Winter 2020: NJ Psychologist

Wi n t e r 2 0 2 0 | VOLU M E 7 0 | N U M B E R 1

NJ PSYCHOLOGIST A Publication of the New Jersey Psychological Association

In this issue...

Special Section: Psychological Issues Faced

by Transgender Individuals in Communities (3 CE Credits) Ethics: Culturally Competent Psychotherapy Informed by Ethical Principles Book Review: APA Handbook of Dementia (2018) Fairleigh Dickinson University: An Overview of the Two New Jersey Psychology Departments

Table of Contents

1 President’s Message

2 Welcome New Members!

2 Member News

3 Executive Director Report: The Year 2020 – Ebb and Flow

4 Treasurer’s Report

4 PAC Contributions

5 Legislative Update: COLA Advocacy

6 Ethics Update: Culturally Competent Psychotherapy Informed by Ethical Principles

8 NJPA Foundation – Starting the Year Off Right

9 Foundation Donors – 2019

10 NJPA Sustaining Members 11 NJPAGS: Where Tomorrow’s Leaders Can Be Heard Today 11 Foundation Awards & Grants 12 Special Section: Transgender Individuals in Communities 15 In Memoriam 22 Fairleigh Dickinson University: An Overview of the Two New Jersey Psychology Departments 23 Book Review: APA Handbook of Dementia

Acknowledgment of the NJPA 2019 Publications Committee By the NJPA Executive Board The NJPA Executive Board would like to thank Gianni Pirelli, PhD, ABPP, and the NJPA Publications Committee’s work with the NJ Psychologist journal. Dr. Pirelli worked as journal Editor since the fall of 2017. Under his leadership, the journal’s Editorial Board achieved the majority of the goals that had been set forth, including making CE credits available through reading the publication, which has been a very popular membership perk. In 2019, Dr. Pirelli submitted his resignation and a message to the Executive Board listing the many successes of the journal, as well as challenges that needed to be addressed. His letter also included recommendations to mitigate these challenges.

For instance, there have been too few submissions to the journal, leaving the Publications Committee to solicit or produce articles in addition to editing and producing the journal.

More support from leadership and the Executive Board, as well as committee chairs and general members, could have resulted in more article submissions.

The Executive Board appreciates Dr. Pirelli and the Publications Committee’s work, and also acknowledges that more attention and support to the journal would be beneficial.

NJPA leaders are meeting with the Publications Committee and its Interim Editor, Francine Conway, PhD, to develop ways to address these current challenges. Through Dr. Pirelli’s work, we have a springboard for addressing these issues and producing a successful journal. We thank Dr. Pirelli for his leadership as Editor and wish him the very best! We thank Dr. Francine Conway for volunteering to serve in the Interim Editor role in 2020.

Who’s Who in NJPA 2020 Editorial Board

www.PsychologyNJ.org

Interim Editor: Francine Conway, PhD Members: Jack Aylward, EdD Ashley Gorman, PhD Eric Herschman, PsyD Herman Huber, PhD Maria Kirchner, PhD Nathan McClelland, PhD Anthony Tasso, PhD Staff Liaison: Christine Gurriere

NJPA Executive Board

President: Lucy Sant’Anna Takagi, PsyD President-Elect: Daniel Lee, PsyD Past-President: Morgan Murray, PhD Treasurer: Daniel DaSilva, PhD Secretary: Mary Blakeslee, PhD Director of Academic Affairs: Francine Conway, PhD APA Council Representative: Rhonda Allen, PhD Members-At-Large: (A) Phyllis Bolling, PhD (A) Aida Ismael-Lennon, PsyD (A) Susan Esquilin, PhD (N) Aileen Torres, PhD (N) Alan Lee, PsyD (N) Nicole Rafanello, PhD Parliamentarian: Joseph Coyne, PhD Affiliate Caucus Chair: Rosalie DiSimone-Weiss, PhD ECP Chair: Christopher King, JD, PhD NJPAGS Chair: Chelsea Torres, MA, LPC 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: Sara Tedrick Parikh, PhD Mercer County Psychological Association: TBD Middlesex County Association of Psychologists: Tammy Dorff, PsyD and Rosalie DiSimmone-Weiss, PhD Monmouth/Ocean County Psychological Association: Deidre Waters, PsyD Morris County Psychological Association: TBD Somerset/Hunterdon/Warren 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: TBD Senior Communications Manager: Christine Gurriere Continuing Education & Event Coordinator: Ana DeMeo Membership Services Coordinator: Jennifer Cooper 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 Francine Conway 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 Interim Editor: Francine Conway, PhD E-Mail: francine.conway@gsapp.rutgers.edu or NJPA Central Office E-Mail: NJPA@PsychologyNJ.org

Published by: New Jersey Psychological Association 354 Eisenhower Parkway, Suite 1150 Livingston, NJ 07039 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, 354 Eisenhower Parkway, Suite 1150, Livingston, NJ 07039. Members receive New Jersey Psychologist as a membership benefit. Periodicals postage pending at Livingston, NJ and additional mailing offices. POSTMASTER: Send address changes to New Jersey Psychologist, 354 Eisenhower Parkway, Suite 1150, Livingston, NJ 07039.

President’s Message NJPA President Lucy Sant’Anna Takagi, PsyD, LLC

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elcome to 2020 at NJPA! I indicated that I would work on communication, transparency, and inclusion in 2020. I am proud to say that during 2019, working together with NJPA’s Executive Director, Keira BoertzelSmith, JD; 2019 Past-President, Stephanie Coyne, PhD; 2019 President Morgan Murray, PhD; incoming 2020 PresidentElect Daniel Lee, PhD; and with the entire NJPA executive board, there were significant and positive changes approved in 2019 to fulfill NJPA’s mission, as well as to move towards my candidacy goals. Yet, there is still much to be done, but the work we completed in 2019 has set the stage for what I want to accomplish in 2020! As we are in February, I would like to report a few significant events from 2019 that will help orient you to where we are now.

The year 2019 was challenging for NJPA, as it involved a move and much anxiety regarding our budget. With the diligent work of our executive director, Treasurer, Daniel DaSilva, PhD and the NJPA staff, the move was successful and kept us within budget. NJPA explored renting offices in a more centralized geographic area. That search indicated that locations in other counties were not only more expensive for the space needed, but also did not offer parking and/or spaces for meetings and CE events. We were able to secure our new office at 354 Eisenhower Parkway in Livingston, NJ, plenty of free parking, and a low-cost space for continuing education programs. If you have not yet visited our new office, please consider doing so. The office is decorated with beautiful paintings on the walls made by our Executive Director, Keira Boertzel-Smith and her daughter, who are gifted artists.

Increasing the communication between leadership and NJPA members is one of my primary goals. However, discussing NJPA Winter 2020

business on the NJPA listserv is a violation of listserv rules. The listserv is a limited members-only forum and not a formal means of communication for NJPA business. In 2019, the NJPA board decided that leaders should be allowed to share important announcements on the listserv. For instance, updates on the status of the NJPA proposed amendment to the Licensure Legislature (Bill A-5307) will now be allowed to be posted on the NJPA listserv. This bill amends the Licensure Act, allowing for the 1,750 post-doctoral hours requirement to also be completed predoctorally. In 2020, we will continue to work towards presenting this bill to the full assembly, the senate, and the governor in order to increase access to psychological services for NJ residents. Additionally, NJPA will continue to work through its affiliate organizations, by inviting legislators to affiliate events, such as the very informative meeting that NJPA leaders and the Essex and Union County Association of Psychologists (EUCAP) members had with Assemblywoman Mila Jasey in 2019.

Other changes will also increase transparency and inclusion in NJPA. The NJPA executive board approved (1) an updated and more transparent confidentiality agreement for the Committee on Legislative Affairs (COLA) that will allow for a more timely flow of information to our members about our current legislative interests; (2) a mechanism to allow for NJPA committees, including the Committee on Diversity and Inclusion (CODI)’s Subcommittee (Immigration Emergency Action Group-IEAG), to engage in board approved collaborations with other groups or agencies; (3) a change for COLA to recommend legislative actions to the executive board instead of deciding on legislative positions for NJPA; and (4) a change for the NJPA president-elect to also become COLA co-chair in order to increase the communication about legislative information between COLA, the executive board, and NJPA members.

The 2020 Mental Health Awareness campaign theme is “Compassionate Communities.” The campaign will run from February through July 2020. We will host a video contest in February and March; April

is Minority Health Month; May is Mental Health Month; June is Pride Month; and July is Minority Mental Health Month.

NJPA and its eight NJPA affiliates are disseminating this campaign through multiple platforms. Inclusion of all New Jersey’s diverse populations is a top priority of this campaign. If you are interested in contributing to this campaign in any way, please call Central Office at (973) 2439800. We can use everyone’s help!

Lastly, as a result of the Listserv reaction regarding the RxP survey dissemination in 2019, we will use a Town Hall model as a second data point (the first data point was the survey) to learn about the history of RxP in NJPA, to increase understanding among members of the challenges that will be encountered by any NJPA position regarding RxP (pro and con), and to obtain members’ opinions about which, if any, position might be in the best interest of NJPA, its members, and the public at large. I am truly hopeful you will attend this Town Hall. I am also hopeful this model would help increase communication, transparency, and inclusion of all constituencies within NJPA. I would like to highlight the collaborative work that NJPA has been doing through the Inter-Mental Health and Psychological Associations Coalition (IMPAC). IMPAC is formed by leaders of the New Jersey chapter of the Association of Black Psychologists (NJABPsi), the Latino Mental Health Association of New Jersey (formerly the Latino Psychological Association of New Jersey), LMHANJ, and the New Jersey Psychological Association (NJPA). IMPAC is the result of the work of many devoted past NJPA leaders to promote equality in mental health care and to advocate for the mental health needs for underserved populations. On April 3, 2020, IMPAC will sponsor a keynote presentation with Luz Garcini, PhD, titled One Scar, Too Many: Addressing the Mental Health Needs of Undocumented Immigrants in the Face of Trauma. Dr. Garcini presented her research and experience, as a MexicanAmerican psychologist, at the APA Council of Representatives in August, 2019, and it was incredibly well received. Her research is the first to quantify trauma among the undocumented immigrants on the US1

Mexican border. You can read more about her scholarship on <https://www.apa.org/ monitor/2018/04/conversation-garcini>.

Consider reserving April 3rd on your calendar and encouraging your friends to attend the program.

Although the above covers exciting events happening at NJPA, there is still much to be done. Anxiety seems to be the norm in our offices and in our lives these days. The psychological impact of social issues on us and our patients is often difficult to manage and presents

us with new responsibilities. We are tasked to learn about the breadth of professional diversity within our field, to advocate and to educate legislators about the needs of our clients, to develop alliances with community stakeholders to strengthen our expertise and scope of practice, and to advance psychology as a means of promoting health and human welfare in an atmosphere that expands and strengthens the diversity of our membership and of the community of New Jersey. New challenges open the

possibility for growth, and I am convinced that the New Jersey Psychological Association is capable of meeting this challenge. ❖ NJPA Mission: The mission of the New Jersey Psychological Association is the advancement of psychology as a science, as a profession, and as a means of promoting health and human welfare in an atmosphere that supports the diversity of its members and the society at large.

WELCOME NEW MEMBERS! Licensed 5+ years Debra Bashist, PhD Ralph Dell’Aquila, EdD JoAnne Gonzalez, PhD Lisa Hahn, PhD Nancy Harrison, PsyD Michael Horowitz, PhD Linda Knust, PsyD Megan Nervi, PsyD Joanne Peart, PhD Lisa Hunter Romanelli, PhD Licensed 2-5 years Geraldine Oades-Sese, PhD Nicole Pensak, PhD Licensed less than 2 years Gemma Boyd, PsyD, MA Aliza Feldman, PsyD Denise Hien, PhD Anna Maleson, PhD Amy Mueller, PsyD Elizabeth Palumbo, PsyD Michelle Petrongolo, PsyD Maria Staropoli-Hafner, PsyD

Non-Licensed Doctoral Degree Christina Chatlos, PsyD Non-Resident Kate Farmer, PhD Stephanie Bunin, PsyD 2nd year Post-Doctoral Jill Caruso, PsyD 1st year Post-Doctoral Corrine McCarthy, PsyD Students Bridget Anton Daam Barker, MA Madeline Bono, BA Jessica Bonumwezi, MA Katie Brundage, BS Paulina Calcaterra, BA Malquiris Castillo, BA Jenna D’agostini, MA Victoria DeLuca, BA Marissa DeStefano Alejandra Feliz, MA Erin Fitzsimmons, BA

Elana Fox, BA Idil Franko, MA Melissa Gizzi, MA Michael Gordon, BA Jared Hammond, MA Francisca Iroh-Donawa Norna P. Jules, BS Rebecca Khiralla, BA Sekinat Kuku, BA Hyein Lee, BA Jenna Lombardo, MA Amy Lopez, MS Michael Marks, PsyM Kimberly Marynowski, BA Shoshana May, PsyM Mir Kamran Meyer, JD Joseph Morgan, MA Stephen Pappalardo, MA Melissa Pedroza, BA A. Keshani Perera, BSc Madison Perry, PsyM Dominique Reminick, MA Sabrina Rodriguez, BA Joel Seltzer David Siegel Matthew Stahl, MS

MEMBER NEWS Ruth Lijtmaer, PhD presented the following papers: Panel: Real and imagined borders: When interior and exterior harden and collapse.

1) Introduction to panel: “Real and symbolic borders.” Paper: A world without borders and 2) Moderator of panel: Between Personal and Universal Ethics at the IFPE Conference theme: “Borders”10-17-19 to 10-23-19. Toronto, Canada. Paper: Where do I belong? I do not have a home: I am a refugee in the panel: On Border Crossings and Displacements: Reflections by Border-crossing Migrants on Belonging, Identity and the Politics of the Illegal Traveller. APCS. Conference theme: Displacement: Precarity and community. 10-25-19 to 10-26-19 Rutgers University, New Jersey, USA. Marta Aizenman PhD, was the keynote speaker at the Annual Conference of The New Jersey Association for Multicultural Counseling on 11/20/2019. She presented the paper: Counseling, Advocacy, and Social Justice: Keeping the flame alight..

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New Jersey Psychologist

The Year 2020 – Ebb and Flow

Keira Boertzel-Smith, JD NJPA Executive Director

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he Merriam-Webster dictionary states that ebb and flow is used to describe something that changes in a regular and repeated way. Over the last nine years with NJPA, I witnessed the remarkable ebb and flow of NJPA’s rhythmical pattern of decline and regrowth through many organizational transitions that taught me about organizational lifecycles, including rebirth, the importance of healthy teamwork, as well as maintaining a core Central Office staff, and a network of volunteers who approach NJPA’s work from a place of genuine interest and passion.

Over the past five years, in my role as executive director, I had many meaningful professional highlights including experiencing NJPA organizational cultural shifts after taking over the association management from retiring, long-term employees and supporting new NJPA diversity and inclusion initiatives. I have the responsibility of overseeing the implementation of a robust NJPA continuing education policy and process to provide psychologists with quality programming to satisfy the new mandatory continuing education requirements. Related, in 2019, we successfully moved the NJPA Central Office to a new building with better access to common space for hosting NJPA meetings and programs. We make good use of our virtual meeting platform to make NJPA and NJPA Foundation meetings accessible. I am vigilant in ensuring that the organization’s work remains firmly within budget each year, even with significant revenue and expense shifts. I enjoy working with the New Jersey Inter-Mental Health and Psychological Associations Coalition (IMPAC) leadership. Throughout these years, I also had the privilege of managing the NJPA delegates at the annual American Psychological Association Practice Leadership Conference and Capitol Hill visits in Washington, DC, and in 2019, became the elected chair of the Council of Executives of State, Provincial, Winter 2020

and Territorial Psychological Associations with a membership of 60 executive directors and chief executive officers.

Of course, I could not do any of these things without the help of the amazing Central Office Team, Christine, Ana, Jennifer, and Marion, or the support of the board.

What can we expect in 2020?

1. A continued commitment to and

focus on the NJPA Mission and

Strategic Plan that incorporates

member, committee, and board feedback.

“The mission of the New Jersey Psychological Association is the advancement of psychology as a science, as a profession, and as a means of promoting health and human welfare in an atmosphere that supports the diversity of its members and the society at large.”

NJPA Strategic Plan Goal 1: Provide a professional community for all members of the New Jersey Psychological Association.

A. Advocate for the Professional Inter ests of Members - Legislative Advo cacy.

B. Regulatory Advocacy.

C. Membership Recruitment and Retention.

D. Provide professional development

opportunities for members.

E. Assess members’ needs and evaluate

efforts to address these on an ongo ing basis.

F. Support and strengthen the interrela tionships among all organizational

components of NJPA. G. Publicize the value and work of

NJPA and of its members both

within the association and with the

general public.

H. Develop and improve opportunities

for member-to-member professional communication.

Goal 2: Infuse and address diversity and inclusion issues into all areas of the association.

Goal 3: Address issues related to social advocacy involving the application of psychological science and psychological services related to the mental health of the diverse populations of New Jersey.

2. Fiduciary Responsibility - A commitment by the NJPA executive board and executive director to due diligence and

oversight to ensure that the organization is well-managed and that its financial situation remains sound.

3. Advocacy Changes - A push for more member engagement and transparency with our association’s advocacy efforts, and stronger statewide relationships with legislators. These changes include a revised confidentiality agreement for the Committee on Legislative Affairs (COLA) to allow for comments on upcoming legislative matters, the NJPA president-elect co-chairing the COLA and reporting to the board and membership, as well as a transition to having COLA submit legislative bill position recommendations to the board for board approval. Read more about the transitions in this journal’s advocacy article.

4. Continuing Education/Membership NJPA will continue to provide a robust calendar of live and homestudy continuing education opportunities for psychologists. NJPA is working on greater inclusion of diversity in NJPA program planning and program presentations. You will also see NJPA hospitality ambassadors at each NJPA program reaching out to our attendees, including non-members and new members. We want you to join us in making all of our members feel welcomed at NJPA events, and help encourage non-members to join NJPA. We keep hearing a call for more personal networking and connection, so let’s make it happen in 2020!

5. Communications and Culture Focus You will see NJPA working hard in making use of our multimedia platforms and perfecting NJPA messaging and news sent out to members, potential members, and the public.

We want to make better use of association and NJPA Foundation’s news and activities and recognize our members on a regular basis.

The NJPA culture will see more attempts to encourage statewide member engagement in a February 14, 2020 association orientation, on April 17, 2020 RxP Town Hall, a September 18, 2020 association check in, leadership road trips across the state, and other ways to connect, unify, engage, and support one another.

This year NJPA should have an exciting and positive ebb and flow of mission and volunteer driven association activities.

The NJPA Central Office team is looking forward to this good association work! ❖ 3

Treasurer’s Report 2019/2020 Treasurer’s Report

Dan DaSilva, PhD

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s we close out 2019 and look to a new year, the New Jersey Psychological Association (NJPA) is financially sound. It was an eventful year as NJPA continued its mission under the guidance of the Executive Director, Keira Boertzel-Smith, JD, our President, Dr. Morgan Murray, and the executive board.

Our financial stability is the result of careful decision-making and advisement from the Finance Committee, comprised by members of the board, the executive director, and the association’s bookkeeper, Marion Medow.

Many of the financial decisions in 2019 occurred against the backdrop of a changing landscape in the association and in our

profession. This backdrop will continue to influence financial decision-making in 2020 as the Finance Committee recognizes that NJPA is in a state of rebirth and will move to establish new, less traditional, financial plans of action.

In 2019, NJPA moved the central office to its new location at 354 Eisenhower Parkway, in Livingston. The new location is solved a number of significant issues at the previous location West Orange while also improving the association’s ability to serve its membership through both onsite and virtual programming. The much-needed move came with the expected expenses that were carefully planned and budgeted, and in the end the move was completed under budget.

A steady decline in membership (a nationwide trend) over the last five years continues to exert a noticeable impact on revenue and the careful work and effort of the membership committee under the leadership of Dr. Randy Bressler, did much to lessen the impact of this trend. At the same time, programming efforts, especially CE programming under the leadership

of Dr. Dennis Finger, and sponsorships have succeeded in filling the financial gap by fulfilling the training and educational needs of NJPA membership. Unfortunately, both of these trends remain somewhat unpredictable going forward and requires the continued efforts of both the committees and the membership. Other financial responsibilities of the association include our publications, including our journal, the operation and staffing of our central office, and governance and advocacy.

At its core, our state psychological association is a member-driven organization supported primarily by membership dues. However, our changing landscape has forced us to be more nimble and conservative in our financial decisions, while at the same time developing new and more creative non-dues revenue. NJPA’s board and the association’s committees have been supportive and integral in these efforts. In the end, the sound financial footing of the organization serves our membership’s needs and the worthy mission of NJPA. ❖

Thank You For Your Generous PAC Contributions in 2019!

Make your online donation today!

Frank Weiss, PhD Mark Singer, PhD 2019 President 2019 Treasurer Leadership Circle ($1000 and over

Virginia Waters, PhD

Platinum ($750-$999 Rosalind Dorlen, PsyD Gold ($500-$749) Bonnie Markham, PhD, PsyD Silver ($250-$499) Rosemarie Ciccarello, PhD Daniel DaSilva, PhD Toby Kaufman, PhD David Szmak, PsyD Daniel Watter, EdD Bronze ($100-$249) Jeffrey Axelbank, PsyD Steven Barnett, PhD Judith Bernstein, PsyD Jeffrey Bessey, PhD Isabel Brachfeld, EdD Randy Bressler, PsyD Carolyn Carbone-Magnero, PhD Stephanie Coyne, PhD Richard Dauber, PhD Daniel Diamant, PhD Charles Dodgen, PhD Karen Faherty, PhD Janie Feldman, PsyD Pamela Foley, PhD Kenneth Freundlich, PhD

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https://www.psychologynj.org/support-njp-pac

Thomas Frio, PhD Leslie Gilbert, PhD Ruth Goldston, PhD Osna Haller, PhD Raymond Hanbury, PhD Maureen Hudak, PsyD Christine Hudson, PhD Sarah Karl, PhD Deirdre Kramer, PhD Ruth Lijtmaer, PhD Cornelius Mahoney, PhD Maria Masciandaro, PsyD Robert McGrath, PhD Barry Mitchell, PsyD Lynn Mollick, PhD Leila Moore, EdD Daniel Moss, PhD Hulon Newsome, PsyD Susan Parente, PsyD Francesca Peckman, PsyD Lori Rayner-Grossi, EdD AnnaMarie Resnikoff, PhD Bart Rossi, PhD Anne Rybowski, PhD Debra Salzman, PhD Louis Schlesinger, PhD Richard Schwartz, PhD William Shinefield, PsyD Tamara Sofair-Fisch, PhD Lucy Sant’Anna Takagi, PsyD Peggy Van Raalte, PsyD Aaron Welt, PhD

Philip Witt, PhD James Wulach, PhD Copper (up to $99) Jessica Arenella, PhD Kyle Barr, IV, PsyD Leslie Becker-Mattes, PhD Monica Blum, PhD Tadd Campbell, PhD Monica Carsky, PhD Deborah Dawson, PsyD Nancy Distel, PhD Laura Eisdorfer, PsyD Renan Erkut-Petermann, PhD Guity Fazelpoor, PsyD Joan Fiorello, PhD Antonia Fried, PsyD Marc Gironda, PsyD Elizabeth Goldberg, PhD Sandra Grundfest, EdD Diane Handlin, PhD Christina Hathaway, PsyD Susan Herman, PhD Monica Indart, PsyD Lisa Jacobs, PhD Arthur Joseph, EdD Elissa Kaplan, PhD Paula Kaplan-Reiss, PhD Mary Louise Kerwin, PhD Joel Kleinman, PhD Peter Krakoff, PhD Phyllis Lakin, PhD

Linda Larkin, PhD Dennis LaScala, PhD Paul Lehrer, PhD Ilana Lev-El, PsyD Alfredo Lowe, PhD Mark Lowenthal, PsyD Susan MacKinnon, PsyD Steven Master, PhD Shirley Matthews, PhD Gail McVey, PsyD Norine Mohle, PhD Morgan Murray, PhD Susan Neigher, PhD Jennifer Oglesby, PhD Lori Pine, PsyD Vincenza Piscitelli, PsyD Sharon Press, PhD Adam Price, PhD Sharon Rausenberger, PhD Steven Reed, PhD Lori Rockmore, PsyD George Sanders, PhD Gail Schrimmer, PhD Ellen Schwartz, PhD Steven Sussman, PhD Tamsen Thorpe, PhD William Walsh, PhD Virginia Walters, PsyD Jennifer Weberman, PsyD Michael Zito, PhD

New Jersey Psychologist

LEGISLATIVE AGENDA

COLA Advocacy

Dr. Aida IsmaelLennon, PsyD Co-Chair, COLA

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he Committee on Legislative Affairs (COLA) is part of the NJPA executive board charged with introducing and monitoring legislation that impacts our profession and the public we serve. Together with the Committee on Regulatory Affairs (CORA), and our Government Affairs Agent (GAA), COLA seeks to maintain and enhance standards of psychology practice in NJ and protect patients’ rights by supporting public policy initiatives. These include the NJ Licensing Act legislation, Maiden Names legislation, Network Adequacy legislation, Duty to Warn Amended law, ABA legislation, among others.

Building on the work of the 2019 committee Chair, Dr. Barry Katz, my CoChair President-Elect, Daniel Lee, PsyD and I have several strategic priorities for COLA in 2020. We look to advance NJPA’s strategic plan by a) continuing to research prescriptive authority’s pros and cons for psychologists and to advocate for responsive action for client’s needs, b) develop in-house Medicaid and Medicare expertise to facilitate member involvement, c) continue to advocate for fair reimbursement rates from insurance companies, d) train members in legislative advocacy for professional issues, and e) develop recruiting efforts for new COLA members. Diverse opinions within COLA, and within the larger organization, abound regarding professional practice issues such as RxP. For example, beginning in 2016 COLA began examining and disseminating information about RxP. Pressures associated with a dearth of qualified professionals to prescribe medication in many areas of the country have weighed against storied arguments about training credentials and associated guild issues.

There are varying opinions on this issue among members. Data indicating that psychologists with a tradition of behavioral, social-emotional, and interpersonal interventions more closely monitor the interaction of personal change and

Winter 2020

psychopharmacological impact serve as supporting arguments. This data suggests RxP may serve the public good, particularly in urban and rural areas where persons-in-need are denied access to full mental health services. The legislation in New Jersey proposes setting high standards for education and supervision.

Others argue against RxP fearing that expanding the scope of practice, in this way, might alter the profession’s identity.

In keeping with NJPA’s strategic plan, COLA will be forming a task force to further research RxP’s pros and cons.

While likely to provoke attention, thinking about prescription privileges illustrates how the work of NJPA, and its committees, intersects along the lines of inclusion, diversity, social justice, and poverty. Issues that COLA considers, including Medicare and Medicaid reimbursement, problems with insurance panels, and the need for legislative action, share a core principle, mental health parity, or the right of all people to appropriate treatment for emotional and behavioral problems. Failure to ensure this right is readily apparent in rising suicide rates among young people, horrific and sensational crimes against vulnerable groups, the opioid crisis, and gun violence. At its core, COLA provides an opportunity for practitioners and researchers to develop ideas about how psychology can care for the public good in ways that are formed by evidence-based policies and interventions. The practice of psychology is governed by socio-political forces that establish legislation regulating our profession, but also can inappropriately steer the public away from access to highly trained psychologists. Some might argue that we are too highly trained, as we recently suggested in reviewing the number of supervision hours required for post-doctoral training. On the other hand, psychology has, until recently, neglected our MA level colleagues in psychology and ignored intrusions from various guilds, including in the recent NJ legislative session, Applied Behavior Analysts, who are essentially seeking parity with licensed psychologists.

As we look ahead to 2020, we intend to elaborate on these efforts and continue our commitment to transparency that we are confident will allow all our members to feel included and to know they have a

voice. These changes include a revised confidentiality agreement allowing for comments on upcoming legislative matters, our president-elect to co-chair COLA and report to the executive board and membership, COLA submitting legislative bill position recommendations for board approval, as well as an RxP Town Hall to be held by Dr. Lucy Sant’Anna Takagi. We also will continue to encourage participation in the committee by recruiting more members to join us.

COLA needs members from a variety of backgrounds that are willing to offer their expertise in matters related to the legislative topics we are charged in monitoring. We need diverse voices and opinions so we can take on the challenges of living in an increasingly polarized society.

Most importantly, we hope to offer expert opinion that encourages legislative action based on psychological research.

I live in Jersey City, about a mile from where a brave police officer lost his life in a cemetery and about two miles from where several members of our community, working in a Kosher grocery, carrying on in good will and good faith, were gunned down, violently and wantonly. Because I live so close and frequently travel past the places where it happened, it is literally difficult to “get past” the images of this horrific tragedy. I also grieve for the loss of life of a young Columbia University student at the hands of young children of 13 and 14 years of age, whose lives will also be inexorably affected. I hope to add a COLA focus on Psychology in the Schools to develop proactive interventions for these lost and wandering children based on evidence-based practice. Finally, I have also been affected by the drawings of a tortured, but innocent man, detained in Guantanamo Bay, in whose agony psychology was apparently complicit. You may have similar events or images in your life. Perhaps, these images will drive you to work with us, lending your training, expertise, and empathy to put psychology in practice for the best interest of the public we serve. Visit the members only page at <www.psychologynj.org> to view and comment on a summary of the legislative priorities of NJPA. Finally, consider joining COLA! If interested, please contact NJPA Executive Director, Keira BoertzelSmith, at njpakbs@psychologynj.org or at 973-243-9800. ❖ 5

ETHICS UPDATE 6

Culturally Competent Psychotherapy Informed

By Ethical Principles

Komal Dutt, PhD Ethics Committee Member

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mpathy, the essence of psychotherapy, is the most important tool psychologists have for understanding and reflecting patients’ feelings, thoughts, and behaviors. Empathy provides patients with validation that in turn motivates them to make desired changes or accept what they cannot change. In order for empathy to be based on a genuine understanding of a patient’s struggles, emotions, and behaviors, psychologists must have a keen understanding of their patients’ cultural world-view.

It is not only critical for psychotherapists to understand their patients’ cultural beliefs but to provide help that is consistent with those beliefs (Choudhuri, Santiago-Rivera, & Garrett, 2012; Hays & Erford, 2010). For example, some researchers have indicated that to ensure culturally competent treatment, family based interventions are more effective for South Asian Americans (e.g., Almeida & Dolan-Delvecchio, 1999; Inman & Tewari, 2003).

In addition to providing empathy from a place of cultural understanding, a psychologist is also obliged to adhere to ethical principles established by the American Psychological Association (APA).

Occasionally, psychologists may face a dilemma between respecting their patient’s cultural worldview and upholding the ethical principles of their profession. This article will illustrate such situations and propose possible solutions, respecting the need for ethical principles to take precedence in all circumstances.

In particular, this article will focus on ethical principles regarding limits of confidentiality (i.e., duty to protect), and boundaries of competence listed under the preamble of the APA Ethics Code.

Using case examples from Indian culture, this article will illustrate potential dilemmas and present possible resolutions.

Ethical Standard 4.05 - Discussing limits of confidentiality: The essence of this principle is that “psychologists may disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose, such as to protect the client/patient, psychologist, or others from harm.” The psychologist’s underlying responsibility is in this case is their “duty to protect.”

It is important that the limits of confidentiality be discussed prior to starting therapy. In addition to providing this information to patients verbally, it should be clearly stated in the psychologist’s informed consent.

Case example: A private psychologist of Indian origin receives a call from an Indian man requesting therapy for his 15-year-old daughter. The caller mentions that his daughter has been feeling depressed, is often irritable, and is struggling socially at school due to a recent falling out with her friends. He elaborates that when he and his wife try to confront her, she often “threatens to harm herself.” The caller goes on to deny that his daughter has ever actually harmed herself.

The caller adds that his daughter has tried therapy with a few Caucasian psychologists, and has not found it helpful.

He then mentions that these psychologists have recommended hospitalization for his daughter when she has threatened to harm herself in the past, and that he and his wife have not appreciated this. The caller shares that he and his wife believe that their daughter threatens to harm herself as a means of seeking attention and managing her mood and struggles at school. He adds that he is specifically contacting an Indian psychologist in the hope that “she would not try to hospitalize her daughter whenever she threatens harm.”

Before accepting the case, the psychologist’s responsibility is two-fold. First, she must communicate that she has a duty to protect, and explain clearly the circumstances in which this duty will apply. The second responsibility is more clinical in nature. The psychologist must demon-

strate her understanding of the parents’ frustration while explaining that understanding and helping patients manage symptoms is more effective than dismissing them. In other words, the clinician must convey to the parent that although she understands the cultural viewpoint (perhaps there is a cultural shame in being hospitalized for mental health reasons, or a culturally influenced tendency to deny or dismiss mental health symptoms), the duty to protect will take precedence.

Ethical standard 2.01 - Boundaries of competence: This principle states that “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.”

Although a growing number of psychologists in the United States come from different cultural backgrounds, there is still a shortage of psychologists from Indian cultures. Many Indian couples prefer to see a psychologist from their own culture, believing that he or she will be more equipped to understand their conflicts. However, in order to work effectively with couples, a psychologist needs to be trained in couples therapy, and may need advanced training or supervision to work with high conflict couples/families.

Simply knowing a patient’s culture is not sufficient to address complex problems.

Case example: An Indian therapist gets a call from a 45-year-old Indian woman, married for 18 years.

She expresses that she is feeling stressed by conflicts in her marriage. She states that she would like to bring her husband for sessions, but he is reluctant (a common problem amongst Indians). The therapist agrees to see the patient.

Therapy ensues and the patient reveals that she suspects her husband is having an affair. This would not be the first time; early in the marriage, the husband had a brief affair followed by many years of trying to work through this issue.

New Jersey Psychologist

After a few therapy meetings alone with the wife, the husband joins the therapy session.

In these sessions their conflict is particularly intense, occasionally escalating to the point of being unmanageable. The therapist struggles and eventually seeks supervision, recognizing that she is missing needed skills to de-escalate conflicts in session and help the couple more effectively. Clearly, while familiarity with a patient’s cultural background is necessary, it is not sufficient.

in which a therapist’s world-view becomes an interfering factor in therapy. Couples often seek treatment (individual therapy or couples) either to resolve their conflicts or to make a decision to end their marriage.

The therapist’s world-view about divorce can interfere in the therapy process. As such, it is important for therapists to be mindful of their own therapy-interfering behaviors and attitudes. For example, a therapist’s accepting view of divorce may create a barrier to those whose culture stigmatizes divorce.

Ethical standard 2.06 Personal Problems and Conflicts: This principle states that “Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. Additionally, when psychologists become aware of personal problems that may interfere with their performing workrelated duties adequately, they take appropriate measures.”

This principle can be applied to cases

Case example: A 55-year-old Indian woman, requests therapy from an Indian therapist. She states that she recently terminated couples therapy.

In the first session, she reveals that she and her husband have struggled with long-standing conflicts (although she denies abuse) in their marriage.

After their children left home for college, the couple decided to end the marriage, but first sought therapy to facilitate a smooth transition for their children and themselves.

After a few sessions, the couple changed their mind and decided against divorc-

ing despite the “loveless” nature of their marriage. On hearing this, their couples therapist, strongly recommend that they reconsider their decision as their differences seemed irreconcilable. Although the couple agreed that their differences may be irreconcilable, they felt that their therapist did not understand their dilemma. In response, the couple decided to terminate therapy with this therapist and look for someone more likely to understand their decision in the context of their culture.

In light of this, the new therapist and the patient collaboratively established the goal of helping the patient to develop skills to manage her well-being while staying in the marriage. The previous couple’s therapist made the mistake of failing to educate himself on the influence of social pressure and religious beliefs on the decision to divorce. As such, he did not incorporate this relevant factor into his understanding of the case.

In sum, psychologists should make every effort to both provide culturally informed psychotherapy and carefully uphold ethical principles listed by the APA. ❖

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Winter 2020

7

FOUNDATION

Starting the Year Off Right – NJPA Foundation Matt Hagovsky, PhD (President); Toby Kaufman, PhD (Secretary); Abby Rosen (Treasurer); Belvin Williams, PhD (Trustee); Richard Klein, EdD (Trustee); Ann Stainton, PhD (Trustee); Regina Budesa, PsyD (Trustee); Alyssa Austern, PsyD (Trustee); Eileen Kohutis, PhD (Trustee)

In addition to supporting the New Jersey Psychological Association (NJPA) mission, the mission of the Foundation is promoting the psychological health of the diverse people of New Jersey. The NJPA Foundation administers and raises money to deliver psychological services to underserved populations, trains psychology graduate students as clinicians and researchers with an emphasis on treating underserved populations, supports the mission of NJPA especially in its commitment to diversity, public health, underserved populations and the training of graduate students in psychology. The NJPA Foundation is a 501(c) (3) corporation and all donations, less any goods and services received, are tax deductible.

In 2020, we look forward to introducing a new dissertation grant, with more flexibility for our graduate students to explore social advocacy issues that impact underserved populations. We welcome 2020 NJPA member benefit dinners, tributes, and individual donations to support the Foundation’s grants and awards. We will also continue our work in supporting our existing four categories of grants/ awards: the NJPA Foundation Community Service Project Grants, NJPA Foundation Student Dissertation Grant (two optional topics of The Impact of School Violence on the Victims and on Society or the Traumatic Impact of Separating Children from Families on the Victims and on Society), the NJPA Foundation Graduate Student Initiated Research Award, and the NJPA Foundation Student Conference Participation Grant.

In this article, we want to take a moment to congratulate to our 2019 Graduate Student Initiated Research Award winners!

The NJPA Foundation 2019 Award Winner for the John M. Lagos Award for Research into Causes and/or Treatment of Social Problems was Tamara L. Quezada, PsyM, for her research paper A MixedMethods Study of the Social-Emotional Learning and the School Experience of Emergent Bilinguals. Visit the NJPAF 8

website page to read her research paper to learn about how as the number of immigrants steadily rises in the United States, our society has become culturally diverse, and the number of Emergent Bilinguals(EBs) continues to increase.

The John M. Lagos Award for Research into Causes and/or Treatment of Social Problems is awarded for the study of causes and/or treatment of social problems. Some possible topics include school issues, work problems, health issues, and aggression.

The NJPA Foundation 2019 Award Winner for the Award for Research on Diversity Issues was Cindy Chang, BA, for her research paper Application of Minority Stress and Suicide Models in Bisexual versus Gay/Lesbian Young Adults. Visit the NJPA Foundation website page to read her research paper to learn about how suicide is a significant public health concern in sexual minority populations (King et al, 2008; Koh & Ross, 2016).

Several frameworks have been developed to explain suicide risk in the general population, including the Interpersonal Theory (IPT, Joiner, 2005) and the Clinical Model (Mann et al., 1999). Separately, other researchers have also utilized the minority stress model (Meyer, 2003) to explain the greater suicide risk in sexual minorities, which posits that stressors unique to sexual minority status increase

risk for adverse outcomes. While both suicidological and minority stress models have been used to explain suicide risk in different populations, only one study to date has integrated them to understand suicide risk in sexual minorities (Plöderl et al., 2014).

The NJPA Foundation Scholarship for Research on Diversity Issues is awarded to a graduate student who advances the following goals: (a) promote scientific understanding of the role of diversity in psychology; (b) foster the development of sensitive models for delivery of psychological services to diverse populations. Some possible topics include issues related to cultural or ethnic issues, socioeconomic issues, gender issues, or work with underserved populations.

Please read more about the NJPA Foundation in the quarterly Foundation Flash e-publications, encourage graduate students to apply for the NJPA Foundation grants/awards, and make a donation!

The Foundation derives nearly all of its funding from NJPA members like you.

The Trustees and Central Office staff work diligently to provide opportunities to give at dues renewal time, when you receive an email Foundation Blast, at our Spring and Fall conferences, at our Foundation dinners, or any time the spirit moves you. Please be mindful of our efforts as we forge ahead into a new decade and, as always, thank you for what you have already done to make the Foundation The “Heart” of NJPA.

New Jersey Psychologist

The NJPA Foundation is most grateful to all of the following colleagues who have contributed so substantially to our efforts in 2019 (includes all contributions processed by December 31).

Our heartfelt thanks to all of you.

Angel $1000 and over Mathias Hagovsky, PhD John Lagos, PhD Sponsor $750-$999 Rosalind Dorlen, PsyD Patron $500-$749 Peter Economou, PhD Toby Kaufman, PhD Contributor $250-$499 Rosemarie Ciccarello, PhD Stephanie Coyne, PhD Susan Esquilin, PhD Bonnie Markham, PhD, PsyD Joan Glass Morgan, PsyD Ann Stainton, PhD Lucy Sant’Anna Takagi, PsyD Daniel Watter, EdD Aaron Welt, PhD Supporter $100-$249 Jeffrey Axelbank, PsyD Elaine Belz, PhD Roderick Bennett, PhD Judith Bernstein, PsyD Mary Blakeslee, PhD Nancy Boyd-Franklin, PhD Randy Bressler, PsyD Monica Carsky, PhD Richard Dauber, PhD Nick Economou, EdD Joan Fiorello, PhD Kenneth Freundlich, PhD Milton Fuentes, PsyD Marc Gironda, PsyD Osna Haller, PhD Raymond Hanbury, PhD Lauraine Hollyer, PhD Lisa Jacobs, PhD Sarah Karl, PhD Joel Kleinman, PhD Eileen Kohutis, PhD Deirdre Kramer, PhD Phyllis Lakin, PhD Marc Lipkus, PsyD Charles Mark, PsyD Susan Marx, PsyD Neil Massoth, PhD Stanley Messer, PhD Barry Mitchell, PsyD Sharon Ryan Montgomery, PsyD Leila Moore, EdD Joan Glass Morgan, Daniel Moss, PhD Morgan Murray, PhD Hulon Newsome, PsyD Sara Tedrick Parikh, PhD Francesca Peckman, PsyD Bart Rossi, PhD Jeffrey Singer, PhD Barbara Von Klemperer, EdD Virginia Waters, PhD Skye Wilson, PhD Alison Winston, PhD Philip Witt, PhD Friend up to $99 Amy Aho, PhD Derek Aita, PsyD Rika Alper, PhD Amy Altenhaus, PhD Benjamin Alterman, PhD Elvira Anselmi, PhD

Winter 2020

Annette Appleheimer,PsyD Alyssa Austern, PsyD Les Barbanell, EdD Vicki Barnett, PsyD Louis Barretti, PhD Lauren Becker, PhD Shari Becker, PhD, JD Amy Becker-Mattes, PhD Janet Berson, PhD Jeffrey Bessey,PhD Bernard Bilicki, PsyD Nancy Bloom, PsyD Carol Blum, PsyD Monica Blum, PhD Keira Boertzel-Smith, JD Michael Boyle, PhD Phyllis Bolling, PhD Alice Bontempo, PsyD Isabel Brachfeld, EdD Joseph Braun, PhD Richard Brewster, PsyD Merrilea Brunell, PhD Charles Buchbauer, PhD Fiona Byrne-Oberman, PhD John Caliso, PhD Tadd Campbell, PhD Carolyn Carbone-Magnero, PhD Monica Carsky, PhD Marvin Chartoff, EdD Judy Clyman, PhD William Coffey, PsyD Jeffrey Cole, PhD Roger Colonna, EdD Louise Conley, PhD Ralph Constantino, PhD Robin Cooper-Fleming, PsyD Joseph Coyne, PhD Sharon Craig, PhD Jacquelyn Cunningham, PhD Debra Davis, PhD Deborah Dawson, PsyD Jennifer Dechert, PsyD Laura DeMarzo, EdD MaryAnn DeRosa, PhD Nicole DeVita, PsyD Daniel Diament, PhD Phyllis DiAmbrosio, PhD Doreen DiDomenico, PhD Rosalie DiSimone-Weiss, PhD Nancy Distel, PhD Charles Dodgen, PhD Gerard Donohue, PhD Sarah Dougherty, PsyD Patricia Dow-Nelson, PhD Frank Dyer, PhD Peter Economou, PhD Laura Eisdorfer, PsyD Donna English, PhD Karen Faherty, PhD Roberta Fallig, PhD James Farmer, PsyD Shapar Farzad, PhD Guity Fazelpoor, PsyD Janie Feldman, PsyD Stephen Feldman, PhD Dena Felsen, PsyD Nancy Fiedler, PhD Joshua Fink, PsyD Pamela Foley, PhD Richard Formica, PhD Sharon Freedman, PhD Elizabeth Frenkel, PhD Antonia Fried, PsyD Thomas Frio, PhD Abisola Gallagher, EdD Nadine Gardner, PsyD

James Garofallou, PhD Eliot Garson, PhD Kenneth Gates, PsyD John George, PhD Marie Geron, PhD Michael Gerson, PhD Nouriman Ghahary, PhD Leslie Gilbert, PhD Ronald Gironda, PhD Linda Glazer, PsyD Elizabeth Goldberg, PhD Gary Goldberg, PhD Ruth Goldston, PhD Lydia Golub, PhD Morris Goodman, PhD Lois Goorwitz, PhD Ashley Gorman, PhD Bonnie Gorscak, PhD Ora Gourarie, PsyD Rhonda Greenberg, PsyD Santa Gregory, PhD Sandra Grundfest, EdD Hadassah Gurfein, PhD Cynthia Haines PsyD Angela Hall, PsyD Kathryn Hall, PhD Judith Halle, PhD Osna Haller, PhD Diane Handlin, PhD Jennifer Hanych, PhD Jeffrey Harrison,PhD Graham Hartke, PsyD John Hennessy, PhD Susan Herman, PhD Eric Herschman, PsyD Judith Herschlag, PhD Susan Herschman, PsyD Nancy Hicks, PsyD Sean Hiscox, PhD Linda Hochman, PhD Ann Nikolai Houston, PhD Maureen Hudak, PsyD Christine Hudson, PhD Susan Huslage, PhD Monica Indart, PsyD William Ivory, PhD Jane Jacobus, PhD Elena Jeffries, PhD Allison Johnson, PsyD Kyung Jung, PhD Deborah Kaplan, PsyD Elissa Kaplan, PhD Paula Kaplan-Reiss, PhD Robert Karlin, PhD Alex Kehayan, EdD Randi Kell, PhD Eileen Kennedy-Moore, PhD Barry Klein, PsyD Kenneth Kline, PhD Hillary Knatz, PhD Michael Koffman, PhD Laura Kogan. PsyD Eileen Kohutis, PhD Robert Kornhaber, PhD Todd Koser, PsyD Peter Krakoff, PhD Deirdre Kramer, PhD Peter Krebs, PhD Phyllis Lakin, PhD Robin Lang, PsyD Dennis LaScala, PhD Stephen Lawrence, PhD Daniel Lee, PsyD Paul Lehrer, PhD Ilana Lev-El, PsyD Gerald Leventhal, PhD

Neal Leynor, PhD Deborah Libero, PhD Ruth Lijtmaer, PhD Michael Likier, PhD Barbara Lino, PhD Marc Lipkus, PsyD Neal Litinger, PhD John LoConte, PhD N. John Lombardi, PsyD Rebecca Loomis, PhD Rona LoPresti, PhD Alfredo Lowe, PhD Mark Lowenthal, PsyD Marilyn Lyga, PhD David MacIsaac, PhD William MacLaney, PsyD Heather MacLeod, EdD Donna Macri, PhD Cornelius Mahoney, PhD Daniel Mahoney, EdD Stanley Mandel, EdD Margery Manheim, PhD Charles Mark, PsyD Maria Masciandaro, PsyD Shirley Matthews, PhD Wendy Matthews, PhD Robert McGrath, PhD Susan McGroarty, PhD Kenneth McNiel, PhD Gail McVey, PsyD Lauren Meisels, PhD Randy Mendelson, PhD Wilda Mesias, PhD Jacqueline Mesnik, PhD Stanley Messer, PhD Rebecca Meyer, PhD Amanda Milleisen, PhD Barry Mitchell, PsyD Tamerra Moeller, PhD Norine Mohle, PhD Caridad Moreno PhD Caroline Mossip, PsyD Charles Most, PsyD Steven Myers, PhD Sangeetha Nayak, PhD Susan Neigher, PhD Jeffrey Newenhouse, PsyD Margaret Nichols, PhD Denise Novaky, PhD Michael Nover, PhD Jennifer Oglesby, PhD Marilyn Oldman, EdD Carly Orenstein, PsyD Susan Orshan, PsyD James Owen, PsyD Behnaz Pakizegi, PhD Pilar Perez-Ortega, PsyD Sueli Petry, PhD Lori Pine, PsyD Vincenza Piscitelli, PsyD Joseph Plasner, PhD Michael Plumeri, PsyD Sharon Press, PhD Adam Price, PhD Nicole Rafanello, PhD Sharon Rauschenberger, PhD Lori Rayner-Grossi, EdD Nancy Razza, PhD Steven Reed, PhD Jeryl Rempell, PhD AnnaMarie Resnikoff, PhD Laura Richardson, PhD Louis Richmond, PhD David Riley, PhD Alisa Robinson, PhD Lori Rockmore, PsyD

Paul Rockwood, PhD Laura Rosen, PhD Barbara Rosenberg, PhD Francine Rosenberg, PsyD Karen Rosenberg, PhD Lori Aks Rosenberg, PsyD Andrew Roth, PhD Elissa Rozov, PhD Nicole Safonte-Strumolo, PhD Joseph Salerno, PsyD Carole Salvador, PsyD Debra Salzman, PhD George Sanders, PhD Jayne Schachter, PhD Louis Schlesinger, PhD Kenneth Schneider, PhD Doris Schueler, PhD Ellen Schwartz, PhD Margot Schwartz, PsyD Richard Schwartz, PsyD Nancie Senet, PhD Nenza Serra, PsyD Dennis Shaning, PhD Marina Shikhman, PhD William Shinefield, PsyD Frank Sileo, PhD Ronald Silikovitz, PhD Sandra Ackerman Sinclair, PhD Leonard Sitrin, PhD Marjorie Slass, PsyD Shawn Marie Sobkowski, EdD Jeffrey Spector, PsyD Jakob Steinberg, PhD Lois Steinberg, PhD David Steinke, PhD Deana Stevens, PsyD Julie Stewart, PsyD Vincent Stranges, PhD Suzette Sularski, PsyD Steven Sussman, PhD Kelly Symons David Szmak, PsyD Avanente Tamagnini, PhD Lynn Taska, PhD Anthony Tasso, PhD Augustus Taylor, PhD Andrew Thomas, PsyD Tamsen Thorpe, PhD Patricia Tistan, PhD Barbara Tocco, EdD Jacqueline Tropp, PhD Carol Turner, EdD Meryl Udell, PsyD Peggy Van Raalte, PsyD Margaret Van Sciver, PhD Richard Waldron, PhD Jonathan Wall, PsyD William Walsh, PhD Melissa Warman, PhD Ronald Wasser, PhD Jennifer Weberman, PsyD Elaine Weinman, PhD Ida Welsh, PhD Carol Wenzel-Rideout, PsyD Mary Elizabeth Westhead, PsyD Miriam Sherr Wolosh, PhD Guy Woodruff, PhD Melissa Woronoff, PsyD James Wulach, JD, PhD Richard Zakreski, PhD Michael Zito, PhD Alan Zwerdling, PhD

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Thank 2020Sustaining Sustaining Members!

Thankyou you 2020 Members!

By advancing your level of membership to Sustaining Membership status,

By advancing your level of membership to Sustaining Membership status, youof have generously demonstrated your additional you have generously demonstrated your additional support your professional association.

We thank youWe for your commitment and dedication to your organization! support of your professional association. 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 Kyle Barr, IV, PsyD Thomas Barrett, PhD Louis Barretti, PhD Theodore Batlas, PsyD Amy Becker-Mattes, PhD Leslie Becker Phelps, PhD Elaine Belz, PhD Roderick Bennett, PhD Todd Bennett, PsyD Rhea Bensman, PsyD Helen Berman, PhD Nancy Bloom, PsyD Monica Blum, PhD Alice Bontempo, PsyD Randy Bressler, PsyD Richard Brewster, PsyD Natalie Brown, PhD Linda Busch, PhD Diane Cabush, PsyD Dina Cagliostro, PhD Rosemarie Ciccarello, PhD Sidney Cohen, PhD Deniz Colak, PhD Anthony Comerford, PhD Louise Conley, PhD John Corbisiero, PhD Joseph Coyne, PhD Stephanie Coyne, PhD Daniel DaSilva, PhD Richard Dauber, PhD Bernice Davis, PsyD Joseph DeMeyer, PhD Phyllis DiAmbrosio, PhD John Diepold, Jr, PhD Charles Dodgen, PhD Rosalind Dorlen, PsyD Edward Dougherty, EdD Frank Dyer, PhD Linda Earley, PsyD Nick Economou, EdD Peter Economou, PhD Daniel Edelman, PsyD Lynn Egan, PsyD Susan Esquilin, PhD Sean Evers, PhD Roberta Fallig, PhD Stephen Feldman, PhD Janie Feldman, PsyD

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Dennis Finger, EdD Christine Fingeroth, PsyD Yesenia Flores, PsyD Resa Fogel, PhD Pamela Foley, PhD Kenneth Freundlich, PhD Antonia Fried, PsyD Thomas Frio, PhD Abisola Gallagher, EdD Jacqueline Gallios, PsyD Kenneth Gates, PsyD Nouriman Ghahary, PhD Kevin Giangrasso, PsyD Leslie Gilbert, PhD Rachel Ginfold, PhD Marc Gironda, PsyD Ronald Gironda, PhD Linda Glazer, PsyD Elizabeth Goldberg, PhD Gary Goldberg, PhD Ruth Goldston, PhD David Gomberg, PhD Lois Goorwitz, PhD Ora Gourarie, PsyD Susan Grossbard, PsyD Hadassah Gurfein, PhD Mathias Hagovsky, PhD Cynthia Haines, PsyD Osna Haller, PhD Raymond Hanbury, PhD Jeffrey Harrison, PhD Steven Hartman, PhD John Hennessy, PhD Susan Herman, PhD Susan Herschman, PsyD Lauraine Hollyer, PhD Ann Nikolai Houston, PhD Christine Hudson, PhD Jeri Isaacson, PhD Lisa Jacobs, PhD Alison Johnson, PsyD Kyung Jung, PhD Nancy Just, PhD Jeffrey Kahn, PhD Paula Kaplan-Reiss, PhD Robert Karlin, PhD Thomas Kavanagh, PsyD Richard Kessler, PhD Charles Katz, PhD Toby Kaufman, PhD Stanley Keyles, PsyD Joel Kleinman, PhD Eileen Kohutis, PhD Steven Korner, PhD

Deirdre Kramer, PhD David Krauss, PhD Phyllis Lakin, PhD Robin Lang, PsyD Paul Lehrer, PhD Roman Lemega, PhD Ilana Lev-El, PsyD Robert Levine, PhD Neal Litinger, PhD John LoConte, PhD Rebecca Loomis, PhD Wendy Loonin, PhD Alfredo Lowe, PhD Mark Lowenthal, PsyD Konstantin Lukin, PhD Marc Lyall, PsyD Marilyn Lyga, PhD David MacIsaac, PhD William MacLaney, PsyD Daniel Mahoney, EdD Stanley Mandel, EdD Melissa Rivera Marano, PsyD Bonnie Markham, PhD, PsyD Donald Marks, PsyD Neil Massoth, PhD Shirley Matthews, PhD John McInerney, PhD David Mednick, PsyD Wilda Mesias, PhD Jacqueline Mesnik, PhD Marshall Mintz, PsyD Barry Mitchell, PsyD Noreen Mohle, PhD Ruth Mollod, PhD Sharon Ryan Montgomery, PsyD Gregory Moore, PsyD Caridad Moreno, PhD Sandra Morrow, PhD Daniel Moss, PhD Richard Mucowski, PhD, EdD Morgan Murray, PhD Susan Neigher, PhD Jeffrey Newenhouse, PsyD Daniel Noll, PhD Cheryl Notari, PhD Carly Orenstein, PsyD Craig Pearl, PsyD Francesca Peckman, PsyD Nicole J. Rafanello, PhD Jonathan Rapaport, PhD Howard Rappaport, PsyD Gina Rayfield, PhD Lori Rayner-Grossi, EdD Ann Reese, PhD, PsyD

Ellen Reicher, PhD AnnaMarie Resnikoff, PhD Deborah Riviere, EdD Marion Rollings, PhD Amelia Romanowsky, PsyD Barbara Rosenberg, PhD Francine Rosenberg, PsyD Lori Aks Rosenberg, PsyD Elissa Rozov, PhD Anne Rybowski, PhD Nicole Safonte-Strumolo, PhD Joseph Salerno, PsyD Carole Salvador, PsyD Jayne Schachter, PhD Peter Schild, EdD Jay Schmulowitz, PhD Margot Schwartz, PsyD Nancie Senet, PhD Eileen Senior, PsyD Laura Shack-Finger, EdD William Shinefield, PsyD Nancy Sidhu, PhD Frank Sileo, PhD Ronald Silikovitz, PhD Jane Simon, PhD Jeffrey Singer, PhD Tamara Sofair-Fisch, PhD Robert Staffin, PsyD Mary Ellen Stanisci, PhD Jakob Steinberg, PhD Deana Stevens, PsyD Julie Stewart, PsyD Vincent Stranges, PhD Ben Susswein, PhD Lucy Sant’Anna Takagi, PsyD Anthony Tasso, PhD H. Augustus Taylor, PhD Tamsen Thorpe, PhD Barbara Tocco, EdD Jonathan Wall, PsyD Virginia Waters, PsyD Arnold Washton, PhD Beth Watchman, PhD Virginia Waters, PhD Daniel Watter, EdD Allen Weg, EdD Ida Welsh, PhD Aaron Welt, PhD Norbert Wetzel, ThD James Wulach, PhD, JD Joshua Zavin, PhD Stanley Zebrowski, PhD Michael Zito, PhD

New Jersey Psychologist

NJ PSYCHOLOGICAL ASSOCIATION OF GRADUATE STUDENTS (NJPAGS)

NJPAGS: Where Tomorrow’s Leaders Can Be Heard Today

Chelsea Torres, M.A., LPC

M

y name is Chelsea Torres and I am honored to serve as NJPAGS chair for the year 2020. I am currently enrolled in the PsyD program in Counseling Psychology at Felician University and I work part-time as a licensed professional counselor. My clinical experience consists of working with diverse populations in community mental health, private practice, college campus, hospitals, and residential settings.

I first became involved with NJPAGS as secretary/treasurer in 2018. Since 2018, I have been fortunate enough to serve as NJPAGS chair-elect for 2019 and now as NJPAGS chair for 2020.

Throughout my past two years with NJPAGS, I have met so many diverse and inspiring students and professionals.

My involvement with NJPAGS has been both rewarding and enriching. I have learned so much and am eager to share

what I have learned and provide similar experiences to other future students and members of NJPAGS. It is my hope this year, as NJPAGS chair, to work closely with NJPAGS board members to increase membership, as well as member engagement, advocate for the diverse needs of students, and focus on leadership development.

Some of these efforts will take shape in the form of providing students with multiple research/dissertation grant opportunities, as well as providing a mentorship program for students to assist one another throughout various stages of their academic or professional career. It is also our hope to work closely with NJPA to improve communication amongst new and existing members by increasing our social media presence and even launch a podcast. We also plan to work closely with early career psychologists (ECPs), just as we have in previous years, to offer a variety of didactics and workshops throughout the year.

What I have come to love and appreciate the most about NJPAGS is that it takes no time at all for strangers to become family. As students in the field of psychology, although diverse, we share a common passion for the field

and are forever bound by the struggle(s) to maintain a work/school/life balance, practice self-care, and excel academically.

Throughout this past year, Past-Chair, Christopher Thompson, MA, EdS, took great initiative in providing students with multiple NJPAGS social events. These outings brought members together in a variety of ways. With his continued help, I hope to continue such efforts as it has helped to build and strengthen rapport amongst NJPAGS members, as well as provide an outlet for self-care.

As students we are only just beginning to embark on the path to becoming professionals in the field of psychology.

Therefore, it is important that students not only increase their presence, but also ensure that we have a platform in which our voices can be heard. If we are, in fact, the future leaders of the field, it is imperative that we work collaboratively with current leaders in the field. I believe NJPAGS provides students with this unique opportunity. For this reason, amongst others, I am most passionate about my current role as NJPAGS chair. ❖ Visit the NJPAGS page <www.psychologynj.org> under the Members tab.

Foundation Awards & Grants Thanks to the generosity and support of our donors, the NJPA Foundation is able to continue providing grants that support the training of graduate students who focus on the underserved residents in New Jersey. Without financial assistance, the Foundation would be unable to continue to fulfill its mission, “promoting the psychological health of the diverse people of New Jersey.”

Here’s what your generous support enables us to do: Student Conference Participation Grants: This grant promotes supplemental training and education experiences in professional practice and research, with an emphasis on treating underserved populations. Attending conferences, workshops, seminars, and other scientific sessions are an essential part of the learning experience for psychology graduate students.

Dissertation Grants: Dissertation Grants: The NJPA Foundation Dissertation Grants are open to doctoral level graduate psychology students, enrolled in a New Jersey doctoral level psychology program. To be a candidate for this grant, a qualified graduate student must have one of the following two areas of study/exploration as the focus of her/his doctoral dissertation: NEW! (open topic) Social Advocacy, (earmarked topics) Impact of School Violence, or Institutional Separating Children from Families.

Community Service Project Grants: The NJPA Foundation identifies exemplary training programs that provide psychological services to those who cannot afford it and supports doctoral students who work with these underserved populations.

Graduate Student-Initiated Research Awards: Provide funding for student-initiated research and projects addressing psychological issues that have significant impact on community health: The John M. Lagos Award for Research Into Causes and/ or Treatment of Social Problems; The NJPA Foundation Scholarship for Research on Diversity Issues; The Dr. Zellig Bach Award for the Study of the Family; The Winifred Starbuck Scott Award.

Visit www.psychologynj.org/njpa-foundation for more information.

Winter 2020

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SPECIAL SECTION

Introduction

Eric Herschman, PsyD

T

he aim of this special section is to explore a variety of psychological issues faced by transgender individuals and communities, through the work

of several professionals representing fields of study ranging from psychology to law.

We believe it is paramount for professional psychologists to have knowledge surrounding the unique set of issues faced by the transgender community, and relevant pre/ post-doctoral training and continuing education are, unfortunately, rare. This section features articles from the following authors: Carmon Lalonde, PsyD who contributed the article titled, Toward Gender Affirming Care for the Trans and Gender Diverse

Community; Peter Economou, PhD who contributed, Transgender Health Care: Integrating CBT with a Transgender Client; and Jodi Argentino, Esq. and Celeste Fiore, Esq. who co-authored, The Convergence of the Legal Rights With Educational and Psychological Well-Being of Transgender Students in New Jersey. We would like to extend additional thanks to Celeste Fiore for their review of the entire section for accuracy and culturally appropriate language.

Instructions for obtaining CE credit: Visit <www.psychologynj.org> and find the CE Homestudy Library link under the Learn Tab. This will take you to the online library where you will find the article and evaluation.

Toward Gender Affirming Care for the Trans and Gender Diverse Community (3 CE Credits) of the basics of gender-affirming care; c) learn of recent gender affirming resources for treating adults and children.

Carmen Lalonde, PsyD Ferkauf Graduate School of Psychology Abstract “Fewer than 30% of psychologists report familiarity with transgender and gender diverse (TGD) clients’ needs. The clients, in turn, report a lack of support in their gender journeys, illustrating a significant gap in knowledge, skill, and competence in this area of practice (Singh & dickey, 2017).” The 2015 US Transgender Survey (USTS) (N = 27,715) reported that almost half of the respondents had attempted suicide during their lifetime.

Given this startling data, clinicians need to make every effort to increase their ability to deliver gender affirming care. Sadly, gender affirming care is not included in many clinicians’ training. This article addresses the disparities that exist between the current state of knowledge about transgender individuals and current clinical practice.

The goal of the article is to contribute to improving clinical practice. After reading this article, clinicians will a) be provided with suggestions for addressing personal biases related to gender; b) become aware 12

Toward Gender Affirming Care for the Trans and Gender Diverse Community Few aspects of human development have undergone such radical exploration and change in the early 21st century as gender. In the last two decades, the visibility of Transgender and Gender Diverse (TGD) people has increased exponentially (Edwards-Leeper & Spack, 2012). More and more are seeking care with confidence and strength in asserting their authentic identities. “Transgender and Gender Diverse people” (TGD) is an umbrella term that describes individuals whose gender identity does not align with their sex assigned at birth. TGD includes both transgender individuals such as trans women and trans men who align with the gender binary, as well as individuals who do not align or conform to the binary. These include individuals who identify as agender, non-binary, genderqueer, and gender fluid (Chang, Singh, & dickey, 2019; Puckett, Cleary, Rossman, Mustanski, & Newcomb, 2018). This list is not exhaustive and is continuously evolving. For this article, TGD will be used to denote the vast array of individuals who identify with

diverse gender identities.

Knowing which TGD resources are affirming, as well as understanding the core elements of providing gender affirming care are essential to developing humility and skill in providing affirmative care for TGD clients. In the following section of this special edition, the author (she/her/hers) will provide a brief introduction to the core elements of gender affirming care as understood through the lens of a White privileged cisgender gay woman. The author draws on current research in the field, her own research, and her clinical work with TGD adults and youth.

Gatekeeping A core element of gender affirming care is understanding, a) the history of gatekeeping that has occurred in the mental health field, and b) the current political climate. Both of these contexts affect access to care, physical safety, and the mental health of TGD clients (American Psychological Association, 2015; Chang et al., 2019; Erickson-Schroth, 2014).

Before the 2016 election, a great deal of progress in transgender rights had been achieved. The Obama administration expanded the interpretation of Title IX to include transgender discrimination, and transgender youth saw progress in being New Jersey Psychologist

able to use bathrooms and locker rooms that aligned with their gender identity, rather than their assigned sex at birth (The National Center for Transgender Equality, 2018). Moreover, transgender affirming services, and the clinical modality of gender affirming care started to gain traction.

The American Psychological Association (APA) published comprehensive guidelines for working with Transgender and Gender Non-Conforming people (TGNC). Moreover, the Diagnostic and Statistical Manuel, Fifth Edition (2013) revised the diagnosis of Gender Identity Disorder to Gender Dysphoria. This event signified a shift from pathologizing and medicalizing non-binary identities (Lev, 2013). Researchers began to explore the subjective experiences of people with diverse identities by focusing on lived experiences, quality of life, and resilience (Bockting et al., 2016; dickey, 2017).

Following the 2016 election, however, the TGD community has experienced severe backlash from the Trump-Pence Administration. This backlash includes: limiting gender diverse people from serving in the military, as well as proposing an outdated redefinition of “sex” with the Affordable Care Act that would allow providers to discriminate against the TGD community (Burns, 2019). Despite these devastating blows, advocates of the transgender population have continued to demand that clinicians and medical providers develop affirmative gender practices.

Cultural Humility In addition to learning about gender affirming terminology and clinical practices, clinicians aspiring to work with the TGD community must develop cultural humility (Tervalon & Murray-García, 1998). This concept has become the center piece of multicultural education in general, but is particularly essential when working with diverse identities. Cultural humility is a commitment to lifelong examination and reflection of one’s power and privilege. Providers must reflect on how power inevitably enters caregiving relationships with marginalized clients.

Cultural humility requires that clinicians and medical providers become more familiar with the content of diverse cultures. Cultural humility requires a commitment to become a lifelong learner with, not of, members of marginalized communities (Tervalon & Murray-García, 1998).

Another critical element to developing a Winter 2020

gender affirming stance is a commitment to relearning and revising one’s own beliefs about gender development (American Psychological Association, 2015). Research now demonstrates that for many people, gender can be fluid and non-binary (Bockting et al., 2016; Chang et al., 2019; Keo-Meier & Ehrensaft, 2018).

This realization is freeing for members of many groups who have expressed identities outside of the gender binary. In contrast, this can be anxiety producing for people who adhere firmly to the gender binary.

Understanding the history of diverse gender identities in different cultures and during different historical time periods can help clinicians begin to see that gender diversity has existed since human beings have existed (Herdt, 1996). Some examples include the Two-spirit people of North America, the Hijra of South East Asia, the Mahu people of what is now known as Hawai’i, and the Kathoey people of Thailand. These groups are but the tip of the iceberg illustrating the diversity of genders historically and cross cultures (Erickson-Schroth, 2014).

Becoming aware of these groups can help professionals begin to revise their views of gender.

beliefs about gender before working with TGD clients. Without this process of selfreflection, mental health providers run the risk of imposing their belief systems on their clients (American Psychological Association, 2015).

It is the ability to relearn and challenge our own gender socialization that truly begins the development of cultural humility and the ability to provide gender affirming care. In order to do this, clinicians must first address their conscious and unconscious biases about gender by asking reflective questions such as; “Do I believe gender can be fluid?,” “Do I believe that gender identities can evolve and change over time?,” “What was my gender socialization like?,” “What was my gender socialization like, and what is my gender identity?,” and “If I were to treat and work with TGD people, what personal challenges would I face?”

These questions can help clinicians begin to unpack, interrogate, and relearn their biases and is a core element of becoming a gender affirming clinician. Having made a commitment to self-reflection and relearning, one is now more ready to receive information about gender affirming resources and best practices in clinical care.

Examining One’s Own Beliefs about Gender In addition to learning about the diversity of genders that have existed throughout history, the process of becoming a gender affirming clinician requires that one interrogate one’s own gender socialization and beliefs about gender (American Psychological Association, 2015; Chang et al., 2019). As listed in the APA guidelines and discussed extensively in A Clinician’s Guide to Gender Affirming Care, clinicians need to reflect on their belief system about gender. Clinicians must explore their understanding of gender development, as well as examine any anxiety that they might feel when their unconscious biases about gender are challenged (American Psychological Association, 2015; Chang et al., 2019).

Clinicians who are operating from outdated and harmful belief systems rooted in the binary too often believe that they are competent in providing gender affirming care (Chang et al., 2019). According to the APA guidelines for working with TGD clients, mental health providers first and foremost need to reflect on and evaluate their own gender identity and

Gender Affirming Resources The updated Standards of Care (Coleman et al., 2012) and the National Trans Health Survey (James et al. 2016) provide a solid foundation from which clinicians and medical providers can access accurate information. These resources have made it possible for all practitioners to achieve at least a minimal level of gender affirmative care. However, it is sometimes difficult for providers to know which additional resources are actually affirming and up-to-date. Being able to select the best resources is essential to providing care that is affirming and culturally informed. The following list of resources is by no means exhaustive. However, they provide a strong base for accessing accurate and affirming information.

A Clinician’s Guide to Gender Affirming Care (2018) (Chang et al., 2019) is the first manual of its type to outline a solid foundation for providing comprehensive Gender Affirming Care. In 2017, Singh and dickey published the Affirmative Counseling and Psychological Practice With Transgender and Gender Nonconforming Clients, (Singh & dickey, 2017) one of the first clinical books to outline different forms of clinical 13

modalities with TGD people. In 2014, Trans Bodies Trans Selves was also one of the first comprehensive and accessible resources appropriate for both providers, TGD clients, and parents of GDE youth (Erickson-Schroth, 2014).

Keo-Meier and Ehrensaft (2018) published one of the first affirming models of gender development and included suggestions for working with Gender Expansive Children (GED). This text is pivotal for providers in that it outlines an evidence-based model of gender development and reinforces the fact that diverse gender identities are variations of human expression. The Gender Affirming Model (GAM) outlines a solid basis for revising and challenging one’s beliefs about gender development. Keo-Meier & Ehrensaft (2018) assert that no gender identity or expression is pathological, but is instead a variation of human expression. The authors discuss how gender presentations vary across cultures and are informed by socialization and cultural diversity (see also Herdt, 1996). The authors further report that gender is fluid and not binary, i.e., that it can change over time. They emphasize resilience, coping, and wellness, and the human right to express one’s gender identity (Ehrensaft, Giammattei, Storck, Tishelman, & KeoMeier, 2018; Ehrensaft, Keo-Meier, & Yuen, 2019; Keo-Meier & Ehrensaft, 2018).

GenderSpectrum, <http://www. genderspectrum.org> is an open source online agency whose mission is to create a gender affirming world for children, youth, and families. It offers a plethora of guidelines, resources, and information created by experts in the field that is accessible to both parent and providers. GenderSpectrum is the first organization to publish a complete guide for schools, Schools in Transition (2015).

Even more recently, on April 19, 2019, GenderSpectrum published the first ever comprehensive principles for genderinclusive puberty and health education (PHE) that was part of a national call to action for creating inclusive sex education for LGBTQI students. This publication was endorsed by leading national PHE organizations, such as Planned Parenthood and the Sexuality Information and Education Council of the United States.

In addition to texts, affirming terminology is also an important resource (Chang et al., 2019). Language is a form 14

of power, creates visibility, and allows for marginalized communities to create a history and identity for themselves. Many clinicians and trainees’ express anxiety about terminology, reporting that they are worried they will use the wrong terms and offend their TGD clients. TGD clients are very aware of the evolving nature of terminology within their community, and respect clinicians who ask for information in a respectful manner. For example, “What are your pronouns?” and “How do you describe your gender identity?” Ask clients how they identify themselves. If the term is new, honor it, and ask respectful and empathic questions about it. If the terminology is unclear, ask them to explain.

One way to reduce the anxiety of not always knowing the correct terminology is to ensure that time is dedicated to learning about current terminology.

Educating oneself on current terminology and reading updated information from resources, such as those listed in the previous paragraphs, are important tasks of the responsible clinician. Seeking consultation from more experienced colleagues, when possible, is also a good strategy. However, it is crucial to be able to differentiate between gaining an understanding that informs treatment and simple curiosity that is unnecessary and unrelated to treatment. A helpful way to know if asking the question is necessary, is to ask oneself whether you would ask a cisgender client the same question. Further, clinicians should not place the burden of educating themselves on the client (American Psychological Association, 2015; Chang et al., 2019).

Defining Gender Affirming Care In addition to the recent development of a more comprehensive base of resources, clinicians need appropriate training and supervision for working with TGD clients.

Research on mental health disparities and TGD clients consistently state a) inadequate training, b) discrimination against clients, and c) outdated practices too often keep TGD people from accessing affirming care (Feldman et al., 2016; Puckett et al., 2018). Given the recent increase in discriminatory governmental laws introduced by the Trump administration, TGD populations require affirming care more than ever.

Gender affirming care is a relatively new term that extends beyond gender

affirming surgery. Gender affirming care includes, but is not limited to, a) social gender affirmation that focuses on terminology, b) affirming pronouns, chosen names, and c) support for social transitions. It includes psychological gender affirmation that supports the ability to a) explore one’s internal sense of gender, b) encourage resilience work against transphobia and internalized stigma, and c) urge clinicians to develop affirming mental health counseling skills.

Medical and affirming-transition care includes supporting clients in accessing gender affirming surgery, hormones, and medical interventions. Legal gender affirmation relates to understanding the legalities and gatekeeping of name changes and gender markers. Finally, clinicians need to commit to advocacy and increasing visibility and the rights of TGD people (American Psychological Association, 2015; Chang et al., 2019; Reisner, Radix, & Deutsch, 2016).

However, the majority of mental health clinicians are unfamiliar with even the basic needs of TGD people. Moreover, there is often a rigid and inadequate understanding of gender affirming care that over-focuses on genitals, leaving TGD people at risk of experiencing microaggressions. This lack of expertise can contribute to discrimination towards non-binary individuals, who are not seeking medical transition care, and might generate stress in TGD individuals seeking standard medical care. These experiences frequently leave TGD people feeling uncomfortable in accessing medical and mental health care (Feldman et al., 2016; Puckett et al., 2018).

Conclusion: Tasks Toward Becoming a More Gender Affirming Clinician 1. Become aware of the history of gatekeeping and discrimination that the TGD community has faced in the past, and continues to face in some contexts in the present.

2. Strive toward cultural humility: self reflection and a commitment to relearning personal assumptions about gender if necessary.

3. Become familiar with current resources, terminology and standards of care for both adults and children.

4. Make a commitment to ongoing supervision and/or consultation with experts in the TGD community.

New Jersey Psychologist

5. Consider becoming an advocate for the TGD community.

It is now up to us, the clinicians and providers to take up the mantle of gender affirming care alongside the TGD community who have dared to defy the gender binary and claim an identity that is their own. ❖ References American Psychological Association.

(2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. <https:// doi.org/10.1037/a0039906> Bockting, B., Coleman, B., Deutsch, B., Guillamon, B., Meyer, B., Meyer, B., …

Ettner, B. (2016). Adult development and quality of life of transgender and gender nonconforming people.

Current Opinion in Endocrinology & Diabetes and Obesity, 23(2), 188–197. <https://doi.org/10.1097/ MED.0000000000000232> Burns, K. (2019, May 29). Perspective: This is the cruelest thing the Trump administration has done to trans people yet. Washington Post. Retrieved from https:// <www.washingtonpost.com/ outlook/2019/05/29/this-is-cruelestthing-trump- administration-has-donetrans-people-yet/> Chang, S. C., Singh, A. A., & dickey, lore m. (2019). A clinician’s guide to genderaffirming care: Working with transgender and gender-nonconforming clients.

Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., … Zucker, K. (2012).

Standards of Care for the Health of Transsexual, Transgender, and GenderNonconforming People, Version 7.

International Journal of Transgenderism, 13(4), 165–232. <https://doi.org/10.10 80/15532739.2011.700873> Dickey, Lore m. (2017). Toward Developing Clinical Competence: Improving Health Care of Gender Diverse People. American Journal of Public Health, 107(2), 222– 223. <https:// doi.org/10.2105/ AJPH.2016.303581> Dickey, Lore m., & Singh, A. A. (2016).

Training tomorrow’s affirmative psychologists: Serving transgender and gender nonconforming people. Psychology of Sexual Orientation and Gender Winter 2020

Diversity, 3(2), 137–139. <https://doi. org/10.1037/sgd0000175> Edwards-Leeper, L., & Spack, NormanP. (2012). Psychological Evaluation and Medical Treatment of Transgender Youth in an Interdisciplinary “Gender Management Service” (GeMS) in a Major Pediatric Center. Journal of Homosexuality, 59(3), 321–336. <https://doi.org/10.1080/00918369.20 12.653302> Ehrensaft, D., Giammattei, S. V., Storck, K., Tishelman, A. C., & Keo-Meier, C. (2018). Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens. International Journal of Transgenderism, 19(2), 251–268. <https://doi.org/10.1080/15532739.20 17.1414649> Ehrensaft, D., Keo-Meier, C. L., & Yuen, J. (2019). Transition Considerations for Transgender Patients. In S. K. Lyons & M. E. Hilliard (Eds.), Transitioning from Pediatric to Adult Care in Endocrinology: A Clinical Handbook (pp. 195–219). <https://doi.org/ 10.1007/978-3-03005045-0_10> Erickson-Schroth, L. (Ed.). (2014). Trans bodies, trans selves: A resource for the transgender community. Oxford ; New York: Oxford University Press, USA. Feldman, J., Brown, G. R., Deutsch, M. B., Hembree, W., Meyer, W., MeyerBahlburg, H. F. L., … Safer, J. D. (2016). Priorities for transgender medical and healthcare research: Current Opinion in Endocrinology & Diabetes and Obesity, 23(2), 180–187. <https://doi.org/ 10.1097/ MED.0000000000000231> Herdt, G. H. (Ed.). (1996). Third sex, third gender: Beyond sexual dimorphism in culture and history (1st pbk. ed). New York : Cambridge, Mass: Zone Books ; Distributed by MIT Press.

James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

Keo-Meier, C., & Ehrensaft, D. (Eds.).

(2018). The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children. Retrieved from <http://content. apa.org/books/16065-000>

Lev, A. (2013). Gender Dysphoria: Two Steps Forward, One Step Back. Clinical Social Work Journal, 41. <https://doi. org/10.1007/s10615-013-0447-0> Puckett, J. A., Cleary, P., Rossman, K., Mustanski, B., & Newcomb, M. E. (2018). Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals. Sexuality Research and Social Policy, 15(1), 48–59. <https://doi.org/10.1007/ s13178-0170295-8> Reisner, S. L., Radix, A., & Deutsch, M. B. (2016). Integrated and GenderAffirming Transgender Clinical Care and Research: JAIDS Journal of Acquired Immune Deficiency Syndromes, 72, S235–S242. <https://doi.org/10.1097/ QAI.0000000000001088> Singh, A. A., & Dickey, L. M. (Eds.).

(2017). Affirmative counseling and psychological practice with transgender and gender nonconforming clients (First edition). Washington, DC: American Psychological Association.

Tervalon, M., & Murray-García, J. (1998).

Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.

Journal of Health Care for the Poor and Underserved, 9(2), 117–125. <https:// doi.org/ 10.1353/hpu.2010.0233> The National Center for Trans Equality.

(2018, May 16). Celebrating the Obama Administration. Retrieved July 25, 2019, from Medium website: <https://medium.com/transequality now/celebrating-the-obamaadministration-86ea2fbf1e65>

In Memoriam Barry Kardos, PhD NJPA member 6 years 15

Transgender Health Care: Integrating CBT working with a Transgender Client

Peter Economou, PhD Transgender History As the 50th anniversary of the riots at Stonewall in New York was celebrated in 2019, it is fair to say that, while society has made strides in lesbian, gay, bisexual, transgender, queer (LGBTQ) rights, challenges still remain. This paper will present a brief history of the transgender literature in psychology, address issues in the health care of transgender individuals, and illustrate the integration of LGBTQ-sensitive treatment along with evidence-based practices.

First, we will take a quick look at the transformation of transgender research.

A review of the transgender literature found that American psychology journals began writing about “transsexualism” in 1954 when physician, Harry Benjamin, published Transsexualism and Transvestism as Psychosomatic and Somatopsychic Syndromes in the American Journal of Psychotherapy, 25 years after the term transvestism was first introduced1. Early conclusions about transgender individuals2 were not entirely based on fact and were speculative. For example, although he is seen as the father of transgender research, Benjamin (1954) made significant assumptions in his early writings including: 1. “most transvestites would be horrified at the idea of being operated” (p. 22), 2. “homosexual inclinations always exist in the transsexualist…” (p. 221), and 3. Hypothesized that “psychological conditioning, infantile trauma, childhood fixations, or an arrested emotional development” yielded a transgender identity (p. 222). He did, however, reference that therapy could not cure transsexualism highlighting that these individuals “require psychiatric help, reinforced by hormone treatment and, in some cases, by surgery” (Benjamin, 1954, p. 230). He concluded that there were many causes of transsexualism, acknowledged the intersection between environment, biology, and 16

psychological conditioning, and stated there were no cures, although he claimed efficacy with hormone treatment (Benjamin, 1954).

In the middle of the 20th century, American psychology researchers were attempting to understand the LGBTQ experience, and there was an apparent struggle between pathologizing and normalizing behaviors labeled as LGBTQ (Benjamin, 1953; Freud & Brill, 1910; Thompson, 1947). Thompson (1947) wrote about the sociocultural pressures of being LGBTQ and acknowledged the fluidity of gender and sexuality as we know it today, just as Kinsey was just about to highlight. Kinsey and his colleagues were nuanced and provocative when they described sexuality on a spectrum in the 1940s, introducing a new paradigm to society. Kinsey, Pomeryoy, and Martin (1948) concluded that more than one-third of males had a male-male sexual encounter between adolescence and old age. They also described independence between sexuality and gender identity that was mostly unclear in the early psychology research (Kinsey, Pomeroy, Martin & Gebhard, 1953). There was a tug-of-war between the pathologizing and normalizing of LGBTQ identities, but ultimately researchers were attempting to understand the LGBTQ identities, just as we still are currently researching.

Still today, the LGBTQ community is often misunderstood and perhaps understudied. In 2017, Wanta and Unger conducted a meta-analysis and found that it took several decades for psychologists to research and publish on transgender health whereby the most significant contributions occurred into the 21st century, some 40 years since Benjamin. Their findings showed that mental health publications related to the transgender community accounted for 11% of all LGBTQ-related publications and this included a review of more than 2400 peer-reviewed articles (Wanta & Unger, 2017). They also noted that there was an apparent shift from identifying transgender individuals as having a mental health disorder to a variation of normal. These accounts from 1900 to 2017 illustrate the shift that occurred within the LGBTQ literature, and it was not until early in the 21st century

where the scientific method shift occurred, and the emphasis was placed on evidencebased practices within health care systems.

Health care and the LGBTQ experience Nearly half of transgender individuals surveyed in 2015 reported their health care providers lacked provider knowledge (James, Herman, Rankin, et al., 2016), and a recent study found nearly 80% of first year medical students expressed implicit bias towards LGBTQ patients and 50% of those medical students endorsed explicit bias towards LGBTQ people (Sabin, Riskind, & Nosek, 2015). Discrimination in the health care context is pervasive for transgender people. In 2015, 33% of respondents to the US Transgender Survey, who had seen a health care provider in the past year, reported at least one negative experience with a health care provider related to their transgender status; 25% reported having issues with insurance coverage because they were transgender. Lack of access to highquality and non-discriminatory care or insurance coverage is a particular concern for this population because transgender people also disproportionately experience negative health outcomes. In the same study, 40% of respondents reported a lifetime suicide attempt, 29% reported illicit drug use in the past month, and 1.4% were living with HIV (as compared to 0.3% of the general US population).

These statistics highlight the need for services for the transgender community, and services that are culturally sensitive.

In 2018, the first text book related to the overall health care needs of transgender individuals was published by psychiatrist, Eric Yarbrough (See Yarbrough, 2018), providing the first comprehensive look at the unique health care needs of the transgender community. Psychologists must be mindful of interventions that support this community in an effort to engage transgender clients and improve their overall well-being.

Integration of CBT and LGBTQSensitive Therapies A meta-analysis that compared the efficacy of Cognitive and Behavioral Therapy (CBT) for multiple disorders with other New Jersey Psychologist

forms of psychotherapy that reviewed 26 studies and 1,981 clients, found that CBT outperformed other psychotherapies in the treatment of multiple disorders (Tolin, 2010). Tolin (2010) suggested that the results of this meta-analysis indicate that CBT should be considered as a first-line choice of treatment, particularly with respect to anxiety disorders, along with other disorders, indicating that CBT should be implemented for the treatment of diagnoses including symptoms of anxiety.

The challenge for psychologists is understanding how issues of diversity interact with manualized and evidencebased practices, such as protocols within CBT. I will highlight this through the presentation of a brief case study3.

The case of Kay. Kay is a 20-somethingyear-old assigned female at birth, who knew that the breasts and vagina were not aligned with gender identity from early childhood.

Both parents noted that Kay would request stereotypical toys for males, was labeled as a tomboy, and asked questions pertaining to why he had breasts and a vagina beginning at least age 3-4-years-old. Kay is White and Catholic, has one sister, and was raised by both parents reared in a middle- class White area. Kay described dysfunction within the family structure whereby his parents would argue often and loudly, and he would catch his father speaking with other women and commanding sexual acts over the computer or phone. Kay had a very close and loving relationship with his mother, who would bring Kay to session, and a distant relationship with his father due to the aforementioned (i.e., he would judge and resent his father for the sexual actions witnessed). His sister was stable with a fulltime job, got married during treatment, and had a child.

Presenting problems included social phobia that was preventing Kay from securing work, from socializing beyond social media, and from learning skills for daily living such as grocery shopping.

There was also agoraphobia evidenced by avoidance and intense fear of attending events outside the home, even when it was determined he would not have to interact with anyone (generalized anxiety disorder was also considered). Kay reported that his gender fluctuated between male and nonbinary. He presented with rigid thought processes and began hoarding. While the main presenting problem was the gender Winter 2020

dysphoria, these phobias and anxiety symptoms were preventing Kay from presenting his actual gender to others and society, and had to be addressed while also targeting the gender dysphoria.

Having an open discussion about pronouns and names was helpful to build rapport, as were assessments of gender identity (e.g., Utrecht Gender Dysphoria Scale and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults), basic CBT psychoeducation such as cognitive distortions, behavioral chain analysis of Kay’s avoidance, and ultimately some values work attempting to address his ambivalence for eliminating his social phobia. While progress was relatively slow, Kay eventually would go to the store with his sister, felt most comfortable going out with his mom (i.e., he would even go to the movies with her, which for a transgender client is anxiety-provoking because of the public bathroom situation), and even applied for a few jobs. Kay would walk outside as a part of exposure practice, speak with someone at the store to ask a question, and would use the bathroom in our office as practice of using the male restroom.

One year into treatment, suddenly his mother died. Kay had been doing quite well and that included decreasing to monthly sessions (for the first 10 months sessions were weekly), regular employment, socializing with some childhood friends at least bi-monthly, decreased hoarding, and he had even babysat his nephew. The sudden death of his mother shocked him, but he presented as resilient. Kay described feeling sad, but he was also determined to persevere and accomplish more. In fact, one of his hoarding behaviors was related to money that in this case might be a strength since he had reported that his father was not responsible with money citing that his father had spent a lot of the life insurance policy.

While treatment assessed gender dysphoria, and this included psychoeducation about the fluidity of gender, the behavioral interventions were essential to overcoming the phobias and his moderate to severe symptoms of anxiety. These are two very discreet principles, but they were intertwined. That is, Kay could not practice living in his gender identity since he was phobic of public spaces and feared interacting with other people. The CBT interventions desensitized him to the social phobia and the hierarchy that was developed

between him and clinician proved to make social settings tolerable. He reported decreases in anxiety symptoms when leaving the house, he was able to purge items that he was hoarding (e.g., cardboard boxes was a big one), and he used social media as a practice tool to conversation starters out in public face-to-face.

In terms of his gender identity, the commencement of hormone replacement therapy4 (HRT) almost immediately decreased the gender dysphoria and provided space for us to explore his gender identity that remained fluid between male and nonbinary. The initiation of HRT illustrates how CBT and gender identity, although discreet, were linked. When Kay had to call the endocrinologist’s office, he was nervous and avoided it for a few weeks.

So, we conceptualized that as an exposure practice, and we made the call during session after modeling and role playing the call the previous week. This allowed him to gain confidence in these social interactions and the significant decrease in gender dysphoria positively reinforced this exposure making calls to surgeons two years later much more accessible. Kay also decided to change his name from his given name to one that was more gender-neutral.

In terms of surgeries, we discussed surgical options and he completed a thorough review including consultations with a few surgeons. He was confident, and discussed with family, that top surgery5 was essential, but remained unsure about bottom surgery6. These decisions were made from my objective understanding of transgender processes, using several pro/con lists, gender dysphoria scales, a few family sessions (even 2 sessions with his sister), and with consultation with other professionals.

At the conclusion of treatment, Kay had worked to improve the relationship with his father and that included the practice of acceptance regarding the nature of their relationship and his father’s sexual behaviors, expressed healing over the loss of his mother, was a regular in the life of his nephew and sister’s growing family, was working full time and saving money, had a driver’s license and was mostly independent, and continued to explore surgery options for the transition. Termination was mutually agreed upon with the understanding that Kay would need additional support in the future as he decided surgical procedures.

This would include the formality of letters 17

of support, but also the psychological shifts that often occur as a transgender client begins the transition anatomically.

Conclusion Kay could not have been treated in my office alone. The unique treatment needs for transgender clients were enhanced by integrating my work and utilizing interdisciplinary networks such as endocrinologists, psychiatrists, social workers, and surgeons. It was imperative that these other practitioners be versed in the current transgender practices that was a challenge in and of itself and is geographically determined. As healthcare has dictated the need for evidence-based practices and psychological science has emphasized the importance of multicultural competence, it is incumbent upon psychologists to practice within these domains. This does not suggest invalidation of other psychotherapies, rather, working in teams to address symptoms associated with interventions based on empirical data.

There is still the need for enhanced treatment protocols for the transgender community, and 50 years after the Stonewall riots, this marginalized group is still in need of the advocacy efforts from various groups, such as psychologists, to ensure the healthcare practices are efficacious, culturally sensitive, and based on empirical research. ❖

References

Benjamin, H. (1954). Transexualism and Transvestism as Psychosomatic and Somatopsychic Syndromes. American Journal of Psychotherapy, 8. P. 218-230.

Freud, S. & Brill, A. (1910). Three contributions to the sexual theory. Journal of Nervous and Mental Disease.

Grant, J. M., Mottet, L. A., and Tanis, J. (Oct. 2010). National Transgender Discrimination Survey Report on Health and Health Care.

Retrieved from (Oct. 2010).

James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 US Transgender Survey.

Washington, DC: National Center for Transgender Equality.

Kinsey, A., Pomeryoy, W. & Martin, C. (1948).

Sexual behavior in the human male.

Philadelphia: W.B. Saunders Co. Kinsey, A. Pomeroy, W., Martin, C. & Gebhard (1953). Sexual behavior in the human female. W.B. Saunders, p. 680.

Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, Gay, Bisexual, and Transgender– Related Content in Undergraduate Medical Education. JAMA.2011;306(9):971-977. doi: 10.1001/jama.2011.1255.

Sabin, J.A., Riskind, R.G., & Nosek, B.A., (2015). Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. American Journal of Public Health. 105(9):1831-41. doi: 10.2105/ AJPH.2015.302631.

Thompson, C. (1947). Changing concepts of homosexuality in psychoanalysis. Journal of Psychiatry. 10, 183-189.

Tolin, D.F. (2010). Is cognitive-behavioral therapy more effective than other therapies?

A meta-analytic review. Clinical Psychology Review. 30(6):710-20. doi: 10.1016/j.cpr.

2010.05.003.

Wanta, J.W., & Unger, C.A. (2017). Review of the Transgender Literature: Where Do We Go from Here? Transgender Health. 2(1): 119–128. doi: 10.1089/trgh.2017.0004 Yarbrough, E. (2018). Transgender mental health.

Arlington, VA: American Psychiatric Association Publishing.

Footnotes

See Hirschfeld, 1925 Labeled as transvestites or transsexuals in the earliest writings 3 Note that consent was given to present this case using a pseudonym, and this section of this article was taken from another article under review for publication elsewhere. I edited it slightly and present just an abbreviated version of the comprehensive case study.

4 Referral to endocrinologist was made within 6 months of treatment, in consultation with Kay and his parents, as was to a psychiatrist who attempted 2-3 SSRIs over the next 6 months, but ultimately decided that HRT and behavioral interventions were most effective so they stopped the SSRI prescription.

5 Subcutaneous Mastectomy 6 Vaginoplasty, phalloplasty, or metoidioplasty 1 2

Convergence of Legal Rights with the Educational and Psychological Well-Being of Transgender Students in New Jersey

Jodi Argentino, Esq.

Celeste Fiore, Esq. 18

Abstract The school setting for transgender students is a critical environment to be considered for not only students’ academic development, but also their emotional and social well-being.

Instances of bullying, discrimination, and non-gender-affirming or exclusionary behaviors and policies are known to have detrimental effects on the all-around wellbeing of transgender students.

Investigating laws and policies to determine whether they are sufficiently protecting the rights of all students regardless of gender identity, and providing appropriate trainings for

professionals working with students are paramount steps in creating an environment of support and affirmation for transgender students.

Convergence of Legal Rights with the Educational and Psychological WellBeing of Transgender Students in New Jersey Educators and those working in a school setting often ask: what does the law allow me to do, or what does the law require me to do when it comes to transgender students? What issues specifically or disproportionately impact transgender students in an elementary or New Jersey Psychologist

secondary school setting? Are there areas in which a mental health professional’s ethical obligation might be at odds with a school or legal policy? Are the laws that govern students in schools developmentally appropriate, or do they negatively impact educational and psychological well-being of transgender students?

Research tells us that 60% of students who identify as transgender or queer have been bullied in school because of gender expression (Day, 2019). Moreover, this toxic environment not only has an extremely negative emotional toll on students, but has a detrimental influence on academics (Day, 2019). Overall, transgender youth have far less academically successful educa-tion experiences than cisgender peers (Day, 2019). Contrarily, when an inclusive and supportive environment exists at school with learned policies and procedures, this causes the opportunity for more stable emotional wellbeing and academic success for all students, not just LGBTQ students (Day, 2019).

Some Sexual Orientation and Gender Identity (SOGI) policies that are helpful in schools include personnel trainings on cultural competency and appropriate handling of harassing or inappropriate situations, having Gay-Straight Alliances (GSA) and/or other diverse clubs and school-sponsored groups, identification of safe spaces where, and individuals from whom youth can access support, and inclusive curriculum (Day, 2019).

Unfortunately, while many schools have supports for LGB youth, they are lacking in specific trainings and supports for transgender students that are different supports than those for LGB youth given that the trainings and supports must be regarding gender identity and expression, not just sexual orientation. Transgender students face significant additional challenges with how their schools handle discrimination and harassment associated with their gender identity and expression (Day, 2019). However, partnerships between school counselors and students (and families subject to privacy considerations), can be essential to positive experiences for transgender students (Beck, 2019).

Title IX of the Education Amendments of 1972 34 CFR 106 et seq. was created to eliminate discrimination in education based upon sex (Overview of Title IX, 2015). Title IX of the Education Amendments of 1972, 20 U.S.C. § 1861, Winter 2020

provides that “No person in the United States shall, on the basis of sex, be excluded from participation in, denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.”

The United States Department of Justice states that the “principal objective of Title IX is to avoid the use of federal money to support sex discrimination in education programs and to provide individual citizens effective protection against those practices” (Overview of Title IX, 2015).

Federal Laws create a “floor” of fundamental rights, not a “ceiling.” A state or locality can provide more rights than those provided by federal law, but the statement or locality cannot provide less protection (Miller & Wright, 2008). The type of protections offered by way of Title IX include rights such freedom from discrimination in housing, sports, and “any academic, extracurricular, research, occupational training, or other education program or activity operated by a recipient which receives Federal financial assistance” (Overview of Title IX, 2015). These protections have been used to protect LGBTQ people with the concept that “on the basis of sex” includes the sex of one’s partner, as well as one’s own gender identity and expression.1 However, because federal law is a baseline as discussed above, New Jersey can and does provide enhanced protections for LGBTQ people that will continue to protect New Jersey residents even if, at any point, the Supreme Court of the United States determines that Title IX does not protect LGBTQ people (Miller & Wright, 2008).

The New Jersey Law Against Discrimination (LAD) enhances the protections under Title IX and includes that persons in New Jersey cannot be discriminated against because of sexual orientation or gender identity or expression in places of public accommodation. New Jersey’s protections under the LAD well expand the federal floor and include protections based upon: race, creed, color, national origin, nationality, ancestry, sex, pregnancy, breastfeeding, sexual orientation, gender identity or expression, disability, familial status, marital status, domestic partnership/civil union status, liability for military service, and in some cases atypical hereditary cellular or blood trait, genetic information, and age (NJ LAD).

In an effort to help students be protected from discrimination and to help schools treat their students with respect and support, in Fall 2018, the Commissioner of New Jersey Department of Education issued the publication: Transgender Student Guidance for School Districts (Transgender Student Guidance for School Districts, n.d.). The Commissioner of Education was required to develop this guidance pursuant to statute, N.J.S.A. 18A:36-41 that was signed into law on July 21, 2017. This guidance policy is necessary because of the significant challenges faced by transgender students (2015 US Transgender Survey, 2016). Students are often denied their basic human needs such as affirmation of identity, appropriate name, and ability to use a restroom associated with their gender identity (2015 US Transgender Survey, 2016). Further, while there is a plethora of research that shows that extracurricular involvement supports students’ developmental needs, transgender students may be excluded from involvement, such as in athletics programs. Exclusion from such opportunities prevents transgender students from having the advantage of those development experiences that cisgender students may access (2015 National School Climate Survey, 2016).

New Jersey State Interscholastic Athletic Association developed a transgender athlete policy in late 2017. While brief, this is a poignant policy that ensures that transgender students are permitted to participate in the sport “gendered” to associated with their gender identity. The policy allows that a trans student may choose to participate in the sports team that conforms to their gender identity or their sex assigned at birth at their election, but cannot thereafter, participate in another team that confirms to their sex assigned at birth (New Jersey Interscholastic Athletic Association Transgender Policy, 2017).

This policy, thus, allows the transgender student, along with the cisgender student, to participate in activities valuable to their development and growth.

Coming out and/or social transitioning at school is something that exposes a transgender student to bullying, peer criticism, differential treatment by educators, and family acceptance issues, all of which contribute to the student’s mental health and emotional well-being (2015 National School Climate Survey, 2016). New Jersey has anti-bullying laws that were enacted 19

in 2011. The Anti-Bullying Bill of Rights Act provides that if a student is being targeted because of their actual or perceived gender identity or expression, it could be considered harassment, intimidation or bullying (N.J.S.A. § 18A:37-14). The Act requires every school board to develop their own policy that conforms with the requirements set forth in the Act and it must be reviewed and revised annually with the school’s designated Anti-Bullying Specialist (New and Amended Harassment, Intimidation and Bullying Laws, n.d.).

The New Jersey Department of Education released (revised as of April 2011) a model policy which is available at <http:// www. state.nj.us/education/parents/bully.htm>.

This guide provides not only a model policy, but references, books, and resources for policy development, assessment, prevention, and intervention.

Students’ “coming out,” a term of art meaning that they are revealing their transgender status, comes with an entire breadth of complications and considerations. Some students may come out at school, but not at home due to fear of unsupportive parents.

These students may fear their parents finding out, but are fully comfortable being true to themselves at school because of a supportive school and peer environment.

Other students may come out at home, but may not have socially transitioned at school and, therefore, may be suffering from dysphoric feelings while trying to progress academically. Yet other students may have socially transitioned in younger years, but are not out to their peers or educators about their transgender status, hoping to just blend in with others sharing their gender identity without revealing their sex assigned at birth or prior name, often known as a “dead name.” Federal and New Jersey laws help protect the privacy of families and students in all three of these scenarios, as well as many others.

The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student records and, as with Title IX mentioned above, applies to all schools that receive federal funding through the US Department of Education. Therefore, disclosure of a student’s birth name, fact that they are transgender, and/or any other personally identifiable or medical information cannot be made without consent. This includes disclosure by personnel to other school personnel unless the disclosure is “related to 20

a legitimate educational interest” (FERPA, 2018). Thus, a student can reveal their transgender status to a teacher, principal, nurse, guidance counselor, etc. and ask the personnel to use a chosen name and gender identity, but the student can also expect, under privacy laws, that their educators will keep their transgender identity, name, expression, etc. private from others. This does mean that the school must also keep the student’s transgender status from the student’s parents/family unless the student has consented otherwise (FERPA, 2018).

FERPA also allows for students to formally amend their school records if the records are “inaccurate, misleading, or in violation of the student’s rights of privacy.”

Thus, transgender students are able to change their original school records to reflect their name and gender marker to match their gender identity and expression.

If a student is under 18 years of age, this ability is shifted to the student’s parents/ guardian (FERPA, 2018). The argument is that if you can change your name and/or gender marker on other identity documents (such as a passport, state issued identification, or birth certificate) but not your school records, then the school records are, in fact, “false or misleading.”

Moreover, if the school record reflects the wrong gender identity, then, again, the school record is “false.” In the case of Powell v. Schriver, a 1999 case generating in New York, but heard in the 2nd Circuit District Court, the Federal Circuit Court determined that it is “beyond a doubt” that someone’s transgender status is “excruciatingly private and intimate” (Powell v. Schriver, 1999).

Despite what appears to be backwards motion in transgender rights from a national perspective, the State of New Jersey continues to move forward in efforts to protect transgender individuals, particularly students, and to ensure that transgender students receive all the benefits, developmental, and educational experiences that cisgender students receive. In 2018, the State of New Jersey’s Transgender Equality Task Force was established “to assess the legal and societal barriers to transgender equality and provide recommendations to the governor and the legislature on how to ensure equality and improve the lives of transgender people” (NJ Transgender Equality Task Force, n.d.). Further, in

early 2019, education-related laws were passed to ensure that middle and high school curriculum includes the historical contributions of disabled and LGBT persons.

It is important for transgender students to see themselves reflected in their staff, their lessons, their heroes, and to feel the support of their school and peers.

Research associated with relationalcultural identity development show that supportive environments with peers and role models that reflect students’ own identities is necessary for positive minority youth development. This is especially true for LGBTQ youth, who have a pervasive environment of heterosexism and transphobia that create the necessity to overcome negative messages even more than for cisgender students (Singh, 2019).

This can be accomplished through the implementation and follow through of the policies and programs such as GSA groups, appropriate academic and athletic policies, diverse staffing in schools, and educated staff and, particularly, experienced and trained mental health professionals in the school system and accessible and relatable to the students.

The guidance provided through the New Jersey Board of Education gives schools and educators the ability to provide these resources and supportive environments to transgender students (Transgender Guidance, 2018).

The guidance encourages open (but confidential) communication between educators and students. Students’ assertions as to gender identity should be accepted and respected without the need for parental consultation. There is no need for legal or medical supports for the student’s assertions as to name or gender marker. The guidance confirms that even if there is a disagreement with a parent as to formal academic records that they have the authority over pursuant to FERPA, the student’s assertions should be respected and used in school. The guidance also provides that staff should receive appropriate trainings and that all activities, functions, and lessons within the school must recognize and be respectful of all gender identities and expressions (Transgender Guidance, 2018).

Unfortunately, while this affirming and supportive guidance exists pursuant to New Jersey statute, not all school districts have updated their policy to conform New Jersey Psychologist

with the guidance documents. Further, even those districts that have developed appropriate policies on paper, they may not have arranged for the trainings so as to appropriately effectuate the constructs therein. This is problematic because, often without a negative intention, schools perpetuate cis-normative structure that is the assumed expectation that the gender identity and expression of all individuals is that of their sex assigned at birth (Lewis, 2019). Trusted teachers and school counselors are poised to be important protective adults in transgender students’ lives at critical stages of development when acceptance, support, and affirmation is essential (Lewis, 2019). ❖ References 2015 US Transgender Survey. (2016, December). Retrieved from http://www. ustranssurvey.org/.

2015 National School Climate Survey.

(2016). Retrieved from https://www. glsen.org/research/ 2015-national-schoolclimate-survey.

Anti-Bullying Bill of Rights Act N.J.S.A. § 18A:37-14.

Beck, M. J., & Wikoff, H. D. (2019).

LGBT Families and School Community Partnerships: A Critical Role for School Counselors. Journal of School Counseling, 17(1–23), 1–25. Retrieved from <https:// search-ebscohost-com.proxy1.ncu.edu/ login.aspx? direct=true&db=ehh&AN=13 8198250&site=eds-live> Day, J. K., Ioverno, S., & Russell, S. T. (2019). Safe and supportive schools for LGBT Youth: Adressing educational inequities through inclusive policies and practices. Journal of School Psychology. <https://doi-org.proxy1.ncu. edu/10.1016/j.jsp.2019.05.007> Development, distribution of guidelines concerning transgender students N.J.S.A. 18A:36-41 Family Educational Rights and Privacy Act (FERPA) 20 U.S.C. § 1232g; 34 CFR Part 99 et seq.). (2018, March 1). Retrieved from https://www2. ed.gov/policy/gen/guid/fpco/ferpa/index. html.

Finkelstein, B. L. (2017). The New Jersey State Legis-lature Has Provided a New Layer of Protection to Transgender Students and Individuals. On Target: Legal Corner. Retrieved from <https://www.njasa.net/site/Default. aspx?PageID=1739> Winter 2020

Finkelstein, B. L. (2018). Commissioner of Education Has Issued Transgender Student Guidance of School Districts. Legal Corner. Retrieved from https://www.njasa.net/site/ Default. aspx?Page ID=1878 James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.

Miller, Marc L., Wright, Ronald F. (2008).

Leaky Floors: State Law Below Federal Constitutional Limits. Arizona Law Review, 50(1), 227-259. Retrieved from http:// arizonalawreview.org/pdf/501/50arizlrev227.pdf Lewis, R. K., & Sembiante, S. F. (2019).

Research and Practice in Transition: Improving Support and Advocacy of Transgender Middle School Students.

Middle Grades Review, 5(1). Retrieved from https://search-ebscohost-com. proxy1.ncu.edu/login.aspx? direct=true& db=eric&AN=EJ1214825&site=eds-live New and Amended Harassment, Intimidation and Bullying Laws. (n.d.).

Retrieved from https:// www.state.nj.us/ education/parents/bully.pdf.

New Jersey Interscholastic Athletic Association Trans-gender Policy (2017). Retrieved from https:// www.njsiaa.org/sites/default/files/ document/ Transgender%20Policy%20 Approved%2011-15-17.pdf NJ Law Against Discrimination N.J.S.A. 10:5-12 NJ Transgender Equality Task Force. (n.d.). Retrieved from http://www. transequalitynj.com/.

N.J.S.A. 18A:35-4.35.

Overview of Title IX Of The Education Amendments Of 1972, 20 U.S.C. A§ 1681 Et. Seq. (2015, August 7). Retrieved from https://www.justice.gov/crt/ overview-title-ix-education- amendments1972-20-usc-1681-et-seq.

Powell v. Schriver, 175 F. 3d 107, 11 (2d Cir. 1999) Singh, A. A., & Moss, L. (2016). Using Relational-Cultural Theory in LGBTQQ Counseling: Addressing Heterosexism and Enhancing Relational Competencies.

Journal of Counseling & Development, 94(4), 398–404. https://doi-org.proxy1. ncu.edu/10.1002/ jcad.12098

State of New Jersey Department of Education. Transgender Student Guidance for School Districts. Retrieved from https:// www.njsiaa.org/sites/default/files/document/ Transgender%20Policy%20Approved%2011-15-17.pdf About the Authors: Jodi Argentino is an owner and the managing partner of Argentino Family Law & Child Advocacy, LLC, where her practice focuses on work involving LGBTQ families and children, non-nuclear family structures, families with special needs, and complex parentage situations. Jo is also qualified by the State of NJ as a Family Law Mediator, is a Parent Coordinator and Guardian ad Litem, and is currently completing her Master’s in Child and Adolescent Developmental Psychology. Jodi was the 2017-18 chair of the NJSBA LGBT Rights Section, is a member of the NJSBA Family Law Section and the Section’s Executive Committee, the Association of Family and Conciliation Courts, and is an appointed member of the NJSBA CLE Advisory Committee. Jodi was also featured on Inside NJ’s LGBT Powerlist, was a recipient of the National LGBT Bar Association’s 40 Under 40 award, and co-authored a chapter in Oxford University Press’ LGBT Divorce and Relationship Dissolution.

Celeste Fiore is an owner and partner of Argentino Family Law and Child Advocacy, where their practice includes family law, school law, special education, and anti-bullying work, civil rights litigation, and legal assistance for the transgender and non-binary identified community. Celeste is a long-time LGBTQ educator and activist and presents regularly on LGBTQ cultural competency and legal issues specific to the LGBTQ community. Celeste serves as a trustee of the NJSBA and is a past-chair of the LGBT Rights Section of the NJSBA. Celeste was also featured on Inside NJ’s LGBT Powerlist, was a recipient of the National LGBT Bar Association’s 40 Under 40 award, wrote an article on LGBTQ cultural competency for the ABA’s Solo and Small Firms publication GPSolo, and co-authored a chapter in Oxford University Press’ LGBT Divorce and Relationship Dissolution.

21

Fairleigh Dickinson University: An Overview of the Two New Jersey Psychology Departments

By Robert Griffo, PhD, Anthony F. Tasso, PhD, Robert E. McGrath, PhD Fairleigh Dickinson University Fairleigh Dickinson University (FDU) was founded in 1942 by Peter Sammartino, and just completed its 76th year of existence.

It is the largest private institution in New Jersey, with over 11,000 students as of 2013. FDU’s recently inaugurated eighth president, Christopher Capuano, PhD, is a psychologist.

FDU Psychology faculty scholarship cuts across the broad areas within the field (e.g., experimental, social, clinical), encompassing quantitative, qualitative, theoretical, and educational modalities. With faculty working independently, as well as in collaboration with FDU colleagues and those scholars outside of the university, the breadth and depth of psychological research is covered.

A less than exhaustive overview of Fairleigh Dickinson psychology reveals that much is being accomplished. Danielle DeNigris and Katherine Viezel are independently engaged in the systematic study of autism in the classroom and language development. Diane Wentworth and a few FDU colleagues have assayed pedagogy via the empirical examination of technology in the college classroom, innovative means to teach General Psychology, as well as the effectiveness of a newer method of evaluating university professors’ teaching effectiveness. Robert Griffo recently published work on the assessment of situations and, along with Anthony Tasso, completed work on a scientific study comparing hypnotizability and non-hypnotic suggestibility. Tasso has also engaged in the examination of intimate partner violence as well as an educational piece on the integration of psychoanalytic approaches within a primary care setting.

Robert Prentky is an internationally recognize forensic psychologist as the author of the Juvenile Sex Offender Assessment Protocol (J-SOAP), the most commonly used instrument in the country for this population. Robert McGrath is a recognized expert in the field of character and virtue measurement and intervention. Katharine Loeb is a nationally recognized expert in 22

the field of eating disorders. Other faculty members have extensive research programs in neuropsychology (Lana Tiersky), cognitive processes (Ben Freer), clinical supervision (Meaghan Guiney), teaching reading (Jamie Zibulsky), substance abuse in college students (Steve Armeli), veganism (Cynthia Radnitz), the use of CBT in schools (Linda Raffaele-Mendez), sleep disorders (Ellie McGlinchey), and other topics.

FDU Psychology at the Florham campus offers both a general undergraduate major and a Behavioral Neuroscience concentration. The Metropolitan campus in Teaneck offers undergraduate tracks in Forensic Psychology, Mental Health, Organizational Behavior, Consumer Psychology, and Social Work as well as the general track.

Both campuses are homes to chapters of Psi Chi (The International Honor Society in Psychology). In addition, the Florham department publishes a peer-reviewed undergraduate student research journal, the Journal of Psychology and the Behavioral Sciences (JPBS), in existence for over 50 years (since 1966), that allows undergraduate students from around the world to publish their research. In partnership with the College of Saint Elizabeth and Drew University, the Florham Campus also participates in the annual Tri-Collegiate Research Symposium that allows students from all three institutions to present their research.

Florham graduate programs Our Industrial/Organizational Master’s Program has been in its current form going back to at least the 1980s. It has a traditional MA component or a combined 5 year BA-MA track.

Our Clinical Mental Health Counseling program became CACREP (Council for Accreditation of Counseling and Related Educational Programs) accredited in 2011.

This degree enables students to become Licensed Professional Counselors (LPCs). It should be noted that although our CMHC program is housed in the Department of Psychology & Counseling, it technically

is not psychology, but rather counseling (CACREP is linked with American Counseling Association, not APA).

Metropolitan graduate programs There are six graduate programs available: • MA Program in Forensic Psychology.

• MA Program in General/Theoretical Psychology: This is meant as a general graduate degree.

• MA + Certification Program in School Psychology: This program is approved by the National Association of School Psychologists.

• MS Program in Clinical Psychopharmacology: This distance program is intended for psychologists who are interested in enhancing their knowledge of psychotropic medications, including in preparation for prescriptive authority.

It is one of only four programs in the country designated by APA as meeting their guidelines for training in preparation for prescriptive authority.

• PhD Program in Clinical Psychology: This program is accredited by the American Psychological Association. As the university’s only PhD program, it is the premier program in the university in terms of research productivity.

• PsyD Program in School Psychology: This program is approved by the National Association of School Psychologists. It is available in two formats. The Advanced PsyD Program is intended for current master’s-level school psychologists who would like to enhance their credentials. The 5-year program combines the master’s and doctoral levels of training in school psychology. ❖

New Jersey Psychologist

Book Review: APA Handbook of of Dementia Anthony F. Tasso, PhD Fairleigh Dickinson University Chair, Department of Psychology & Counseling

N

eurocognitive disorders are one of the most destructive and life-altering ailments, with the fear of developing dementia even surpassing the fear of a cancer diagnosis. At its worst, dementia, that includes vascular dementias, AIDS-related, Lewy body (LBD), frontotemporal, and of course, Alzheimer’s disease (AD) completely eradicates any semblance of the individual, wreaking havoc on the inflicted, as well as the loved ones forced to bear witness to the figurative, and eventual actual, disappearance. Even less severe neurodegenerative deficits have grave effects, resulting in significant quality-of-life issues undeniably interfering with one’s ability to love, work, and play.

With almost six million Americans currently diagnosed with some form of dementia, the emotional tab of these illnesses is immeasurable; although the annual Medicare and Medicaid tally comes in at an astonishing $160 billion (Alzheimer’s Association, 2016). The fact funding from the national Institute of Health for dementia significantly lags behind cancer and AIDS does not help, particularly as death rates from neurocognitive diseases are accelerating, adding further dread among the US population.

Given this increasing impact on the population at-large, the American Psychological Association (APA) published a comprehensive text on the broad domain of dementia. As part of the APA’s highly productive “Handbook series” (20-plus and counting), the nearly 700-page APA Handbook of Dementia (2018) provides wide-ranging assistance to psychologists by offering an overview of the extant empirical and practical literatures on neurocognitive disorders. Editor-in-Chief Glenn Smith brings together more than 70 pre-eminent scholars to plumb the breadth and depth of this most dreaded illness.

APA Handbook opens by discussing diagnostic criteria for dementia (e.g., declining cognitive functioning in at least two domains, including social abilities), as well Winter 2020

Smith, G.E. (Ed.) (2018) Washington, DC: American Psychological Association.

as the non-linear progression of the disease, noting how 10-30% of individuals have neuropathological biomarkers (e.g., neuritic plaques, neurofibrillary tangles), yet do not exhibit discernable manifestations of the disease for decades, or ever. The text underscores how the apparent etiological x-factor is neuronal loss suggesting that AD and other dementias can lie dormant until the inflicted experiences a significant loss of neurons. APA Handbook outlines the data identifying upwards of 20 AD risk genes, with particularly attention to apolipoprotein E (APOE), and explains how Alzheimer’s is characterized by extracellular amyloid-B (AB) and intracellular tau deposits. The text explicates two types of Alzheimer’s disease: hippocampal-sparing AD that affects more of the cortex and less of the hippocampus and has an earlier onset (mean onset 63 years-old). This subtype is on contrast with the more limbic-based, hippocampus-focused AD, with a mean onset of 76 years-old. APA Handbook describes the common trajectory of AD’s presentation, with the typical first stage comprised of anterograde episodic memory, followed by impaired executive and attentional functioning along with possible deterioration in semantic and visuoperceptual capabilities. This contrasts Lewy Body Disease that is characterized by more motoric symptomatologies concurrent with cognitive decline, with neuronal loss experienced in the substantia nigra, caudate, and putamen with a concomitant underfunctioning of dopamine.

APA Handbook devotes a separate chapter to the assessment of the different dementias beginning with Alzheimer’s Disease that accounts for 60-80% of all dementia cases and affects 11% of people 65 and over and those numbers increasing to 32% for those 85 years old and older. As the sixth leading cause of death, APA Handbook highlights factors associated with AD pathology (e.g., neuronal atrophy, synapse loss, abnormal accumulation of amyloid plaques and neurofibrillary

tangles in the limbic structures and cortices).

The text also examines AD’s clinical presentation: episodic memory impairment, followed by impaired memory consolidation and encoding that creates difficulty in transferring newly learned information into longer-term memory. It is later characterized by diminished semantic memory and compromised use of language, eventually giving way to executive functioning deficits. The text identifies how Lewy body disease and Parkinson’s disease both follow a similar progression, although they vary in severity that has a subset of investigators hypothesizing that the two diseases represent different stages of the same underlying pathology rather than disparate conditions. Frontotemporal dementia (FTD, or Pick’s disease) is the third most common neurodegenerative dementia (behind Alzeimer’s and Lewy body) and is denoted by its early onset, with a mean age of onset is 58 years old. APA Handbook overviews the clinical symptoms of FTD that include motor disinhibition, apathy or inertia, compulsatory behaviors, diminished executive functioning, and language deterioration. The book describes how strokes or even “minor” cerebral hemorrhages can lead to alterations in white matter, the likely cause of vascular dementia (VaD). APA Handbook addresses the pathogenesis of HIV-associated neurocognitive disorder (HAND) that is the virus’ ability to cross the blood-brain barrier and infiltrate the central nervous system. The book reports on the early accounts of HAND during the heyday of the AIDS crisis, first seen in a subset of men with AIDS demonstrating impaired abstract thinking, trouble with learning, and slowed cognitive processing. This disease has witnessed a significant reduction in symptomatology thanks to today’s more sophisticated HIV/AIDS treatments.

Traumatic brain injuries and subsequent longer-term neurological sequelae are studied by exploring chronic traumatic encephalopathy (CTE, now more commonly called trau23

matic encephalopathy syndrome, or TES) a concept cemented in today’s lexicon given the increased public attention born out of the systematic study of football and military-related injuries. APA Handbook examines data that reveal even subclinical assaults to the brain can result in greater vulnerability for neuropathology later in life such as amyotrophic lateral sclerosis (ALS), vascular, Alzheimer’s, and Parkinson’s diseases, as well as various psychiatric conditions (e.g., lability, impulsivity, suicide). The text discusses brain-imaging apparatuses (e.g., CT, MRI, PET) and how these increasingly powerful tools provide rich information on healthy and unhealthy neurological functioning, offer useful data on the clinical presentations associated with different dementia subtypes, and represent a potentially fruitful means of detection, treatment, and ultimately prevention. However, it does appropriately temper expectations by indicating that such tools currently are incapable of providing a formal neurocognitive diagnosis.

APA Handbook examines culture and dementia by first exploring African Americans’ elevated rates of ADs compared to older White Americans and taps into possible biological, socioeconomic, and psychological causes for these racial disparities. Spanishspeaking persons are examined with attention to the roles of cultural and language factors associated with healthy and unhealthy cognitive processes. The book also provides an overview of cognitive processes in older Chinese Americans, with data suggesting parallel rates of AD and vascular dementias between Chinese Americans and White Americans. The chapter concludes with a useful vignette illustrating the nuances of clinical work with a neurocognitively impaired Chinese American patient.

The tome reviews frequently used dementia assessment measures from mental status exams to the Montreal Cognitive Assessment, Washington University Dementia screening, and Frontotemporal Lobar Degeneration tests. This section also looks at the assessment of everyday aging and functionality, including standardized assessment measures, self- and informant-reporting, observational measures, and the sensitive differentiation between normal age-related cognitive decline and pathological decline. APA Handbook touches on ethics and the law by honing in on capacity and competency in adults with mild cognitive impairment, and explains how the former refers to a health care professional’s assessment and the latter a legal decision.

This chapter punctuates the notion that cognitive impairment does not automatically 24

equate incapacity or incompetency.

The text covers primary, secondary, and tertiary preventions by first explaining the concept of cognitive reserve, which is the observed disparity between the underlying neurological pathology and observable neurocognitive functioning. It should be noted that a considerable percentage of individuals that exhibit the underlying dementia characteristics at the time of death (e.g., neurofibrillary tangles, plaques) did not exhibit clinical signs of such pathology, even during their later senior years. APA Handbook explores plausible explanations, such as larger brains (hypothesizing these can withstand neuronal decline) and greater intelligence, to the more active protective variables of higher education (specifically literacy mastery), active leisure activities, bilingualism, and aerobic exercising (that stimulates hippocampal neurogenesis).

The text explores additional controllable preventative factors, such as conscientiousness, social connectedness, and having a purpose in life, while depression, neuroticism, loneliness, and lacking purpose are identified risk factors.

Also studied is nonpharmacological secondary prevention, targeting both those at risk and those already exhibiting signs of mild cognitive impairment (MCI). The book provides an overview of the research on cognitive remediation and memory compensation, with aggregate data suggesting their efficaciousness in enhancing cognitive functioning in healthy older adults and those with MCIs; however, it shows more spotty findings with more severely symptomatic patients.

APA Handbook tackles the delicate process of talking with a patient about their possible dementia diagnosis. As the evidence indicates that almost half of health care professionals avoid direct discussion of a cognitive impairment with patients or families, the book provides a clear three-step module for doing so, beginning with before disclosure (e.g., explaining the pros and cons of knowing vs. not knowing, who else they would want to know, preferred breadth and depth of information), during disclosure (e.g., use of easily understood language, pacing of information, asking for feedback), and after disclosure (e.g., followup assessment of comprehension, referrals).

The book then outlines common comorbid psychiatric conditions starting with depression that afflicts more than 50% of those with neurocognitive disorders. Noteworthy (and complicating the differential diagnostic process) are the overlapping symptoms between the two conditions as well as how depression is frequently evident during the prodromal

phase of dementia. The book delves into sleep problems, linked to dementia and also owning a bidirectional relationship with a host of emotional disturbances. The text reports on how sleep plays an intricate role in proactively clearing problematic substances in the brain such as amyloids, and underscores how the increased understanding of the intricacies of sleep pathology may serve as a vehicle into dementia etiology and intervention. APA Handbook also explores pharmacology management. With nearly 70% of people with dementia on at least one psychotropic medication, it accordingly reviews the roles of antipsychotics, antidepressants, anti-epileptics, and cognitive enhancers for those with neurocognitive ailments. It also examines support groups, the longest-standing modality of intervention for those with dementia, and explicates the nuances of educational programs for patients and caregivers.

With elder abuse garnering more professional and public attention, APA Handbook hones in on the disconcertingly high rates of family violence perpetrated against those with dementia, with plausible reasons being their increased vulnerability in concert with the frustration regularly experienced by caregivers. Person-centered care, anchored in the Montessori philosophy, is explored, with its ethos of appreciating a person’s idography, illuminating choices, underscoring abilities (as opposed to only deficits), and modifying the environment to maximize support all with an eye on how to help the individual with dementia experience the best quality of life.

The text closes with a concerted focus on palliative care and how to help with end-of-life issues for those with dementia. It overviews how health care professionals can support those with dementia and educate caregivers on options. The book closes by exploring the oft-complicated bereavement process.

APA Handbook is packed with useful information on the biochemical processes, pathogenesis, dementia typologies, and associative factors, and it soundly incorporates clinical, neuropsychological, and neurological disciplines. It also discusses the various means of prevention and support. Although the dense neurochemical terminology and concepts may be a challenge for the non-biologically based psychologist, the reader has the ability to gloss over the more medically intricate material without missing key take-home messages. With contributing authors brilliantly covering the range of issues associated with neurocognitive ailments, APA Handbook of Dementia represents a sound, highly useful tool for today’s psychologist. ❖ New Jersey Psychologist

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