Spring 2021 | Volume 71 | Number 2
NJ Psychologist Special Section: Agile Resilience The Mental Health Challenges Medical Professionals Face During the COVID-19 Pandemic and How They Can be Addressed (1 CE) Refocusing Education Post COVID-19: Affective Attunement and the Human Needs of Students, Teachers, and Parents (1 CE) Creativity, Imagination, & Resilience From Tragedy to Resilience: One Psychologist’s Journey Group Therapy En Plein Air: Promoting Agile Resilience Through Ecotherapy
Also in this Issue: Student Affairs Grit in the Era of COVID: A Neuropsyological Perspective Student-Athlete Resiliency During COVID-19 Agility, Resilience and Student-Parents in the time of a Pandemic
Ethical Concerns Acquiring and Maintaining Competence: Ethical Considerations and Options
Book Review Understanding and Treating Chronic Shame: A Relational / Neurobiological Approach
Table of Contents 3 2019 - 2021 Continuing Education Cycle 4 President's Message: The Power of Agile Resilience 5 Make Use of the New NJPA Online Communication and Tracking Tools 6 Acquiring and Maintaining Competence: Ethical Considerations and Options 8 Creativity, Imagination, and Resilience 10 Group Therapy En Plein Air: Promoting Agile Resilience Through Ecotherapy 16 From Tragedy to Resilience: One Psychologist's Journey 18 Special Section Introduction: Promoting Agile Resiliency in Medical & Educational Settings During the COVID-19 Health Pandemic (CE section) 19 The Mental Health Challenges Medical Professionals Face During the COVID-19 Pandemic and How They Can Be Addressed (1 CE) 24 Promoting Agile Resilience in Education Post-COVID: Affective Attunement and the Human Needs of Students, Teachers, and Parents (1 CE) 29 Continuing Education: Are You Ready for the June Deadline? Student Affairs: 30 Grit in the Era of COVID: A Neuropsychological Perspective 33 Student-Athlete Resiliency During COVID-19 36 Agility, Resilience, and Student-Parents in the Time of a Pandemic 40 2021 APA's Practice Leadership Conference: A Virtual Call for Action 42 Book Review: Understanding & Treating Chronic Shame: A Relational/Neurobiological Approach
44 APA Council of Representative's Overview NJPA Publication Disclaimers Errors and Omissions: The NJPA Central Office staff is responsible for the layout and formatting of the NJPA journal publication, the NJ Psychologist. The authors of the articles produce and edit the grammar and content of the articles and references. Under no circumstances shall NJPA be liable for any direct, indirect, incidental, special, punitive, or consequential damages that result in any way from your use of or inability to use the New Jersey Psychologist or its contents, that result from any services provided by anyone named in the NJ Psychologist, or that are in any way associated with any mistakes, errors, omissions, interruptions, deletion of files, errors, defects, delays in operation, or transmission or any failure of performance, or for any other damages associated with the NJ Psychologist. NJPA makes no warranties or guaranties concerning the accuracy or reliability of the content contained in the NJ Psychologist or other sites or materials to which it may link or reference, nor does any link or reference imply an endorsement by NJPA of those sites or materials or content contained therein. This disclaimer also applies to use of the NJ Psychologist articles posted on the NJPA website or their platform for homestudy continuing education learning. Legal Advice Disclaimer: The articles and forms found on the NJPA website, mentioned on NJPA social media platforms, and in the NJPA journal publication the NJ Psychologist are not intended as legal advice. Practice issues are complex and highly fact-specific and require legal expertise that will not be provided by such generalized articles or forms. The information should not be used as a substitute for obtaining
Editorial Board Editor: Aaron Gubi, PhD Editorial Board Members: Ashley Gorman, PhD Eric Herschman, PsyD Nathan McClelland, PhD Anthony Tasso, PhD Staff Liaison: Christine Gurriere
personal legal advice and consultation prior to making decisions regarding individual circumstances. Editorial Policy: Articles accepted for publication will be copyrighted by NJPA, and NJPA 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 receiving the written consent of NJPA , to freely use material otherwise published by NJPA in books or collections of readings authored by themselves. Please be advised that authors will not receive remuneration for any articles submitted to, or accepted by, the NJ Psychologist. Any opinions that appear in material contributed by others are not necessarily those of the Editors, Advisors, or NJPA, nor of the particular organization with which an author is affiliated. Manuscripts should be sent to: NJPA Central Office E-Mail: NJPA@PsychologyNJ.org New Jersey Psychological Association | 354 Eisenhower Parkway, Suite 1150 | Livingston, NJ 07039 | 973-243-9800 | FAX: 973-243-9818
2021 NJPA EXECUTIVE BOARD (1YR) PRESIDENT: Daniel Lee, PsyD (1YR) PRESIDENT-ELECT: Peter DeNigris, PsyD (1YR) PAST PRESIDENT: Lucy Sant’Anna Takagi, PsyD (3YR) (2019-21) SECRETARY: Mary Blakeslee, PhD (3YR) (2021-23) TREASURER: Marc Gironda, PhD PRESIDENT’S APPOINTMENT (1 YR) (2020) PARLIAMENTARIAN: Joseph Coyne, PhD MEMBERS-AT-LARGE (3YR) (A=Affiliate generated; N=NJPA generated) (A-2019-21): Phyllis Bolling, PhD (A-2020-22): Aida Ismael-Lennon, PsyD (A-2018-23): Elio Arrechea, PhD (N-2019-21): Nicole J. Rafanello, PhD (N-2020-22): Aileen Torres, PhD (N-2018-23): Dan DaSilva, PhD (3YR) (2019 -21) APA COUNCIL REPRESENTATIVE: Rhonda Allen, PhD SPECIAL REPRESENTATIVES (1YR) ECP CHAIR: Melany Rivera Maldonado, PhD
(serve through year indicated)
(1YR) NJPAGS CHAIR: Jared Hammond AFFILIATE CAUCUS CHAIR: Phyllis Bolling, PhD (1YR) CODI CO-CHAIRS: Phyllis Bolling, PhD and Susan Herschman, PsyD EXECUTIVE DIRECTOR: Keira Boertzel-Smith, JD DIRECTOR OF PROFESSIONAL AFFAIRS: Susan C. McGroarty, PhD AFFILIATE ORGANIZATION REPRESENTATIVES Northeast Counties Association of Psychologists: Nansie Ross, PsyD Essex/Union County Association of Psychologists: Sara Tedrick Parikh, PhD Mercer County Psychological Association: TBD Middlesex County Association of Psychologists: Tammy Dorff, PsyD Monmouth/Ocean County Psychological Association: Deirdre Waters, PsyD Morris County Psychological Association: TBD Somerset/Hunterdon/Warren County Psychological Association: Janie Feldman, PsyD South Jersey Psychological Association: TBD
Every biennial license renewal period, licensees shall attest that they have completed courses of continuing education. Each applicant for biennial license renewal shall be required to complete during the preceding biennial period 40 credits of continuing education related to the practice of psychology. (see Section 13:42-10.19 of the BoPE Regulations for details)
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ON-DEMAND WEBINARS! Relationship Between Death-Anxiety and Sexual Behavior: An Alternative View of Sexual Addiction (2 CE) Child Abuse Reporting: Recognizing Maltreatment, Legal Requirements, and Ethical Considerations Reporting (1.5 CE - qualifies for DV requirement) READING ACTIVITIES: Burnout, Compassion Fatigue, Secondary Traumatic Stress: Effects, Treatment & Implications for COVID-19 (1 CE) COVID-19’s Impact on Students with Special Needs (3 CE) Psychological Perspective on Transgender Issues (3 CE) Need opioid credits? NJ Department of Human Services Response to the Opioid Crisis (2 CE) Continuing Education Requirement: Why is There an Emphasis on Addressing Diversity in Every Program? (1 CE) Practical Applications of Neuropsychological Testing (3 CE)
The Power of Agile Resilience By, Daniel Lee, PsyD NJPA President
Make Use of the New NJPA Online Communication and Tracking Tools
by NJPA Executive Director, Keira Boertzel-Smith
uring the ongoing COVID-19 pandemic, NJPA evolved our methods of project management for advocacy, membership, communications, continuing education, and governance work. Part of this evolution is incorporating new technology tools when possible and prudent. We strive to build into our ongoing leadership and Central Office dialogues a reassessing and adapting of work processes to best meet the needs of membership and the NJPA Executive Board. Below are two examples of how we are using technology to adapt to current association expectations and needs. NJPA Advocacy: Real-Time Promotion, Protection, and Enhancement of the Science and Profession of Psychology In 2021, NJPA paired up with the VoterVoice platform to provide you with easy access to current advocacy initiatives that promote, protect, and enhance the science and practice of psychology. Members can sign up for advocacy alerts, participate in campaigns, review federal and New Jersey legislation, and find their officials. Visit the new NJPA advocacy page here.
NJPA Advocacy Outreach Made Easy NJPA will alert you to an advocacy issue, provide you with information on each issue, target the appropriate officials on your behalf, and help you craft a personalized message to your legislators to accompany the NJPA message. We will automatically broadcast the message to the appropriate advocates based on targeting. Year-Round Tracking of NJPA Advocacy Campaign Progress As NJPA members respond to psychology advocacy issues, NJPA will receive data on our outreach efforts to legislators. We will share with you detailed, easy to
read, actionable data on the campaign’s progress. NJPA does not stop working after current campaigns are published. Year-round, NJPA will be able to survey our members to get your perspective on our advocacy efforts, monitor legislative vote scorecards to see how legislators voted on the issues that matter to NJPA, and engage members for better advocacy results within New Jersey. New! NJPA Continuing Education Learning Management System NJPA is enhancing, producing, and delivering relevant learning content to our continuing education audience quickly and easily. Find the new platform under the Learn tab at www.psychologynj.org. NJPA is making use of an intuitive platform where members and prospects can create custom learning pathways when they need to, saving our program registrants time and administrative trouble. We automated the delivery of our continuing education certificates, and we can track our performance for content optimization. Our new platform is integrated with our website so that the Central Office staff can continue meeting our goals and membership needs in an efficient manner. Organization of Continuing Education Our new platform offers an easy and attractive way to use digital assets and put them to work for NJPA and our members. Tracking Continuing Education Performance With our new high-level dashboard insights and detailed reporting options, we can now quickly understand continuing education course adoption and completion and learner progress, empowering NJPA to make adjustments and offer excellent customer service. Take advantage of both new platforms today!
Acquiring and Maintaining Competence: Ethical Considerations and Options By, Donald J Franklin, PhD
he APA Ethical Code (APA, 2017) 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.” The code also states that “Psychologists undertake ongoing efforts to develop and maintain their competence.” NJ psychologists are required to complete education and supervision requirements to become licensed, and to complete 40 continuing education credits related to psychology in every two-year licensure cycle (State of NJ, 2017). Does this satisfy the ethical requirement to develop and maintain competence? More to the point, are you satisfied that you have done enough to maintain your competence?
those credits contribute to your broad education as a psychologist, not to maintaining your current areas of competence. Completion of CE credits is a legal requirement. Maintaining competence in your areas of practice is an ethical requirement. As such, it is important to have a plan for maintaining competence that goes beyond simply attending CE presentations. Fortunately, there are a variety of options for doing this. Whether you are looking to maintain competence in your current areas of practice or to develop competence in new areas, peer supervision and consultation, mentoring, and selfstudy are all good possibilities. Although CE courses can be helpful, I recommend a combined approach to maintaining competence, that combines peer consultation with self-study. Peer supervision or consultation tends to focus on case presentations by group members followed by feedback and suggestions from other participants. Many peer consultation groups are successful, but this model has its challenges. Psychologists may be reluctant to join a supervision group for fear of exposing individual deficits or “mistakes” to their peers. Group dynamics can also affect peer consultation groups. Peer supervision groups often fail over time, as attendance drops off, and replacement members are not easily integrated. To maximize the group’s chances of success, it is helpful to clarify group structure and members’ expectations at the outset (Counselman, 2013).
Certainly, some level of competence is developed and maintained through these efforts. But if we are honest, this is only a starting point. Often, when you attend a continuing education program, you receive handouts that include a list of references on the presented topic. Should you obtain copies of all, or most, of the references and review the presentation’s original sources? If you provide, or wish to provide, services related to the CE topic, then the presentation should be a starting point on the road to competence, not the finish line. At times you might select a continuing education program because of convenience or cost, without considering its relevance to your practice. There is nothing wrong with attending CE programs that are not directly relevant to your practice, but
Self-study is self-explanatory. You identify sources of knowledge (e.g., journal articles or books) about
a topic relevant to your practice, locate the materials, and review them to add to your knowledge base. Selfstudy sounds simple in theory, but it is not always easy in practice. A psychology practice is already an isolated endeavor. Completing literature searches followed by a solitary review of the material can feel even more isolating, as you are not even interacting with clients. Not surprisingly, self-study is highly susceptible to procrastination. This can be overcome, though. Many years ago, I asked a professor to guide me in an independent study of personality theory. He provided me with a list of books to read, and my task was to read one book per week, in preparation for a scheduled discussion of the book with the professor. The deadlines cured my procrastination, and our discussions were meaningful and educational. More importantly, the professor’s comments and questions helped me identify aspects of the theory that I would have missed, had I simply read the book on my own. A study group comprised of several psychologists with a similar client base can be effective in the same manner. Whether you focus your practice on adolescents, couples, forensic cases, anxiety treatment, or any other area of psychology, you can find other psychologists whose practices share a similar focus. Instead of discussing cases, the group discusses a book or an article on a specific topic. Another alternative would be to select two or three articles exploring the same topic from different perspectives. Study groups like this expand your knowledge through exposure to the content of the book or article(s), as well as through your fellow group members’ ideas and insights. How do you begin? You might want to identify a small group of psychologists with similar practices. If you have a specialty within your practice, such as victims (or perpetrators) of sexual abuse or domestic violence, eating disorders, or anger issues, you might start with a few psychologists who treat the same problems. A small group of three to six members is probably preferable to a large group, since in larger groups some members have difficulty expressing
their thoughts and opinions. If you do not know enough psychologists who focus on a topic of interest, you can review the NJPA Member Directory to identify potential study group members. Finding material for the study group is easy. As a member of the American Psychological Association, you can subscribe to APA PsychNet. This subscription will give you access to full text journal articles and book chapters, as well as to relevant book reviews. Group members can identify topics of interest, and rotate responsibility for selecting the reading material. The meetings can take place virtually, which reduces schedule conflicts and eliminates distance as a deciding factor for group membership. Start by talking to one other psychologist about forming a study group, and then identify a few other possible members. With the formation of a successful study group, maintaining your competence will no longer be limited by available CE programs or conferences. About the Author Donald J Franklin, PhD has been a NJ licensed psychologist and member of NJPA since 1987. He provides psychotherapy services for adults and forensic psychological services for family, civil and criminal court issues. He has been a member and former chair of the Forensic committee and is currently a member of the Ethics Education and Resource Committee.
References State of NJ, (2017), New Jersey Administrative Code, Title 13, Law and Public Safety, Chapter 42, Board of Psychological Examiners. www.njconsumeraffairs.gov/Regulations/Chapter-42-Board-ofPsychological-Examiners.pdf American Psychological Association (2017) Ethical Principles of Psychologists and Code of Conduct (2002 amended effective June 1, 2010, and January 1, 2017). http://www.apa. org/ethics/code/index.aspx Counselman, E. (2013) The Power of Peer Groups, Psychotherapy Networker, https://www. psychotherapynetworker.org/blog/details/941/the-power-ofpeer-groups
Creativity, Imagination, and Resilience By, Leanne Domash, PhD
grew up in a small conservative Pennsylvanian town, and my family practiced Orthodox Judaism. As I attended Hebrew School, I discovered multiple laws that my obedient child mind took very literally. My secular teacher became concerned about me and wrote to my parents that I was too serious in school. Then I discovered Alice in Wonderland.
that lightened the mood. Spending two full days there helped me work through my mother’s and grandmother’s vicarious Holocaust trauma that was passed down to me. They lived in the United States during the war but many close relatives in Europe were captured and some murdered. Expertly designed physical space can become transitional potential space and foster change.
I must have read Alice over a hundred times. She introduced me to the magic of dreams, the power of language, and the nature of courage. I didn’t realize then, but Alice taught me the richness of the unconscious and how art can heal.
Another example is therapeutic theater. I have written a number of plays, all of which deal with trauma. One purpose is to help the viewer work through painful
I wrote my recently published book, Imagination, Creativity and Spirituality in Psychotherapy: Welcome to Wonderland (Domash, 2021) to do for my clinician-readers what Alice did for me: to inspire, to give courage, to appreciate the value of dreams, and to understand the power of the poetic use of language. I give many practices and techniques clinicians can use to help patients adapt, innovate, and weather crises. I also empower clinicians to contribute to the literature in our field. Symbols and concept become worn and tired and hopelessly out-of-date. We need to be able to respond to the myriad challenges that arise from our constantly changing culture. Participating in many different types of art can help us work through psychological issues. One example is my visit to the Jewish Museum in Berlin. Architect Daniel Libeskind designed a space that recreated the horror of the Holocaust, but also displayed the beauty of the Jews’ contributions to Berlin, as well as provided interactive games
issues. The aesthetic distance of the medium helps the viewer reflect on his suffering in a less threatening manner than if asked directly. In the Talkbacks after the performances, the audience members were thoughtful and responsive, eager to rework and rethink their experiences. In sum, trauma makes us rigid. Working through trauma helps us become more imaginative and resilient. Dreamwork can also help us become more agile. One dreamwork technique I discuss is called Embodied Imagination, designed to help the patient work through psychological blocks so as to create new patterns of thinking, feeling, and behaving. It is used with patients but also artists, scientists, and writers to facilitate their creative projects. The technique is as follows: as the patient works the dream, he or she embodies selected images which form a composite. The patient mentally practices this composite for days after the session, and this eventually creates new networks and patterns. I advocate an interdisciplinary approach. Looking at psychotherapy through the lens of spirituality and biblical themes, art and aesthetics, and biology and
evolution all jolt the reader into thinking about psychotherapy in new ways (Ambrose, 2008, West, 2016) and can help the clinician become more nimble as he or she navigates frequently difficult and unknown waters.
“hum in the ear,” as the esteemed Russian poet Osip Mandelstam wrote. By this he meant that a poem first appeared to him as a musical melody, which gradually formed itself into words. Listening to the thoughts and feelings that come from our unconscious helps us find fulfilling new ways to meet challenges. Our unconscious can talk to us, especially when we first wake up or are in the shower, and give us interesting ways to adapt and meet challenges.
Navigating the unknown is a challenging and intriguing part of our work. Here I find the theme of spirituality very useful. Bion (1988) has famously told us to enter each session without memory or desire, to clear our mind and just be in the present. This is essentially entering into the unknown, or the “void” as Kabbalists say – a crisis of sorts. However, from “nothing” comes “something” that is, understanding and form. This “nothing,” in a very profound sense, is pure potential (Starr, 2008).
Another fun thing I have done is resurrect an old hobby of mine: sewing. My adult daughter also sews, and we have had a great time together, experimenting and even making matching clothes. I always buy extra material for this! I am also enjoying gifting my friends with clothing created just for them. My love of fabric and color is wonderfully satisfied by this endeavor, and it a great antidote to our deep listening to patients.
In their creation myth, Kabbalists posit that God contracted and created a void so the world could be created. Analogously, we clinicians pull back so the coconstructed reality of the session can emerge. Similarly, the artist faces a blank canvas, the writer a blank page. In any creative act, and psychotherapy certainly is, one goes through a period of unknown, of darkness, of chaos. We as clinicians learn to understand and tolerate this process to let the patient come into being.
As therapists, we sometimes have to believe in what may at first seem impossible to the patient. For this we need courage, faith, resilience, and imagination. The Queen gave Alice some good advice when Alice said she can’t believe in impossible things, like whether she could feel less lonely. The Queen told Alice that she just needed more practice, “Why, sometimes I’ve believed as many as six impossible things before breakfast” (Carroll, 2013, p.151). We may all need to listen to the Queen.
On a personal note, during this pandemic, I, along with all of you, have felt constrained, bored, and lonely. However, I have also found that this vast expanse of dark time has provided a landscape to try some new adventures, although admittedly just within the confines of my home. I had an idea for a graphic novel and proposed this to an artist/ psychologist colleague, Terry Marks-Tarlow, and she and I have been avidly working on this with much joy. I attribute this idea to listening to my
About the Author Leanne Domash, PhD is a licensed NY psychologist/ psychoanalyst, writer and playwright, and Embodied Imagination practitioner. She has had a life-long interest in the creative process and has written and/or presented nationally and internationally on art, architecture, writing, wit and humor, theater, and spirituality as they intersect with the psychotherapeutic process.
unconscious or intuition – that is listening to the
References furnished upon request.
Group Therapy En Plein Air: Promoting Agile Resilience Through Ecotherapy By, Gail Schrimmer, PhD
Introduction: The Consultation Room
sychologists are more aware of the importance of numbers than ever before. Symptom Ratings. Diagnostic codes. Treatment codes. Virtual treatment code modifiers. Telehealth Platform ID numbers. Electronic insurance identifiers. Annual deductibles. COVID-19 rates. For psychotherapists who have reacted to the COVID-19 pandemic by moving their practice outside, another number was added to the mix: temperature, with or without wind-chill. For what has turned into a minority of psychotherapists, the spring of 2020 offered new ground, literally and figuratively. Prior to the international pandemic, psychotherapy was deemed an indoor activity. Early psychoanalytic doctrine was uncompromising in its description of the optimal consultation room. “I adhere firmly to the plan of requiring the patient to recline upon a sofa, while one sits behind him out of his sight. This arrangement has an historic meaning; it is the last vestige of the hypnotic meout of which psychoanalysis was evolved; but for many reasons it deserves
to be retained. The first is a personal motive, one that others may share with me, however. I cannot bear to be gazed at for eight hours a day” (Freud, 1921). Years passed before researchers applied quantitative exploration to assess the productive qualities of the
psychotherapy office. The significance of the office setting was supported by Bloom, Weigel, & Trautt (1977), who discovered that subjects perceived psychologists who practiced in mimicked stereotypical representations of more professional (i.e. traditional medical or legal) offices as more credible than psychologists who practiced in seemingly more humanistic or relaxed offices. Decades later a sea-change occurred: Devlin and Nasar (2012) observed subjects tending to perceive a psychotherapist as more expert, trustworthy, and socially attractive if the office decor is experienced as soft, personalized, and orderly. Understandably, the zeitgeist of expected professional interior design is expected to undergo periodic adjustments. Whatever the treatment orientation, when constructing the psychotherapy consultation room, the majority of practitioners continue to weigh the balance between requisite framed certifications and scholarly tomes, with the more personalized paintings or plants. Psychologists again wrestled with the conceptualization of the “office” as COVID-19 lockdown played havoc with lost income coupled with pricey yet empty indoor rental space. Increasingly, for both financial and safety reasons, psychotherapists joined other professionals in domestic lockdown. They demonstrated resilience in the face of Internet vulnerabilities, video/audio glitches, insurance snafus, and household interruptions as they began to practice fullscale telehealth. Many psychotherapists were surprised at how effective (and cheaper) was this initially unwelcome treatment setting. A few cracks started surfacing. Many individuals and groups found telehealth wanting (Shklarski, Abrams, & Bakst, 2021). The difficulties of telehealth were quite apparent for psychologists working with children, performing personality and neuropsychological evaluations for complex disorders, treating those already challenged with social anxieties or social skills disorders, and working with patients whose careers already contributed to daylong “Zoom fatigue.” A complex dilemma emerged quickly in the spring of 2020: How can psychotherapists most ethically serve those clearly not benefiting from telehealth, while retaining the necessary quarantine recommendations outlined by the CDC? For those practitioners having access (and a preference) to an outdoor or en plein air experience, a solution was discovered. ECOTHERAPY "Ecotherapy,” is not new. As a concept traced back to the early twentieth century, it refers to the healing and psychotherapeutic effects of natural settings, horticultural experiences, and “green” exercise (Buzzell & Chalquist, 2009). Evidence drawing upon research from environmental psychology has explored the effects of nature on our perception, emotions, behavior, and cognition. During the US outbreak of tuberculosis during the late 1800s, sanatoriums believed that fresh air expedited cure. One such institution housed the doubly stricken: those with tuberculosis and psychiatric disorders. When psychiatric patients were housed in tents, researchers observed a mental health improvement. Following a return to their indoor facility, an uptick in psychiatric symptoms was observed (Caplan, 1967). Preschoolers who spent more time outside reap activity, metabolic, and social rewards (Klesges et al., 1990). Medical and assisted care institutions took some notice of the research detailing how the quality and content of a view from a hospital window quickens post-surgical recovery (Clinebell, 2016). Those who work with urban minority populations understand how the urban poor, and particularly African Americans, are especially vulnerable to climate changes, environmental hazards, health risks, and the difficulties accessing healthy and safe outdoor options (Meraji, 2015). Scandinavians describe friluftsliv, literally translated as “open-air living,” as a passion for nature. Those who subjectively experience the curative benefits of the natural world may offer a nod to the “biophilia hypothesis.” Theorized by Edward Wilson, biophilia is the innate tendency to seek kinship with more than our human world (1994). Biophilia suggests that human fulfillment rests on our dependent relationship with the environment, and prioritizes the natural world’s influence on our emotional, cognitive, aesthetic, and spiritual development (Kellert & Wilson, 2013). Researchers accessing social media posts to assess photographed daily routines, weddings, vacations, and other celebrations
demonstrated a clear connection with nature, humans, positive memories, and life satisfaction (Chang et al., 2020). Buzzell and Chalquist have outlined many forms of ecotherapy, including horticultural therapy, “green” exercise, animal-assisted therapy, and wilderness therapy (2009).
Group psychotherapy has a sturdy history of helping individuals cope with prolonged social isolation, distress, bereavement, trauma, addiction, and social inequities. Emotions such as anger and sadness, shared in a group setting, are associated with later positive psychological effects (Brans et al., 2014). Medical improvement and longevity are also linked to socialization: the more social roles and social connections experienced by an individual, the better the lung function and telomere length (Stein et al, 2018; Crittenden et al, 2018). The association between social ties and mortality was found to be independent of self-reported physical health status, with a longitudinal survey studying 6929 adults. The analysis indicated that those who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. These social findings were more predictive than socioeconomic status and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services (Berkman, 2017).
Is ecotherapy grounded in efficacy? One metasynthesis of ecotherapy practice articles amassed from the past 25 years determined some key components attesting to its success; ecotherapy effectively connects patients to the natural world, enriches the therapeutic encounter, provides novel ways to incorporate more orthodox or conventional therapy orientations, is effective with a wide range of diagnoses, and enhances both the patient’s and the practitioner’s sense of wellbeing (Cooley et al., 2020). Given this information, it noteworthy that a 2021 list produced by the American Psychological Association of probable future psychology trends includes the impact of social media, mental health apps, distance learning, and virtual therapy and no mention of the state of the environment or the merits of ecotherapy (APA, 2021).
Conversely, a meta-analysis indicated that social ostracism triggers suicidal thoughts, as the lack of social affirmation identity is associated with lower self-worth (Chen et al., 2020). In August of 2020, the CDC reported results of a national survey: more than 40 percent reports symptoms of anxiety, depression, and/or increased substance use. Compared to a similar 2018 survey, the 2020 existence of suicidal thoughts in the population had more than doubled from 4% to 10% reporting suicidal ideation (Czeisler et al., 2020).
Following decades of debate regarding which therapeutic orientations and programs are most effective, we do know that therapist variables, and specifically the quality of the treatment alliance, reign supreme. The greater the treatment alliance, the lower is the reported psychiatric symptomatology (Fluckiger et al., 2020). If biophilia is also a component of mental and physical health, could holding psychotherapy sessions outside be an additive component to an effective treatment outcome?
One could argue that social support by a lone therapeutic partner is as important as mere companionship with a group of disparate others. Five studies explored this difference, and delineated that while social support can serve as a buffering effect on life’s stressors, companionship and a concrete social role within a community are the stronger predictors of psychological well-being (Rook, 1987).
Ecotherapy can be envisioned as two main camps. Some patients passively receive the aesthetic and healing beauty of nature and natural environments that in themselves become places of healing and restoration. This would include individual and group therapy held outdoors, while seated or playing a group game. A second delineation is the more active and physical environmental engagement, whereby therapy is conducted utilizing the resources of the natural environment, as in adventure, wilderness, and horticultural therapy (Frost & Harding, 2009).
Researchers and theorists suggest that human beings are fundamentally social; the need to gather with others increases in importance during periods of crisis and distress. COVID-19 quickly amplified both the need and
benefits of group psychotherapy. While individuals were encouraged to socially distance, we were paradoxically encouraged to connect. There was little doubt that group psychotherapy during quarantine would effectively reduce depression, anxiety, and complicated grief (Marmarosh et al., 2020). Concurrently, for most practitioners running long-term psychotherapy groups, teleheath became a relatively new modality. Prior to publication, no substantial research has either evaluated the effectiveness nor provided clear guidelines of online group therapy (Weinberg, 2020). Group therapists were riding into the frontier, largely on their own. Ecotherapy Psychotherapy Groups Following a two-month period of telehealth sessions, all of Gail Schrimmer’s five interpersonal psychoanalytic groups (with 38 total patients) were asked to vary their session setting. One week each group would meet via telehealth, and the following week the same group would meet outside Schrimmer’s Morris County office. One weeknight group was moved to Saturday morning, to capture sunlight. This cycle (roughly two outside meetings and two telehealth meetings each month for each of the five groups) repeated itself from May of 2020 until February of 2021, unless rain, snow, or cold necessitated a replacement telehealth session. Group members were asked to wear masks if six feet apart, and were able to unmask if more distanced. Sessions were held on a patch of shady lawn in the back of a suburban office building. Close to the group were three entities playing a strong role in the group: a funeral home, an assisted care center, and elevated train tracks. Unexpected Group Members: Canines COVID-19 has been linked to a record increase in dog adoption. Intuitively humans are connected to a variety of animals, and studies have verified that physical
proximity to dogs has the power to release significant oxytocin (Pierce, 2016). Group members were invited to bring their dogs to therapy, and a weekly rotation of seemingly pleased pets became part of the group process. There was clear joy in the proud sharing, wild mishaps, and relaxed petting of each pet. One patient reported gratitude that the group sessions served to “better socialize” her dog. Outdoor Gifts Bunnies, foxes, and numerous birds made an appearance. The splash of autumn leaves offered a brilliant backdrop. Slight rain was tolerated. During colder days, a burst of sunshine could render all patients mute with pleasure. The “group tree” was decorated for the winter holidays. During “talent day” group members took turns unicycling around the parking lot, giving members a hip hop dance class, exhibiting artwork, singing a Beatle’s song, and reciting slam poetry. Patients showed off their new clothes, tattoos, baked goods, hairstyles, and warm boots. New teen drivers enjoyed displaying parking skills. One patient, who had cloistered himself for several months and has a history of agoraphobia, unexpectedly walked 1.5 miles to group. Sweating and rosy-cheeked, he was greeted with a cheer. Outdoor Glitches Ecotherapy in a suburb has its novel idiosyncrasies and annoyances. The noisy trains provided a moment of forced silent staring. The nearby assisted care facility introduced an outdoor one-man-band playing Vegasstyle hits. The nearby funeral home provided a somber recognition of the temporality of life: this was most obvious during the height of the county’s COVID-19 deaths, when an additional casket trailer was temporarily parked at the end of the shared parking lot. Some dog walkers
(understandably) misinterpreted the group setting as an ad-hoc get-together. Following a brief chat about breeds and some puppy play, the uninvited guests took their leave. When the February temperatures plunged to a steady subfreeze, blankets and propane heaters could not compete with telehealth. Attendance Commitment to the group process was altered. Gail Schrimmer has been running groups for 20 years, and attendance for older adults had previously been unproblematic. However, for the groups composed of teens or younger adults, attendance had historically been an issue. Since spring of 2020 the majority of group members, of all ages, attended both outside and telehealth sessions more regularly. Out of the 38 group members, there was only one termination (corresponding to a new job conflict and a successful resolution of family issues). One group member took a leave, due to significant illness. For those patients receiving their education online, forced to work from home, losing employment, and/or cleaved from their social activities, dating, and group athletics, the group became a welcome and dependable focal point. Anecdotal Observations Group members, with two clear exceptions out of the total of 38, voiced approval of ecotherapy. One group member refused to meet outdoors, reporting that the act of leaving his home or driving risked the health of his retired parents. No encouragement regarding the successful outside precautions would shift this patient’s stance. Another group member, with auto-immune disorders and agoraphobia, would not attend outdoor sessions. A highly isolated patient reported feeling increased anxiety about attending outside group sessions, after sheltering completely alone for several weeks; this proved to be an initial reaction, and one that dissipated by the third session. For most patients, the outdoor sessions offered a welcome respite from virtual engagement. One young woman observed that “with my office job, it was nice to get some fresh air…and meeting outside was a way to not miss the conversational details and facial expressions we don’t see on Zoom.” Another patient stated that outdoor group therapy was superior to Zoom sessions.I In addition to his general enjoyment of nature, outdoor sessions offered “a better read of a person’s posture and body language.” When asked to directly compare the virtual and outdoor group sessions, one high school senior replied that “I love it outdoors. I can feel other people’s energy…brings you closer…a better connection.” Biophilia played a strong role in patient preferences. One female patient described initial “worry about being able to communicate about private thoughts” in this new setting, and later commented that “I was so surprised at how lovely it was: the smell of the earth, being in nature…there was something about being under the tree, and feeling interconnected with its root system…and it was probably more private than ‘Zooming’ at home.” The introduction of a various canines was an additive factor. One group member reported that “I loved the fresh air and being one with nature…meeting the other members’ dogs was another form of therapy, with their unconditional love.” Another woman “liked being outside because it was less stuffy and more relaxing. I like sitting in lawn chair, with the dogs…having them attend took the edge off a difficult and overwhelming time.” One male patient reported that outdoor sessions were more helpful than virtual sessions, as being “out in nature was a more lively connection, and live interaction replicates the relationships destroyed by COVID-19.” In addition to this more passive and aesthetic subgroup of ecotherapy, anecdotal support is offered by those practicing a more active and physical environmental engagement. Dr. Michele Kinderman and Dr. Kelly Yanek’s Gloucester, Hunterdon, and Somerset counties partnership, Wellness Outside The Box: Therapy Redefined is a rarity in NJ. These psychologists lead mindfulness, yoga, rock-climbing/ropes courses, and other hands-on challenges during daily
and weekend retreats held at parks and campgrounds. In addition to more typical psychotherapeutic goals, their active outdoor programs create teamwork, build leadership skills, and facilitate calm. One patient observed that the outdoor setting, coupled with ”the guidance of Kelly and Michele... created an opportunity for reflection and growth.” Dr. Yanek had the luck of receiving a “gift” from two different birds during the same session. In addition to creating welcome humor, this became a “teachable moment to utilize the analogy that we cannot always anticipate the difficulties we will encounter in life, but how we respond to them” (M. Kinderman & Y. Yanek, personal communication, February 18, 2021).
neuropsychological evaluations for complex disorders, those treating patients already challenged with social anxieties, social isolation, or social skills disorders, and for practitioners working with patients whose careers already contributed to daylong “Zoom fatigue,” other solutions will be necessary. Ecotherapy, stemming from our innate biophilia, can be a vital addition to a psychotherapist’s toolbox. Additionally, practicing outdoors is an antidote to the practitioner’s own digital boredom and separation from nature. Outside psychotherapy during a pandemic requires safety precautions. Three patients (none of whom were attending the same group) tested positive for COVID-19; the outside precautions and two-week furlough from meeting the group “live,” may be associated with the lack of contraction by their fellow group members. For the majority of group members, ecotherapy was the only chance they had to meaningfully and tangibly interact with others outside their nuclear families. When asked if members were amenable to switching in the spring of 2021 to an all-outdoor format, the option was greeted with agreement. Rain dates, however, are predicted.
The gifts are not only for the patients; practicing outdoors is a welcome antidote to the practitioner’s own digital boredom and separation from nature. Dr. Nancy Blanco Melendez, a psychologist with a private practice in Morris County, reports that after the quarantine initially significantly challenged her largely pediatric group and individual practice, her transition to ecotherapy proved to be “….an easy adjustment…being able to hear the sounds of nature and experience natural sunlight provided a peaceful environment that I didn’t realize was missing in my indoor work. Being outside opened new avenues of conversation. One of my favorite activities with children is teaching mindfulness exercises by listening to the sounds, smells, colors, and textures found in nature. Being able to focus on these elements helped the patients and I became more centered in the present moment, and less over-whelmed and stressed.” (N. B.
Obvious obstacles when practicing outdoors include unpredictable weather and limited access to a defined and safe space. Classic roles and hierarchical boundaries can shift radically, such as when a stranger intrudes on the therapeutic space or when the psychotherapist is nipped by an untrained puppy. Confidentiality concerns, as well as changes to the patient’s shifting experience of the therapy and the therapist, can be an ongoing discussion (Jordan & Marshall, 2010). This current review of ecotherapy relies heavily on biophilia theory and anecdotal experiences of patients and therapists. It is hopeful that the promising components of this form of agile resilience, in the face of any pandemic, be supported by empirical research.
Melendez, personal communication, February 16, 2021). Conclusion and Future Considerations
About the Author
Despite the promising indications of an increasingly vaccinated public, many epidemiologists predict the ongoing necessity of social distancing due to the probability of ongoing mutations and new viral crises. Telehealth has proved to be a lifesaver for a swath of psychiatric and medical disorders. For those working with children, those performing personality and
Gail Schrimmer, PhD is a licensed psychologist specializing in the areas of group therapy, relationship disorders, ASD, trauma, personality testing, and career coaching. In addition to her Morris County outdoor and indoor practices, she is a Rutgers GSAPP testing and clinical supervisor. email@example.com
References furnished upon request.
From Tragedy to Resilience: One Psychologist's Journey By, Lise Deguire, PsyD
with rewarding work and many friends. In contrast, my brother, a genius, who was not burned, or bullied, killed himself. No one would have predicted those odds.
My mother quickly appraised the danger and realized her only escape was to dash through the wall of flame into the nearby lake. She ran off. In her panic, without thought, she left me in that fire. I was trapped, abandoned, and alone.
Resilience, the capacity to bounce back from adversity, is remarkable, but not as rare as we once thought. Key researchers in the area found that up to two-thirds of people achieve a resilient recovery from trauma (Bonanno et al, 2006; Bonanno, 2004). What helps people have a good outcome? What lessons are there for all of us, as we endure this time of COVID-19, political turmoil, racial unrest, and economic uncertainty?
t four years old, I stood next to my mother while she lit the coals for a barbeque. She poured lighter fluid on the coals, but they wouldn’t light. Frustrated, my mother poured more lighter fluid onto the grill. But it wasn’t lighter fluid in her hand. It was a highly flammable household solvent. In a sudden flash, we were engulfed by flame.
My father found a way to grab me through the porch fence and he hurled me into the lake. An ambulance came, and my mother and I were transferred to the best burn hospital in the country. There, I underwent weeks, months, and years of excruciating procedures, as they reconstructed my lip, chin, neck, arms, and grafted my tiny body again and again. I had so many operations that my grandmother stopped counting. I had third degree burns on two-thirds of my body and was disfigured for life. I endured most of these procedures alone because my parents, although loving, were intensely self-absorbed, and not able to care for me or my brother. Ten years later, my brother, my favorite person, took his own life.
There are many components contributing to resilience. Some are beyond our control, such as genetic factors. There are also economic factors. Having financial resources grants better access to quality health care, and education. Having a supportive family and community also enhances resilience. In contrast, many aspects of resilience are based on the individual’s cognitive and emotional strengths. These are the growth areas in which psychologists can make a huge difference. I have developed a mnemonic for this set of teachable resilience skills: G.O.A.L.S. + M.M. In brief:
• G is for Gratitude: The capacity to notice and
appreciate one’s blessings in life. The simple act of noticing one’s blessings can have a quick and positive effect on both mindset and physical
This is my true story. So, how is it that I am now a happy, well-loved, successful psychologist? I lead a beautiful life, happily married, the mother of two,
• O is for Optimism: The capacity to look
forward, anticipating something positive; the ability to have hope, even during challenging times. Sometimes the call for optimism can sound fake or superficial. However, it is important to imagine positive outcomes and not just gloomy “what-ifs.” These optimistic thoughts keep a glimmer of hope alive.
• A is for Active Coping: The ability to do
omething productive to solve problems. Even in times of crisis, there are ways we can help ourselves. Sometimes those possibilities are small: getting outside, getting sleep, calling a friend. Still, each of these activities can help a person feel somewhat better, somewhat more stable.
• L is for Love: Most lives worth living involve
being in loving relationships. Resilient people have good support systems. Their support may not come from expected sources. Parents may be neglectful; marriages may be disappointing. But support can still be found in friends, neighbors, coworkers.
• S is for Social Skills: The capacity to form and
keep positive relationships. Resilient people tend to be good at relationships. They connect well with teachers, neighbors, friends. These social skills can help form connections with healthier people, which may in turn compensate for other less robust relationships.
• M.M. is for Meaning Making: The ability to
find meaning and purpose from the experience of one’s suffering. At some point after trauma, it is vital to make sense out of what one has been through. Over time, resilient people find meaning in their suffering. Perhaps they volunteer. Perhaps they fundraise. Many of my clients report that their own suffering forever deepened their capacity for empathy.
Notice anything about G.O.A.L.S. + M.M.? Many of
these resilience skills are the focus of psychotherapy. Most psychologists help their clients with these skills every day. Every time we help a client step away from catastrophic thinking, we help grow optimism. Every time we help a client develop an action plan, we cultivate active coping. Every time we help a client resolve a marital conflict, we help with both love and social skills. Many sessions revolve around finding meaning out of a client’s pain. Our work helps to build clients’ resilience, one session at a time. Like many of our clients, and like many of you, I am a survivor. I survived a fire, countless excruciating surgeries, social ostracism, bullying, parental neglect, divorce, and four family suicides. With help from loved ones and professionals, I developed the qualities of resilience that helped me thrive: gratitude for my blessings, optimism for the future, problemsolving abilities, loving relationships, and good social skills. The meaning I take from my trauma is that I am now here to help others. Like many of you, I use the pain of my life to deeply connect with clients. In this time of universal struggle, it can be easy to worry that our work has limited impact. So many people suffer, unendingly. But psychotherapy can build crucial resiliency skills that help clients with current struggles and those yet to come. The work we do is important. The work we do changes lives. About the Author Lise Deguire, PsyD is a psychologist in private practice in Pennington NJ and author of Flashback Girl: Lessons on Resilience From a Burn Survivor. For information on speaking, media engagements, and her blog, please contact her at https://www.lisedeguire. com. Correspondence concerning this article should be addressed to Lise Deguire, PsyD, 114 Straube Center Blvd. Suite 1-7, Pennington, NJ 08534. Email: drlisedeguire@ verizon.net
References furnished upon request.
Introduction: CE Section Promoting Agile Resiliency in Medical and Educational Settings During the COVID-19 Health Pandemic By, Aaron Gubi, PhD
his homestudy continuing education section aligns with the broader theme of the special issue of the NJ Psychologist, namely to promote agile resiliency through our professional practices as psychologists. Such work is especially poignant given the interpersonal and societal challenges posed during the COVID-19 pandemic. The articles in this section focus on two critical domains and populations, namely how to promote well-being and learning among medical professionals and children.
The writers address many of these challenges and propose various frameworks and approaches that psychologists can use to support health workers moving forward. Korner, in his article (Promoting Agile Resilience in Education Post-COVID: Affective Attunement and the Human Needs of Students, Teachers, and Parents), critically examines traditional educational praxes utilized by educators and schools. He emphasizes the oftenoverlooked importance of emotional attunement and student attachment, and proposes evidence-based and student-centered perspectives and practices to promote learning as schools begin the full re-opening process.
Both groups are clearly highly vulnerable and in need of support during these challenging times. Medical professionals, as front-line workers, have had to deal with a wide array of ongoing and evolving challenges ranging from a lack of personal protective equipment to constant potential exposure to a virus that can endanger both their own lives and those of their loved ones. Similarly, children have experienced disrupted learning and learning loss, in addition to a variety of mental health challenges that can stem from social isolation, economic upheaval, health, anxiety, and numerous other complications that may have befallen family members, friends, or others during these challenging times.
Both articles provide valuable information to psychologists seeking to promote agile resiliency within medical and educational settings. In addition, we hope psychologists working within other settings or with different populations will also find these articles meaningful. On behalf of the publication and continuing education committees, I thank the authors for their important contributions as we all work to move forward during these challenging times. About the Author Aaron A. Gubi, PhD, is a licensed psychologist and an assistant professor at Kean University where he also serves as clinic director of Kean Psychological Services, a community-based psychology training clinic. He also works part-time as a psychologist within a residential treatment facility and in a local private practice. He is currently serving as editor of the NJ Psychologist.
It is with those insights in mind that we can now turn to the two articles in this special section. The article by Vorillas, Emmanuel and Garro (The Mental Health Challenges Medical Professionals Face During the COVID-19 Pandemic and How They Can be Addressed) examines the challenges and psychological vulnerabilities of medical professionals since the start of the pandemic.
The Mental Health Challenges Medical Professionals Face During the COVID-19 Pandemic and How They Can Be Addressed (1 CE)
Stephanie Vorilas, MA
Claudia Emmanuel, MA
Adrienne Garro, PhD
Kean University Earn 1 CE credit when you read this article and successfully complete the post-test. Instructions for obtaining CE credit: visit www.psychologynj.org under the Learn Tab.
(e.g., ventilators, beds, testing equipment) and which patients’ lives to save (i.e., younger versus older, healthier versus sicker) that creates vulnerability to mental health problems for medical staff (Godderis et al., 2020; Pappa et al., 2020; Zaka et al., 2020).
The Experience of Medical Professionals During COVID-19
Physical and Mental Health Risks
he Coronavirus (COVID-19) pandemic has caused worldwide psychological stress and other significant mental health ramifications for the general population, especially the medical workforce (i.e., doctors, nurses) (Lu et al., 2020). In addition to the severity of the virus itself, its quick and vast spread placed a heavy burden on those on the frontline. While a substantial portion of the world population was in partial or total lockdown to prevent the spread of COVID-19 (Vieta et al., 2020), medical professionals were in direct contact with the virus on a daily basis in hospitals, urgent care clinics, and other healthcare facilities. There is now an increased workload, physical and mental exhaustion, insufficient supply of personal protective equipment (PPE) (i.e., masks, gloves, gowns, hand sanitizers), and the pressure of making difficult decisions such as rationing care
Due to their frequent one-on-one contact with infected patients, medical professionals face higher exposure and infection risk for COVID-19, as well as long-term mental health complications related to chronic stress and traumatic experiences (Godderis et al., 2020; Maunder et al., 2006). In addition to the stress and fear of being exposed to and transmitting the virus, other factors affect the mental health of these workers, including lack of flexibility in shifts or adjustment to new working conditions and lack of access to paid sick leave. Kisely and colleagues (2020) conducted a meta-analysis regarding the psychological effects of the COVID-19 outbreak on healthcare workers and found that staff who were younger, female, parents of dependent children, less experienced, or had more contact with affected patients were more prone to psychological distress, as were those with preexisting psychological or
physical issues. Furthermore, in clinical groups, nurses were more at risk for psychological distress than were doctors.
health of medical staff in response to COVID-19 focus on those countries that have been most affected by the pandemic.
Medical professionals struggle to maintain their own physical and mental wellbeing, as well as balance their duties at work with their time and attention to family and friends. They are not only putting themselves at risk for contracting the virus, but also put their loved ones at risk, especially those within their household who are elderly and/or have underlying health conditions. Upon returning home from work, many workers have decided to change in the garage or another secluded area in the house so that they do not come into contact with other members of the house (Kisely et al., 2020). Many individuals have even steered clear of returning home at all so as to not potentially transmit the virus to their family and friends. As a result, there is an increase in isolation and lack of social support. The lack of support coupled with the intensity of their job increases their likelihood of developing internalizing problems such as anxiety, depression, posttraumatic stress disorder (PTSD), and insomnia (Pappa et al., 2020; Sekowski et al., 2020).
Unprecedented Circumstances Due to the high contagiousness of the disease and the overwhelming number of cases entering hospitals, many physicians are not only exposed to the virus, but are also infected. Even among physicians in hospitals, who are able to remain virus free, they are overworked. While the pandemic was at its peak in the United States, physician labor supply was stretched thin. To address this issue, many physicians devoted their time to areas outside of their expertise (e.g., moving to the emergency room or inpatient units); retired physicians returned to work; alternative healthcare professionals (e.g., nurse practitioners, physician assistants) took on some of the advanced roles of physicians; and many fourth-year medical students graduated early to enter the medical workforce (Ruhnke, 2020). With their abrupt entrance, as well as the entrance of other newly recruited healthcare workers in the intensive care unit, adequate psychological training for managing stressful situations and emotions was not provided (Zaka et al., 2020).
Preliminary evidence has shown that symptoms of anxiety, depression, and self-reported stress are common psychological reactions amongst healthcare workers fighting the COVID-19 outbreak (Rajkumar, 2020). When examining the psychological status of the medical workforce during this pandemic, Lu and colleagues (2020) found that medical staff in China who had close contact with infected patients experienced greater fear, anxiety, and depression than did administrative staff. Furthermore, staff in the intensive care unit and the respiratory, emergency, and infectious diseases departments had more psychological disorders and were almost twice as likely to endure anxiety and depression than were non-clinical staff who hardly came into contact with infected patients. It is important to note that findings from the existing literature regarding the mental
Medical professionals are facing unprecedented circumstances where they are expected to make life-and-death decisions and work under intense pressure, which may pose moral dilemmas (Greenberg et al., 2020). These individuals also face potential moral injury as a result of witnessing restricted visiting for those approaching the end of life (Cole-King & Dykes, 2020). They have had to watch people die on a regular basis, whether they are patients or loved ones, and have experienced existential stress. Many staff members are even dealing with the deaths of colleagues, which also
reduces workforce and adds workload to surviving staff. The awareness of these untimely deaths and that these individuals cannot be with loved ones during this time causes great stress and grief that is carried by health care workers even after they leave work. Working with Vulnerable Populations The COVID-19 pandemic has also highlighted large racial and ethnic health-related disparities. Factors such as unequal resource allocation and lack of social distancing due to overcrowding, multigenerational households, or even the lack of opportunity to work from home have caused communities of color to be hit harder than other communities by the virus (Haynes, et al., 2020). According to a Washington Post analysis conducted across the country, counties with majority-black populations have three times the rate of COVID-19 infections and nearly six times the rate of fatalities compared to counties with majority-white populations (Thebault et al., 2020). Members of disadvantaged communities may be more susceptible to the virus due to socioeconomic or cultural factors, genetic predisposition, or differences in infection response, in which the lack of universal healthcare in the US remains a major issue during this intense time (Khunti et al., 2020). Therefore, medical professionals working in healthcare facilities within these communities not only continuously watch their patients and colleagues become infected or die from COVID-19 but are also even more exposed, overworked, and overburdened. Implications for Mental Health Care Providers As the pandemic continues to unfold, it is crucial that we address the mental health status of medical professionals. The need for psychological support is essential given that medical professionals are at greater risk for higher stress, burn-out (i.e., emotional exhaustion), and comorbid psychological complications both during and post-COVID-19
(Fessell & Cherniss, 2020). In order for these professionals, who are working on the frontline, to be able to care for patients with COVID-19, protective and preventive measures must be applied (Zaka et al., 2020). Unfortunately, accessing psychological support can be challenging for many, whether it is due to financial, geographic, or other external factors. It is important for healthcare workers to have access to proper psychoeducation and psychological treatment (e.g., online courses about managing psychological complications, psychological support hotline, group interventions) (Chen et al., 2020; Zaka et al., 2020). Mental health professionals (e.g., psychologists, psychiatrists, counselors) can regularly visit rest areas in the workplace to listen to staff’s challenges and concerns and provide support accordingly (Chen et al., 2020). Potential interventions to promote wellness during this stressful period include cognitivebehavioral therapy (CBT), mindfulness (e.g., mindfulness-based stress reduction (MBSR), and personal coaching (Dyrbye et al., 2019; Panagioti et al., 2016) Alternatively, administrative staff should create a detailed psychological intervention plan, as well as an in-house psychological intervention medical team, to rapidly respond to psychological pressures placed on staff (Chen et al., 2020). Support can be provided both individually and in groups. It is noted that without proper self-care, medical professionals may not have the longevity to continue to provide the best care for their clients. Therefore, staff should be encouraged to practice self-care (e.g., increased physical activity, mindfulness). Essentially, more guidelines need to be set in place to prioritize the mental health needs of medical professionals, which, in turn, allows them to continue helping others. Preventative and protective mental health needs for medical professionals may also include the need for adequate personal protection. This may include the access to proper sanitizations, protective equipment, and COVID-19 testing. Lack of access to these resources may spark concern about one’s own health and the health of those around them,
generating fear and contributing to the adoption of drastic measures, such as reusing masks or wearing garbage bags instead of gowns. Therefore, detailed rules on the use and management of PPE should be provided in order to reduce worry (Chen et al., 2020). Additionally, medical professionals should prioritize, both at work and outside of work, timely rest and comfort breaks, essential needs (i.e., food, drinks, sleep), while administrators, to the best of their ability, schedule fair working hours (Cole-King & Dykes, 2020; Kisely et al., 2020). During breaks at work, they should be provided access to rest areas, proper nutrition, and the ability to virtually communicate with family and friends, which would then increase socialemotional support. Moreover, when working with high-risk patients, medical professionals should be welcomed to communicate their thoughts and concerns with other staff members, as well as look out for their colleagues to ensure everyone on the team feels safe, supported, and valued (Maben & Bridges, 2020). Communication and collaboration
psychiatric professionals, organizations, and research to expand knowledge and solutions (Kaufman et al., 2020; Vieta et al., 2020). Practical Suggestions Medical professionals should be provided the practical tools to conduct their jobs effectively, especially within the parameters of this pandemic. Such tools should include resources and support for medical professionals to perform their jobs effectively, comfortably, and safely. Resources should stem from the administration level. Administrators of medical facilities should make sure staff are properly cared for, both physically and emotionally. Psychological services should be readily available and supportive outlets should be encouraged. Techniques practiced with mental health professionals should also be encouraged for use outside of the workplace as well. For example, mindfulness micro practices are practical tools that require a brief amount of time (i.e., a few seconds to a few minutes) to learn and implement with ease and can be used daily, such as when using hand sanitizer, sitting at a red light, or before answering a text or email (Fessell & Cherniss, 2020).
with other medical professionals encourage staff support, validation, and compassion during these challenging times.
Along with being aware of the psychological implications the pandemic poses for medical professionals, we need
Another key factor to consider in addressing the needs of medical workers, in the time of COVID-19, is the reduction of stigma surrounding seeking mental healthcare. Such stigma prevents many individuals from seeking the help they need and should be eliminated. Medical professionals should have readily accessible psychological treatment available and should be encouraged to use other psychological supports when needed. On a systems level, medical administrators should collaborate with mental health professionals as well as take steps to tackle stigma including, but not limited to, encouraging staff to seek psychological treatment and/or support, validating medical professionals’ experiences and challenges, and promoting a climate that supports their employees’ utilization of psychological interventions. Lastly, there is also an urgent need for collaboration and consensus guidelines amongst psychological and
to be mindful of the physical implications as well. The basic physical considerations, such as food, shelter, sleep, need to be factored in. Among many other relevant topics, physical implications should be addressed in a workshop or psychoeducational intervention for both medical professionals and administrative staff. For example, psychologists leading such groups should inform administrative staff the importance of encouraging medical professionals to take time to eat, drink, and rest. Psychologists can also encourage setting aside time for mindfulness practices, either individually or in groups, such as yoga, use of apps (e.g., Headspace, Calm), or use of a quiet corner or room for the purpose of self-regulation or calming the body and emotions to help with physical aspects. Therefore, psychologists should emphasize recharging and boosting physical well-being to all staff members as well as collaborate with administration to determine the feasibility of the
aforementioned suggestions and practices (e.g., fitting in breaks during busy shifts, finding space for a quiet room or corner) and ensure their utilization. From a holistic perspective, all facets of medical professionals and their care should be accounted for, supported, and treated with care. Conclusion The challenges experienced by those on the frontline during the COVID-19 pandemic are wideranging and pervasive. Without a vaccination, COVID-19 may persist indefinitely. The hardships medical professionals have faced thus far should be acknowledged and commended. They are putting their lives, as well as the lives of their families, on the line every day to protect the lives of many others. Their efforts, dedication, and courage should be appreciated and honored. However, with such stress-inducing work, mental health complications may arise. It is essential to validate the psychological needs of today’s medical professionals, especially in the midst of our nation’s prevailing pandemic. Moreover, discriminations directed towards medical professionals should be reduced (Kisely et al., 2020) and replaced with support and compassion. In response to COVID-19 and the events that follow, mental health care should be considered a major public health initiative. Medical professionals should be encouraged to continue utilizing psychological support to process the nature of this societal crisis. Medical administrators should take the time to seek psychological services for their staff so that supervisors and workers alike can discuss their experiences with COVID-19 and welcome continual psychological support. Medical professionals should be prompted to reflect on their experiences and therefore learn from these challenging times. Moreover, difficult experiences should be validated and be arranged into positive and worthwhile narratives as opposed to traumatic ones, and clinicians should help staff talk through, rather than avoid, their feelings of guilt or shame (Greenberg et al., 2020)
Conclusively, we should reflect on these current circumstances related to COVID-19. The mental health implications for medical professionals working on the frontline of this pandemic must be addressed. Medical professionals have endured long, tiring, and stressinducing shifts to manage the spread of this virus. They require support that will allow them to process their experiences and learn from the events that have transpired, which will help prepare them for the potential of a second wave of COVID-19 or any future pandemic. About the Authors Stephanie K. Vorilas, MA, NCSP is a fourth year doctoral student in Kean University’s PsyD program in Combined School and Clinical Psychology. She has focused on youth and parents/families and has had training experiences in a variety of clinical and educational settings including SUNY Downstate Medical Center and Children’s Specialized Hospital. Claudia R. Emmanuel, MA is a fourth year doctoral student in Kean University’s PsyD program in Combined School and Clinical Psychology. She has a passion for delivering therapeutic services across the lifespan and has experience working in a variety of clinical and educational settings. Adrienne Garro, PhD is a professor in the Department of Advanced Studies in Psychology at Kean University and also serves as coordinator for the School Psychology Professional Diploma Program. Her research and clinical interests include child and family adjustment/adaptation to developmental disabilities and pediatric chronic health conditions and the application of mindfulness to improve psychosocial functioning in youth, parents/families, and school personnel. Dr. Garro is licensed as a psychologist in New Jersey and Pennsylvania.
References furnished upon request.
Promoting Agile Resilience in Education Post-COVID: Affective Attunement and the Human Needs of Students, Teachers, and Parents (1 CE) By, Steven Korner, PhD
Earn 1 CE credit when you read this article and successfully complete the post-test. Instructions for obtaining CE credit: Visit www.psychologynj.org under the Learn Tab.
Teaching and Learning as Emotional Activities: The Importance of Attachment and Affective Attunement How do we make education more human? First, we must acknowledge that teaching is, in part, an emotional activity. One need not look any further than the challenges students, teachers, and parents have experienced attempting to make remote learning work during the pandemic to be convinced that the difficulty in conveying the “personal touch” literally and figuratively has made virtual instruction problematical for all involved, contributing to endemic reports of a lack of student motivation that have been reflected in not attending online classes or in task completion issues. The absence of the personal touch belies the simple and basic human need to feel connected that has been documented long ago in the professional literature (Bowlby, 1973; Grolnick,1990). Although the role of attachment in achieving a sense of safety, self-esteem, and overall well-being cannot be underestimated, it has received relatively scant attention when applied in the context of the teacher-student relationship even when the ecological evidence points to its’ significance. Yet, “…it would be difficult to disagree with the idea that the importance of feeling emotionally attuned, that connection between two people that facilitates their wanting to be with one another and learn from one another, and the consequences of its absence cannot be undervalued in the school setting (Korner, 2013).
n an important New York Times opinion piece entitled, Making Education More Human, Dr. Jal Mehta, a professor at the Harvard Graduate School of Education, made the case that the pandemic has not only exposed and laid bare problems that have previously existed regarding the way we educate our children, but also given us an opportunity to re-think and change education by making it “more human.” The purpose of this paper is to elaborate on this idea by: (1) acknowledging that teaching is, in part, an emotional activity; (2) connecting how affective attunement on the part of teachers, administrators, students, and parents makes school a safe place, and, thus, a place stakeholders want to be; (3) revisiting some core principles in education like differentiation of instruction; and (4) advocating for the use of the latest science in the form of the neuropsychological bases of learning to inform differentiation, and re-fashion the curriculum and teaching practices. What follows is not meant to be exhaustive in scope, but, instead, aimed at refocusing our thinking on the importance of the emotional component in education. Only by redesigning our educational system to make the human needs of stakeholders primary will we promote the resilient lifelong learners post-COVID that our evolving society needs.
Attachment and attunement contribute to the establishment of a holding environment that can
offer safety and the opportunity for mastery. Students who feel “held” by their teachers will experience the personal touch because teachers are accurately emotionally responsive to students by understanding students’ cognitive processing skills and not exposing them to stimulation in the form of either curricula content or teaching methods that can either overpower or are out of sync with those capacities. (I will have more to say about how to accomplish this later). For now, it is enough to agree with Pouts and Gregory (2000-2001) who stated, “We suspect that many teachable moments in a classroom are times in which there is psychological safety, emotional openness and a readiness on the part of both the student and teacher.” Stevens, Van Werkhoven and Castelijns (1997) state that the sequence of events that demonstrate the importance of establishing the atmospheric conditions of emotional safety for children begins with the idea that they come to school to advance their development and to let themselves and others see what they are capable of. However, soon after starting the formal curriculum, differences in the tempo of pupils’ progress are manifest, and teachers and pupils must determine that some of the pupils cannot rise to meet expectations. This is a predictable result of a uniform curriculum that must be completed by all of the pupils in a time specified to meet fixed performance criteria, a phenomenon that Dr. Mehta, too, points to as a one-size-fits-all type of schooling. A proportion of students will come to the conclusion that they are not competent enough for what the curriculum asks of them. Because of this, the abilities that these pupils possess lose relevance, together with any chance of being valued positively. The aim for competence is not honored. At this point, there may be a disconnection between effort and result. The possible result of this will be that students will disconnect motivation to expand competence from the goals set by the curriculum and put effort into other goals. In other words, they may seek
something else to do in which they feel mastery, an apparently meaningful choice to protect their own experience of competence, leaving the teachers (and parents) without being able to rely on the motivation and efforts of their students. The degree to which parents, and teachers are willing and able to adapt to the needs of an individual child will influence the eventual maturational trajectory of that child. Perry (2000-2001) states: A child’s capacity to learn in any given moment is determined by internal rhythms. Our bodies and our minds move through predictable rhythms driven by powerful physiological processes. Sleep and wake. Hunger and satiety. The human brain’s capacity to focus, listen, learn, and communicate is shaped by the symphony of dozens of patterns of rhythmic biological activity, creating, in any given moment, a person’s internal state. In some of these states, we are attentive and receptive (for instance, calm and satisfied), while in other states, we are incapable of learning (when asleep, exhausted, and so on). In order to be attuned to someone, we must interpret his nonverbal (and verbal) cues, which are reflections of these powerful physiological rhythms. Furthermore, in addition to the individual rhythms of the child, each day, week, and school year have superimposing rhythms that influence a child’s “receptivity.” The first few weeks of school, for example, are so novel that most children require time to adjust and become familiar with the novelty before they are able to learn efficiently. In the last month of school, children sense the change in pace and anticipate the upcoming transition, again being less capable of learning efficiently. There is also a rhythm to the week-Mondays are different from Fridays-and a rhythm to the day. A teacher is more likely to find a receptive class in the middle of the morning than in the 30 minutes before school is over. Throughout our lives, attunement helps us build and maintain our relationships. Retrieved from http://www.scholastic.com/teachers/article/ attunement-reading-rhythms-child
Lest we not forget teachers’ needs, Dr. Mehta noted the reciprocal nature of students’ and teachers’ human needs saying that “… the same is true for teachers — they need to feel physically safe, they need support, they need their work to be recognized and honored, and they need working conditions that make it possible for them to succeed.” Again, the pandemic has paradoxically highlighted for all concerned the importance of teachers, and, in particular, what they bring to the learning process not only in terms of their knowledge of subject matter, but also, most significantly, the attunement to their students that permits them to be accurately emotionally invested and responsive. It has also brought to the surface their own needs in terms of working conditions, compensation, support for continued accrual of knowledge, and for being creative rather than compulsive conveyors of knowledge.
reaches out to an individual or small group to vary his or her teaching in order to create the best learning experience possible, that teacher is differentiating instruction. Teachers can differentiate at least four classroom elements based on student readiness, interest, or learning profile: (1) content: what the student needs to learn or how the student will get access to the information; (2) process: activities in which the student engages in order to make sense of or master the content; (3) products: culminating projects that ask the student to rehearse, apply, and extend what he or she has learned in a unit; and (4) learning environment: the way the classroom works and feels.” This feels akin to the academic equivalent of affective attunement and accurate emotional responsiveness. Yet, even in pre-pandemic times, differentiating instruction has been a daunting ask. The reasons for this range from the need for more knowledge on the part of faculty in how to differentiate to the constant and palpable pressure on teachers to push the curriculum forward even when students are already manifesting signs of “not getting it.” Relatedly, the weight on teachers’ psyches of having to prepare students for standardized tests, a practice called teaching to the test, and the overt or implicit practice of holding them accountable for their students’ performance can work counter to the establishment and maintenance of the atmospheric conditions congruent with differentiating instruction and being accurately emotionally responsive to students’ needs. While this is not an indictment of the need for accountability, it is a call for the focus to shift from prepping for exams for exams' sake to continued attention on accurate emotional responsiveness to personalize the educational experience. After all, isn’t learning supposed to be engaging, stimulating, and fun?
Revisiting Some Core Educational Principles and Practices A core educational principle is the need for differentiation of instruction based upon the idea that not all students learn in the same way. Gardner and Hatch (1989), in their exposition of the Theory of Multiple Intelligences, stated that, “… each human being is capable of seven relatively independent forms of information processing, with individuals differing from one another in the specific profile of intelligences that they exhibit (p.4).” The implications were that students have a set of strengths and weaknesses, an idea that has come a long way since it was first introduced. For example, we now know how to assess and identify the specific cognitive processing skills underlying academic subjects and to use this information to differentiate instruction (Flanagan, Hale, and Alfonso, 2010). Tomlinson (https://files. eric.ed.gov/fulltext/ED443572.pdf) wrote that, “At its most basic level, differentiation consists of the efforts of teachers to respond to variance among learners in the classroom. Whenever a teacher
Another factor complicating the differentiation of instruction is the inclusion of curriculum that is inherently uninteresting and not meaningful. For example, I have observed teachers of social studies asking students each year to memorize each state
capitol. Out of context, this exercise is meaningless for students, and, for those students whose shortand long-term memory skills are limited, this kind of demand may exacerbate matters by focusing on a skill in which they are particularly weak, amounting to an assault on their own sense of mastery and self-esteem. Similarly, when social studies or history is taught as a series of disconnected facts with no contextual referent to students’ current life experiences, this, too, robs the learning experience of any personal touch to which students can connect, making this subject, at best, boring. In contrast, when history is taught as a story that has a referent, it can be exciting, offer an emotional connection to the material, and bring to life the old saying, “history repeats itself.” While this is not the place to take up the many facets of the core curriculum that need changing, my observations affirm for me that modifications in the areas of mathematics, science, and language arts to make them more ecologically valid for students may also be in order. A truly differentiated curriculum may obviate some of the need for what are currently known as accommodations, educational interventions meant to “level the playing field” mainly for learners with a diagnosed learning disorder. For example, the practice of timed tests in mathematics to assess basic number operations has caused problems for students whose processing speed is slow. These students may have acquired knowledge of basic operations, but their speed of retrieval may be too slow to complete problems in a test of one-minute duration. Yet, for these students, the pressure of trying to retrieve information fast enough to complete the test, exacerbated by looking around the room at other students who may be less skilled, but have faster processing speed, this kind of task can only make them feel bad. Moreover, a popular accommodation, extended time, would not be applicable here as the task has to do with speed. To make school more human/differentiated, these kinds of tasks would not be part of students’ assignments and other ways could be created to assess their basic knowledge.
For other common accommodations like regulating the quantity and speed demands of the curriculum by breaking down tasks into smaller segments, these strategies while potentially helpful, still constitute ways to accommodate to either curriculum content or instructional formats that were either not meaningful or not differentiated, paradoxically supporting the status quo. In other words, the basic problem of content or teaching method remain and while students may benefit from accommodations, they still must struggle with personally irrelevant content or teaching approaches that compound the problem. These situations are often beyond individual teachers’ place to change and require a systemic change. The Neuropsychological Basis for Learning In a previous paper (Korner, 2016), I wrote, “The professional community is rapidly moving toward a general agreement that academic subjects are byproducts of cognitive abilities and neuropsychological processes and the simultaneous acceptance of the Cattell-Horn-Carroll (CHC) theory as the linchpin for understanding linkages between the two (p.31).” The initial strength and weakness idea of Gardner and Hatch has evolved into the Pattern of Strengths and Weaknesses (PSW) model espoused by Hale and Fiorello (2004) which posits that assessing the presence of a deficit in a basic psychological process provides information about how to direct (i.e., differentiate) instruction. Flanagan, Fiorello, & Ortiz (2010) base their ideas on CHC theory which describes the linkages between academic subjects and students’ cognitive processing skills, positing that academic subjects are really groups of processing skills, an assertion that has reached a consensus in the field (Hale, Alfonso, Berninger, Bracken, et.al., 2010) and has formed the theoretical/neuropsychological basis for the most widely used assessment tools in our armamentarium. Using these tools together with functional data gleaned from careful observations of students’ performance at school to provide ecological validity, professionals can develop a profile of strengths and weaknesses that can guide how to approach instruction in an individualized manner, debunking the one-size-fits-all academic curriculum and
similar one-size-fits-all teaching formats.
Intervention (RTRI) program based upon Della Toffalo’s ideas (2010), applying these neuropsychological understandings at the point where students are identified as struggling rather than waiting for them to fail, a change from the usual RTI approach which limits the tests and tools available to students at different points in their educational travels.
The social and cultural implications of this approach are staggering in that arbitrary divides between special and regular education and advantaged and disadvantaged students fall away as everyone (not just those with a diagnosis) has a pattern of cognitive strengths and weaknesses that determine how they can best learn and how to remediate areas of limited capacity. This is not to say that entities like learning disabilities or economic disadvantage do not exist. However, rather than a demarcation, a proverbial line in the sand, that separates special and regular education or advantaged and disadvantaged students by placing them in different learning settings, a map of students’ skills and the teaching approaches to which they would best respond, can drive the long sought-after goal of inclusion.
Recommendations What is needed to make learning a more human process? Stakeholders need to be given an understanding of how all students learn, how learning can be derailed, and how our knowledge of the way students acquire information and skills can be used in their best interests. Specifically, teachers and administrators must be on the same page and support must be given to them first in order that they may, in turn, support students. Just as the adults traveling with children on a plane are instructed to place the oxygen mask over their face in the event of cabin depressurization problems so that they are able to help their children, teachers and administrators need all kinds of supports previously lacking so that they can be better equipped to breathe life into their students and make education what it was meant to be-a collaborative, interesting, and fun enterprise that will enhance not only students’ knowledge base, but their emotional health. Defining those supports, revisiting the content of the core curriculum, which according to Gardner and Hale, should reflect congruence with developmental norms, and making the process of educating our kids more human would be the goals.
While teachers are generally not trained in CHC theory, psychologists and learning specialists use the instruments which are based upon this neuropsychological model and are learning how to apply the insights obtained from students’ cognitive processing profiles to help teachers support students in ways congruent with their learning styles. These professionals are already engaged on child study (CST) and multiple tiered support system (MTSS) teams to support special education and regular education students, respectively, and with some changes to their functions to free them up from the cumbersome and time-consuming rigors of compliance with federal laws (i.e., IDEA, ADA), can spend the bulk of their time in classrooms working more directly with teachers and students. This is not to say that protections under the law should be abandoned. Instead, a division of labor should be considered to place the most highly trained professionals where they belong-providing direct and consultative services. In fact, by positing the similarities between how students learn rather than their differences, innovations can be implemented to bring much needed services to students, teachers, and parents earlier in the educational process. For example, I have developed a Response to the Right
About the Author Dr. Korner earned the doctorate from the University of Pennsylvania, and has been appointed to director of psychology, at New York Medical College-Metropolitan Hospital, associate professor (tenured) doctoral program in child-clinical psychology and director of school psychology program, Seton Hall University, coordinator of special education, Harrington Park School district, and has been in private practice for 43 years in Cresskill, New Jersey.
References furnished upon request.
CONTINUING EDUCATION ARE YOU READY FOR THE JUNE 30TH DEADLINE? Every biennial license renewal period, licensees shall attest that they have completed courses of continuing education. Each applicant for biennial license renewal shall be required to complete during the preceding biennial period 40 credits of continuing education related to the practice of psychology. For New Jersey Continuing Education Requirements (see Section 13:42-10.19 of the BoPE Regulations for details) Live-In Person Requirements: On April 13, 2020, The State Of New Jersey Department of Law And Public Safety Division of Consumer Affairs issued a Notice of Rule Waiver pursuant to Executive Order No.103 (Murphy) COVID-19 State Of Emergency DCA-W-2020-04 – All Continuing Education credits earned during the public health emergency, including but not limited to credits earned prior to the date of this rule waiver will be counted as in-person credits.
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Student affairs Grit in the Era of COVID: A Neuropsychological Perspective By, Jared B. Hammond, MA
t was roughly one year ago that the US initiated social distancing measures in an effort to reduce strain on our medical infrastructure in response to the novel coronavirus. As it raced throughout the country, some claimed these practices would be over in a few weeks, others said longer. Notwithstanding, there are now upward of 500,000 Americans who are no longer with us. In their wake, millions more mourn their absence with others struggling to handle the extreme strain the pandemic has upon us: individually and collectively.
navigated the emotional turbulence of the past year and is there something that has aided in their success? The literature has been rife with exploration of how people successfully cope and navigate the unthinkable. Grit. Resiliency. Perseverance. Psychological flexibility. The ability and/or capacity for managing and recovering from stress has been a focus of research in the last decade. Many have examined these constructs as personality traits (Kong et al., 2018; Smith et al., 2010), while some have begun to explore it as a psychological process (Hayes et al., 2018).
History points to the end of the Second World War as the impetus for modern psychological assessment and treatment with veterans complaining of a slew of behavioral challenges resulting from post-traumatic stress. As we begin to emerge from social isolation and reintegrate into safer social activities, we cannot underestimate the hidden and visible scars the pandemic has left on us. There seems to have been a tremendous shift in our environment despite the obvious feeling that, for the last year, everything has been on pause. But, with the recent string of mass shootings in the US, it seems we are restarting our society once again, even while many BIPOC and AAPI individuals still fight for basic rights.
Previous work in this area has largely focused on posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) and neuroepigenetic correlates of behavior (Agaibi & Wilson, 2005; Kong et al., 2018; Russo et al., 2012) with a focus on the neuroendocrine system. Historically, the hypothalamic-pituitary-adrenal axis (HPA) has been highlighted by way of glucocorticoids in connecting the HPA and the prefrontal cortex (PFC) following trauma, particularly for individuals with adverse childhood experiences (ACEs). This finding was present regardless of diagnosis (e.g., PTSD, MDD). Adolescent athletes who reported lower trait resiliency reported a higher number of postconcussive symptoms following mild traumatic brain injury (mTBI), as well as higher severity of anxiousness, nervousness, sadness, and irritability
Amidst all this suffering, some people have emerged by all perceptions unscathed, almost victorious. So, how have people successfully
(Bunt et al., 2019). Advancement in neuroimaging has allowed for techniques to supplement functional magnetic resonance imaging (fMRI), with subtle measurements the magnitude of activity through regional homogeneity (ReHo) or fractional amplitude of low-frequency fluctuations (i.e., fALFF) as a degree of resting state MRI (rsMRI). This been integral in neuropsychological studies examining the neuroanatomical correlates of grit and resilience as potential frontally mediated executive processes. Multiple aspects of the PFC, particularly the orbitofrontal cortex (OFC), are implicated in emotion regulation and reward processing (i.e., pain versus pleasure) for individuals who scored high on trait resiliency measures (Kong et al., 2018; Reynaud et al., 2013). In addition, the dorsomedial PFC (dmPFC) is thought to mediate the relationship between grit and academic success (Wang et al., 2017). This region of the brain is theorized to be responsible for various higher cortical processes, such as self-monitoring, planning and organization, and goal directed behavior (e.g., goal setting, task completion), as well as problem solving and opponent processing of previous failures (i.e., providing evidence to oppose rumination). The anterior cingulate cortex (ACC) is implicated in earlier development (Holz et al., 2020) through adulthood (Reyanud et al., 2013) in convergence studies examining protective factors, grit, and resiliency, and is responsible for connecting more limbic structures of the brain to the PFC. Interestingly, the insula appears over-activated in people that self-rated with low resiliency when presented with both aversive and neutral stimuli (Waugh et al., 2008). However, there is not consistent evidence regarding the association between resiliency, ACC, OFC, and dmPFC (Kong et al., 2015; Sekiguchi et al., 2015). Toward that end, language appears to be a moderating factor (Kong et al., 2018; Hecht, 2013; Dolcos et al., 2016) and a potential area for future research. Given the involvement of cortical and subcortical
structures, neuropsychological testing may be helpful in elucidating future research endeavors. Though grit may be negatively correlated with depressive or anxious symptomatology, it is not necessarily related to cognitive status or impairment (Rhodes et al., 2019). Executive dysfunction, a more cortical disruption, is often examined using neuropsychological tasks like the Wisconsin Card Sorting Test (WCST), Controlled Oral Word Association Test (COWAT), and Raven’s Progressive Matrices, or using batteries like the Delis-Kaplan Executive Function System (D-KEFS). Basic attention and working memory, conceptualized often as more subcortical processes, are usually examined using tasks like the Digit Span subset from the Wechsler Intelligence Scales (WIS) or the Conners Continuous Performance (CPT) or Continuous Auditory Test of Attention (CATA). Interestingly, several studies have pointed to a correlation between low levels of reported grit and attention difficulties (Kalia et al., 2018). As such, future researchers may wish to utilize the aforementioned measures, as well as the Trail Making Test (TMT) given the possibility for examining differences between basic attention and rapid executively mediated set shifting. Furthermore, the use of the COWAT to examine any phonemic or semantic fluency discrepancies could also be used to highlight executive challenges mediated by language. However, future studies will have to account for the potential that individuals with lower levels of reported grit may be less motivated and/or more likely to engage inconsistently in neuropsychological testing (Hill & Aita, 2018). So how do we teach grit? Can we increase resilience? Unfortunately, this answer it not clear. Some question if a personality trait can be taught or altered. Notwithstanding, it seems the adage “quantity builds quality” applies in theory, with repeated exposure to stressors helping to build resiliency; however, this process is not necessarily supported yet by research, with a need to validate the efficacy and effectiveness of grit development programs (Hwang & Nam, 2021). While early neuroscientific
research suggested more of a stable process, it seems the development of grit occurs over a lifetime (Barkley, 2005; Duckworth & Eskreis-Winkler, 2013) and may be related to focused and deliberate practice (Duckworth, 2016). As such, mindfulness and acceptance based practices and therapies may prove helpful in understanding a process for developing grit and resiliency. Acceptance and commitment therapy (ACT) focuses on increasing psychological flexibility through mindfulness and committed action to help “defuse” from unhelpful narratives to engage in a life more consistent with an individual’s values. As a transdiagnostic approach to psychological well-being, it could be one of multiple process-based approaches the field needs to better understand these complex concepts. About the Author Jared B. Hammond, MA is a fourth year doctoral student at Kean University’s Combined PsyD program and aspires to be board certified in clinical neuropsychology. He has completed externships in clinical neuropsychology at Kessler Institute for Rehabilitation, Lenox Hill Hospital, and Livingston Public Schools while concurrently working as a neuropsychometrist for Head to Head Consultants. Jared will be completing his internship in clinical neuropsychology at Denver Health/University of Colorado School of Medicine with a focus on providing access to neuropsychological services for marginalized and underserved communities. References Furnished Upon Request
Student-Athlete Resiliency During COVID-19
By, Daniel Watson, Simone Cooper, and Rafael Inoa, PhD Kean University
n addition to the typical academic stressors of being a college student, student-athletes can experience sport-specific stressors such as pressure from teammates, coach demands, family expectations, fear of failure, and loss of identity due to retirement or injury (Fletcher & Hanton, 2003). These unique stressors put student-athletes at risk for anxiety, depression, and burnout, among other psychological obstacles (Hammond et al., 2013; Purvis, Gonsalves, & Deuster, 2010; Rao & Hong, 2016). Student-athletes are also expected to manage full academic loads in addition to demanding athletic training responsibilities, stressful competitions, and challenging travel schedules (Sudano et al., 2017). While the taxing nature of being a student-athlete can cause unique distress, the challenges they face can also provide them with increased mental toughness, tools to overcome adversity, and agile resilience. According to Galli and Gonzalez (2015), a defining part of being a successful athlete is the ability to respond positively to setbacks and remain strong in the face of adversity. One such example is Maritza, a student-athlete during the COVID-19 pandemic.
Maritza is a junior in college studying International Business and a member of the women’s volleyball team at Marshalltown University (a pseudonym). Like many other student-athletes across the country, she experienced her fall competitive season cancelled due to COVID-19, and things remain uncertain around what may happen next season. Maritza is no stranger, however, to adapting to the various challenges and obstacles inherent with being a student-athlete. At any given semester, she will find herself juggling team practices, a full-time course schedule, and finding time to foster a social life. She is a member of a competitive athletic program in a strong division and is constantly pushing herself and teammates to get better. Everyone on the team is vying for playing time.
In her freshman year of college, Maritza initially struggled to acclimate to the demands of being a student-athlete. Furthermore, she picked up a knee injury from skiing at the end of her first season. This kept her sidelined for the end of her freshman year and set her back for the start of her sophomore season. During this time, she struggled with fluctuating levels of guilt and depression, which at times were intense. However, she was able to bounce back from injury through her sheer determination to come back “better and stronger,” in addition to having a strong support system around her. She consistently attended her
rehabilitation program, while keeping up with her studies, and regularly showed her face at team practices and events to remain connected to the team. Maritza managed to have a positive impact toward the end of her second season and was looking forward to continuing this upward trend until the pandemic hit.
COVID-19 Pandemic Though student-athletes like Maritza are trained to expect typical sportsrelated setbacks and failures, the sudden onset of the COVID-19 pandemic in the spring of 2020 initiated a cascade of unprecedented stressors. Athletic programs across the country were forced to abruptly cancel their spring seasons and thousands of student-athletes were left struggling to come to terms with this sudden end to what may have been their very last season competing in their sport (Bullard, 2020). Many student-athletes were forced to train independently in hopes of being able to compete in the impending 2021 season. Additionally, many have been forced to delay their projected graduation to maintain eligibility, consider postgraduate options prematurely, or abruptly leave their sport altogether. These adjustments, similar to those experienced by an athlete with a career-ending injury, may cause student-athletes to experience increased levels of stress, anxiety, and depression related to their futures and self-identities (Butt & Molnar, 2009). Athletes are generally expected to transition out of their sport at some point. However, circumstances such as injury or other unexpected life events can cause athletes to involuntarily or prematurely end their athletic careers. Early athletic termination and involuntary transition out of sports has been linked with feelings of loss and social rejection (McKenna & Thomas, 2007; Wippert & Wippert, 2010). It is crucial to consider the role of athletic identity and the profound loss that many athletes experience when they must involuntarily give up this part of their lives, ultimately losing the social support of teammates and coaches, as well as the structure and motivation that comes along with being a member of a team (Butt & Molnar, 2009; Chang et al., 2018; Lally, 2007; Park et al., 2013). While the studentathlete is no stranger to resiliency, as demonstrated in Maritza’s story, the impact of the COVID-19 pandemic on this population can have serious implications similar to injury or other unexpected life events. With the real possibility of more season cancellations, as we approach the year mark of the abrupt termination of the spring 2020 athletic season, proper support and resources must be provided. A significant amount of research has been dedicated to expected transition out of sport and resources to help this subsection of the athlete population (Clemmet et al, 2010; Fuller, 2014). Additionally, research has addressed unexpected or involuntary transition out of sport relating to injury or other unforeseen life events such as health problems (Butt & Molnar, 2009; Park et al., 2013). While the COVID-19 pandemic is a unique circumstance with many unknowns, we can draw parallels to the resources and responses utilized for those involuntary transitioning out of sport due to injury or health problems as a
guideline. Regardless of the reason for a premature transition, athletes who are forced to leave their sport unexpectedly may experience adverse outcomes. We know from the literature that athletes who transition out of sport prematurely experience feelings of loss and social rejection (Butt & Molnar, 2013). The pandemic has led to similar outcomes, which has likely brought about experiences akin to loss and social rejection in relation to their salient athletic identity.
Recommendations In light of the consequences to student athletes resulting from the current pandemic, it is necessary to look to prior literature for supportive strategies. Most prominent in the literature are findings related to athletes who experienced losing their athletic season as a result of injury or other unanticipated circumstance. Such research has shown fostering social support networks, goal setting, pre-retirement planning, and post-graduation planning to be some key approaches to helping athletes effectively transition out of sport (Arvinen-Barrow et al., 2019; Evans et al., 2010). Considering some of the current constraints related to COVID-19, social support can be fostered by actively staying connected with teammates, friends, and family. This can be as simple as scheduling daily check-ins with others via phone and video calling. Further, coaches can be instrumental in facilitating social support and connectedness by holding and encouraging virtual meetings and practices within their teams. Goal setting can also be helpful by keeping athletes focused on concrete, measurable aims to help direct efforts. Similar to an athlete returning from injury, short-term and long-term goals can help keep athletes affected by COVID-19 grounded and focused. Post-graduation planning or pre-retirement planning can be a helpful endeavor to explore with athletes to begin preparing them for life after sport. These supports should be addressed throughout the studentathlete experience, and not just when most applicable, such as after sustaining a career-ending injury, an unprecedented event (COVID-19), or during the final
year of eligibility. Rather, implementing workshops focused on post-graduation or pre-retirement planning may be offered by athletic programs in collaboration with career services throughout an athlete’s collegiate career. Finally, while it is known that an abrupt transition from sport can lead to adverse outcomes, and that the pandemic has been such a transition, it is still unknown exactly how the pandemic affects athletes in comparison to other transitions, such as injury and graduation. Some athletes have identified stress management and time management skills as desired areas for intervention during this time (Bullard, 2020). This makes sense as many athletes have lost out on playing their sport during this time, an activity which likely served as a stress management tool. Further, student-athletes have lost the support and structure that their athletic responsibilities provided as a result of the pandemic, which may be impacting their ability to effectively manage their time. Future research should aim to further explore studentathlete experiences and possible interventions that may serve to benefit those affected during and in the aftermath of COVID-19, as well as those who may encounter abrupt transitions from sport resulting from related and unrelated factors. About the Authors Daniel Watson is a doctoral student, and former studentathlete, in the combined school and clinical psychology program at Kean University. He holds research interests within the at-risk youth and student-athlete population, as well as clinical interests in trauma-informed care. Simone Cooper, EdM is a doctoral student in combined school and clinical psychology at Kean University. As a former studentathlete advisor, she holds research and clinical interests in Sports and Performance Psychology, as well as in mental health and wellbeing among gender and racial/ethnic minority groups. Dr. Rafael Inoa is an assistant professor at Kean University with a PhD in Educational Research and Program Evaluation. He is the assessment coordinator for the Department of Educational Leadership at Kean and is an external evaluator for out of school programs in the State of New Jersey.
References Furnished upon request.
Agility, Resilience and StudentParents in the Time of a Pandemic
By, Elease Wiggins and Nouriman Ghahary, PhD
ccording to a 2018 study conducted by the Institute for Women’s Policy Research (IWPR), 1.7 million single mothers were enrolled in colleges across the United States between 2015 and 2016. These students were referred to as “student-parents” (Tehan, 2007), and many of them were first-generation college students of African American descent, from families with low socioeconomic status. Understanding the needs of student-parents amidst a global pandemic is important, both in terms of psychological theory and interventions. This paper provides a look at concepts of agility and resiliency as it relates to student-parents. Through the depiction of adversity experienced by the student-author of this article as a student-parent, this paper will demonstrate how agility and resilience help in the achievement of academic success. Implications for research and support are discussed. In 2020, the COVID-19 pandemic triggered one of the most unparalleled health and economic crisis of our times. The strains posed by the pandemic have exacerbated the already challenging experiences of student-parents. Recent studies report that pandemicrelated psychological stress can significantly undermine students-parents’ ability to cope with their learning and completion of course requirements perpetuating academic stress (Lin, 2021). These challenges may take a harder toll on student-parents who are single mothers. Extensive research has documented that single mothers face psychological distress such as maternal depression and anxiety, as well as financial insecurities. These experiences can adversely impact the daily lives of
single mothers and the development of their children (Lashley, 2014). With the sudden closure of schools and childcare facilities, as a result of the COVID-19 pandemic, student-parents have been forced to balance remote learning for themselves and their children, along with having to manage many other salient responsibilities. The construct that characterizes individuals who survive stressful and maladaptive situations is called resilience. “Resilience is a term deeply rooted in the world of stressful life events and circumstances” (Garmazy, & Neuchterlein, 1972, as cited in Cowen, 1991), and according to Jew, Et al. (1992), in the absence of environmental stressors, resiliency is not evident. Research in the field of trauma and on the sequelae of restrictive conditions, adversity, stressful life events, political violence, and oppression shows that where certain conditions can cause trauma, they can at the same time lead to growth for some people (Ghahary, 2003). Resilience explains “posttraumatic growth,” and its brief definition is the ability to bounce back. Resilience is not necessarily the absence of trauma or lack of impact by adversities one has endured. Resilience is not mere survival, but it is standing up stronger than before, having integrated the lessons of traumatizing events into one’s knowledge about one’s strength and how to manage one’s environment in a meaningful way. Agility is defined as “the ability to adapt and innovate by adding new practices to react to a crisis.” (NJPA, 2021). A recent paper from Columbia University’s Teachers College found that people who are learning agility usually exhibit six characteristics. The first
of the six characteristics are being “open to learning.” Gligor, et al. (2019) examined the relationship between agility and resilience and found that these two constructs share three common dimensions such as the ability to adjust tactics and operations (flexibility), speed/ accelerate operations, and scan the environment/ anticipate. Many individual and group examples illustrate how this phenomenon crystallizes in individuals and communities. For example, exiles, who, despite numerous dangers and difficulties, reach the host countries and become part of the most successful people in those societies, can be named as resilient people. Forced abandonment of a familiar environment, the ascent of dangerous mountain slopes, and rebuilding of life in a country unfamiliar with a language and culture that often does not value the part of the “identity of the exiled man,” along with economic problems, distance from loved ones and acquaintances, asylum conditions, etc., leaves most exiles wounded. Despite enduring this wound, they reappear as useful and successful individuals in society. And, this is the meaning and crystallization of resilience (Gligor, 2009). It is not easy to “bounce back“ from a negative experience, overcome it, and get back to life stronger and wiser, however, it is possible. Agility and resiliency are essential characteristics in transforming pain into positive statements and actions. As a student-parent during the pandemic, I believe that people closest to the problem have the solution (Wiggins, 2015). Two years before attending Felician University, I was an adjunct professor who was homeless, on welfare, and supporting two children. During those challenging times, people closest to me labeled my behavior as “crazy.” I would argue that my “faith” was guiding me. McWilliams (2004) describes faith as “a gut-level confidence in a process despite inevitable moments of skepticism, confusion, doubt, and even despair.” In several other studies, student-parents identified spirituality as a strong influence and perceive it as a source of resiliency when trying to meet their educational goals (Mattis, 2002; Patton and McClure, 2009). “Belief systems are powerful forces in resilience” (Walsh, 1998), and I believe they can help student-parents navigate through their unique challenges.
During chaotic and uncertain times, educational institutions will benefit from “developing interventions and educational programs that may help foster resilience and effective coping strategies that assist in dealing with stressful situations” (Ghahary, 2003). These programs can specifically be built to support student-parents. Due to the diversity of the students-parent’s population, identifying and supporting their basic needs will advance educational intuitions’ efforts towards diversity, equity, inclusion, and belongingness while also increasing retention rates. If resources and opportunities are not available, student-parents can demonstrate agility by advocating administrators for “innovative” online support services. Such forms of support may prove vital in reducing isolation and loneliness and instilling strength and resilience in student-parents (Lin, 2021). Further research is needed for a further understanding of the students-parents’ experiences. This paper depicted the personal experiences of an African American woman in a counseling psychology doctoral program. Besides being a mother of two children. Challenges, adversity, resilience, and agility were illuminated. About the Authors Elease A. Wiggins is a first-year counseling psychology doctoral student at Felician University. Her research interest is the administration of mental health services provided to underrepresented and marginalized populations. She is the author of, A Farewell to Welfare: 25 Strategies to Freedom, Independence and Prosperity. Nouriman Ghahary is a licensed psychologist and an associate professor and Director of Clinical Training in the PsyD program in counseling psychology at Felician University. She is an intensively trained DBT therapist in private practice with specialization in child, adolescents and family therapy. Her research is focused on trauma and resilience. References furnished upon request.
CALL FOR BOARD SLATE NOMINATIONS As stated in the NJPA bylaws, all NJPA elections shall follow the policies and procedures set forth by the Nominations and Leadership Development Committee that are approved by the Executive Board. Click here
to review the Nominations Policies Manual (log in required). Click here to review the board job responsibilities (revised 2020 - log in required).
Every effort will be made to secure at least two nominees for every office on the slate. In the event that the Nominations Committee is unable to recruit two candidates for each open seat, one candidate and a writein option will be presented to the membership on the ballot. The exception is the Affiliate Member-At-Large position, no write in line will be provided as the nominees come from the Affiliate Caucus. The Affiliate Caucus shall draw names from the entire affiliate population. No name shall appear on the ballot for more than one office. All NJPA elections shall take place electronically. The voting period shall commence on the first Tuesday of September and will remain open for three weeks after electronic voting begins. NJPA NOMINATIONS & ELECTIONS COMMITTEE CRITERIA FOR EXECUTIVE BOARD NOMINATIONS 1. NJPA member in good standing; 2. Evidence of volunteer involvement in NJPA and/or a leaderhsip role in an NJPA affiliate organization for at least one year; 3. No current legal or ethical violations as determined by the BOPE, court or other governing body. Members of the executive board have the responsibility to govern the association and to set policy and priorities. In addition to these major roles, each board member has specific responsibilities. Important Note: Material for executive board meetings is sent electronically. Board members must be able to access and review these documents prior to Board Meetings. Additional criteria will apply as follows: President-elect: Candidates must have served on the NJPA Executive Board or in a leadership position in an affiliate organization, or chaired an NJPA committee, special interest group, task force, resource group, or had an active role as an NJPA committee, special interest group, or resource group member within the last three years. Term of office: January 2022 to December 2022 as President-Elect; January 2023 to December 2023 as President; January 2024 to December 2024 as Past-President. After the September election, the elected president-elect will become a mentee to the current president-elect (October through December), at the NJPA Executive Committee and Executive Board meetings, to learn the role. The role will begin in January. Secretary: Candidates must have familiarity with fundamental operations of the NJPA Executive Board; experience as secretary in other organizations and/or committees will be helpful; technological and organization skills required. The candidate should have had an active role as an NJPA committee, special interest group, resource group, or affiliate within the last five years. Term of office: January 2022 to December 2024 After the September election, the elected secretary will become a mentee to the current secretary, (October through December) to shadow the current secretary at the NJPA Executive Committee and Executive Board meetings to learn the role. The role will begin in January. Member at Large (Nominations): Candidates must be a member in good standing in NJPA and have had an active role in an NJPA committee, or other NJPA group including NJPAGS, task force, special interest group, resource group, or affiliate within the last year. Term of office: January 2022 to December 2024 Submit nominations for the above board positions online by May 15. The form can be found in the Members Only section of the website www.psychologynj.org (login required). We will also be circulating notices via the Friday Update and direct messaging. Member at Large (Affiliate): Candidates must be a member in good standing in NJPA and his/her affiliate and have had an active role in an NJPA committee, or other NJPA group including NJPAGS, task force, special interest group, resource group, or affiliate within the last year. Interested members please contact Phyllis Bolling, Affiliate Caucus Chair, at firstname.lastname@example.org by April 1.
2021 APA's Practice Leadership Conference: A Virtual Call for Action By, ECP Committee Chair, Melany M. Rivera-Maldonado, PhD
oming from a rural town of a small island, I found out early in life what it means to feel like a “small fish in a big pond.” I am honored to be writing this testimonial for a journal with the theme, Agile Resiliency because the theme resonates deeply with my life experiences and, most recently, with my participation during the annual APA’s Practice Leadership Conference (PLC). My sincere appreciation goes out to the New Jersey Psychological Association for allowing me to be a participant in such an important event.
related to APA’s strategic plan and detailed past efforts during the pandemic. The work of Dr. Mayso Akbar, the recently appointed APA’s Chief Diversity Officer, was also highlighted with optimism. After each presentation, there was an opportunity to continue the discussion in an open format at the tables. During the breakfast for Early Career Representatives, I had the chance to meet other state-level young leaders and their initiatives, generating ideas to create a more cohesive ECP’s network. In between presentations, awards were presented by Division 31. We were proud to see our Executive Director, Keira Boertzel-Smith, JD, receiving the Outstanding Achievement by a Psychological Association Staff Member Award for her amazing work with NJPA.
Due to the ongoing pandemic, the conference took place online during two weekends: March 5-7th and 1415th. Remo, the platform where the conference took place, simulated a convention center. Once logged in, you were randomly “assigned to a table of eight,” with the possibility to “move around” nine different floors full of attendees.
Attending a virtual conference throughout two weekends allowed the possibility to multitask, including cooking while listening to different speakers, and researching their work simultaneously. Topics such as student debt, Medicare/ Medicaid cuts, and ensuring access to telehealth are issues that require our attention. Understanding the impact of Medicare cuts on private payers and the new rule related to information blockage in electronic health information (EHI) highlighted the importance of staying connected to discipline-relevant discussions.
In front of the screen, hundreds of delegates from APA’s leadership from state, provincial, and territorial psychological associations gathered in a virtual pond. I never pictured myself sitting at a table with APA’s PastPresident, Dr. Sandra Shullman. And yet, there I was, trying to fix my microphone while introducing myself with my Spanish accent. Throughout the different tables, early career psychologists like me had the opportunity to meet and exchange thoughts with established leaders within the discipline.
The conversation about the Distinctiveness of the Doctoral Degree was relevant for newer generations of students and psychologists trying to find a career path with multiple possibilities for professional development. Statistics related to an increased number of diverse psychology undergraduates who decide to apply to master’s terminal degrees opened up a conversation regarding barriers and access to doctoral programs. APAGS Chair, Mary Fernandez, emphasized the importance of considering equity matters, including the accessibility of doctoral degrees from a financial standpoint and the need to continue advocating to promote accessibility for multiple groups. This, particularly in a moment where APA continues
Once each presentation was about start, the “table view” on the screen would close, and you would see the individual presenters, with an option to use the chat. You can watch the recordings of all presentations by visiting the APA’s 2021 Practice Leadership Conference website. Topics about equity, diversity, and inclusion were consistent throughout the various presentations, involving areas such as health care access, APA’s leadership, advocacy, and doctoral training. During the plenary session, APA’s Chief Executive Officer, Dr. Arthur C. Evans, Jr., and APA’s President, Dr. Jennifer Kelly, answered specific questions
to have a representational gap of Black, Indigenous, People Of Color (BIPOC), gender minorities, and other groups that face the impact of systemic barriers (APA, 2020).
provide euqitable access for all; the Tele-Mental Health Improvement Act; and the increase of fiscal year (FY22) appropriations for Critical Psychology Workforce Training Programs.
As the first weekend ended, it was evident that the call for leadership to continue advancing psychology during these unprecedented times is necessary. The COVID-19 public health emergency has undoubtedly brought an increased need for psychologists to be invested in direct care and public policy matters. To this end, the second weekend emphasized advocacy in
Although PLC was intimidating at first, participating in this event was an unforgettable experience. Finding a voice among psychologists in various stages of their careers, who are constantly partnering to advance our discipline, was a reminder that collectively we accomplish more. Now the work continues in our
a moment of political divide. On March 14th, Former Senate Majority Leaders Tom Daschle and Trent Lott, started the day with a discussion on the importance of finding opportunities for collaboration as a bridge to hold a divided Senate’s day-by-day operations. Later that day, Dr. Tania Israel emphasized her work with Beyond Your Bubble. This recently published book integrates social psychology research into creating opportunities for connection across the polarized points of view. These sessions prepared us for our Virtual Lobbying Visits to Capitol Hill, where we had virtual meetings with the offices of Senator Booker, Senator Menendez, Representative Sires, Representative Payne, Representative Malinowski, and Representative Sherrill. Having the opportunity to join Dr. Daniel Lee, Dr. Peter DeNigris, Dr. Lucy Takagi, Dr. Virginia Waters, Keira Boertzel-Smith, and Dominique Reminick was an honor. At all our meetings, we advocate for the following: telebehavioral health policies that
everyday practices and advocacy. I am looking forward to continuing the work and call for leaders as we move forward from this last year. About the Author Melany Rivera-Maldonado, PhD (pronouns: she, her, hers), is the current chair for the NJPA ECP Committee. She is a licensed bilingual-Spanish psychologist in NJ and NY. Dr. RiveraMaldonado is currently the Director of Training of the YCS Institute for Infant and Preschool Mental Health, where she oversees an APA Psychology Doctoral Internship Program. She taught at higher education institutions and currently provides consultation and workshops to non-profits on topics such as, diversity, child development, and trauma-informed care. In addition, she has a part-time private practice in Jersey City where she provides therapy and assessment services. At NJPA, she participated on the Immigration Emergency Action Group (NJPA), and was recognized with the 2020 Distinguished Teacher Award. Her work integrates multicultural issues, attachment theories, psychodynamic therapy and the impact of early relationships across lifespan.
Book Review: Understanding and Treating Chronic Shame: A Relational / Neurobiological Approach Routledge, New York. DeYoung, PA (2015)
By, Ben Susswein, PhD
n Understanding and Treating Chronic Shame: A Relational / Neurobiological Approach, published several years ago but garnering increasing attention in clinical circles more recently, Toronto-based relational psychotherapist Patricia DeYoung argues that “shame is a much more powerful and pervasive phenomenon than most of us realize.” While shame is typically understood as an inhibitory emotion, an acute instance of embarrassment, “chronic shame,” as De Young unpacks it, is a more
be over this by now,” not entitled to their own experience. Failing to address chronic shame can make the therapeutic process feel like driving with the handbrake on. De Young presents her own definition of chronic shame as the “disintegration of the self” in response to a “dysregulating other,” and presents a number of cases that demonstrate her relational conceptualization of chronic shame and how to address it in treatment. She admirably grants equal time to the contributions of many other practitioners -- self psychologists, relational psychoanalysts, and family therapists -- not to debate the relative merits of each approach so much as to point out that despite different terminology, there is a common focus on creating a therapeutic connection that makes it possible to accept and examine painful experiences, both ones recalled from the past and ones that arise in the course of treatment.
complex phenomenon, both a state of being and a narrative about one’s state of being, in the words of intersubjective psychoanalyst Donna Orange, “a world of experience.” De Young illustrates how chronic shame is an “elusive shapeshifter” that assumes many guises, animating the pathology of individuals she identifies with delicious alliteration as “perfectionists, procrastinators, and pleasers.” The book highlights the impact of chronic shame on the experience of the self as deficient and defective, unloved and unlovable, an imposter who lives in fear of being revealed as incompetent, or an undocumented alien in a world of bona fide citizens, anticipating inevitable deportation.
De Young’s generous pluralism reflects the disclaimer she issues in the introduction: “While I appreciate sciencebased explanations of how psychotherapy works, I hold them somewhat lightly. For I also believe, along with relational therapists of a more philosophical / hermeneutic bent, that all theory is interpretation. As a psychotherapist, I am not a scientist; I am a partner with clients in searching out the metaphors and meanings that make sense of their lives.” Later in the book, she declares that “in the artful creation of narrative, almost any theory can be useful when it helps us resonate more fully with our clients’ emotional, embodied experience of shame.” One of the merits of the experiential approaches to psychotherapy De Young advocates that rather than imposing a theory on the
Understanding and Treating Chronic Shame argues that establishing a secure and trusting therapeutic relationship may not be sufficient if a client has not addressed feelings of unworthiness and incompetence. I’m thinking of all the folks who can grow to love their therapists but still don’t make much progress in loving, or even liking, themselves; those who don’t allow themselves to explore their own pain by consistently interrupting themselves with statements like “maybe I’m making too big a deal about this” or “I should
therapeutic process to shape its meaning, the work stays on the “experience-near” level, with explanations emerging from a narrative co-created in the process of processing emotional experience. The book is a whirlwind tour of different perspectives and approaches to dealing with the core problem, which De Young identifies as chronic shame, introducing different formulations and interventions reflected by the case vignettes. The experience is a bit like a tasting menu, rather than a meal, appetizing but not entirely satisfying. There are brief references to a variety of theoretical approaches, which all sound interesting and credible, but no integrative formulation. Clearly, this is De Young’s intention, given her explicit disinclination to embrace any particular theory. My simultaneous engagement and dissatisfaction with this book prompted me to formulate my own understanding of chronic shame, which may be very different from your own understanding, if you read the book. I had some difficulty getting comfortable with DeYoung’s definition of chronic shame as the “disintegration of the self” until I thought of it as the “dys-integration of the self,” as an organizational defect, a splitting of identity into dissociated “good and “bad” fragments that predisposed the individual to experience “disintegration” in the face of what might otherwise be manageable and inevitable frustrations, disappointments, losses, or failures. Considering the explicit impact of relational misattunement on personality structure provided me with a more coherent view of the etiology of chronic shame. Another reader might have connected the dots between chronic shame and complex trauma, with the loss of both connection and sense of agency. Perhaps this was the author’s intention, to invite -- or incite -- the clinician / reader, as she does with her patients, to co-construct a personally-meaningful narrative to make sense of chronic shame.
De Young might also have explored the extent to which chronic shame plays a role in our social lives as well as our inner lives. It may be a force that animates both compliance and competitiveness. Envy and resentment could be understood as defenses against chronic shame, reflected in both interpersonal dynamics and in what Richard Sennett described as the “hidden injuries of class” and the tragedies played out collectively on the political stage in racism, identity politics, and ethnic nationalism. The difficulty of tolerating diversity, and the creation of “otherness,” whether sexual or ethnic, may be a manifestation of clinging to privilege as a fragile sense of group identity, status, and agency. I note these omissions not to criticize the book, but underscore the importance of its central premise. Perhaps the greatest merit of this book for the psychotherapist is not the answers it provides, but the questions it raises in prompting us to consider how we each understand chronic shame, and in each session we conduct whether chronic shame is impeding or even hijacking progress in the treatment. About the Reviewer Ben Susswein, PhD has maintained a private practice in Montclair, NJ, since the late 1970s, providing individual and family therapy and conducting neuropsychological evaluations.
APA Council of Representatives Overview A summary of highlights from the APA Council Meeting held February 26 & 27, 2021 By NJPA APA Council Representative, Rhonda Allen, PhD
During its two-day meeting in February, APA’s Council of Representatives (COR) held its second all virtual meeting. A different platform was used that allowed for more interaction and discussion between council members which facilitated our work. Many members expressed hope that we will be able to meet in person in August, but that is still undecided. Much of the following report is part of the summary sent to COR members from APA. Master’s Accreditation On February 26, the Council voted 135-36, with two abstentions, to approve standards for accrediting master’s level programs in health service psychology. This was the culmination of several years of study and public comment. Health service psychology includes clinical, counseling, and school psychology programs, and combinations of these areas, plus specialty practice internship and residency programs. There was considerable discussion and debate about this business item before it was passed. A motion was made, but ultimately defeated to send it back to the Commission on Accreditation to provide more details about the content of the coursework in these master’s programs and the level of skill that would be expected of its graduates. The next step in this process is for the Commission on Accreditation to develop procedures and regulations that will be required for a program to obtain APA accreditation. These will be subject to public comment and will define the competencies that are part of master’s level education. Resolutions on Gender Identity Change Efforts and Sexual Orientation Change Efforts Also that day, the Council adopted a resolution opposing coercive efforts to change people’s gender identity, citing research showing that such actions may be psychologically harmful. The measure, which passed by a vote of 164-3, with five abstentions, aligns with the association’s stance against similar efforts aimed at changing people’s sexual orientation, also based on scientific knowledge.
The Resolution on Gender Identity Change Efforts emphasizes that “individuals who have experienced pressure or coercion to conform to their sex assigned at birth or therapy that was biased toward conformity to one’s assigned sex at birth have reported harm resulting from these experiences, such as emotional distress, loss of relationships, and low selfworth.” The Council also adopted, by a vote of 165-3, with three abstentions, an updated Resolution on Sexual Orientation Change Efforts, which reiterates APA’s opposition to using nonscientific explanations to frame same-gender and multiple-gender orientations as unhealthy. APA adopted its first resolution discouraging efforts to change people’s sexual orientation in 1997 and a second in 2009, when it also issued a task force report with a systematic review of research on the topic. Denunciation of Racism On February 27, the Council overwhelmingly approved a resolution reaffirming APA’s denunciation of racism in all forms and pledging to undertake an analysis of psychology’s history “with the goal of understanding the harms that diverse racial groups have experienced and the actions necessary to create a more equitable, diverse, and inclusive association, discipline, and society going forward.” The resolution, passed by a vote of 168-1, builds on a body of guidelines and other resolutions adopted by the association over the past two decades acknowledging and denouncing the societal damage caused by racism. “APA reaffirms its denunciation of racism in all forms for its destructive psychological, social, educational, and economic effects on human rights and human welfare throughout the lifespan,” the resolution says. “… APA will call upon all psychologists to eliminate processes and procedures that perpetuate racial injustice in research, practice, education, and training; speak out against racism; take proactive steps to prevent the occurrence of intolerant or racists acts; and promote effective strategies based on psychological research to alleviate racial injustice.”
Kelly called the resolution “one more important step aimed at moving the field of psychology forward to help mitigate racism. Key foundational components of the resolution include establishing a definition of racism for psychology and acknowledging the need for the discipline to come to terms with its own history of promulgating, or not challenging, racial bias in research, education, and clinical practice. The resolution, which was developed with input from representatives of many ethnically diverse communities and other interested groups, will provide the foundation and guidance for APA, psychology, and psychologists to help eliminate racism at all levels, ranging from individuals to systems.” The resolution acknowledges that to eradicate racism, “we must understand what it is, how it operates, and who it benefits and harms, with the knowledge that many White people who do not personally harbor racial animus nonetheless benefit from racism.”
Professional Practice Guidelines For Evidence-based Psychological Practice In Health Care Council adopted, as APA policy, the professional practice guidelines for evidence-based psychological practice in healthcare. This motion passed by 96%. The following are the guidelines: Psychologists are mindful of the principles and importance of evidence-based practice. 2. Psychologists strive to maintain and enhance their knowledge of the research literature applicable to their practice. 3. Psychologists endeavor to conduct assessments that are appropriate for the setting, purpose, and population. 4. Psychologists seek to participate in collaborative treatment planning with patients and others when appropriate. 5. Psychologists aim to cultivate and maintain effective therapeutic relationships, therapist characteristics, and change principles. 6. Psychologists endeavor to adapt their clinical approach to patient characteristics, culture, and preferences in ways that increase effectiveness. 7. Psychologists aim to monitor the treatment process and clinical outcomes routinely. 8. Psychologists seek to modify their clinical approach when appropriate and terminate treatment when the patient is no longer benefitting or when treatment goals have been met. 9. Psychologists endeavor to collaborate with other professionals when appropriate to facilitate effective care. 10. Psychologists strive to promote overall patient health, functioning, and well-being. 1.
Human Rights Framework The Council also adopted a resolution affirming APA’s support for human rights, by a vote of 168-1, with two abstentions. The measure commits the association to adopt a human rights framework and integrate the association’s “longstanding concerns for human welfare, public interest, and social justice within a broader international consensus-
building process.” This will provide “guidance and structure for organizational decision-making, including accountability, on issues related to societal good.” Adoption of the resolution fulfills a commitment made by the Board of Directors in 2015 in the wake of the Independent Review into APA’s actions surrounding national security detainees during the George W. Bush administration. Through this resolution, APA pledges to prioritize human rights, including in such vital areas as education, research, ethics, practice, and advocacy. Psychological Consultant to the United States. A new NBI calling for a creation of a task force investigating creating an office of a Psychological Consultant to the United States was presented at the end of our meeting. However, this motion did not pass with 18.7 % voting for it and 77% against. Council Effectiveness Work Group CLT’s Council Effectiveness Work Group (CEWG) presented recommendations and proposed action items on how Council can more effectively carry out its role to direct and inform APA policy. Recommendations included: developing APA policies informed by psychological science and research and expertise of APA members; expanding opportunities for engagement and communications between APA entities including boards and committees; and ensuring diversity in the composition of all groups of Council working on each APA policy. Eight subgroups have been formed to work on delineating how these recommendations can become enacted. I am a member of the Education and Access subgroup that is meeting weekly and is focused on educating council members how to become more engaged in the process of creating policy that affects our profession. Presidential Citations APA President Jennifer F. Kelly, PhD, honored two psychologists with Presidential Citations for their outstanding contributions and service to psychology. Chester D. Copemann, PhD, Council of Representative member representing the Association of Virgin Island Psychologists (AVIP), was recognized for his many years of broad range work with children, adolescents, adults and families in the Virgin Islands, his efforts to organize and support the AVIP, and his efforts to keep AVIP connected to the American Psychological Association. CPT Carrie Kennedy, PhD, ABPP, was awarded a Presidential Citation for her service as a twoterm representative to Council for the Society for Military Psychology, and being a leader in the field of Military Psychology, first as a service member and second as a clinical psychologist. Respectfully submitted, Rhonda Allen, PhD Council of Representatives (NJ) (2019-21)
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