Spring NJ Psychologist 2023

Spring 2023 | Volume 73 | Number 2

NJ PSYCHOLOGIST The Professional Journal of the New Jersey Psychological Association

In this issue: President's Message Trifecta (1 CE) Ethical Concerns in American Football: Examining the NFL’s Response to Game-Related Head Injury and Treatment of Concussion in Players Toxic Narcissists Abusing, Controlling, and Gaslighting Our Clients: The Divisive Effects of Media on Our Clients’ Relationships APA Council of Representatives Report Book Reviews: The Zen of Therapy: Uncovering the Hidden Kindness in Life & Why I Am Not A Buddhist ...and more!

Executive Board President: Briana Cox, PsyD President-Elect: TBD Past-President: Peter DeNigris, PsyD Secretary: Alexandra Miller Clark, PsyD Treasurer: Marc Gironda, PhD Parliamentarian: Bonnie Markham, PhD Members-At-Large: Elio Arrechea, PhD Daniel DaSilva, PhD Jane Simon, PhD Alex Gil, PsyD Lauren Gerardi, PhD Deirdre Waters, PsyD

Contents 2

Executive Director Update

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President's Message

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Trifecta (1 CE)

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Ethical Concerns in American Football: Examining the NFL’s Response to Game-Related Head Injury and Treatment of Concussion in Players

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APA Council of Representatives Report

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NJPA Foundation Community Service Program Grants

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Welcome New Members!

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Book Reviews: The Zen of Therapy: Uncovering the Hidden Kindness in Life

by Mark Epstein

APA Council Representative: Rhonda Allen, PhD Special Representatives: ECP Chair: TBD NJPAGS Chair: Jaclyn Hammond Affiliate Caucus Chair: Phyllis Bolling, PhD CODI Co-Chairs: TBD Executive Director: Sara Tedrick Parikh, PhD Director of Professional Affairs: Susan C. McGroarty, PhD Affiliate Organization Representatives: Essex/Union County Association of Psychologists: William MacLaney, PsyD Northeast Counties Association of Psychologists: Alison Winston, PhD Mercer County Psychological Association: Loraine Washton, PhD Middlesex County Association of Psychologists: TBD Monmouth/Ocean County Psychological Association: TBD Morris County Psychological Association: Sarah Dougherty, PsyD Somerset/Hunterdon/Warren County Psychological Association: TBD South Jersey Psychological Association: Ange Puig, PhD

Why I Am Not A Buddhist

by Evan Thompson

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Toxic Narcissists Abusing, Controlling, and Gaslighting Our Clients: The Divisive Effects of Media on Our Clients’ Relationships

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2023 NJPA Hybrid Spring Conference

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Are You Ready? CE Homestudy Library

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96 and Counting

We're here to help!

Central Office: 8:30 am – 4:00 pm Phone: 973-243-9800

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NJPA Executive Board Call for Nominations

STAFF CONTACT INFORMATION Executive Director: Sara Tedrick Parikh, PhD njpaed@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: Susan McGroarty, PhD Consultation Request (login required)

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NJPA Annual Awards Call for Nominations

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NJPA Referral Network

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The NEW NJPA Career Center is Here!

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 Staff Liaison: Christine Gurriere

NJ Psychologist

Spring 2023

Executive Director Update

By Sara Tedrick Parikh, PhD NJPA Executive Director

I know I look good, but it’s been hard.

and Drs. Cox and McGroarty pitched in to show my kiddo that the characters (and Mama) were having a great time in our nation’s capital. We are grateful for the working relationships we built during PLC, and our only regret was that we didn’t have more delegates to share it with. I am already looking forward to attending PLC next year, and I hope to bring a full delegation of President, President-Elect, Diversity Delegate, Early Career Psychologist Delegate, Federal Advocacy Coordinator, and DPA. PLC is an opportunity to learn more about the role of SPTAs within the profession, understand APA’s current priorities, and identify ways to create change back home with NJPA.

APA President, Dr. Thema S. Bryant, had us 2023 Practice Leadership Conference (PLC) delegates look at each other and say these words out loud. These words also serve as an apt description of NJPA. The last few years have been difficult as the association navigated the pandemic, two executive director transitions, a new website, and volunteer fatigue. We have continued to govern, advocate, serve members, develop new leaders, and offer robust continuing education, but it has been hard.

PLC is when leaders from many State, Provincial, and Territorial Associations (SPTAs) come together to Washington, DC, to discuss major issues facing the field and our individual associations. It also provides an opportunity for those of us in one-of-a-kind NJPA roles, such as President, Director of Professional Affairs (DPA), and Executive Director (ED), to speak with our counterparts in associations of varying sizes and locations.

In years past, PLC culminated in a day on Capitol Hill. This year, the APA Advocacy Day training and Hill event took place virtually on March 26-27th. This year’s priorities include Medicare policies to increase access to psychological services, including those provided by advanced psychology trainees, and federal investments in the mental & behavioral health workforce. I met with the offices of Senator Cory Booker (D-NJ) and Representative Mikie Sherril (D-NJ-11), who represents portions of Essex, Morris, and Passaic counties. If you are interested in legislative advocacy, Advocacy Day is a tangible, time-limited commitment (typically one day of training, some portions with CE credit, and one day of about 3 half-hour Hill visits, ideally with staff from the offices of your own senators and representative). In 2024, I hope to bring Advocacy Day delegates from at least three of New Jersey’s 12 Congressional districts, and I would love for you to be one of them.

We were a small but mighty delegation: 2023 NJPA President, Dr. Briana Cox, Director of Professional Affairs, Dr. Susan McGroarty, and Executive Director, Dr. Sara Tedrick Parikh. I enjoyed seeing Dr. McGroarty in her element: In addition to stopping every 10 feet or so to greet yet another person she has collaborated with in her work for NJPA members, Dr. McGroarty was elected to be the co-chair for the DPA meetings and a co-liaison between APA and the DPAs. One thing that struck me was how APA is tracking developing issues and proactively helping SPTAs monitor and prepare a response; the full schedule of topics can be found here. SPTAs shared ideas for membership growth, advocacy, and effective governance and leadership. Topics included specific practice issues such as licensure and reimbursement, as well as bigger conversations about how to focus on our core values and market psychologists as the people who know the science.

At PLC, Dr. Bryant had us say one more thing out loud to each other: I see you in your future, and you look much better than you look now. I believe that’s going to be true for NJPA, too. Join us on committees and task forces, at the Spring Conference and Foundation Social Hour on April 28th, and at our other events throughout the year. Continue having rich, moving discussions on the LISTERV, and also using it as your go-to resource for professional questions, referrals, and announcements. We have worked hard to build what we have in NJPA, and we will continue to do the work to become better.

As the NJPA delegation, we also remembered how good it is to be together in-person and especially to break bread together.

While walking to dinner the first night, we got so caught up in conversation that we walked 15 minutes past our turn and had to call an Uber to make our reservation! I brought along some characters from my 5-year-old’s favorite Mo Willems books,

Sara Tedrick Parikh, PhD

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President's Message

By Briana Cox, PsyD NJPA President NJPA has had been through a lot of changes in the last three years. One of the more important things I learned at PLC this year is that we are not alone in our challenges.

Like us, several associations have lost their executive directors, and a majority have had difficulties with membership recruitment, and volunteerism. We talked a lot about what was causing this: Burnout from the pandemic? Lack of relevancy to younger members? Not enough time? Shifting priorities? It’s unclear, but by anecdotal report, it is rampant across the country. In some ways, it was a relief to hear that we are not alone.

On the other hand, the problems feel significant and insurmountable. If other states haven’t figured it out, how will we?

The excitement continues at NJPA this Spring! I am very much looking forward to this year’s Spring Conference, Hot Topics in Psychology, on April 28th at the Hanover Manor in East Hanover. I am endlessly grateful to our Council on Continuing Education Affairs (COCEA) for their dedication to the highest quality programming. I hope that you will join us for this conference that was created specifically in response to members’ suggestions about what they wanted to learn more about. The conference includes dynamic programming on forgiveness therapy, MDMA assisted therapy, virtual reality therapy, and gender diversity in children and adolescents. I want to thank COCEA for their commitment to getting NJPA members back together inperson and, thanks to COCEA, this year NJPA will be offering its first Spring Social Hour. I hope that you will come and spend some time catching up and networking. A portion of the proceeds will benefit the NJPA Foundation.

A strong state psychological association is essential to the survival of our profession. That cannot be understated.

NJPA volunteerism fuels advocacy for our profession and the public we serve. One trend that is holding steady: younger psychologists want their SPTAs to prioritize advocacy. This was a major focus in my early career meetings in 2016 and I heard it over and over in the presidents' meetings in 2023. In order for STPAs to remain relevant and worth it for younger psychologists, SPTAs have to be willing to advocate for the social issues they

In March, NJPA leaders had the opportunity to attend APA’s 40th Annual Practice Leadership Conference (PLC). I first attended PLC in 2016, as NJPA’s early career delegate. That seems like a little lifetime and many pandemic seasons ago.

And actually, it kind of was. My kids were babies when I left them for 4 days to attend PLC in Washington, DC, that year.

Now one is off to middle school and the other is in third grade. Much has changed—in our lives and in our world.

care about.

With that said, I am incredibly interested in hearing from students and ECPs. If you have ideas, concerns, time to share your thoughts, time to volunteer, I promise, I want to hear about it. You are welcome and needed at the table.

We need to know about your experiences and how NJPA

This time around, I had the honor and pleasure of spending most of my time at PLC with other SPTA presidents. Most of the SPTA presidents from the United States and Canada were in attendance. I came away from the presidents’ meetings energized by what I learned and with so many ideas for future collaborations. One of the most helpful things to come out of our meetings were informal presentations about what was going particularly well in some SPTAs. Several SPTA presidents generously provided detailed information about how they solved certain problems, grew their membership, and succeeded in advocacy.

can serve you in your professional lives in the future. Here is my email: Briana.L.Cox@gmail.com. Please feel free to reach out. Or, even better, come say “hello” in-person at the Spring Social Hour after the conference!

Briana Cox, PsyD

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Trifecta (1 CE) “Life is one damn thing after another”' --Attributed to Mark Twain, ca. 1908

By Francisco Ramos, MS, PA-C, CAQ (Psychiatry)

By Daniel P. Greenfield, MD, MPH, MS, FASAM

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

Introduction: Although the health professions have been deluged in the past several years with the consequences of war and conflict, inflation, climate change, racial injustice, public safety, women's reproductive rights, health disparities, and political conflicts, the "trifecta" of the current crisis, driven to a large extent by COVID-19, is (1) The effects of COVID-19 itself; (2) An increase in opioid and other substances abuse and overdose; and (3) An increase in domestic violence ("Intimate Partner Violence", or "IPV"). Figure 1 illustrates the relationships and interactions among these three elements of the "Trifecta."

Figure 1 The Trifecta

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In this paper, we will (1) Review epidemiologic aspects of these three elements of the "Trifecta"; (2) Discuss the mechanisms and linkages among the three elements; and (3) Propose therapeutic ways in which psychologists and other mental health professionals can address these difficult problems.

epidemic, the World Health Organization declared the SARS-CoV-2 outbreak to be a pandemic, and worldwide morbidity and mortality increased dramatically (Coronavirus/Definitions, Features, and Examples, 2022).

Over the ensuing months, variants of the virus occurred, with differing levels of infectivity and mortality. By late 2020, vaccines became available to increasing numbers of people. One result of vaccination, in combination with other public health control measures (such as masking, quarantining, social distancing, and the like), was a reduction in the severity of COVID-19-related illness, reduced hospitalizations, and reduced deaths even in the elderly and those at risk. The virus remains prevalent, however, and its consequences may include both obvious and subtle neuropsychiatric and psychosocial effects.

The Trifecta: SARS-CoV-2 "...there is probably no species of organism which has not at some time been host to a parasite or a parasite itself...

Infectious disease is universal..."

--F. Burnet and D. White, 1972 Residuals of one of the most devastating pandemics of all time, the Great ("Spanish") Influenza of 1918, may be gone after more than a century (Barry, 2018), but its scope and effects have been apparent to the current world through the COVID-19 pandemic. That viral infection began in Wuhan, China in late 2019, and spread rapidly, virulently, inexorably, and in several clinical strains and changing strains, throughout the world. The effects and aftermath of the COVID-19 pandemic have included, broadly, extensive international morbidity and mortality, unimaginable economic consequences, wideranging and serious clinical consequences (such as the “long COVID syndrome), and, for present purposes, extensive emotional, interpersonal, and psychosocial damage.

Initially, COVID-19's effects on humans were felt to be primarily respiratory. However, as time and experience with the virus continued, associated symptomatology came to be seen as multisystemic, including the nervous system, both in acute and long-term manifestations (“long-haul COVID," or "long COVID") (Shaw, October 2022). Neuropsychiatric/neurocognitive, gastrointestinal, cardiovascular, orthopedic and rheumatologic, chronic pain, chronic fatigue, headaches, and a variety of related unremitting symptomatology may be associated with "long COVID" on a chronic basis.

After likely existing in one form, variant, strain, or another, almost since life began, a particular coronavirus' in the taxon (family) Coronavividae, related to two earlier such viruses, "SARS" ("Severe Acute Respiratory Syndrome” in 2002) and “MERS”(“Middle East Respiratory Syndrome” in 2012), began in late 2019, in Wuhan, China. However, this virus was much more virulent, contagious, damaging, and, at first, unstoppable than SARS or MERS. This virus was named "Severe Acute Respiratory Syndrome Coronavirus 2 ("SARS-CoV-2"), was similar to SARS, was primarily thought early on to cause respiratory and febrile symptomatology, and the illness it caused came to be called "COVID-19” (“19” after the year when the virus was first noted: 2019). The rest of the recent history of COVID-19 is well known: after only a few months of the onset of the COVID-19

The Trifecta: Substance Abuse A review article in this journal, (Fall, 2018), prior to the COVID pandemic, (Labins, 2018) described several psychotropic agents used for treating opioid abuse, without referencing the extent of the national opioid crisis leading up to that time (about 40,000 opioid overdose deaths that year). However, within the following several years, reports in the APA Monitor (Abramson, 2021) noted that "Opioid and stimulant use are on the rise...,'questioning'...how can psychologists and other clinicians help a greater number of patients struggling with drug abuse?" The numbers and manifestations are staggering (Seervai, 2022).

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Figure 2 Substance Use Disorders and Emotional Disorders during the Covid Pandemic

In these and other sources, a variety of causes and factors is given as bases for these distressing patterns and data:

been well documented: Substance use has been found to co-occur in 40% to 60% of IPV incidents across various studies (Easton, 2006). In the National Crime Victimization Survey, 43% of the victims of IPV reported the perpetrator had been under the influence of drugs (Klostermann & Kelley, 2009). Half of the men in batterer intervention programs appear to abuse alcohol or drugs, approximately half of the men in treatment for substance abuse batter, between a quarter and half of the women in treatment for substance abuse have been battered, and a substantial proportion of the women in IPV programs are substance abusers (Peitzmeier, 2001).

Isolation/lack of personal contact (early on in the pandemic) (Crowe et al., 2022) Self-medicating (anxiety and depression) with substances (especially alcohol) Reduced access to treatment, including counseling and psychotherapy (early on in the pandemic) Reduction in availability of SUD treatment services resulting from diversion for COVID treatment Financial losses from unemployment and unwillingness to work because of potential exposure to COVID Uncertainty, anxiety, stress, loss, and other such expectable, predictable, and not necessarily pathological responses to all these stressors

Concerning the influence of COVID-19 on IPV, evidence suggests that the COVID-19 pandemic has exacerbated rates/severity of IPV. For example, an online general population survey found that a majority (64.2%) of individuals who experienced IPV since COVID reported that the IPV was new to the relationship (34.1%) or of increased severity during COVID-19 (26.6%) (Peitzmeier, 2001). This data presents a strong relationship between IPV, substance use, and the COVID-19 pandemic: The "Trifecta."

The Trifecta: Intimate Partner Violence ("IPV”) Substantial empirical data exists describing the relationship between intimate partner violence (IPV), substance use, and COVID-19 pandemic. According to the Centers for Disease Control and Prevention, independent of COVID-19 involvement, about 1 in 5 women and nearly 1 in 7 men report having experienced severe physical violence from an intimate partner in their lifetime; about 1 in 5 women and 1 in 12 men have experienced contact sexual violence by an intimate; and 10% of women and 2% of men report having been stalked by an intimate partner (Preventing Intimate Partner Violence, CDC Factsheet, 2021). In addition, the correlation between IPV and substance dependence has

Intimate partner violence includes physical and sexual violence, stalking, and/or psychological aggression. IPV begins early in the lifespan and is associated with multiple risk factors. In an effort to combat this crisis, the CDC has published Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies and Practices targeted at preventing/ mitigating IPV. All of these points lead to the profound interplay between IPR and substance abuse, exacerbated by the current COVID-19 pandemic (Preventing Intimate

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Partner Violence, CDC Factsheet, 2021).

all patients.

What Clinicians Can Do: COVID Patients

Second, to the extent applicable, direct opioid-using patients toward medical providers who can use medication-assisted treatment ("MAT") also recognizing the value of MAT for such patients.

Although geared primarily for psychologists, readers of this journal, several general principles of treatment/therapy, psychological and physical, have become clear during the several years of the COVID pandemic.

Third, while the status of the "X-waiver" (Khatri, 2020) permitting providers to prescribe an opioid treatment agent, buprenorphine (various forms) for addicted individuals is in flux, (Becerra, 2021) that approach (“Medication-Assisted Treatment," or "MAT"; also known as "Medication for Opioid Use Disorder," or "MOUD") to opioid treatment ought to be encouraged by nonMAT/MOUD clinicians, as just noted.

First, given the rise in psychopathology and demand for services, telehealth can be the “answer." As described earlier, many therapists and their patients have begun with and/or switched to virtual sessions, with good results. Virtual psychotherapy/treatment was well underway before the pandemic: The pandemic has assured the continuation and expansion of that treatment modality.

The types of behavioral treatment approaches used by psychologists, e.g., cognitive behavioral therapy (“CBT”), can be useful specifically for patients using stimulants (such as cocaine and amphetamines) (Abramson, 2021).

Second, given the prevalence of loneliness during the quarantine early phase of the pandemic and the likelihood of further quarantining in subsequent waves of new variants of the pandemic, the importance of teletherapy is even further underscored.

Finally, the use of naloxone and the maintenance of that opioid blocker by psychologists in their practice settings (available as a nasal spray, carried by police officers and other first responders, and available through pharmacies) can be lifesaving for overdosed patients (Naloxone Drug Facts, 2022).

Third, as also discussed below, the importance of medication assisted treatment (“MAT”) or, in the case of opioid abuse, "medication for opioid use disorder” (“MOUD”) for individuals with SUDs, is also underscored.

Psychologists/psychotherapists are well advised to be aware of this important modality for their patients.

What Clinicians Can Do: Intimate Partner Violence (“IPV”) First and foremost, it is imperative that clinicians evaluate all patients for intimate partner violence, regardless of healthcare setting or delivery system.

Recommendations for the prevention of IPV noted in the CDC's Preventing Intimate Partner Violence Across the Lifespan: A Technical Package of Programs, Policies, and Practices, include teaching safe and healthy relationship skills, engaging influential adults and peers, disrupting the developmental pathways toward partner violence, creating protective environments, strengthening economic supports of families, and support survivors to increase safety and lessen harm (Preventing Intimate Partner Violence, CDC Factsheet, 2021). Prevention plays a vital role in mitigating the risk of IPV. However, healthcare professionals often encounter victims after a pattern of IPV has already been established. If suspected, healthcare workers are considered mandatory reporters, and therefore must abide by the procedures and laws

Fourth, and last, again in terms of SUD patients, the traditional weekly individual session may not be enough for patients, especially those in quarantine with excessive time on their hands: "...coordinate care with other providers as needed... intensive outpatient care...virtual community support groups..." ("Psychologists Report Large Increase...," 2020).

Flexibility in treatment planning is key.

What Clinicians Can Do: Substance Abuse Focusing again on the psychologists'/psychotherapists' role in addressing the needs of SUD patients during the time of COVID, several points ought to be made.

First, recognize the increased prevalence of serious SUD during COVID-19, especially opioids and opioid overdose deaths, and include substance abuse history-taking for

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put forth by one's own jurisdiction. In addition to reporting an incident, treatment of comorbid psychiatric and substance use disorders is imperative. The mental health consequences of IPV can be severe and include posttraumatic stress disorder (PTSD), depression, anxiety, and eating disorders. IPV is also a major cause of mortality due to suicide and homicide (Ellsberg & Emmelin, 2014).

American Psychological Association. (2020). Psychologists report large increase in demand for anxiety, depression treatment [Press release]. https://www.apa.org/news/press/releases/2020/11/anxietydepression-treatment

Summary and Conclusions

Burnet, M., & White, D. (1972). Natural history of infectious disease. (4 ed).

Barry, J. M. (2018). The Great Influenza: The story of the deadliest pandemic in history. Penguin Random House.

Becerra, X. (2021). Practice guidelines for the administrative of Buprenorphine for treating opioid use disorders. Federal Register.

In the face of what seems like innumerable and insuperable problems in today's world, this CE article focuses on the "Trifecta" of COVID-19; substance abuse and overdose; and intimate partner violence ("IPV"), all closely interactive and interrelated, and synergistic with one another.

Britannica, T. Editors of Encyclopaedia (2023, September 28). coronavirus. Encyclopedia Britannica. https://www.britannica.com/science/coronavirus-virus-group Crowe, C. L., Liu, L., Bagnarol, N., Fried, L. P., and Bagnarol, N. (2022).

Loneliness prevention and the role of the public health system.

Perspectives in Public Health, 10.1177/17579139221106579 Easton, C. J. (2006). The role of substance abuse in intimate partner violence. Psychiatric Times, 23(1), 25-25.

In the initial three parts of this article, we review salient features of the Trifecta's component, citing data, trends, scope, and other such aspects of the Trifecta: the "diagnosis."

Ellsberg, M., & Emmelin, M. (2014). Intimate partner violence and mental health. Global health action, 7, 25658. https://doi.org/10.3402/gha.v7.25658

In the second three parts of this article, we review clinical approaches to the amelioration of the elements of the Trifecta, especially from the perspective of the psychologist: the "treatment."

Khatri, U. G., & Perrone, J. (2020). Opioid Use Disorder and COVID-19: Crashing of the Crises. Journal of addiction medicine, 14(4), 6–7. https://doi.org/10.1097/ADM.0000000000000684 Klostermann, K., & Kelley, M. L. (2009). Alcoholism and intimate partner violence: Effects on children's psychosocial adjustment.

International journal of environmental research and public health, 6(12), 3156–3168. https://doi.org/10.3390/ijerph6123156

However, we do not wish to suggest or imply that psychologists operate from their respective silos, doing only what psychologists do. Rather, we suggest cooperation, coordination, and collaboration among healthcare providers, to minister to the serious and various needs, psychological and physical, of Trifecta patients.

Labins, Z. W. E. (2018). The role of medication and psychologistsphysician collaboration in treating substance abuse disorders. NJ Psychologist, 68(3), 12-15.

National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. (2022). <nida.nih.gov.> Peitzmeier, S. M., Fedina, L., Ashwell, L., Herrenkohl, T. I., & Tolman, R. (2022). Increases in intimate partner violence during COVID-19: Prevalence and correlates. Journal of interpersonal violence, 37(21-22), NP20482-NP20512.

And that's a lot of people!

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

Psychologists Report Large Increase in Demand for Anxiety, Depression Treatment, APA Monitor (online): <www.apa.org/news/press/releases/2020/11/anxiety-depressiontreatment>. Accessed August 17, 2022.

References

Seervai, S. (2021). It's really, truly everywhere: How the opioid crisis worsened with COVID-19. The Dose. Apple Podcast.

Abramson, A. (2021, March 1). Substance use during the pandemic.

Monitor on Psychology, 52(2). https://www.apa.org/monitor/2021/03/substance-use-pandemic

Shaw, J. (2022). The long COVID Conundrum. Trying to understand infections' persistent effects. Harvard Magazine. 1(124). 28 - 31.

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Ethical Concerns in American Football: Examining the NFL’s Response to Game-Related Head Injury and Treatment of Concussion in Players

By Jaclyn Hammond, MA Chair, NJPAGS

Over the course of the 2023 National Football League (NFL) season, fans and spectators alike watched from the sidelines as team personnel and league administrators displayed what, at times, has appeared to be an inconsistent approach to the health and treatment of the games’ professional athletes. This has been characterized by a general disregard for the concussion protocols put in place to protect the brain health of their athletes, and to help ensure their overall safety. Throughout the 2023 season, perhaps no player was more affected by this apparent approach than Miami Dolphins quarterback, 24-year-old Tua Tagovailoa.

indicating severe damage in the brain (Davis & Lauletta, 2022). Tagovailoa was eventually taken off the field on a stretcher and transported to a hospital with reported head and neck injuries. Only then was it determined that he would sit out the next two games.

Tagovailoa later told reporters that he was unconscious after hitting the ground and still had no memory of anything that happened immediately after his head struck the turf (Foster, 2022). Three days later, the Dolphins announced the firing of the unaffiliated neurotrauma consultant (UNC) who evaluated Tagovailoa during the Week 3 game (Shaw, 2022).

In December 2022, Tagovailoa suffered his third concussion of the season in a Week 16 game against the Green Bay Packers (Rivera, 2023). During the tackle, he was hit from behind and below the waist, causing the back of his head to hit the turf as he fell to the ground (Gordon, 2022). Tagovailoa was not removed from the game and instead continued to play (Rivera, 2023). It was later confirmed that he had sustained a head injury after reporting concussion-like symptoms to team doctors the following day (Gordon, 2022).

Since September 2022, Tagovailoa has sustained several serious game-related injuries. Most notably, in the Week 3 matchup against the Buffalo Bills, Tagovailoa was reported to have suffered a back injury during the first half of the game, although the Dolphins had initially suggested it was a head injury (Gordon, 2022). Immediately following the hit, Tagovailoa appeared unsteady and disoriented, stumbling to his feet before collapsing to his knees after taking a few steps (Shaw, 2022). Despite this, Tagovailoa cleared the NFL’s concussion protocol shortly after and was subsequently returned to play to finish out the second half of the game. Dolphins’ head coach, Mike McDaniel, later reported that Tagovailoa had injured his back in the first half and that the injury was made worse by an additional hit later on (Rivera, 2023).

Both the NFL and NFL Players Association (NFLPA) have committed to a review of the league’s concussion protocol, recently modifying the protocol by adding the term “ataxia” (lack of muscle coordination and control) to the mandatory “no-go'” symptoms, thereby prohibiting the athlete from returning to the game (Gordon, 2022). And yet, the question remains whether this addition to the protocol will be enough to bring about an improvement in player safety. Perhaps a more immediate change can be brought about through UNCs, the neurotrauma consultants hired by the NFL and NFLPA to work with team physicians to identify, screen for, and diagnose concussions (Shaw, 2022).

Four days later, during a Week 4 matchup against the Cincinnati Bengals, Tagovailoa was sacked again in a similar hit during the game’s first half, when he was tackled to the ground with his head making contact with the turf field. Tagovailoa did not get up and instead became rigid, showing signs of decorticate posturing, a primitive brain response to trauma often

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Based on the terms of the agreement between the NFL and the NFLPA, there must be three UNCs present at each US professional football game (two on the sidelines and one in a booth above the field). As for their qualifications, the requirements specified in the concussion protocol are broad: UNCs must have documented competence and experience in the treatment of acute head injuries; and should be “board certified in neurology, emergency medicine, physical medicine and rehabilitation, or any primary care CAQ [certificate of added qualification] sports medicine certified physician or board eligible or board certified in neurological surgery” (Shaw, 2022). Requiring that one of the three UNCs be either a neurologist, neuropsychologist, clinical or health psychologist may be one way that the NFL can help to mitigate the risk of missing the subtle behavioral changes that a more qualified individual with additional expertise in this specific area would have noticed.

For nearly 60 years, research on the biomechanics of head impacts and concussion in American football has led to advances in sensor technology making it possible to collect on-field head impact data (Rowson & Duma, 2020). The last 15 years have seen a spike in scientific interest regarding the potential long-term effects of football-related repetitive concussive and sub-concussive blows on cognitive aging (Schaffert et al., 2022). Exposure to repetitive head impacts (RHI) in contact sports, especially, has led to a growing concern (Karton et al., 2020).

A substantial percentage of concussions go unrecognized, are widely under-reported, and many of the deficits stemming from the long-term consequences of RHI do not appear until years later (Karton, et al., 2020). Furthermore, athletes are often much less likely to come forward with reporting lower-grade concussions, due to a lack of recognition surrounding the seriousness of the impact or not correctly identifying the symptoms of the hit as being associated with concussion (Rowson & Duma, 2020).

Additional findings have suggested that increased head impact exposure can actually make athletes more susceptible to additional concussions, and that RHIs of lower severity may still result in adverse neurologic consequences that may lead to neurodegenerative changes later in life (Rowson & Duma, 2020).

A prime example of this is chronic traumatic encephalopathy (CTE)—a degenerative brain disease often described in association with the brains of contact sport athletes, military veterans, and other individuals with a history of repeated traumatic brain injuries (TBI), which can include concussions and sub-

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first. This population so often consists of studentathletes. Thus, the priority should be ensuring that their intellectual abilities and academic futures are not compromised due to poor role modeling, misguided medical advice, or inadequately enforced safety protocols that inevitably trickle down to the younger competition levels.

concussive hits (Concussion Legacy Foundation, 2022).

Characterized by deficits in areas related to cognitive, motor, and psychiatric functioning (Karton, et al., 2020), CTE can only be conclusively diagnosed after death via brain autopsy (Concussion Legacy Foundation, 2022). Professional football in the US is presently correlated with some of the highest rates of documented concussions and accounts for the highest number of cases of CTE diagnosed post-mortem (Karton et al., 2020).

References Concussion Legacy Foundation (2022). What is CTE? https://concussionfoundation.org/CTE-resources/what-is-CTE

Given what we know, how is it that the NFL is permitted to continue operating in this way making decisions at the expense of its players’ brain health?

Too often we see sports teams and leagues seemingly making corporate cost-benefit analyses associated with decision making to continue playing an injured athlete—a choice between protecting the player and securing a win. With players’ brain health hanging in the balance, this dilemma begs an additional question: how much change can be affected with any revision to the concussion protocol if the protocol continues to be deprioritized and/or not enforced? And what example does this set for all of the children, adolescents, and young adults playing this sport while their brains are still developing?

Davis, S. & Lauletta, T. (2022, September 30). A concussion expert says Tua Tagovailoa’s stiffened hands were ‘primitive’ response that suggests damage to brain’s cortex. Insider. https://www.insider.com/tua-tagovailoa-decorticateposturing-bengals-chris-nowinski-2022-9 Foster, M. (2022, October 19). Tua Tagovailoa reveals he doesn’t remember being carted off the field after concussion. CNN. https://www.cnn.com/2022/10/19/sport/nfl-tua-tagovailoaconcussion-spt-intl/index.html Gordon, G. (2022, December 26). Dolphins QB Tua Tagovailoa in concussion protocol after showing symptoms on Monday. NFL. https://www.nfl.com/news/dolphins-qb-tua-tagovailoa-backin-concussion-protocol-status-uncertain-vs-patri Karton, C., Blaine Hoshizaki, T., & Gilchrist, M. D. (2020). A novel repetitive head impact exposure measurement tool differentiates player position in National Football League. Scientific Reports, 10(1), 1-14. doi:10.1038/s41598-019-54874-9

In 2017, a Boston University study looked at the brains of 202 deceased American football players, ranging from high school to professional levels (Mez et al., 2017). Based on the findings, CTE was found in 87% of them; 21% of the high school football players, 91% of the college players, and 99% (110 out of the 111) of the professional football players studied were shown to have CTE in their brains. And despite symptoms not typically appearing until years after the head impacts, CTE has been diagnosed in individuals as young as 17 (Concussion Legacy Foundation, 2022).

Mez, J., Daneshvar, D. H., Kiernan, P. T., Abdolmohammadi, B., Alvarez, V. E., Huber, B. R., Alosco, M. L., Solomon, T. M., Nowinski, C. J., McHale, L., Cormier, K. A., Kubilus, C. A., Martin, B. M., Murphy, L., Baugh, C. M., Montenigro, P. H., Chaisson, C. E., Tripodis, Y., Kowall, N. W., … & McKee, A. C. (2017).

Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. Jama, 318(4), 360370. doi:10.1001/jama.2017.8334 Rivera, J. (2023, January 15). Tua Tagovailoa injury history: A complete timeline of injuries for Dolphins QB. Sporting News. https://www.sportingnews.com/ca/nfl/news/tua-tagovailoainjuryhistory/1jkj193wgdml41xpwcfsdkg1nf#:~:text=%E2%80%94%20D ecember%202022%3A%20Tagovailoa%20suffers%20his,throws% 20three%20second%2Dhalf%20interceptions.

Professional athletes from all contact sports (not just football) put their bodies and their minds on the line each time they step on the field or enter a game.

Though they are paid employees, knowing full well what kind of job they signed up for, they are also people working hard to build their futures and support their families. They deserve to be treated with respect for their health and not as an expendable commodity existing solely for the enjoyment of their shortsighted employers and the insatiable spectators. As for the children and younger populations currently active in the sport, it is the duty and responsibility of the adults around them (parents, coaches, athletic trainers, team physicians, etc.) to ensure that safety is always put

Rowson, B., & Duma, S. M. (2020). A review of on-field investigations into the biomechanics of concussion in football and translation to head injury mitigation strategies. Annals of Biomedical Engineering, 48, 2734-2750. doi:10.1007/s10439-02002684-w Schaffert, J., Didehbani, N., LoBue, C., Hart Jr, J., Motes, M., Rossetti, H., Wilmoth, K., Goettea, W., Lacritz, L., & Cullum, C. M. (2022). Neurocognitive outcomes of older National Football League retirees. Brain Injury, 36(12-14), 1364-1371. doi:10.1080/02699052.2022.2143567 Shaw, G. (2022, November 17). Neurologists on the sidelines: The sports neurotrauma consultant: What they do, how they train, and liability risks. Neurology Today, 22(22), 16-17. doi:10.1097/01.NT.0000904352.88139.21

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APA Council of Representatives Report Establishment of a Committee for the Advancement of General Applied Psychology The Council voted 144-13, with one abstention, to amend the Association Rules to establish a Committee for the Advancement of General Applied Psychology.

The committee’s purpose will be to promote, in settings outside the direct delivery of health care services, the utilization, application, and advancement of science where psychologists work to enhance performance, learning, and well-being of individuals, groups, organizations, and society as a whole.

By Rhonda Allen, PhD APA Council Representative

The Council of Representatives of the American Psychological Association of Representatives held a hybrid meeting, with most Council members convening in person in Washington, DC, on February 24-25, 2023.

Adoption of Policies The Council unanimously adopted revised APA Principles for Quality Undergraduate Education in Psychology and approved December 2032 as the expiration date. These principles offer best practices that faculty members, programs, and departments can adopt to facilitate student learning and development, in ways that fit their institutional needs and missions.

This document is designed to complement, and to be used in conjunction with, the APA Guidelines for the Undergraduate Psychology Major.

The following is a summary of the major decisions and votes at this meeting. Some of what is reported below is excerpted from a meeting summary provided to council members from APA. Confidentiality and Reproductive Health The Council passed a policy asserting that confidentiality is central to the practice of psychology, and that psychologists should follow the APA Ethics Code when it comes to patient confidentiality surrounding reproductive health. The policy reaffirms “that a psychologist’s allegiance to the Ethics Code, including ethical standards related to patient confidentiality, should be given the utmost attention and significance especially when psychologists are faced with ethical conflicts with a law requiring the disclosure of confidential information regarding sexual and reproductive health, including birth control; fertility treatment; contemplating, seeking, or having had an abortion; and related issues.”

The Council voted by 151–4, with one abstention, to adopt Educational Guidelines for Equitable and Respectful Treatment of Students in Graduate Psychology Training Programs. These guidelines encourage graduate psychology programs to promote the equitable and respectful treatment of graduate students throughout their education and training so that students may fully benefit from their graduate education and maximize their potential within and beyond their graduate programs.

The Council adopted a resolution on Equity, Diversity, Inclusion, and Accessibility in Quality Continuing Education and Professional Development by a vote of 139-8, with two abstentions. This resolution is aimed at providing CE sponsors and the broader public evidence-based recommendations to support the integration of equity, diversity, inclusion, and accessibility in continuing education. The policy may be used as a foundation to develop additional resources that build on this document and provide tangible support to CE sponsors to infuse EDIA thoughtfully and intentionally in their offerings.

The vote was 148-4, with one abstention. This measure follows on a resolution the Council passed in February 2022 reaffirming APA’s commitment to reproductive justice as a human right, including equal access to legal abortion, affordable contraception, comprehensive sex education, and freedom from sexual violence, with a particular emphasis on individuals from marginalized communities.

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Amendments to Association Rules

to First Peoples in the United States. This report builds upon APA’s Apology to People of Color for APA’s role in Promoting, Perpetuating, and Failing to Challenge Racism, Racial Discrimination, and Human Hierarchy in the US, which the Council adopted in October 2021. The offer of apology to First Peoples will be delivered by the APA president to the Society of Indian Psychologists at a time and place to be determined jointly with the SIP leadership. The report was received by a vote of 148-2, with three abstentions.

The Council voted 147-2, with four abstentions, to amend the Association Rules to modify the review process for Board of Director member-at-large candidates and to apply that review process to all other members of the Board of Directors. Changes include asking prospective candidates, upon being slated, to disclose to the Election Committee claims made against them within the last 10 years for malpractice or unethical or unprofessional conduct, or if they are currently the subject of criminal indictment. The Election Committee will then evaluate the disclosures and determine whether the candidate can remain on the slate. The decision of the Election Committee can be appealed to the Board of Directors.

Reflecting on APA's Strategic Plan and Progress ToDate Council began the process of reviewing and updating APA’s current strategic plan. Since the strategic plan was adopted in 2019, APA has been regularly gathering information to assess progress in advancing its shortand long-term goals. Rooted in APA’s organizational foundation of science and belief in data-driven decision making, APA governance and staff are asking questions that probe the effectiveness of APA’s transformation in accomplishing the association’s mission and achieving impact. Four years into the implementation and evaluation of the strategic vision, the data show APA is generating noticeable momentum as an association. A review of the strategic plan and accomplishments are available publicly, IMPACT in Action: Reflecting on APA’s Strategic Plan and Progress To-Date.

Guidelines The Council voted unanimously to extend the effective date of the APA Specialty Guidelines In Forensic Psychology through December 2026. The purpose of these guidelines is “to improve the quality of forensic psychological services; enhance the practice and facilitate the systematic development of forensic psychology; encourage a high level of quality in professional practice; and encourage forensic practitioners to acknowledge and respect the rights of those they serve.”

Recommendations from the Council Effectiveness Implementation Oversight Task Force

Presidential Citations

The Council voted to accept recommendations to publicize new business items in advance of Council meetings and give the movers and any opponents time to address the new business items at the Council plenary session. The motion passed by 104-40, with eleven abstentions. This was part of a series of recommendations aimed at making it easier to get new business items on the Council agenda. Several recommendations related to this effort were postponed until the Council’s August meeting.

APA President Thema Bryant, PhD, presented Presidential Citations to psychologists Gordon C. Nagayama Hall, PhD, and Wendi Sharee Williams, PhD, for their contributions to the field.

A moving and powerful moment occurred at the opening of the session on Saturday when Robin McCloud, Council Rep from Minnesota, surrounded by a group of supportive council members, read a statement asking council to support their Jewish colleagues on that day, which was the “Day of Hate,” which was being promoted by anti-Semitic groups in the media. From my perspective, all colleagues, who were able to, stood in support as well.

The Council voted 103-52, with two abstentions, to create a liaison program of Council members who would be assigned to up to eight selected boards and committees. The program will be managed by the Council Leadership Team.

I look forward to representing NJPA at the next Council of Representatives meeting in August 2023 in Washington, DC. Until then, I wish everyone good health and peace.

Report of An Offer of Apology, on behalf of APA, to First Peoples in the United States The Council accepted a Report of An Offer of Apology, on behalf of the American Psychological Association,

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Community Service Program Grants

By Mathias Hagovsky, PhD President, NJPA Foundation

Through your generous donations, the NJPA Foundation is able to administer grants to higher education institutions and organization sites that provide psychological services to those who cannot afford them, and offers programs that train doctoral students to work with these underserved populations. We invite applications from programs across the state of New Jersey, with the goal of identifying and supporting model programs from each county.

Listen below to NJPA member Melanie Rosen, who is a 3rd year clinical PsyD student at Rutgers GSAPP and a 2nd year extern at the Dialectical Behavior Therapy Clinic at Rutgers University (DBT-RU), talk about her experience this year. The DBT-RU is one of the seven sites approved to receive Community Service Program Grants for the 20222023 academic year.

In addition to supporting the New Jersey Psychological Association (NJPA) mission, the mission of the Foundation promotes the psychological health of the diverse people of New Jersey. Funds are used to support training sites and graduate students through grants and awards in support of our commitment to diversity, public health, and assisting our most vulnerable community members. Learn more about the NJPA Foundation here!

The NJPA Foundation is able to continue its mission because of your support and generosity. By contributing you'll help ensure that this important work continues. Donate Today!

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Welcome New Members!

Licensed 5+ years

Licensed < 2 years

1st year Post-Doctoral

Kathryn Arcari, PsyD Brian Chu, PhD Katherine Fackina, PhD Kelly Gilrain, PhD Judith Green, PsyD Timothy Hamway, EdD Jaycie Herman, PsyD Madhu Sheila Josephs, PhD Jessica Kornwasser, PsyD Christina Liparini, PhD

Michael Appelgren, PsyD Lara Aunio, PsyD Rachel Hutt Barbas, PhD Rebecca Boswell, PhD Hongmarie Martinez, PsyD Ellen Park, PsyD Lynn Seskin, Psy.D., MA Theresa Strunk, PhD Azlen Theobald, PsyD

Marie Gagliano, PhD

Licensed 2 - 5 years John Fechter, PsyD Joseph Keifer, PsyD

3rd Year Post-Doctoral Marykate Burke, PsyD Adam Herbert, PsyD

Associate Kelly Medvin, MS

Non-licensed Doctoral Lucy Wood, PhD

Non-Resident Tiffany Duffing, PhD Jennifer Lewis, MA Lauren Siletski, PsyD

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Graduate Students Maya Citron Dana Casolaro Haley Clancy Karen Dang Lida Far Daniel Farina Melissa Gizzi Nuu Grenier Lauren Harnedy Jacy Knaggs Cristian Morillo Rosanna Rodriguez Sonali Singal Yevheniy Vasilov Evelyn Verna

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Book Reviews:

The Zen of Therapy: Uncovering the Hidden Kindness in Life

by Mark Epstein

Why I Am Not A Buddhist

by Evan Thompson

Reviewed by Ben Susswein, PhD

I have prepared a brief quiz, unfortunately without an answer key or Continuing Education credits:

and that Hinduism was in fact a culture, and Buddhism a critique of culture. While the beliefs and practices of Buddhists are not uniform across historical, geographical, and sectarian differences, the basic premises of Buddhism are that a significant amount of emotional suffering is self-created and that self-examination and meditation can provide relief. With this psychological rather than theological emphasis, Buddhism has a unique relevance and appeal for people living in the modern and secularized world in which, as Philip Rieff famously observed, therapeutic authority has triumphed over theocratic authority. Stephen Batchelor, the author of Buddhism Without Beliefs and Confessions of a Buddhist Atheist, suggests we “distinguish between Buddhism as a belief-based religion and Buddhism as a pragmatic philosophy with ethical and contemplative practices.”

What is a psychotherapist? a) A scientist-practitioner, applying the principles of interpersonal neurobiology to alter the nervous system functioning of patients/ clients (circle one) to provide new and more adaptive ways of experiencing themselves and the world? b) A relational improv artist, whose response to the other is always “yes, and…”? c) A “socially-sanctioned healer” who conducts ritualized encounters, either religious or secular, to restore the morale of the disheartened, encourage the socially isolated to rejoin a community, and offer comfort and consolation to grieving souls?

I have been curious about the relationship between science, religion, and spirituality ever since I read Jerome Frank’s Persuasion and Healing and William James’ Varieties of Religious Experience in the late 1970s.

Could all three answers, paradoxically, be true? Are psychotherapists behavioral scientists or contemporary shamans? I have stopped holding my breath and waiting for the correct answer. Now I just count my breaths and try to tolerate the mystery.

Two recently published books address, in very different ways, the relationship between Buddhism and contemporary secular Western psychology, with regard to both theoretical developments in cognitive science and in the practice of psychotherapy. Both authors have longstanding personal involvements with Asian spiritual practices that preceded and informed their professional development.

Among the major world religions, Buddhism appears to be unique, in some respects, as a number of commentators have observed. Alan Watts argued that neither Hinduism nor Buddhism were strictly religions,

Shunryu Suzuki, Zen master and master of the Zen one-liner, has observed that "if it doesn't sound like a

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paradox, it probably isn't true." He neglected to add that it also makes for a catchy book title, but that point Goleman as a section instructor, and enjoying close encounters of the spiritual kind while studying with the triumvirate of Berkshire Buddhism, Joseph Goldstein, Jack Kornfeld, and Sharon Salzberg at the Insight Meditation Center in Western Massachusetts. He hung out with the godfather of Asian-flavored transpersonal psychology Ram Das and worked with Herbert Benson who was pioneering the medical use of meditation.

search for understanding and acceptance, culminating in a revelation while sitting under a tree. Epstein characterizes this spiritual quest as the Buddha’s reenactment of the presumptive trauma of losing his mother days after his birth by abandoning his own family (the prince’s father was also married to the sister of Buddha’s mother, who presumably raised him, but there appears to be limited information about the family dynamics). This spin on Buddhism’s origin story appears to be, as far as my limited scholarship has been able to ascertain, unique to Epstein’s writings. Epstein’s approach to Buddhism may reflect a clinician's preference for poetry over precision and scholarly rigor, with the exercise of some poetic license, such as the use of “Zen,” the name of the Japanese branch of Buddhism, to refer to the secret sauce of kindness in therapy.

Epstein's previous books have addressed how Buddhist thought might support, complement, supplement, or supplant Western psychotherapeutic theories. Or paradoxically, all of the above. His new book, The Zen of Therapy: Uncovering the Hidden Kindness in Life, is a departure, focusing on practice rather than theory, in that it describes selected sessions from a year of treating a number of patients. It reflects how Buddhism plays a role in his thinking and informs some of his interventions, which was Epstein’s explicit intention in writing it, but it also reveals that his work is surprisingly eclectic. While Epstein can draw from a deep and impressive reservoir of Buddhist parables and can quote Japanese Zen haikus at the drop of a hat, he also advises, explains, interprets, reframes, and exhorts, in encouraging his patients to refrain from continuing their “clinging” to experiences that are painful. There seems to be a minimal amount of encouragement of fuller and deeper emotional expression in his therapeutic approach, but instead, self-examination at arm’s length.

His stance as a therapist, and as a “spiritual friend,” encourages his patients to disengage from negative or toxic emotions, rather than exploring and expressing them. He cites the Dalai Lama’s suggestion that if your relationship with your mother is conflicted, think about your grandmother instead. Some may not be convinced that “movement from grievance to gratitude,” as Epstein felicitously describes the trajectory of therapy, is an express train that can always breeze by the local stations of anger and grief.

Evan Thompson, a professor of philosophy at the University of British Columbia, in his most recent book, explains Why I Am Not A Buddhist. Thompson grew up in his parents’ spiritual community Lindesfarn in the 1960s. He still has the copy of a biography of the Buddha his father gave him when he was eight years old, with the passages about Siddartha’s search for enlightenment underlined in red ink. Thompson, along with Francisco Varela and Eleanor Rosch, wrote the influential volume The Embodied Mind in 1991, which argued that knowing was best understood as emerging from action in the world, rather than from a computational process that took place entirely inside the cranium. His subsequent work has been aimed at getting the philosophy of mind out of the Cartesian rut of starting with human verbal intelligence, but rather recognizing the operation of at least “minimal cognition” in all living organisms, and in advocating for the integration of Buddhist-inspired introspective exploration and Western cognitive science.

Thompson’s approach to Buddhism, in contrast to Epstein’s, characterizes it as a dynamic and diverse lore codified only after four hundred years of oral transmission, and presumably revision, that has been adopted and adapted by various Asian cultures and more recently, in the West in the form of "Buddhist modernism." He dismisses attributions of classical Buddhist texts to the person of Siddartha Gotama as “literary fiction” rather than scholarship. Thompson provides a compelling argument for the

Epstein often appears to be a scriptural originalist, reverently citing what the Buddha did and reciting what he said, but he offers an alternative version about the origins of Buddhism. The canonical narrative describes the privileged and sheltered young prince Siddartha Gotama's discovery of suffering and mortality in the world outside the castle walls, and his subsequent

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complementarity of classical Buddhist psychology and contemporary cognitive neuroscience, and argues that Buddhism offers the modern world a rich and nuanced investigation of the phenomenology of different states of mind. In addition, Buddhism may promote “cosmopolitanism,” a pluralistic, tolerant, and compassionate secularized worldview. Not all Buddhists act like cosmopolitans, and not all cosmopolitans identify themselves as Buddhists, but cosmopolitanism appears to be a Buddhism-informed way of not being a Buddhist – or at least not necessarily calling oneself a Buddhist – but acting like one. Which is really the point, isn’t it?

Epstein’s collection of stories – his own story, the Buddha’s, and those of his patients’ – demonstrates how he has used Buddhism to translate his psychotherapeutic insights into communications that are healing. His account, it seems to me, is not so much an endorsement of Buddhism as a basis for psychotherapy so much as a demonstration of how one’s own self-awareness provides the foundation for guiding others in cultivating those capacities. His self-described Winnicottean “noninterfering attentiveness” allows his patients to discover that they are more than who they think they are. Someone familiar with Buddhist metaphors might suggest that Epstein is confusing the moon with the finger pointing to the moon. If the essence of psychotherapy is compassionate presence, then the healing power of his work lies not in Buddhism and the stories he tells, but in his telling. Buddhism has provided Epstein himself with a path toward personal and professional growth, but this should not imply that it is the only path to assuming the paradoxical role of the therapist, promoting change by starting with selfacceptance. Thompson, in his book, takes exception to “Buddhist exceptionalism,” and G.K. Chesterton, the late 19th century convert to Catholicism, has opined that “all religions are essentially the same, especially Buddhism.”

I guess you don't need to be a Buddhist to love a paradox.

These two interesting and thought-provoking books explore, from very different vantage points, the intersection of religion, spirituality, and psychology, and the particular relevance of Buddhism to contemporary life and thought.

This is the sound of one hand applauding.

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Toxic Narcissists Abusing, Controlling, and Gaslighting Our Clients: The Divisive Effects of Media on Our Clients’ Relationships

By Lidia Abrams, PhD Chair, Ethical Education and Resource Committee

This short essay is not about clear-cut abuse and its harms. It is about perceptions, semantics, judgments, and conceptualizations brought to us by clients influenced by social media. We are licensed to practice using the science of psychology, and popular psychology is not quite science. As per ethical Principle C, we are to have integrity and promote accuracy, honesty, and truthfulness in the science and practice of psychology. We should hold back from adopting popularized psychological terms that have not been validated and defined as scientific concepts; and we should come to our own conclusions about whether the dynamics described by our clients are applicable to their difficulties.

Social media provides platforms that cater to seemingly every group with every view or grievance. Writings which we can agree with, make us feel good about ourselves, and find others to be at fault for our sufferings are more likely to gain traction than thoughtful, well-balanced essays. Those who feel they have been mistreated in their relationships can be drawn to writings about “toxic persons” and “narcissistic abuse,” defining themselves as “victims.” Armed with verbiage, which helps blame their significant others (past or present) for their difficulties, they tend to resist seeking and engaging with a more objective and balanced reality. Clients with borderline tendencies are particularly easily drawn into this dialectic of victim and abuser.

When clients tell us that they are in a “narcissistically abusive relationship” with a narcissistic partner, we should certainly be wary. Not having met and evaluated the client’s (current or past) partner whom they have identified as a narcissist, we

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cannot diagnose them. It is unethical to diagnose someone we have not directly examined (APA Ethical Principles 9.01), and even more so to diagnose based on the sole input of a very personally involved and, thus, biased party.

Further, Principle A Beneficence and Nonmaleficence tells us that we must strive to do no harm to those with whom we interact professionally and other affected persons. Our inappropriately diagnosing a partner could be harmful to that person, as well as to our client, and also to our profession overall by misrepresenting our field.

The media and our clients sometimes take concepts, such as emotional abuse, and over-apply them. This phenomenon has been labeled “concept creep” the process by which harm-related topics experience semantic expansion to include topics which would not have originally been included under that label (Haslam, 2021). Emotional abuse is a purposeful, continuous attempt to control another person by criticizing, embarrassing, shaming, blaming, or otherwise manipulating them. There are real examples of emotional abuse as per this definition.

But, in many situations, the intent to control and manipulate may not be fueling couples’ arguments. Or it may be, a little bit, and may be on both sides: two people arguing badly, saying hurtful things to make themselves feel better, and to try to get the upper hand. Not infrequently, the person who comes to our office claiming the status of “victim of emotional abuse” engages in such angry and belligerent ways that they can easily fit the profile of the “abuser” themselves. Indeed, self-labeling as

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victim correlates with feelings of entitlement and vengefulness (Gabay et al, 2020).

such, and the partners being demonized as toxic, abusive, controlling narcissists. These terms strike a chord with those stuck in unhappy relationships, and also with the very human tendency to look for an external source for one’s suffering. Empathizing with clients who describe being victimized strikes a chord with helping professionals, because of our training and our empathetic natures. But, endorsing such one-sided, black and white ways of thinking will not serve our clients well. Linehan (1993) notes that all or nothing thinking leads to conflicts and agitation. We should be alert to this and other cognitive distortions such as overgeneralization, personalization, and emotional reasoning, all of which can result in mislabeling people and their intentions.

The concept of “gaslighting,” originating from the 1944 movie with the same name, meaning that the other person is purposefully trying to make one question their reality and lose their sanity, may rarely actually apply. Again, through semantic expansion, it is nowadays being applied to many undesired behaviors, with the malevolent intent of “gaslighting” loosely inferred. It may not be with the intent to have one question one’s reality and lose their sanity that their partner is being defensive, making careless mistakes and trying to cover up, exhibiting poor communication skills, and fear of confrontation or trying to avoid prolonged arguments (which is then characterized as “silent treatment”). In fact, wrongly accusing one’s partner of “gaslighting” is in itself an aggressive act, imputing malevolent intent, a characterization likely to escalate conflict within a relationship.

When clients come in with very specific ideas of what ails them or their partners, based on exposure to popular psychology, we face the delicate task of conveying empathy and an understanding of the issues, while respectfully withholding judgment about the diagnoses and dynamics presented to us. While we may get resistance and disapproval from clients when we do not wholeheartedly endorse the views and concepts they bring to us, clients ultimately come to us for our help as professionals, not as fellow consumers. Ethical Principle B, Fidelity and Responsibility, guides us to maintain professional and scientific responsibility to our clients and communities we serve. We can help our clients struggling with relationships in many ways, including helping them gain self-acceptance, self-efficacy, an internal locus of control, objectivity, appropriate expectations, good communication, assertiveness training, and decisionmaking skills. We can provide empathy and support, but not at the unfair expense to others not in the therapy room. In fact, by helping our clients react appropriately to undesired behaviors of others, we might have a positive and/or educational effect on those others as well. We might even have further-reaching influence – a positive ripple effect to others remotely affected.

Intent of a party not in our therapy room cannot be discerned, and often it is not properly discerned by our client. Even actual behaviors of the partner recounted to us by our client may not have happened quite as described.

Perception is selective, primed by the observer’s needs, interpretation can be biased and memory again is selective and distorted by one’s emotions. We will of course form opinions based on information provided, and we may in fact come to suspect that our client’s partner suffers from narcissistic personality disorder and therefore is not meeting our client’s needs. But, as far as our work with our client, the latter is the most important part to consider.

Pop psychology attempts to empower readers by suggesting that their life problems are due to “toxic people” hurting and controlling them, and they just need to rid themselves of these people. Although that may be good advice at times, this is a very reductionistic and flawed view. It is ethically and logically incorrect to label someone a “toxic person.”

Although a continually unhappy/dysfunctional relationship with said person may be considered “toxic” to our client, that other person is not a toxic person but rather a complex human being with positive and negative traits, with behaviors that may sometimes be misinterpreted by our clients and construed as more malevolent than intended.

Or, they may not be good at relationships or just not good as a partner to our client. An exercise in empathy towards the so-called toxic person would usually reveal complicated feelings and motives of another fallible human being, some in direct reaction to the aggrieved partner’s own behaviors.

References Gabay, R., Hameiri, B., Rubel Lifschitz, T.& Nadler, A. (2020). The Tendency for Interpersonal Victimhood: The Personality Construct and its Consequences. Personality and Individual Differences. 165.

Haslam, N., Vylomova, E., Zyphur, M. & Kashima, Y. (2021).

"The cultural dynamics of concept creep". American Psychologist. 76 (6): 1013–1026.

The most troubling effect of popular psychology in the area of relationships is the black and white thinking, with clients assuming the role of victims of “narcissistic abuse” and

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

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Upcoming NJPA CE Programs New Jersey Continuing Education/ FAQs When are Continuing Education credits due?

Licensed psychologists are required to complete the required continuing education by the end of each renewal period, June 30 of each oddnumbered year.

Must I document my Continuing Education credits?

You must maintain your continuing education documentation for 4 years after completion. Course work vs. other means of accumulating credit must be specifically documented as spelled out in the regulations. For every biennial license renewal, you shall attest that you have completed your continuing education requirements and the Board of Psychological Examiners will perform random audits of licensees to determine compliance with continuing education requirements. It is very important that you create a tracking system for yourself. Please note: we strongly recommend that you maintain a hard copy and electronic copy of all CE certificates. NJPA members have the ability to document and store electronic CE certificate information. You will find the access to the portal in your NJPA web profile (see below).

Programs: Keynote Speaker: Forgiveness Therapy for Healing From the Trauma of Injustice (1 CE) MDMA Assisted Therapy for PTSD (1 CE) Using Virtual Reality Therapy to Treat Mental Health Disorders and Beyond (1 CE) Navigating Genderland: Gender Diversity in Children and Adolescents (2 CE) After the conference, join us at our first Spring Social hour! Come and join your fellow NJPA members for an evening of socializing, networking, appetizers, and cocktails!

Find full details here!

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96 and Counting

By Kenneth Herman, EdD I am a 96-year-old retired clinical psychologist and continue to think of ways to be productive. After fifty years of private practice, I retired to publish a book and seek an altruistic venture. What followed has been more rewarding and impactful than I could have imagined.

When I retired from my practice, I was invited to join a group of medical professionals who intended to launch a free medical facility for the working uninsured in Bergen County, NJ. Despite the enormity of the goal, the thought of being able to help people in our community access more affordable healthcare inspired me, and I jumped to be involved.

At the beginning, all we had was the idea. What we did not have was a plan, a facility, the required state approvals, staff, furnishings, equipment, sufficient volunteers, or money. Nevertheless, we started on a journey that took five years to complete and by 2009, we were seeing our first patients.

It has been fourteen years since we opened the doors to the Bergen Volunteer Medical Initiative (BVMI), also called the Lynn Diamond Medical Facility, located in Hackensack, New Jersey. The facility is operated by paid and volunteer staff. Plans are in place for a second facility to open in Garfield, New Jersey.

I was on the original board of trustees and now serve on the advisory board. My involvement with BVMI has made my retirement years meaningful, and I am immensely proud to be part an impactful non-profit organization which is saving lives and improving the quality of life for our deserving community.

I feel fortunate to continue to be of sound mind and body and have the opportunities to continue to publish articles, provide counsel, and be a part of this thriving medical facility.

My advice to colleagues is to take the best care of yourselves in order to make each day as meaningful as you can. Perhaps you will find your BVMI project.

To learn more about the Bergen Volunteer Medical Initiative visit bvmi.org. They welcome and thrive on volunteer support.

Dr. Kenneth Herman is a board-certified clinical psychologist and a fellow in the American Academy of Clinical Psychologists. He was the Director of the Psychological Service Center in Teaneck for many years and is the author of Secrets from the Sofa. He lives in Wyckoff, NJ with his wife, Benita. Dr. Herman is a 65-year member of NJPA.

Member News Ruth Lijtmaer, PhD presented the following papers: * No Apologies: Unfinished Business and the Pact to Forget. IFPE (International Forum for Psychoanalytic Education).

Conference theme: Disruptions and Transformations. 9-15-22 to 9-17-22 Evanston, Chicago, Illinois, USA. In Person. * How Human are we? Reflections on Malevolence and Paranoid Fantasies. APCS (Association for the Psychoanalysis of Culture and Society). Conference theme: Totalitarianism and Psychoanalysis: Psychosocial perspectives on Fear and Anxiety. Rutgers University Continuing Education Conference Center. 10-20-22 to 10-23-22. New Brunswick, New Jersey, USA. In Person. * Dehumanizing the "Other" and Ignoring Their Pain. Presented in Spanish as Dehumanizacion del otro e ignorando su dolor. IARPP Hogar Relacional, 11-12-22 Barcelona, Spain. Hybrid.

We'd love to share your news!

Share your book launch, media contributions, community activity participation, speaking engagement, awards, or any other accomplish you would like mentioned in an upcoming issue of the NJ Psychologist! Send submissions to Christine. Next issue will circulate in early October.

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NJ Psychologist

Spring 2023

Call for NJPA Executive Board Nominations!

Nominations are currently being solicited for positions on the 2024 NJPA Executive Board. As stated in the NJPA bylaws, all NJPA elections shall follow the policies and procedures set forth by the Nominations and Leadership Development Committee that are approved by the Executive Board.

Every effort will be made to secure at least two nominees for every office on the slate, and two nominees for each MemberAt-Large position to be filled. In the event that the Nominations Committee is unable to recruit two candidates for each open seat, one candidate and a write-in option will be presented to the membership on the ballot. The exception is the Affiliate Member-At-Large position, no write in line will be provided as the nominees come from the Affiliate Caucus. The Affiliate Caucus shall draw names from the entire affiliate population. No name shall appear on the ballot for more than one office.

All NJPA elections shall take place electronically. The voting period shall commence on the first Tuesday of September and will remain open for three weeks after electronic voting begins.

NJPA NOMINATIONS & ELECTIONS COMMITTEE Criteria: All candidates for elected office in the New Jersey Psychological Association must meet the following criteria.

1. NJPA member in good standing; 2. Evidence of volunteer involvement in NJPA for at least one year, and/or a leadership role in an NJPA Affiliate Organization for at least one year; and 3. No current legal or ethical violations as determined by the BOPE, court or other governing body.

Members of the executive board have the responsibility to govern the association and to set policy and priorities. In addition to these major roles, each board member has specific responsibilities. Important Note: Material for executive board meetings is sent electronically. Board members must be able to access and review these documents prior to board meetings.

Additional criteria will apply as follows: For candidates for President-Elect, must have served on the NJPA Executive Board or in a leadership position in an affiliate organization, or chaired an NJPA committee, special interest group, task force, resource group, or had an active role as an NJPA committee, special interest group, or resource group member within the last three years. After the September election, the elected president-elect will become a mentee to the current president-elect October through December. For those three months, the newly elected president-elect mentee will shadow the current president-elect at the NJPA Executive Committee and Executive Board meetings to learn the role. The role will begin in January.

Term of office: January 2024 to December 2024 as President-Elect; January 2025 to December 2025 as President; January 2026 to December 2026 as Past-President.

For candidates for Treasurer, must have familiarity with finances, budgets, and investments. The candidate should have had an active role in an NJPA committee, special interest group, resource group, or affiliate within the last five years. After the September election, the elected treasurer will become a mentee to the current treasurer, October through December. For those three months, the newly elected treasurer mentee will shadow the current treasurer at the NJPA Finance Committee and Executive Board meetings to learn the role. The role will begin in January.

Term of office:

January 2024 to December 2026

For candidates for Member-at-Large (Nominations), must be a member in good standing in NJPA and have had an active role in an NJPA committee, or other NJPA group including NJPAGS, task force, special interest group, resource group, or affiliate within the last year. Term of office: January 2024 to December 2026 Submit nominations for the above board positions online by May 15. The form can be found in the Members Only section of the website (login required). We will also be circulating notices via the Friday Update and direct messaging.

For candidates for Member-at-Large (Affiliate), must be a member in good standing in NJPA and his/her affiliate and have had an active role in an NJPA committee, or other NJPA group including NJPAGS, task force, special interest group, resource group, or affiliate within the last year. Interested members please contact Phyllis Bolling, Affiliate Caucus Chair, at p.bolling@att.net.

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NJ Psychologist

Spring 2023

The NJPA Lifetime Achievement Award, the association’s highest honor, recognizes exceptional leadership in the form of enduring and exemplary contributions to NJPA, over a sustained period of time, which collectively, has significantly enhanced the association’s ability to positively impact the lives and careers of its membership, as well as advancing the field of psychology in New Jersey, and beyond. It is suggested that the candidates be at least 65 years of age, however remarkable life circumstances will be taken into consideration for those candidates under 65 years of age.

The NJPA Psychologist of the Year Award recognizes an NJPA member who has made important contributions to the profession of psychology in New Jersey, made important contributions to the profession through service to NJPA, and is a valuable asset to the association, through his/her character and unique professional abilities.

Dr. Moldawsky was a true champion for the profession of psychology and a sought after mentor for psychologists. In honor of his amazing professional life, in 2018, NJPA created the NJPA Dr. Stanley Moldawsky Mentor Award, recognizing exceptional leadership of an NJPA member in the form of enduring and exemplary contributions to mentoring new psychologists and/or graduate doctoral level students, over a sustained period of time, which collectively, has significantly enhanced the association’s ability to positively impact the lives and careers of its new membership, as well as advancing the field of psychology in New Jersey, and beyond.

Ms. Jane Selzer was a long time employee of NJPA and passionately involved with NJPA membership. She retired in 2015. To acknowledge her long standing service to NJPA, and in an effort to publicly acknowledge and recognize those members who contribute so much to NJPA in so many diverse ways, the NJPA Membership Committee renamed this established award after her, NJPA Jane Selzer Member Recognition Award, to recognize members who add value to NJPA every day.

The NJPA Citizen of the Year is awarded to a non-psychologist who has made significant contributions to the ideals of mental health or social welfare. Nominations should consist of several paragraphs detailing why this individual deserves the honor.

The NJPA Legislator of the Year honors a New Jersey Legislator who has sponsored or championed legislation that directly benefits psychologists and/or consumers of psychological services.

Please take a moment to consider a fellow NJPA member or member of your community for one of these prestigious awards!

Awards will be presented at our Fall Conference. To learn more about the criteria for nominations, please visit our NJPA Awards page.

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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.

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. We are in need especially in the southern and western part of NJ and those with foreign language proficiency in any part of the state.

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

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