lamb, 2018) and New Jersey Law (NJSA 9:2-4) both indicate that, barring ongoing abuse or neglect, children benefit from having ample time with each parent.

Families going through the very difficult time of divorce benefit from a speedy and fair dissolution, all along maintaining the children’s relationships with each parent.

Having two, or sometimes more, psychologists battling out the best interests of the children adds a layer of adversariality, increases the cost of the divorce, and extends the time the divorce proceedings will last. The medical and educational needs of vulnerable children may not be properly addressed and may worsen while custody responsibilities remain in dispute. Absent early resolution, children caught in the middle of parental feuding are vulnerable to developing polarized cognitions about the feuding parents, taking the side of one and becoming increasingly detached from the other. Reunification therapy is often ordered in such cases where children become alienated from one parent and refuse and resist dynamics set in, but these services are often too late and unsuccessful (Greenberg & Schnider, 2020).

NJ Psychologist

Spring 2022

Contentious divorces are potentially traumatic and can become Adverse Childhood Experiences or ACEs (Centers for Disease Control and Prevention, 2019), which are correlated with many negative short- and long-term outcomes for the child, including drug abuse and alcoholism, suicide, violent/criminal behavior, depression, STDs, fetal death, sexual abuse, and chronic physical illness. The potential alienation from one parent, and even loss of a parent as a result of an extended, acrimonious custody battle, is yet another potential ACE. Summary of Best Practices

9. We should use processes likely to decrease bias, such as meeting with both parents together initially, and spending equal amounts of time interacting with both parties.

10. If at one point in the evaluation process we realize that our conclusions are not favorable to the client who hired us, we should make them aware of this immediately to give them the choice of not paying for the completion of a report that will not be helpful to them.

References Furnished Upon Request

The best practices below derive from the ethical principles and guidelines noted above, as responsibilities to the retaining parties and others are immediately affected.

About the Author

1. We should be informed about the research surrounding the harm caused by extended, adversarial divorces.

2. We should be informed about the prevalence of and sources of bias, implicit, and otherwise.

3. New Jersey law and our ethics tell us that, regardless of who hires us, we should carry out unbiased evaluations. We should strive to do so, being aware of the research on bias and being mindful of our thought processes.

4. As ethical psychologists, we would do well to advocate systemically for a process our science tells us is beneficial for most families, a more streamlined process including as little redundancy as possible, using one qualified, unbiased evaluator.

5. If approached to serve as one side’s evaluator in a custody case, it would be ethical, and in that family’s best interest, to explain the benefits of cooperation and conciliation, and the benefits of using a shared evaluator.

6. Early in the process, we should clearly and convincingly explain to prospective clients that whether hired by them or the other party or by both, we will endeavor to use the same process and be nonpartisan, and that our recommendations may not be in their favor.

7. We should offer our services as a shared evaluator.

Depending on circumstances, or as a matter of routine practice, we may decline the job of evaluator for one parent versus the other.

8. If the client insists on using us as their own expert, and we agree, we should proceed to conduct speedy and fair evaluations, being as unbiased as possible, seeking to include both parents in the child’s life rather than excluding either.

24

Dr. Lidia Abrams has a forensic and clinical private practice and is the executive director of Resolve Community Counseling Center, Inc. Resolve is a nonprofit mental health organization in Scotch Plains serving surrounding communities and Union County Family Court.

NJPA Ethics Education & Resource Committee Consultations The NJPA Ethics Education and Resource Committee offers free, confidential consultations, 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.

Complete a request for an ethics consultation: Once your form is submitted, it will be reviewed by an Ethics Committee member and they will reach out to you.

Consultation Request form 8 Important Member Practice Resources A licensee shall preserve the confidentiality of information obtained from a client pursuant to and compliance with the NJ Board of Psychological Examiners Regulations and laws.

NJ Psychologist

Spring 2022

COVID and the Rapid Changes in the Landscape of Mental Health Services: What We Need to Know as Private Practitioners to see their therapists, this was another change that we had to work very quickly at to make happen.

Marketing was turned on its head. We used to go into schools and mental health organizations and do presentations, but everyone stopped meeting in-person.

We used to staff information tables at conferences, but there were no conferences. We would visit physician offices and other professional offices, bring them goodies and brochures and tell them of our services, but no one was in their offices. Parents would talk to each other and refer to therapy services through word of mouth, but they were not meeting at soccer games or playgrounds, or school-related functions.

By Allen Weg, EdD

The delivery of mental health services, in this country, has been going through a major transformation. COVID has changed the way we do business. Nationwide companies, like Talkspace and BetterHelp, have changed the way people find and receive therapy. And now, a New Jersey law that just went into effect in November, will be a game-changer for New Jersey licensed psychologists throughout the state.

With the eventual advent of virtual conferences, we not only found new ways to get more training, but we became able to “virtually table” at these online conferences. We developed private Facebook groups for collegial contact and support. We updated our websites, focused more on social media for marketing purposes, sent out E-Newsletters and emails to colleagues and other potential referral sources. We developed new ways of providing online therapy with screen sharing and the use of whiteboards to engage and connect better with even our youngest patients. We reinvented ourselves.

Over the last two years, running a psychology practice in New Jersey, as has been the case for many small businesses, has required multiple pivots and intense resiliency in order to survive. Initially experiencing a complete shutdown when COVID hit in earnest in March 2020, psychologists had to recreate how they provided services, leaving their offices empty and learning how to deliver therapy services over the Internet, now commonly called, “telehealth.”

Next, for the first time, and again turbo-charged by the social effects of COVID, large, sometimes multi-national companies began to spring up, offering lower-cost mental health services, accepting most insurances (something many private practice psychologists do not do), presenting with very large advertising budgets, and having hundreds of therapists on their payroll. On the one hand, these companies offer a great opportunity for persons struggling with mental health issues to avail themselves of more affordable care. On the other hand, licensed psychologists worry about the quality of these services with regards to the help that patients are actually getting, and if the widespread availability of these online services will impede or, at the very least, delay the consumer from finding the proper highly specialized care that many patients often need. Educating the public about the

We had to negotiate with our professional liability coverage to make sure we were protected in the same way as when we provided in-office therapy, and we had to solicit political representatives to make sure they supported insurance parity for our patients so that our patients had insurance coverage for services equal to when they saw their therapist in the office. Many practices had clinical staff members that included student externs or interns, or those that did have their doctorates, but were not yet licensed, and were practicing under the supervision of more seasoned psychologists. These early career psychologists were prohibited in New Jersey from providing services, or being supervised, via telehealth. With patients waiting

25

NJ Psychologist

Spring 2022

potential differences in the level of therapeutic care, and helping them learn how to become more discerning “shoppers” for therapeutic services, has become another new role for those of us in small, mental health practices.

with other PSYPACT states who may be marketing to New Jersey consumers in need of mental health services. They may also be searching for new talent among NJ licensed psychologists, who, if providing telehealth services, experience no difference whether their online services are being afforded to persons located in New Jersey or in any other PSYPACT state.

Overall, we have prevailed, and for most small psychological practices the challenge has been procuring more talent in an employee-favored marketplace, as our waiting lists swell with patients waiting to be treated. And now, the latest change to rock our professional world unfolded here in New Jersey, when it became the newest state member of PSYPACT.

Overall, these changes in mental health delivery, namely, the ubiquitous availability of telehealth, lower-cost online services from national companies, and inter-jurisdictional practice along state lines, all serve to provide more options and access to those who may be psychologically suffering. This is a good thing. From the perspective of those in psychological practice, these changes have strengthened our business acumen by challenging us to face our own anxieties, teaching us to be more flexible and creative, and ultimately, demonstrating that we can recreate ourselves. How ironic, as these are the very lessons, after all, that we strive to impart to our own patients.

PSYPACT is the Psychology Interjurisdictional Compact that allows for a psychologist who is licensed in a PSYPACT state, to now practice across borders through telehealth, to persons located in any other PSYPACT state. On Nov 23, 2021, New Jersey effectively became the 24th PSYPACT state in the country. This means that anyone who lives in, or travels to, any of those other 23 PSYPACT states can now be seen via telehealth by a New Jersey licensed psychologist.

About the Author Dr. Allen Weg is a New Jersey licensed psychologist. He is founder and executive director of Stress and Anxiety Services of New Jersey, an independent group practice specializing in individual, as well as group, cognitive behavioral treatment of anxiety disorders in children, adolescents, and adults, with offices in East Brunswick and Florham Park. Allen is also co-founder and past-president on the Board of Directors of OCD New Jersey, an affiliate of the International OCD Foundation, where he is a member of the Scientific and Clinical Advisory Board.

For psychologists, marketing is once again turned on its ear. Now, we can not only reach out to those who might benefit from our services from all over the country, but we can search for new talent located in other PSYPACT states to join our practice and provide telehealth to New Jersey residents, without needing them to become licensed in New Jersey, a process which historically involved considerable time and expense. On the flip side, we are now in competition

26

NJ Psychologist

Spring 2022

2020/2021 Social Advocacy Open Topic Dissertation Grant Recipient Highlight The NJPA Foundation

By Mathias Hagovsky, PhD NJPA Foundation President The NJPA Foundation is the

of NJPA.

The Foundation Board is proud to highlight 2020/2021 Social Advocacy Open Topic Dissertation Grant Recipient, Cindy Chang, PsyM, and her work on Buffers Against the Effect of Discrimination on Mental Health in Sexual Minority Individuals. Mx. Chang, a doctoral student at Rutgers, The State University of New Jersey, recently defended her dissertation successfully, and is now analyzing project data and preparing a submission

Cindy Chang, PsyM

to formally publish Suicide and Life-Threatening Behavior. Mx. Chang is currently a psychology intern at the VA Puget Sound, in Seattle, Washington.

survey at baseline, one-month follow-up, and twomonth follow-up assessing constructs related to IPTS, the minority stress model, and SI.

In addition to other grant opportunities, the NJPA Foundation provides the Social Advocacy Open Topic

Results: Over half of our sample (52.9%) reported any SI

Dissertation Grant to doctoral level graduate

at baseline. In the full sample, all types of minority stress at baseline were significantly associated with SI at two-month follow-up via perceived burdensomeness

psychology students enrolled in a New Jersey doctoral level psychology program, to support the process of a student’s doctoral dissertation, which may, or does,

(PB) and thwarted belongingness (TB) at one-month follow-up. In the bisexual+ subsample, all bisexualspecific minority stressors at baseline were

impact underserved populations of New Jersey.

Information and applications for this grant opportunity are available on the NJPA website and accepted on a rolling basis throughout the year.

significantly associated with SI at two-month follow-up via PB at one-month follow-up; internalized binegativity was also associated with SI via TB. However, effects became non-significant when controlling for previous levels of the mediators and outcome variables.

Conclusion: Both minority stress and IPTS are relevant for understanding suicide risk among sexual minority young adults.

Buffers Against the Effect of Discrimination on Mental Health in Sexual Minority Individuals By, Cindy Chang Introduction: Sexual minority young adults are at increased risk for suicidal ideation (SI) compared to heterosexual young adults. Though several frameworks exist to explain the development of suicide risk, including the Interpersonal Theory of Suicide (IPTS) and the Minority Stress Model, few studies have examined these frameworks simultaneously. This study examines these frameworks longitudinally among sexual minority young adults.

Learn about the NJPA Foundation, and grant opportunities at www.psychologynj.org/njpafoundation. We need your support to continue to fund future psychologists dedicated to working with underserved populations. Easily donate to the NJPA Foundation using this Foundation Donation Form.

Methods: A total of 792 sexual minority young adults (50% bisexual+, 50% gay/lesbian) completed an online

27

NJ Psychologist

Spring 2022

NJ Psychologist

Spring 2022

Book Review: Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0 Edited by Diana Fosha, PhD Accelerated Experiential Dynamic Psychotherapy (AEDP) places the relationship between client and therapist, and the provision of feedback about the relationship, in the forefront of the therapeutic process, and gets quite specific about that nonspecific factor. Two decades after the publication of The Transforming Power of Affect, Diana Fosha’s manifesto that was AEDP’s birth announcement, AEDP is now taught by a faculty of 20 psychotherapists and practiced on six continents. Recently Fosha and her collaborators have issued Undoing Aloneness & the Transformation of Suffering Into Flourishing: AEDP 2.0. This new volume, more than 400 pages long with contributions by 13 members of the AEDP Institute faculty, provides a broader and deeper presentation of both the theory and practice of AEDP, and incorporates recent advances in research on interpersonal neurobiology, memory reconsolidation, attachment, positive psychology, therapeutic presence, the role of the body in the understanding and treatment of trauma, and the psychology of resilience and emotional growth.

Reviewed by Ben Susswein, PhD

While the empirical findings of research on the outcome of psychotherapy demonstrate that psychotherapy is effective, there is no clear understanding of why psychotherapy is effective. The quality of the therapeutic relationship, that “nonspecific factor,” is often identified as the most robust predictor of the outcome of treatment, more than specific variables such as the modality of therapy, amount of supervision, or the years of experience of the therapist. “Positive regard,” acceptance, warmth, empathy, support, the Rogerian notion that has been invoked in research examining the benefits of the therapeutic relationship, does not, to my mind, definitively differentiate the psychotherapeutic relationship from a relationship with a close friend, bartender, hair stylist, or even a Golden Retriever. The outcome research on “evidence-based therapy” thus provides us with generic affirmation, but not useful information. A more nuanced and fine-grained understanding of what is unfolding in each session between therapist and client might yield what Scott D. Miller has termed “therapy-based evidence” that can be translated into action. Miller is a zealous advocate of “feedback-oriented treatment,” to monitor the quality of the therapeutic alliance during the course of therapy.

An elevator speech summarizing the theory and practice of AEDP would require a pretty long ride, but the view from the top, when you get there, is worth it, in my opinion, and being mindful of the reader’s time I will type this as quickly as I can. Over the past two decades, Fosha and collaborators have developed a relational and attachment-based account of psychological functioning under conditions of either safety and social connection, or threat and isolation.

Safety and connection allow for what Fosha has termed “transformance,” the inherent tendency for growth and flourishing, while threat and isolation

29

NJ Psychologist

Spring 2022

elicit “resistance,” which is AEDP-speak for the functional prioritization of survival over growth.

Transformance and resistance are the yin and yang of

the client’s anxiety through warmth and affirming words and expressions (lots of paraverbals: “mmm,” “I see,” “oh, yes”) and calls attention to somatic

psychological existence, expansive and warm expression of emotion as opposed to contractive and cold inhibition and defense. Secure attachment and the activation of transformance generate adaptive affective states characterized by a sense of vitality, spontaneity,

manifestations of suppressed emotion (“Did you notice how you smiled when you said you were angry at your boss?” and “What are you aware of in your body right now?”) to soften or bypass defenses.

and agency (which Fosha describes as “feeling and dealing while relating”). Attachment difficulties, from selective misattunement to wholesale abandonment, engender resistance, manifested in psychological

“Processing emotions to completion” is the first target of the AEDP therapist, a goal shared by therapists of various psychodynamic and experiential persuasions, but she does not stop there. AEDP is all about “making

difficulties that include either over-regulated and restricted awareness of emotion (“dealing but not feeling”) or insufficient regulation of emotion (“feeling

the implicit explicit.'' And, here’s where the feedback comes in. In the afterglow of the intense release of contacting and expressing a long-repressed or

but not dealing, or just reeling”), and either limited relatedness to others or an excessive need of support and affirmation from them.

dissociated core emotion, the “metaprocessing” that ensues is therapeutic pillow talk that promotes the integration of the experience. The therapist may ask,

Fosha sees a safe and secure therapeutic relationship as

“So what was it like to have that experience?” and “What was it like to have that experience with me?”

not only a necessary precondition for a “corrective emotional experience,” to use Franz Alexander’s apt phrase, but is in fact the corrective emotional

Metaprocessing underscores both the personal and the relational significance of the experience, prompting the client to reflect on and savor the sense of coherence

experience. While therapeutic interpretations might explain suffering, they may not relieve it, and the

and personal truth that emerges from processing long suppressed emotions to completion as well as the

expression of inhibited emotions may provide temporary relief, but neither cognitive insight nor

experience of vulnerability and intimacy with safety and clear boundaries. Metaprocessing had only a cameo in

catharsis will necessarily lead to conflict resolution and characterological repair. AEDP turns Freud on his head, with the target of treatment not the emergence of

“The Transforming Power of Affect,” but has been promoted to a leading role in AEDP 2.0. Fosha has developed a granular, and exquisitely nuanced,

transference, but of the activation of transformance, facilitated by the reality of a secure attachment to the person of the therapist herself, rather than fantasies about her. Fosha and her collaborators note that the provenance of this perspective on psychotherapy can be traced all the way back to the seminal work of two of Freud’s dissenting disciples, Sandor Ferenczi and Otto Rank.

description of the states and transformations of state that unfold during the therapy session, from initial dysregulated anxiety or over-regulated defense against feeling, to the experience and expression of “core emotions” with the ensuing relief, and, in the course of metaprocessing, a sense of mastery and vitality, along with compassion for oneself, gratitude, and an awareness of personal truth that emerge with the experience of the “core-self.”

To create the secure therapeutic partnership, the AEDP therapist has to be much more active than a reactive and reflective Rogerian, and she requires the client to do some hard work as well, responding to her “pressuring with empathy” to face the “intolerable aloneness” of living with unexpressed and inexpressible emotion. Through attuned “moment to moment tracking” of the therapeutic interaction, the AEDP therapist slows down the dialogue and both reduces

But wait, there’s more. Metaprocessing can entail not only inquiries by the therapist about the client’s experience, but also disclosures by the therapist about the therapist’s own experience in the session and her feelings about what has just transpired. The AEDP therapist is encouraged to express her own delight in the ongoing process and progress. Fosha stipulates that “neutrality is actually contraindicated.” Psychoanalyst

30

NJ Psychologist

Spring 2022

Peter Fonagy defines “mentalization,” the ability to represent other persons and their emotional states, as “existing in the mind of the other.” Fosha ups the ante, asserting that the client must feel he exists “in mind and the heart of the therapist.” While in most other psychotherapeutic paradigms, traditional or contemporary, the therapeutic relationship is a means to the end for the application of specific techniques – cognitive, expressive, or behavioral – in AEDP, specific techniques are means to the end of deepening the therapeutic relationship through metaprocessing.

When self-disclosure is embedded in the course of metaprocessing, both the therapist’s response to the client and its impact on the client are made is explicit, and it tests and expands the client’s ability to take in positive experiences. It seems to me that the iterative process of metaprocessing is a powerful means of generating feedback and solidifying the therapeutic relationship, at least under certain conditions. It does risk blurring the boundary between a therapeutic relationship and a friendship, or at least expanding the boundary of the therapeutic relationship.

least on holidays. The therapeutic attachment is a bit more complicated, and perhaps unique; the goal of the therapeutic relationship is to make the relationship obsolete or redundant, not simply more differentiated, culminating in termination. While attachment is the central theme of the volume, only one contributor, Eileen Russell, addresses agency and individuation, and termination does not seem to have been addressed. SueAnne Piliero, another of the contributors to “AEDP 2.0,” has said in another context that the therapist is “not your friend, but your way to new and deeper friendships,” which is a very useful distinction that perhaps should be made more explicit.

“AEDP 2.0” articulates a bold and thoughtful reimagining of the therapeutic relationship, expanding (and sometimes exploding) previous paradigms. I suspect that some of you will be curious, some intrigued, and some quite uneasy and skeptical, if not completely dismissive. If nothing else, this approach might provoke some interesting discussions about our complex and complicated profession, which is, in the words of psychoanalyst Adam Limenati, written 44 years ago and still relevant today, “not only impossible but also extremely difficult.”

Fosha and her collaborators assert, quite rightly, that attachment is not a stage but a precondition for healthy functioning, taking different, developmentallyappropriate forms over the entire lifespan. The developmental goal of attachment is perhaps better characterized as individuation and differentiation, rather than separation, growing up and moving out, but not necessarily moving on, and continuing to come to dinner on every Sunday, or at

About the Reviewer Ben Susswein has maintained a private practice, in Montclair, NJ, since the late 1970s, conducting individual, couples, and family therapy, and has accepted the fact that practice does not make perfect, but he’s still trying.

Classified Ad Office Space: Waldwick, Bergen County Several offices available, both furnished and unfurnished, in relatively new construction therapist building (fully handicap accessible) with many recent upgrades in Waldwick, Bergen County. Safe location in residential area, abundance of off-street parking in large on-site parking lot, shared waiting room with kitchenette provided (full sized fridge, microwave, table for therapists private use). Easy access from Rt. 17, as well as local roads. Several therapists-tenants have been here for 14 years since the building was constructed and because they are very satisfied and have no reason to leave this very comfortable collegial environment with therapists frequently referring to each other in our little internal network. You are invited to become a potential future long term therapist-tenant-colleague (the landlord is also a psychologist with his practice at the location) as part of the premier professional office space for therapists not only in Waldwick, but throughout all of Bergen County! Please call or text for more information regarding specific offices and to arrange a visit: 973-669-0909.

31

The NJPA Referral Network

Become part of our in-demand network of providers: Be a part of the solution!

During the pandemic, individuals seeking mental health services skyrocketed. The expansion of telehealth services enabled many individuals to access the critical services psychologists provide creating a high demand for referrals.

In 2021, our Find a Psychologist network was accessed over 14,000 times, a 13% increase over 2020. Your unique blend of specialized services, orientations, practice area expertise, and foreign language proficiency will help us successfully assist our diverse populations, throughout NJ, who are often conducting frustrating searches for practitioners who meet their needs.

Are you a licensed NJPA member? Consider joining our network today!

(Free for all NJPA Sustaining Members/reduced rate for newly licensed members)

Welcome New Members!

Licensed 5+ years

Licensed 2 - 5 years

Laurie Appel, PsyD Christopher Barker, PhD Carol Christofilis, PsyD Daniel Chung, PsyD Dinorah D'Auria, PsyD Nathalie Edmond, PsyD Arlene Gordon, PhD Melissa Katz, PsyD Jennifer Kelly, PhD Stuart Kurlansik, PhD Ashley Lyden, PsyD Yeraz Markarian, PhD David Masur, PhD Joel Nunez, PhD Yadira Sanchez, PhD Joel Sneed, PhD Diane Snyder, PhD

Audrey Halpern, PsyD Darren Lumbard, PhD Diana Zamora, PhD

Non-licensed doctoral

Students

Elizabeth Seebode, PhD Melissa Starr, PsyD

Louise Athens, BA Mary Isaac Cargill, BA Jeannine Ederer, BS Yosr Elsobky, MS Jaclyn Hammond, MA Jolisa Johnson, BA Brittany Juncosa, MA Gladys Martinez, EdM Alison McCann, BA Daniel Muhlbach, MA Moshe Selengut, BS Leah Teichberg-Sabath, BA Casey Theriault, BS Stephanie Urzi MS Zoe Verrico BA Erica Vieira MA

Associate Carissa Fresco, MSW

Licensed < 2 years Adrienne Abramowitz, PhD Rebecca Edelsberg, PsyD Margaret Edwards, PsyD Julia Hodgson, PsyD Saba Khan, PsyD Nohelani Lawrence, PsyD Marissa Norman, PsyD Alisha Thom-Hayes, PsyD Laura Venuto, PsyD Matthew Zakreski, PsyD

33

1st year post-doctoral Jenna Landrigan, PsyD Lindsey Leiman, PsyD Melissa Miller, PsyD

Non-Resident Patrick Meade, PhD

Find your dream job on the NJPA Career Center!

Have you been thinking about what’s next on the horizon for your career?

The NJPA Career Center can help you discover the opportunity of your dreams.

Sign up for job alerts and you’ll be notified by email as soon as jobs matching your criteria are posted.

Serious about finding the perfect job? Take the next step and create a profile and upload your resume and watch as employers contact you with jobs that match your unique qualifications! Visit https://careers.psychologynj.org/ to get started.

Resources to help you find and land your dream job: 3 Qualities You Should Be Looking For In Your New Employer

How to Get the Referrals You Want For Your Job Application

What Should You Know Before the Interview?