A Publication of the New Jersey Psychological Association
Special Section: Earn 3 CE Credits! Practical Applications of Neuropsychological Testing
Clinical Competency as an Ethical Issue
What’s New in Suicide Prevention in New Jersey
Daring to Address Race: Mindfulness, Allophilia, & Microaffirmations in Psychotherapy
1 Who’s Who in NJPA 2019
2 President’s Message
3 Happy New Year from the NJPA Executive Director
4 Welcome New Members! & Member News
5 Ethics Update: Clinical Competency is an Ethical Issue
6 NJPA Sustaining Members
7 Daring to Address Race: Mindfulness, Allophilia, and Microaffirmations in Psychotherapy
9 Foundation Dissertation Grants & Donations 2018
10 Professional Advocacy Corner & 2018 Contributions
12 Special Section: Practical Applications of Neuropsychological Testing
23 What’s New in Suicide Prevention in New Jersey
24 From Margins to Center: Expanding Student-led Advocacy & Support
25 Book Review: APA Handbook of Psychopathology
26 In Memoriam
28 2018 Fall Conference Recap
29 Psychologist of the Year: Kenneth Freundlich, PhD
31 Business Meeting Minutes
www.PsychologyNJ.org
Editorial Board
Editor: Gianni Pirelli, PhD
Members:
Jack Aylward, EdD Maria Kirchner, PhD
Ashley Gorman, PhD Nathan McClelland, PhD
Eric Herschman, PsyD Anthony Tasso, PhD
Herman Huber, PhD Staff Liaison: Christine Gurriere
NJPA Executive Board
President: Morgan Murray, PhD
President-Elect: Luciene Takagi, PsyD
Past-President: Stephanie Coyne, PhD
Treasurer: Daniel DaSilva, PhD
Secretary: Mary Blakeslee, PhD
Director of Academic Affairs: Francine Conway, PhD
APA Council Representative: Rhonda Allen, PhD
Member-At-Large:
A) Elio Arrechea, PhD
(A) Phyllis Bolling, PhD
(A) Daniel Lee, PsyD
(N) Randy Bressler, PsyD
(N) Alan Lee, PsyD
(N) Nicole Rafanello, PhD
Parliamentarian: Joseph Coyne, PhD
Affiliate Caucus Chair: TBD
ECP Chair: Michelle Pievsky, PhD
NJPAGS Chair: Christopher Thompson, MA, EdS
Latino/a Psychological Association of NJ Rep: TBD
ABPsi Rep: TBD
CODI: Co-chairs Phyllis Bolling, PhD and Aida Ismael-Lennon, PsyD
Affiliate Representatives
Northeast Counties Association of Psychologists: Nansie Ross, PsyD
Essex/Union County Association of Psychologists: Susan Esquilin, PhD
Mercer County Psychological Association: TBD
Middlesex County Association of Psychologists: Tammy Dorff, PsyD & Rosalie DiSimone-Weiss, PhD
Monmouth/Ocean County Psychological Association: Tamara Latawiec, PsyD
Morris County Psychological Association: Randy Bressler, PsyD
Somerset/Hunterdon County Psychological Association: Janie Feldman, PsyD
South Jersey Psychological Association: Daniel Lee, PsyD
Central Office Staff
Executive Director: Keira Boertzel-Smith, JD
Director of Professional Affairs: Judith Glassgold, PsyD
Senior Communications Manager: Christine Gurriere
CE & Foundation Coordinator: Ana DeMeo
As noted in the last issue, one particularly important goal we have achieved is that we now are able to offer Continuing Education (CE) credits through the journal. We are especially proud of accomplishing this goal given its timeliness, as CEs are now required in New Jersey. As such, the Special Section in this issue is eligible for three (3) CE credits, provided that you take and pass the associated quiz. There is a relatively nominal fee for members of $10 per credit, or $30 for the 3 credits. More detailed instructions and information related to how to proceed with the quiz is provided along with the Special Section, but you will ultimately access the quiz through the NJPA website’s Learn tab on the main menu at <www.psychologynj.org>
On behalf of the editorial board, I want to extend special thanks to our Guest Editor, Ashley Gorman, PhD, the contributors of the Special Section: Randy Bressler, PsyD, Phyllis Lakin, PhD, Ashley Gorman, PhD, Emily Brislin, PhD, and Maria Perry, PhD. We also want to thank the NJPA CE committee, particularly Raymond Hanbury, PhD and Mark Lowenthal, PsyD for considering and approving this Special Section for CEs. In addition, I want to personally thank Dr. Tony Tasso and Dr. Nate McClelland for spearheading the effort to deliver this CE-eligible Special Section. We believe it is a tremendous member benefit to be able to secure CEs from a journal you already receive with your membership (and at such a nominal cost). If we, as your Editorial Board, can continue to provide such at this rate, we will be able to provide members with approximately half of their required CEs.
We are grateful for the opportunity to serve as your Editorial Board and will continue to work toward achieving the goals we have set forth, all of which are for you, our colleagues and fellow NJPA members. ❖
Preparation of Manuscripts
All manuscripts submitted for publication should follow APA style. Manuscripts should be edited, proofread, and ready for publication. Please prepare your manuscript in a word-processing program compatible with MS Word using Times New Roman font in 12 point type, left flush. Please submit your manuscript via e-mail to NJPA Central Office and to Gianni Pirelli at e-mail addresses below.
Editorial Policy
Articles accepted for publication will be copyrighted by the Publisher and the Publisher will have the exclusive right to publish, license, and allow others to license, the article in all languages and in all media; however, authors of articles will have the right, upon written consent of the Publisher, to freely use of their material in books or collections of readings authored by themselves. It is understood that authors will not receive remuneration for any articles submitted to or accepted by the New Jersey Psychologist
Any opinions that appear in material contributed by others are not necessarily those of the Editors, Advisors, or Publisher, nor of the particular organization with which an author is affiliated. Manuscripts should be sent to the Editor: Gianni Pirelli, PhD
E-Mail: gpirelli@gmail.com or NJPA Central Office E-Mail: NJPA@PsychologyNJ.org
Published by: New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 973-243-9800 • FAX: 973-243-9818
E-Mail: NJPA@PsychologyNJ.org
Web: www.PsychologyNJ.org
New Jersey Psychologist (USPS 7700, ISSN# 2326098X) is published quarterly by New Jersey Psychological Association, 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052. Members receive New Jersey Psychologist as a membership benefit. Periodicals postage pending at West Orange, NJ and additional mailing offices. POSTMASTER: Send address changes to New Jersey Psychologist, 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052.
As I begin my year as president of NJPA, I find myself reflecting on the past year as president-elect. It was a lot of work and required many hours of my time attending meetings and engaging in countless discussions that focused on the many decisions that the NJPA leadership and the executive board faced. In spite of the hard work, the feeling I am left with is one of gratitude for all the people I have met, collaborated with, and debated. I have gained so much. And, as I think further back over previous positions I have held, each helped me to prepare. First as a member in my local affiliate organization, Morris County Psychological Association, as their board secretary and then president, and then for NJPA as member at large (MAL), listserv monitor, co-chair for the Committee on Diversity and Inclusion (CODI) and eventually president-elect. At every step of this journey I have had the privilege of working with, and learning from, our members.
I am grateful for having many role models and mentors, two of whom I would like to mention. I feel indebted to Hulon Newsome, PsyD for the clarity and breadth of his vision and his drive to execute that vision, and Stephanie Coyne, PhD for her tireless dedication to the success of NJPA and her empathic attention to the needs of all our members. And above all else, I am grateful to both of them for their friendship and support. I also want to express my appreciation for all that I have learned working with our Executive Director, Keira Boertzel-Smith. Her extensive knowledge of NJPA and her sound judgement and insight are indispensable to the effectiveness of NJPA leadership and executive board functions.
The work ahead will necessarily be a collaboration and everyone is welcome.
As I have met more and more of you, I am amazed by the extensive knowledge and expertise within our association. If I start to feel intimidated by all the responsibilities of this job, I remind myself that my job is not to know everything, since I don’t and can’t, but to harness the energy within the association. This is where I invite everyone to join me. There are many ways for everyone to contribute; through our committees, task forces, affiliate organizations, and simply by sharing your thoughts and suggestions. I want to hear from you.
With our theme, “Get Psyched: Know, Go, Grow,” we are in the planning phase of our Mental Health Awareness Project. We are expanding our recognition of mental health month this year to include both April and May. April is National Minority Health Month and May is Mental Health Month, so our project will give focus to access to care for marginalized groups. The kickoff event will be a conference on April 12 at Rutgers University. Mark your calendars now! The event is being sponsored by the Inter-Psychological Association Coalition (IPAC) that is a joint coalition comprised of the New Jersey Chapter of the Association of Black Psychologists (NJABPsi), the Latinex Mental Health Association of New Jersey (LMHNJ), and NJPA. We are also planning events and activities through our affiliates, including collaborative events with Stigma Free, and a statewide student video competition. Stay tuned and follow NJPA on Facebook, Twitter, and LinkedIn for updates on our progress.
A significant challenge for the coming year is our move. Yes, we are moving. As I write this, we are hopefully nearing the end of a negotiation for a new office space in Livingston. It will be a big improvement over our current space for many reasons, one of which is the access to low cost space for our ongoing program of providing CE’s to our members. By lowering the cost of the venue for our smaller standalone events, we can pass these savings along to our members in the form of lower program costs, while maintaining this crucial source of non-dues revenue.
The one thing that this new location does not provide is geographic diversity and inclusiveness. It is still located not far from our current location in the northern portion of our state. This issue was discussed at length by the executive board and several properties further south were considered, but the Livingston location still had the best features in terms of cost, access to meeting space, and low-cost venues for our programing. In our decision to move forward with negotiations on the Livingston property, we included a requirement that our board establish a task force to explore ways to be more inclusive of other parts of the state, hopefully through a combination of teleconferencing to make meetings easier to attend, and alternating the locations of meetings and conferences. Drs. Stephanie Coyne and Hulon Newsome agreed to co-chair this task force, so that we can think beyond a northeast centric view of New Jersey.
At its core, inclusiveness is about making sure everyone is given a seat at the table and that all voices are valued. I believe it is through this mindset that we attract diverse membership in every sense of the word. NJPA should give a voice to New Jersey psychologists whether they are a member of a historically marginalized group, or an academic psychologist who is not a clinician, and whether you are a psychologist that lives as far north as High Point or as far south as Cape May and anywhere in between. In order to do this, we need to understand the needs and experiences of these various groups. Parallel to this, NJPA can also give voice to the diverse residents of New Jersey that we serve. We do this through the power of our research and scholarship. We plan to continue issuing statements in support of social issues where psychologists speak with particular expertise based on scientific psychological research. NJPA has always advocated for our profession in many ways, such as through the legislative efforts of COLA, and the charitable efforts of the NJPA Foundation. In fact, inclusiveness is a goal in all NJPA activities.
I look forward to a wonderful collaboration in 2019! ❖
Ilook at the New Year as an opportunity for new beginnings, however many 2018 end-of-year updates and goals carry over into 2019. We ended 2018 with our annual business meeting, held at the NJPA 2018 Fall Conference in November. Below I highlight some of the important carry over topics from the 2018 business meeting.
At the 2018 business meeting, I shared with our members that NJPA continues to work on membership retention and recruitment, including looking at our newly expanded continuing education learning opportunities, live and homestudy, as ways to introduce non-members to our association. At the end of 2018, our membership numbers were approximately 1700. We will continue to determine, and then provide, relevant association benefits for all of our NJPA member populations: students, academicians, early career psychologists, mid-career psychologists, late-career psychologists, and retired members. The 2018 business meeting attendees asked, and we will consider in 2019, how NJPA can improve outreach and promote NJPA to non-members.
We discussed that NJPA is more than a brick and mortar building. We strive to be a statewide presence for our members and the public. We are working on getting NJPA leadership out and about to visit NJPA affiliates and to hold leadership gatherings outside of the NJPA Central Office space. We are also working on moving our continuing education programs around the state. Virtual gatherings have been an amazing addition to our association. We can accommodate members who are unable to attend meetings in-person for reasons such as family or professional obligations.
We discussed how NJPA is continually working on improving NJPA communications for our members and also sharing
our mission and achievements with the public. In 2018, we had members participate in focus groups and surveys to review our website layout and Friday Update distribution. We added the Leadership Quarterly and are working on further promoting our continuing education programming. In 2019, we will also be sure to improve our advocacy updates. In 2019, you can expect to see more of an NJPA social media and public relations presence. Soon, you will also see our 2019 Mental Health Awareness efforts, to promote mental health within the state of New Jersey. This includes working alongside with the other Inter-Psychological Association Coalition of New Jersey (IPAC) leaders from the New Jersey Chapter Association of Black Psychologists (NJABPsi), the Latino Mental Health Association of New Jersey (LMHANJ), formerly the Latino Psychological Association of New Jersey, and NJPA. IPAC will work together as equal partners to contribute their unique educational acumen, expertise, experience, and perspectives to obtain synergy as a resource to promote equality in mental health care and to zealously advocate for the mental health needs for the diverse population of the state of New Jersey. Stay tuned for information about our April 12, 2019 IPAC continuing education program.
We discussed NJPA continuing education live and homestudy programming. This includes continuing education credits you can obtain by reading certain journal articles, followed by a post-test. In June 2019, the Board of Psychological Examiners will require that licensees renewing their licenses, must attest that they have completed 40 continuing education requirements, including four credits in domestic violence. If audited, you will need to provide verifying documentation of your continuing education credits completion. Please be sure to read up on the regulations, which can be found on both the NJPA and the Board of Psychological Examiners websites. Also be sure to review the NJPA FAQs about continuing education found on our website.
We discussed NJPA governance including our finances. NJPA Treasurer,
Dr. Daniel DaSilva, reported that we will be conservative in our 2019 spending and estimates of income, work on increasing membership numbers, and providing quality continuing education programs at an affordable cost for our members. The Central Office lease at 414 Eagle Rock Avenue in West Orange expires in June 2019, and the NJPA Executive Board approved moving to a new rental space that is a work in progress. The approved 2019 budget can be found on the Members Only page of the website.
We discussed the importance of promoting and contributing to the NJPA Foundation that provides learning, research, and in-person experience for our rising psychologists serving the underserved populations of New Jersey. Please read the quarterly Foundation Flash e-publications to learn more about the Foundation’s good work. We also mentioned members promoting the NJPPolitical Action Committee that makes contributions, from funds received from NJP-PAC contributors, to candidates for office and political committees in New Jersey who demonstrated their interest in, and support of, mental health issues without regard to party affiliation. Funds are distributed in such a manner as to advance the stature of the profession of psychology in New Jersey. The NJP-PAC is working on funding a 2019 Trenton Day gathering. Stay tuned for more information!
Lastly, I wanted to mention to our members that I am now the Chair of the American Psychological Association (APA) Council of Executive of State, Provincial and Territorial Psychological Associations (CESPPA). The purpose of the CESPPA is to promote the professional development of its members, to enhance the development of all state, provincial, and territorial affiliates, and to advocate for issues of importance to state, provincial, and territorial psychological associations and members of these associations, and to the governance of the APA. My role as CESPPA chair is to serve as the primary interface between CESPPA and APA. I will be conducting business with the assistance and guidance of the CESPPA Executive Committee on matters that relate to, and affect,
SPTAs, and will lead monthly calls with the Executive Committee. I am proud to represent NJPA, and to help keep our association on the map at the national level. I am currently busy preparing for the CESPPA meetings that I will be running in March 2019, and the CESPPA Practice Leadership Conference sessions. I am also organizing and preparing our NJPA delegates for the 2019 Practice Leadership Conference and the Capitol Hill visits
May your 2019 be filled with wellness, joyfulness, inspiration, and opportunity! As a reminder, our NJPA Central Office team is here to provide assistance with membership benefits, communications, continuing education programming, and advocacy, joining committees, and/or professional developments and networking opportunities. ❖
Licensed 5+ years
Linda Busch, PhD
Allan Cooper, PhD
Joyce Fichtenbaum, PhD
Paula Ludica-Costa, PsyD
Kimberly Beckwith McGuire, PhD
Teresa Taylor, PhD
Licensed 2-5 years
Kerry Pitter, PsyD
Licensed less than 2 years
Stacey Dobrinsky, PhD
Michael Femenella, PhD
2nd year Post-Doctoral
Anne Rothernberg, PsyD
First year Post-Doctoral
Rivka Halpert, PsyD
Non-Licensed Doctoral Degree
Karen Schwartz, PhD
Associate Member
Wayne Poppalardo, MA
Students
Matthew Figueira
Yessine Figueroa Griffin, MA
Lotan Lunski
Taylor MacLean, MA
Edward Mone, MS
Kristen Parente, BS
Maria Poston, MA
Tyshawn Thompson, BA
Ruth Lijtmaer, PhD presented the following: Paper: Can Apologies Transform Social Trauma? in APCS 10-19-18 to 10-20-18 at Rutgers University, New Brunswick, New Jersey; Paper: Silenced and unsilenced: Why they did not talk before? in the panel: Unsilencing the Bicultural Self: Implications for Psychoanalytic Theory and Practice and a video presentation: 21st Century Multi-Racial Reactions to Mid-Century Interracial Psychoanalysis: What has changed and what has not with Veronica Abner, PhD both at the IFPE Conference: Unsilencing 10-25-18 to 10-27-18. Seattle, Washington. Dr. Lijtmaer also published: (2018). A Latina immigrant’s response. Commentary on Paul Elowitz’s paper: Awakening the nightmare of the subjugation and violation of women. In: Clio’s Psyche, 25,1, 11-15 and (2018) Introduction to the book: El Dolor es Sordo (“Pain is Deaf”) by Laura Molet Estapler. Introduction in Spanish. Editorial Academica Espanola. Espana. ISBN: 978-620-2-15073-6.
Ken Hoyne, PhD released an album called Sublime that is available on all the usual digital sites (iTunes, Amazon, Spotify, Youtube, etc.). CD’s are available at Cd Baby.com and The Princeton Record Exchange in Princeton, NJ. The album is infused with western and eastern psychological themes across an eclectic mix of rock genres.
Chris Kotsen, PsyD, CTTS, Melissa L Santorelli, PhD, MPH, Erika Litvin Bloom, PhD, Adam O Goldstein, MD, MPH, Carol Ripley-Moffitt, Mdiv, CTTS, Michael B Steinberg, MD, MPH, Michael V Burke, EdD, Jonathan Foulds, PhD, authored A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations published in Nicotine & Tobacco Research, <https://doi.org/10.1093/ntr/nty162>, published August 17, 2018, Oxford Academic.
treatment began. A common example would be a client who initially presented with depression, but reveals a substance abuse problem as treatment continues.
With the advent of mandatory continuing education credits in New Jersey, psychologists are now legally required to complete 40 hours of education every two years (State of NJ, 2017). However, we have always had an ethical obligation to maintain competence. The APA Ethical Code (American Psychological Association, 2017) requires all psychologists to undertake ongoing efforts to develop and maintain their competence. We are expected to provide psychological services only within the boundaries of our competence based on our education, training, supervised experience, consultation, or other professional experiences. The relevant sections of the APA ethical code are:
Provide services with populations and in areas only within the boundaries of competence based on education, training, supervised experience, consultation, study or professional experience.
Psychologists undertake ongoing efforts to develop and maintain their competence.
How competent is competent enough?
When we receive a referral for new services, how much knowledge and experience do we need to have if the clinical problem is outside of our usual range of practice?
When do we decide to refer the client to another professional rather than accept the new client and remediate our lack of knowledge and experience? The answers to these questions need to address both clinical and ethical considerations.
The clinical and ethical decision can be further complicated when we are already treating a client and discover a clinical issue that must be addressed in addition to the primary problem presented when
The ethical code provides guidance to inform the decision of whether to accept a new client with a unique problem or refer the client to another psychologist. First, we should consider whether our lack of competency is based on insufficient knowledge of the problem, or whether the problem requires a specific treatment approach in which we lack training. Knowledge can be supplemented through formal continuing education courses, online courses in the specific subject area, or general reading of professional articles and books on the topic. Consulting with a colleague, who has experience treating that clinical problem, can also augment knowledge.
However, there are some clinical problems that have been found to respond better to specific treatment approaches, such as Dialectical Behavior Therapy. It may be difficult to gain competence in a new treatment approach within a short period of time. A psychologist who lacks the clinical skills to address a problem should refer the client to a colleague or a treatment program better suited to provide treatment. If no referral options are available, competency gaps can be addressed through ongoing supervision from a psychologist with the appropriate skills and knowledge.
Maintaining competency is another clinical area that presents ethical issues. Most psychologists regularly treat clients with depression and anxiety problems. We have an obligation to remain current regarding research on treating depression and anxiety. If we have been practicing for more than five years, diagnostic criteria for many clinical disorders have been revised since the completion of our degree. In addition to mastering new skills as needs arise, as psychologists we must maintain our competency in diagnosing and treating problems we encounter regularly in our practice.
The new requirements for ongoing continuing education have resulted in expanded opportunities for maintaining clinical competence. Organizations who
are approved to provide continuing education to psychologists are offering more local programs now that all psychologists are required to accumulate continuing education credits. Technology has also contributed to the availability of relevant continuing education opportunities. Both local and nationally based continuing education providers are offering podcasts that allow psychologists to watch presentations on a broad range of clinical topics. Many organizations also offer approved continuing education programs online. Technology allows psychologists to access quality continuing education programs in virtually any clinical problem area, at a level of sophistication that fits their knowledge and experience in the topic area.
There are no guidelines in the ethical code directing psychologists to accumulate a specified amount of knowledge or training in order to maintain competence. Mandatory continuing education requirements outlined by the New Jersey Board of Psychological Examiners (State of NJ, 2017) do require a specific number of hours related to domestic violence and a minimum number of hours that must be accumulated in interactive settings, but also do not mandate how to maintain clinical competence. The ethical code simply states that psychologists should undertake ongoing efforts to develop and maintain their competence.
As psychologists, it is our responsibility to develop a plan for maintaining clinical competence that not only addresses our current strengths and weaknesses, but also outlines goals for increasing our competency in new clinical areas. In our plan, we should identify the main clinical areas that we address currently in our practice. We can then rate our own expertise in each of these clinical areas and establish a goal for expanding our knowledge base in each of those clinical areas. Ethically, we will want to put more effort into increasing our competency in the areas where we have the least knowledge and experience. Remember that our efforts do not need to be restricted to formal continuing education programs. We can also participate in clinical supervision, peer supervision, or consultation with colleagues who have ex-
pertise in the areas where we lack expertise. There are benefits to developing and implementing a clinical competency plan. First, we will be providing services that are more likely to be helpful to our clients. Second, the development of competency ultimately leads to the establishment of expertise in specific clinical areas. This is likely to be beneficial
to the development of our practice. Third, maintaining competency is part of an ethical practice, which will have a positive impact on all areas of our professional lives. ❖
References
State of NJ, (2017) New Jersey Administrative Code, Title 13, Law and Public
Safety, Chapter 42, Board of Psychological Examiners. <www.njconsumeraffairs. gov/Regulations/Chapter-42-Board-ofPsychological-Examiners.pdf>
American Psychological Association (2017) Ethical Principles of Psychologists and Code of Conduct. <http://www.apa.org/ ethics/code/index.aspx>
By advancing your level of membership to Sustaining Membership status, you have generously demonstrated your additional support of your professional association. We thank you for your commitment and dedication to your organization!
Mitch Abrams, PsyD
Rhonda Allen, PhD
Amy Altenhaus, PhD
Mark Aronson, EdD
Alyssa Austern, PsyD
Jeffrey Axelbank, PsyD
Thomas Barrett, PhD
Louis Barretti, PhD
Leslie Becker-Phelps, PhD
Margaret Beekman, PhD
Roderick Bennett, PhD
Rhea Bensman, PsyD
Helen Berman, PhD
Harvey Block, PhD
Janet Bloodgood, PhD
Monica Blum, PhD
Alice Bontempo, PsyD
Randy Bressler, PsyD
Richard Brewster, PsyD
Natalie Brown, PhD
Diane Cabush, PsyD
Dina Cagliostro, PhD
Rosemarie Ciccarello, PhD
Karen Cocco, PhD
Sidney Cohen, PhD
Deniz Colak, PhD
Louise Conley, PhD
Francine Conway, PhD
John Corbisiero, PhD
Joseph Coyne, PhD
Stephanie Coyne,PhD
Kathleen Cullina-Bessey, PsyD
Richard Dauber, PhD
Bernice Davis, PsyD
Phyllis DiAmbrosio, PhD
John Diepold, PhD
Charles Dodgen, PhD
Rosalind Dorlen, PsyD
Frank Dyer, PhD
Linda Earley, PsyD
Nick Economou, EdD
Peter Economou, PhD
Daniel Edelman, PsyD
Lynn Egan, PsyD
Susan Esquilin, PhD
Anne Evers, PhD
Sean Evers, PhD
Roberta Fallig, PhD
Cassandra Faraci, PsyD
Janie Feldman, PsyD
Stephen Feldman, PhD
Dennis Finger, EdD
Resa Fogel, PhD
Pamela Foley, PhD
Kenneth Freundlich, PhD
Antonia Fried, PsyD
Thomas Frio, PhD
Joseph Ganz, PhD
David Gelber, PhD
Leslie Gilbert, PhD
Marc Gironda, PsyD
Linda Glazer, PsyD
Elizabeth Goldberg, PhD
Gary Goldberg, PhD
Wayne Goldman, PhD
Lois Goorwitz, PhD
Ora Gourarie, PsyD
Susan Grossbard, PsyD
Lori Rayner Grossi, EdD
Hadassah Gurfein, PhD
Mathias Hagovsky, PhD
Raymond Hanbury, PhD
Steven Hartman, PhD
Douglas Haymaker, PhD
Marsha Heiman, PhD
John Hennessy, PhD
Ann Nikolai Houston, PhD
Jennifer L. Jackson, PhD
Lisa Jacobs, PhD
Nancy Just, PhD
Tamar Kahane, PsyD
Jeffrey Kahn, PhD
Paula Kaplan-Reiss, PhD
Robert Karlin, PhD
Barry Katz, PhD
Charles Katz, PhD
Toby Kaufman, PhD
Thomas Kavanagh, PsyD
Richard Kessler, PhD
Lisa Kestler, PhD
Kyung Sil Kim, PhD
Joel Kleinman, PhD
Steven Korner, PhD
Deirdre Kramer, PhD
David Krauss, PhD
Phyllis Lakin, PhD
Robin Lang, PsyD
Roman Lemega, PhD
Veronica Lenzi, PhD
Ilana Lev-El, PsyD
Robert Levine, PhD
Neal Litinger, PhD
Rebecca Loomis, PhD
Alfredo Lowe, PhD
Mark Lowenthal, PsyD
Geraldine Lucignano, PhD
Konstantin Lukin, PhD
Marc Lyall, PsyD
Marilyn Lyga, PhD
David MacIsaac, PhD
Daniel Mahoney, EdD
Stanley Mandel, EdD
Charles Mark, PsyD
Bonnie Markham, PhD, PsyD
Nicole Martell, PsyD
Neil Massoth, PhD
Shirley Matthews, PhD
John McInerney, PhD
Kathleen McNulty, PhD
Wilda Mesias, PhD
Marshall Mintz, PsyD
Barry Mitchell, PsyD
Noreen Mohle, PhD
Lynn Mollick, PhD
Ruth Mollod, PhD
Sharon Ryan Montgomery, PsyD
Gregory Moore, PsyD
Caridad Moreno, PhD
Sandra Morrow, PhD
Daniel Moss, PhD
Morgan Murray, PhD
Susan Neigher, PhD
Jeffrey Newenhouse, PsyD
Ronald Newman, PhD
Hulon Newsome, PsyD
Daniel Noll, PhD
Cheryl Notari, PhD
Carly Orenstein, PsyD
Nicole Paolillo, PsyD
Michelle Papka, PhD
Craig Pearl, PsyD
Francesca Peckman, PsyD
Mark Pesner, PhD
Michele Rabinowitz, PsyD
Nicole J. Rafanello, PhD
Richard Rapkin, PsyD
Howard Rappaport, PsyD
Gina Rayfield, PhD
Steven Reed, PhD
Ann Reese, PhD, PsyD
Ellen Reicher, PhD
AnnaMarie Resnikoff, PhD
Debra Roelke, PhD
Marion Rollings, PhD
Barbara Rosenberg, PhD
Lori Aks Rosenberg, PsyD
Gianine Rosenblum, PhD
Elissa Rozov, PhD
Anne Rybowski, PhD
Carole Salvador, PsyD
Jayne Schachter, PhD
Peter Schild, EdD
Lynn Schiller, PhD
Doris Schueler, PhD
Margot Schwartz, PsyD
Nancie Senet, PhD
Eileen Senior, PsyD
Laura Shack-Finger, EdD
Arline Shaffer, PhD
William Shinefield, PsyD
Tamara Shulman, PhD
Nancy Sidhu, PhD
Ronald Silikovitz, PhD
Jane Simon, PhD
Jeffrey Singer, PhD
Tamara Sofair-Fisch, PhD
Jeffrey Spector, PsyD
Mary Ellen Stanisci, PhD
Jakob Steinberg, PhD
Deana Stevens, PsyD
Benn Susswein, PhD
Luciene Takagi, PsyD
Anthony Tasso, PhD
H. Augustus Taylor, PhD
Tamsen Thorpe, PhD
Barbara Tocco, EdD
Elizabeth Vergoz, PhD
Jonathan Wall, PsyD
William Walsh, PhD
Melissa Warman, PhD
Beth Watchman, PhD
Virginia Waters, PhD
Daniel Watter, EdD
Allen Weg, EdD
Ida Welsh, PhD
Aaron Welt, PhD
Norbert Wetzel, ThD
Philip Witt, PhD
Joshua Zavin, PhD
Stanley Zebrowski, PhD
Michael Zito, PhD
Harold Zullow, PhD
identities and experiences in our racially stratified society.
Marianne G. Dunn, PhD
Most people are told throughout their lives not to talk about race. Regardless of your racial background, you may have heard one or more of the following messages at some point:
“There is one race, the human race.”
“Skin color doesn’t matter.”
“Race doesn’t matter, everyone has equal opportunities and has for years.”
“Reverse racism, or racism against Whites is a real problem.”
In psychotherapy, imagine these messages in the context of a clinical scenario in which a well-intentioned White psychotherapist is treating a young Black male client living in an urban environment. In the first session, the client communicates anger and sadness about lifelong experiences as a Black man dealing with racism. The therapist, operating from her psychodynamic orientation asks the client, “Tell me about your relationship with your mother.” These examples of Color-Blind Racial Ideology (CBRI) communicate that race does not and should not matter and therefore talking about race is unnecessary.
Often, race is construed as something biologically influenced and socially constructed; according to the US Census (ND), race is defined as self-identification with social groups (e.g., Black or White). Recent research has highlighted the pervasiveness of color-blind racial socialization practices particularly within White American families (Vittrup, 2018). In contrast to this ideology, APA’s (2017) Multicultural Guidelines highlight the importance of recognizing privilege, power, and race in the practice of psychology. These guidelines provide a layered ecological framework, one that underscores intersectionality, and developmental, and contextual issues in clinical practice. Thus, psychologists are encouraged to consider adopting color-conscious psychotherapeutic approaches by recognizing and acknowledging various levels of intersecting
According to Neville and colleagues (2013), color-blind racial ideology has two components: color evasion and power evasion. Color evasion involves denying differences by emphasizing sameness, while power evasion emphasizes equal opportunities across racial groups. Both People of Color and White individuals are often socialized to avoid difficult dialogues about race, becoming color mute. Like all humans, psychologists often struggle when challenged to acknowledge privilege and talk about race in therapy with a client of color. Moreover, the prevailing assumption is that if both the therapist and the client are White, then race is not part of the clinical picture and does not need to be discussed.
Notably, race shapes identity and psychological experience, with racial socialization beginning in infancy and continuing throughout the lifespan (Katz, 2003). Thus, even when race is not a part of the client’s presenting issue, race is part of the air we breathe and ground we tread; its presence inevitably influences the nature, context, and course of psychotherapy.
There is a wide body of research that focuses on psychologists’ multicultural counseling competence and psychotherapy with diverse clients (Sue & Sue, 2016). An analysis of this impressive literature is beyond the scope of this article. Instead, I would like to present three constructs that might encourage psychologists to adopt a strength-based approach within a sociocultural context acknowledging color and power.
According to Kabat-Zinn (2015), mindfulness is an ancient eastern practice that involves paying attention on purpose in a particular way, non-judgmentally, in the present moment as open-heartedly as possible. Kabat-Zinn (2015) argued that mindfulness is critical to well-being, healing, and transforming ourselves and the world. Components of this practice and approach have been adopted into a range of mental health treatment modalities, educational interventions in classroom settings, and workplace locales including corporate offices (e.g., modern companies like Google
have invested in mindfulness practices, offering a “Search Inside Yourself” mindfulness course).
A central tenant of mindfulness relevant to adopting a color-conscious racial approach in psychotherapy is that suffering cannot be avoided, and instead should be acknowledged and observed. Adopting a color-conscious approach entails acknowledging the role of White privilege and racism in the US, and may be associated with contradictory thoughts and feelings including fear, guilt, defensiveness, anger, helplessness, and shame. Individuals wrestling with racial identity in the US commonly experience opposing and seemingly contradictory impulses. According to Todd and Abrams (2011), one can be both color-blind and color-conscious, while concurrently having and lacking advantages.
Given that mindfulness involves paying attention to divergent experiences in the moment without judgment, this practice may facilitate greater acknowledgment and acceptance of contradictory experiences about race in psychotherapy. One recent study suggested that mindfulness predicts multicultural counseling competence after controlling for race/ethnicity, multicultural course completion, and empathy (Ivers, Johnson, Clarke, Newsome & Berry, 2014). According to the authors, mindfulness involves self-awareness, compassion, non-judgment, and reflexive thinking and may thereby support multicultural counseling competence. Future research might expound upon this finding, and clarify how, why, when, and for whom, mindfulness practice might facilitate multicultural counseling competence and possibly promote color-consciousness in psychotherapy. For instance, research might elucidate ways in which mindfulness may help psychologists become aware of the color evasion and power evasion that undergird color-blind racial ideology.
Pittinsky and colleagues (2011) defined allophilia as positive attitudes toward outgroups. Applied to a multicultural counseling competence framework, allophilia may encourage moving beyond a mere tolerance and respect of marginalized individuals
and developing authentic positive regard. According to Pittinsky’s research, allophilia includes five related but distinct factors: affection, comfort, kinship, engagement, and enthusiasm toward outgroups. This framework has been applied to helping teachers move beyond tolerance in the classroom (Pittinsky, 2009). Developing allophilia embodies the spirit of APA’s Multicultural Guidelines (2017), and may counteract color and power evasion in psychotherapy. However, it remains to be seen if this type of “outgroup liking” can actually translate to eradicating CBRI in psychotherapy. Also, in conceptualizing allophilia in psychotherapy, it is important to note that discussing “outgroups” may inadvertently reinforce power differentials and assume Whiteness is the norm. As psychologists with expertise in nuance and complexity, we walk a delicate balance in talking about race, color, power, and privilege, and “outgroup liking,” while being mindful of language and behavior that may oppress marginalized groups and reinforce oppression.
While allophilia describes attitudes or cognitions, mircoaffirmations speak to behaviors that may foster a strengths-based approach to psychotherapy that recognizes color and power. In contrast to microaggressiosns, microaffirmations is a lesser-known term that has not been carefully integrated in the psychological science literature. Pittinsky (2016) argued that, just as microaggressions might be small unconscious actions to make marginalized individuals feel put down, micraoffirmations may help individuals feel welcomed and encouraged. Microaffirmations entail intentional or unintentional communications or practices that promote inclusion. Ellis and colleagues (2018) suggested that microaffirmations include microcompliments (e.g., providing praise or respect), microsupports (e.g., eye contact and providing resources), and microvalidations (e.g., verbally affirming experience). Applied to psychotherapy, microaffirmations might include talking to clients in direct, honest, and supportive ways about color, race, power, and privilege. Thus, microaffirmations may include micro-level behavioral mechanisms that could counteract “color muteness” in psychotherapy. For instance, a therapist might use microaffirmations to acknowledge potential power differentials and explicitly affirm a client’s racial/ethnic identity (e.g., talking about racial differences between the
therapist and client). Practicing microaffirmations in psychotherapy could incorporate a color-conscious approach, as psychologists intentionally consider ways in which to help a racial/ethnic minority client feel validated, included, and respected. Moreover, microaffirmations seemingly entail behavioral complements that, when applied appropriately, may counteract color and power evasion inherent in CBRI. As psychologists, we are called to move beyond cognitive awareness, racial empathy, outgroup liking, and kind gestures. Indeed, we should consider ways of engaging in difficult, honest, and ongoing conversations about race, color, power, and privilege. In so doing, we may find ourselves practicing microaffirmations and developing authentic allophilia.
In summary, practicing mindfulness, cultivating allophilia, and providing microaffirmations in clinical practice represent possible strength-based constructs relevant to multicultural competence in psychotherapy. Although these approaches may sound daunting and antithetical to unspoken yet omnipresent rules governing dialogues about race, such ongoing reckoning with our thoughts and behaviors is essential for engaging in ethical and competent clinical practice. Moreover, these approaches elucidate exciting opportunities for us as psychologists to enhance our clinical efficacy as healers and health service providers. ❖
References
American Psychological Association. (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. Retrieved from: http://www.apa.org/about/policy/multicultural-guidelines.pdf
Ellis, J. M., Powell, C. S., Demetriou, C. P., Huerta-Bapat, C., & Panter, A. T. (2018). Examining first-generation college student lived experiences with microaggressions and microaffirmations at a predominately White public research university. Cultural Diversity and Ethnic Minority Psychology. Advance Online Publication. https://doi.org/10.1037/ cdp0000198
Ivers, N. N., Johnson, D. A., Clarke, P. B., Newsome, D. W., & Berry, R. A. (2016). The Relationship Between Mindfulness and Multicultural Counsel-
ing Competence. Journal of Counseling & Development, 94(1), 72–82. https:// doi.org/10.1002/jcad.12063
Kabat-Zinn, J. (2015). Mindfulness. Mindfulness, 6(6), 1481–1483. https://doi. org/10.1007/s12671-015-0456-x
Katz, P. A. (2003). Racists or Tolerant Multiculturalists? How Do They Begin? American Psychologist, 58(11), 897–909. Doi: .1037/0003-066X.58.11.897
Neville, H. A., Awad, G. H., Brooks, J. E., Flores, M. P., & Bluemel, J. (2013). Color-blind racial ideology: Theory, training, and measurement implications in psychology. American Psychologist, 68(6), 455–466. https://doi. org/10.1037/a0033282
Pittinsky, T. L., Rosenthal, S. A., & Montoya, R. M. (2011). Measuring positive attitudes toward outgroups: Development and validation of the Allophilia Scale. In L. R. Tropp & R. K. Mallett (Eds.), Moving beyond prejudice reduction: Pathways to positive intergroup relations (pp. 41-60). Washington, DC, US: American Psychological Association.
Pittinsky, T. L. (2009). Allophilia: Moving Beyond Tolerance in the Classroom. Childhood Education, 85(4), 212–215.
Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice., 7th ed. Hoboken, NJ, US: John Wiley & Sons Inc.
Todd, N. R., & Abrams, E. M. (2011). White dialectics: A new framework for theory, research, and practice with White students. The Counseling Psychologist, 39(3), 353–395. https://doi. org/10.1177/0011000010377665
US Census (N.D.). Race. Retrieved from https://www.census.gov/topics/population/race.html
Vittrup, B. (2018). Color Blind or Color Conscious? White American Mothers’ Approaches to Racial Socialization. Journal of Family Issues, 39(3), 668–692. https://doi. org/10.1177/0192513X16676858
NJPA is committed to strengthening our political outreach and advocating for the interests of NJ psychologists and mental health issues that are important to the public. Over the years, our advocacy has taken many forms. Through our Committee on Legislative Affairs (COLA), Committee on Regulatory Affairs (CORA), and our Government Affairs Agent (GAA), NJPA is instrumental in maintaining standards of psychology practice in NJ, protecting patients’ rights, and supporting public policy. We monitor state rules and laws that regulate the profession, and maintain a liaison with the NJ Board of Psychological Examiners to stay informed about any changes that may affect our members. As an affiliate of APA, NJPA is involved in federal advocacy initiatives and regularly lobbies for federal issues that affect psychology. Below is an update of our current legislative initiatives.
NJ Licensing Act Legislation – NJPA will propose amendments to the NJ Licensing Act to follow the APA Model Licensing Act. NJPA believes that our state must re-examine the licensing requirements for psychologists due to the substantial increase in the number of supervised hours most doctoral students must accumulate during their doctoral studies. They are required to complete half of the required hours after graduation even though most students complete the total number of required hours (or even more) prior to graduation. APA pointed out that this results in delayed licensing for qualified graduates, thereby negatively affecting access to mental healthcare.
NJPA Past-President, Dr. Stephanie Coyne, was quoted in a 2018 NJBIZ.com article, Dearth of In-Network Psychiatrists Highlights NJ’s Mental Health Gaps: Delaying Licensing for Qualified Graduates Thereby Negatively Affects Access to Mental Health Care. She added, “In addition, access is negatively impacted because of the ‘brain drain’ that results when graduates decide to forego licensing in our state and choose instead to get licensed in other nearby states where the total number of their supervised hours enables them to be licensed more quickly.”
Maiden Names Legislation - Modify
New Jersey Division of Consumer Affairs’ policy on the use of legal names on the NJ psychologist license and other professional identification materials. Currently, a licensed professional is required to use his or her legal name when applying for a professional license and is only permitted to practice under his or her legal name. The division created this policy in order to protect the public by ensuring that a licensee is not engaging in inappropriate behavior under a different name and to conduct a criminal background check on an applicant. This policy affects a large percentage of female professionals. Women are most likely the individuals who would be changing their name when they marry and choose to take their spouse’s last name. Prior to marrying, a woman could be in professional practice for a number of years, and then upon taking her husband’s last name, be forced to start over in her professional life due to having a new last name.
Network Adequacy Legislation – Research is needed to examine the adequacy of the numbers of mental healthcare providers in insurance company networks, as well as the relationship of in-network reimbursements for psychologists in relation to other types of healthcare providers.
Legislation that enhances enforcement and oversight of behavioral health parity laws This bill, supported by NJPA, requires hospital, medical and health service corporations, commercial insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program, to provide coverage, for medically necessary behavioral health care services and to meet the requirements of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which prevents certain health insurers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than
on medical or surgical benefits, commonly referred to as mental health parity. On October 29, 2018, it was passed by the Assembly. On January 17, 2019, Bill S1339, passed the Senate Commerce Committee. The bill now goes to the full senate for a vote and then to the Governor for his signature.
Medicaid Update – NJPA had a faceto-face meeting with the New Jersey Director of Medicaid Services and several staff members, including the Director of Behavioral Health Services. After this meeting, NJPA was in touch with the Director of Behavioral Health Services over the course of this past year discussing this issue repeatedly and assisting with the text of the newsletter.
Duty to Warn Amended Law – We reached out to the NJ Attorney General in response to P.L. 2018, CHAPTER 34, approved June 13, 2018 Assembly, No. 1181 (First Reprint). NJPA closely followed the bill development over the years and provided the bill sponsors with suggested amendments to ensure that the spirit of the bill, to protect the public, was preserved while allowing for the most efficient and effective way to implement an additional public safety provision related to mental health providers’ duty to warn. Our suggested amendments were focused on ensuring that the motivation of the public to seek mental health care was not stifled or deterred in any way by a fear that sensitive information would be disclosed to police departments where patients live. We also wanted to encourage and allow for mental health providers to provide services without concern that patients might be less than forthcoming during sessions. In addition, we wanted to address the best manner in which mental health providers communicate with law enforcement and under what circumstances. The Attorney General is considering clarifications for this new amendment, with NJPA’s input.
Parity Coalitions - NJPA will be reviewing options to become involved in parity efforts, potentially by joining a parity coalition.
In addition to new bills that come through the NJ legislature that may impact psychologists or psychology, NJPA is also following Governor Murphy’s efforts related
to graduate student loans, funding for opioid treatment, and efforts to legalize marijuana in NJ. NJPA is also researching the NY mandatory mental health education
law to see if we might pursue something similar in NJ. ❖
Make your online donation today! www.psychologynj.org
Mark Singer, EdD Mathias Hagovsky, PhD 2018 President 2018 Treasurer
The Political Action Committee (“NJP-PAC”) is a voluntary, non-profit political action committee. NJP-PAC is a separate entity, and is not affiliated with any political party or other political committee. The NJP-PAC makes contributions, from funds received from NJP-PAC contributors, to candidates for office and political committees in New Jersey who have demonstrated their interest in and support of psychology, without regard to party affiliation. NJP-PAC, Inc. thanks and acknowledges the following individuals who have given generously to the 2018 PAC campaign (includes all contributions processed by December 31).
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The term clinical neuropsychology refers to a health care discipline that involves evaluation of people with brain dysfunction. Common domains assessed in a neuropsychological evaluation include memory, attention, visuospatial functioning, executive functioning, language, motor skills, mood, and personality. Effort testing (i.e. performance validity testing), although not a cognitive domain, is perhaps the largest area of growth in the field in recent years. Other areas of growth in the field include test security and protection of raw data, the use of computerized testing, the use of technicians, and the application of test results in forensic setting. In addition, our awareness has become increasingly focused on the importance of developing cross cultural competence and how able we are to meet the needs of an increasingly diverse population.
Historically, referral questions posed to neuropsychologists suggested a false diagnostic distinction between “organic” (i.e. neurological) and “non-organic” (i.e. psychogenic) brain disease. The fields of neuropsychology and psychiatry have addressed these misguided attempts to artificially compartmentalize psychiatric conditions from their neurological underpinnings. The types of referral questions now posed to neuropsychologists pertain more to differential diagnostic issues in patients with various psychiatric and/or neurological symptoms, such as: Are a patient’s memory and attention complaints due to a primary attention disorder, such as Attention Deficit Hyperactivity Disorder, or to a mood disorder, such as Major Depression? In addition, the referral question may pertain not merely to diagnostic questions but to issues of functional capacity in a patient’s everyday life or a patient’s potential response to treatment or rehabilitation efforts. Neuropsychological findings remain uniquely able to provide data driven recommendations pertaining to a patient’s ability to live independently, drive, work, manage finances, or participate in treatment.
Neuropsychologists are first and foremost clinical psychologists. No neuropsychologist is properly trained or qualified to practice their subspecialty without a foundation in clinical psychology. This foundation allows for the understanding of the interconnection between cognition, emotions, and behaviors to be applied to a wide variety of settings, including psychotherapeutic treatment, school, rehabilitation, mental capacity, employability, and independent living. The general public knows very little about the discipline of neuropsychology or how and why a neuropsychological evaluation can help them. One of the primary goals of the neuropsychologist is to serve as a bridge between the medical, psychiatric, academic, and psychotherapeutic aspects of a patient’s care.
The goals of this special section are to increase the reader’s understanding of how cognitive deficiencies interact with psychiatric symptoms, how results from a neuropsychological evaluation can be used to optimize therapeutic treatment in both children and adults, and how we, as clinicians, can improve our cultural competence in addressing the needs of a diverse population. ❖
Pediatric neuropsychology is a subspecialty within the field of clinical neuropsychology that focuses
on the understanding of brain-behavior relationships in children and adolescents with known or suspected traumatic brain injury or disease (e.g., cancer), neurodevelopmental disorder (e.g., autistic spectrum, intellectual disability, Tourette’s Syndrome), learning disorder (e.g., dyslexia, dyscalculia, dysgraphia, etc.), psychiatric conditions (e.g., ADHD, depression, anxiety, etc.) or other congenital (e.g., down syndrome, fetal alcohol syndrome) or acquired disorder affecting brain development and function (Baron, 2018). While conducting assessments is the most common role associated with neuropsychologists, they also carry out other integral functions in the delivery of psychological care. For example, neuropsychologists serve as members of
a cross-disciplinary team in healthcare settings providing input about a patient’s functioning to providers and family, guiding rehabilitation, appraising program development for academic and treatment settings in order to improve the effectiveness of interventional strategies. In the forensic arena, neuropsychologist provide expert testimony when assessing whether brain dysfunction has been acquired, psychological effects of injury, disease, and exposure to emotional trauma, and proffering opinions regarding the response to educational and therapeutic interventions (Sherman and Brooks, 2012).
With the advances in medicine and improved treatment outcomes for those who have experienced trauma, the roles of a pediatric neuropsychologist have
expanded in-step. More specifically, the applications of neuropsychological impressions have shifted from predominantly answering diagnostic questions towards building a profile of strengths and weaknesses that relate to the way a child learns, adapts, and what to expect in their developmental trajectory. The reason one sought neuropsychological input has evolved from solely explaining “what” is going on, or arguably more important, the “why” s/he is experiencing difficulties in learning and life. (Silver, Blackburn, Arffa, et al, 2006). This article will highlight the manner that these impressions are used to help inform guidance with developing therapeutic interventions and treatment monitoring in children.
A parent, pediatrician, teacher, or attorney usually will request a neuropsychological evaluation for a child or adolescent due to observed difficulties and concerns in general functioning. These problems can be with learning, behavior, or with emotional control. Sometimes a youngster is referred because of a newly identified medical or neurological condition that can be developmental or acquired. Children who have significant problems controlling and managing their behavior and emotions are also seen for evaluation. Diagnoses for ADHD, Mood Disorder, Autistic Spectrum, Anxiety, intellectual and learning disabilities are common reasons for a child to be evaluated (SemrudClikeman and Ellison, 2009).
Frequently, a neuropsychological evaluation is considered for diagnostic clarification when attempted treatments have not been effective, to provide a diagnosis to allow access to services, or before a specific medical treatment is to be started. At other times, it is to confirm a caregiver’s or professional’s intuition that “something” is just not right. Indeed, an important referral question to ask is whether a child’s overall sense of well-being is negatively impacted by cognitive, behavioral, or emotional factors that is triggered by their condition. A neuropsychological evaluation can provide the foundation for an accurate diagnostic conceptualization and useful recommendations. As per Holmes- Bernstein, Kammerer, and Rey-Casserly (2013), a pediatric neuropsychological evaluation should be considered when:
• Unexpected failure to meet environmental demands in academic or psychosocial circles
• Lack of adequate explanation for presenting behavior or insufficient
information to guide intervention planning, subsequent to psychological, psychiatric, psychoeducational, or multidisciplinary assessment
• Change in behavior in the context of known/suspected neurological disorders, systemic disorders, and/or treatment regimens with potential central nervous system impact, degenerative/ metabolic/genetic disorders, and disorders associated with structural central nervous system abnormalities
• Need to clarify the relationship of behavioral change to specific medical/ neurological/psychiatric diagnoses or to specific neural substrates
• Need for baseline profile and ongoing monitoring of neurobehavioral status to track recovery, effects of treatment and/or the impact of developmental change on behavioral function
• Measurements of change in clinical research with neurological, psychiatric, and psychological populations
It is helpful to appreciate the nature of the kinds of psychological evaluations by viewing them on a continuum ranging from psychoeducational to psychological to neuropsychological assessments. With that viewpoint, psychoeducational assessments address whether there is an impact on learning based on an individual’s cognitive, academic, and social emotional functioning. School psychologists are often primarily interested in the score that the child obtains from testing to determine whether criteria has been met for an educational classification that would lead to receiving special education services and supports. In non-forensic settings, psychological evaluations administered to children often answer questions involving the influences that their cognitive functioning, behaviors, or personality are having on socio-emotional adjustment. A pediatric neuropsychological evaluation focuses on appreciating brain function and activity and uses a battery of assessment instruments to acquire information and historical data about a child or adolescent’s cognitive abilities, achievement maturation, social-emotional adjustment, communication skills, behavior, and adaptive levels. There are several testing models or approaches (e.g., fixed, flexible, process, maturational, personal, etc.) that a pediatric neuropsychologist may use regarding their respective clinical evaluation of a child. While all neuropsychological evaluations involve examining one’s thinking,
behavior, and social-emotional functioning, the writers of this article do so to not only investigate what the child knows, but how the child thinks and arrives at solutions, also recognized within the neuropsychological literature as the process approach. Regardless of how a neuropsychologist conceptualizes a child’s presentation, arguably all neuropsychologists tend to “dig deeper” into understanding functioning by breaking down problems into their component parts, integrating findings across domains, and presenting a unified profile of a youngster. In doing so, Reinstein & Burau (2014) contend that this facilitates a narrative depicting the whole child. A neuropsychological evaluation is an invaluable source of information to design, guide, and assess treatment choices, encompassing cognitive ability, as well as neurodevelopmental, emotional, and behavior regulation assessment. It is qualitative, as well as quantitative, allowing for greater insight into the youngster’s ability to meet demands faced every day. Given that children can present with similar concerns, but have difficulty for a variety of reasons, a neuropsychological evaluation helps to define what a problem is for the child, what a strength in functioning is, and what are appropriate and meaningful treatment recommendations from a holistic standpoint.
The major domains of functioning assessed by a neuropsychological evaluation cover the following (Holmes- Bernstein, Kammerer, and Rey-Casserly, 2013):
• Regulatory and goal directed executive capacities (arousal, attention, motivation, memory, learning, mood, affect, emotional reasoning, planning, decision making, monitoring, initiating, sustaining, inhibiting, & shifting abilities)
• Skills and knowledge bases (sensory and perceptual processing in [primarily] visual and auditory modalities, motor capacities, communicative competence, social cognition, linguistic processing, speech functions, spatial cognition)
• Achievement (academic skills, adaptive functioning, social comportment, social adjustment)
Due to their comprehensive nature, the information obtained through neuropsychological assessments are uniquely positioned in that they offer a thorough diagnostic conceptualization that leads to targeted recommendations for patient, caregivers, educators, court systems, and
healthcare providers. One of the fastest growing roles in pediatric neuropsychology is that concerned with making specific recommendations and implementing instructional and rehabilitative strategies (Farmer, Donders, & Warchausky, 2006; Hunter, & Donders, 2007 in Baron, 2018). The results of a neuropsychological evaluation provide an understanding of a youngster’s cognitive functioning, academic performance, and behavior that will help guide interventions at home and school.
A neuropsychological evaluation focuses on where a child is developmentally to obtain both a profile of personal performance and in comparison to same age peers. Such findings provide quantifiable data about different aspects of functioning. While observational information is a requisite aspect in arriving at accurate impressions, much of the assessments administered to the child, and/or questionnaires completed by parents and educators, have been standardized using normative data reflecting a child’s age, grade, gender, ethnicity, and when possible disability. Pediatric neuropsychologists are especially cognizant of the importance of using reliable and valid tests with appropriate normative data for the specific population evaluated (American Educational research Association, American Psychological Association, and the National Council on Measurement in education, 1985 cited in Baron, 2018). Research has shown us that basic brain areas that mature early are “hard wired” or genetically programmed (i.e. auditory verbal processing, visual processing, somatosensory input, and motor control), while other brain areas involved in the ability to learn, pay attention, recall and remember, and self-regulate behavior continue to develop throughout childhood. Some parts of the brain (i.e. frontal lobes) involved in executive functioning do not fully mature until the mid-twenties. (Semrud-Clikeman and Ellison, 2009)
The literature on maturation and expected task benchmarks at each stage of development, indicates that it is critically important that a child is not viewed as a little grown-up or a preschooler regarded as very young child. A child’s performance during testing is viewed by an approach that integrates “vertical dimension of development with horizontal dimension of a child’s current neurobehavioral repertoire (Holmes- Bernstein, Kammerer, and Rey-Casserly, 2013) The evaluation of preschoolers generally focuses on cogni-
tive development, language, and motor functioning, while evaluation of school age children focuses on cognitive development, academic progress, attention, behavior, emotional regulation, and social functioning. Adolescent evaluations focus on cognitive development, academic growth, executive functioning, emotional and behavioral regulation, and social functioning. Using this developmental lens allows the neuropsychologist to understand children in their maturational context when conceptualizing their wide range of presentations whether a child is presenting with learning difficulties, a concussion, undergone a medical treatment (e.g., chemotherapy), showing signs of a mood/anxiety disorder, struggles with social relations, finds it markedly trying to focus and control impulses, etc.
Indeed, the major purposes of a pediatric neuropsychology assessment are to assist with questions about the integrity of cognitive functions, learning, emotional regulation, and behavioral control, to make a differential diagnosis, and to ultimately provide treatment recommendations and planning. Test results are most often combined and coupled with information and findings from clinical impressions, related discipline reports, medical and physical examinations, and both historical and current self and informant reports. Since each neuropsychological test has both strengths and weaknesses in validity, reliability, sensitivity, and specificity, it is important to obtain a comprehensive profile and picture incorporating multiple sources of data. The assessment looks at how an individual’s brain impacts thinking skills, affective tone, and behavioral functioning, and provides insight into the psychological functioning of an individual. This information and data from the tests can then be compared with normative data that must consider a variety of demographic factors and criteria, including, but not limited to, age, race, gender, cultural background, education, socioeconomic status, linguistic competency, and can then be interpreted and used by an experienced and well trained neuropsychologist to make a diagnosis or confirm a diagnosis, localize organic abnormities in the central nervous system, guide the development of effective remedial treatment methods and programs, track appropriateness and efficacy of treatment recommendations, and track progression of a specific condition. Children and adolescents with concussions, genetic and neurological disorders, or emotional, learning, or behavior
disorders may be seen for repeat evaluations to make sure they are being provided enough support and appropriate treatment and programming to meet their needs.
Providing feedback is arguably the most critical aspect of an evaluation. Once testing is completed, the neuropsychologist will integrate the findings to conceptualize each youngster’s pattern of strengths and challenges and determine if diagnostic criteria are supported by background history, behavioral observations, self, parent, and teacher reports, and develop a profile of the youngster. The profile will be helpful to clearly identify areas of success and areas where a youngster may need assistance and support and should illuminate why the youngster is having trouble in learning and in life. Results are meaningless without being able to explain them to the patient, caregivers, educators and/or other professionals in ways that have relevance to a child’s development. It is vital that feedback be very clear and informative about the ways in which the profile of strengths and challenges has and can be expected to impact the day to day functioning of the youngster (e.g. “noted executive function deficits in working memory, planning, and organization will create difficulties in homework, long term project management, test performance…”). This is done so, by articulating how a child’s brain-behavior relationships impacted their performance and relating it to how it effects their current abilities to meet the demands they encounter at school and home. Considering when a brain insult may have occurred and what area of the brain it materialized (i.e., focal, multi-focal, or diffuse), onset and manifestation of psychological/psychiatric condition, societal demands, and individual performance leads to formulating recommendations that are more ecologically valid and could be put into practice when guiding therapeutic (medical & educational) interventions. In best practice, a neuropsychological evaluation is both diagnostic and therapeutic, providing an opportunity for a youngster and family to experience and develop an appreciation of abilities and challenges, collect and integrate a wealth of data with parents allowing them insight into their concerns, and lay the groundwork for needed treatments and supports. Once educated, patients, caregivers, and healthcare providers can become collaborators in the feedback process, which then helps them better understand the impact or clinical meaning of findings from testing.
Feedback sessions yield multiple benefits such as, but not limited to helping reframe how patient/caregivers/professions views the condition, a sense of relief or a cathartic moment for those involved with now having a better understanding of their functioning and possible challenges, and lastly, it positions patients and parents to be more effective advocates (Postal, 2013, p.8-9). A very important first step for a caregiver is understanding a youngster’s profile of abilities, accepting and acknowledging their special needs, and moving forward in this process to access and employ appropriate interventions. As noted, caregivers and, even patients, will be relieved to have information that is comprehensive and is a clearly articulated picture of current functioning and a well-designed road map to begin to address their unique needs.
The neuropsychological evaluation is often the beginning of treatment, and the results and conclusions of a neuropsychological evaluation are used to contribute to various phases of treatment planning:
• development of initial treatment plan
• problem solving during treatment
• monitoring treatment progress
As described by Margret SemrudClikeman (2009), for children who are experiencing specific learning difficulties, the profile can explain why they may be having trouble and provide the necessary information to understand the underlying difficulties to develop appropriate interventions. For instance, reading problems may be due to an underlying attention problem, a perceptual problem, a language problem, an information processing problem, emotional reasons, or dyslexia. Knowing the factors contributing to the observed difficulty will inform treatment choice. Some youngsters may need a structured literacy program for dyslexia, while other youngsters may need targeted interventions to address other cognitive and behavioral factors contributing to learning challenges. The evaluation will document the need for the school to provide the child with either a 504 Accommodation Plan or to classify the child in the school system as eligible for special education services under different known classifications with needed remedial interventions, support services, and accommodations /modifications to academic program provided to the child.
A concussion or traumatic brain injury can also cause difficulty with learning and
with novel learning retention. A neuropsychological evaluation can pinpoint areas of difficulty and address the need for cognitive remediation and accommodations to academic program. Medications and medical treatments for seizure disorders, genetic disorders, and cancers can also cause difficulty with learning. Since most parents and teachers do not have the knowledge, experience, and information to fully understand these disorders and resultant impact on functioning, a comprehensive profile of a child’s strengths and challenges can aid in developing appropriate teaching strategies, remediation programs, and behavioral management treatments. (Hale, SemrudClikeman, & Fiorello, 2016)
Children who have undergone treatment for cancer or brain tumors, or who have been diagnosed with genetic syndromes can demonstrate learning, attention, and behavioral patterns that need to be understood for treatment needs. Since it is not unusual for some children to show a regression or loss of skills due to medical treatments or to extended hospitalizations, it is also important to monitor and track progress for any needed changes to remedial programs or behavioral treatment regimen.
Children diagnosed with ADHD often can also experience an anxiety disorder, an oppositional defiant disorder, and a depressive disorder. Indeed, approximately 25-30% of children diagnosed with ADHD also experience a mood disorder or behavior disorder. It is important to determine other disorders co-morbid with the diagnosis of ADHD to inform medication usage, treatment choice, and needed school supports. Of note is that children with a primary disorder of anxiety or depression can also demonstrate significant problems with attention even if they do not have a primary diagnosis of ADHD, and it is important to determine whether these disorders are co-morbid with ADHD or the more appropriate diagnosis. In addition, children diagnosed with ADHD often also experience learning difficulties. However, youngsters with significant learning disorders can also appear inattentive, impulsive, and distracted at school, and it is equally important to delineate if a child has ADHD with learning difficulties or if a child has a primary learning disorder with secondary attention features.
Difficulties with language processing can also impact both learning and social interaction. It is extremely important to determine whether a youngster may have a language delay as opposed to just being shy,
reserved, or socially hesitant as the underlying cause of observed behavior. In the more extreme case of social awkwardness and poor social reciprocity, it is important to consider the possible diagnosis of autism. Children with significant language delays can often present with autistic-like behaviors and social interaction deficits, and it is critical to understand the nature of the difficulty for appropriate treatment. In addition, children with autism often present with significant language delays or challenges in social language. A neuropsychological evaluation is critical in being able to delineate and separate out these difficulties for treatment selection. (Semrud-Clikeman & Ellison, PAT, 2009).
In essence, the neuropsychological evaluation affords the clinician a more comprehensive understanding of a child or adolescent at home, at school, and in the community. The ability to understand why a child is having difficulty is the first step in designing, implementing, and monitoring appropriate treatments and supports for the child to reach his/her potential. Treatment informed by neuropsychological evaluation can target specific areas of challenge, and help a youngster to learn how to compensate for areas of weakness, help a student learn needed organizational skills to improve functioning in school, support parents and teachers to set up behavior management plans for children with challenging behaviors, help parents and families cope with the impact of medical and neurological disorders, and help children develop better social skills to foster friendships and activity engagement.
Pediatric neuropsychologists must be aware of several issues when conducting a neuropsychological assessment and making treatment recommendations. The administration and interpretation of results from a neuropsychological evaluation must be conducted with consideration of a child’s race, ethnicity, culture, age, gender, socioeconomic status, and awareness of how such factors may have a significant impact on health and psychological well-being (Baron, 2018). “A neuropsychologist unfamiliar with the client’s culture or without a good conceptualization of how culture affects all aspects of a neuropsychological evaluation can easily miss relevant information by not approaching the client in the right manner, not communicating the right way, not asking the right questions, or not attending to the right nonverbal behaviors. Moreover, the
clinician may not appreciate the limitations or makes sense at the data that are collected” (Fujii, 2017, p. 27). It is warranted that if a pediatric neuropsychologist is assessing a culturally different client, that they make concerted efforts to develop an understanding of the cultural norms, preferred modes of behavior, linguistic competency, and ethnic customs of a youngster’s background. It is also important to select appropriate tests with appropriate norms for the youngster being evaluated. Not all recommendations fit all groups, and the clinician must be sensitive to the cultural issues of the youngster and his/her family. Indeed, an understanding of a youngster’s background is critical for collecting accurate data and interpreting it to make useful treatment recommendations. It is important to maintain an ethno-relative attitude (i.e. acceptance of other as different but equal), as opposed to an ethnocentric attitude (i.e. considering the other within one’s own cultural lenses and values with the assumption of superiority) in making treatment recommendations and offering intervention strategies. Fujii (2017) contends a good template to follow is one that integrates the APA Ethics Code (2010) and Multicultural guidelines for assessments (2003) that states the following:
• Tests need to be in a client’s language. (APA Standard 9.02, Use of Instruments)
• Tests need to be validated with the client’s population. (APA standard 9.02, Use of Instruments)
• Psychologists should be aware of test’s reference population. (Multicultural Assessment)
• Psychologists should be aware of limitations of assessment practices in test for culture, including test bias, test fairness, and cultural equivalence. (Multicultural Assessment)
• Neuropsychologists should avoid using interpreters who have a dual relationship with the client (e.g., family member). Doing so that could lead to either exploitation or loss of objectivity. Neuropsychologists must also ensure that interpreters are adequately trained and supervised to provide competent services. (APA Standard 2.05, Delegation of Work to Others)
• If procedures are not explained, a client may feel disrespected and perceive that the therapist does not value their relationship and may not follow rec-
ommendations. (Multicultural Assessment)
• Informed consent must be understandable to the client and include consent to use an interpreter. (APA Standard 9.03, Informed Consent in Assessments)
• When interpreting tests, exercise critical judgment because situational, personal, linguistic, and cultural differences may affect judgments or accuracy of interpretations. (APA Standard 9.06, Bases for Scientific Judgment; Multicultural Assessment)
• Data needs to be sufficient to justify findings. (APA Standard 9.01; Bases of Assessments)
• Limitations of data need to be documented, especially if using an interpreter. (APA Standard 9.01, Bases of Assessments; Standard 9.02, Use of Instruments; Standard 9.06, Bases of Scientific Judgment)
Although a neuropsychological evaluation offers quantifiable data for decision making, it is not enough to simply review test scores, as “A good decision is based on knowledge and not on numbers.” (Plato) ❖
Baron, I. S. (2018). Neuropsychological evaluation of the child: Domains, methods, and case studies. New York, NY: Oxford University Press.
Fujii, D. (2017). Conducting a culturally informed neuropsychological evaluation.
Hale, JB., Semrud-Clikeman, M., Fiorello, CA. School Neuropsychology. New York: Guilford Press, 2016.
Holmes-Bernstein, J., Kammerer, B., & ReyCasserly, C. (2013). Developmental Neuropsychological Assessment. In G. P. Koocher, J. C. Norcross, & B. A. Greene (Eds.), Psychologists desk reference (pp. 100-105). New York, NY: Oxford University Press.
Postal, K. (2013). Feedback that sticks: The art of communicating neuropsychological assessment results.
Reinstein, D. K., & Burau, D. E. (2014). Integrating neuropsychological and psychological evaluations: Assessing and helping the whole child. New York: Routledge, Taylor & Francis Group.
Semrud-Clikeman, M., & Ellison, PAT., Child Neuropsychology: Assessment and Intervention. New York: Springer, 2009.
Sherman, E. M., & Brooks, B. L. (2012). Pediatric forensic neuropsychology. Oxford: Oxford University Press.
Silver, C.H., Blackburn, L.B., Arffa, S., et. al. The importance of neuropsychological assessment for the evaluation of childhood learning disorders, NAN Policy and Planning Committee. Archives of Clinical Neuropsychology 21 (2006) 741-744
The current landscape in the field of neuropsychology is focused on various topics. These topics include test security and requests from attorneys for copies of test protocols, the use of test technicians in clinical practice, performance validity testing (aka “effort testing”) and symptom validity testing when the neuropsychological evaluation results impact secondary gains, computerized testing versus paper-and-pencil tests, and providing evaluations that meet the needs of a rapidly increasing diverse population. One topic that is receiving much attention at an organizational and administrative level is the increasing need for culturally competent neuropsychological services to address the needs of a growing diverse population.
Among the many reasons for this surge in attention is based on information gathered by the US Census Bureau regarding past trends and future population projections. For example, in 2014, non-Hispanic Whites accounted for more than 50 percent of the nation’s total population; however, in 2060 the percentage of non-Hispanic Whites alone is projected to decrease to less than 50 percent of the total population. This change is estimated to occur in 2044, at which point although non-Hispanic Whites will be the largest single group, no one group will have the majority status over the total population.1 While diversity amongst patients is growing, there is a scarcity of neuropsychologists who are trained and feel competent to appropriately serve the needs of the current diverse (linguistically, cultural, socioeconomic, religious, etc.) population.2, 3
Given the scarcity of neuropsychologists that represent the current and rapidly changing population, there is an urgent thrust across the field to address the ethical issue of competently providing service. Through the years, various journal articles,
position papers, summits, and books have detailed the areas that need to be addressed to meet the needs of the continually growing diverse population. In acknowledgement of the lack of preparedness within the field of neuropsychology, many professional organizations have made a concerted push to address the disparity within the field. Most notably, the American Academy of Clinical Neuropsychology (AACN) has embarked in the Relevance 2050 Initiative that aims to address this broad practice issue at every level (patient care, training, research, and administration). Its goal is to increase the percentage of patients that can be competently served by supporting new training models, clinical strategies, midcareer supervision models, and new assessment methods.
The focus of this paper is to highlight what clinicians can do, right now, that will contribute towards creating a positive change in a direction of cultural competence in the context of the neuropsychological evaluation and general psychological treatment. First, it will be important to define the terms “cultural competence” and “diversity” that are referred to here.
Although there is some variation when defining cultural competence, in 2009, Sue, Zane, Nagayama Hall, and Berger4 defined it as having (1) knowledge of the patient’s culture, worldview, and expectations for treatment, (2) awareness of one’s own values and biases that can influence perception of the patient, and (3) having the necessary skills to effectively work in a culturally sensitive manner. In 2017, the American Psychological Association updated the multicultural guidelines that were originally published in 2003 to include the current trends in the literature. Multicultural Guidelines: An Ecological Approach to Context, Identity and Intersectionality
5 provides a general framework with the goal of increasing cultural competence of psychologists when providing services to patients. Diversity was defined as the intersection of gender, ethnicity, race, sexual orientation, age, physical and mental ability, socioeconomic status, physical attributes, and personal and social characteristics that comprised an individual’s identity. Further, within the guidelines, cultural competence
was emphasized as a lifelong process of reflection and commitment as opposed to an end goal of competence that is achieved.5 With that spirit, the goal of neuropsychologists is to strive towards cultural competence, as it is a fluid and evolving standard. The diversity that is pertinent to the discussion here is cultural, ethnic, linguistic, and racial.
Broadly defined, a neuropsychologist is a psychologist who has in depth understanding of the brain-behaviors relationship that is then used as the foundation when assessing, diagnosing, providing treatment recommendations, and implementing intervention strategies of patients across a lifespan.6 A recent survey of neuropsychologists regarding the perceived challenges of assessing someone representative of the ethnic minority population listed the lack of appropriate norms and of appropriate tests as the main issue. Lack of training was at the bottom of the list.3 Since the appropriateness of tests and having representative norms is a complicated area due to the heterogeneity among ethnic groups and subgroups, it is very difficult to create datasets that are representative for each group. Further, since many practicing neuropsychologists cannot immediately address the lack of appropriate norms of tests, focusing on what we can do now with the tools we have is a way of taking some control and taking a small step towards increasing culturally competent services. Since many neuropsychologists and other healthcare and mental health professionals use the neuropsychological evaluation to guide treatment and clinical practice, this is a great place to start. At the beginning of this year, Fujii (2018)7 introduced the acronym ECLECTIC as a useful and practical framework and guide for constructing culturally competent neuropsychological evaluations. The acronym is a grouping of characteristics previously described in the literature that takes into account the potential biases in fairness as described by the American Education Research Association (AERA). In addition to introducing this framework, Fujii provided a list of websites as references to assist the evaluator in gathering pertinent data in each area within the ECLECTIC framework (see Table 3).7
Briefly, the E in ECLECTIC represents
Education – level, quality, and literacy. Fujii (2018)7 suggests that the evaluator needs to be familiar with the level of education attained and the quality of education of the culturally diverse client. He discusses that an understanding of the patient’s level of education and the quality of education received is important as education has been linked to verbal knowledge and reading skills. He adds that the socialization aspect of education in addition to gaining vocabulary and reading skills assists in developing cognitive skills. As noted earlier, Fujii (2018)7 included various websites where information about the level, quality, and overall level of literacy of individuals within the country of origin can be obtained. It is important to have an understanding of the patient’s exposure to education when conceptualizing the case and when interpreting the results. It would also be important to include it in the background section of the evaluation.
C: Culture and acculturation. An understanding of the general family structure, values, language structure, social stratification, gender roles, and overall beliefs of the patient’s culture is critical in the evaluation process. The World Culture Encyclopedia website <http://www.everyculture.com> contains a wealth of information regarding the areas listed and more. Having an understanding of the patient’s culture is important in developing rapport and effective communication throughout and when interpreting test results as neuropsychological measures are generally developed within the context of Western-define constructs.
There is much information in the literature regarding the importance of understanding the level of acculturation of the patient to the mainstream culture. Having an understanding of the patient’s cultural identity and the extent to which the individual and his/her parents, for younger children, is acculturated is critical in test selection and in interpreting findings. There are numerous formal acculturation scales that are readily available for clinicians to use. For example, the Short Acculturation Scale for Hispanic 8 or the Abbreviated Multidimensional Acculturations Scale,9 etc.
L: Language spoken and English proficiency. Since it is essential that the patient and clinician understand each other and it is essential that the patient be evaluated in his or her dominant language, through the years this area has received much attention in the literature. This can become a
complex issue when evaluating someone from a nonnative English language background since there is a scarcity of neuropsychologists that are fluent and proficient in various languages that represent the diverse groups in the US. A focus on measures that have minimal verbal demands, alone, has been shown to be inadequate for various reasons. Moreover, there are various dialect differences with individuals that speak the same language. Further, there are a limited amount of measures that are formally translated into other languages, and site translations are strongly frowned upon within the literature for various important reasons. Irrespective of these complications, it is essential that the clinician understands that there is a difference between two types of language proficiency: Basic Interpersonal Communication Skills (BICS) and Cognitive Academic Language Proficiency (CALP).10 BICS are acquired first and are characterized by someone listening and speaking the language. Acquiring CALP takes longer and is an essential area to assess prior to conducting the evaluation and selecting measures. The Woodcock-Munoz Language Survey Revised11 assesses CALP levels in English and Spanish. Furthermore, Fujii (2018) also reports various other useful measures that are correlated with English proficiency.
E: Economic issues. Having an understanding of how someone’s socioeconomic status (SES) as well as level of poverty has a significant impact on cognitive skills is vital when interpreting test results. The effects of poverty are multifaceted and noxious. Poverty is possibly one of the most prevailing and insidious high-risk factors for academic failure that children confront.12 The answer as to why poverty has such a negative effect on children does not fall with just one cause or process. Children born into poverty are more likely to live within a single family household, have limited exposure to enrichment activities, attend low performing schools, and have increased exposure to violence and familial stress.13 A neuro-imaging study conducted by Kishiyama, Boyce, Jimenez, Perry, and Knight (2009)14 revealed that SES affects the prefrontal functions of the brain. Kishiyama et al. (2009) measured the brain functions of children of high and low SES using an electroencephalograph (EEG). The participants were required to watch, on a screen, a sequence of triangles and when a tilted triangle appeared, they
were to press a button. An EEG measured the electrical activity produced by the brain while engaged in this activity. The results demonstrated that children of low SES have a similar brain pattern to patients with lateral prefrontal cortex damage. That is, their brain patterns were similar to adults who suffered a stroke. In addition to the prefrontal cortex, poverty has been found to affect various other cognitive processes. Fujii (2018)7 notes that having knowledge of the economy of the patient’s country and family of origin provides information on measurement bias and potential comfort within the testing situation.
C: Communication style. Understanding the general communication style of the patient’s culture is also foundational in establishing rapport and obtaining the relevant information needed for a thorough evaluation. There are cultures that favor directness while others view this manner as potentially rude and abrasive. Incongruence between the communication style of the clinician and the culturally different patient can influence every level of the evaluation process 7. He refers clinicians to the Social Customs sections of the Country and Cultural Guides at the <http://www.commisceo-global.com/country-guides>.
T: Testing situation as it relates to comfort and motivation. For many individuals, the testing situation is a stressful one in which a psychologist or neuropsychologist asks questions and writes down the responses on paper that is hidden from the patient usually on a clipboard. Depending on the task, the person being assessed generally has limited awareness if the response is correct or incorrect. This is generally not the way individuals interact in any culture. Nonetheless, in the West, we are introduced to testing, albeit usually group tests, early on. This is not the case in every culture. Further, in some cultures, just being alone in a room with an unfamiliar person of the opposite sex is considered inappropriate.15 Information regarding gender relationships and relationships with strangers is provided in the World Culture Encyclopedia website <http://www. everyculture.com >. Fujii (2018)7 also provides a list of Internet resources to better understand social customs and etiquette of various cultures. Regarding motivation, in most neuropsychological evaluation reports, the person’s effort and motivation throughout the evaluation process are addressed as motivation and effort can influence perfor-
mance. Therefore, the more informed the clinician is in the cultural factors that can influence performance prior to testing, the better the chances that the data obtained is valid.
I: Intelligence - Conception of. Since obtaining a measure of an individual’s intelligence is generally the standard by which results on other measures are compared, test selection and having an understanding of the attributes that are valued within the culture as it relates to how our measures evaluate intelligence is important. For example, is the culture more monochromatic or polychromic? Is speed and meeting deadlines valued or are outcomes more important than deadlines. Therefore, test selection and the interpretation of the results based on this understanding may make a difference in the diagnosis and subsequent recommendations. When engaged in test selection, clinicians are strongly encouraged to review journal articles and chapters in books for information on tests that have been validated with different cultures. One resource that provides a small compendium of tests that includes information on many cultures, can be found in the book Conducting a Culturally Informed Neuropsychological Evaluation.16
C: Context of Immigration. Again, as in the other areas addressed within this framework, this section has multiple layers and is complicated. However, having a general understanding of the ethnic group’s immigration history to the United States and the particular details of how the patient and family immigrated to the United States is important.
This brief outline of the ECLECTIC framework is not meant to replace the article. Clinicians are strongly encouraged to read the full article and obtain a full list of the Internet resources that will aid in gathering the pertinent data. This outline is meant to invite busy practitioners to explore ways in which they can take steps to provide more culturally sensitive service right now. Although utilizing the ECLECTIC framework can initially be time consuming, it is our ethical obligation to strive towards multicultural competence. Also, once the information has been obtained with one group, the full process does not have to be repeated.
There are various ways in which a clinician can make changes to strive for a more culturally competent evaluation. There are various compendiums that provide
advantages and disadvantages of utilizing measures with individuals of various cultures. There are recently published books that provide guidance on providing more culturally competent services. It is also recommended to consult with psychologists within the field who have expertise in this area as well as seeking clinical supervision for more complicated cases that require consideration of more nuanced information. There are also various live and recorded webinars via professional organizations, which can earn clinicians continuing education credits. There is a scarcity of neuropsychologists representative of the current diverse population, and there are many neuropsychologists that don’t feel competent to appropriately serve the needs of a culturally diverse population. Nonetheless, there is action that can be taken, right now, with the tools we have that is a step towards cultural competence in current clinical practice. ❖
1. US Census Bureau (2015). Projections of the Size and Composition of the U.S. Population: 2014 to 2060. Washington, DC: Retrieved from <https://www. census.gov/library/publications/2015/ demo/>
2. Rivera Mindt, M., Byrd, D., Saez, P., & Manley, J. (2010). Increasing culturally competent neuropsychological services for ethnic minority populations: A call to action. The Clinical Neuropsychologist, 24(3), 429-453.
3. Rabin, L. A., Brodale, D. L., ElbulokCharcape, M .M., & Barr, W. B. (2017). Diversity issues in neuropsychology: A survey of practicing neuropsychologist. National Academy of Neuropsychology Bulletin, 31(1), 18-23.
4.Sue, S., Zane, N., Nagayama Hall, G C., & Berger, L. K. (2009) The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60, 525-548.
5. American Psychological Association (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity and Intersectionality. Retrieved August 28, 2018, from <http://www.apa.org/about/ policy/multicultural-guidelines.aspx>
6. NAN Definition of a Clinical Neuropsychologist (2001). Official Position of the National Academy of Neuropsychology. . Retrieved August 20, 2018, from
https://www.nanonline.org/docs/PAIC/ PDFs/NANPositionDefNeuro.pdf
7. Fujii, D. (2018). Developing a cultural context for conducting a neuropsychological evaluation with a culturally diverse client: the ECLECTIC framework. The Clinical Neuropsychologist, doi: 10.1080/13854046.2018.1435826
8. Marin, G., Sabogal, F., Marin, B. V., Otero-Sabogal, R., & Perez-Stable, E. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9, 183–205. doi:10.1177/ 07399863870092005
9. Zea, M. C., Asner-Self, K. K., Birman, D., & Buki, L. P. (2003). The abbreviated multidimentional acculturation scale: Empirical validation with two Latino/Latina samples. Cultural Diversity and Ethnic Minority Psychology, 9, 107. doi:10.1037/1099-9809.9.2.107
10. Cummins, J. (1981). Empirical and theoretical underpinnings of bilingual education. Journal of Education. 163, 16–30.
11. Woodcock, R., Muñoz-Sandoval, A., Ruef, A., & Alvarado, C. (2005). Woodcock-Munoz language survey revised. Itasca, IL: Riverside.
12. Vanderbuilt-Adriance, E., & Shaw, D. S. (2008). Protective factors and the development of resilience in the context of neighborhood disadvantage. Journal of Abnormal Child Psychology, 36, 887-901.
13. Abelev, M. S. (2009). Advancing out of poverty: Social class worldview and its relation to resilience. Journal of Adolescent Research, 24, 114-141.
14. Kishiyama, M. M., Boyce, W. T., Jimenez, A. M., Perry, L. M., & Knight, R. T. (2009). Socioeconomic disparities affect prefrontal function in children. Journal of Cognitive Neuroscience, 21, 1106-1115.
15. Ardila, A. (2008). On the evolutionary origins of executive functions. Brain and Cognition, 68, 92-99.
16. Fujii, D. (2016). Conducting a culturally-informed neuropsychological evaluation. Washington, DC: American Psychological Association Press.
and greater cognitive deficits, research with bipolar patients has found that greater disease severity and chronicity, particularly earlier age of onset and increased exposure to antipsychotic medication, is associated with greater neuropsychological impairments.4 Cognitive domains affected in BD include new learning and recall, attention, and executive functioning.5
Depression can result in a pattern of cognitive impairment that affects day to day functioning and includes impairments in attention, psychomotor speed, memory, and problem solving.1 Memory impairments tend to be secondary to underlying attention problems and reflect encoding and retrieval problems, rather than a true deficit in learning and consolidating new information. In other words, depressed patients may be preoccupied by their negative mood state and are therefore inattentive to incoming information and do not encode this new information into memory. However, they are usually able to store new information (i.e. keep new memories). Cognitive impairments apparent during acute depressive states have long been thought to be reversible upon remission from depression2; however, more recent research has shown continued impairments in attention and executive functioning after depression symptoms had remitted, suggesting that cognitive symptoms may occur separately from mood symptoms.3 Many depressed patients show minimal to no neuropsychological impairment on objective testing, even in the context of significant self-reported memory or attention problems. Interestingly, the selfreport of a depressed patient is often a poor predictor of actual cognitive functioning on objective testing.
In contrast to studies of unipolar depression that do not show a consistent relationship between depression severity
Memory and executive functions are also impaired during manic episodes, and patients are more likely to be impulsive and make poor-quality decisions during manic episodes. A patient who presents as acutely manic is likely going to present as too agitated or distractible to participate in testing, and results would not be a stable marker of their functioning. Although “state” phenomenon of cognitive dysfunction during acutely depressed or manic symptoms has been well established, continued deficits in working memory have also been shown to persist during periods of euthymia, indicating a more “trait” like phenomena in these patients.6 Assessment of a patient with BD can help the clinician understand how cognitive deficits may interact with certain aspects of treatment, such as medication compliance, risk for relapse, psychotherapy, and rehabilitation.
Common findings in this population include specific aspects of executive dysfunction, such as cognitive flexibility and goal-directed planning (add here). This pattern of deficits is consistent with the proposed neuroanatomical underpinnings of this disorder involving the frontalsubcortical circuit.7 Patients with OCD often recognize that their obsessions are nonsensical, and yet they are compelled to engage in ritualistic behaviors to cope with these obsessions. The inability to control a compulsive behavior, despite having awareness that the obsession underlying the compulsion is not reality-based, is related to executive dysfunction and is not merely a manifestation of anxiety. Understanding whether objective cognitive impairment exists may influence the scope or focus of psychotherapeutic interventions.
Processing speed, attention, and executive functions are the most common domains affected in a variety of mood disorders. Decreased psychomotor speed may reduce an individual’s overall efficiency and productivity, and problems with attention can impact all other cognitive functions. Individuals with executive dysfunction often have difficulty in environments that lack structure, boundaries, limits, and expectations. Therefore, patients with executive dysfunction, particularly high functioning individuals, may appear more intact in the therapeutic environment than in real life because the therapy room itself can act as “frontal lobes” by establishing a clear set of rules and behavioral expectations in a structured and distraction-free environment. As a result of their inability to successfully initiate, plan, or monitor the appropriate sequence of actions, real world functioning may pose greater problems for them because they cannot effectively utilize other cognitive skills that may be intact. For example, a patient with normal to above average memory, but poor executive functioning, may experience a great deal of difficulty managing workrelated duties, not because they cannot understand or remember what is asked of them, but because they cannot effectively plan and initiate the small, incremental steps involved in accomplishing the larger task at hand. Also, this person may have difficulty discerning irrelevant details from the broader picture and as a result may get “lost in the details.” Therefore, a patient with executive dysfunction may be very bright from an intellectual standpoint but may function well below expectation.
Traumatic brain injury (TBI) and concussion patients are some of the most common referrals to neuropsychologists, and they often present with comorbid psychiatric symptoms that require therapeutic intervention. The frequency of TBIs, particularly mild TBIs and concussions, is so prevalent that it is quite
probable most psychologists will encounter such patients. These patients present the unique challenge of working with individuals who may have varying degrees of cognitive impairment as well as depression, anxiety, trauma, or personality changes, such as aggression, impulsivity, or irritability.8 In approximately half of these individuals, psychiatric symptoms occur pre-morbidly, with the most common diagnoses being substance abuse, depression, and anxiety.9 The exact etiology of post-TBI psychiatric symptoms remains unclear and may include neuropathological changes, as well as premorbid personality traits and post-injury adjustment to disability.
Traumatic brain injury does not preclude someone from participating in psychotherapy but it may alter the style and course of treatment. Individuals with mild to moderate TBI are the most likely to have the ability to participate meaningfully in therapeutic intervention as compared to those with more severe deficits. Treatment may be multi-dimensional and include cognitive rehabilitation, behavioral therapy, social skills training, anger management, and individual therapy, group or family therapy. Psychologists possess the necessary skillset to effectively address many of the concerns in TBI patients, including mood and impulse regulation, relationship discord, occupational/vocational challenges, inattention, and memory problems. Methods of treatment are often directive, such as behavioral, cognitive-behavioral, and psychoeducation. Inclusion of family or caregivers is common based on the client’s physical and cognitive capacity and independence.
Unfortunately, rehabilitation following TBI is not equivalent across various populations. Disparities exist among ethnic minorities, who have poorer outcomes following TBI. This variability in outcome may be due to limited access to rehabilitation as a result of lack of insurance or proximity, socioeconomic status, or language barriers. Factors such as availability of interpreters, establishing rapport, language subtleties, and session time are impacted in non-English speaking clients and may result in reduced attendance or patient dropout. According to the American Psychological Association, best practices to improve the treatment experience for patients and clinicians include clinician education, open discussions, addressing challenges, and streamlining the interpreter process.10
In patients with psychiatric and/ or neurological disorders such as TBI, neuropsychological testing may help the patient, their family, and the treating clinician better understand the nature of a complex constellation of symptoms. In turn, this can help the clinician with appropriate treatment planning.
For example, a depressed patient with severe cognitive slowing and forgetfulness may have difficulty following complex, therapeutic recommendations spoken quickly by the clinician and may require simplified, slowly spoken instructions and frequent repetition. An individual with strong verbal and abstract reasoning skills may benefit more from insight oriented therapy, whereas someone with a more concrete thinking style may be overwhelmed by this type of therapy and would benefit more from a behavioral approach. A TBI patient with memory problems may have trouble remembering the content of previous psychotherapy sessions, or may have difficulty following complex medication regimens, in which case emphasis on behavioral techniques such as repetition, note taking, and pill boxes/medication assistance may become a focus of treatment.
A patient with executive dysfunction may, on the surface, appear to have the overall cognitive abilities necessary for functioning independently and maintaining successful employment; however, their inability to organize and effectively use their cognitive abilities in a goal-directed way may limit their success in their realworld environment. These patients may frustrate the clinician and appear to be non-compliant with treatment, when in reality they are struggling to cope with compromised executive functioning abilities. A neuropsychological evaluation can help identify these areas of cognitive weakness and hence better inform the clinician and the patient about specific treatment strategies that might uniquely help with the specific case in question.
Neuropsychological assessment can not only help clinicians become aware of existing cognitive weaknesses in their patients, but it can also emphasize strengths that may not be readily apparent in the context of a complex symptom presentation. Studies have shown that in a variety of both psychiatric patient populations and
non-psychiatric neurological populations (e.g. Traumatic Brain Injury, Multiple Sclerosis, and Epilepsy), subjective ratings of cognitive impairment are often more closely correlated with depression or other psychiatric etiology than with actual, objective impairment on neuropsychological testing. For example, a concussed patient with severe anxiety may complain of distractibility and memory problems in everyday life that significantly interfere with their ability to perform adequately at work. However, results of neuropsychological tests may indicate that under conditions of reduced stress, their attention and memory abilities are actually quite normal, or even above average. Factors such as depression or anxiety may prevent the individual from accurately monitoring their thinking and understanding the true cause of subjective cognitive complaints. Helping a patient appreciate their true cognitive potential and the impact that emotional symptoms can have on their everyday life is crucial to both psychotherapeutic interventions (e.g. maladaptive beliefs about their cognitive ability can be refuted with objective evidence) and pharmacological interventions (e.g. concerns about cognitive side effects of medication can be explored).
The following case example illustrates how results from a neuropsychological evaluation can help guide psychotherapeutic treatment. The patient’s name and demographic information have been changed to protect confidentiality.
Mr. Jones is a 45 year-old, married, Caucasian male who sustained a TBI in a motorcycle accident approximately six months prior to his evaluation. There was no loss of consciousness and he was wearing a helmet at the time of the accident; however, he reported experiencing residual cognitive and psychological sequelae. Specifically, Mr. Jones noted short-term memory problems, difficulty with word finding (e.g., recalling the names of familiar tools at work), and struggling to track and participate in conversations. Cognitive difficulties had been recently exacerbated by a stressful work environment. Mr. Jones was employed as a lineman for a cable company with a high school level education. His place of employment was undergoing a change in management that led many employees to fear job loss. Simultaneously, Mr. Jones was experiencing difficulty
performing his work duties due to cognitive changes including forgetting components of safety protocol or trouble recalling the names of equipment or tools.
Psychologically, Mr. Jones endorsed feeling “flat,” as well as experiencing a loss of interest in things previously enjoyed. Difficulty concentrating, insomnia, and a 30-pound weight loss over the past five months were also endorsed. Mr. Jones reported a high level of stress and symptoms of anxiety including restlessness, worry, fatigue, and racing thoughts. He was not prescribed any psychiatric medications at the time of the evaluation. He denied a history of prior psychiatric diagnoses or treatment. Medically, Mr. Jones’s additional history was unremarkable with the exception of high blood pressure and mild arthritis.
Mr. Jones was referred for a neuropsychological evaluation by his neurologist in order to objectively ascertain his cognitive strengths and weaknesses following his injury and to inform treatment planning. Results from his evaluation revealed difficulty with sustained attention and working memory skills. He also evidenced deficits in immediate and delayed recall of verbal information with intact recognition. This pattern of performance in which information is more easily retrieved with prompting (i.e., recognition) rather than free recall is common following a mild TBI. Mr. Jones demonstrated better visual than verbal memory as well as intact visuospatial and construction skills. These results were consistent with his self-report of being a “hands on” learner and enjoying mechanical and construction hobbies. In spite of his self-reported difficulty with word retrieval in conversation, he demonstrated no difficulty with word finding skills as objectively measured. Executive functions were intact including behavioral inhibition, shifting, and abstract reasoning. Self-report measures revealed moderate symptoms of depression and anxiety. Based on the results of the evaluation, Mr. Jones was referred for outpatient, individual psychotherapy to address the resulting symptoms of his TBI including depression, anxiety, insomnia, and cognitive changes.
Sleep disturbance such as insomnia is a common consequence of TBI and can negatively impact cognition and psychological functioning. As such, a primary treatment goal for Mr. Jones was to improve sleep quality and quantity using
cognitive behavioral therapy for insomnia. Specifically, the use of stimulus control was implemented to establish a consistent sleep schedule and reduce anticipation anxiety when attempting to go to bed. Sleep hygiene tips were also reviewed and provided in a printed handout for easy reference. Mr. Jones made use of a sleep tracking app on his smart phone in order to monitor his sleep and wake times and reduce the burden on his memory to recall such details.
In tandem with sleep regulation, goals for treatment also included ameliorating symptoms of depression and anxiety. Based on the evaluation and follow-up inquiry, Mr. Jones was fearful of losing his job as a result of his injury and cognitive changes. Adjusting to such changes in his functioning, as well as how they impacted his relationships, employment, and activities of daily living, resulted in depressed mood and anxiety. Given Mr. Jones’ limitations in attention and verbal memory, as well as the nature of his symptoms, a cognitive behavioral therapeutic approach was appropriate. Treatment was modified by implementing repetition as well as visual and verbal modalities, as he demonstrated difficulty recalling verbal material, but a relative strength in visual skills. For example, a small white board or paper was often used to write or draw related concepts in session. Also, Mr. Jones was provided with a written note card with main points and homework at the end of each session. Finally, cognitive difficulties were addressed in treatment using both compensatory strategies and enhancement techniques. Psychoeducation aided in helping Mr. Jones to understand the nature of TBI and connecting that with his experienced symptoms. Bibliotherapy with The Brain Injury Survival Kit: 365 Tips and Tricks to Deal with Cognitive Function Loss by Cheryle Sullivan, MD was assigned. Due to Mr. Jones’ difficulty with attention and working memory, learning to minimize distractions, focus his attention fully on the task at hand, and remain on task until completion was practiced. Regarding verbal memory, compensatory strategies included a calendar, written lists, photographs and videos, and a small notebook to document important information throughout each day. Skills to improve his encoding and recall were also practiced including linking new information with things previously learned.
Over the course of treatment, Mr. Jones experienced moderate resolution of his cognitive difficulties. He was able to maintain gainful employment and eventually felt more confident participating in social settings. His sleep had reverted to a typical schedule and his mood and anxiety stabilized aside from ongoing turmoil in his work environment due to changing management. Overall, Mr. Jones’ treatment plan was individualized to address his specific cognitive and emotional symptoms, as informed by objective neuropsychological assessment. ❖
1Goodall, J., Fisher, C., Hetrick, S., Phillips, L., Parrish, E.M., Allott, K. (2018). Neurocognitive Functioning in Depressed Young People: A Systematic Review and Meta-Analysis. Neuropsychology Review, 28, 2, 216-231.
2Merens, W., Booij, L., & Van Der Does, W. (2008). Residual cognitive impairments in remitted depressed patients. Depression and Anxiety, 25, 27-36.
3Rock, P.L., Roiser, J.P., Riedel, W.J., Blackwell, A.D. (2014). Cognitive impairment in depression: a systematic review and metaanalysis. Psychological Medicine, 44, 10, 2019-2040.
4Zubieta, J.K., Huguelet, P., Lajiness O’Neil, R., Giordani, B.J. (2001). Cognitive function in euthymic Bipolar I Disorder. Psychiatry Research, 2001, 9-20.
5Quraishi, S. & Frangou, S. (2002). Neuropsychology of bipolar disorder: a review. Journal of Affective Disorders, 72, 3, 209226.
6Volkert, J., et al. (2015). Cognitive deficits in bipolar disorder: from acute episode to remission. European Archives of Psychiatry and Clinical Neuroscience, 266, 3, 225-237.
7Vaghi, M.M., Vertes, P.E., Kitzbichler, M.G. et al. (2017). Specific Frontostriatal Circuits for Impaired Cognitive Flexibility and GoalDirected Planning in Obsessive-Compulsive Disorder: Evidence From Resting-State Functional Connectivity. Biological Psychiatry, 15, 8, 708-717.
8Orlovska, S., Pedersen, M.S., Benros, M.E., Mortensen, P.B., Agerbo, E., & Nordentoft, M. (2014). Head Injury as Risk Factor for Psychiatric Disorders: A Nationwide Register-Based Follow-Up Study of 113,906 Persons with Head Injury. The American Journal of Psychiatry, 171,4, 463-469.
9Whelan-Goodinson, R., Ponsford, J., Johnston, L., & Grant, F. (2009). Psychiatric Disorders Following Traumatic Brain Injury: Their Nature and Frequency. Journal of Head Trauma Rehabilitation, 24 (5), 324-332.
10Smith-Wexler, L. (2014, December). Cultural Competency in TBI Rehabilitation. Spotlight on Disability Newsletter. Retrieved from <http://www.apa.org/pi/disability/ resources/publications/newsletter/2014/12/ rehabilitation.aspx>
substance use have a significantly increased risk for suicide.
Maria Kirchner, PhD NJ Department of Health
Suicide is a national public health problem. Compared with the rest of the United States, New Jersey has historically low rates for deaths by suicide, consistently varying between the lowest and second lowest state in the nation (CDC; WISQARS, 2016). However, suicide rates in NJ have been following national trends and have risen by approximately 26% from 1999 to 2014. The nation’s overall suicide rate increased by 24% during the same time period (New Jersey Violent Death Reporting System [NJVDRS], 2016).
Every day, on average, approximately two NJ residents die by suicide. While the number of recorded deaths by suicide of New Jersey residents was 804 in 2014 and 811 in 2015, 2016 showed, for the first time in the last 10 years, a decrease (689). However, based on preliminary data this dip is expected to be only temporary (NJVDRS, 2016).
Suicide in NJ is the 2nd leading cause of death for ages 10-14; the 3rd leading cause of death for ages 15-24; and the 4th for ages 35-44. The highest increase of deaths by suicide was seen in age group 45 to 54 years (NJVDRS, 2016).
For every NJ resident who dies by suicide, there are another 5.5 inpatient hospitalizations and emergency room discharges for suicide attempts and self-inflicted injuries treated in New Jersey hospitals, the cost of care totaling an estimated $186.3 million in 2015 (New Jersey Violent Death Reporting System 11/21/2016).
A study demonstrated that almost half of people who died by suicide had contact with primary care providers in the month before their death (Luoma, Martin, & Pearson, 2002). At the time of their death, the great majority were not receiving mental health treatment despite their extremely increased suicide risk. As we deal with the epidemic of drug overdoses, we also need to recognize that individuals with
Every suicide death and attempt presents an opportunity for treatment providers to evaluate their delivery of care and consider opportunities for improvement. On a health care level, we can save lives and reduce health care costs in NJ by adopting the Zero Suicide Approach, as other states have done. The foundational belief of Zero Suicide is that suicide deaths for individuals under care within health care systems are preventable. Suicide prevention must become a core component of health care services and be integrated into the work, values, culture, and leadership of a broad range of organizations and programs.
Suicide is a complex human behavior, with no single determining cause, that can touch people from all walks of life. Nevertheless, there are some population groups that are known to be at a higher risk than the general population. These include people bereaved by suicide; in justice and child welfare settings; who intentionally hurt themselves (non-suicidal injury); with medical conditions; with mental health and/or substance use disorders; individuals of the LGBTQI community; members of the military; and men in midlife and older.
On a state-level, suicide prevention in NJ is addressed by two inter-departmental and inter-agency working groups: Division of Mental Health and Addiction Services (DMHAS) in the Department of Human Services. This department leads the Adult Suicide Prevention Advisory Council, consisting of state and community agencies; professional, consumer, and advocacy organizations; universities; and individuals with lived experience. Meanwhile, the Department of Children & Families, Division of Family & Community Partnerships, leads the Youth Suicide Prevention Advisory Council, consisting of representatives of Juvenile Justice Commission, Department of Education, Department of Human Services, along with public members (appointed). Each group has developed and implemented a NJ Suicide Prevention Plan (one for youth and one of adults), consistent with the 2012 Federal Guidelines (US Department of HHS, 2012).
These two departments, together with other state and private entities, held an allday Suicide Prevention Conference entitled Prevention: A Community Effort – Working Together to Prevent Suicide, on September 13, 2018 in Trenton. This free event attracted more than 500 people. The focus of this conference was on the critical role of healthcare in suicide prevention, as well as the critical role of communities in suicide prevention. Nine different state departments pledged their commitment to suicide prevention. Panel discussions featured people with lived experience: suicide attempt survivors, suicide loss survivors; representatives of high risk groups such as LGBTQI community, gambling addiction, mental illness, alcohol and substance use disorders, older adults, veterans, first responders and incarcerated individuals. PowerPoint slides of all presentations can be accessed via <https:// www.nj.gov/health/integratedhealth/dmhas/ home/suicide_prevention.shtml>
DMHAS created, launched, funds, and oversees the NJ Suicide Prevention HOPELINE, operated by Rutgers University, Behavioral Health. This is the only 24/7/365 suicide prevention hotline in NJ that serves all ages and has been active since May 1, 2013. Since 2017 they have been consistently responded to more than 2000 calls each month. On average the number of daily incoming calls climbed up to more than 130.
It is essential to regularly screen and assess individuals for risk of suicide, no matter the setting. Evidenced-based tools can be valuable aids in the process of identifying risk levels. Several excellent screening tools exist, and many of these instruments are designed to be used without clinical backgrounds. Although assessment tools can never replace clinical judgment, their strength is that these are based on research conducted on suicide warning signs and protective factors.
Major warning signs include: writing or talking about suicide, death, or the wish to die; buying or storing things that can be used for suicide; preparing for their own death. These signs are even more dangerous if the person has attempted suicide in the past, has a family member or close friend who died by suicide, or has access to or
plans to use a highly lethal method (e.g., gun). Protective factors include having a reason for living, having responsibility for family/others, living with others, having a supportive social network or family, being fearful of death or dying due to pain and suffering; believing that suicide is immoral; having high levels of spirituality; and/or being engaged in work or school or hobby. For a brochure of support services and resources for suicide prevention in NJ please go to the DOH website, <https://www. nj.gov/health/integratedhealth/dmhas/ home/helpme.shtml> ❖
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQAR) [online].(2005) [cited 2016 Apr26]. Available from URL: <www. cdc.gov/injury/wisqars>.
Luoma J.B., Martin C.E., Pearson J.L. Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry. 2002;159(6):909-916.
New Jersey Violent Death Reporting System (NJVDRS) 11/21/2016; New Jersey Hospital Discharge Data System; Center for Health Statistics and Informatics; Division of Population Health; New Jersey Department of Health. US Department of Health and Human Services (HHS), Office of the Surgeon General and National Action Alliance for Suicide Prevention. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: HHS, September 2012.
Iam excited and honored to serve as the 2019 NJPAGS Chair. When I was introduced to NJPAGS as a first year doctoral student, I was eager to learn from fellow students and mentors, and to engage with others in a professional capacity within NJPA. I am currently a third-year PhD student in the Counseling Psychology program at Seton Hall University. In research and practice, my work reflects a multicultural, social justice emphasis consistent with Division 17 and the broader mission of APA. My interests include community-based research aimed at elevating narratives to reduce stigma and bias, empowering poor and working families, and expanding on multicultural training models. My clinical experience consists of working with diverse populations in community mental health, primary care, corrections, college counseling, substance abuse, and with veteran populations. Currently, I work part-time as a licensed counselor and adjunct instructor.
During my first year as a member of NJPAGS, I served as campus representative and had the honor to work alongside NJPA members on the Committee on Diversity and Inclusion (CODI), collaborating with and learning from professionals engaged in social justice work within and outside the organization. Working with fellow students and professionals in this capacity has afforded me the opportunity to contribute to
NJPA in ways that reflect my own principles and values, centered on promoting equity and addressing the needs of marginalized communities. As someone who grew up in an economically disadvantaged, workingclass family and faced my own set of adversities, I will continue to incorporate these principles as NJPAGS chair, working closely with Chelsea Torres (Chair-Elect) and Alexandria Gil (Past-Chair) to strengthen our support network, advocate for the diverse needs of students, and ultimately make longterm, sustaining contributions within NJPA.
This year, one of our central priorities will be to build upon Alexandra Gil’s important NJPAGS initiative of addressing diversity issues within the organization. This will involve not only working toward increasing diverse membership, but also fostering a culture within the organization itself that reflects the lived experiences of diverse students across the intersections of race, ethnicity, class, gender identity, sexual orientation, ability status, age, religion and other social identities. By exchanging ideas based on our diverse experiences, NJPAGS will continue to grow as an organization and by extension, inform important initiatives within the broader organization that meet the needs of the community at large.
As part of this initiative, we are creating a large database of all academic programs in the tristate area and reaching out to program directors to attract more students to serve as campus representatives and MALs to represent student voices on all NJPA committees. We will also be working closely with ECPs to provide didactics and workshops that are particularly relevant to the diverse training needs of emerging psychologists and new professionals. Lastly, we are providing more outreach to undergraduate students inter-
ested in pursuing graduate studies, which we believe will increase NJPAGS membership and strengthen the sustaining pipeline of involvement from NJPAGS to NJPA.
As graduate students, we are closely tied to emerging theory, research, and practice in the field of psychology. Thus, we are well-positioned to continue to build bridges between academic institutions and NJPA membership. As 2019 NJPAGS chair, I look forward to working with the Director of Academic Affairs, Francine Conway, to create more opportunities for students to have a seat at the table and make unique contributions to the organization as NJPAGS members.
One of the main aspects that initially drew me to NJPAGS was the support and camaraderie I received from fellow students. I look forward to continuing to serve in my new role, learning from students in other programs about their experience and how best to serve them and the organization. As graduate students, it can be difficult to manage all the various responsibilities that come along with being a psychologist-in-training. In New Jersey, there are many graduate students who are the first in their families to go to college, who are either first-generation or come from underserved communities that overcame multilayered challenges to gain access to higher education. Even for those students who have access to resources, their immediate support systems may not truly understand the unique challenges we face as graduate students. NJPAGS is one of the few places however, where we as students can strive to be responsive to each other’s experience, feel heard, and provide tangible resources. I look forward to being able to continue fostering mutual support among students in ways that keep us all resilient and inspired in our academic and professional pursuits. ❖
Psychopathology, once considered the undisputable bedrock of applied clinical psychology and psychiatry, is today experiencing a strained (and strange) relationship with the mental health field. Whereas the elucidation of abnormality was once categorically accepted as indispensable to clinical work, many of today’s theories avoid psychodiagnosis. With long overdue concepts like wellness and positive psychology now decidedly in our lexicon and productively affecting the consulting room, some practitioners have counterproductively approached patient work in a bifurcated “wellness/pathology” fashion – essentially regulating the technique of buttressing patients’ healthy propensities as precluding of examining their abnormality. The latest iteration of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, with its susceptibility to diagnostic inflation and its tendency to convert everyday human struggles into mental illnesses, leaves even practitioners who appreciate the need to examine psychopathology apprehensive of the psychiatric bible. Today, many mental health professionals harbor an almost hostile attitude toward a concerted focus on psychopathological constructs, regarding such approaches as undermining of a patient’s striving for greater health. Sadly, this antipathetic attitude toward psychopathology only serves to foster conflict and confusion, and ultimately stymies our abilities to comprehend and conceptualize our patients’ struggles.
The problem is that despite today’s aforementioned zeitgeist, psychopathology is not going anywhere. The mere avoidance of psychological disturbances does not negate their existence. In fact, one can argue that the need for systematic efforts to illuminate and treat that which is wrong with a person has never been more relevant. Put otherwise, the need to understand psychopathology remains vital.
The American Psychological Association
Butcher, J.N. (Ed.) (2018). Washington, DC: American Psychological Association.crucially aids in the identification and utility of psychopathology. APA Handbook of Psychopathology helps bridge the formidable gap between the study of abnormal psychology and the consulting room. In this two-volume series, Editor-in-Chief James Butcher brings together a group of preeminent clinical scholars to plumb the breadth and depth of psychological distress. As part of APA’s ongoing, highly erudite “Handbook” series, this book brings contemporary psychopathological phenomena to today’s clinician.
As a means of understanding abnormal psychological processes, Volume One peers back at the history of psychiatric classifications and putative etiologies, moving from supernatural demonic beliefs, to the early days of the DSM, to today’s confluence of psychological, biological, and sociocultural factors. APA Handbook explores behavioral genetics and provides aggregate data showing that although heritability accounts for a considerable amount of psychopathology (most notably concordance rates of monozygotic twins), environmental influences are empirically identified as responsible for the lion’s share of the etiological variance. From the relatively immutable genetic component, the text moves to the progressing awareness of sociocultural factors (e.g., SES, attachment, resilience, immigration, discrimination) in creating and sustaining psychopathology.
The broad domain of adult assessment is discussed by delving into personality assessment beginning with the Rorschach and MMPI, and emphasizing these triedand-true tests’ ability to identify symptoms, character, and context. The burgeoning specialty of neurological and neuropsychological testing is covered from its embryonic stages as a research tool, to the prominence of functional magnetic resonance imagining (fMRI) in examining psychopathology, to how such assessment processes are now used in the laboratory and consulting room. APA Handbook also explores pre-employment
assessments, with a focus on law enforcement, airline pilots, and air traffic controllers. Elderly psychopathology’s common age-related biomedical (e.g., hearing loss, vision impairment, physical compromises), psychiatric (e.g., depression, anxiety), and the array of dementia conditions are addressed. The text even touches on report writing by beautifully articulating ways in which psychologists can address psychiatric conditions in concert with personality and relational penchants.
The next section, Clinical Manifestations of Adult Psychopathology, opens with the DSM-5’s revamping of the classification of neurocognitive disorders and taps into the etiological interaction between genetics and environment. This book studies psychosis and schizophrenic conditions (i.e., schizotypal and paranoia personality disorders, attenuated psychotic-like experiences) by productively transcending phenotypical symptomatologies. Next, APA Handbook draws attention to the deleterious and pervasive impact of stress by examining the neurological structures of the anterior insula and HPA axis, the stimulation of proinflammatory cytokines, mutually interactive processes with psychiatric conditions (e.g., depressed mood, appetitive), as well as stress vis-à-vis asthma, rheumatoid arthritis, and cardiovascular illnesses. Separate chapters are devoted to mood, anxiety, and obsessionality. With epidemiological data indicating nearly 15% of the population will experience diagnosable depression, the book discusses several contemporary psychotherapeutic and psychopharmologic treatment approaches. The breadth of anxiety conditions are touched on by explicating empirically demonstrated genetic, temperamental, and personality vulnerabilities. The text later taps into obsessive-compulsivity and related conditions such as trichotillomania, excoriation, hoarding, and body dysmorphic disorder, with attention to
overlapping (e.g., particularly with OCD and BDD) and distinct (e.g., the impulsive skin-picking and hair-pulling subtypes) underpinnings. Risk factors for addictive conditions, one of the most destructive of all behavioral control issues, are described, as are associative interventional stages (i.e., detoxification, recovery, relapse prevention) for substance use disorders. Also examined are eating disorders, with the treatment and preventative foci on the individual, familial, and sociocultural. The range of somatic conditions are reviewed beginning with the early Greek philosophers’ belief in gynecologic “causes” and ends with today’s understanding of the inextricable mind-body link. This section concludes by overviewing the historical views of personality pathologies (DSM and otherwise) and their associated controversies (e.g., ego syntonicity vs. dystonicity, tendencies vs. adaptations).
The book next delves into suicidality. As suicide is the 10th leading cause of death in the United States and 15th worldwide, APA Handbook provides data on risk factors (e.g., divorced, younger than 35, lower education), familial constellations (e.g., parental impulsivity and suicide history), psychiatric (e.g., depressive illnesses), and neurochemistry (e.g., dopamine, serotonin). This section looks at psychological assessment, once viewed as boilerplate and disparate from psychotherapy, which now consists of a more relationally based approach in which testing not only facilitates treatment but is a component of it. APA Handbook covers trauma, now a stand-alone DSM-5 chapter, by explicating vulnerabilities as well trauma’s comorbidity with a range of biomedical illnesses. Intimate partner conflict and the interaction between each partner’s mental abnormalities and the couple unit are examined, as are subsequent interventions such as individual and/or conjoint treatment with the individual therapy falling into the categories of partner-assisted (i.e., partner actively supports the other’s individual treatment) or disorder-specific (i.e., concerted attention to the salient symptoms). The book also highlights data on empirically supported psychotherapeutic treatments, and concludes with a discussion on ethics (mandatory and aspirational) as well as the practicalities of psychotherapeutic work with criminals.
Volume Two, Child and Adolescent Psychopathology, mirrors the adult volume in structure and opens with the historical boom and bust of the psychological study of
nonadults. Childhood resiliency is explored by fully incorporating the confluence of genetics, development, and culture, and also takes a look at psychopathology prevention on biomedical, psychological, and societal levels. Neurological dimensions of child psychopathology are studied via the centrality of neuroplasticity (most pronounced in the earliest years), followed by the assessment of temperament, intelligence, and personality. Child abuse is addressed, with a description of commonly used instruments and punctuated with the caveat that even the most sophisticated assessment measures are unable discern whether or not abuse did occur. The text rightly concludes by emphasizing that clinical judgment is paramount to any specific psychological test.
The Clinical Manifestations section begins by examining childhood trauma and its relationship to children’s anxiety, depression and how traumatic experiences may manifest as adolescent disruptiveness and substance abuse. APA Handbook leans on evidence suggesting that the experience of even a singular traumatic event can leave a child more susceptible to future traumas. The book illuminates the nuances of nonadult anxiety and obsessive compulsivity, and the high comorbidity rates with depression as well as generalized, social, and separation anxieties. Mood disorders are further parsed, with specific attention to disruptive mood dysregulation disorder (DMDD), a new classification in the DSM-5, as a productive means of avoiding the historical over-diagnosing of childhood bipolar disorder. APA Handbook investigates neurodevelopmental disorders, with attention to the roles of genetics and environmental factors. Adolescent substance abuse, including contemporary assessment and approaches to intervention, is discussed, as are youth eating disorders and common comorbid psycho- and biopathologies associated with disordered eating. The book also touches on eating disorders preventative measures. APA Handbook addresses sleep difficulties by reporting on sleep assessment (e.g., self-reporting, parent reporting, physiological measurements, laboratory assessments) and different types of nonadult sleep disorders (e.g., insomnia, nightmares, somnambulism). Contributing authors delve into deficit/hyperactivity and oppositionality, conduct disorder, intermittent explosiveness, and the most disconcerting antisocial behaviors, identifying shared and
discriminatory psychological, neurobiological, and societal factors. The autism spectrum disorder chapter covers the range of interventional processes reported as useful. In sum, this robust section provides detailed theoretical and empirical information on a variety of childhood and adolescent psychopathological conditions.
The Child and Adolescent Treatment part outlines the nature of contemporary nonadult treatments for trauma, including PTSD and associative proclivities such as substance abuse, self-injurious penchants, and risky sexual activities. The chapter addresses trauma focused-CBT, with attention to individual and group treatment modalities. The book’s final section explores legal issues with children and adolescents. The text discusses the basic principles of today’s juvenile justice system, the prevalence of oft-serious psychopathology within adolescent criminal offenders, and the logistics of child custody evaluations such as assessing the child, parent, and in vivo parent-child observations and collateral contacts. Ethical issues in assessing nonadults closes the section and the text. From psychologist competency to informed consent, confidentiality, to communication with third parties, the author identifies key pieces needed for psychologists to conduct child custody evaluations in an appropriate, ethical fashion.
APA Handbook of Psychopathology is a welcomed reference. Covering the breadth of adult and child mental disturbances, the contributing authors comprehensively examine behavioral, etiological, and treatment issues. Leaning on data derived from both the laboratory and consulting room, this two-volume text provides a wealth of usable information for clinicians of all experiential levels. A shortcoming is that as comprehensive as the text is, contemporary psychoanalytic perspectives and treatments are conspicuously missing. Therefore, those looking to expand their psychodynamic conceptual and interventional abilities will be better served elsewhere (see Handbook of Psychodynamic Approaches to Psychopathology or the Psychodynamic Diagnostic Manual-2).
Given how the APA Handbook solidly aligned with the DSM-5, clinicians are sure to find this book both an aid in their diagnostic and conceptual abilities and a useful treatment guidepost. As such, the APA Handbook of Psychopathology deserves a place on any psychologist’s bookshelf. ❖
Lingiardi, V. & McWilliams, N. (2017). Psychodynamic diagnostic manual: PDM2, 2nd Eds. (V. Lingiardi & N. McWilliams). New York, NY: Guilford Press.
Luyten, P., Mayes, L., Fonagy, P., Target, M., & Blatt, S. (Eds.) (2015). Handbook of Psychodynamic Approaches to Psychopathology. New York, NY: Guilford Press.
About the Author:
Anthony F. Tasso, Ph.D., ABPP is Professor of Psychology and Chair of the Department of Psychology and Counseling at Fairleigh Dickinson University in Madison, NJ. He also maintains a private practice in Whippany (Hanover Township), Morris County, NJ.
The book also aggregates the genetic preventative research suggesting that there is a clear genetic/environment interaction.
The chapter discusses suicidality interventions (e.g., psychotherapeutic, psychopharmologic, and hospitalization).
The broad range of somatic conditions are subjected to review from the early Greek philosophers’ belief on the gynecologic foundations, to forerunner of today (see Briquet syndrome the
The massive undertaking of the Human Genome Project is discussed, and the chapter concludes denoting that the role of heritability is applicable to most forms of
psychopathology (accounting for 30%-60% of mental disorders), which indicates that various environmental factors account the majority; and upon further parsing noting that nonshared environmental factors account for more than shared environmental factors (i.e., similar familial experiences).
The manifestation of psychological duress into the physical is studied from the genesis.
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Find a Psychologist is the most visited webpage at www.psychologynj.org racking up over 15,000 visits in 2018!
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Visit www.psychologynj.org and log in to the Members Only section to fill out the form and complete your profile. Instructions can be found there to assist you.
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Thank you to all attendees who made our Fall Conference a success! Friday night we were joined by 75 guests who got to meet and mingle with fellow attendees at our social cocktail hour followed by our annual awards ceremony and the Diversity CE program, Engaging Clients Across Cultural Divides: Using the New APA Multicultural Guidelines. Saturday’s programs were attended by over 200 individuals including students, early career psychologists, established members, and new prospective members. The day offered 6 CE credits featuring speaker Paul Wachtel, PhD.
NJPA is actively preparing for a year of wide ranging CE programs. Save the Date: Spring Conference, Friday, May 3rd and Fall Conference, Friday and Saturday, November 1 & 2. More details will be made available in the near future. Mark your calendars!
Peg Wright, President and CEO of The Center for Great Expectations (CGE) since 1998, founded the Center to assist homeless, pregnant women and adolescents in “breaking the cycle” of homelessness, abuse, and addiction. The program began in a rented apartment in Somerset serving 12 women on an annual basis. Under Peg’s leadership, CGE now serves over 500 people on an annual basis through a host of dynamic and comprehensive service programs, including: an expanded residential program treating both adult women and adolescent mothers and their children; an outpatient center that specializes in gender specific treatment for women and men with substance use and or co-occurring disorders; a supportive
housing department providing 28-units of supportive housing in Somerset and Middlesex counties; a vibrant and enriching child development center; and an in-home program providing clinical and case management service to opioid-addicted mothers and women in recovery. Peg leads a team of over 100 full and part-time employees, countless volunteers, and a dedicated Board of Directors. Her commitment to providing the most impactful programming supports an innovative clinical approach that integrates trauma-informed care with parent-infant mental health, resulting in programs that address underlying traumas and focus on building self-esteem, life skills, and the critical relationship between mother and child. During her first career in sales and sales management of Diagnostic Imaging equipment, Peg developed the dynamic skills she uses today to partner with the public, private, and academic sectors to bring the highest level of care to the clients of the center. She is passionate collaborating with dedicated behavioral health clinicians,
who specialize in trauma informed care and parent infant mental health, to advance the individualized, compassionate mental health and substance use treatment that Great Expectations provides to marginalized women and men from all counties of New Jersey. In 2015, Peg was selected as an NJBIZ “Top 50 Women in Business,” an affirmation of her outstanding contribution in the nonprofit sector and our New Jersey communities, and was honored to be named a “New Jersey Hero” by the NJ Heroes Foundation. Mary Pat Christie and leaders of the Foundation visited Great Expectations to tour the facilities, meet clients and staff, and deliver Peg’s award along with a foundation grant. In 2015 Peg was awarded the Citron Cooperman “Woman at the Wheel” recognition. Peg attended John Carroll University, Ohio and New Jersey City University, and currently sits on the board of the Somerset County Business Partnership, and the Advisory Board of Fairleigh Dickinson University’s Center for Excellence. ❖
the office to attend meetings and my family understood the late nights I worked. Many of the previous Psychologist of the Year honorees were instrumental to my success. I thank all of you, as well.
Kenneth Freundlich, PhD
Thank you very much. This is a special honor and I am thrilled to be standing here before you – my colleagues, friends, and family. I want to begin by thanking my long-time partner, Dan Watter, for that kind introduction and for nominating me. I also thank Jeff Singer and Joe Coyne who supported my nomination, as well as the committee who selected me. I have many others to thank, and I will get there.
I am very fortunate. I grew up in West Orange on Colonial Woods Drive. My home was a warm and loving home and I had supportive parents, as well as very involved extended family. Things like HIPPA, privacy, and confidentiality . . . they did not exist on Colonial Woods Drive. Everyone knew everyone else’s business. That’s just the way it was in my family. It still is today.
Tonight, several family members are here we me. I am accompanied by my dear mother, Lillian and her companion, Roger, as well as my sisters, Lisa & Amy, my sister-in-law, Bonnie, my brothersin-law, Mitchell and Ron, my cousins, Richard & Nancy and of course, my wonderful wife, Tara. My son, Jesse is in Philadelphia and my daughter, Brooke is in Hollywood. They are busy pursuing their passions, but they are here in spirit. I thank all of you for your love and support. You have been central whatever success I have enjoyed in life.
The truth is, none of my achievements have been solo efforts. I have always been fortunate enough to be surrounded by good people who encouraged me and, at times, pushed me. I would not be standing here if not for others: teachers, mentors, colleagues, and partners, who selflessly gave of their time to help me along the way. My partners understood and supported my frequent absences from
As a result of so much kindness and generosity, I owe a large debt to others and the hours I have spent serving on various committees is part of my repayment plan.
Those of you who know me have often heard me say, “I should have never become a psychologist . . . I just don’t understand people.” That’s true, but for the most part, what little I do know about people, did not come from textbooks. It came from life. It came from experiences, like growing up on Colonial Woods Drive.
• From my grandmother, I learned about psychopathology, when she explained that her neighbors were a bit meshuga.
• From my mother, I learned about resilience, when she told us kids that if we didn’t stop misbehaving, she was going to have a nervous breakdown, but yet never did.
• From my father, I learned about integrity, when he explained that just because you had a right to do something, it didn’t mean it was the right thing to do.
• Later, I learned from my wife the meaning of strength and character and I learned from having children and being a father, what it truly means to be a man.
Most importantly, I learned that belonging to a family transcends all differences. I live this every day at home. My wife and I occupy opposite ends of the political spectrum, but it does not diminish our love. It is a shame too few people have learned this lesson. Whether we are talking about our professional family, NJPA, or the larger the family of humanity, our differences should not define us.
There is too much misery and negativity in this world. Without getting political, yet, I can honestly say that I find the news to be distressing. Hatred and violence seem erupt everywhere, but kindness and understanding are powerful antidotes. My
father used to respond to my empathic failures with a simple phrase, “have a heart.” Every day, we have an opportunity to “have a heart.” We impact the people around us and not just in the course of our work. We can be a positive force or a negative one. “Have a heart” is simple lesson I learned on Colonial Woods Drive.
For those of you who don’t know me, I need to tell you something: I am a Republican; a conservative Republican; and much to the dismay of my dear, but very liberal . . . commie wife, I am a cardcarrying member of the RNC. I know that for some in this organization and perhaps, even for some in this room, I might as well have just said, I’m racist, sexist, homophobic, xenophobic and so on. That is sad, especially because NJPA claims to value diversity. In fact, our mission statement explicitly states that we support the diversity of our members and society at large. Therefore, it is frustrating to see how the concept of diversity is applied to so many different things – except ideology . . . diversity of thought.
During my term as your president, I encountered this bias on a regular basis. For example, I recall responding to a member who wrote on the listserv:
“Should such a move on the part of NJPA turn off highly conservative members who prefer to turn back the clock, they are free to end their memberships and join groups that advocate their views.”
Sadly, such expressions of contempt are not isolated events and when they do occur, they are not met with the kind of rebuke that is directed towards those who reside on the other side of the proverbial aisle, when they commit similar transgressions.
With the advent of social media, it has become increasingly easy for us to surround ourselves with views that we like and avoid those that we do not, but this only increases distance between us.
This past summer, in a speech honoring the centennial of Nelson Mandela’s birth, former President Barack Obama said:
“Most of us prefer to surround ourselves with opinions that validate what we already believe. You notice the
people who you think are smart are the people who agree with you, but democracy demands that we’re able also to get inside the reality of people who are different than us, so we can understand their point of view. Maybe we can change their minds, but maybe they’ll change ours. And you can’t do this if you just out of hand disregard what your opponents have to say from the start. And you can’t do it if you insist that those who aren’t like you – because they’re white, or because they’re male – that somehow there’s no way they can understand what I’m feeling, that somehow, they lack standing to speak on certain matters.”
Although I disagreed with many of President Obama’s policies, I cannot disagree with his wisdom on this point. We need to work together and if you truly value diversity and inclusion, you should value diverse opinions and include those who hold such opinions.
During my time on NJPA’s Executive Board, I often disagreed with and vigorously argued with our current President, Stephanie Coyne and our Past-President, Hulon Newsome, but our arguments were always respectful and civil and the only name we ever called each other was “friend.”
You lose nothing when you hear and respect criticism. To the contrary, you gain trust. The importance of building bridges and mending fences was another one of those lessons I learned on Colonial Woods Drive. Speaking of lessons, I know there are 10 commandments, but most of my time in Sunday School was spent staring out the window, so I can’t list them all. However, I do remember learning about the great Jewish scholar, Hillel, who when asked by a non-Jew to teach him the whole Torah while standing on one foot, replied:
“That which is hateful unto you, do not do to your neighbor. This is the whole of the Torah. The rest is commentary. Go forth and study.”
Most of us are familiar with a version of this saying known as the “Golden Rule,” and I believe that if you follow it, most everything else falls into place. I have been told that this is simplistic and naïve, and that may be true, but much like Occam’s Razor, simpler is often better.
In the summer of 2017, when John McCain cast a deciding vote against his own party’s attempt to repeal the Affordable Care Act, he said:
“Stop listening to the bombastic loudmouths on the radio and the television and the Internet. Let’s trust each other.”
Even those who disagreed with his politics, recognized that John McCain was an honorable man and he was concerned that tribalism was pulling our country apart.
Today, I am concerned that a similar phenomenon – albeit on a much smaller scale – is occurring here – within our own organization. We are becoming increasingly polarized. I routinely hear, “If NJPA continues to pursue a political agenda, I am going to resign,” but yet, I also hear, “if NJPA does not do more to promote social justice, I am going to resign.”
We have a fundamental disagreement about the nature of our organization. Personally, I believe that a professional organization should first and foremost be about protecting and advancing the profession, but I also believe that by doing good work, we do right by others.
Anyone who has ever been on a commercial flight has heard the standard instructions: In the unlikely event of a loss of cabin pressure, an oxygen mask will descend and of course we are told, “secure your own mask first before helping others.” This is an important metaphor: If we do not take care of ourselves, we cannot take care of others. On an individual level, this can mean preventing burnout, but in a broader sense, I believe we must also take care of our profession. Our efforts to advance the profession should not cause us guilt and they certainly do not mean that we have become selfish. If I am not for myself, who will be?
Now, I recognize that some of my colleagues, who are good people, well intentioned people, disagree. I do not question their motives, but from my own experience, such respect is not always the norm.
As I said earlier, I don’t understand people. For example, I don’t understand why so many of our fellow members claim to be so concerned about the underserved and marginalized among us, but yet they do not support our own Foundation, whose mission is specifically to serve those very groups. On average our members donate about $12.00 per person per year to the Foundation, and frankly, that’s embarrassing. I also don’t
understand why so many of our members who say they are concerned about protecting our profession, do not support the PAC, whose mission is to advance the stature of the profession of psychology in New Jersey.
I believe that the best way to teach values is to live by them. Don’t say . . . do. Words only show who someone pretends to be, but actions prove who they are.
Therefore, I challenge all of you to show who you are by stepping up and supporting The Foundation, or the PAC, or preferably, both. Pledge sheets have been distributed to everyone, and even though I already support the Foundation and the PAC, I am going to start by donating $1000; $500 to The Foundation and $500 to the PAC. I urge each of you to step up, as well, and show who you are.
As psychologists, we have chosen a career in which we seek to better the lives of others. This is important work. It is good work, so let’s do what we can not only to improve the health of our patients, but also to improve the health of our profession.
Our days may be long, but the years are short, so if not now, when? ❖
Bud Feder, PhD NJPA Member, 51 years Jo-Ann Marchal, MA Member, 39 yearsI. President’s Welcome and Call to Order – Dr. Hulon Newsome, President called the meeting to order at 10:18 a.m.
• It was noted that based on member input from the 2016 NJPA Fall Conference, NJPA made the decision that the 2017 NJPA Business Meeting would occur on a day outside of the conference to allow for sufficient time to discuss NJPA current events. On October 27, 2017, NJPA hosted Direction - Following the Blueprint of the NJPA Strategic Plan - NJPA Business Meeting and Member Town Hall at St. Luke’s Episcopal Church, centrally located in Metuchen, NJ. NJPA Executive Board member and Affiliate Caucus Chair Rosalie DiSimone-Weiss, PhD was thanked for arranging the use of the spacious venue for the meeting!
• Attendees were welcomed and introduced to the NJPA Executive Board and the newly elected 2018 board members were mentioned.
• Executive Board members present were acknowledged including: Lale Bilginer, PhD, Mary Blakeslee, PhD, Keira Boertzel-Smith, JD, Phyllis Bolling, PhD, Randy Bressler, PsyD, Joseph A. Connell Sr., PhD, JD, Francine Conway, PhD, Joseph Coyne, PhD, Stephanie Coyne, PhD, Jennifer Dechert, PsyD, Rosalie DiSimone-Weiss, PhD, Tammy Dorff, PsyD Elisabeth Endrikat, MA, Judith Glassgold, PsyD, Daniel Lee, PhD Caridad Moreno, PhD, Morgan Murray, PhD, Hulon Newsome, PsyD, Lynn Schiller, PhD, Alison Strasser Winston, PhD, Luciene S. Takagi, PsyD, Sara Tedrick Parikh, PhD.
• Dr. Newsome noted several accomplishments including: more members being involved in decision-making, being more transparent and decisionmaking being bottom up rather than top-down.
Approval of October 2016 Business Meeting Minutes –Dr. P. Bolling, Secretary
Motion #1: Motion to Approve October 22, 2016 Minutes
Motion #1 Vote Results: Approve – 21, Opposed – 0, Abstained – 3. Motion approved.
President’s Report - Dr. Hulon Newsome’s report focused on NJPA’s transformation to relevance and emphasized the work done in 2017 including:
• Strategic Plan Task Force – Assisted in developing the Strategic Plan that included 3 goals: 1) Provide a professional community for all psychologists, 2) Infuse and address diversity, 3) Address social advocacy.
o The Strategic Plan goals and objectives will inform and influence every board activity.
o A Strategic Plan objective or goal will be attached to each agenda item.
o The NJPA Parliamentarian will be the “Sherpa” to ensure what is being done is grounded by the Strategic Plan.
• Social Media Task Force – Their work was completed including: completion of policy that guides how social media (e.g. Twitter, Facebook, Linked In) is used to promote the organization, YouTube Channel (Psychology Matters – NJPA) will allow the development of short videos to educate members and the public on psychology issues. The importance of NJPA beginning to use the YouTube Channel to disseminate psychology knowledge and promote NJPA was noted.
• Community Outreach Task Force
– This Task Force creates statements to benefit members and others on psychology issues.
• Early Career/Permit Holders Task Force – This Task Force was charged with looking at how NJPA attracts younger members. The Task Force developed several recommendations that will be go before the board.
• Listserv Committee Structure Task Force – Their work was completed including: development of a governance structure, terms of use policy.
o Changes include: there is now a committee that will monitor the Listserv. There will be increased accountability for Listserv users and monitors. The Listserv will move away from a more punitive approach to an educative approach. Changes will be posted when they are approved by the board.
• Technology has been an important change this year with a number of enhancements. One aspect of technology that has been used a great deal this year is videoconferencing capability which allows members to participate remotely. This technology is not only used by the board, but committees can also use it for meetings.
• Social & Regulatory Advocacy – An important initiative this year was to explore if social advocacy is something that is feasible for the organization. The conclusion was that it is feasible and should be part of the organization.
o A definition of social advocacy was developed that is consistent with NJPA’s mission and supports our guild interests.
o Policies are being worked on for board approval
• Committee on Diversity and Inclusion (CODI) – CODI has been a committee of the board for two years. They have helped the board to impact NJPA’s commitment to diversity and inclusion.
• Committee on Regulatory Affairs (CORA) – This committee focuses on bringing committees together (cross pollination) on issues that may impact NJPA and the BoPE. This committee provides a new way to bring the organization to the forefront regarding government and regulation and not just practice issues.
• Board Elections – New board members for 2018 include: Dr. Morgan Murray (President-Elect), Dr. Daniel DaSilva (Treasurer), Dr. Brett Biller ( Memberat-Large), Dr. Luciene S. Takagi (Member-at-Large).
Executive Director’s ReportMs. Boertzel-Smith’s report focused on association management. The executive director is responsible for day-to-day operations including staff, consultants (e.g. accountant, lawyer) and addressing association business and membership.
• Membership Member 1429; Associate 9; Student 141; Senior 73; Emeritus 46; Non-Resident 10
Total 1708
• Discussions have suggested making retention and recruitment a priority.
• Continuing Education – The CoCEA has four subcommittees including the Conference Committee, Stand-Alone Committee, and CE Approval.
• The Fall Conference will occur on November 10th - 11th. Registrations include over 100 on Friday and 350 on Saturday. This represents significantly more registrations and presents new challenges for Central Office staff in managing these numbers.
• The Telepsychology Program on 12/1, a new program already has 80 registrants.
• Communication – The Friday Update goes out to the membership every Friday. Central Office Buzz is included in the Friday Update and the Director of Professional Affairs (DPA) also has a column.
• The NJPA journal will undergo some changes. Dr. Gianni Pirelli will lead efforts on the journal.
• Website – Discussions are underway re: making the website easier to navigate and organized in a user-friendly way.
o NJPA is being looked at as a whole as an organization. As a 501c6 organization there are discussions regarding commercial use. NJPA cannot be in the business of profit. Discussions are underway to look at what can be done on the List-
serv to achieve a balance on what can be done.
• The NJPA lease expires in June 2019. Central Office and leadership are working hard to look at space, and discussing the purpose of space (e.g. programming, staff space). A Capital Investment Work Group has been established to explore needs and options. A commercial real estate advisor will also be assisting in these efforts.
• Advocacy – Dr. Frank Weiss will be the chair for COLA. Several issues are being followed and/or explored including:
o Telehealth – has been passed as law. Comments were created and recommendations were sent regarding the regulations that are being drafted. The regulations are not yet out.
o Medical Necessity – Work is being done on a coalition, however it may not come to fruition.
o Medicaid – has been a legislative priority and work is being done on expanding Medicaid reimbursement for interns. Training has been done and more training will be done. There is an openness to discussion on this.
• A letter has been sent to the Division of Consumer Affairs regarding the issue of maiden names. We are awaiting a response.
• RxP –A focus group will be developed to look at this issue.
• Council of Executives of State, Provincial (and Territorial) Psychological Associations (CESPPA) – Ms. BoertzelSmith was elected as 2017 Secretary. She is working with CESPPA on planning the Practice Leadership Conference (PLC).
Treasurer’s Report – Dr. Peter Economou focused on the 2018 NJPA budget.
• The importance of NJPA non-dues revenue was discussed, including continuing education event sponsorship used to offset the growing expenses associated with hosting offsite continuing education programs.
• Underwriting and sponsorship has been a focus to offset our programming costs.
• The desire to find other ways to increase income rather than through increasing dues was noted.
Director of Professional Affairs Report –Dr. Judith Glassgold focused on her role as the Director of Professional Affairs and ways in which she can assist our members.
• The DPA is available to the membership ~12 hours/week responding to calls, e-mails, and board meetings. She coordinates with APAPO who have deep expertise.
• A great deal of work has been done with Telehealth and Medicaid. Legislation for Telehealth was primarily written for physicians. It is hoped that better regulations can be developed for mental health.
• A proposal for Medicaid has been developed that will allow reimbursement for doctoral level interns and post-docs. NJPA met with Medicaid representatives and raised concerns about our licensing act being a barrier. Regulatory changes are being explored to allow billing for interns. It was also noted that psychiatrists and psychologists received a Medicaid rate change. Members are encouraged to look at Medicaid for our practices. This indicates that we are a good partner.
• The NJPA website will be revised regarding practice resources.
• It is hoped that virtual coffee hours will be instituted next year (with ECPs).
Bylaws Changes - Governance Committee
Report – Dr. Barry Katz – Chair reviewed three Bylaws changes:
• Article III – Membership, Article IV – Conduct of Meetings and Article X – Committees. The discussion for bylaws changes begins with this meeting and will continue at the NJPA Fall Conference on November 11, 2017. There will be information (by-laws posters) and the opportunity to pose questions at the conference. It was noted that a vote of yes regarding the bylaws is an endorsement for the changes, A no vote means not voting for changes and the current language remains in the bylaws in their original form.
• There will be an e-vote for bylaws changes.
• It was noted that there is a difference between bylaws and procedures (what is done to institute bylaws).
• Clarification was requested on undergraduate participation on committees. The suggestion was made to include this information in procedures.
To read the full report, go to www.psychologynj.org and log in to the members only section.
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