New Jersey Psychologist Publication of the New Jersey Psychological Association Winter 2012 • Volume 62 • Number 1
Special Section: Treatment of OCD
PRSRT STD U.S. POSTAGE PAID TRENTON, NJ PERMIT NO. 114
e Center for Psychotherapy and Psychoanalysis of New Jersey Co-Sponsor: New Jersey Society of Clinical Social Workers SPRiNg 2012 CONFeReNCe
e Integration of Attachment eory and Neurobiology: Clinical Applications
Dan Hill, PhD
Sunday, February 26, 2012 • 9:00 am – 12:30 pm The workshop will consist of two parts: In the first part Dr. Hill will be presenting the basic components of the clinical model of affect regulation: the broad strokes of the model's theory of bodymind, theory of development, theory of pathogenesis, and theory of therapeutic action. He will pay special attention to clinical aspects of the model including the emphasis on dissociation, and giving relational trauma center stage in the understanding of developmental psychopathology. Finally, he will discuss how the integration of attachment theory and neurobiology has led to a deepening of attachment theory and the understanding of the capacity to regulate affect. In the second part Dr. Hill will focus on clinical vignettes that illustrate many of the theoretical concepts discussed in the first half of the workshop. Attendees will learn interpersonal neurobiology’s developmental theory of bodymind, how attachment theory and affective neurobiology are integrated into a modern attachment theory, a relational trauma-based understanding of disorders of affect regulation, and therapeutic actions and techniques for treating disorders of affect regulation.
Location: e Institute for Women’s Leadership, Ruth Dill Johnson Crockett Building 162 Ryders Lane, New Brunswick, NJ 08901-8555
Cost: Faculty, Associates, and Others: $65 at the door/$50 pre-registration by Feb. 15. Candidates: $45/$35; Students with ID: $15
www.cppnj.org • www.njscsw.org • http://blog.cppnj.org • Find us at www.Facebook.com/CPPNJ
is program is co-sponsored by the New Jersey Society for Clinical Social Work, which provides leadership and support to clinical social workers in all practice settings. e New Jersey Society for Clinical Social Work has given voice to clinical social workers dealing with the health care industry. e organization provides outstanding continuing education programs and opportunities for collegial contact. www.njscsw.org
Save the date! • Summer 2012 Conference
Sue Johnson, PhD An Emotionally Focused Couples erapy Approach to Sexual Problems and Crises Sunday, June 24, 2012 • 8:30 am – 4:30 pm Lenfell Hall, e Mansion, Fairleigh Dickinson University, Madison, NJ
e Center for Psychotherapy and Psychoanalysis of New Jersey New Classes begin September, 2012 e Center for Psychotherapy and Psychoanalysis of New Jersey is dedicated to the training of skillful and eﬀective psychotherapists. Contemporary psychoanalytic psychotherapy is an empirically validated treatment methodology proven to oﬀer the clinician a ﬂexible tool for treatment of a wide variety of patients. Over the last century, psychoanalysis and psychoanalytic training have evolved, integrating the best of psychotherapy approaches including those from infant research, neuroscience, attachment theory, and body-based therapies. Psychoanalytically informed treatment is, at its heart, a process by which people discover the freedom to establish an enduring capacity for satisfying relationships and genuine living. Candidates have the opportunity to form new professional networks to develop both their skills and their practices. Low-cost personal therapy and low-cost supervision are available. Referrals to candidates’ practices are available through our Psychotherapy Clinic. For further information, please call 973-912-4432 or visit us online at www.cppnj.org Write us at: CPPNJ, 235 Main Street #184, Madison, NJ 07940 Licensed and license-eligible clinicians are invited to apply for admission to CPPNJ. CEU's are available for all classes and programs
http://blog.cppnj.org/ Find us on:
New Jersey Psychologist Publication of the New Jersey Psychological Association
Table of Contents 2 3 4 5 6 7 8 9 10 12 14 16 17 18 19 21 22 23 25 39 42 43 46 47 51 52 53 54 55
Who’s Who in NJPA 2012 IMPORTANT DATES ▼ From the Editor Advanced Clinical Practice President’s Message Workshop Executive Director’s Report Difficult Patients & Director of Professional Affairs Report Difficult Dialogues: Advanced Clinical Practice Registration Form Three Theoretical Approaches March 23, 2012 Legislative Agenda NJPA Central Office, West Orange, NJ New Members NJP-PAC 2011 Contributions 2012 Spring Conference April 21, 2012 Psychology and the Law Renaissance Woodbridge Hotel , Iselin, NJ New Jersey Psychological Association of Affect Regulation, Attachment & Graduate Students (NJPAGS) Trauma: Sensorimotor Approach Featured Speaker 2011 NJPA Scientific & Academic Affairs Pat Ogden, PhD Award Winners Ethics Update Risk Management Adventures on the Member News Electronic Frontier Foundation September 29, 2012 2011 Foundation Awards & Scholarship Winners Featured Speaker Jeffrey Younggren, PhD, ABPP 2011 Foundation Contributions Diversity Corner 2012 Fall Conference Special Section: Treatment of OCD October 20, 2012 Renaissance Woodbridge Hotel, Iselin, NJ Psychologist of the Year Speech – Featured Speaker Jeffrey Axelbank, PsyD Jonathan Shedler, PhD Legal Action Initiative Update What’s New – Addressing Heterosexism in Consultation Book Review Social Justice in Clinical Practice: Family Consultations with Adolescents in Urban Schools – Part II Fall Conference Annual Membership Business Meeting Sustaining Members Call for Nominations Classifieds
We are accepting submissions for the cover photo of our spring issue. We encourage those of you who are amateur photographers to submit a spring inspired photo for consideration (vertical shots only). All photos must be submitted electronically in high-resolution digital format or jpeg file. If you have any questions or wish to submit a photo, please contact: Christine Gurriere at NJPAcg@PsychologyNJ.org All decisions are the sole responsibility of the Editorial Board and Central Office staff. Winter 2012
Who’s Who in NJPA 2012 www.PsychologyNJ.org
New Jersey Psychological Association
Editor: Jack Aylward, EdD Associate Editor: Craig Fabrikant, PhD Herman Huber, PhD Michael Jaffe, PhD Megan Lytle, EdS Gianni Pirelli, PhD Sarah Seung-McFarland, PhD Anthony Tasso, PhD Claire Vernaleken, PhD
NJPA 2012 Executive Board
President: Mathias Hagovsky, PhD President-Elect: Sean Evers, PhD Past-President: Sharon Ryan Montgomery, PsyD Treasurer: Kenneth Freundlich, PhD Secretary: Stephanie Coyne, PhD Director of Academic Affairs: Kathleen Torsney, PhD APA Council Representative: Neil Massoth, PhD Members-at-Large: Phyllis Bolling, PhD Jeffrey Kahn, PhD Francine Rosenberg, PsyD Milton Spett, PhD Aaron Welt, PhD Jeannine Zoppi, PhD Parliamentarian: Joseph Coyne, PhD Affiliate Caucus Chair: Jeannine Zoppi, PhD NJPAGS Rep: Krista Dettle, MA Latino/a Psychological Association of NJ Rep: Lorna Myers, PhD ABPsi Rep: Phyllis Bolling, PhD
Central Office Staff
Executive Director: Josephine Minardo, PsyD Administrative Director: Jane Selzer Membership & Program: Susan Beatty Communications: Christine Gurriere Administrative Assistant: Keira Boertzel-Smith Director of Professional Affairs: Barry Helfmann, PsyD
NJPA 2012 Committee & Special Interest Group Chairs Committees of the Board:
Diversity: Co-Chairs: Susan McGroarty, PhD; Deirdre Waters, PsyD; Phyllis Bolling, PhD Finance: Kenneth Freundlich, PhD Governance: Sharon Ryan Montgomery, PsyD Nominations & Leadership Development Committee: Lisa Jacobs, PhD Personnel: Neil Massoth, PhD
Academic & Scientific Affairs: Ilyse O’Desky, PsyD Committee on Continuing Education: Mark Lowenthal, PsyD Committee on Legislative Affairs: Brett Biller, PsyD Conference: Jeffrey Singer, PhD Ethics: Pauline Bergstein, PhD Insurance Committee: Jeffrey Axelbank, PsyD Membership: Anne Farrar-Anton, PhD Publications: Jack Aylward, EdD Public Education: Rosalind Dorlen, PsyD Anti-Bullying Sub-Committee: Jeannine Zoppi, PhD Healthy Workplace Sub-Committee: Cheryl Notari, PhD Media Sub-Committee: Lynn Schiller, PhD Technology Committee: Aaron Welt, PhD
Special Interest Groups:
Early Career Psychologists: Co-Chairs: John Macri, PhD; J. Oni Dakhari, PsyD Forensic: Co-Chairs: Madelyn Milchman, PhD; Eileen Kohutis, PhD Health Psychology: Daniel Gallagher, PhD NJPAGS: Krista Dettle, MA Co-Advisors: Dawn Gemeinhardt, PhD; Kathleen Torsney, PhD Prescriptive Authority: Co-Chairs: Bruce Banford, PsyD; Joseph Zielinski, PhD Psychology in the Schools: Thomas Massarelli, PhD Sport Psychology: Marshall Mintz, PsyD Trauma Response: Raymond Hanbury, PhD
Task Force Chairs:
Health Care Reform: Robert McGrath, PhD Self-Care Across the Career Spectrum: Neil Massoth, PhD
Addictive Behaviors: Raymond Hanbury, PhD DYFS: Barry Katz, PhD LGBTQ: Jonathan Wall, PsyD
Regional Organization Presidents Bergen: Stephanie Coyne, PhD Essex-Union: Cheryl Futterman, PhD Mercer: Marta Aizenman, PhD Middlesex: Mark Weiner, PsyD Monmouth-Ocean: TBD Morris: Morgan Murray, PhD Somerset/Hunterdon: Jane Simon, PhD South Jersey: Hulon Newsome, PsyD
2012 NJP-PAC Inc. Officers
President: Robert Rosenbaum, EdD Treasurer: Pamela Foley, PhD
2012 NJPA Foundation Officers President: Ilyse O’Desky, PsyD Treasurer: Abigail Rosen Secretary: Toby Kaufman, PhD
Preparation of Manuscripts All manuscripts submitted for publication should follow APA style. Manuscripts should be edited, proofread, and ready for publication. Please prepare your manuscript in a word-processing program compatible with MS Word using Times New Roman font in 12 point type, left flush. Please submit your manuscript via e-mail to NJPA Central Office and to Jack Aylward at e-mail addresses below. Editorial Policy Articles accepted for publication will be copyrighted by the Publisher and the Publisher will have the exclusive right to publish, license, and allow others to license, the article in all languages and in all media; however, authors of articles will have the right, upon written consent of the Publisher, to freely use of their material in books or collections of readings authored by themselves. It is understood that authors will not receive remuneration for any articles submitted to or accepted by the New Jersey Psychologist. Any opinions that appear in material contributed by others are not necessarily those of the Editors, Advisors, or Publisher, nor of the particular organization with which an author is affiliated. Manuscripts should be sent to the Editor: Jack Aylward, EdD E-Mail: firstname.lastname@example.org or NJPA Central Office E-Mail: NJPA@PsychologyNJ.org Published by: New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 973-243-9800 FAX: 973-243-9818 E-Mail: NJPA@PsychologyNJ.org Web: www.PsychologyNJ.org
Deadlines for Submission of Manuscripts ISSUE DATE FALL WINTER SPRING SUMMER
SUBMISSION DEADLINE August 10 November 10 February 10 May 10
New Jersey Psychologist
From the Editor
Parity or Parody? by Jack Aylward, EdD
he long awaited parity law affecting health plans offered by employers of companies with 51 or more workers holds the promise of regulating all mental health and substance conditions by allowing for the same level of co-pays, annual and lifetime benefits, and additional conditions that apply to other medical or surgical coverage. Technically in effect since January 1, 2010, many psychologists are hoping for a more professional even playing field, one capable of extending treatment options. Much still needs to be worked out in terms of definition and implementation as to just how parity will be operationally defined and enacted, primarily with respect to what determines “medical necessity.” Thus, the relationship of physiological and biological factors in creating psychological dysfunction will be given a somewhat figural role. Certainly, the boundary between what is “physical” and what is “psychological” is viewed by many of us as being, if not seamless, certainly semi-permeable. After all, we assume that our theoretical construct of “mind” is located somewhere in the brain that we agree is the body, thus giving credence to a psychosomatic paradigm to most stress-related symptom formations. And, as recent developments in our troubled times have shown, financial duress, among other issues, has had a telling effect on psychologically related health difficulties. The Wall Street Journal cites a study done by Janet Currie of Princeton and Erdal Tekin of Georgia State University showing a direct correlation between property foreclosure rates and health issues in people in New Jersey, Arizona, California, and Florida. According to their data, an increase of 100 foreclosures corresponded with a 7.2% rise in emergency room visits and hospitalizations for hypertension, along with an 8.1% increase in diabetes, among people aged 20 to 49. The top fifth of foreclosure activity accounted for more than double the number of visits for preventable conditions usually not requiring hospitalization, than did the bottom fifth. The increase in such psychosomatic disorders was evidenced through subjective reports of chest pain and shortness of breath, some with accompanying suicidal ideation in people generally below 50 years of age. More importantly, such data did not show up in cases of cancer and other types of elective surgery. Clearly a case has been made for parity necessity. However, the means whereby such is guaranteed remains a matter of considerable debate. The Wellstone-Domenici Act would allow managed care companies the power to determine what would constitute “medical necessity.” This leads some observers concluding that “adjustment disorders,” ones that mark a Winter 2012
significant proportion of psychological practice, may not be viewed as “medical conditions” and therefore not covered. Theoretically, any plan could then either reduce the number of conditions covered or eliminate mental health or substance abuse treatment as not conforming to such standards. And, if a company can prove, after operating a parity plan for six months, that it has created “excessive costs” (defined as 2% the first year and at least 1% in annual increases in subsequent years), they may be legally able to opt out. As would be expected, the managed care industry has circled the wagons, put the spin doctors in the foreground, and formulated ways to implement these new standards in a manner that would insure continuing corporate profits. First, they warn of a .4% increase in mental health costs as a result of parity. (Remember, mental health’s portion of the healthcare pie is between 4-5%, with 1.3% of that total going to outpatient care). Taking credit for parity in the first place, managed care proponents claim they have been pondering “medical-behavioral integration” for the last 20 years and optimistically look forward to the growth of such facilities with full-time staffs of “physicians, nurses, and behavioral health clinicians.” (Note the absence of any credentialing, licensing, titles, or educational standards for “behavioral health clinicians”). In gathering data on the industry’s take on these changes, Psychotherapy Finances interviewed several representatives of managed care personnel and consultants. One respondent, Joan Pearson, a health benefit consultant to major employers made it perfectly clear to behavioral practitioners: “Expect no increases. But consumers will have more access to services which is a good thing.” When reminded that therapists have not seen any increase for about 15 years, she replied: “The only bright spot is that out-of-network providers may be able to demand more money.” And the beat goes on. ❖ The views expressed in the editorial are those of the editor, with support of the NJPA editorial board, and do not necessarily reflect the opinions of NJPA leadership or staff. The Publication Committee of NJPA is seeking out new members interested in joining the editorial board of the New Jersey Psychologist. Responsibilities include quarterly meetings, occasional participation as a liaison editor for special sections, editing input, and working with other committee members in contributing ideas and suggestions for maintaining and advancing the professional image and intellectual integrity of the literary flagship of the New Jersey Psychological Association. For further information, contact either Christine Gurriere at Central Office at NJPAcg@PsychologyNJ.org; or editor Jack Aylward at email@example.com 3
by Mathias Hagovsky, PhD
y friends and colleagues: as I assume the role of president of NJPA, I write to you as a different person than I was one year ago. At the outset of my president-elect year, I looked forward to a time of gradual education by absorption and osmosis, a moderate and steady experience wherein I would systematically, but comfortably, attend board meetings, be there for some committee meetings, meet and greet members at various functions, work with leadership and the office staff… well, basically do all those things that one might expect of any reasonable volunteer position in any professional organization. I had no idea then, as I do now, that the term “learning curve” – in this instance – has no bend to it whatsoever and turned out to be essentially a nearvertical line aimed straight to the top! Well, you might think I’m exaggerating and perhaps I am….but not by much. What a year to be at NJPA. It has been an amazing ride from day one and, more amazingly, I find myself anticipating the next free-fall or hairpin curve with excitement and enthusiasm. I did not expect this to happen, but I can share with you that it has and I am both surprised and thankful for it. For those who have been a part of this “ride,” I have nothing but admiration. Our new Executive Director, Josephine Minardo, PsyD, has engineered numerous, positive changes, revisions, innovations, and new initiatives to the point that she has literally challenged each of us to re-organize every aspect of the organization; why? Simply because she wants to make it better. The NJPA website alone is remarkable in its own right and reflects her dedication to quality, transparency, 4
and increased user-ship. Sharon RyanMontgomery also deserves a huge round of applause for her dedication, leadership, and guidance, not to mention the dignity and strength she has brought to the presidency of our organization. And, since it is not possible to properly estimate all that Lisa Jacobs brings to the table, all I can do is share with you that she has been incredibly and eagerly helpful, knowledgeable, and available at every turn. Finally, when I consider the steady and invaluable contributions of Barry Helfmann, PsyD, Phyllis Lakin, PhD, Jane Selzer, and so many others, I can only say that I have been honored and humbled by my involvement with NJPA this past year. Of course, the year has been dramatic and demanding on many fronts. COLA continues to watch, warn, and not just protect our professional standing, but advance our profession with proactive decision-making that continues to justify the hard work of our PAC on our behalf. Our multiple legal-action initiatives – voracious in every way – have pushed us to the brink of our resources and tolerance almost, it has seemed at times, without any reprieve. Our newly-formed Insurance Committee has been charged with assisting NJPA in maintaining a steady course of monitoring and protecting our membership, and those we serve, from insurance company abuses. While other states gratefully admire and support our efforts, NJPA nonetheless continues to stand alone at the front of this battleground that represents an enormous challenge to our organization and those of us who lead it. I can only hope to stand tall in this regard, for all of us, for as long as we are able to do so. I have been privileged to learn about the Foundation, how it operates, and about the wonderful people who manage it so carefully. I have learned respect
for the power of COLA and its dedicated membership, the value of the Committees of the Board, the necessity and importance of the ongoing committees, and how essential the interest and resource groups are. I have become committed to developing new ways of encouraging non-members to join NJPA to insure a future of robust and diverse membership at every level of our organization, and I stand ready to work to address the growing needs of psychologists in training and early career psychologists as well. I can be an obnoxiously proud New Jerseyan, raised in Bergen County, but educated at my overall favorite alma mater, St. Benedict’s Prep in Newark. I worked as a teacher while studying at Seton Hall, and then as a school psychologist while finishing up at Fordham….nights, at Lincoln Center. I learned to conduct evaluations at the Child Development Center of Children’s Hospital (at the now defunct United Hospitals in Newark), and pursued licensure via the guidance of a wonderful woman, Gloria Steiner, who introduced me to my still-partner, Mike Gerson, in l977. Yes, I am that old. I became acquainted with writing for the court and testifying during my nearly ten year tenure at the hospital, and have essentially functioned as a forensic psychologist since the early 80s, working mostly in family court. My “sanity” is revised each week when I consult for two hours at the High Risk Infant Follow-Up Clinic at St. Barnabas Hospital where I can play with (aka: evaluate) kids from 12-48 months of age. I have four grown children and six grandchildren. I look forward to continuing to work with and represent the membership of NJPA as president of this terrific organization. I wish all of you not only a Happy New Year, but a Happy Good Year at NJPA as well. ❖ New Jersey Psychologist
Executive Director’s Report
Protecting The Profession: Regulatory Accomplishments by Josephine S. Minardo, PsyD
JPA remains committed to enhancing and protecting the profession of psychology in New Jersey. While we continue to immerse ourselves in legal actions with insurance companies, there is also much to do on the regulatory front. We have been successful in establishing a strong positive working relationship with the New Jersey Board of Psychological Examiners (BoPE) and have regular contact with them on issues that affect our members. NJPA is grateful to Dr. David Panzer for assisting us, as NJPA liaison to the BoPE, in cultivating this relationship. After many years of service to us in this role, Dr. Panzer has stepped down; we thank him sincerely for all his efforts and wish him much success in his practice and other endeavors. The executive director will be representing NJPA at the monthly meetings of the BoPE in the interim. Among some of our recent regulatory accomplishments in 2011, we advocated strongly and successfully on amendments to the education experience requirements for NJ licensure. There were proposed amendments to the Qualifications to Sit for Examination that would adversely affect students who are currently enrolled in non-traditional psychology doctoral programs. As a result, the BoPE included a grandfathering clause for students currently enrolled in a doctoral program, who will not be required to show that the doctoral program met these new requirements to be license-eligible. Further, the BoPE clarified and offered a more liberal interpretation of the term “continuous” to mean only one year or its part-time equivalent with regard to the residency requirement that students demonstrate an on-campus presence. In addition to the BoPE, there are Winter 2012
many other regulatory agencies that influence the work of psychologists in New Jersey. NJPA advocated strongly with the NJ Deptartment of Banking and Insurance (DoBI) with regard to significant changes in the NJ Personal Injury Protection (PIP) fee schedule for individuals injured in an automobile accidents. Specifically, NJPA strongly opposed the reduction of reimbursement for the neuropsychological testing (CPT Code 96118) and requested clarification of the title “qualified healthcare professional” indicated in the new CPT Code (96125) defined as Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s [emphasis added] time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report, as this is a service typically provided by licensed psychologists. NJPA is concerned about protecting patients and the neuropsychological community from non-psychologists who would practice administering these tests without the unique skill and neuropsychological training that psychologists possess. We await a response to our comments. The following item comes with a great deal of history attached to it. For over a decade, NJPA has been a zealous advocate opposing the creation of an independent “State Certification” for psychoanalysts that proposes to exempt psychoanalysis as a profession from regulation without licensing it independently. This began with legislation dating back to 1999 that was originally strongly opposed, but passed. Later, a Certified Psychoanalysts Advisory Committee was formed to develop regulations and training requirements as determined in the statute. When these regulations were issued in 2004, NJPA also mobilized and strongly opposed what appeared to be
sub-standard training requirements and other matters of concern. This resulted in regulations not being adopted. More recently, these regulations have been proposed anew virtually unchanged and NJPA has again re-mobilized the psychoanalytic community and is advocating strongly for the following: 1) due process to address grievances by the public; 2) greater clarity and stronger enforcement of informed consent to protect the consumer and guard against confusion among training standards; 3) exemption for psychologists and members of other healthcare professions who have already been practicing psychoanalysis for many years; 4) the ability for psychologists to request a waiver and obtain the state certification if they possess the appropriate training; and 5) more diverse and balanced representation of the wider psychoanalytic community among the members who comprise the advisory committee. In the near future, NJPA plans to meet with the Commissioners of many of the state regulatory agencies and departments of the governor’s office to establish positive connections. COLA has been making plans and reaching out to other groups within NJPA to collaborate on information gathering that will best prepare us for a successful set of meetings. We aim to proactively build relationships with senior policy advisors to: 1) educate them about the field of psychology, in general; 2) to emphasize how NJPA can be a resource to them when policies are being considered or reviewed; and 3) to begin informing them about some of the critical issues facing psychologists in New Jersey. NJPA is always working to meet your professional needs, provide concrete services and benefits to members, and to be a proactive and positive agent of change for psychology in New Jersey. Working together, anything is possible. ❖ 5
Director of Professional Affairs Report
Privacy: Whats The Big Deal Anyway? by Barry Helfmann, PsyD
rivacy, or as sometimes referred to as patient confidentiality, is one of the basic tenets under which psychologists practice. It is fashioned after the attorney/client privilege that has been upheld in courts throughout the United States. From the beginning of graduate school, students are taught that patients must feel safe in order to develop the necessary climate to provide psychotherapy treatment. The patient needs to believe that the therapist/patient relationship is one of complete privacy and what is revealed in the session will stay there. When such a climate exists, the opportunity to help the patient improve is greatly enhanced. Without this climate, chances for failure and patient harm will increase. The medical rule “Do No Harm” sets the bar way too low in my opinion. With the onslaught of insurance abuses and intrusions, maintaining privacy has become a real challenge. The requests for treatment plans, telephonic reviews, and justifications for ongoing care are such examples. Third party payors ask for treatment notes or other confidential patient information violating the legal and ethical principles of privacy. This behavior falls under the rubric of the need to meet medical necessity criteria. Failure to provide such information results in authorizations being denied or significant reductions in the frequency of treatment. Ethical and legal guidelines permit breaking confidentiality only if the patient is in imminent danger to self or others, or in cases regarding mandatory report of child abuse. The one exception to the above is the New Jersey Peer Review Law that allows an insurer to obtain additional patient information if they request a Peer Review conducted under the authority of the Board of Psychological Examiners. Since the passage of the law in 1985, I know of only two such requests, both of which were denied by the board. This law prohibits a patient from waiving his or her own confidentiality in order to secure coverage for treatment. Unfortunately, the law does not apply to the State Health Benefits Plan of New Jersey or instances where an employer is self-insured. In these instances, they come under federal law instead of state law. Some psychologists may believe that we should give the insurer what they demand and that such an alteration to the privilege statute is not such a big deal. The supposed rationale is that this is what their patients want them to do in order to be able to use their benefits to obtain treatment. I believe that such a view is extremely short-sighted and potentially very harmful to patients. The end does not justify the means. What is being asked of us is just plain wrong. This is not about meeting medical necessity but a thinly veiled attempt at cost containment and increasing profits by cutting necessary care. As we have demonstrated previously in the Wrich report (2007), there are serious unintended negative economic consequences in such behavior. 6
For these reasons and more, the association has taken legal action to preserve our patients’ privacy. This lawsuit is about one, and only one, legal principle and that is requests for such patient information violates our New Jersey Psychology Licensing Statute. We are asking Judge Klein to make such a ruling. On November 15, 2011, Judge Harriet Klein heard oral arguments on the defendants motion to dismiss this case. As they had previously attempted, the lawyers for Horizon/Magellan argued that the case is really about utilization review and not the law. Therefore, they argued that the State Health Benefits Commission should rule on our claims. Judge Klein denied their motion completely and agreed this is a legal question that the courts should rule on. In addition, the Court ruled that NJPA has legal standing to represent our members. She also confirmed that our patient plaintiffs have the standing to bring forth their claims. So, what would a victory look like? At the very least, the intrusions violating privacy would stop. We hope that the basic content of the Peer Review Law would serve as the definition of minimal necessary that meets both state and federal requirements. Will this lawsuit cure all the ills regarding case management that Horizon and its agent Magellan continue to espouse? We all know the answer to this is no. But, fighting to maintain the patient/doctor privilege is crucial in what psychologists provide to our patients. Judge Klein indicated in court, on November 18th, that she anticipated our case would be adjudicated within one year. It is crucial to financially support this lawsuit now. We have raised $200,000 to date, but need an additional $100,000 to proceed through a trial. Many members have already generously donated. We all need to take ownership of this issue and I hope all of our members will contribute as much as they can. New Jersey psychologists have taken up the right issue at the right time and for the right reasons. ❖
Congratulations! ~~~~~~~~~~~~~~~~~~~~~ NJPA’s Director of Professional Affairs will be presented with the “Distinguished Fellow” Award from the American Group Psychotherapy Association. Dr. Helfmann will receive this award at the Annual Meeting in NYC on March 9, 2012. To qualify, fellows must maintain membership with the association for at least 15 years and have a professional career such as to distinguish them as among the top theoreticians, practitioners, or trainers in the group psychotherapy field or whose leadership in the association been marked with utmost distinction. New Jersey Psychologist
Join us for the Next Level in Professional Training
Advanced Clinical Practice Workshop Difficult Patients & Difficult Dialogues: Three Theoretical Approaches March 23, 2012 Light Breakfast/Registration Program
8:30 am – 9:30 am 9:30 am – 12:30 pm
To be held at the NJPA Central Office, 414 Eagle Rock Ave, West Orange, NJ 07052
This workshop will focus on working with difficult patients and the difficult dialogues involved in their treatment. A team of experienced psychologists, each of whom will bring their expertise in a distinct area of private practice, will offer their approach to working with these patients. Case studies will be presented and panelists will be exposed to the examples at the same time as attendees. Ample time will be allotted for Q & A. At the end of this workshop, participants will Become familiar with the issues involved in the challenging clinical encounter. Become aware of their own obstacles in working with difficult patients. Learn initial treatment assessment and planning for working with these patients. Panel: Barry Helfmann, PsyD, Moderator, NJPA Director of Professional Affairs, Private practice, Springfield. Milton Spett, PhD, Co-founder, Steering Committee member, and Publications Editor of the New Jersey Association of Cognitive-Behavioral Therapists; Private practice, Cranford. Patricia Steckler, PhD, Private practice, Westfield. Seth Warren, PhD, Director, Center for Psychotherapy and Psychoanalysis of NJ; Visiting Faculty, Graduate School of Applied and Professional Psychology, Rutgers University.
Attendance at each session qualifies for 3 CE credits. The New Jersey Psychological Association is approved by the American Psychological Association to sponsor continuing education for psychologists. NJPA maintains responsibility for this program and its content.
--------------------------------------------------------------------------------Advanced Clinical Practice Workshop March 23, 2012
Name: Billing Address: ___________________________________ Phone (
□ Workshop Fee - $49 (includes Breakfast) □ Method of Payment:
Sustaining Member - $41.65
3-digit code ______ (on back of card)
Refunds less a $15 administrative fee will be granted until March 16, 2012. No refunds after March 16, 2012. Online registration: www.PsychologyNJ.org NJPA● 414 Eagle Rock Ave, Suite 211 ● West Orange, NJ 07052 973-243-9800 ● Fax: 973-243-9818 ● Email: NJPA@PsychologyNJ.org
The Legislative Agenda
by Brett Biller, PsyD Chair, COLA
am both excited and honored with the opportunity that lies ahead in my role as chair of the Committee on Legislative Affairs [COLA]. While I have served as a member of COLA for approximately five years, the past year as chairelect has provided me great experiences, including attending the APA Leadership Conference in Washington, DC. The experience and knowledge attained during the conference will serve me well during the upcoming year. On behalf of the membership, I would like to thank Dr. Rob Rosenbaum, our outgoing chair, for his dedication to COLA. Throughout my involvement in COLA, I have spoken with many of my colleagues who have asked: “What is COLA and what is the committee’s role within NJPA?” Interestingly, the question parallels the question many legislators (and members of the community) ask that is: “What do psychologists do and are you the people who can prescribe medication?” The parallel lies in that psychologists are paramount to the wellbeing of our community just as COLA is paramount to the wellbeing of psychology. So what can we do to answer these questions? Since each of you are intimately able to answer the latter question, allow me to explain the role of COLA. Through legislative efforts and advocacy, COLA seeks to enhance psychologists’ ability to serve the members of our community. Many of the current legislative initiatives being monitored and/or advocated for by COLA include protection of patient rights, addressing psychologists’ ability to practice, and advocating for expansion of scope so that psychologists can best serve the needs of the members of our community. COLA members review many bills and choose to monitor or advocate for or against the legislation based on its impact on the NJPA membership or the members of the community who are served by our membership. In the current economic zeitgeist, in which businesses are being forced to cut back and healthcare is limiting reimbursement, the need for psychological services are increasing; however access to services may be limited by red tape or financial constraints. It is important that as psychologists we remain focused on advocating for our patients and ensuring ease of access to the psychological services we provide. Accomplishing this goal is often achieved through ongoing advocacy at the legislative level. Despite one’s best intention, individual efforts are often not powerful enough to facilitate change. 8
Gaining an understanding of the legislative process, and COLA’s role along the way, should demonstrate the importance and utility of COLA. The initial birth of a bill occurs when developed by a member or group of members. COLA members, with the assistance of our government affairs agent, John Torok, discuss the ideas brought forward by membership to strategize how best to utilize NJPA resources that include financial as well as the relationships that have been built with legislators. Once agreed upon by COLA, a legislative representative is sought to sponsor and present the bill in the state legislation. In matters that involve the need for utilization of greater resources, the NJPA executive board is consulted prior to moving forward and contacting a legislator. After a legislative representative agrees to sponsor the bill, information is provided to the Office of Legislative Services that drafts the bill in the appropriate format. The bill is than given by the sponsor to the Senate Secretary or Assembly Clerk so the title of the bill can be read on the floor and the bill is made public. The bill is then referred to a committee chosen by the legislative leadership. The chair of the assigned committee then chooses if, and when, the bill will be discussed within a public hearing. During the hearing, COLA frequently asks a member of COLA, or an NJPA member with particular knowledge in a specific area, to “testify” at a public hearing held by the assigned committee. Providing testimony affords NJPA an opportunity to address the reason for the bill and the impact of passing the bill. After testimony is heard, the committee votes to pass the bill to the assembly for vote, move forward with the bill with identified amendments, or with a substitute bill. If the bill is not considered or placed on the agenda for a public hearing, it can sit and never be heard. If the bill is moved forward to the general assembly or senate, further amendments can be made or a vote to determine the fate of the bill can occur. A bill is “passed” when a majority of the authorized legislators vote in favor of the bill. If the bill is not ratified, it can be sent back to the committee for further review. Once approved, the bill then goes to the second house where the review process is reinitiated. A bill is given full legislative approval after it is passed by both Houses (Assembly and Senate), in an identical form. Although the bill is approved by the legislature, it is not considered law until the bill is signed by the governor. The governor has the ability to sign the bill, conditionally veto, or veto the bill all together. New Jersey Psychologist
The Legislative Agenda The legislative process described within is complicated and impacted by numerous variables (hey, that’s why they call it politics). A typical bill can take several two-year legislative sessions before it is passed (if at all) and established as a law. In many cases, due to last minute amendments, time limitations for completing the process or the impact of an election causes the bill to stall or eventually die. Without the ongoing experience and dedication of NJPA’s staff, our government affairs agent, and the members of COLA, the ideas and concerns of our membership would go unaddressed. Through the efforts of COLA, the members of NJPA are afforded access to resources and legislators not readily accessed by individuals within the community. COLA often serves as the pulse and voice of the NJPA membership and the community we serve through advocacy of established bills or the initiation of a bill. In reality, a successful COLA member is someone who is concerned about the field of psychology, the community we serve, and is dedicated to do something about it.
Despite popular perception, COLA’s success is not predicated on members who are astute to the principles of political science. Rather, COLA’s success, and ultimately the well being of our field, thrives on dedicated members who seek to enhance the field of psychology and advocate for the well being of the members of the community we serve. COLA leadership is continually seeking input and contributions from our membership so that your voice and concerns can be addressed. As I begin my year as COLA chair, I challenge you to utilize our committee as the valuable resource it has been established to serve. Please feel free to attend any of the five meetings held throughout the year to learn about the pulse of where the field of psychology in New Jersey is today and where we look to move tomorrow. Better yet, I challenge you to challenge yourself and become a COLA member so that together we can improve the lives of those individuals we serve. ❖
Welcome New Members! Members Melissa Acquavella-Lightfoot, PsyD Lilline Adler, PsyD Daphne Anshel, PhD Roy Aranda, JD, PsyD April Bickoff, PsyD Christopher Cunningham, PsyD Daniel Davenport, PsyD Christine Denario, PsyD Megan Duffy, PsyD Elaine Garrod, PsyD Rebecca Giagnacova, PsyD Judith Halle, PhD Kendra Haluska, PsyD Ilona Harris, PhD Lara Kasoff, PhD Eunae Kim, PhD Monika Kushwaha, PsyD Dorothy Latella-Zakhireh, PsyD Florence Leone, PhD Marc Lombardy, PsyD Margaret Lundrigan, PsyD Anita McClean, PhD, PsyD Lisa Orsini, PhD Jeane Rajacic-Poppe, PhD Christie Schueler, PhD Randy Simon, PhD
Denise Steiner, PsyD Rosemarie Stewart, PhD Suzette Sularski, PsyD Renuka Ati Tanna, PsyD Victoria Wilson, PhD, JD Tal Yonai, PhD Student Members (NJPAGS) Diana Amodeo, MA Brian Amorello Michael Becht, MA Brienne Brown, MA Shannon Connell, MS Nicole Djakow-Fransko, MA Eugene Dunaev, PsyM Jacqueline Gallios Limarie Hentschke Mia Hutchinson Gloria Jones, MA, MS Laura Koller Kelly Kovack, MA Lori Magda, MA Shira Mechanic Eliyahu Melen, MS Zuzanna Molenda-Kostanski Angel Montfort Jenna Moschetto
Jessica Perez Greg Petronzi, MA Vernell St. Prix Stacie Shivers Shannon Stodnick Alexandra Stratyner Mary Toolan, EdS Erin Weinstein Samantha Weltz Danielle Zurawiecki Senior Membership Sandra Feldman, PhD Alfred Hurley, PhD Ellen Lacy, PsyD Robert Levine, PhD Alan Rappaport, PhD Peter Richman, PhD Barbara Starr, EdD Lois Steinberg, PhD Charles Waitz, PhD Emeritus Members Louis Flumen, EdD Susan Kasper, PhD Nancy Stuart, EdS Maria Valdes, PhD
Robert Rosenbaum, EdD 2012 President, NJP-PAC, Inc.
Pamela Foley, PhD 2012 Treasurer, NJP-PAC, Inc.
NJP-PAC, Inc. thanks and acknowledges the following individuals who have given generously to the 2011 PAC campaign (includes all contributions received by December 31). Please join your colleagues and make your donation by sending your check to NJP-PAC, Inc., 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052-4224, or call the Central Office and make a contribution via credit card.
Guardian ($1000 and over) Rosalind Dorlen, PsyD Michael Gerson, PhD Virginia Waters, PhD
Margaret Beekman, PhD
Jeffrey Axelbank, PsyD Mathias Hagovsky, PhD Frances Hecker, PhD John Lagos, PhD Alfredo Lowe, PhD Richard Schwartz, PsyD David Szmak, PsyD Daniel Watter, EdD
Howard Adelman, PhD Pauline Bergstein, PhD Donald Bernstein, PhD Elisa Bobrow, PhD Susan Buckley, PsyD Monica Carsky, PhD Kathleen Cullina-Bessey, PsyD Jeannette DeVaris, PhD Sean Evers, PhD James Fosshage, PhD Larry Gingold, PsyD Jane Hochberg, PsyD Barbara Holstein, EdD Russell Holstein, PhD George Kapalka, PhD Toby Kaufman, PhD Ilene Kesselhaut, EdD Richard Kessler, PhD Linda Klempner, PhD Ruth Lijtmaer, PhD William Boyce Lum, PsyD Bonnie Markham, PhD, PsyD Steven Master, PhD Sharon Ryan Montgomery, PsyD Margaret Nichols, PhD Marilyn Oldman, EdD Lori Pine, PsyD
Champion ($250-$499) cont. Robert Rosenbaum, EdD Letitia Sandrock, PsyD Jeffrey Spector, PsyD H. Augustus Taylor, PhD Karl Trappe, PhD Nina Williams, PsyD Amie Wolf-Mehlman, PhD Michael Zito, PhD
Toni Ann Amabile, PhD John Aylward, EdD Steven Barnett, PhD Judith Bernstein, PsyD Jeffrey Bessey, PhD Mary Blakeslee, PhD Alison Block, PhD Monica Blum, PhD Philip Bobrove, PhD Richard Brewster, PsyD Suzanne Buchanan, PsyD Dorothy Cantor, PsyD Shelley Carroll, PhD Rosemarie Ciccarello, PhD Sidney Cohen, PhD Robin Cooper-Fleming, PsyD Mark Cox, PhD Sheila Dancz, PhD Richard Dauber, PhD Rochel David, PhD Daniel Diamant, PhD Phyllis DiAmbrosio, PhD Frank Dyer, PhD Lynn Egan, PsyD Kali-Roy Eklof, PhD Donna English, PhD Eliot Garson, PhD Roberta Fallig, PhD Bud Feder, PhD Thomas Frio, PhD Sharon Freedman, PhD Milton Fuentes, PsyD Stephen Garbarini, PsyD Eliot Garson, PhD Kenneth Gates, PsyD
Contributor ($100-$249) cont. Elizabeth Goldberg, PhD Ruth Goldston, PhD Risa Golob, PsyD Gail Gunberg, PhD Osna Haller, PhD Howard Hammer, PsyD Stanley Hayden, PhD Douglas Haymaker, PhD Hilary Hays, PhD Lauraine Hollyer, PhD Margery Honig, PhD Kathy Howley, PhD Kenneth Hoyne, PhD Maureen Hudak, PsyD Ellen Hulme, EdD Monica Indart, PsyD Glendessa Insabella, PhD Lisa Jacobs, PhD Barry Katz, PhD Charles Katz, PhD Roberta Katz, PhD Eileen Kohutis, PhD Steven Korner, PhD Deirdre Kramer, PhD Judith Kramer, PhD David Krauss, PhD Phyllis Lakin, PhD Neal Leynor, PhD William Linden, PhD Bonnie Lipeles, PsyD Marc Lipkus, PsyD Gloria Loew, PhD Marilyn Lyga, PhD Phyllis Marganoff, EdD Susan Marx, PsyD Neil Massoth, PhD Robert McGrath, PhD Susan McGroarty, PhD Leslie Meltzer, PhD Randy Mendelson, PhD Stanley Messer, PhD Barry Mitchell, PsyD Bea Mittman, PhD Lynn Mollick, PhD Joan Morgan, PsyD
New Jersey Psychologist
Contributor ($100-$249) cont. Marsha Morris, PhD Sandra Morrow, PhD Daniel Moss, PhD Charles Most, PsyD Andrew Musetto, PhD Candice Nattland, PsyD Gene Nebel, PhD Janet Nelson, PhD Ilyse Oâ€™Desky, PsyD Rose Oosting, PhD Laura Palmer, PhD Nicholas Papouchis, PhD Susan Parente, PsyD Irene Parisi, PhD Howard Paul, PhD Francesca Peckman, PsyD Mark Pesner, PhD Jonathan Rapaport, PhD John Rathauser, PhD Gina Rayfield, PhD Nancy Razza, PhD Katheleen Reidy, PhD Mark Reuter, PhD Louis Richmond, PhD Debra Roelke, PhD Barbara Rosenberg, PhD Anne Rybowski, PhD Carole Salvador, PsyD Debra Salzman, PhD George Sanders, PhD Daniel Schievella, PhD Doris Schueler, PhD Nancie Senet, PhD Arline Shaffer, PhD Brian Shannon, PhD Marjorie Slass, MA Milton Spett, PhD Ann Stainton, PhD Barbara Starr, EdD Julie Steinberg, PsyD Daniel Sugarman, PhD Steven Sussman, PhD Ben Susswein, PhD John Tarpinian, EdD Andrew Thomas, PsyD Phyllis Tobin, PhD Barbara Tocco, EdD Jacqueline Tropp, PhD Barbara Von Klemperer, EdD William Walsh, PhD Allen Weg, EdD
Contributor ($100-$249) cont. Aaron Welt, PhD Gail Winbury-Klizas, PsyD Philip Witt, PhD Joan Wolkin, PhD Gwen Wolverton, PsyD James Wulach, PhD, JD Joshua Zavin, PhD Advocate (up to $100) Kathryn Adorney, PhD Amy Aho, PhD Betty Allen, PhD Annette Appleheimer, PsyD H. Kyle Barr IV, PsyD Louis Barretti, PhD Beata Beaudoin, PhD Gordon Boals, PhD Janet Bloodgood, PhD Carol Blum, PsyD Lily Bollinger, PsyD Susanne Breckwoldt, PhD Richard Bruno, PhD Charlotte Buchmann, MA Laurence Chasin, PhD Margaret DeLong, PsyD Nancy Distel, PhD Charles Dodgen, PhD John Dovel, PhD Seth Ersner-Hershfield, PhD Michael Farris, PsyD Michael Feldman, PhD Joan Fiorello, PhD Resa Fogel, PhD Richard Formica, PhD Muriel Fox, PhD James Garofallou, PhD Ellyn Geller, EdD Jill Gentile, PhD Leslie Gilbert, PhD Marc Gironda, PsyD Carol Goodheart, EdD Sandra Grundfest, EdD Diane Handlin, PhD Sandra Harris, PhD Nancy Hicks, PsyD Joy Huston, PhD Elaine Hyman, PsyD Robert Karlin, PhD Judy Kaufman, PhD Terence Kearse, PhD Stanley Keyles, PsyD MaryAnn Kezmarsky, PhD
Advocate (up to $100) cont. Henry Kogler, MA Phyllis Kresch, PsyD Miriam LaTorre, PsyD Marvin Leibowitz, PhD Nancy Lerner, PsyD Ilana Lev-El, PsyD Renee Levin, PhD Robert Levine, PhD Barbara Lino, PhD Mark Lowenthal, PsyD Heather MacLeod, EdD Cornelius Mahoney, PhD Stanley Mandel, EdD Margery Manheim, PhD Robert Massey, PhD Frank McElroy, PhD Fawn McNeil-Haber, PhD Barbara Menzel, PsyD Dante Mercurio, PhD Lauren Meyer, PsyD Elizabeth Nadle, PsyD Alice Nadelman, PhD Behnaz Pakizegi, PhD Kristen Peck, PhD Sharon Perrotta, PsyD Katherine Placek, PhD Alan Radzin, PhD Katherine Rhoades, PhD William Rosenblatt, EdD Dorothy Saynisch, PhD David Schaub, PhD Peter Schild, EdD Lynn Schiller, PhD Jay Schmulowitz, PhD Gail Schrimmer, PhD Richard Silvestri, PhD Pierce Skinner, PsyD Shawn Sobkowski, EdD Tamara Sofair-Fisch, PhD Jeffrey Spector, PsyD Stacey Spencer, EdD Mary Ellen Stanisci, PhD Ira Sugarman, PhD Joanne VanNest, PhD Elizabeth Vergoz, PhD Virginia Walters, PsyD Skye Wilson, PhD Deborah Worth, PsyD Elaine Weinman, PhD Michael Wexler, D Ed Grace Zambelli, PhD
Psychology and the Law
Therapeutic and Forensic Roles by Gianni Pirelli, PhD
n this article, I clarify the distinction between therapeutic and forensic roles. The distinction is important, as it has practical and ethical implications, with respect to standards of practice and care. A lack of clarity in this regard has been due, in part, to confusion about what constitutes the practice of forensic psychology. Although many scholars have offered their definitions of forensic psychology, coansensus has not existed until this past year. On August 3, 2011, the Specialty Guidelines for Forensic Psychology (Committee on Ethical Guidelines for Forensic Psychologists, 2011) was approved by the American Psychological Association’s (APA) Council of Representatives, replacing the existing (i.e., 1991) version of the Guidelines. In addition to numerous substantive revisions and expansions of the document, a major conceptual change was made. The document is now entitled, Specialty Guidelines for Forensic Psychology, rather than Specialty Guidelines for Forensic Psychologists. The change is meaningful because the Guidelines are intended to apply to the work a psychologist engages in that is not dependent on the way the psychologist defines his or her practice. Put differently, the Guidelines apply even to psychologists who do not define themselves as forensic psychologists if they engage in forensic work as it is defined in the Guidelines: For the purposes of these Guidelines, forensic psychology refers to professional practice by any psychologist working within any sub-discipline of psychology (e.g., clinical, developmental, social, cognitive) when 12
applying the scientific, technical, or specialized knowledge of psychology to the law to assist in addressing legal, contractual, and administrative matters. Application of the Guidelines does not depend on the practitioner’s typical areas of practice or expertise, but rather on the service provided in the case at hand. (p. 1) Although guidelines such as these are aspirational and technically cannot be enforced by the APA or other governing bodies (e.g., state licensure boards), it is incumbent upon practitioners to maintain professional competence by keeping abreast of the standards of practice in the field. The updated Guidelines provide psychologists with such and, as a result, they should be beneficial in lessening potential role conflicts. In their seminal work, Greenberg and Shuman (1997) contrasted the role of the therapeutic clinician with that of the forensic evaluator. They outlined 10 differences between therapeutic and forensic relationships: (i) identifying the client; (ii) relational privilege; (iii) cognitive set and evaluative attitude; (iv) areas of competency; (v) nature of the hypotheses tested; (vi) scrutiny applied to the information utilized; (vii) amount and control of the structure; (viii) nature and degree of “adversarialness;” (ix) goal of the professional; and (x) impact of critical judgment by the psychologist. I highlight the most crucial differences below. One difference relates to the determination of who the client is in the professional relationship – an issue first explored by Monahan (1980). In a therapeutic context, identifying the client is typically straightforward; it is usually the
person receiving therapy or therapeutic interventions (i.e., the patient). In a forensic context, there are often several clients that may include the person being evaluated (e.g., the defendant), the attorney, the court, and the community. It is essential to identify the client(s) in each context to provide the foundation and associated considerations for the work moving forward. A second difference is related to the relational privilege. In the context of therapeutic services, privilege and confidentiality are generally protected and will be maintained barring any Tarasoffrelated exceptions. In forensic work, privilege may exist within the context of the attorney-client relationship (e.g., attorney work-product); however, no such privilege exists in certain situations (e.g., court-ordered evaluations). As a result, an examinee’s confidentiality will be limited or even absent during the course of a forensic evaluation. The aforementioned principles related to privilege are important for the practitioner to recognize for many reasons, particularly as they pertain to informed consent. A third difference, cognitive set and evaluative attitude, is one that clearly differentiates the two areas of psychological practice. Therapeutic care providers typically strive to be supportive, accepting, and empathic, whereas forensic practitioners are trained to be as neutral, objective, and detached as possible. It has been noted in many forensic contexts that “empathy gets in the way.” A fourth difference relates to the hypotheses tested in clinical and forensic work. Clinicians test hypotheses potentially associated with treatment goals, including considering differential diagNew Jersey Psychologist
Psychology and the Law
noses and relevant themes brought about in therapy sessions. Forensic practitioners test hypotheses related to the psycholegal question at hand (e.g., competency to stand trial). As such, forensic practitioners must have an understanding of the law and be able to operationalize psycholegal constructs. For instance, when conducting a competency to stand trial evaluation, a practitioner must know how to appropriately assess a defendant’s competence-related abilities (i.e., understanding, reasoning, and appreciation). The aforementioned difference (i.e., the nature of hypothesis testing) is closely associated with the ninth distinction outlined by Greenberg and Shuman (1997): the goal of the professional in each relationship. The main goal of clinicians is to benefit the patient via the therapeutic relationship, whereas the main goal of forensic practitioners is to address the psycholegal question to assist the trier of fact (i.e., the judge or jury) in the legal decision-making process.
Clear distinctions between clinical and forensic work exist. It is incumbent upon psychologists to understand and appreciate such distinctions to avoid conflicting roles, but also to be able to provide the most competent and ethical services possible. Professionals engaging in forensic work can be more confident in providing such services now that clearly defined practice guidelines and standards have been developed. Please email your contributions to me at firstname.lastname@example.org ❖ References Committee on Ethical Guidelines for Forensic Psychologists. (1991). Specialty guidelines for forensic psychologists. Law and Human Behavior, 15(6), 655-665. Committee on the Revision of the Specialty Guidelines for Forensic Psychology. (in press). Specialty guidelines for forensic psychology. American Psychologist.
Greenberg, S. A., & Shuman, D. W. (1997). Irreconcilable conflict between therapeutic and forensic roles. Professional Psychology: Research and Practice, 28, (1), 50-57. Monahan, J. (1980. Who is the client? The ethics of psychological intervention in the criminal justice system. Washington, DC: American Psychological Association. GIANNI PIRELLI, PhD is a Staff Clinical Psychologist 3 on a Forensic Unit at Greystone Park Psychiatric Hospital (GPPH) in Morris Plains, New Jersey. He is a graduate of the Clinical-Forensic Psychology PhD Program at The Graduate Center at John Jay College of Criminal Justice (CUNY). Dr. Pirelli’s areas of expertise include forensic mental health assessment, standards of practice in forensic psychology, psychometric properties of traditional and forensic assessment instruments, and clinical judgment and decision-making.
JAMES PhD, JD JD JAMES S. S. WULACH, WULACH, PhD, 28206 MILLBURN AVENUE, SUITE MAIN STREET SUITE 22 6 SPRINGFIELD, NEWJERSEY JERSEY07041 07081 MILLBURN, NEW (973) 763-4588 Telephone Consultation Available ATTORNEY AT LAW Legal & Ethical Issues, State Board Matters LICENSED PSYCHOLOGIST #1299 Therapy, Supervision, Testing, Forensic, Custody Author: Law & Mental Health Profs: NJ Former President, NJ Psychological Assn. Certificate, NYU Postdoctoral Program
New Jersey Psychological Association of Graduate Students (NJPAGS)
Sustainability of NJPAGS by Krista Dettle, MA Seton Hall University
erived from the Latin root sustinere, to hold up, sustainability is the capacity to endure. Ecologically speaking, sustainability describes the means through which systems maintain diversity and productivity over time. Nurtured systems create a reciprocal exchange of vital resources and energy. I consider NJPAGS to be one of those nurtured systems. Since its inception in 2006, NJPAGS has seen its leadership and membership grow and flourish. But what does it take to foster true sustainability? Imagine for a moment that building and sustaining an organization was likened to building and sustaining a house. Long standing sustainability would require the house to have a strong infrastructure, at minimum a stable foundation, protective roof, and sturdy walls. Despite the strength of that infrastructure, if the house is to maintain its strength over time, it requires people to care for it. In the same vein, improving sustainability of NJPAGS requires a continuous reappraising, reorganizing, and incorporating of new practices and technologies. As a whole, the NJPAGS board strives to ensure a realistic vision and goals that include high quality programs for its membership. As growth continues, it becomes even more vital to ensure the next generation of reliable members, as they are the heart of the organization. Without the support of dedicated members and officers, NJPAGS would cease to exist. In an effort to tap into strengths and make our programs stronger, we have conducted our first ever membership survey, and have focused our Fall 2011 retreat on the sustainability of NJPAGS. Through the survey, we ascertained important information such as where students are in their training, what topics 14
they are interested in, and what are the most convenient times and locations to hold programs. In addition, 100% of respondents indicated their overall level of satisfaction with NJPAGS, rated as “Very Satisfied” or “Satisfied.” Coffee and Conversation meetings were one of the most highly lauded programs, thanks to our wonderful advisors and NJPA hosts! Students are reporting that they would greatly appreciate similar programming in the future. Our retreat further focused on increasing involvement and reducing barriers to participation. Contributors brainstormed ways to recruit new members and to extend our reach to more campuses. Needless to say, we will be wholeheartedly continuing our efforts to plan more student-friendly initiatives. One of our resolutions for the new year is to promote an inspired spirit of interconnectedness in our student community through social media. (“Like” us on
Facebook!) We would like to encourage members to use NJPAGS as a venue for networking and exchanging ideas, as well as being an avenue for career exploration and development. Whether students wish to enter leadership positions, join a Special Interest Group, attend the annual Internship Fair and Conferences, or simply read the NJ Psychologist, participation is a plus and keeps our organization going strong. The bottom line: the more students participate, the greater their voice and the better NJPAGS can continue to serve students’ changing needs in the years to come. As I step into my new role as NJPAGS chair, I look back on the past four years of my experience with the organization with contentment at all that has been accomplished and all that can potentially be accomplished in the future. NJPAGS truly has sustain-ability. ❖
So many NJPA members have made the choice.
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New Jersey Psychologist
New Jersey Psychological Association of Graduate Students (NJPAGS)
CONGRATULATIONS! At the NJPAGS Fall Retreat, the first ever Dawn Gemeinhardt Student of Excellence Award was presented to 2011 NJPAGS Chair, Antoinette Welsh, MA in acknowledges her hard work and dedication to the student organization. This award recognizes outstanding student leaders and encourages them to continue on their leadership path. Focus areas may include, but are not limited to, creating programs to raise consciousness to issues of diversity, advocating for the needs of graduate students, creating programs to service the needs of graduate students, facilitating communication between NJPA committees and NJPAGS, and recruitment of new members.
Undergraduate and Graduate Students Awards Undergraduate Student Researcher Award:
This award is presented either to an undergraduate psychology major attending a New Jersey college or university who has demonstrated exceptional research potential as determined by his or her academic department. The awardee is invited to present their research as a poster at the NJPA Fall Conference on October 20, 2012 and receives a certificate.
Graduate Student Research Award:
This award is presented to a graduate student in psychology who is either attending a New Jersey college or university or interning in a New Jersey institution or an NJPA student affiliate, who has demonstrated exceptional research potential as determined by his or her academic department. This research should have been completed within the last two years. The awardee is invited to present his/her research as a poster at the NJPA Fall Conference on October 20, 2012 and receives a certificate.
Applications for either award should provide the following information: • Name, address, telephone numbers and institutional affiliation of the applicant • Name, address, telephone numbers, and institutional affiliation of department/faculty sponsor • Title of research presentation • 100-150 word abstract and/or one page summary of project • Resume of applicant • Two letters of endorsement from faculty members
The deadline for submission is July 13, 2012
Applications may be made either electronically or by hard copy. Please send completed applications to: Academic and Scientific Affairs Committee New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 973-243-9800 NJPA@PsychologyNJ.org Winter 2012
Gretchen Chapman, PhD
Gary Lewandowski, PhD
Cristina Shaheen, MS
Steven James Simmons
2012 Research and Teaching Awards The Distinguished Researcher Award is given to a psychologist who has a distinguished record of research in any area of psychology and holds a full-time academic or scientific position. Awardee receives a certificate and $300. The Distinguished Teacher Award is given to a psychologist who has a distinguished record of teaching in any area of psychology and holds a full-time academic or scientific position. Awardee receives a certificate and $300. The Emerging Researcher Award is given to a psychologist who has made a substantial contribution to research in any area of psychology, is a full-time academician or scientist, and has received a doctoral degree within the past 10 years. Awardee receives a certificate and $100. Nominations should include: Name and terminal degree of candidate, institutional affiliation Address and telephone number/email of candidate 2 copies of a 500-word statement describing the candidate's achievements and contributions Abstracts of any relevant work Curriculum vita Three letters of endorsement including the endorser's credentials
Mail to: Kathleen Torsney, PhD Director, Academic Affairs New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052
Deadline for nominations is July 13, 2012. Self-nominations are encouraged. Nominees need not be members of NJPA. The Committee on Academic and Scientific Affairs reserves the right to make all final determinations on which awardees will be selected.
Master’s Thesis and Doctoral Dissertation Awards The New Jersey Psychological Association’s Academic and Scientific Affairs Committee is seeking nominations for the best Master’s Thesis and Doctoral Dissertation from any specialty within a psychology graduate program in New Jersey. They should be superior in quality, design, and especially, represent a significant contribution to psychology or society as a whole. Each graduate program is asked to nominate one student in each category and forward two copies (photocopies acceptable) of the thesis/dissertation to the New Jersey Psychological Association by June 29, 2012. Please provide contact information for the student as well as the school. Awardees will be honored with a special citation at the NJPA 2012 Fall Conference on October 20, 2012.
Please send two copies directly to: Kathleen Torsney, PhD, Director of Academic Affairs to the address listed above. 16
New Jersey Psychologist
Forensic Ethical Guidelines for Therapists by Ronald Silikovitz, PhD
s you know, the primary mission of the reconstituted NJPA Ethics Education and Resource Committee is to assist members in applying the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct in their respective practices (NJPA Ethics and Education Resource Committee Procedure Manual, 2011). The purpose of this article is to discuss various ethics resources that focus on forensic practice and have relevance to all NJPA members providing non-forensic, clinical services. One of the most comprehensive, but perhaps not fully utilized, ethics resources, is the American Psychological Association website <www.APA.org>. The specific link is APA Guidelines for Practitioners. Please note that guidelines are aspirational. Some of the specific forensic practice guidelines, of which all practitioners should be aware in order to facilitate ethically sound practice, are as follows: • Guidelines for the Practice of Parenting Coordination Parenting Coordination is a non-adversarial process designed to minimize the emotional impact of high-conflict custody disputes through parent education, mediation, conflict resolution, and intensive case management. Parenting Coordinators are highly trained specialists, appointed by the court, or by mutual consent of the parties, in highconflict post-divorce matters. Their primary role is to assist the parties in implementing the parenting plan and their day-to-day communications and parenting responsibilities. Often, ParWinter 2012
enting Coordinators communicate with the children’s or parents’ therapist, in order to promote the children’s best interests. Therefore, it is helpful for all therapists to be familiar with the guidelines for Parenting Coordination. As an example, imagine that you are the therapist treating a nine-year-old boy whose adoptive parents are recently divorced. The child has not been told that he is adopted. One of the parents, let us say, the father, is interested in sharing information with the boy about his adoption. The mother has been reluctant to provide for her son what she feels may be highly disturbing information. The Parenting Coordinator has been working with the parents regarding this issue and may seek your input, as the child’s therapist, as to what may be the most appropriate course of action. • Guidelines for Child Custody Evaluations in Family Law Proceedings Forensic evaluators who conduct child custody, parenting time, and relocation assessments, whether court appointed or retained by one of the parties, often communicate with the therapist working with the one of the children, one of the parents, or the family. Therefore, it is helpful for all therapists to be familiar with the guidelines for child custody evaluations. As an example, forensic psychologists who conduct custody and parenting time evaluations reach out to collateral contacts, including a child’s teachers, pediatricians, coaches, and therapists, in order to obtain objective information about the child’s needs and interests. Information provided by the
child’s therapist is often most helpful in the overall assessment of the child’s best interests, and his relationships with each of his parents. In addition, please note that, if you are a therapist for a child, a parent, or a couple, proper ethical practice precludes you from becoming an evaluator, and therefore you should not be making any recommendations regarding parenting time or custody. • Guidelines for Psychological Evaluations in Child Protection Matters Forensic evaluators, who conduct child protection evaluations (risk assessments of future abuse and neglect; parental fitness; bonding; termination of parental rights; and adoption), often consult with therapists working with one of the children, parents, or the family. Therefore, it is helpful for all therapists to be familiar with the guidelines for psychological evaluations in child protection matters. For example, a forensic psychologist, who conducts a termination of parental rights evaluation, focuses on the clinical appropriateness of a child’s reunification with a parent who has been abusive or neglectful. That forensic psychologist may seek the input of you, the child’s therapist, regarding that child’s current relationship with the formerly abusive or neglectful parent. • Record Keeping Guidelines All psychologists, including forensic experts and non-forensic therapists, need to be thoroughly familiar with the ethical and regulatory requirements for all record keeping, including electronic records. 17
An increasing number of forensic and non-forensic psychologists are utilizing current technology, including e-mails and texting, in a variety of innovative ways in communicating with patients, referral sources, collateral sources, attorneys, etc. From an ethical point of view, it is recommended that such communications be encrypted and then printed out and placed in patient files (Kenneth Drude and Michael Lichstein, Ohio Psychologist, August, 2005, p. 13-17). The ethical and regulatory principles that apply to record keeping, i.e., documenting sessions, interventions, and progress, also apply to electronic communications such as texting and e-mails. • Guidelines for Court-Involved Therapy The Association of Family and Conciliation Courts (AFCC) is an interdisciplinary and international association of professionals dedicated to the resolution of family conflict. Its members are judges, mediators, researchers, counselors, custody evaluators, court admin-
istrators, parent educators, attorneys, psychologists, academics, parenting coordinators, social workers, and financial planners. In 2010, AFCC promulgated guidelines for “court-involved therapy.” These guidelines, that are aspirational, were developed to assist AFCC members and others who provide treatment to court-involved children and families. “Court-involved therapists” are defined as mental health professionals who provide therapeutic services to family members involved, or who may become involved, in child custody or juvenile dependency court processes. While appropriate treatment can offer considerable benefit to children and families, inappropriate treatment may escalate family conflict and cause significant psychological harm. Any psychologist who provides therapeutic services may become a “courtinvolved therapist,” and the AFCC guidelines may be helpful. The AFCC website is <www.AFCC.net>. For example, you have been the
Member News Ruth Lijtmaer, PhD presented the following paper: “Passion and politics in the consulting room: Who talks about it? Who does not? What does the analyst do?” in the Panel: Power, Politics and Clinical Process at the Association for the Psychoanalysis of Culture and Society Annual Conference held November 4-5, 2011 at Rutgers University, New Brunswick, New Jersey. Dr. Lijtmaer also presented “Back to our ethnic roots: The analyst unavoidable involvement in the patient’s world” at the International Federation for Psychoanalytic Education (IFPE) held November 11-13, 2011 in Fort Lauderdale, Florida. Stan Zebrowski, PhD presented a program to the Robert Wood Johnson Network Educators on Skills to Address Workplace Bullying, Incivility, and Enhancing Relations at the Next Generation Plan of Care: Cultural Perspectives in Communication Program sponsored by Children’s Specialized Hospital and CentraState Medical Center this past September.
therapist for two years for a now eleven-year-old girl. Her parents have had a high-conflict relationship, including incidents of domestic violence, but they have remained together and involved in the child’s therapy even as their marital relationship has deteriorated. Suddenly, there is a major domestic violence incident in which the police are involved. The girl’s father is removed from the home, his parenting time with her is curtailed, and, within months, the mother has filed for divorce. You are now a “court-involved therapist,” and, in the girl’s best interests, you will need to be familiar with, and comply with, the AFCC guidelines. In conclusion, psychologists should be familiar with various guidelines, ethical standards, principles, and regulations that have been promulgated to promote ethical practice, competence, fairness, and honesty in our professional work. The NJPA Ethics Education and Resource Committee is in place to assist and guide psychologists towards these aspirational goals. ❖
Office Hours by Appointment
Sandra H. Wulach, MD Psychiatry 28 Millburn Ave 75 Oak Street Suite 6 Ridgewood, NJ 07450 Springfield, NJ 07081 Phone: 201-447-1773 Phone: 973-467-1773 Fax: 973-763-2088
AMY L. ALTENHAUS, PH.D LICENSED PSYCHOLOGIST #1479 80 EAST MAIN STREET FREEHOLD, NJ 07728 732-780-6644
LIFE TRANSITIONS, PARENTING, RELATIONSHIPS, CUSTODY EVALUATIONS NEW: HELPING ADULTS MAKE CAREER CHANGES AND IDENTIFY WHAT GETS IN THE WAY NYU CERTIFICATE IN ADULT CAREER PLANNING AND DEVELOPMENT
New Jersey Psychologist
It Takes a Group – and Some Individuals: The NJPA Foundation supports group therapy services at the GSAPP Psychological Services Clinic by Donald Morgan, PsyD Clinic Director
ometimes it is good to know the history so we can appreciate how good things happen. I would like to share the story of how the Group Psychotherapy Services at the GSAPP clinic came to be, and in so doing, honor the group and the individuals who made it happen. The group, of course, is all of the NJPA members who support the Foundation. Since early 2000, the NJPA Foundation has bestowed a yearly grant upon our clinic to support the delivery of psychological services to the underserved population in the greater New Brunswick area. As the director of the clinic, I typically awarded these funds to two needy graduate students in the PsyD program each year, who saw low fee clients from the community. For many years this is how funding was distributed until one year, two students, Shawn Ewbank and Brett Kociol, came to me with a plan to develop group therapy services at the clinic. They had taken David Panzer’s course in group therapy, had experience with groups before coming to GSAPP, and were excited to try to create groups to serve more community patients and also provide training for students. They understood that this would take considerable work that they were willing to do, but it would mean that they would need some support in order to devote the time to this project. And, so it came to be that I began using the NJPA funding to support what would become known as GPS – Group Psychotherapy Services. Here is the important history that allows us to see the ways that groups and individuals all contributed to the GPS program at GSAPP: In 1977, when I was a graduate student at GSAPP taking Morrie Goodman’s group therapy course, we watched through a one-way mirror Winter 2012
as an advanced PhD candidate, Gordon Boals, ran a demonstration group. The course was structured such that the observed group was crucial to the learning experience, in that the group was to be passed down to other therapistsin-training when the current therapist moved on in his or her training. It came to pass, however, that the group did not continue for the entire year, and some time after that there was not only no demonstration group, but the class also ceased to be offered at GSAPP. Sometime later, David was asked to teach a group course to the School Psychology students, and by the early ‘90s he was teaching it regularly for all GSAPP students. To this day it continues to be a very popular class at GSAPP. Beginning in the late 1990s, David and I discussed the need to find ways to start groups at the clinic so the students in the class could have the experience of leading them and to be able to make videos of the sessions for classroom study [no more one-way mirrors!] After several false starts and failures in keeping the groups going, we were pessimistic. But then, the aforementioned group zealots, Brett and Shawn, arrived with a comprehensive plan for starting and maintaining groups as part of a whole program in group therapy. They had taken David’s course and sought his guidance in developing a business plan that they presented to me, received my hearty approval and help, and we began assembling groups. It was clear that these students were most deserving of the NJPAF funding for a project that combined training and service to underserved people and, happily, Jack Lagos and the NJPAF Board agreed to renew this grant of support each subsequent year.
The students worked hard over a couple of years and, with David’s guidance and supervision, as well as supervision provided over the many years by Gordon Boals, Jeff Axelbank, Morrie Goodman, Nina Thomas, Mike Andronico, Myrna Frank, Nina Williams, Barry Helfmann, Christine AtkinsHutchinson, and Pat Connelly, they were able to grow the GPS program and pass it down to successive generations of students. To date, the GPS program has created and run groups at the GSAPP Clinic in residences at Rutgers University, and in the Piscataway school system. There have been groups for young adults, older adults, Rutgers and high school students, and LGBT clients. The GPS program is always looking to provide low cost group therapy to more underserved clients in the greater New Brunswick area. It is often true that when people dedicate themselves to creating a new project, their good energy and passion multiply and grow in ways that can not be anticipated, and attract new energy and support. Students who had become passionate about group therapy have always wanted to attend the yearly American Group Psychotherapy Association (AGPA) conference, but the costs were prohibitive. It had always been David’s intent to find ways to help students attend the AGPA conference. In recent years, there was a large donation made to GSAPP by the family of the late Bert Schwartz, a pioneer teacher and supervisor of group therapy, and his business associate, Morrie Goodman. The Bert Schwartz and Morris Goodman Endowment was intended to support learning about group therapy at GSAPP. David Panzer added a generous gift to the fund 19
alongside contributions by Barry Helfmann, Susan Marx, Mark Geller, and donations from other New Jersey group therapy stalwarts. At present, the fund generates enough support to allow five to eight students to have full scholarships for travel, hotel, and tuition to the annual AGPA meeting. The synergy of good energy around this program continues to grow! The dean of GSAPP, Stanley Messer, as well as the faculty and I, have expressed gratitude for the generosity of the NJPA Foundation and to all the strong supporters in New Jersey of
group psychotherapy. But most of all, it is our students who are grateful for the financial support, generous supervision, and opportunities for training with which the GPS program is blessed due to the efforts of all the contributors and supervisors. One of our current group leaders, Matthew Dickson, noted that he will have had the opportunity to lead an ongoing group for three years by the time he applies for internship. This is an extraordinary training opportunity that will give him and others a great advantage in obtaining excellent internships and in providing high quality group
therapy services. In our weekly clinic staff meetings, we routinely evaluate each assigned case for suitability for concurrent group therapy and make appropriate referrals. David and his students have made a video teaching therapists how to best refer patients for group therapy, and our students see this as part of their clinic orientation. The GPS has made a home for itself in our GSAPP system and we honor the individual seeds planted and the individuals and groups, notably the NJPA Foundation, that have tended them and helped them to grow. Many thanks to all. ❖
40 Hour Divorce Mediation Training New Jersey Association of Professional Mediators
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Teaching methods include lecture, faculty demonstrations, and student role-plays
Offered by NJAPM— the only group in New Jersey with a structured accreditation process and dedicated to the practice of mediation
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New Jersey Psychologist
2011 Foundation Awards and Scholarship Winners
“To build a dream, you need a Foundation” Research into Causes and/or Treatment of Social Problems Award
Dr. Zellig Bach Award Treatment of Social Problems Award
The NJPA Foundation Scholarship for Minority Graduate Students
Atara Hiller, PsyM “Predictors of treatment treatment outcome outcome for for a game-based game-based cognitive cognitive behavioral behavioral group treatment Group treatment for for children childrenwho whohave have been sexually sexually abused.” abused.”
Nita Makhijini, EdM “The relationship between traumagenic dynamic responses towards childhood social support, trauma severity and sexual abuse, ethnic identity, attitudes towards interpersonal relationships in adolescent females.”
Leigh Solano Wilton “On the color line: The impact of claiming biracial White/minority identity.”
The recipients were recognized and presented awards at the 2011 NJPA Fall Conference.
AWARDS & SCHOLARSHIPS CRITERIA The applicant must meet at least ONE of the following criteria to be considered: 1. 2. 3.
NJPAGS student affiliate OR Enrolled in a New Jersey University or college master’s or doctoral level psychology program OR Psychology intern at a New Jersey facility.
2012 – NJPA Foundation Awards Application & Requirements The following awards may be given by the NJPA Foundation. As this is a competitive process, the NJPA Foundation reserves the right to provide an award to only those proposals that meet a standard of excellence. Please check the award you will be applying for: Research into Causes and/or Treatment of Social Problems ($2000). Some possible topics include school issues, work problems, health issues, and aggression. __
The NJPA Foundation Scholarship for Research on Diversity Issues ($2000): Awarded to a graduate student in psychology who advances the following goals: (a) Promote scientific understanding of the role of diversity in psychology; (b) Foster the development of sensitive models for delivery of psychological services to diverse populations. Some possible topics include issues related to cultural or ethnic issues, socioeconomic issues, gender issues or work with underserved populations. Dr. Zellig Bach Award for the Study of the Family ($1000). Awarded for the study of behavior related to divorce, teenage pregnancy, adoption, single parents with dependent children, interpersonal abuse, substance abuse, custody, dual careers, childcare, etc. Winifred Starbuck Scott Award ($1000). Awarded to a graduate student in school psychology for completing a distinguished project, usually during internship. To see complete requirements and evaluation criteria, visit the Foundation at <www. PsychologyNJ.org> ALL SUBMISSIONS MUST BE EMAILED Application Deadline: July 16, 2012 New Jersey Psychological Association Foundation 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052 (973) 243-9800 Fax: (973) 243-9818 Email: NJPA@PsychologyNJ.org
Foundation The NJPA Foundation is committed to advancing the psychological health of our New Jersey community by supporting psychological services for children and adults who cannot afford them, by supporting the training of new psychologists, and by disseminating psychological knowledge to the general public. The Foundation’s work would not be possible without the generous donations of our colleagues in NJPA.
“To build a dream, you need a Foundation”
The NJPA Foundation is most grateful to all of the following colleagues who have contributed so substantially to our efforts in 2011. Our heartfelt thanks to all of you. President: Ilyse O’Desky, PsyD Angel $1000 and over Susan Kasper, PhD Richard Klein, EdD John Lagos, PhD Viola Sutherland, PhD Patron $500-$749 Rosalind Dorlen, PsyD Mathias Hagovsky, PhD Viola Sutherland, PhD Daniel Watter, EdD Everett Belvin Williams, PhD Contributor $250-$499 Jeffrey Axelbank, PsyD Susan Buckley, PsyD Jane Hochberg, PsyD Kenneth Kline, PhD Alfredo Lowe, PhD Sharon Ryan Montgomery, PsyD Janet Nelson, PhD Supporter $100-$249 Howard Adelman, PhD Vicki Barnett, PsyD Judith Bernstein, PsyD Jeffrey Bessey, PhD Richard Brewster, PsyD Dorothy Cantor, PsyD Monica Carsky, PhD Rosemarie Ciccarello, PhD Kathleen Cullina-Bessey, PsyD Patricia DeSear, PhD Jeannette DeVaris, PhD Susan Esquilin, PhD Bud Feder, PhD Donald Franklin, PhD Thomas Frio, PhD Milton Fuentes, PsyD Kenneth Gates, PsyD Larry Gingold, PsyD Elizabeth Goldberg, PhD Allen Hershman, PhD, PsyD Margery Honig, PhD Ellen Hulme, EdD Sarah Karl, PhD Robert Karlin, PhD Charles Katz, PhD Richard Kessler, PhD Deirdre Kramer, PhD Judith Kramer, PhD Marvin Leibowitz, PhD Ruth Lijtmaer, PhD N. John Lombardi, PsyD William Boyce Lum, PsyD Marilyn Lyga, PhD Roger Maitland, PhD Neil Massoth, PhD Frank Mazza Nancy McWilliams, PhD Barry Mitchell, PsyD Lynn Mollick, PhD Marsha Morris, PhD Rosemarie Moser, PhD Laura Palmer, PhD Nicholas Papouchis, PhD
Howard Paul, PhD Francesca Peckman, PsyD Debra Roelke, PhD Barbara Rosenberg, PhD Elissa Rozov, PhD George Sanders, PhD Komal Saraf, PhD Arline Shaffer, PhD Jeffrey Spector, PsyD Milton Spett, PhD Martha Temple, PsyD Carol Turner, EdD Peggy Van Raalte, PsyD Barbara Von Klemperer, EdD Duncan Walton, PhD William Walsh, PhD Aaron Welt, PhD Nina Williams, PsyD Philip Witt, PhD Stanley Zebrowski, PhD Michael Zito, PhD Friend up to $99 Annette Appleheimer, PsyD Pauline Bergstein, PhD Janet Berson, PhD Carole Beyer, EdD Bernard Bilicki, PsyD Carol Blum, PsyD Angelica Diaz-Martinez, PsyD Nancy Distel , PhD John Dovel, PhD Joan Fiorello, PhD Richard Formica, PhD Eliot Garson, PhD Marc Gironda, PsyD Sandra Grundfest, EdD Osna Haller, PhD Joy Huston, PhD Monica Indart, PsyD Phyllis Kresch, PsyD Phyllis Lakin, PhD Ilana Lev-El, PsyD Renee Levin, PhD Robert Levine, PhD Gloria Loew, PhD Heather MacLeod, EdD Cornelius Mahoney, PhD Melissa Marano, PsyD Susan Marx, PsyD Robert McGrath, PhD Susan Neigher, PhD Julie O’Rourke, PhD James Owen, PsyD Carol Quintana Nancy Razza, PhD Mark Reuter, PhD Lloyd Ross, PhD Michele Rubin, EdD Zelig Schrager, PhD Paul Schottland, PhD Mancie Senet, PhD Daniel Sugarman, PhD Jacqueline Tropp, PhD
Joanne VanNest, PhD Grace Zambelli, PhD Student Lunch Roderick Bennett, PhD Gordon Boals, PhD Rosalind Dorlen, PsyD Sean Evers, PhD Pamela Foley, PhD Daniel Gallagher, PhD Larry Gingold, PsyD Mathias Hagovsky, PhD Raymond Hanbury, PhD Barry Helfmann, PsyD Mary Kelly, PhD Deirdre Kramer, PhD Jack Lagos, PhD Phyllis Lakin, PhD Mark Lowenthal, PsyD Neil Massoth, PhD Susan McGroarty, PhD Norine Mohle, PhD Louis Schlesinger, PhD William Shinefield, PsyD Jeffrey Singer, PhD Laurence Straus, PhD Jonathan Wall, PhD Aaron Welt, PhD Dinner Elinor Bashe, PsyD Philip Bobrove, PhD Cynthia Bratman, PsyD Craig Callan, PsyD Rosalind Dorlen, PsyD Lew Gantwerk, PsyD Marc Geller, PsyD Larry Gingold, PsyD Morris Goodman, PhD Osna Haller, PhD Raymond Hanbury, PhD Barry Helfmann, PsyD Lisa Jacobs, PhD Eileen Kennedy-Moore, PhD Deirdre Kramer, PhD Phyllis Lakin, PhD Judith Margolin, PsyD Charles Mark, PsyD Bonnie Markham, PhD, PsyD Neil Massoth, PhD Wendy Matthews, PhD Stanley Messer, PhD Stanley Moldawsky, PhD Sharon Montgomery, PsyD Lawrence Perfetti, EdD George Sanders, PhD Kenneth Schneider, PhD Laura Skivone-Fecko, PhD Milton Spett, PhD Daniel Watter, EdD Aaron Welt, PhD Mark White, PhD Nina Williams, PsyD Gail Winbury-Klizas, PsyD James Wulach, PhD, JD Jeannine Zoppi, PhD
New Jersey Psychologist
“The L, the G, the B, the T: 2011” By Peter J. Economou, PhD, Felician College, NJPA Diversity Committee member Sam Klugman, Rutgers Graduate School of Applied and Professional Psychology, NJPAGS member
Introduction he lesbian, gay, bisexual, and transgender (LGBT) population makes up anywhere from 10-15% of the general population (Kinsey, 1948, 1953; Fassinger, 1991). This community possesses a significant history of stigmatization and criminalization for homosexual and gender variant behaviors, even following the removal of homosexuality from the DSM-II in 1973 (Drescher, 2008). There have been significant gains with regard to the LGBT equality movement including the approval of gay marriage in six states within the United Sates from 2004-2011 (i.e., Connecticut, Iowa, Massachusetts, New Hampshire, New York, Vermont, plus Washington, DC, and Oregon’s Coquille and Washington State’s Suquamish Indian tribes). In addition, the LGBT community has made gains in its right to adoption and other anti-discrimination policies (e.g., workplace protection). This article addresses the broad spectrum of the LGBT population with a focus on discrimination, socio-political implications, and effective techniques for the advancement of the LGBT population including outreach and interventions when working with LGBT clients.
Discrimination Of the reported hate crimes in the United Stated in 2007, 17% were against individuals based on sexual orientation; anti-male homosexual reports were five times higher when compared to the anti-female homosexual reported hate crimes (Langton & Planty, 2011). Minority groups, in this case sexual minorities (i.e., LGBT individuals), experience various forms of discrimination including vocational stressors, verbal and physical assault, and prejudice. Moreover, discrimination for any marginalized group Winter 2012
can also manifest as a major life event or daily hassles (Swim, Johnston, & Pearson, 2009; Herek, 2009). These experiences affect psychological and physical health, as well as social and emotional functioning. Heterosexism There are many terms used to define anti-gay acts or feelings; variations include heterosexism, homophobia, heteronormativity, and homonegativity. Most often used, Herek (1990) defined heterosexism as “an ideological system that denies, denigrates, and stigmatizes any nonheterosexual form of behavior, identity, relationship, or community” (p. 316). Swim (2009) and her colleagues defined heterosexist hassles as “comments or behaviors that reflect or communicate hostile, denigrating, or stigmatizing attitudes and beliefs about lesbians, gay men, or bisexuals that are embedded in people’s everyday lives” (p. 598). No matter the term (i.e., heterosexism, homophobia, or homonegativity), the implications are the same. These experiences place the LGBT population at risk for discrimination, prejudice, physical and verbal abuse, and physical and mental health issues. Transphobia Although frequently lumped into the LGBT “umbrella,” transgender individuals experience unique stressors, clinical issues, and barriers to healthcare. The term transgender is itself broad and is used to describe a very heterogeneous group, including individuals who are transsexual, gender non-conforming, twospirited, genderqueer, and androgynous (Bockting, Knudson, & Goldberg, 2006). Transgender individuals are more likely to experience bias, discrimination, harassment, and associated negative psychosocial outcomes than individu-
als whose gender identity matches their assigned sex and gender at birth (i.e., cisgender individuals). A recent survey of over 6,000 transgender individuals, conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force (Grant et al., 2011) found staggering rates of transphobia, harassment, abuse, and discrimination in all areas of the United States. Respondents were more likely than the general population to live in extreme poverty; to experience harassment, sexual, and physical assault in school, home, prison, and public settings; to face employment and housing discrimination; to experience discrimination from medical and mental health providers; and to have higher rates of HIV and suicide attempts. Nearly 80% of transgender individuals reported experiencing harassment in schools, and 90% reported mistreatment or discrimination in the workplace. Further, transgender individuals of color were at even greater risk for these acts of discrimination, as the correlates of transphobia were compounded by experiences of ongoing, systemic racism (Grant et al., 2011).
Moving Beyond Competence: Outreach & Interventions
Outreach There are many actions that we as psychologists can take toward becoming stronger advocates for the LGBT population, including being active in public policy, advocacy, and outreach efforts. For example, several university counseling centers are conducting large outreach programs to LGBT individuals since many college students struggling with issues of identity and marginalization may not seek mental health services due to actual and perceived stigma. Professionals in NJ are likely familiar with 23
the tragic case of 18-year-old Rutgers University student Tyler Clementi, who jumped to his death after he experienced teasing and harassment around his identity. Our efforts of outreach can aid in preventing such tragedies. Clinicians should be active in assessing if their service settings are welcoming to LGBT clients (e.g., gender neutral bathrooms, intake forms that do not use heterosexist language) and if staff members have received training on the unique issues inherent in working with LGBT individuals. Allies are essential in these outreach efforts and can have a strong influence in the final outcome. Interventions Clinicians working with clients identifying as L, G, B, or T should be aware that there is no monolithic LGBT community. Rather, clients who identify as LGBT come from diverse racial, ethnic, religious, and geographic backgrounds, and many may not identify with LGBT communities. Subsequently, it is important to avoid labeling clients and to utilize the descriptors that clients provide for themselves. Here is the good news: Fassinger (2008) has created multiple models for working with LGBT individuals and has stated that, when working clinically with LGBT clients, common therapeutic factors are of central importance for both LGBT and heterosexual/ cisgender clients alike. Still, clinicians working with LGBT clients must attend to issues of identity development, loaded language, experiences of prejudice and discrimination, and internalized stigma. Before working with any population, it is imperative that clinicians take the time to explore his/her positions of privilege, as well as the unique developmental obstacles faced by diverse communities. Clinicians should be particularly attuned to issues faced by clients who may be additionally marginalized as a result of disability, gender, race, or ethnicity, both within and outside of the LGBT community. Some significant areas affecting clinical work with LGBT individuals includes sexual behavior, gender presentation and identity, substance abuse, internalized heterosex24
ism, and domestic violence. Clinicians working with LGBT individuals, and perhaps their families, should be familiar with the ways discrimination leads to psychosocial stressors and creates barriers to resources. Readers are encouraged to consult McGoldrick (2008) and Gurman (2008) for a more comprehensive overview of these issues in couples and family practice. Conclusion As struggles for LGBT rights continue to unfold daily on the streets and in the headlines, many positive achievements have been recorded to date. Psychologists have been instrumental in much of this success, contributing significantly to the areas of public policy, scientific research, and through empirically validated interventions with LGBT individuals. Certainly, we have a long way to go in confronting issues of oppression and intolerance in our field and throughout the country, underscoring the importance of maintaining a focus on multiculturalism and emphasizing its importance in our clinical work as psychologists. ❖ References Bockting, W., Knudson, G., and Goldberg, J.M. (2006). Counseling and mental health care of transgender adults and loved ones. Vancouver Coastal Health Transgender Health Program. Retrieved from: <http://www.vch.ca/ transhealth>. Drescher, J. (2008). A history of homosexuality and organized psychoanalysis. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 36, 3; p. 443. Fassinger, R (1991). The hidden minority: Issues and challenges in working with lesbian and gay men. Counseling Psychologist, 19, 157. Fassinger, R (2008). “Counseling Sexual Minority Clients: Affirmative Approaches for Working with Individuals, Couples, and Families.” Seton Hall University. Multicultural Seminar. South Orange, NJ. May 2008. Grant, J.M., Mottet, L.A., Tanis, J., Harri-
son, J., Herman, J.L., and Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force. Gurman, A. S. (2008). Clinical Handbook of Couple Therapy. New York: Guilford Press. Herek, G. M. (1990). The context of antigay violence: Notes on cultural and psychological heterosexism. Journal of Interpersonal Violence, 5, 3; p. 316-333. Herek, G. M. (2009). Hate crimes and stigma-related experiences among sexual minority adults in the United States: Prevalence estimates from a national probability sample. Journal of Interpersonal Violence, 24, 1; p. 54-74. Johnson, T. (2004). Gay Spirituality. Lethe Press in partnership with White Crane Institute: Maple Shade, NJ. Kinsey, A., Pomeroy, W., and Martin, C. (1948). Sexual Behavior in the Human Male. Philadelphia: W.B. Saunders. Kinsey, A., Pomeroy, W., Martin, C., and Gebhard, P. (1953). Sexual Behavior in the Human Female. Philadelphia: W.B. Saunders.Kitts, R. L. (2005). Gay adolescents and suicide: Understanding the association. Adolescence, 40, 159; p. 621. Langton, L. & Planty, M. (2011). Hate crime, 2003-2009. U.S. Department of Justice Ofﬁce of Justice Programs Bureau of Justice Statistics. Retrieved from: <http://bjs.ojp.usdoj.gov/content/pub/pdf/hc0309.pdf>. McGoldrick, M. (2008). Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice. New York: Guilford Press. Swim, J. K., Johnston, K., & Pearson, N. B. (2009). Daily experiences with heterosexism: Relations between heterosexist hassles and psychological wellbeing. Journal of Social and Clinical Psychology, 28, 5, p. 597-629.
New Jersey Psychologist
Introduction to Special Section
Treatment of OCD By Allen H. Weg, EdD, Guest Editor Stress & Anxiety Services of NJ, East Brunswick, NJ Herman Huber, PhD, Liaison Editor
bsessive Compulsive Disorder (OCD) has become the “psychiatric disorder du jour.” In the last few years, at any given time, there have been several TV series dedicated exclusively to examining (and sometimes sensationalizing) this disorder. Several major motion pictures have been made starring some of the biggest names in Hollywood where the main character clearly suffers from OCD (e.g., Leonardo DiCaprio in The Aviator, Jack Nicholson in As Good As It Gets). Other, smaller films on the topic of OCD have been made (OC87, Therapy Productions, 2010) and others are in pre-production (The Machine Man, Madison Films, in pre-production). Some in the media have “come out” to declare that they suffer from the disorder in their own lives (e.g., Howard Stern, Howie Mandel, David Beckham.) Our adolescents have adopted the disorder’s name as part of their everyday jargon, (“Don’t be so OCD!,” “Stop OCDing!”) though, of course, they misuse and misrepresent it at every turn. This fascination with OCD goes beyond the general voyeuristic zeitgeist that fuels our pop culture’s addiction to reality TV. With OCD, clinicians as well as lay people are intrigued by the seemingly contradictory aspects of the disorder. On the one hand, those with OCD appear at first glance to be psychotic, seemingly delusional, and completely irrational. On the other hand, they seem to talk about their own disorder with the same objective and appropriately evaluative stance that we, as onlookers, take when we observe them. They express frustration resulting from their own irrational behaviors, and clearly verbalize the wish to regain control, expressions usually limited to those with neurotic disorders. In addition, they may demonstrate excellent judgment and exhibit high functioning levels in all those aspects of their lives untouched by OCD. They often present with excellent social skills, and may be warm, endearing, and engaging. Beyond this dynamic of appearing psychotic, yet at the same time presenting with the kind of insight and self-observance usually limited to those who are neurotic, there is another incongruence, that of our own reaction to those with OCD. We can be completely perplexed by the strangeness of the behaviors we observe in them and the cognitions they report to us, yet, at the same time, we can be intrigued by the familiarity of these experiences, the universality of the Winter 2012
struggle with uncertainty, and the recognizable experience of having thoughts that one does not fully believe, while observing oneself engaging in behaviors that one does not fully understand. It is within this context of fascination and familiarity, incongruence and contradiction, that we bring to you this Special Section in the New Jersey Psychologist on Obsessive Compulsive Disorder. Even the most conservative estimates suggest that the prevalence rate for OCD is 1% for adults (Ruscio, Stein, Chiu, & Kessler, 2008) and .5% for children (March & Benton, 2007), the latter statistic indicating that it is about as prevalent as childhood diabetes. According to the International OCD Foundation, “on average, it takes 14-17 years from the time OCD begins for people to get the right treatment,” <http:www.ocfoundation.org> suggesting that despite its popularity in the mass media, much work is left to be done in educating professionals about the diagnosis and treatment of this disorder. We begin our series with Milton Spett, PhD, who provides us with a very comprehensive and exhaustive review of the behavioral, cognitive, family, and medication treatments available for OCD. His “matter of fact/shoot from the hip” style will not leave you guessing about his clinical impressions, and the clinical vignettes that are sprinkled throughout his article nicely illustrate his points. Joseph Springer, PhD, addresses the relatively recent introduction of one of the more popular “third wave” adjunct therapies to traditional Exposure & Response Prevention (ERP) in the treatment of OCD. He provides us with a thorough review of Acceptance and Commitment Therapy (ACT), and delineates the basic concepts that provide the foundation of this clinical approach. He then illustrates how ACT can be applied specifically in the treatment of OCD. His use of metaphor in this article is an effective strategy that should help the reader more fully comprehend the nuances of this therapeutic intervention. Cindy Haines, PsyD, shares with us an article about the treatment of pediatric OCD that has, at its center, a personal account of her treatment with a six-year-old girl. Particular challenges in the treatment of children with OCD are reviewed, as are those aspects of diagnosis and treatment that differentiate this work from addressing the disorder in adults. These articles do not in and of themselves exhaust all 25
Introduction to Special Section the major treatment options available for OCD. Other interventions, however, such as Eye Movement Desensitization and Reprocessing (EMDR), while claimed by some to be helpful in OCD treatment, have not yet clearly demonstrated clinical efficacy. Still other interventions, such as Gamma Knife surgery, where lasers are used to destroy small areas of brain tissue, or Deep Brain Stimulation, wherein an implanted electrical device is remotely controlled to electrically stimulate certain brain centers, have been used in only very extreme cases, can have multiple inherent dangers, and have not had sufficient application to fully generalize the results of their use <http://www.ocfoundation.org>. The good news is that we do know of treatments that work and treatments that work well. The problem has been more of a lack of education and experience in the larger mental health community. Time and time again, those of us whose work is spent largely with persons who struggle with this disorder hear complaints from our new clients. They report to us that they have previously been to multiple therapists, sometimes for years on end, and have experienced repeated treatment failures. Further questioning often reveals that these clients never received any of the treatments that have clearly been demonstrated to positively affect OCD recovery. While presently classified as an anxiety disorder, OCD is in some very important ways treated differently than phobias, panic disorder, or Generalized Anxiety Disorder. For one thing, relaxation training is usually seen as an inappropriate clinical
intervention for OCD. Yet this is very often the treatment that is received by those with an OCD diagnosis. It is this very problem that specific, effective, relatively short-term protocols are available to treat OCD, yet appropriate treatment is often not delivered because it is misunderstood or unknown by mental health professionals, that this Special Section of the New Jersey Psychologist will try to address. The authors have, as a whole, written their articles to provide specific, concrete descriptions of what OCD treatment looks like. Without a doubt, this reading will not be sufficient to make an OCD expert out of a novice therapist or a seasoned psychologist who has had no formal training in OCD treatment, but we hope to alert you to the possibilities that are available, so that if you choose to work with this fascinating, motivated, and appreciative population, you will spend the time and effort to explore these treatment options more fully. â?– References Johnson, S. (Director-Writer). OC87. Philadelphia, PA. Therapy Productions, LLC, 2010. (Film) Madison, K. (Director-Producer). Machine Man. West Hollywood, CA. Madison Films, in pre-production. (Film) March, J. & Benton, C. (2007). Talking Back to OCD. (pp.1011). The Guilford Press. Ruscio, A.M., Stein D.J., Chiu, W.T., Kessler, R.C. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry. 2008,(1):53-63.
New Jersey Psychologist
Special Section: Treatment of OCD
CBT for OCD: Cognitive Interventions, Family Treatment, and Medication By Milton Spett, PhD Psychology Associates of Cranford and Westfield
Every working day, a man takes the commuter train from New Jersey to New York City. As the train passes over a river, the man rolls up the NY Times and throws it into the river. Finally the commuter sitting next to him asks him why he does this. “To keep the wild elephants away,” responds the first commuter. “But that’s ridiculous. There isn’t a wild elephant within 5,000 miles of here.” “Yes, my technique is very effective,” replies the compulsive commuter.
xposure and response prevention (ERP) is generally considered to be the treatment of choice for OCD. But Cottraux et al., (2001) found cognitive therapy (CT) equal to ERP for OCD, and Whittal et al., (2008) summarized the long-term results of two studies and found that although ERP was superior to CT in group format, there was no difference between ERP and CT in individual therapy. In addition, CT was better tolerated than ERP. Sixteen of 77 patients (21%) dropped out during ERP treatment, compared to only 6 of 67 patients (9%) in CT. However, I do not believe this evidence is definitive. There is far more research supporting ERP, and most practitioners, including myself, utilize ERP far more than cognitive interventions. But when treating OCD, cognitive interventions, and probably other interventions as well, should always be considered in addition to ERP. It is likely that there are some patients who will benefit more from cognitive interventions, or from ERP plus cognitive interventions, than from ERP alone. I will first give a brief summary of exposure and response prevention for OCD, and then discuss cognitive interventions, family interventions, and medication as additional techniques for treating OCD. 1. Summary of Exposure and Response Prevention (ERP) for OCD. 1.1 Exposure. In treating OCD, exposure means experiencing obsessions and the situations that provoke obsessions. Patients can perform exposure either by not avoiding situations that provoke their obsessions, or by intentionally confronting those situations. Patients can practice in vivo exposure by intentionally confronting the actual situation that provokes their obsession, or they can practice imaginal exposure, by imagining that they are confronting that situation. Imaginal exposure can also be done by writing or recording scenarios describing their worst fears, and then reading or listening to them over and over and over and over and over. Exposure works best when it is frequent and prolonged, that is, when it lasts long enough for the patient’s anxiety to increase, reach a peak, and then diminish by at least 50%. Winter 2012
1.2 Graduated Exposure. Here is a clinical vignette that illustrates graduated exposure: Barbara Had the Obsession That She Might Stab Her Infant Daughter. Barbara could practice imaginal exposure by imagining that she was stabbing her daughter, and also by leaving her kitchen knives in plain sight. Initially, Barbara could not tolerate the anxiety created by leaving her sharp kitchen knives in plain sight. So we agreed that she would expose herself to leaving a plastic knife in plain sight. After several of these exposures, she was able to expose herself to a butter knife, then a dinner knife, and eventually to leaving her sharp kitchen knives in plain sight. 1.3 Response Prevention. Exposure creates anxiety. CBT theory asserts that compulsions are responses to that anxiety, compulsions are attempts to reduce the anxiety created by obsessions. Response prevention means refraining from performing any compulsive behavior, and refraining from doing anything that will reduce the anxiety created by an obsession. Response prevention means that when experiencing a compulsive urge, OCD patients do not seek reassurance, do not distract themselves, and do not try to leave the situation that is evoking their anxiety. They should simply experience their obsession and wait passively for the anxiety to diminish by itself. 1.4 Graduated Response Prevention. When patients cannot perform complete response prevention, they should do whatever they can to delay or disrupt their compulsive rituals. Sometimes patients will agree to delay performing their compulsion for an agreed-upon number of minutes. That time can be gradually lengthened until it is long enough for the patient’s anxiety to diminish, enabling the patient to omit the ritual completely. Disrupting the ritual means making any small change, then gradually making larger and larger changes in the compulsive ritual. 27
Special Section: Treatment of OCD
John Had the Obsession That He Had Left Home Without Turning Off the Gas This obsession triggered intense anxiety and the fear that his house would burn down. His compulsion was to check the gas four times, just to be sure it was off. Initially this reduced John’s obsessive thinking and his anxiety. But, over time, checking the gas four times no longer reduced his obsession and his anxiety. To feel comfortable, he started checking the gas four sets of four times, then four sets of four sets of four times. Leaving his house eventually became elaborated into a 30-minute ritual. Ideally response prevention means that John would leave the house without checking the gas. But this would have created very intense obsessive thoughts of the house burning down, and intense anxiety. John was not willing to tolerate that level of discomfort. So I suggested that he disrupt his compulsion by checking the gas three sets of three, or three sets of four, or even five sets of five - any change that would disrupt his ritual of checking in multiples of four. John very quickly reduced his checking of the gas to one time, paying very close attention to the check so he would remember that he had checked. He was stuck there for several weeks until I used a cognitive intervention. I asked him, “How many times would a person without OCD check the gas whenever he left the house?” He sheepishly replied, “None.” The following week he reported that he was able to leave the house without checking the gas at all. Seven-word summary of ERP for OCD: Have the obsession -- don’t do the compulsion. 1.5 The Cognitive theory of exposure and response prevention. If OCD patients practice response prevention, they learn that nothing bad happens. Not acting on their obsessions serves as an experiment that disproves the content of their obsessive fears (Foa & Kozac, 1986). But if they perform their compulsive rituals, they never learn that their obsessive fears are unwarranted. Remember the compulsive commuter who threw the NY Times into the river to keep the wild elephants away? A cognitive theorist would assert that because he never refrains from throwing the NY Times out the window, the commuter never learns that his compulsive behavior is unnecessary. 2. Cognitive Interventions to Motivate Patients to do Exposure and Response Prevention 2.1 Remind yourself that the discomfort of ERP is temporary, but the discomfort of OCD is permanent. Doing ERP is uncomfortable in the short run, but alleviates OCD in the long run. Avoiding ERP is comfortable in the short run but maintains or worsens OCD in the long run. Every time you perform a compulsive ritual, the urge to perform that ritual becomes 28
stronger. Every time you resist performing the ritual, the urge to perform that ritual becomes weaker. 2.2 You can tolerate anxiety. Doing ERP may cause anxiety, even high anxiety, but that anxiety is neither intolerable nor dangerous. 2.3 Seek out and welcome situations that evoke your obsessions. View these situations as opportunities to work on overcoming your OCD. Tolerating the anxiety and not performing the compulsion means you are winning the fight against OCD. 2.4 View your obsessions and urges to perform compulsions as an alien force that is trying to control you. But you are stronger than that force. You can face it, fully experience it, and not let it tell you what to do. 2.5 Do not become discouraged when you have a bad week or month. Remember that stress will temporarily worsen OCD or any psychological problem. A bad week or a bad month usually means that you are under extra stress, not that you are regressing. 2.6 Keep fighting your OCD even if you haven’t seen improvements recently. Remember that improvement is slow and includes many setbacks. Every week or month will not be better than the last week or month. Gauge progress over longer periods of time. Have the last three months been better than the previous three months? 3. The Cognitive Theory of OCD: Negative Appraisals of Fleeting Thoughts of Danger Convert Those Thoughts Into Obsessions Clark (2004) reports that 90% of all people occasionally have fleeting thoughts of danger. For example: “What if I forgot to turn off the gas before leaving home?” or “What if I contracted AIDS from shaking hands with that gay man?” In fact, about 70% of all people report that they have had the thought “Did I leave an appliance on that could cause a fire?” And about 71% of all people have had the thought “Did I leave the door unlocked, allowing an intruder to come inside?” Most people dismiss these thoughts as unrealistic or meaningless, and their minds move on to other thoughts. But a small percentage of people have intense negative reactions to these kinds of thoughts. These people believe that the thoughts represent real dangers, or that the thoughts mean they have a serious mental disorder, or the thoughts mean they are bad or immoral people, or that they will be punished for these thoughts. Clark asserts that these negative appraisals of fleeting, unrealistic thoughts cause some people to become fixated on the thoughts. This fixation is what we call an obsession, a distressing thought that comes into one’s mind unbidden, and won’t leave. Because obsessions are unbidden and unwanted, they are sometimes called “intrusive thoughts.” Negative appraisals of intrusive thoughts convert those thoughts into obsessions, the obsessions create anxiety, and OCD patients then develop compulsive rituals that are attempts to reduce that anxiety. New Jersey Psychologist
Special Section: Treatment of OCD
Clark believes that when treating OCD, therapists should not just challenge patients’ unrealistic obsessions of contamination, doing harm, illness, danger, etc. Clark believes that therapists should also challenge OCD patients’ intense negative appraisals of these obsessions. 4. Common Cognitive Errors Made by OCD Patients 4.1 Thought-action fusion. Believing that having the intrusive thought will lead to the feared event actually happening, or that the thought is the same as the act. For example, thinking about stabbing one’s child is as bad as actually stabbing the child. 4.2 Believing that they are bad or crazy or will be punished for having the intrusive thoughts. 4.3 Believing that they must control their intrusive thoughts, that is, they believe they must stop themselves from having these thoughts. Of course it is not possible to control one’s thoughts. Wegner et al., (1987) found that after trying not to think about a white bear for two minutes, subjects had more thoughts about a white bear than control subjects who had not previously tried to suppress thoughts of a white bear. You can demonstrate this to OCD patients by asking them to try to not think of a white bear for two minutes. 4.4 Overestimating the probability that their intrusive thoughts are realistic. Most OCD patients recognize that their intrusive thoughts are probably unrealistic, but they still overestimate the likelihood of their intrusive thoughts actually occurring. 4.5 Intolerance of uncertainty. Most OCD patients cannot relax unless they are 100% certain that nothing bad will happen. Of course this is not possible. No one can be 100% certain that anything will or will not happen. When we leave home in the morning, we cannot be 100% certain that we will return home alive at night. Most people accept this reality and quickly forget about it. But OCD patients cannot do this. They need 100% certainty that their intrusive thoughts are impossible. 4.6 Perfectionism and the belief that everything must be “exactly right.” This cognitive error leads to compulsions to do things in a certain way, or a certain number of times, or to do something the same number of times on each side of their body. If some OCD patients tap their right index finger twice, they become anxious until they tap their left index finger twice. OCD patients will tell you that these rituals “just feel right,” or they become anxious if they don’t do these things “correctly.” 4.7 Inflated Responsibility is the mistaken belief that because the OCD patient did something in the past and something bad happened (or didn’t happen), the patient’s behavior caused the bad thing to happen (or not happen). These patients then feel they must not (or must) do that same thing again, like the commuter who threw the NY Times into the river. He threw his newspaper into the river, and wild elephants stayed away. Therefore, he concluded that the wild elephants stayed away because he threw his newspaper out of the window. Winter 2012
5. Cognitive Techniques for Changing Negative Appraisals of Intrusive Thoughts 5.1 Disputation means using logic to convince patients that they should change their negative appraisals of their intrusive thoughts. For example, pointing out to OCD patients with harm obsessions that OCD patients never perform their harm obsessions. The kind of person who actually harms others is very different from someone with OCD. Disputation was emphasized by Albert Ellis, but it is currently out of favor with CBT therapists because it is thought to provoke resistance, and also because many therapists, especially Acceptance and Commitment Therapists, believe that disputation puts the therapist in a superior power position. 5.2 Socratic questioning is a less authoritarian technique. Socratic questioning means asking questions that will gently lead patients to change, or at least begin to doubt, their dysfunctional cognitions. With resistant or oppositional patients, Socratic questioning is probably more effective than disputation. Here is an example of Socratic questioning: “How many times have you thought you had run over a child?” “How many times have you actually run over a child?” “What is the probability that this time you have actually run over a child?” “What is the probability that your obsessive thought is caused by actually having run over a child?” “What is the probability that your obsessive thought is caused by OCD?” Asking patients to estimate the probability that their obsessions are realistic not only increases patients’ doubts about their obsessions, but also enables both therapist and patient to observe therapeutic progress as patients reduce the estimated probability that their obsessions are realistic. Socratic questioning can be used to address inflated responsibility, such as the belief that throwing the NY Times into the river keeps the elephants away. The therapist could ask questions like, “In addition to you throwing the NY Times out of the window, what else might contribute to keeping the elephants away?” 5.3 Downward arrow. This refers to continually asking patients what would happen next in their obsessive scenarios. The goal of this technique is to encourage patients to consider that their worst case scenario is not really so bad. Patient: I cannot have an annual check-up because the doctor may find something terribly wrong with me. Therapist: What if that happened? Pt: I would become terribly anxious and upset. Th: And then? Pt: I might become so anxious that I would faint. Th: And then? Pt: I guess the doctor would give me something to revive me. Th: And how terrible would that be? Pt: I guess it wouldn’t be that terrible. Even if this type of downward arrow technique ends with something catastrophic like the death of the patient, the inter29
Special Section: Treatment of OCD
vention will constitute an exercise in imaginal exposure, and will probably be therapeutic. 5.4 Behavioral experiments are another technique for changing negative appraisals of intrusive thoughts. Ask patients to do experiments that will disprove their negative appraisals. For example, if a patient believes that thinking of molesting children will cause him to molest children, ask that patient to intentionally think about molesting a child every day for a week, and then observe if that thought has caused him to molest a child. Or, if a man thinks the wild elephants stay away because he throws his newspaper into the river, ask him to refrain from throwing out his newspaper, and observe if wild elephants appear. 6. Solicit Family Members to Assist in the Treatment. Family members can remind or encourage patients to do what will help alleviate the patient’s OCD. Family members can also provide reinforcement when patients do exposure and response prevention. Family members can tell the therapist about successes or missed opportunities that the patient may have forgotten. A family member can be particularly helpful if that family member also has OCD or OCD tendencies, and understands the problem and the treatment. Family members can encourage but should not pressure patients to practice exposure or response prevention. If a family member is doing this, tell the family member that OCD patients must make their own decisions about what they will or will not do. If family members’ attempts to help the patient lead to conflict, tell family members that patients must overcome their OCD on their own, and advise family members not to comment on the OCD. Ask family members to refrain from making the following three common mistakes in dealing with OCD patients: 6.1 Family members should not express criticism, anger, or tell OCD patients to just cut out the foolishness. Family members who do not suffer from OCD often have difficulty understanding why the OCD patient cannot leave the house without performing five sets of five checks that every gas jet is turned off. Family members often need education about how difficult it is for OCD patients to refrain from performing their compulsive rituals. Explaining the genetic component of OCD can help family members understand the difficulty of resisting OCD compulsions. Tell family members that OCD patients have an illness and cannot “just cut out the foolishness.” If a person could not walk due to a broken leg, no one would tell that person to cut out the foolishness and just walk. Family arguments about OCD patients’ compulsions usually increase patients’ self-criticisms, depression, and feelings of hopelessness, thereby exacerbating the OCD. 6.2. Family members usually should not provide reassurance to OCD patients that their obsessive fears are unwarranted. Reassurance usually reduces the OCD patient’s anxiety in the moment, but the reassurance also provides reinforcement that increases the frequency of future obsessions and reassurance-seeking. Tell family members that OCD pa30
tients need to learn to reassure themselves instead of seeking reassurance from others. And to prevent family conflicts, ask OCD patients to agree that family members will not provide the reassurance patients usually seek. 6.3 Family members usually should not do things for patients that are difficult for OCD patients to do for themselves. To do so would enable patients to avoid exposure to anxiety-provoking situations and impede treatment. Although these three types of family behaviors are countertherapeutic, families (and therapists) must use a little common sense. Sometimes the consequences of not providing reassurance or not helping the OCD patient can cause serious problems, such as the loss of a job. And, sometimes patients need more time and more therapy before they can give up asking for reassurance or seeking help doing things that are too anxiety-provoking for them to do themselves. 7. Drug Treatment 7.1 Research on drug treatment. Several anti-depressants have been found to be more effective than placebos in treating OCD. But this is true only for patients who are not receiving cognitive-behavior therapy. Several studies have found that CBT alone is just as effective as CBT plus medication. For example, Franklin et al., (2002) found that CBT plus medication reduced OCD symptoms by 65% while CBT without medication reduced OCD symptoms by 63%, a non-significant difference. March et al., (2004) found that CBT plus Zoloft reduced scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) by 12.8 points while the CBT alone group reduced Y-BOCS scores by 12.0 points, another non-significant difference. Finally, Van Balkon (1998) concluded that Luvox added nothing to the benefits of either cognitive therapy or ERP for OCD. 7.2 The biological imbalance theory of OCD. One problem with concomitant medication is that psychiatrists often tell OCD patients that they have a “biological imbalance” that requires biological treatment. This is untrue. Several studies have found that CBT makes biochemical changes in OCD patients that are similar to the biochemical changes made by medication (for example, Baxter et al., 1992). And, psychotherapy makes permanent changes while the benefits of medication end as soon as patients stop taking their medication. When patients believe they have a biological disorder, they tend to attribute any increases in symptoms to biochemical rather than psychological causes. They then meet with their psychiatrists who “adjust” their medication in an attempt to control the increase in symptoms. This focus on medication adjustments requires time and energy, and distracts patients from their psychological treatment. The most dangerous side effect of medication is that it can cause patients to attribute their OCD to biological causes, to focus on drug treatment, and to not devote the necessary time and energy to the psychological causes and treatment of their OCD. The key question is “Whom do patients call when they experience an increase in their symptoms?” If they call their New Jersey Psychologist
Special Section: Treatment of OCD
psychiatrist, they are viewing their OCD as a biological disorder that needs to be treated biologically. If they call you, their psychotherapist, they are committed to their psychological treatment and they are much more likely to overcome their OCD. 7.3 Withdrawal from medication. I have treated many OCD patients who were taking medication when they began treatment with me. With most of them, I wait until we establish a strong therapeutic relationship and their OCD has improved significantly. Then I bring up the possibility of weaning them off their medication. Although it is sometimes difficult, not one OCD patient experienced more than temporary, mild to moderate depression, OCD symptom increase, or other withdrawal effects. And, they all felt much more self-confident and hopeful when they realized that they did not need to be dependent on medication. 8. Cognitive Techniques for OCD-Induced Low Self-Esteem and Depression. Patients who suffer from OCD often develop low selfesteem and depression as a result of their OCD and the restrictions OCD makes in their lives. Here are three cognitive interventions for treating the low self-esteem and depression that are often reactions to OCD: 8.1 Don’t berate yourself for having OCD any more than you would for having diabetes or being short. Everyone has problems and OCD is yours. Having OCD does not mean that you are less of a person. 8.2 OCD is only one aspect of who you are. You also have many positive qualities and achievements. Remind yourself of all the positive things in your life. Do not spend three quarters of your time thinking about the one quarter of you that is your OCD. 8.3 Do what you can. Don’t beat yourself up if you don’t do a behavioral or cognitive exercise. Any psychological problem, most commonly depression and low self-esteem, worsens and is worsened by OCD. Alleviating these other psychological problems will reduce the OCD. I always recommend treating the whole patient, not just treating the OCD. ❖ References Baxter, L.R., Schwartz, J.M., Bergman, K.S., Szuba, M.P., Guze, B.H., Mazziotta, J.C., Alazraki, A., Selin, C.E., Ferng, H.K., Mumford, P., & Phelps, M.E. (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry, 49, 681-689. Clark, David A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford. Cottraux, J., Note, I., Yao, S.N. et al. (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 70, 288-297. Foa, E. B. & Kozac, M. J. (1986).Emotional processing of fear: Exposure to corrective information, Psychological Bulletin, 99, 20-35. Winter 2012
Franklin, et al. (2002). CBT with and without medication for OCD. Professional Psychology, 33, 2, 162-168. March et al. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder. Journal of the American Medical Association, 292, 1969-1976. van Balkom, A.J., de Haan, E., van Oppen, P., Spinhoven, P., Hooqduin, K.A., van Dyck, R. (1998). Cognitive and behavioral therapies alone versus in combination with fluvoxamine on the treatment of obsessive compulsive disorder. J. of Nervous and Mental Disease, 186, 8, 492-499. Wegner, D. M., Schneider, D. J., Knutson, B., & McMahon, S. R. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53, 5-13. Whittal, M., Robichaud, M., Thordarson, D.S., McLean, P.D. (2008). Group and individual treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 76, 6, 1003-1014.
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Special Section: Treatment of OCD
Acceptance and Commitment Therapy and Obsessive Compulsive Disorder: A Promising New Alternative by Joseph M. Springer, PhD Department of Psychology, Georgian Court University
he prognosis for individuals being treated for Obsessive Compulsive Disorder (OCD) has improved significantly over the past several decades due to the introduction of serotonin-reuptake inhibitors (Simpson, 2010) and the psychological intervention of Exposure and Response (sometimes also termed Ritual) Prevention (ERP) (Abramowitz, 2006). ERP utilized with Cognitive Therapy is also a well-supported treatment (Abramowitz, Taylor, & McKay, 2009). ERP involves the deliberate exposure of individuals with OCD either through imagination (in-vitro) or in real-life (in-vivo) to thoughts or external stimuli that trigger psychological discomfort, with the client’s agreement not to engage in behaviors that had previously been used to reduce discomfort. With the passage of time there is a reduction of the discomfort triggered by the thoughts or external stimuli, a process termed “habituation” (Steketee, Foa & Grayson, 1982; Foa & Kozak, 2004). Although this technique is effective for individuals who adhere to this protocol (Simpson et al., 2011; Bonchek, 2009), a significant percentage of individuals do not adhere to this treatment, with reported dropout rates as high as 25% (Abramowitz et al., 2009) and refusal rates estimated as ranging from 5% to 22% (Foa, et al., 2005; McLean, et al., 2001). Reported adherence rates for SSRI’s in general also indicate a sizable percentage of individuals (57%) who are non-adherent over a 6-month period (Cantrell, Eaddy, Shah, Regan & Sokol, 2006). The above studies suggest that despite the improvements in the treatment of OCD, a closer look provides a “good newsnot so good news” scenario. The fact that a sizable percentage of individuals do not adhere to the established treatments calls for the development of additional treatments, not necessarily to replace treatments that are known to work, but to give clinicians additional options to match treatment to the clients in order to move away from a “one size fits all” approach. One promising alternative approach is Acceptance and Commitment Therapy or “ACT” (pronounced as one word) developed by Hayes, Strosahl, and Wilson (1999). ACT is based on a theory of language and cognition referred to as Relational Frame Theory, or RFT. Although a comprehensive discussion of RFT is beyond the scope of this article, the interested reader is referred to Hayes et al., (1999) for an in-depth discussion of the theory. ACT has received empirical support in the clinical literature for a number of disorders, including anxiety disorders, depression, pain, trichotillomania, psychotic disorders, and substance abuse (Pull, 2009). ACT has also 32
received support in its application to children and adolescents (Coyne, McHugh & Martinez, 2011). Although the clinical literature regarding the application of an ACT approach specifically to OCD is still nascent, Twohig et al., (2010) reported significantly greater pre- to post-treatment change on the Yale Brown Obsessive Compulsive Scale (Y-BOCS) for a treatment group that received eight sessions of ACT as compared to a control group that received Progressive Relaxation Training (PRT). Twohig et al., (2010) also reported treatment refusal and dropout data. Treatment refusal was 2.4% for the ACT group and 7.8% for the PRT group, while dropout rate was 9.8% for the ACT group and 13.2% for the PRT group. The authors concluded that the suggested efficacy of an ACT approach on OCD symptoms as well as the relatively low dropout and refusal rates of the ACT group support further exploration of ACT as a treatment for OCD. Hayes (2004) described ACT as belonging to a category of treatments that he characterized as being part of the “third wave” in the behavioral tradition, along with other approaches such as Dialectical Behavior Therapy (Linehan, 1993), Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991), Integrative Behavioral Couples Therapy (Christianson & Jacobsen, 1998), and Mindfulness-Based Cognitive Therapy (Segal, Williams & Teasdale, 2002). Hayes (2004) stated that these approaches share an emphasis on issues such as “acceptance, mindfulness, cognitive defusion, dialectics, values, spirituality, and relationship” (p. 640). One key difference between an ACT approach and what would be termed a “second wave” (e.g., traditional cognitive behavioral) approach involves the assumption that changing cognitions is necessary for clinical improvement. Instead of trying to challenge thoughts, an ACT approach teaches individuals to “notice” their thoughts from a neutral perspective while not engaging with them or defining oneself by them (Hayes & Smith, 2005). However, some have argued that ACT and other mindfulness approaches may not constitute a “new wave” in the behavioral tradition, being instead a variation that fits well with the existing CBT paradigm (Hofmann, Sawyer & Fang, 2010; Hofmann & Asmundson, 2008). These authors do acknowledge that ACT and traditional CBT do differ in their targets for emotion regulation. The present author would offer an analogy regarding the distinction between the approaches as being similar to the martial arts of Taekwondo (loosely translated “to strike or break with foot or fist”) as compared to Aikido (loosely translated “the New Jersey Psychologist
Special Section: Treatment of OCD
way of the harmonious spirit”) and Jiu-Jitsu (loosely translated “a gentle or yielding art-form”). All three approaches share a commonality in that they are martial arts initially developed in Asia, however Taekwondo places more of an emphasis on force meeting force, while Aikido and Jiu-Jitsu place more emphasis on blending with the opponent and redirecting or neutralizing the attack. Certainly, all three approaches can be very effective when utilized by a skilled practitioner. ACT Basic Concepts ACT differs from some other perspectives in Western psychology in that instead of starting with the assumption that psychological healthiness is the normal state for humans, normal psychological processes frequently result in psychological suffering because “the logical mind is being asked to do what it was not designed to do” (Hayes & Smith, 2005, p. 2). A problem solving style based on attempting to change, control, eliminate, or avoid situations can be quite effective when dealing with situations in the external environment, however it is much less effective in dealing with internal experiences (e.g., thoughts and feelings). Hayes and Smith go on to point out the ubiquity of human suffering, and cite statistics to support the idea that suffering is the norm rather than the exception. The parallels between this view and the Buddhist First Noble Truth (e.g., suffering is part of all life) has been noted, and there are a number of parallels between many ACT and Buddhist concepts (Hayes, 2002). However, ACT is not meant to be viewed as a “Buddhist Psychology” (S.C. Hayes, personal communication, August 13th, 2009). A primary goal of an ACT approach is to foster psychological flexibility that involves being able to engage in positive behaviors instead of avoiding experiences or emotions that are uncomfortable or unpleasant. There are six major processes that are targeted in order to facilitate flexibility (Hayes et al., 1999): 1) Acceptance that is a willingness to experience inner states, regardless of whether they are experienced as pleasant or unpleasant. 2) Defusion that involves learning to perceive thoughts from a neutral perspective, as “just thoughts” as op posed to responding to the thoughts as though they are literally true. 3) Self as Context, also referred to as “the observing self” that involves an experience of self as a continuity of consciousness beneath or behind the everyday experi ence of oneself. 4) Contact with the present moment that involves the ability to attend to events in the here and now in an open, receptive, and non-judgmental manner. 5) Values that involve clarifying what is important to the way one desires to live one’s life. 6) Committed action that involves flexibly moving to wards goals that are consistent with one’s values. Acronyms used to summarize the causes of psychological distress and the utilization of effective strategies are described Winter 2012
by Hayes et al. (1999). One is F-E-A-R that stands for: Fusion with thoughts: Treating thoughts as if they are identical with the experiences or events they describe. Evaluation of Experiences: Assuming that one’s evaluation of experiences literally reflects reality as opposed to being one’s opinion of the experiences. Avoidance of Experience: Avoiding or escaping experiences that engender unpleasant thoughts or feelings. Reason-Giving for Behavior: Providing reasons to explain why one is not behaving in a manner that is not consistent with a chosen, valued direction. A second acronym is A-C-T that stands for: Accept: Letting go of the struggle against inner experiences and allowing them to be. Choose: Identifying one’s values and one’s life-direction that is consistent with these values. Take Action: Committing to specific action to behave in ways that are consistent with one’s values and chosen direction. Application of ACT to OCD Twohig et al., (2010) noted that formal in-session exposures, as is done with traditional ERP, is consistent with an ACT approach to treatment. However, formal in-session ERP was not included in their study in order to investigate whether an ACT protocol would be effective without this treatment component. Outside of sessions, subjects were instructed to utilize ACT skills when they were exposed to anxiety triggers during their day-to-day activities. They were not asked to remain in anxiety-producing situations until they habituated, however the intent was to give the subjects “an opportunity to practice experiencing anxiety without also struggling with anxiety” (Hayes, 1987, p. 365). The present author has used a “roller coaster” analogy with clients to illustrate this. Many individuals are aware of the different ways in which people ride on a roller coaster. Some tightly grip the bar in front of them, grit their teeth, and “white knuckle” it as the roller coaster drops. Other riders hold their arms up over their heads and let go of the illusion of control that gripping the bar provides. The actual sensations that the riders of each style experience may be similar, but the phenomenological experience of their sensations and the ride itself likely differs. The ACT approach is consistent with the latter riding style. ACT and OCD: Some Concluding Thoughts The clinical literature certainly shows that there are effective treatments for OCD. However, as discussed, a significant portion of individuals are non-adherent with these treatments. In considering any treatment, a clinician takes into account not only efficacy but also tolerability. If a treatment is not well-tolerated, its overall efficacy may become moot. Medication prescribers often have several choices of medications that are efficacious in treating a disorder. Part of the art of prescribing is to match the medication to the individual. So 33
Special Section: Treatment of OCD
it can also be with psychological treatments. Although at the present time the empirical evidence supporting ACT for OCD is limited, preliminary results suggest that it holds promise in increasing the range of treatments for OCD that are presently available. This increased clinician flexibility could enable the application of effective treatment to a wider range of individuals suffering from OCD. ❖ References Abramowitz, J. S. (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry, 51, 407-416. Retrieved from http://ww1.cpa-apc. org:8080/Publications/cjpHome.asp Abramowitz, J. S., Taylor, S., & McKay, P. (2009). Obsessivecompulsive disorder. The Lancet, 374, 491-499. Bonchek, A. (2009). What’s broken with cognitive behavior therapy treatment of obsessive compulsive disorder and how to fix it. American Journal of Psychotherapy, 63, 6986. Retrieved from http://www.ajp.org Cantrell, C. R., Eaddy, M. T., Shah, M. B., Regan, T. S., & Sokol, M. C. (2006). Methods for evaluating patient adherence to antidepressant therapy: A real-world comparison of adherence and economic outcomes. Medical Care, 44, 300-303. Christiansen, A. & Jacobson, N.S. (1998). Acceptance and change in couple therapy: A therapist’s guide to transforming relationships. W. W. Norton: New York. Coyne, L. W., McHugh, L., & Martinez, E. R. (2011). Acceptance and commitment therapy (ACT): Advances and applications with children, adolescents and families. Child and Adolescent Clinics of North America, 20, 379-399. Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R. Franklin, M. B., …Tu, X. (2005). Randomized placebo-controlled trial of exposure and ritual prevention, clomipramine and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry,162, 151-161. Foa, E.B. & Kozak, M.J. (2004). Mastery of obsessive-compulsive disorder: A cognitive behavioral approach-therapist guide. New York: Oxford University Press. Hayes, S. C. (1987). A contextual approach to therapeutic change. In N. Jacobson (Ed.), Psychotherapists in clinical practice: Cognitive and behavioral perspectives (pp. 327387). New York: Guilford. Hayes, S. C. (2002). Buddhism and acceptance and commitment therapy. Cognitive and Behavioral Practice, 9, 58-66. Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 639-665. Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance & commitment therapy. Oakland, CA: New Harbinger. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press. 34
Hofmann, S. G., Sawyer, A. T., & Fang, A. (2010). The empirical status of the “new wave” of cognitive behavioral therapy. Psychiatric Clinics of North America, 33, 701-710. Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychiatry Review, 28, 1-16. Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy: Creating intense and curative therapeutic relationships. New York, NY: Plenum. Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York, NY: Guilford Press. McLean, P. D., Whittal, M. L., Thordarson, D. S., Taylor, S. Sochting, J. Koch, W. J., Patterson, R., & Anderson, K. W. (2001). Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting & Clinical Psychology, 69, 205-214. Pull, C. B. (2009). Current empirical status of acceptance and commitment therapy. Current Opinion in Psychiatry, 22, 55-60. Segal, Z. V., Williams, J. M. G. & Teasdale J. D. (2002). Mindfulness-based cognitive Therapy for depression: A new approach to preventing relapse. New York: The Guilford Press. Simpson, H. B. (2010). Pharmacological treatment of obsessive-compulsive disorder. Current Topics in Behavioral Neuroscience, 2, 527-543. Simpson, H. B., Maher, M. J., Wang, Y., Bao, Y. Foa, E., & Franklin, M. (2011). Patient adherence predicts outcome from a cognitive-behavioral therapy in obsessive-compulsive disorder. Journal of Consulting & Clinical Psychology, 79, 247-252. Steketee, G., Foa, E. B., & Grayson, J. B. (1982). Recent advances in the treatment of obsessive-compulsives. Archives of General Psychiatry, 39, 1365-1371. Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D. Collins, A. B., Hazlett-Stevens, H, & Woldrick, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78, 705-716.
Barry W. Klein, Psy.D. Psychologist
Child, Adolescent, Adult, Family PDD, Autism, Asperger’s Syndrome, ADHD Behavior Problems, Parenting, School Consultation, Supervision 68 Essex Street Millburn, NJ 07041 973.376.8890 NJ Lic 4204
915 West End Ave. Ste 1A New York, NY 10025 917.692.1281 NY Lic 8960
New Jersey Psychologist
Special Section: Treatment of OCD
Treatment for Pediatric OCD by Cindy Haines, PsyD Stress & Anxiety Services of NJ, East Brunswick, NJ
ix-year old Stephanie (name and identifying facts changed) came into my office with tears streaming down her face. Her mother and father requested this initial session due to frequent sobbing and tantrums by Stephanie during the past month. Stephanie was having “scary thoughts” that caused her to cry. With gentle prompting, Stephanie was able to tell me her scary thoughts. The first was that she sometimes thought, “Mommy is fat and ugly.” If Stephanie tapped her left foot three times and her right foot three times, the thought would go away. The second thought related to her baby brother. All Stephanie would tell me was that she was afraid she would hurt him. If she washed her hands a certain way six times after having the thought she could keep him safe. Thus began Stephanie’s journey into obsessivecompulsive disorder (OCD) treatment for young children. Stephanie’s treatment will be explained in detail, but first let us review the impact, prevalence, and research surrounding this disorder. Impact OCD can significantly impair a child’s life at home, at school, and with peers. Piacentini et al., (1999) reported over 85% of parents and children had significant impairment in the areas of completing chores at home, getting ready for bed, getting along with parents and siblings, and getting schoolwork done. March and Benton (2007) write that children and teenagers have mental “hiccups” (obsessions) that make them feel uncomfortable. To feel better, they try to eliminate the anxiety by performing compulsions that can seem nonsensical to them as well as others. The impact on family members may be less recognized, but equally as problematic. Families may have difficulty functioning effectively due to enabling several OCD behaviors in order to keep peace. Families may change routines, reassure, and assist in the child’s compulsions. Other families may become antagonistic, completely opposing the OCD behaviors and accusing the child of manipulation (Steketee, 1985). OCD is not about good or bad behaviors. It is an illness of the brain (March & Benton, 2007) and needs to be treated much as one would treat a condition such as diabetes or asthma. Children need to know they are not alone. Statistics tell us that one in every 200 children or teenagers has OCD, Winter 2012
about the same number that has diabetes. Yet, children tell me they would rather have a physical illness they could see than one they believe they have to hide. Children who have OCD often feel frightened and isolated as family, teachers, and peers mistakenly believe that they are just being lazy and can control these behaviors by themselves. Problems with sleep are common as nighttime rituals can take hours to perform. Children may suffer from anger and guilt over not being able to “prevent bad things from happening” because they have not been able to perform the required amount of rituals (Wagner, 2007). Prevalence and Epidemiology Obsessive-compulsive disorder in children can closely resemble symptoms in adults. Either obsessions or compulsions must be present for the diagnosis. Obsessions are defined as persistent thoughts, images, or ideas that are considered inappropriate and intrusive creating significant anxiety and distress. Compulsions are the repetitive behaviors or mental acts engaged in to prevent the distress and anxiety (American Psychiatric Association, 1994). However, there are some notable differences. Children with OCD may engage in compulsions without well-defined obsessions and rituals such as blinking and breathing a certain way. Patients with pediatric OCD show a higher rate of tic and mood disorders than adults and more attention-deficit and oppositional behaviors (Geller et al., 2001b). The age of onset for pediatric OCD is typically earlier for boys, (age nine) than girls (age 12) with one-and-a-half to two boys with OCD for every girl (Leonard et al., 1991). One-third to one-half of all OCD cases have onset by age 15. In pre-adolescent children, prevalence is thought to be in the 0.5-1.0% range, increasing to the 1.0-3.5% range during the teenage years. Onset is at times acute and children can usually remember when they first began to have symptoms. Symptoms commonly change over time with cleaning rituals giving way to checking or repeating (Swedo & Rapoport, 1988). The course of OCD is variable with some children experiencing significant reduction in symptoms during periods of distraction and low stress, but experiencing increases in symptoms during boredom and stress. Only about 15% of 35
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people show a progressively declining course of symptoms (American Psychiatric Association, 1994). Follow-up studies indicate that OCD is a chronic disorder with 43% to 68% still meeting criteria for OCD 2-14 years after initial diagnosis (Leonard et al., 1993). The most frequent compulsions seen in children are washing, repeating, checking, touching, counting, arranging, hoarding, and scrupulosity. Common obsessions include contamination, danger, doubts, disorder, guilt, as well as aggressive and sexual thoughts (King & Scahill, 1999). PANDAS “Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection” (PANDAS) has been a highly controversial topic since it was first recognized in 1987. The National Institute of Mental Health found that an autoimmune disturbance might produce obsessivecompulsive and tic-like behavior in some children who had strep infections. The onset of PANDAS-triggered OCD is sudden, however; symptoms can remit just as suddenly when proper antibiotic treatment is administered. Symptoms tend to be severe with the child also showing irritability, mood changes, and separation anxiety. PANDAS research suggests that the clinician should investigate the possibility of infection if symptoms appear suddenly and severely. Research Current research supports two forms of treatment for pediatric OCD, psychotropic medications and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are well studied and are thought to be effective on serotonin neurotransmission (Pediatric OCD Treatment Study Team, 2004). Therapy with SSRIs is usually long-term due to the possibility of relapse when these medications are discontinued (Leonard et al., 1989). The most well-researched psychotherapeutic treatment for pediatric OCD is cognitive-behavioral therapy (CBT) involving exposure and response prevention (ERP). ERP is considered the treatment of choice for children and adolescents (March & Leonard, 1996) with its aim of weakening the associations between obsessions and increased anxiety and between compulsions and anxiety relief. Specifically, ERP involves confronting and remaining in a feared situation and not performing rituals until the anxiety lessens significantly. Many experts recommend that medication for children should only be used when the OCD is debilitating and CBT is not providing sufficient relief (March, Frances, Carpenter, & Kahn, 1997). As is true for the entire OCD population, a combination of CBT and medications may be necessary for optimal relief. March, Mulle, and Herbel (1994) found that children on medication who were also given CBT showed greater improvement than those on medication alone. In a comprehensive meta-analysis conducted by Abramowitz, Whiteside, and Deacon (2005), their analyses indicated 36
that SSRI medication and ERP are both effective, with some findings suggesting that ERP is superior to medication and others indicating no difference. Their analyses also indicated that youngsters who completed ERP still experienced mild symptoms at post-test, thus validating that ERP is a treatment, not a cure for OCD. Relatively recent research suggests that the long-term prognosis for pediatric OCD may be better than originally thought. Many children may become subthreshold over time (Stewart et al., 2004). Earlier age of onset, inpatient treatment, and specific subtypes such as sexual, religious, or hoarding obsessions predict poorer outcomes. Stephanie’s Treatment Engaging very young children can be a daunting task for even the most seasoned therapist. Young children are scared and think all doctors are going to come at them with needles. Speaking to young children directly in a soft voice helps, as does good eye contact and a friendly demeanor, but in my practice, I bring out the heavy arsenal. I have a certified therapy dog named Clyde, a big Golden Retriever who works his magic every time he is in the office. Stephanie stopped crying once she saw Clyde and actually started laughing during the assessment. Mother and father were present much of the time, but Stephanie was able to stay with me as long as Clyde was there. Stephanie answered several questions about the nature of her thoughts and what she did to stop them. Stephanie had been a “worrier” since preschool, but only in the past four months was she bothered by recurrent, intrusive thoughts. After a thorough assessment using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), parent, and child self-reports, I explained to the parents what Stephanie was experiencing, and how, at this point, she did not know how or why she was having these thoughts. Her thoughts were explained as “false alarms,” a concept used by Wagner in her manual Treatment of OCD in Children and Adolescents (2007). Realizing that fears are “false alarms” helps quell the subsequent guilt and anxiety brought on by the thoughts. The initial assessment also included providing the parents with psycho-education and reference materials on OCD. As mentioned, ERP is the treatment of choice for OCD. But, how does a therapist get a six-year-old to engage in this kind of treatment? In March’s book, Talking Back to OCD (2007), he discusses the importance of naming the OCD as something outside of oneself. In session two, Stephanie and I made a list of what scared her and what rituals she performed to make her feel less afraid. We then sat on the floor surrounded by paper, crayons, markers, and glitter. Stephanie was asked to draw a monster that we would name. I would then teach her how to “boss back” the scary creature. Stephanie named her monster “Mr. Meany,” and he was a big green giant with purple eyes that bugged out. Much of the session was spent yelling at the monster, telling him “You can’t make me do that, Mr. Meany; you are a big ugly creep!” Stephanie thought the whole scene New Jersey Psychologist
Special Section: Treatment of OCD
in the office was quite funny and she went home to hang her picture on her bedroom wall. At the next session, Stephanie’s mother reported symptom improvement. Stephanie was still having the thoughts, but did not seem as frightened by them. Stephanie was very excited to tell me how she yelled at the monster. Even though she was not “really scared” anymore, she still believed she had to do her rituals. Stephanie and I made up a game to “trick” Mr. Meany. When she had an intrusive thought about hurting her brother she would yell, “Mr. Meany, watch this!” Instead of tapping each foot three times, she would tap just once on the left and twice on the right. Mr. Meany sure was fooled! Stephanie then expanded her trickery, tapping all different ways, twice on the right, none on the left, three times on the left, twice on the right. Each time, Stephanie checked her anxiety on the Fear Thermometer, with one being “no big deal” and ten being “uh oh, this is scary!” Initially her fear was about a seven, but after three minutes the fear was reduced to a level three. Stephanie was asked to do this every time the thought came until she believed she did not have to tap at all. Stephanie was able to reduce her fear of the obsessive thought by yelling at Mr. Meany to stop trying to boss her around. By making the therapy fun, Stephanie was able to break her ritual of tapping her feet to keep her brother safe. Next on the list was Stephanie’s thought, “My Mom is fat and ugly.” Mr. Meany sure got an earful as Stephanie yelled at him repeatedly that he was not her boss. Stephanie then tricked Mr. Meany again by changing her washing rituals. Stephanie was able to delay when she washed her hands, thus confusing the OCD even more. Stephanie then practiced these new skills at home every day until this thought was greatly reduced on the fear thermometer. When Stephanie was finished, her fear was between two and three for obsessions and compulsions. Stephanie was seen a total of seven times, including the assessment. The factor that contributed a great deal to her success was her ability to engage fully in ERP treatment. Engagement in therapy helped her learn the necessary tools to “boss back her monster.” At the last session, relapse prevention was discussed with Stephanie and her parents. Stephanie said it was “really cool” that she could think scary thoughts and know they could not harm her. Stephanie’s parents were also a big part of treatment, encouraging her and praising her for her success. Stephanie was a highly motivated client and did not require additional incentives to help face her OCD, however I have found it useful to offer occasional inexpensive rewards for completing ERP. When a child is reluctant to engage in the treatment, a reward may help jumpstart the therapy. If a parent questions “paying” a child for doing ERP, I say that this is their job right now and they should be paid for work well done. ERP can be hard work and children show great courage and resilience each and every time they face their OCD. Winter 2012
Conclusion OCD is a pervasive and, at times, debilitating disorder. Children with OCD may isolate rather than risk the ridicule of peers and questions of teachers and parents. Many times children see their symptoms as “crazy” or “silly” and hide them as long as possible. Compulsive ritualizing can start off so gradually that parents may mistake symptoms for “picky eating” or a “weak bladder.” Months can go by before a child is seen for treatment. Parents usually seek care as the rituals become so pervasive, they disrupt the child’s and/or the family’s life (Snider & Swedo, 2000). Children may be seen at the physician’s office for a medical condition brought on by ritualizing, such as lesions from frequent hand washing or sores from compulsive scratching. Of primary importance in the treatment and diagnosis of OCD is the child’s developmental stage at the time of assessment. The therapist needs to be able to distinguish between normal, developmentally appropriate rituals and OCD symptoms. Generally, normal development rituals cause little disruption to the child’s life and provide comfort. An example might be lining up stuffed animals or wearing “lucky” pajamas. Compulsive rituals are associated with distress and anxiety and interfere with sleep or playtime. An example might be having to rearrange one’s books until they “look just right” or frequently changing clothes because of an imaginary or tiny stain. OCD is now thought to be a relatively common disorder with the World Health Organization (WHO) expected to list it among the ten leading causes of global disability (WHO, 2005). In the last ten years, our knowledge of this disorder has grown with large-scale studies conducted with families, comorbid disorders, PANDAS, and various medications. Once thought to be rare, clinicians are seeing an increase in cases of OCD. There are effective treatments, but training programs need to be made readily available to all mental health clinicians. While considerable strides have been made, we have a long way to go before sufferers of this disorder can get maximum sustained relief for their debilitating obsessions and compulsions. ❖ References Abramowitz,, J.S., Whiteside, S.P., & Deacon, B.J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: a meta-analysis. Behavior Therapy, 36, 55-63. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Geller, D.A., Biederman, J., Faraone, S.V., Bellorde, C.A., Kim, G.S., & Hagermoser, L.M. (2001b). Disentangling chronological age from age of onset in children and adolescents with obsessive compulsive disorder. Int J Neuropsychopharmacol, 4:169-178.
Special Section: Treatment of OCD King, R.A., & Scahill, L. (1999). The assessment and coordination of treatment of children and adolescents with OCD. Child Adolesc Psychiatr Clin North Am., 8, 577-597. Leonard, H.L., Swedo, S.E., Lenane, M., Rettew, D.C., Hamburger, S.D., Bartko, J.J., & Rapoport, J.L. (1993). A two-toseven-year follow-up study of 54 obsessive compulsive children and adolescents. Archives of General Psychiatry, 50, 429-439. Leonard, H.L., Swedo, S.E., Lenane, M., Rettew, D.C., Cheslow, D.L., Hamburger, S.D., & Rapoport, J.L (1991). A double-blind desipramine substitution during long-term clomipramine treatment in children and adolescents with obsessive-compulsive disorder. Archives of General Psychiatry, 48, 922-927. Leonard, H.L., Swedo, S.E., Rapoport, J.L., Koby, E.V., Lenane M., Cheslow, D.L., & Hamburger, S.D. (1989). Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents: A double-blind crossover comparison. Archives of General Psychiatry, 46 (12), 1088-1092. March, J.S. & Benton, C.M. (2007). Talking back to OCD. NY: Guilford Press. March, J.S., Frances, A., Carpenter, D., & Kahn, D. (1997). Expert Consensus Guidelines on obsessive-compulsive disorder. Journal of Clinical Psychiatry, 58 (Supp. 4). March, J.S., & Leonard, H.L. (1996). Obsessive-compulsive disorder in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1265-1273. March, J.S., Mulle, K., & Herbel, B. (1994). Behavioral psychotherapy for children and adolescents with obsessivecompulsive disorder: Open trial of a new protocol-driven treatment package. Journal of the American Academy of
Child and Adolescent Psychiatry, 35(3), 333-342. The Pediatric Obsessive-Compulsive Disorder Treatment Study (POTS) Team (2004). Cognitive-behavioral therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder. The Pediatric Obsessive-Compulsive Disorder Treatment Study Randomized Controlled Trial. JAMA; 292:1969-1976. Piacentini, J., Bergman, R.L., McCracken, J., Rosenberg, D., Busner, J., Jaffer, M., & Kretchman, J. (1999). Functional impairment in childhood OCD. Program and Abstracts of the Anxiety Disorders Association of American Annual Meeting, 22, 69. Snider, L.A., & Swedo, S.E. (2000). Pediatric obsessive-compulsive disorder. JAMA, (284) 24. Steketee, G. (1985). Personality traits and disorders in obsessive-compulsives. Journal of Anxiety Disorders, 4, 351364. Stewart, S.E., Geller, D.A., Jenike, M., Pauls, D., Shaw D., Mullin, B., Faraone, S.V. (2004). Long term outcome of pediatric obsessive compulsive disorder: A meta-analysis and qualitative review of the literature. Acta Psychiatr Scand, 110:4-13. Swedo, S.E., & Rapoport, J.L. (1988). Obsessive-compulsive disorder in childhood. In M. Hersen & C.G. Last (Eds.)., Handbook of child and adult psychopathology; A longitudinal perspective (pp. 211-219). NY: Pergamon Press. Wagner, A.P. (2007). Treatment of OCD in children and adolescents: A cognitive-behavioral therapy manual. NY: Lighthouse Press, Inc. World Health Organization. Mental health: Facing the challenges, building solutions. Paper read at Report from the WHO European Ministerial Conference, January 12-15, 2005, at Helsinki.
GET INVOLVED!! Do you have a professional passion you would like to share with our readers? If so, consider creating a special section for the New Jersey Psychologist! The editorial board is seeking authors and guest editors, with similar interests, to develop a theme for a future special section. A liaison editor is assigned to work with the selected guest editor. The guest editor maintains contact with the various individual authors and streamlines the editing process prior to publication. As you know, the journal is the professional publication of our association and is read by fellow psychologists, students, and affiliate and state psychological associations across the country. So, if you or someone you know, are involved in an area of psychology that would be of interest to the NJPA membership tell us about it! Contact Editor Jack Aylward at email@example.com or Central Office at NJPA@PsychologyNJ.org
New Jersey Psychologist
Psychologist of the Year
NJPA 2011 Psychologist of the Year Acceptance Speech – October 29, 2011 Jeffrey Axelbank, PsyD
hank you, Thank you. It’s just this kind of spirit and togetherness that gets things done. We have four lawsuits going, an active PR campaign, and essential fundraising, all on top of everything else NJPA does. This is what we can accomplish when we overcome our differences to find common ground. Differences between members and leadership, central office and local affiliates, CBT and psychoanalytic people, in and out of network, all these differences don’t matter when we are all pulling together. In fact, these differences make us stronger as everyone contributes their unique perspective. There are many people to thank for this honor since, as I said, this has been a collaborative effort. I’ll try my best in the limited time I have here. If you don’t hear your name, please know that I am still very grateful! First, I want to thank Jim Wulach for calling on me to organize MCAP 15 years ago. Without that phone call, I would not be here. The MCAP organizing committee, Jackie Gilbert, Ann Reese, Gordon Boals, Marta Aizenman were the team that got MCAP going. There are too many people in MCAP to thank everyone individually. But, I want to say that MCAP remains my true professional “home.” I positively URGE, in the strongest possible way, everyone to join and get involved in your local county affiliate. There is nothing like having a local community of colleagues to trade referrals with, learn with, complain with, and grow up professionally with. The Steering Committee of the NJPA Project on the Crisis in Mental Health Insurance was an incredible group – an example of how much can get done when disagreements are worked out in the interest of moving forward on common ground. I’d like to thank Mickey Spett, Andy Bernstein, who is now in Arizona, Rosalie DiSimone-Weiss, Barry Helfmann, and Lisa Jacobs. And, I want to make a special mention of Phyllis Lakin, last year’s winner of this award, whose energy, commitment, and, as she would say, “I’m going to be completely honest,” her brutal directness, was essential. Phyllis, you were the right president at the right time, and I am so grateful to you. The arrival of Josephine Minardo as the new executive director came not a moment too soon, believe me. I cannot imagine where we would be, Josephine, without you competently steering this crazy ship called NJPA. Winter 2012
Finally, I want to thank my family. My children, Ariella and Elan – only Elan is here today because Ariella is away at college – have put up with my obsession with MCAP and NJPA for so long. I could almost hear their eyes rolling every time we would drive by someone in Highland Park, and I’d get excited and say, “Hey, look, there’s so and so, psychologist!” My wife, Lori Freedman, whose patience and available ear during both the good and aggravating times, has always been there, even though she was immersed in her own activism. And then there’s my mother, Mickey Axelbank who, along with my father, provided me a powerful role model of community involvement and activism, and steeped me in the belief that, yes, you can have a role in making the world a better place. By the way, do me a favor everyone: when you get a moment, stop by and say hello to my mother, and tell her that, yes, I am a good boy. I’ve been trying to convince her for a long time, and maybe she’ll believe all of you! My mother tells a story. This was back when I was working as an engineer. She and my father came to visit, and my father asked if I was thinking about going to grad school to get a master’s degree. I told him, yes, I am thinking about grad school, but actually I’m considering going back to get a doctorate in psychology. He looked a bit surprised, but just said, “Oh.” The story my mother tells me is that on the way out, he turned to her and said, “Don’t ever mention graduate school to him again.” Well, Dad, look at me now! Now I want to tell you a story of my own. I have a patient; we’ll call him Carl. Carl was lucky enough to get a job working for the State, and therefore to have that great insurance plan, The State Health Benefits Program. He chose the NJ PLUS plan, a PPO, to have the extra privacy you used to get by seeing a therapist out-of-network. He paid more for this plan, and also paid more to see me, in order to get these benefits. I’ll repeat that: He paid more to get these benefits. Carl did pretty well with therapy, though progress was slow. I won’t go into many details, but he grew up in a violent household. One example: his parents would trap rats using those glue boards, then take the live rats and toss them in the fireplace while he was playing in the living room. He'd hear the screams of the rats as they hit the fire. No wonder that he had fantasies of setting their house on fire now as an adult. Starting in September 2006, the extra level of privacy he was paying extra for was taken away. He still had to pay extra, mind you, but he lost his privacy. And, there was this new hovering worry that they would decline to authorize our sessions, pull the rug out from under him. 39
Psychologist of the Year
Then, in April 2008, NJ PLUS changed to NJ Direct, and over time the authorization process got more and more onerous. Because I continued to refuse to violate my licensing law, refused to violate his privacy, they reduced his authorization. We went through the two levels of appeal available, and both times the answer was the same. During this time, Carl got worse. His depression passed from Dysthymia to Major Depression, his mild general anxiety worsened, and he was experiencing panic attacks for the first time in his life. He also developed some stress-related medical conditions, including Irritable Bowel Syndrome and Eczema. And, his Axis 5 GAF went down accordingly. Three months after the reduction of benefits, we had to renew the authorization. I thought, for sure, that with these changes in his diagnoses, information that was clearly allowed by the Peer Review Law, Magellan would see that Carl’s condition had worsened under the reduced treatment, thus meeting their own criteria for medical necessity. But no-o-o-o, they didn’t buy that. They still wanted more information. They continued to deny Carl the treatment I was recommending, the treatment level that he had been doing well with, and instead only authorized the treatment that had been clearly demonstrated to be harming him. The amount of time we took during sessions to deal with this process and Carl’s reactions to it was enormous. Not only did Magellan and Horizon’s policies harm my patient, they also interfered massively with his treatment, wasting money instead of saving it. The health insurance that was supposed to support his well-being was hurting him, at the same time it was denying him the help he needed to deal with the stress that their policies caused. Carl's situation is not unique. The State Health Benefits Program accounts for 51% of all complaints on the NJPA Insurance Complaint Registry. And, if you add in other Horizon/ Magellan plans, the number increases to 69%. My mother tells another story. This was before I was born. I have two older brothers, and one night the older one, who was about six years old, comes into their bedroom and wakes up my mother. “Mommy, I can’t sleep.” “Why not? What’s the matter honey?” “There’s too much smoke in the room.” Well, of course she popped up out of bed, running into the room where my other brother was asleep, and finding the space heater smoldering, she was able to quickly unplug it just as it burst into flames, and throw a blanket on it to put out the fire. It’s terrible to contemplate what would have happened if he’d slept through the smoke. And it’s equally horrible to consider what would have happened if my mother had ignored his warning, dismissing it as just a silly complaint by a little boy: “Oh, don’t worry about it, just go back to bed.” She never would have roused my other brother, and been able to put out the fire. It took both my older brother’s alertness, and my mother’s responsiveness to save their lives. It’s the same with NJPA. Every time you have a problem with an insurance company, it’s like your office is starting to fill with smoke. You can just ignore it and keep going about 40
your business, just keep sleeping. Or you can take action, let someone know, ask for help. And when you alert the NJPA Central Office, they can either respond, or tell you to go back to sleep. But it also works the other way. What if my mother went in, and tried to wake up my sleeping brother, and he just said, “leave me alone,” rolled over, and went back to sleep? So it is also in NJPA. Sometimes Central Office puts out a call for action, or for volunteers, and it’s an opportunity to wake up, or just say, “leave me alone,” roll over, and go back to sleep. Our survival depends on the choices that are made. The challenges we face on multiple fronts are complex we need all hands on deck. We need members to be active in reporting problems, when there is smoke in their offices. Insurance companies violating privacy? Smoke in the office. Nonsensical manipulation of in- and out-of-network status? Smoke in the office. Unexplained reductions in allowable, or usual and customary fees? Smoke in the office. Sending payment to the patient even when the patient asks to have it sent to you? Smoke in the office. Lost and delayed claims? Smoke in the office. Violations of Mental Health Parity laws? Smoke in the office. Phantom networks? Smoke in the office. "Life coaches" offered as an alternative to therapy? Smoke in the office. The problem is that with so much smoke, it’s easy to get overcome, suffocated, and not be able to call out, or not have the energy to. But, take after my brother – don’t go back to sleep, go get help. And NJPA leadership needs to respond, like my mother did. But it is not so simple. Most of the time, it will take action on all our parts to put out the fires, eliminate the sources of smoke. It’s not as easy as unplugging a space heater and throwing a blanket on it. So the call will go out to all of us, the roles will be reversed: NJPA leadership will issue an alert, and the members will have to respond. Now I know that we are all feeling busy and overwhelmed. It’s hard to balance work and family. Times are tough and money is short. But make no mistake: if we don’t take action, the smoke will get to be too much, and we’ll be snuffed out. And don’t think you’re safe if there isn’t yet smoke in your office, say if you work in an agency, or in an academic setting, if it’s only in your private practice neighbor’s office now. Smoke has a way of seeping under doors and out into hallways. It will come into your office. Because the root of all this smoke is a devaluing of mental health care, a devaluing of the importance of psychology in the human picture. And, if the insurance companies can get away with devaluing us, then before you know it, your agencies will have their funding cut, your academic institutions will see psychology departments as expendable. Our fates are all tied together – if smoke fills one room and kills its inhabitants, it will spread to others. There are so many ways to respond, some obvious and some subtle. Some take time and money, some cost nothing. But they are all important. The most direct way to report smoke in your office is to log New Jersey Psychologist
Psychologist of the Year
it on the Insurance Complaint Registry. Without data, we have no legal case, no PR case, no case to make to legislators. It takes five minutes. We are asking everyone to contribute money to the legal and PR fund that is supporting our lawsuit. A pledge of $100 per month is reasonable – one session per month. But anything you can afford would be helpful. Remember what happens if we don't act. We need lots of human resources, too. The new Insurance Committeethat I chair, has a huge task, so many possible areas to work in. But without the people to do this work, NJPA cannot respond to all the smoke and work to eliminate the sources. So please, step up and volunteer. But there are also many small ways to pitch in. We very much need to spread the word about the value of our work. How many people are on Facebook or Twitter? It takes almost
nothing to “Like” the Speak Your Mind NJ Facebook page and follow “Speak Your Mind NJ” on Twitter. And then to start passing on to your friends and social networks the messages that come from Speak Your Mind NJ. Another thing that is free, and takes almost no effort: go to the video booth we have set up today, and talk about your experiences with insurance companies. What is creating smoke in YOUR office? It takes ten minutes. We can do this. We can clear the air in our offices. We can create a day when no parent wants to avoid bringing up grad school, for fear that a child might want to be a psychologist. But, we will only be successful if everyone does their part, if we resist the temptation to ignore the smoke. Our professional lives depend on it. Thank you. ❖
PSYCHOLOGIST OF THE YEAR & CITIZEN OF THE YEAR 2012 PSYCHOLOGIST OF THE YEAR NJPA members have the opportunity to recognize and nominate a fellow member who has made an outstanding contribution to the profession of psychology through demonstrated excellence in practice, research, or teaching.
2012 CITIZEN OF THE YEAR The Citizen of the Year is awarded to a non-psychologist who has made significant contributions to the ideals of mental health or social welfare. Nominations should consist of several paragraphs detailing why this individual deserves the honor. Supporting documentation may be enclosed. Recipients will be selected by the NJPA Executive Board based upon how well they meet the criteria of the award. Please take the time to think of someone you admire and/or appreciate that you wish to nominate. The deadline for submissions is May 4, 2012. Entries should be forwarded to: New Jersey Psychological Association 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 Or email to: NJPA@PsychologyNJ.org
Legal Action Legal ActionInitiative Initiative A court victory! In November 2011, NJPA achieved its first important legal victory in the legal complaint that charges Horizon/Magellan with insurance company abuses.2011, The ruling NJPA’s standing to legal victory in the legal complaint that charging A court victory! In November NJPA upheld achieved its first important represent its members in the lawsuit, and determined patient plaintiffs Horizon/Magellan with insurance company abuses. The ruling upheld NJPA’s standing to represent its members in the also haveand standing to bring legal plaintiffs action against the insurance compalawsuit, determined patient also have standing to bring legal action against the insurance companies, as nies, as well. well. Our case caseisismoving moving forward!Since Since favorable ruling, NJPA Our forward! thethe favorable ruling, NJPA hashas been preparing for the next phase of the legal process; discovery, depositions, ultimately a trial or summarydejudgment ruling by Judge Klein. We expect these been preparing for the next phaseand of the legal process; discovery, proceedings move swiftly relying on Judge Klein’s in-court positions, andtoultimately a trial or summary judgment ruling bystatement Judge that she makes every effort to complete her cases within a 12-month period. Klein. We expect these proceedings to move swiftly relying on Judge Klein’s in-court statement that she makes every effort to complete her Let’s within reach aour goal! We continue to have excellent legal representation but this comes at a significant cost to cases 12-month period. NJPA. We cannot do this without UNIVERSAL member support and it is essential that we continue to raise funds for this effort. If youWe have not yet to contributed, PLEASE TODAY THE DAY. If you alreadycost contributed, Let’s reach our goal! continue have excellent legalMAKE representation but this comes at have a significant to NJPA.we We sincerely thank you and ask that you consider making an additional pledge. Your contributions can become much cannot do this without UNIVERSAL member support and it is essential that we continue to raise funds for this effort. If more substantial if made via payments over time: Most of us do this when directing payments to other causes, so you have not yet contributed, PLEASE MAKE TODAY THE DAY. If you have already contributed, we sincerely thank you and why not take advantage of this easy way to contribute? A pledge of $100 per month for 12 months – a total pledge ask that you consider making an additional contributions canpicture, become muchconsider more substantial via payof $1,200 would be most helpful. Or, if thatpledge. does notYour fit into your financial please a pledge if ofmade $75, $50, ments over time: Most of us do this when directing payments to other causes, so why not take advantage of this easy or $25 a month for 12 months. The NJPA website Donation page, <www.PsychologyNJ.org>, gives you the option toway to contribute? A pledge of $100 month for 12 months – a total pledge of $1,200 be most helpful. Or,Follow if that does make a single contribution, set upper recurring payments, or designate a pledge amountwould (and pay incrementally). not fit into your financial picture, please consider a pledge of $75, $50, or $25 a month for 12 months. The NJPA website our progress by viewing our new “thermometer” that tracks our advancement toward our legal fund goal. We cannot do Donation page, <www.PsychologyNJ.org>, gives you the option to make a single contribution, set up recurring payments, this without member support and it is essential that we continue to raise funds for this effort. Contribute today to or designate a pledgerights amount pay incrementally). Follow this our landmark progress by viewing our new “thermometer” that tracks our ensure patients’ to(and privacy be maintained through case. advancement toward our legal fund goal. We cannot do this without member support and it is essential that we continue to raise fundsyou for in this effort. for Contribute today tosupport ensure! patients’ rights to privacy be maintained through this landmark case. We thank advance your generous
We thank you in advance for your generous support!
New Jersey Psychologist
What’s New: Addressing Heterosexism in Consultation by Megan C. Lytle, EdS Seton Hall University
n the United States, there is a misconception that discrimination is against the law. While the majority of Americans are protected from discrimination under the Equal Employment Opportunity (EEO) and the Civil Rights Acts of 1964 and 1991 (The US EEO Commission, 2002), this is not true for everyone. The US EEO Commission contributors reported that EEO laws protect individuals from discrimination based on race, color, religion, sex, national origin, disability, and age, but do not safeguard gay, lesbian, bisexual, and transgender (GLBT) individuals. In 2011, it is legal, in 29 states, to fire employees based on their sexual orientation and in 35 states employees can be fired based on their gender identity (Human Rights Campaign, HRC, 2011a). In addition to the legalized discrimination of GLBT individuals at work, youth and college campuses are also impacted by inequality. Hence, psychologists who provide consultation as well as industrial/organizational, school, community, and college psychologists should recognize the impact of heterosexism. As the American workforce continues to diversify due to the EEO laws, multicultural consultation in businesses and schools has become a necessity. According to Leong and Huang (2008), diversification through organizational consultation has focused on helping the workforce become more multiculturally competent with regard to race/ethnicity, but as a hidden minority, GLBT workers are overlooked in the process. It would seem that it is more beneficial for organizations to seek consultation for legally protected groups than for individuals who can be legally discriminated against. According to Fassinger (2008), our society allows for prejudice against GLBT individuals to continue, resulting in wage disparities and denial of domestic partner benefits. In 2007, Badgett testified before the House of Representatives supporting the Employment Non-Discrimination Act, and reported that there was an income disparity of 10-32 % between gay and heterosexual men, whereas GLBT individuals earn 2-4% more in states that prevent discrimination. GLBT workers also face homonegativity from their colleagues and may choose to hide their sexual orientation or gender identity to ensure safety and job security (Blustein, 2006). GLBT employees who hid their identities were less productive, while workers who disclosed their identities were more involved, satisfied, and productive (Badgett, 2007). Winter 2012
Furthermore, employers are able to structure their benefit programs with few restrictions and have the right to decide who qualifies for coverage (HRC, 2008). Therefore, employers may decide to offer benefits only to married couples despite having the option to extend benefits to same-sex partners. New York and the District of Columbia took steps towards decreasing heterosexism by recognizing same-sex marriages from other jurisdictions prior to passing their own marriage equality laws, and this forced employers to reconsider who qualified for marriage benefits regardless of a spouse’s sex (HRC, 2008, 2011a). Romney (2008) explored the intersection of diversity and social justice in consultation, and introduced the notion of utilizing consultation to assist organizations in expanding their fixed ideas as well as policies. She suggested that domestic partner benefits, among other propositions, be included in developing new guidelines. Increasing the multicultural competence of an employer requires a gradual process in order to limit resistance. Organizations have traditions, hierarchies of power, often reject new ideas (Dougherty, 2009), and are slow to change, especially when they are not legally required to do so. While organizations often seek diversity training in response to incidents, they often try to limit their responsibility for change (Romney, 2008). Consequently, training may occur after bias incidents, rather than as preventative measures. Although few researchers have focused on GLBT consultation, GLBT individuals should be considered in organizational consultation. According to Romney, before the consultation entry phase can begin, consultants need to be up-to-date and informed about diversity. Consultants must be aware of their own cultural identities and biases as well as the organization’s view of sexual orientation and gender identity (Constantine & Sue, 2005). Consultants should also be aware of organizational resistance and attempt to contract for continuous diversity trainings, rather than a single training. Resistant organizations tend to view discrimination as a problem between a few people rather than a systemic concern (Romney). The HRC (2011b) contributors developed the Corporate Equality Index (CRI) to rate GLBT equality in workplaces. The CRI includes employment opportunities, employee benefits, and GLBT competence among other criteria, and could be a helpful tool for psychologists who provide consultation. 43
Dougherty (2009) noted that the diagnosis stage of consultation begins by reviewing as much data as possible, including but not limited to surveys, interviews, observations, discussions, and archives to understand the system as well as consultee. By completing a full assessment of an organization, the consultant can recognize individual, group, and organizational levels of heterosexism. Archives and policies would show administrative practices regarding discrimination against GLBT employees, whereas surveys and observations would demonstrate the environmental climate towards GLBT co-workers. For example, Exxon Mobil, Verizon, and WalMart are a few companies that have refused to develop more inclusive policies although their shareholders have requested non-discrimination policies (HRC, 2011b). Romney (2008) explained that the implementation stage of consultation should be developed based on the level of organizational resistance towards diversification. In other words, interventions would drastically vary if an organization wanted a multicultural training compared to an organization that requested diversity training in response to a bias incident. Consultants would be able to develop a more thorough program with follow-ups if the consultee was interested in multiculturalism as a preventative measure rather than a reaction. Consultants are also responsible for representing underserved individuals who experience discrimination even though the consultee may want to focus on organizational needs (Romney, 2008). While these two perspectives appear to have different interests, the results could be mutually beneficial. Fassinger (2008) reported that GLBT individuals who were â€œoutâ€? at work had greater organizational commitment, and organizations that increase multicultural competence would be more likely to retain valued employees. The same need for consultation addressing heterosexism in the workplace pertains to the educational system. Jevolta and Fish (2005) noted the need for traditional and systematic consultation approaches in order to make safer school environments for GLBT students and families. As of 2007, contributors to GLSEN (2008) reported that 86.2% of GLBT students were harassed in the previous year. The first step in developing safe school environments for GLBT students and families is familiarity with the client system and the consultee (Jevolta & Fish, 2005). Successful entry into multicultural consultation requires support from influential consultees as well as powerful individuals within the client system (Jevolta & Fish, 2005). For example, community leaders and school administrators need to buy into an idea before the consultation process can begin. In particular, a school-based GLBT consultation may require support from religious organizations and political leaders. Obtaining the required support begins by teaching the power holders how the school environment as a whole could change by welcoming GLBT students and families (Jevolta & Fish, 2005). Consultants could keep track of violent incidents and harassment against GLBT students to demonstrate how consultation could improve school safety. Since GLBT youth 44
are at higher risk for committing suicide, resources such as the Trevor Project (2010) survival kit, could aid in the consultation process. After the client system and consultees recognize the need, the diagnosis stage would conclude by establishing goals and possible interventions. Jevolta and Fish reported that the goal would be for the power holders to envision their school as an affirming environment for GLBT students and a safer environment for all students. Jevolta and Fish (2005) suggested role plays and psychoeducation for school professionals could be implemented to initiate the process of change. Role play would be used to teach school employees about homonegative harassment, how to respond effectively, and how to prevent harassment (Jevolta & Fish, 2005). Contributors to GLSEN (2005) reported that the majority of school professionals do not mediate when GLBT students are bullied, and could benefit from learning about the effects of harassment. Therefore, the entire client system, as well as the consultees, needs to learn about GLBT individuals, GLBT families, their experiences of being harassed, and how to advocate. In addition to education, the school could implement GLBT safe space programs and GLBT student organizations. Furthermore, Jevolta and Fish (2005) suggested that schools make physical changes such as buying books about GLBT individuals and to consider displaying GLBT symbols (i.e., rainbow flag, pink and black triangles). Industrial/organizational, school, community, and college psychologists could play an integral part in decreasing heterosexism through consultation. For instance, psychologists could assist with making diversity trainings more inclusive and establishing safer schools, as well as work environments, for GLBT individuals. Psychologists in school and universities could assist in advocating for safe space programs for GLBT students or act as consultants in decreasing homonegativity at their school or university. In addition, school psychologists must also be familiar with how state and federal laws impact businesses and schools. For instance, while the majority of states do not protect GLBT students from harassment, federal law requires that public schools protect these students (American Civil Liberties Union Foundation, 2008). With recent legislative debates over equal rights for GLBT individuals, it will also be essential for psychologists to understand how these legal decisions could impact their clients. In recent years the number of GLBT equal rights legislation proposals has increased. One such proposal, HR 1397 and S811, Employment Non-Discrimination Act of 2011, was reintroduced to protect GLBT individuals from discrimination and while this law is a step forward, it has numerous exemptions that allow discrimination based on sexual orientation as well as gender identity to continue (HRC, n.d.). For example, preferential treatment based on sexual orientation would be allowed and religious organizations, the military, and small businesses would not have to follow these legislative guidelines (HRC). Therefore, psychologists should be familiar with how current, as well as proposed legislation, offers protection or allows for continued discrimination. New Jersey Psychologist
In conclusion, GLBT individuals are hidden minorities who are not legally protected from discrimination. GLBT individuals often face prejudice from organizational and educational systems. So while consultation is a crucial element in the process of decreasing heterosexism in these institutions, this process will also require a change in society as a whole. The lack of legislative reform regarding GLBT rights speaks to the need for further advocacy and consultation in psychology. ❖ References American Civil Liberties Union Foundation. (2008). Know your rights. Retrieved from <http://www.aclu-em.org/down loads/schoolsknowyourrights.pdf> Badgett, M.V. L. (2007). Testimony: HR 2015, the employment non-discrimination act of 2007. Retrieved from <http://repositories.cdlib.org/cgi/viewcontent.cgi?article=1111&con text=uclalaw/williams> Blustein, D. L. (2006). The psychology of working: A new perspective for career development, counseling, and public practice. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. Constantine, M. G. & Sue, D. W. (2005). Strategies for building multicultural competence in mental health and educational settings. Hoboken, NJ: John Wiley & Sons, Inc. Dougherty, A.M. (2009). Psychological consultation and collaboration in school and community settings. (5th. Ed.). Belmont, CA: Cengage-Brooks/Cole Publishing Co. Fassinger, R. E. (2008). Workplace diversity and public policy: Challenges and opportunities for psychology. American Psychologist, 63, 252-268. GLSEN. (2008). 2007 National school climate survey: Nearly 9 out of 10 LGBT students harassed. Retrieved from <http://www.glsen.org/cgibin/iowa/all/library/record/ 2340.html?state=research> GLSEN. (2005). 2004 state of the states report: The first objective analysis of statewide safe school policies. Re-
trieved from <http://www.glsen.org/cgibin/iowa/all/library/ record/1687>html Human Rights Campaign. (2008). Marriage for same-sex couples: considerations for employers. Retrieved from <http://www.hrc.org/documents/Human_Rights_Campaign_Foundation_-_2008_-_Marriage_for_Same-Sex_ Couples_-_Considerations_for_Employers.pdf> Human Rights Campaign. (2011a). Maps of state laws and policies. Retrieved from <http://www.hrc.org/resources/ entry/maps-of-state-laws-policies> Human Rights Campaign. (2011b). Corporate equality index: Rating American workplaces on lesbian, gay, bisexual, and transgender equality. Retrieved from <http://www.hrc.org/ resources/entry/corporate-equality-index-2011> Human Rights Campaign. (n.d.). Employment non-discrimination act. Retrieved from <http://www.hrc.org/laws-andlegislation/federal-legislation/employment-non-discrimination-act> Jeltova, I. & Fish, M. C. (2005). Creating school environments responsive to gay, lesbian, bisexual, and transgender families: Traditional and systemic approaches for consultation. Journal of Educational and Psychological Consultation, 16 (1 & 2), 17-33. Leong, F. T. L. & Huang, J. L. (2008). Applying the cultural accommodation model to diversity consulting in organizations. Consulting Psychology Journal: Practice and Research, 60 (2), 170-185. Romney, P. (2008). Consulting for diversity and social justice: Challenges and rewards. Consulting Psychology Journal: Practice and Research, 60(2), 139-156. Trevor Project (2010). The Trevor survival kit. Retrieved from <http://www.thetrevorproject.org/survivalkit> The US Equal Employment Opportunity Commission. (2002). Federal laws prohibiting job discrimination questions and answers. Retrieved from <http://www.eeoc.gov/facts/qanda.html>
Share your ideas with us! Do you have an interest in a particular area in the field of psychology and are keeping up with the latest literature and research that you would like to share with your colleagues? We would like to speak to you! Consider sharing your knowledge in a submission for a future “What’s New” article. Exchange your ideas with Herman Huber at firstname.lastname@example.org.
Adventures in the Orgasmatron: How the Sexual Revolution Came to America by Christopher Turner Reviewed by Herman Huber, PhD Here’s a quiz for you. What do Albert Einstein, Fritz Perls, Sigmund Freud, A. S. Neill, the FDA, the FBI, Lewisburg Penitentiary all have in common? The answer: they all had relationships with Wilhelm Reich. If you’ve ever wondered how a psychoanalyst whom Freud labeled the most gifted of the 2nd wave of analysts, who coined the term “sexual revolution” and was partly responsible for creating it in America, who wrote brilliant texts on character analysis and the psychology of fascism still widely respected nearly 80 years later, could later create telephone booth-size boxes to collect orgone energy to cure cancer, and shoot down flying saucers in the Arizona desert – then you need to read Christopher Turner’s riveting account of Reich and the world in which he lived. Much more than a biography, Turner creates an historical narrative that explains the many social forces operating in Europe and America which lead to Reich’s fame and ultimate downfall. Believing in the curative and political power of the orgasm, Reich relentlessly argued that repressed societies were dangerous and that true political harmony and social justice could come only with the free and complete experience of orgasms by all members of the society. Indeed, Reich, a Marxist, believed that sexual repression had doomed the Bolshevik revolution. Although initially greatly admired by Freud, Reich’s increasing focus on the orgasm as a panacea for all neurotic maladies, so alienated the master, that he was eventually ousted from psychoanalytic societies. He was especially hurt when Freud would not accept him as a patient. Not only his fellow analysts were alarmed by his ideas, but Nazi Germany began to focus on him. Escaping to other parts of Europe, he eventually came to the United States where he lived the rest of his life. Undaunted, with a cadre of true believers, he became increasingly unbalanced. Turner beautifully describes Reich’s personal foibles, troubled childhood, and descent into paranoid schizophrenia, as well as the remarkable brilliance gone awry. Along the way, we are viewers of the struggles of the early analysts, trying to align with Freud yet castigated for injecting new ideas. We also are witness to the remarkable infighting and jealousies of the early pioneers, and the astounding lack of ethics, not to mention sexual misconduct, not unusual in the early decades. The United States during the late 40s and 50s was no paradise for outlandish ideas with political themes. The Cold War, McCarthyism, communists under every rock, and Alfred Kinsey’s revolutionary sex studies, created widespread fear of 46
political upheaval and personal corruption, especially sexual corruption. And Reich was at the forefront of the movement for liberating sexuality, although he had disagreements with the free-love movement and refused to treat homosexuals. Prominent Americans sat in their orgone boxes hour after hour, collecting orgasmic energy, curing their ills, strengthening their orgasms. The FBI kept a watchful eye on the “subversive” Reich, but his undoing was the FDA, which labeled his orgone accumulator a medical device and a hoax. Unsparingly hounded by the FDA in Maine, where he set up his research institute, as well as in New York, Reich who never gave an inch, was jailed in Lewisburg Federal Penitentiary where he died of a massive coronary days before his parole hearing in 1957. Sadly in his final years, Reich managed to alienate nearly all of his family, friends, and colleagues, though a few diehards hung on. His paranoid psychosis led him to see UFOs, conspiracies everywhere (though not completely unfounded), create increasingly bizarre devices, “produce” rain for drought-ridden farmers, and he vainly tried to warn the world about alien invaders. Reading Turner’s wonderful account of the life and times of Wilhelm Reich was both fascinating and disturbing, and a great deal is to be learned about the world in the first half of the 20th century and the remarkable role that a brilliant and severely disturbed man played in shaping it. In case you’re wondering, Woody Allen, not Reich, coined the term “orgasmatron” in his movie “Sleepers.” The connection to Albert Einstein? Amazingly, Reich convinced Einstein to test the validity of the orgone accumulator, which he did, only to prove it did nothing. ❖
IN MEMORIAM Grete Hesse, PhD NJPA Member, 14 years New Jersey Psychologist
Social Justice in Clinical Practice
Social Justice in Clinical Practice: Family Consultations with Adolescents in Urban Schools Part II by Norbert A. Wetzel, ThD and Hinda Winawer, MSW, LCSW The Center for Family, Community, & Social Justice, Inc. Princeton • <www.cfcsj.org> (Note: Part I of this article (see the Fall 2011 issue of the NJ Psychologist, pp, 40 – 42) described the “Context-centered Family Systems Counseling” (CFSC) model and its innovative features.) The “Kaleidoscope of Contextual Lenses” (see Figure 2) The Center has developed a set of contextual perspectives that, much like photographic lenses, helps the teams to focus on the relational and contextual world of the students and their families and to use the insights derived from the perspectives as orientations for their clinical practice. Applying the relational paradigm’s axiom, “how you look determines what you see,” these perspectives guide the Center teams’ way of looking and help them to perceive the most relevant aspects of the young people’s and their families’ contexts. The contextual perspectives intersect with each other in multiple ways and highlight reality aspects of a family that otherwise would have remained invisible.
Figure 2 (1) Economic Status The socio-economic class of a family co-determines many aspects of a family’s life, especially when the intergenerational view of the family reveals a “poverty trap” that does not Winter 2012
seem to have an exit and for which all too often the family is blamed. (Laszloffy, 2008; Cohen, 2010; Harding, Lamont, Small, 2010.) Financial situation, housing circumstances, persistent “food insecurity” (Winawer-Wetzel, 2008), the type of parents’ employment and job details, such as length of daily commute, unpredictable work hours, lack of job security, unavailability of jobs in the neighborhood, are all areas to be explored during the initial phase of the encounter with a family. Because the professionals are outsiders, a family’s skepticism and reluctance to trust is viewed positively as a family’s selfprotective mechanism. The Center teams’ empathic curiosity about the economic conditions of a family is, therefore, a first step toward building trust between family and team. (2) Race, Culture, Ethnicity Civil rights legislation and general upward mobility brought social and economic advances including leadership positions in all areas of public life for many African-American, Latino, and Asian families. Yet the economically disadvantaged urban areas and schools where the Center teams work are characterized by a high degree of ethnic “minority” groups. The cultural identification and the ethnic background of a family are a highly significant component of the contextfocused counseling process as it should be for any individual and family therapy. Counselors who are not inquiring about the cultural aspects of a family’s life will not ever hear of a student’s daily experience of “racial micro-aggressions” (Sue, 2007) and racially motivated insults by others. And, they will also not find out about the particular strengths and sources of resilience inherent in a family’s cultural identity. Similarly, inquiries about immigration stories generally reveal narratives of struggle, determination, and survival. Striving for cultural sensitivity and respect distinguishes all levels of relational processes at the Center. Faculty and teams consider what their cultural identity means for themselves and their interactions with each other. In counseling sessions with families, the cultural homogeneity or diversity between team and family is an important topic of conversation. The Center 47
Social Justice in Clinical Practice
team is curious to listen to the stories of racial oppression, racial profiling, or discrimination in job interviews; they also inquire about stories of hidden, often heroic resilience that are part of the intergenerational narrative of a family. It is equally important that the teams understand how people in the family feel about the present cultural climate in their environment, particularly at school. (3) Gender identity, gender role definitions, transgender people (Ashton, 2010) Social constructions of class and race/culture influence powerfully how families see and define gender roles. How is a man’s role in the family envisioned and experienced if he is white, Latino, or African American? And, how is a man seen if he is also gay or transformed his gender identity? Similarly, how diverse are the experiences of women depending on their economic class, their ethnic background, and their gender or sexual identity? Subtle and, unfortunately, often not so subtle forms of gender related oppression of girls and women or of transgendered people become visible for teams with a gender sensitive perspective in school and neighborhood contexts. Male teens’ school drop-out, teen pregnancy, invisibility of men and constant overload of mothers, discrimination of women in jobs are functions of societal constructions of economic and racial realities that will only be perceived as such by the teams if they ask questions informed by a gender perspective that intersects with socio-economic and racial considerations. Needless to say, the issues of gender identity are of particular concern for Center teams who work with children and adolescents in urban schools. (4) Sexual identity, sexual orientation, and relationship education (Ashton, 2010) One of the most concealed and denied conflicts of adolescents is their struggle to find their own sexual orientation and identity. Teens who sense their attraction to same gender friends are frequently teased or bullied by their peers and misunderstood by parents before they develop the courage to speak with a Center team member. The experience of finding oneself sexually attracted to friends of the same gender can initially be very disturbing for adolescents, particularly when they belong to cultural groups and religious communities where homosexuality is considered a grave sin, an offense against cultural norms, or an attack against strongly held family values. Coming out to parents and family often becomes an ordeal (LaSala, 2010). In several schools, the Center teams have initiated LGBTQI1 (or Gay Straight Alliance) conversation groups that became quite popular. Several homophobic hate motivated murders and the recent rash of suicides among gay youth who could not stand the constant bullying any more makes this work particularly important (see also <www. thetrevorproject.org>). Most counseling of adolescents is in fact relationship counseling because issues of sexual identity 1
have become so much more prominent in the age of Internet social media. (5) Religion, spirituality; membership in a religious congregation As part of their focus on a family’s community context, the teams explore a family’s membership in a religious congregation. At times, the religious community can be a significant source of support and strength. In other cases, conservative pastors may look at counseling by a secular team with misgivings. In addition, Center team members who belong to an evangelical church may have to struggle with their own beliefs regarding homosexuality, pregnancy termination, or premarital sex when faced with students and families with very different religious values. Muslim families having experienced much discrimination and disdain for their cultural and religious practices following the 9/11 events, may feel accepted if they sense respect for their religion. Conversations about religion and spirituality yield indications of the hidden strengths of the family and lead to greater understanding and esteem for the faith of others. (6) Medical health, addictions (history and present status), and disabilities A relational paradigm includes focus on the individual, i.e. the students seen by Center teams are also as individuals a focal point of the teams’ explorations. This holds true particularly for their present and past medical health. Often it is necessary for Center staff to refer a student to the nurse at the school-based youth services or to make a connection with a physician to get a clear understanding of a student’s medical health. Many of the students do not have health insurance and, therefore, receive no regular medical check-ups or preventive care. Again, the perspective of the individual student’s health is context-centered. A student’s physical symptoms may be a sign of environmental stress. Illness is a family event and has an impact on students’ lives and can lead to considerable stress, sometimes not immediately apparent to outsiders. What may manifest as a student’s behavioral problem, e.g. truancy, may be her devoted care for a close family member. In this health perspective, we include exploration of early experiences of trauma, the adolescent’s substance abuse history and that of family members. Finally, it is important to inquire about any disabilities in the family, often not evident without specific inquiry. (7) Safety; contextual or domestic violence In many districts some students live in neighborhoods that are unsafe for them and their families. Gang related physical violence and shooting incidents are rather common and students involved in the Center programs have personally experienced or witnessed violence. Center teams have been called upon to intervene in fights between students in some of the
LGBTQI stands for Lesbian, Gay, Bi-sexual, Transgender, Queer, and Intersex.
New Jersey Psychologist
Social Justice in Clinical Practice
schools. Physical conflicts between girls, as mentioned at the beginning of Part I, are a more recent phenomenon (Ness, 2004). Some teams are advisors to groups of high school students who organized themselves and pledged to deal with conflicts nonviolently (some as part of the national S.A.V.E organization: <http://www.nationalsave.org>). (In one high school, the S.A.V.E group membership has risen to almost 100, a potential for a shift in the adolescent culture to “Peaceful is Cool”.) In some towns, the team’s “Community Resource Specialist” has met with community leaders and representatives of the town’s administration to find ways to curb violence in the neighborhoods. Counselors’ inquiries about violence in the community or in the family can yield greater understanding about the level and frequency of trauma in the students’ lives. The teams see it as their task to contribute to the restoration of safety in the students’ environment, to assist them to heal from traumatic experiences, and to support student-led efforts to create alternatives to violent behavior in the schools. (8) Immigration & Family Survival Narratives It is essential to listen to the family narratives about their history. For those who have recently immigrated to the US, these conversations are particularly important and can be healing. Immigration stories of Latino, African, and Asian families may reveal not only survival, but also family stress and grief: for those left behind, for loss of homeland and, for many, social status. Center teams are asked to familiarize themselves with the country of origin and the special conditions prevailing at the time the family left the country. Some families came from war torn countries (Liberia, Sierra Leone) and experienced severe trauma on their journey to the US. The teams also address with newly immigrated families their immigration status, the special history connected with their immigration, and any support they may need. People who are in this country without proper documents, i.e. many Latino and African parents, may need encouragement to become connected with the school their son or daughter attends despite fears of arrest, detention, and possible deportation. They may need advice and information about language courses and legal help regarding their immigrant status. The Center recognizes that people who immigrated without documents are in a legal limbo and are exposed to additional multiple hardships, such as exploitation in wages, substandard housing, minimal legal rights, and lack of health insurance, to name but a few. (9) Family dynamics & family life cycle, intergenerational view The core idea of the “Context-centered Family Systems Counseling” model is to understand and assist children and adolescents in urban schools through focusing on the family. The Kaleidoscope’s contextual lenses turn on this core idea and highlight various aspects of the students’ and families’ life. In all respects, the focus on the family is central. With this last perspective we detail specific steps the teams Winter 2012
take in order to assess the overall condition of a student and his family. They explore the relational dynamics within the family of the teenager, especially the family’s phase within the family life cycle, the family structure and narratives, the degree to which a family is part of a destructive or supportive social environment, and the ability of the parenting figures to be in charge of the family’s life and to guide and nurture the children. A family tree (“genogram”) over several generations with the history and main events and dates of the extended family produces important indications of beliefs, behavioral and experiential patterns, as well as intergenerational models of resilience that may play a significant role in the life of the family’s young people. (Sharkey, 2008) This is also the place, with the family dynamic as a backdrop, to assess a teenager’s emotional, cognitive, and social maturity in the family context (Ungar, 2010). Social Justice as a “Meta-Perspective” “Context-centered Family Systems Counseling” means context centered learning for Center teams and faculty supervisors alike. To the degree teams and supervisors open themselves and get involved in the counseling process with families and their communities, they become affected by the stories they hear, by the other reality that they are faced with in counseling, and by the strength with which young people and their families struggle through their lives. Empathy for the social, cultural, and gender specific realities opens Center teams and supervisors to unexpected insights that come from children, adolescents, and families. One of the insights that led supervisors and teams to a broad conceptual reflection is the growing awareness how much teenagers’ interactional and behavioral difficulties, emotional suffering, or trauma induced thought disturbances are linked with societal injustice structures. Social justice is an integral aspect of the “Contextcentered Family Systems Counseling” model. Structures of Injustice Injustices in our society’s history and structure are experienced daily and are significant factors in human suffering, psychic pain, and physical illness. The separation of psychological inside and social outside is an artificial construct intended to make us overlook the power of unjust societal and economic structures that contribute to emotional pain. The students and families in the Center’s programs face personal and interpersonal issues that do not arise from their biological, psychological, and social development or from their family dynamics in isolation. Youth in urban environments are exposed to many stressors and injuries that are rooted in our society’s structural injustices: Economic exploitation and the growing disparity of wealth between rich and poor; rigid walls between social classes; lifelong status as marginalized within the dominant culture; poverty and violence in the neighborhoods; continuing racism, so evident in the administration of justice; disparities in health care and social services delivery; hardships due to the imprisonment of family mem49
Social Justice in Clinical Practice
bers; discrimination against women, children, gays, lesbians, or transgendered people, - in general, the likely mistreatment of anyone who is different according to the norms of the dominant discourse. Social justice, therefore, is integral to the teams’ inquiry and understanding of adolescents and families. Social Justice Work in Clinical Practice Social justice as a “meta-perspective” orienting the counseling process and guiding clinical practice transforms and enriches the Center teams’ conversations with families. Some important steps of “justice work” are listed here. Witnessing stories and public remembrance Families tell stories, often in the language reflecting their ethnic heritage and culture that they try to preserve. They talk about present or past traumatic incidents or about long smoldering conflicts and irreconcilable relational traps, or about their journeys replete with danger as they were forced to immigrate to this country to survive. As eye and ear witnesses, the teams ask questions, encourage other family members to join in the narrations, or broaden the generational context so people can listen to the voices of previous generations. In the relative safety of a family session, incidences of physical or sexual abuse, tales of deprivation and general affliction, times of despair or helpless rage, of mental confusion and bewilderment, or long-standing family disagreements can surface and be heard. Remembering and acknowledging in the public sphere of the family conversation the struggles, sufferings, and injustices family members had experienced in previous generations is healing and strengthening for all. It is a form of restoring justice to those who went before us whose life and death made the family’s life better. The work of reconciliation The teams pursue actively the goal of reconnecting fragmented personal relational networks, of reconciling hostile family members, and of assisting them to rebuild the relationship with each other. This process requires a sense for justice and for balance of opposing forces, cultural empathy and humility, attentiveness to time, and “multi-partiality”, i.e. the ability to do justice to each person’s perspective. Justice work in the family’s social environment Beyond the family’s immediate context, the teams see the task of supporting all efforts to transform and restore societal, cultural, and gender specific justice in neighborhoods where civic and community life has suffered. Families are encouraged to not give up advocating for justice. “Context-centered Family Systems Counseling” can provide the groundwork to motivate families to take initiative in their neighborhood or in their children’s school and advocate for change and address issues of justice on many levels. After the physical brawls between the two groups of girls (see the beginning of Part I), the school administration, at the 50
recommendation of the Center team, suspended the decision to expel the group leaders to give the counseling process time - perhaps an indication of the FEP team’s reputation. The FEP team began counseling at the level of the two hostile family systems. The mother and maternal grandmother of one family readily agreed to family sessions. The mother of the other leading girl was more reluctant. Eventually she moved her family out of town and the daughter completed her education in a new school environment. At the same time, the two counselors started to meet with the girls in groups and with their leaders individually. The rivalries gradually dissipated. The tensions in the high school calmed down. Eventually, students within the high school formed networks among their peers who advocated alternatives to violence and influenced the atmosphere at the school. The team’s consideration of the multiple contexts of the conflict included the students’ proximity to youth gangs and the ongoing tensions between culturally diverse groups in the community. The integration of the community contexts into the youth and family counseling process remains a continuing task. ❖ References: Ashton, D. (2010). Lesbian, Gay, Bisexual, and transgender individuals and the family life cycle. M. McGoldrick, B. Carter, & N. Garcia Preto (Eds.), The expanded family life cycle, (4th ed.) Boston: Allyn & Bacon. Cohen, P. (2010). ‘Culture of Poverty’ Makes a Comeback. New York Times, October 18, p. A1 <http://www.nytimes. com/2010/10/18/us> Harding, D., Lamont, M., Small, M. (eds.). (2010). Reconciling Culture and Poverty. American Academy of Political and Social Science, The Annals Vol. 629 (5) (Special Issue) LaSala, M. C. (2010). Coming out, coming home: Helping families adjust to a gay or lesbian child. New York: Columbia University Press. Laszloffy, T.A. (2008). Social Class: Implications for Family Therapy. McGoldrick, M. & Hardy, K.V. (eds.) Re-Visioning Family Therapy. Race, Culture, and Gender in C l i n i c a l Practice. 2nd Ed. New York: The Guilford Press; 48–60. Ness, C.D. (2004). Why Girls Fight: Female Youth Violence in the Inner City. The ANNALS of the American Academy of Political and Social Science. Vol. 595: 32-48. DOI: 10.1177/0002716204267176 Sharkey, P. (2008). The Intergenerational Transmission of Context. American Journal of Sociology 113 (1), 931–969. Sue, D.W. et al. (2007). Racial Microaggressions in Everyday Life. Implications for Clinical Practice. American Psychologist 62 (4), 271 – 286. Ungar, M. (2010). Families as Navigators and Negotiators: Facilitating Culturally and Contextually Specific Expressions of Resilience. Family Process, 49: 421–435. Doi: 10.1111/j.1545-5300.2010.01331.x Winawer-Wetzel, S. (2008). Beyond Hunger Management. From Charity to Social Justice. Boston: The Heller School for Social Policy and Management, Brandeis University. New Jersey Psychologist
2011 NJPA Fall Conference October 28 & 29, 2011
Aaron Welt, PhD; presenters Peter and Phyllis Sheras, PhDs; Roderick Bennett, PhD
Featured Speaker, Steven Walfish, PhD
Student Award Recipients: David Barker & Steven Simmons
NJPAGS: Brian Amorello; Greg Petronzi, MA; Jonathan Dator
John McInerney, PhD & Eileen Senior, PsyD Winter 2012
Foundation President, Ilyse Oâ€™Desky, PsyD 51
Annual Membership Business Meeting
Annual Membership Business Meeting Minutes NJPA Fall Conference Renaissance Woodbridge Hotel October 29, 2011 11:15 AM – 12:30 PM I. Welcome & Call to Order: Dr. Sharon Ryan Montgomery, NJPA President. II. President’s Report: Dr. Montgomery reviewed her presidential year and highlighted that NJPA is involved in multiple agendas including four lawsuits, two major bills (“immunity and RxP”), codifying the structure of the organization, and solidifying policies and procedures. NJPA leadership has worked to increase transparency in the association, and to promote greater inclusion of members at all levels of the association. NJPA leadership has also worked on enhancing the role of committees and the establishment of co-chairs in every committee to improve the pipeline to leadership. Other initiatives in the last year have included the creation of an insurance committee to address all the issues related to insurance issues, and a HealthCare Reform Task Force to address the upcoming changes in the healthcare system. We are also involved in coalition building addressing issues of child abuse and maltreatment with the NJ Department of Children and Families (DCF), and represented in a collaborative initiative with psychiatry, on increasing access to children’s mental health care. NJPA will also be working on a new strategic plan in 2012. Dr. Mathias Hagovsky, incoming NJPA president, offered remarks and highlighted some of his plans for 2012. III. Executive Director’s Report: Dr. Josephine Minardo reported that membership is steady. We are cultivating our early career psychologists (ECPs) and establishing connections among them, students, and leadership, at large, to further reinforce a more fertile leadership pipeline. She highlighted the accomplishments of the public education committee (PEC), including the Media Sub-Committee who is providing novel opportunities for psychologists to connect with media, and the Anti-Bullying Sub-Committee who is establishing important relationships with agencies and the community to combat bullying.
a. Action Item: Bylaws modifications. i. Motion to amend proposed bylaws changes in Article III Membership 1. in order to restore “Members, Senior Members, and Members Emeritus may vote on all matters and hold office. Associate Members, after five consecutive years of membership in good standing, may vote on all matters” from original bylaws language. Dis cussion. Approved. ii. Motion to approve changes to bylaws in Article III (as amended) and Article XII (as proposed). Dis cussion. Approved. IV. Treasurer’s Report: Dr. Toby Kaufman reported that NJPA is a financially healthy organization. There was an effort by executive director and treasurer to reform the format of the budget to create a document that presents information in a clearer, more concise, and transparent manner. a. Action Item: 2012 Budget. i. Motion to approve budget for 2012. Discussion. Approved. V. Election Results: Dr. Phyllis Lakin, Chair of Nominations & Leadership Development Committee (newly re-named) announced election results for 2012. VI. INSURANCE UPDATE: Dr. Barry Helfmann, NJPA Director of Professional Affairs provided confidential update on legal actions. a. Horizon/Magellan/State Health Benefits Plan (SHBP) b. Class Action Lawsuit Updates c. Assignment of Benefits Update – SHBP d. Member Discussion VII. Adjournment. Motion to adjourn. Approved. Respectfully submitted, Sean R. Evers, PhD NJPA Secretary
New Jersey Psychologist
NJPA acknowledges 2012 Sustaining Members
By advancing your level of membership to Sustaining Membership status, you have generously demonstrated your additional support of your professional association. We thank you for your commitment and dedication to your organization!
Rika Alper, PhD Jeffrey Axelbank, PsyD John Aylward, EdD Thomas Barrett, PhD Leslie Becker-Phelps, PhD Margaret Beekman, PhD Roderick Bennett, PhD Janet Berson, PhD Mary Blakeslee, PhD Philip Bobrove, PhD Richard Brewster, PsyD Daniel Bromberg, PhD Susan Buckley, PsyD Diane Cabush, PsyD John Corbisiero, PhD Stephanie Coyne, PhD Kathleen Cullina-Bessey, PsyD Deborah Dawson, PsyD John Diepold, PhD Charles Dodgen, PhD Rosalind Dorlen, PsyD Michael Dribbon, PhD Lynn Egan, PsyD Donna English, PhD Susan Esquilin, PhD Anne Evers, PhD Sean Evers, PhD Brian Farran, PhD Ellen Fenster-Kuehl, PhD Resa Fogel, PhD Pamela Foley, PhD Kenneth Freundlich, PhD Thomas Frio, PhD Joseph Ganz, PhD David Gelber, PhD Marc Geller, PsyD Dawn Gemeinhardt, PhD Leslie Gilbert, PhD
Debra Gill, PhD Larry Gingold, PsyD Gary Goldberg, PhD Lori Goldblatt, PsyD Wayne Goldman, PhD Ora Gourarie, PsyD Luise Gray, PsyD Lisa Greenberg, PhD Susan Grossbard, PsyD Lori Grossi Rayner, EdD Mathias Hagovsky, PhD Lawrence Hall, PhD Osna Haller, EdD Jennifer Hanych, PhD Steven Hartman, PhD Douglas Haymaker, PhD Gladys Hirschorn, PhD Jane Hochberg, PsyD Christine Hudson, PhD Glendessa Insabella, PhD Lisa Jacobs, PhD Thomas Johnson, EdD Nancy Just, PhD Jeffrey Kahn, PhD Robert Karlin, PhD Barry Katz, PhD Charles Katz, PhD Roberta Katz, PhD Toby Kaufman, PhD Kristine Keane, PsyD Richard Kessler, PhD Joel Kleinman, PhD Deirdre Kramer, PhD David Krauss, PhD Stephen Kuwent, PsyD Phyllis Lakin, PhD Robin Lang, PsyD Roman Lemega, PhD
William Linden, PhD Neal Litinger, PhD Rebecca Loomis, PhD Mark Lowenthal, PsyD Marilyn Lyga, PhD Jonathan Mack, PsyD Stanley Mandel, EdD Phyllis Marganoff, EdD Neil Massoth, PhD John McInerney, PhD Kenneth McNiel, PhD David Mednick, PsyD Barry Mitchell, PsyD Norine Mohle, PhD Lynn Mollick, PhD Ruth Mollod, PhD Leila Moore, EdD Sandra Morrow, PhD Daniel Moss, PhD Susan Neigher, PhD Cheryl Notari, PhD Rose Oosting, PhD James Owen, PsyD David Panzer, PsyD Carmen Pelaez, PsyD Mark Pesner, PhD Ann Rasmussen, PsyD John Rathauser, PhD Gina Rayfield, PhD AnnaMarie Resnikoff, PhD Mary Roberts, PhD Debra Roelke, PhD Robert Rosenbaum, EdD Barbara Rosenberg, PhD Lori Rosenberg, PsyD Gina Rudolph, PsyD Anne Rybowski, PhD
Carole Salvador, PsyD George Sanders, PhD Lynn Schiller, PhD Nancie Senet, PhD Eileen Senior, PsyD Brian Shannon, PhD Edmund Shimberg, PhD William Shinefield, PsyD Ronald Silikovitz, PhD Jeffrey Singer, PhD Jeffrey Spector, PsyD Milton Spett, PhD Ann Stainton, PhD Barbara Starr, EdD Jakob Steinberg, PhD Lois Steinberg, PhD Ben Susswein, PhD Anthony Tasso, PhD H. Augustus Taylor, PhD Tamsen Thorpe, PhD Barbara Tocco, EdD Carol Turner, EdD Elizabeth Vergoz, PhD Claire Vernaleken, PhD Jonathan Wall, PsyD Beth Watchman, PhD Virginia Waters, PhD Daniel Watter, EdD Mark Weiner, PsyD Ida Welsh, PhD Skye Wilson, PhD Philip Witt, PhD James Wulach, PhD, JD Stanley Zebrowski, PhD Michael Zito, PhD Jeannine Zoppi, PhD Harold Zullow, PhD
Show your support and join your colleagues by becoming a Sustaining Member! Receive free enrollment in the Referral Service, a free Membership Directory and Handbook, CE discounts, and special public recognition. Contact the Central Office for more information.
New Jersey Psychological Association CALL FOR NOMINATIONS Nominations are currently being solicited for four positions on the 2013 NJPA Executive Board. All candidates for elected office in the New Jersey Psychological Association must meet the following criteria: 1. Full Member, in good standing, for at least two years. 2. Evidence of volunteer involvement in NJPA for at least one year. 3. No pending ethical or legal violations. Volunteer yourself or nominate a colleague to serve. Submit a prepared statement of nomineeâ€™s qualifications along with this form and return to the Central Office by June 1, 2012. Members of the Executive Board have the responsibility to govern the Association, 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 these documents.
Please print the name of the person you nominate on the line after the position title and print and sign your name at the bottom of the form. Check if you know the member is willing to serve. The Nominations Committee will establish the list of eligible candidates for ranking by the Executive Board to develop the slate.
PRESIDENT-ELECT Candidates for President-Elect must have served three years or one term on the Executive Board; or chaired a committee, special interest group (SIG), or resource group; or had an active role as a committee/SIG/Resource group member in the last seven years. Term of office:
January 2013 to December 2014 as President-Elect; January 2014 to December 2015 as President; January 2015 to December 2016 as Past-President.
Willing to serve _______
Responsibilities: Serve as a member of the Executive Board and perform the duties of president in the event of absence or incapacity of the president. Member of Executive Committee, Personnel Committee, Nominations & Leadership Development Committee, and Finance Committee, and become fully familiar with the affairs of the association. Attend COLA meetings, NJPA Foundation meetings, work with NJPA Affiliate Organizations, and attend other meetings at the request of the president. Attend the APA State Leadership Conference in Washington, DC. Serve as president of NJPA Foundation during past-president year.
Term of office: January 2013 to December 2015 Willing to serve________ Records minutes of the executive board meetings, executive committee meetings, and Fall Conference business meeting. Also serves as a member of executive committee, and others as designated by the president. Responsibilities:
MEMBER-AT-LARGE - 1 seat open
__________________________________________ Term of office:
January 2013 to December 2015
Willing to serve _______
Responsibilities: Serve on the executive board and board committees as appointed by the president. Represent the broader constituency of NJPA. Participate in all discussions and decision-making of policy, priorities, and planning for NJPA. Attend board meetings, board retreats, and committees of the board meetings as assigned.
Print name of nominator
Signature Return this form and the statement of qualifications of the nominee(s) to: NJPA 414 Eagle Rock Avenue, Suite 211 West Orange, NJ 07052 Fax: 973-243-9818 Deadline: June 1, 2012
New Jersey Psychologist
Classified Ads The NJ Psychologist accepts advertising of interest to the profession. The minimum rate for Classified Ads is $69 for up to 50 words each, $5 for each additional ten words. For display ad information, visit our website at <www.PsychologyNJ.org> Acceptance of advertising does not imply endorsement by NJPA. Email inquiries to NJPAcg@PsychologyNJ.org ATTN: Christine Gurriere, or call 973-243-9800. The NJ Psychologist is mailed on or about the 10th of February, May, August and November. The journal is mailed as part of a bulk mailing, therefore delivery times may vary with local post offices.
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LICENSED PSYCHOLOGIST Seeking licensed psychologist who has experience and/or strong interest in forensic work (custody evaluations, parenting coordination, mediation, and other Court-involved family services) to join our busy group practice in Montclair, NJ. Please respond with letter of interest and CV to firstname.lastname@example.org ❖ GREAT OPPORTUNITY! NEUROPSYCHOLOGIST/ EDUCATIONAL PSYCHOLOGIST-TESTING (Central NJ) For PT/Per Diem/Student/Intern/ Extra Income: Neuropsychological Testing Administration; Experience with Head Injuries/Concussions and Attention Disorders a plus; Experience with Cognitive Rehabilitation/Memory Training/ Speech-Language Therapy preferred. Full Time and LongTerm Employment Possibility. Excellent working conditions. State Licensure/Permit preferred. Email: email@example.com ❖
CALL FOR POSTERS The New Jersey Psychological Association encourages dissemination of research by NJ psychologists to other psychologists in the state. It seeks to encourage development of research by psychologists, whether they are novices or established in research endeavors. NJPA invites data-based research or theoretical presentations on any topic of interest to psychologists to be presented as a poster for its 2012 Fall Conference. Posters may be submitted by graduate or undergraduate student researchers as well as any other academic, applied, or research psychologist. Those submitting do not need to be members of NJPA. However, student research should be endorsed by a faculty member. The deadline for all proposals is July 13, 2012 and should include following information: • Title of proposed presentation • Author’s name, academic degree, address, telephone and email • Institutional affiliation • Faculty sponsor (if the author is a student researcher) with institutional affiliation and contact information • One page abstract including a description of methods and results Poster sessions will be scheduled during the morning at the NJPA Fall Conference on October 20, 2012. Abstracts will be distributed at the conference. Submissions should be sent either electronically or by hard copy to: New Jersey Psychological Association Academic & Scientific Affairs Committee 414 Eagle Rock Avenue, Suite 211, West Orange, NJ 07052 NJPA@PsychologyNJ.org Inquiries should be directed to: Ilyse O’Desky, PsyD; firstname.lastname@example.org Winter 2012
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New Jersey Psychologist
Kendall-Tackett, K. (2009).
The Psychoneuroimmunology of Chronic Disease: Exploring the Links Between Inflammation, Stress, and Illness. Washington, DC: American Psychological Association. by Anthony F. Tasso, PhD Fairleigh Dickinson University Recent decades have seen a growing body of biomedical evidence thoroughly linking the deleterious effects of inflammation to chronic illness. Controlled experimental investigations coupled with physician-generated anecdotal clinical data have demonstrated a robust connection between inflammatory processes and a range of illnesses such as (though not limited to) heart disease, diabetes, and autoimmune disorders. Conspicuously absent from much of this medical literature is an examination of the role of psychological factors underpinning inflammatory conditions and subsequent corporeal or psychological diseases, thus leaving this burgeoning area of health care primarily in the medical field predicated on a presumed unidirectional inflammation-biomedical illness relationship. The Psychoneuroimmunology of Chronic Disease: Exploring the Links Between Inflammation, Stress, and Illness (American Psychological Association; 2009) represents a successful consolidation of the psychoneuroimmunology field and expands the parameters of inflammation to firmly incorporate psychological processes. Edited by Kathleen Kendall-Tackett, this text demonstrates how common psychiatric conditions such as depression, anxiety, and hostility are associated with inflammatory processes and physical illnesses, powerfully elucidating the bidirectionality of physical conditions resulting in inflammation and psychological conditions as well as psychological conditions resulting in inflammation and physical illnesses. The twelve contributing authors provide a scientifically grounded book that sheds light on the mutually facilitative relationships between psychosocial and biomedical pathways, adding substantial depth to the multidetermined aspects of human illness and well-being. The Psychoneuroimmunology of Chronic Disease is divided into two parts; 1) the role of inflammation in disease; and 2) the psychological and social factors of inflammation and physical disease. In Part One, the authors discuss the basic biochemical principles underlying inflammation and provide the necessary backdrop to explain the body’s adaptive inflammatory response to internally derived biological threats as well as external stressors such as illness and injury, along with the conversely pervasive negative effects of protracted inflammation (e.g., tissue damage, obesity, insulin resistance, cardiovascular illness). Inflammation is also linked to psychological factors such as depression, obsessive-compulsiveness, panicWinter 2012
anxieties, and hypersensitivity to pain. The authors describe the neuroanatomical structures and neurochemical processes involved in the body’s proinflammatory processes – namely the sympathetic “fight-or-flight” response system as well as hormonal regulation via the hypothalamic-pituitary-adrenal axis. Also central to the early part of The Psychoneuroimmunology of Chronic Disease is the firm establishment of bidirectional communication in the central nervous system – meaning that numerous physiological ailments lead to inflammation with resultant psychological sequelae in concert with psychological factors (e.g., depression, anxiety, hostility) that stimulate proinflammatory processes and result in medical disturbances. The bidirectionalty of these processes underscores much of the text. The researchers later describe the influence of prolonged inflammation on the normal aging process, as well as its acceleration in neurodegenerative conditions such as Parkinson’s and Alzheimer’s diseases. The authors offer promise that such elucidation of the inflammation-neurodegeneration connection may aid in the early detection and treatment of these devastating diseases. The role of sleep in illness is also examined, first by covering the vast empirical evidence, highlighting that poor sleep is a potential trigger for, or cause of, emotional and physical illnesses just as emotional and physical illnesses frequently lead to poor sleep, resulting in a sleepillness-inflammation cycle. The authors lean on self-report and laboratory research that suggest the destructive impact of too little or too much sleep on diabetes, cardiovascular disease, hypertension, and numerous psychological conditions (especially depression). Next, the book delves into the intricacies of healthy polyunsaturated fatty acids, namely Omega-3, and unhealthy proinflammatory Omega-6, and reports on a handful of carefully controlled randomized double-blind clinical trials indicating that supplementing anti-inflammatory Omega-3 fatty acids (i.e., “oily fish” such as tuna, salmon, sardines) has demonstrated effectiveness on conditions such as rheumatoid arthritis, inflammatory bowel diseases, and asthma. Part Two moves the inflammation-disease discussion beyond biomedical determinants and turns sharply toward the emotional/psychological factors of inflammation and disease. The researchers examine the bidirectional relationship between the negative states of depression, hostility, and the constellation of traumatic reactions on the quality of social 57
relationships and self-destructive behaviors, and on medical conditions such as cardiovascular disease, obesity, and sleep quality – with the stimulation of inflammatory processes and the compromising of immunity underscoring these affective and biochemical disturbances. The authors also highlight the centrality of acute and chronic social stressors in exacerbating the symptoms of multiple sclerosis and other diseases, and they conclude with an exploration of psychosocial interventions in the treatment of these conditions. The Psychoneuroimmuniology of Chronic Disease also examines gender differences in chronic stress and immune functioning by honing in on the concept of allostatic load, or the propensity for the cumulative effect of internal and external stressors to adversely impact health. The authors outline how neuroanatomical and endocrinological gender differences may help to explain the greater predisposition for cardiovascular disease in men, while these same biological differences commonly coupled with multiple social demands (e.g., work, childrearing) may explain the predisposition to depression and autoimmune diseases in women. Additionally, the authors incorporate data suggesting how these differences along with socioeconomic disadvantages may explain the higher rates of hypertension and cardiovascular disease in African-American women. The Psychoneuroimmunology of Chronic Disease closes by building on the foundational data of the text with an investigation of pluralistic interventions aimed to concomitantly
address depression and inflammation. The authors review the literature on treatment approaches focused on dietary modifications (e.g., Omega-3 foods or supplements), exercise, herbs (e.g., St. John’s wort), antidepressants, and, of course, psychotherapy – all of which have been empirically demonstrated to be effective in their abilities to treat specific psychological and biomedical conditions – and to reduce inflammation. With the mind-body (constitutional-psychological) delineation long debunked, The Psychoneuroimmunology of Chronic Disease embodies a successful demonstration of the mutually influential, bidirectional relationship between psychosocial and biomechanical processes. Kendall-Tackett brings a group of researchers together to provide a comprehensive text thoroughly examining psychoneuroimmunology vis-à-vis psychological and medical illnesses. With over 70 pages of references, this book provides basic and applied research directly and indirectly linking stress and physical disease with inflammation. Refraining from hyperbole, the authors provide a framework for better understanding, preventing, and treating a range of psychological and physical conditions. Although the dense neurochemistry terminology makes this text a challenging read for the non-biologically-based psychologist, I would argue that engaging in this process is a worthwhile endeavor as the takehome message is sure to expand one’s etiological, conceptual, and treatment capabilities. ❖
New Jersey Psychologist
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