30 Jun 2017

Expanding the Scope of Your Practice to Address the Needs of the Community

Communities have unique needs (e.g., serving veterans, the underserved, disaster relief, health challenges, etc.) which may change over time. Positioning to meet these needs can better serve the community and make your practice relevant. Learn how to address these needs and make them available to your community. During this presentation you will learn the following:

• Incorporating your vision into niche development
• Using research to build a niche
• Niches and managed care
• Ethics and scope of practice (training and mentorship)
• Marketing a niche practice

Learning Objective 1
List practice niches outside of managed care.

Learning Objective 2
Describe how research can be used to build and market a niche practice.

Learning Objective 3
Describe key ethical considerations that need to be addressed when building a niche practice.

Dr. Jeff Zimmerman has been in independent practice for over 35 years in solo practice and as founding and managing partner of an inter-disciplinary multi-site group. Dr. Zimmerman is a founding partner of The Practice Institute, LLC. He is President of the Society for the Advancement of Psychotherapy, Division 29. Dr. Zimmerman is co-author of The Ethics of Private Practice: A Guide for Mental Health Clinicians. He is co-editor of a soon to be released book entitled the Handbook of Private Practice: Keys to Success for Mental Health Practitioners and is Editor of Practice Innovations, the journal of Division 42.



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30 Jun 2017

A Collection of Core Psychology Articles Booklet

A Collection of Core Psychology Articles Booklet

This booklet, A Collection of Core Psychology Articles from APA’s publishing office, drills down into some of the most fascinating topics in the field, from personality disorders to youth violence and homelessness.

If you enjoy these articles, don’t stop here. APA’s Journals Program maintains a database of hundreds of papers on core psychology. And as an APA member, you enjoy highly discounted access that enables you to explore these and other research topics online at www.apa.org/pubs/journals.


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28 Jun 2017

Psychologists Work to Help Communities Adopt, Sustain Evidence-based Treatments

Psychologists Work to Help Communities Adopt, Sustain Evidence-based Treatments
Ten years ago, as a clinical psychology graduate student working at an academic clinic for children with anxiety disorders, Rinad Beidas, PhD, planned to pursue a career running her own lab and identifying treatments that could really help these kids.

"But then I kept seeing kids come to our clinic having already seen lots of different community providers, without getting any better"—most likely, she says, because they weren't receiving evidence-based interventions. What the community had in its toolbox just wasn't working.

But her hope was renewed when children at the clinic participated in an evidence-based treatment for anxiety called Coping Cat, and nearly all of them were able to improve the quality of their lives. That's when Beidas became convinced about the effectiveness of evidence-based practices and the need for them to be more widely available.

"Evidence-based practices need to be available in the community so that kids have access to them and can benefit from them, as a matter of social justice," says Beidas, now an assistant professor of psychiatry at the University of Pennsylvania.

Today, she is one of many psychologists working at the state, county and city levels to make sure evidence-based treatment is available beyond academic medical centers, which aren't accessible to most people. As part of that effort, she sought to find out why more evidence-based practices aren't in wider use. In a study she conducted with clinical psychologist Arthur C. Evans Jr., PhD, commissioner of the city of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services, she found some answers: When it comes to treating children and adolescents with psychiatric disorders, organizational factors—such as the support therapists get from others on the health-care team—are better predictors of the use of evidence-based practices than an individual therapist's knowledge and attitude about therapy techniques (JAMA Pediatrics, 2015).

"Implementation happens at multiple levels," says Beidas, who also directs implementation research at Penn's Center for Mental Health Policy and Services Research. "Even though a provider might be the one in the room with a patient, it's not just about that provider deciding to do an evidence-based practice. It's also about their organization and their supervisor supporting them, and the larger system supporting that process."

Focus on accountability

Serene Olin, PhD, a professor of child and adolescent psychiatry at New York University, is fostering the use of evidence-based treatments in another way: She is exploring how the use of evidence-based practices can help health-care systems establish greater accountability for patient care.

"Care in the real world is so much driven by who pays for what and what you're being held accountable for," she says.

In line with this shift toward more accountability, New York's state mental health department is focusing on what works—and how to train providers in these evidence-based treatments as efficiently and effectively as possible, says Olin, deputy director of New York University's Center for Implementation-Dissemination of Evidence-Based Practices Among States, known as the IDEAS Center. In 2011, the center began training clinical staff to implement evidence-based practices such as the "4 Rs and 2 Ss for Strengthening Families Program," at nearly 350 child-serving outpatient clinics in the state. The trainings vary in intensity, from one-hour webinars to yearlong collaborative learning experiences. The goal is to help clinics develop strong business and financial models, informed by empirical evidence, to ensure sustainability.

The IDEAS research team is using state administrative data to predict who will adopt these business-improvement and evidence-based clinical practices to help the state target its funding. They found that state clinical trainings were more likely to be adopted by clinics with more staff, likely because they're more easily able to release health-care providers for training compared with agencies with smaller staffs. In addition, clinics affiliated with smaller health-care systems were more likely to attend and implement business-practice trainings compared with clinics associated with larger, more efficiently run agencies (Psychiatric Services, 2015). These findings suggest that policymakers should understand the factors that influence the type and amount of training clinics are willing or able to adopt.

Sustaining evidence-based practice

In another effort to understand the use of evidence-based practices in community settings, Anna Lau, PhD, a psychology professor at the University of California, Los Angeles, and Laura Brookman-Frazee, PhD, a University of California, San Diego, psychiatry professor, are working to understand what happens when community therapists are required to deliver these interventions.

According to the American Medical Informatics Association, it can take 17 years for evidence-based practices to trickle down to practice in community-based settings. In a system-driven reform that cuts short that lag time, the Los Angeles County Department of Mental Health is reimbursing contracted agencies for delivering evidence-based practices through a countywide prevention and early intervention initiative. Lau and Brookman-Frazee are investigating how those practices are sustained. The Knowledge Exchange on Evidence-based Practices Study (4KEEPS) examines how community therapists work with evidence-based practices for youth and identifies barriers and facilitators to their implementation with ethnically diverse and disadvantaged communities.

Through the study, Lau and Brookman-Frazee are collecting data from agency leaders and frontline therapists about their experiences implementing six evidence-based interventions for child mental health problems. The pair is studying whether and how these treatments are still being used up to eight years following their adoption.

"We hear a lot about people's concerns that these evidence-based practices aren't equally applicable or equally accessible across different cultural or socioeconomic groups, so we're trying to see if there's evidence of that," she says.

As of September, more than 800 therapists and nearly 200 program managers from 68 agencies have participated in the study with an additional two years of data still to be gathered, says Brookman-Frazee.

"There are huge benefits in learning from what therapists are doing that might inform the intervention development process and allow for a more bi-directional communication process between research and practice," she says.


By Amy Novotney

This article was originally published in the January 2017 Monitor on Psychology

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28 Jun 2017

Six Questions to Ask Before Applying to Any Psychology Grad Program

Six Questions to Ask Before Applying to Any Psychology Grad Program

You've started your search for a doctoral program, but do you know how to pick the one that's right for you?

"In psychology, we pride ourselves on being evidence-based, but sometimes we forget to look at all the data when we're making our most important career choices," says John Norcross, PhD, a University of Scranton psychology professor and co-author of "The Insider's Guide to Graduate Programs in Clinical and Counseling Psychology" (2010).

According to graduate program directors and other experts, you've done your homework if can answer these six questions:

1. What kind of job do you eventually want?

Imagine your future career, and work backward to determine the kind of training and education you need. If you'd like to help companies select employees and build better teams, look into industrial-organizational psychology programs. If you want to investigate learning and memory, check out experimental psychology programs. If you hope to someday help judges determine who is competent to stand trial, explore forensic psychology programs.

"Talk with the psychology professors at your undergraduate institution about pathways in psychology, and read books and websites about psychology careers," advises Cynthia Belar, PhD, executive director of APA's Education Directorate. Then, check out APA's online database, "Graduate Study in Psychology," which provides descriptions, admission requirements and application deadlines for more than 600 psychology graduate programs in the United States and Canada.

2. How much debt can you reasonably take on?

Figure out how much you can expect to earn once you have your degree, and then use that number to calculate the amount of graduate school debt that's reasonable for you. According to 2009 data from APA's Center for Workforce Studies, the median starting salary for assistant psychology professors is $53,000, while a clinical psychologist can expect to start out earning $58,000. Given those salaries, it could take years to pay off the median debt loads of new psychologists: $120,000 for clinical PsyDs, $68,000 for clinical PhDs and $38,500 for research-focused PhDs.

If you don't want to be eating ramen into your golden years, limit your applications to psychology programs that offer financial aid in the form of fellowships, scholarships, research and teaching assistantships, and traineeships. "While cost shouldn't be your only basis for selecting a doctoral program, you don't want to wind up saddled with debt you didn't expect," says Elizabeth Klonoff, PhD, co-director of the San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology.

3. What is the added value of selecting an APA-accredited program?

If you're studying clinical, counseling or school psychology, choosing an APA-accredited doctoral program increases your career options. Many internships require students to attend an APA-accredited program, and some state licensing agencies and employers — including academic institutions and government agencies — likewise require a diploma from an APA-accredited doctoral program.

APA accreditation also helps provide some assurance that you'll receive a quality education. To be awarded accreditation, a program must demonstrate that it meets a set of standards established by APA's Commission on Accreditation — for example, it has to have qualified faculty and adequate facilities and student support services, and it must publicly disclose its requirements and policies. View a list of APA-accredited doctoral programs.

4. What are the internship match rates of the graduate programs you are interested in?

Before you can earn your degree in clinical, counseling or school psychology, you'll need to complete a yearlong internship. Unfortunately, there's a shortage of internship programs, with a quarter of psychology graduate students unable to find internships through the Association of Psychology Postdoctoral and Internship Center's match. Not having one can indefinitely delay your degree. So, before you apply to grad school, be sure the programs have good records for matching students to APA-accredited internships, says Klonoff. To find out programs' match rates to all internships (not just APA-accredited ones), visit the APPIC website (PDF, 1.4MB). APA-accredited graduate programs are required to list their match rates to APA-accredited internships on their websites. "A program that has historically matched really well is likely to match well in the future," says Klonoff.

5. What are your potential programs' EPPP pass rates?

Another issue for future therapists: Practicing psychologists must pass the Examination for Professional Practice in Psychology, a computerized test of 225 multiple-choice questions. It's designed to evaluate your knowledge of core areas of psychology such as assessment and treatment and the biological bases of behavior. Pick a program with a high pass rate — for a list of pass rates by graduate school, visit the Association of State and Provincial Psychology Boards website

6. Who are the schools' top researchers?

If you're aiming for a research-focused program, study university websites to identify faculty members under whom you'd like to work. Ideally, you should pick a program where several professors are doing research that interests you, says M. Ellen Mitchell, PhD, dean of the College of Psychology at Illinois Institute of Technology in Chicago. "If you want to do developmental psychology, it may not be the best decision to go to a program with only one faculty member whose work is in that area, unless that person's work aligns very closely with what you want to do," she says.

If possible, meet future faculty advisers at professional conferences or when you visit campuses for pre-admission interviews. "That's probably the best way to assess whether there's a good fit," says Rod Wellens, PhD, who chairs the University of Miami psychology department. "Also, look at the past performance of a potential faculty mentor — are their students publishing and getting good postdocs or other employment positions?" Check the professors' webpages for a list of their current students and postdocs. Then enter those students' names into PsycINFO and Google to search for their publications or other information about their work. 

If a particular faculty member shows he or she is really interested in working with you, that school should zoom to the top of your list, says Norcross. That's because a good faculty adviser is key to graduate school success. "They can offer individualized advice, serve as role models, and assist you in selecting an internship and launching your career," says Klonoff.

By Jen Uscher,  a writer in Brooklyn, N.Y.

This article was originally published in the September 2011 gradPSYCH Magazine

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27 Jun 2017

Coaching Adults, Students and Young Kids with ADHD

Coaching helps clients cope with attention-deficit/hyperactivity disorder while helping psychologists flourish without relying on insurers

Children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) don't necessarily need psychotherapy, says psychologist Abigail Levrini, PhD. What they often do need is help getting themselves organized and reaching their goals—coaching, in short.

To fill that niche, Levrini founded an ADHD coaching business called Psych Ed Connections in 2008. Demand for her services has been so great that the company now has three offices in two states. And what's good for consumers with ADHD has also been good for Levrini by allowing her to fulfill her dream of building a practice independent of insurance companies.

"I had heard many unfortunate horror stories about psychologists not getting reimbursed for the clients they had seen and worked with," says Levrini. "Fortunately, I have never had to go that route and have been able to make it without it."

Whether ADHD coaching is a full-time business or just a small supplemental income stream, it's a real growth area, says Frances Prevatt, PhD, the Florida State University psychology professor who developed the evidence-based ADHD coaching intervention that forms the basis of former student Levrini's coaching practice. "More and more people are being diagnosed," says Prevatt. "And there aren't that many people who specialize in treating those with ADHD."

A specialized business

Prevatt developed the coaching intervention 14 years ago when she realized she had no place to send students she was diagnosing with ADHD as director of Florida State's Adult Learning and Evaluation Center. "Other than recommending medication and accommodations, we didn't really have anything good to offer them," says Prevatt.

Grounded in cognitive-­behavioral therapy principles, the intervention she developed is an eight-week program that matches clients with doctoral psychology students who serve as coaches as a practicum experience. Working one-on-one, the coaches and their clients identify two or three goals to tackle, such as improving time-­management strategies, managing long-term projects, passing a specific class or even learning to do laundry. Each week, the pair identifies intermediate steps and brainstorms how to overcome obstacles, with rewards and consequences built in to boost motivation. "We're not telling them what to do," says Prevatt. "We're teaching them the problem-solving process."

Levrini was one of Prevatt's coaches at Florida State and studied the intervention for her dissertation. Once she graduated and launched her own practice, she took that model, tweaked it and established it in Ponte Vedra, Florida; Alexandria, Virginia; and Ashburn, Virginia. One key difference is that the coaches are all licensed psychologists and other mental health professionals. Because the Florida office is located in an underserved area, it offers services beyond coaching, but coaching represents at least half its business.

Educating children and adults about the difference between coaching and therapy is a crucial first step, says Levrini, who often compares being an ADHD coach to being an athletic coach for kids. "You'd never expect to be able to just put on a uniform and go out onto a sports field and play effectively on your own, so why should people with ADHD expect that they should just be able to figure out ways to stay organized or manage their lives effectively without help?" she says. "A coach can help you learn the rules of the game, see where your strengths and weaknesses are and help you 'play' more effectively, in sports or in life."

Coaches and clients then meet each week to outline "baby step" actions and track progress on two to four overall goals. These goals must be specific, measurable, action-driven, realistic and time-sensitive, says Levrini. They should also focus on the process of achieving them as well as the outcomes, she adds. "A student with ADHD might procrastinate, stay up until 3 in the morning to work on a project and still get a good grade," she points out. "But doing so generates a lot of stress and anxiety in the process, so it's important not to encourage positive outcomes that are not a result of healthy processes." As in the Florida State program, Levrini's coaches also use external rewards and consequences to help clients who need an extra dose of motivation.

Another twist on the original program is that coaches and clients don't necessarily meet face to face, thanks to Psych Ed Connections's online coaching option. That expands the potential client base to include the entire country or even the whole world, says Levrini.

A helpful sideline

For psychologist Peter C. Thomas, PhD, of Atlanta, a small ADHD coaching sideline represents a way to help his clients while bringing in a little extra income.

In his practice, Thomas focuses on evaluating children for ADHD and learning disabilities and providing psychotherapy to children, adolescents and families. About 20 years ago, he realized his clients needed something more: ADHD coaching.

What people with ADHD need most is help structuring their time, says Thomas. "Having someone to check in with helps them stay focused on what they want to accomplish," he says, adding that his clients tend to be disorganized college students and adults. "Coaching can help them learn to develop the habits that they're having trouble developing on their own."

To get the training he needed to launch his coaching business, Thomas attended a three-day workshop conducted by child psychiatrist and ADHD expert Edward Hallowell, MD, EdD, founder of the Hallowell Centers, which offer ADHD treatment in Boston MetroWest, New York, San Francisco and Seattle. Conducted by Hallowell and other coaches, the workshop focused on the intervention as well as the business aspects of coaching.

As a result of that training, Thomas developed a simple coaching intervention he dubbed FOCUS (From Organized Coaching Ultimate Success). The process begins with coaches interviewing new clients—who come to the service via referrals from other psychologists, psychiatrists, word of mouth and Thomas's own practice—about their problems and goals.

Clients then call their coaches each morning during the work week to discuss the three main goals they want to accomplish that day. Together clients and their coaches discuss how to accomplish those goals and make a plan. The process takes from five to 10 minutes. Clients renew their contracts and prepay with credit cards every two weeks as long as they need, which may be several months or even years. As clients internalize these problem-­solving skills, the calls taper off. To help keep the service affordable, Thomas doesn't provide coaching himself. Instead, he trains psychology graduate students to offer coaching services and monitors their work on an ongoing basis. He then splits the proceeds from the coaching with his coaches.

"It's not a big money maker, but it's slow and steady," says Thomas, who estimates that ADHD coaching represents 1 percent of his income. "It brings a little extra into the revenue stream."

Additional reading

ADHD Coaching: A Guide for Mental Health Professionals
Prevatt, F., & Levrini, A. APA, 2015

ADHD Coaching With College Students: Exploring the Processes Involved in Motivation and Goal Completion
Prevatt, F., et al. Journal of College Student Psychotherapy, 2017

By Rebecca A. Clay

 This article was originally published in the March 2017 Monitor on Psychology

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27 Jun 2017

The Men America Left Behind

The Men America Left Behind

They suffer from the the largest shortfall of jobs. Their mortality rate has been rising. What are psychologists doing to help?

For as long as America has been a country, the straight white American man has been king of the hill. But as society changes and culture evolves, the ground beneath that hill is growing shaky. Economically, physically and emotionally, many American men are fighting to maintain a foothold.

"What it means to be a man today is different than what it meant 20 years ago," says James O'Neil, PhD, a psychologist at the University of Connecticut who studies gender role conflict. "There's a paradigm shift occurring in our country regarding what it means to be masculine, and many men have had difficulty adjusting to that transition."

That shift might have been a factor in the 2016 presidential race. President Donald J. Trump's vow to "make America great again" seemed to resonate with the nation's male voters: Exit polls showed the widest gender gap among voters since exit polling began in the 1970s, with men favoring Trump over Hillary Clinton by 12 percentage points and women favoring Clinton over Trump by the same margin—for a total gender gap of 24 percentage points.

In red states and blue states alike, many men are struggling to figure out their place in 21st century America, says Ronald F. Levant, EdD, a former APA president who studies men and masculinity as a professor of psychology at the University of Akron.

"With globalization, automation, the evolution of manufacturing, the increase in disparity of both income and wealth, there are all kinds of things going on that have had a devastating impact on white working-class men," he says.

Distress and disconnection

Several recent analyses highlight the modern challenges for white, working-class men in America. In a working paper released in October, Princeton economist Alan Krueger, PhD, reported that more than 11 percent of men age 25 to 54 were unemployed and not seeking work (Boston Federal Reserve Bank, 2016). That figure has been trudging upward for decades, but particularly during the last 20 years. Survey data suggest that nearly half of those men sitting on the sidelines of the workforce take pain medication on a daily basis, Krueger reported.

Indeed, the United States is in the midst of what the U.S. Centers for Disease Control and Prevention (CDC) has described as an "opioid epidemic." Between 1999 and 2014, the number of opioid prescriptions in the United States nearly quadrupled, according to the CDC—and deaths related to opioid overdose, including prescription painkillers as well as illicit drugs such as heroin, also quadrupled during that period.

Other data suggest many of the nation's white men—as well as women—are struggling with both physical and mental health problems. While other ethnic and racial groups have seen their health improve over the years, death rates have increased for middle-aged white Americans with no college education. Princeton economists Angus Deaton, PhD, and Anne Case, PhD, analyzed health data and found that increase can be explained by an epidemic of deaths related to alcoholism, substance abuse and suicide, a category sometimes referred to as "despair deaths" (PNAS, 2015).

While the latter data apply to both men and women, experts say that some cultural changes appear to be affecting men in uniquely troubling ways. "Society is changing, but we don't talk to white men and ask them what they are struggling with," says William Liu, PhD, a professor of counseling psychology at the University of Iowa who studies masculinity. "There's a tendency to minimize it, yet the distress and disconnection are very real."

Over the last several decades, working-class men have seen jobs in manufacturing and mining grow scarcer. Meanwhile, the economic disparity between the haves and have-nots has only gotten wider. "Working-class men look into the future and see that their options are limited. They're not sure what their role in society is," says Liu.

Many men feel their masculinity ideology is under attack, Levant adds. That ideology is built on a set of gender norms that endorses features such as toughness, dominance, self-reliance, heterosexual behaviors, restriction of emotional expression and the avoidance of traditionally feminine attitudes and behaviors. "These gender roles come through our parents, male relatives, teachers and peers, and we're socialized into these roles starting in infancy," Levant says.

Men who strive to meet these masculine "ideals" might feel threatened, consciously or otherwise, by societal shifts, including the increasingly powerful role of women in the workplace or the growing acceptance of same-sex relationships. "The culture is changing, and it no longer privileges [the stereotypical male] point of view," says Liu.

Unfortunately, that viewpoint can be self-defeating, say experts who study gender role conformity. In a new meta-analysis, Y. Joel Wong, PhD, a professor of counseling psychology at Indiana University Bloomington, and colleagues found that overall, men who conformed to traditional masculine norms had higher rates of mental health problems such as depression, anxiety and stress, and lower rates of positive mental health outcomes, such as life satisfaction, self-esteem and psychological well-being (Journal of Counseling Psychology, 2016).

In particular, Wong found conformity to three masculine norms—playboy behavior, power over women and self-reliance—were significantly linked to psychological maladjustment. That suggests that sexist attitudes might have detrimental effects on men's mental health, Wong says. And men who assign a great deal of value to self-reliance are less likely to seek help when they need it, he explains. "Self-reliance may have been helpful in the past, but it is becoming increasingly outdated in our interdependent world," Wong says.

The traditionally male trait of "restrictive emotionality" also works against men's well-being, adds O'Neil. Many men haven't been given the tools to discuss their feelings in healthy ways. "Men are experiencing the loss of [traditional male] stereotypes but they don't have the capacity to process the loss emotionally. Men don't know what to put in place of what they're giving up," he says.

Gender role conflict doesn't just damage the way a man sees himself, Liu adds. It can also strain the relationships a man has with male family members and friends. If a man starts to challenge traditional "locker-room talk," for example, he might find he doesn't know how to connect with his father or his brother as easily as he once did. "A lot of men are socialized into messages and mottos and identities that have been passed down. That allows them to relate to important people in their lives," he says. "As society changes, individual narratives start to change, and that puts stress on the intergenerational connections men have."

Masculinity gets in the way

Endorsement of traditional gender role norms can be a challenging issue to address, says Levant. "In many ways, masculinity is the problem—and it also gets in the way of the solutions."

One traditional male norm, for example, is to avoid all things feminine. Yet some of the fastest-growing occupations in the United States are in fields traditionally embraced by women, such as child care, health care, education and food preparation, Levant says. "Men who strongly endorse these masculine norms probably wouldn't consider a 'pink-collar' occupation," he says—a catch-22 for men who are unemployed and struggling to find a place in modern society.

The men America left behindBut while traditional gender roles are deeply entrenched, they aren't immutable. One of the best ways to chip away at old-fashioned gender norms, Levant says, is with education. "Working-class, less-educated men tend to believe it's very important for men to meet these standards. More educated men have more occasions to challenge these ideas," Levant says.

He proposes targeted campaigns to challenge gender roles, such as public service announcements that encourage men to pursue careers traditionally thought of as feminine. He points to projects such as the Man Up Campaign, which engages youth to promote gender equality and end violence against women.

Levant also encourages men in positions of power to violate outdated male norms. A politician crying during a press conference, or a popular pro athlete talking openly about his depression, can go a long way toward breaking down those barriers, he says.

In addition, the psychology field has to get creative to reach the men who are struggling. One example is "Boys Don't Cry," a YouTube video produced by APA's Public Interest Directorate, which was designed to let boys know it's OK to show emotions.

"Therapy should always be there, and we should always advocate for it. But we know masculine norms that are correlated with mental health problems also prevent men from seeking psychological help," Wong says. "We need to look beyond therapy to find other ways to reach men."

Liu agrees, and says psychologists must be proactive in reaching out to men through channels such as blogs, TED talks or social media. While academics often talk in nuances and approximations, he says, the public responds best to language that is direct and discrete. "We have to make our message more easily digested," he says.

It's especially crucial to give psychology a new public face, he adds, since so much of the information on the internet reinforces toxic male stereotypes. "Instead of the positive masculine scripts we could be putting out there, we're competing against YouTube channels that talk about how to be alpha men. When you type in 'masculinity,' that's what you get," he says.

But creating a digital presence is only one place to start, Liu adds. Psychologists also need to make themselves more visible in the real world, offering talks, discussions and workshops for the lay public. That might mean partnering with local agencies or workplaces to start getting positive messages of masculinity into the minds of men who might be struggling.

Wong acknowledges that men who are most in need of outreach are the least likely to attend workshops or talks. Instead, he's been pondering the idea of reaching them through their friends. He suggests providing training in schools and community centers to teach progressive men how to talk about and model gender-egalitarian behavior to their traditional male friends, and how to challenge toxic masculine norms in everyday conversation.

"These men can serve as a bridge to traditional men," he says. "As psychologists, we have to be more publicly engaged and visible," Liu adds. "That's the way we can disseminate our science."

Additional reading

Measurement of Masculinity Ideologies: A (Critical) Review
Thompson Jr., E.H., & Bennett, K.M. Psychology of Men & Masculinity, 2015

Men's Gender Role Conflict: Psychological Costs, Consequences, and an Agenda for Change
O'Neil, J.M., American Psychological Association, 2015

Meta-Analyses of the Relationship Between Conformity to Masculine Norms and Mental Health-Related Outcomes
Wong, Y.J., Ho, M.R., Wang, S., & Miller, I.S.K., Journal of Counseling Psychology, 2016

The Psychology of Men and Masculinities
Levant, R.F., & Wong, Y.J., 2017

By Kirsten Weir

This article was originally published in the February 2017 Monitor on Psychology

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27 Jun 2017

Cultural Competence is Key

Cultural Competence is Key

When working with refugees or asylum-seekers, something as seemingly straightforward as greeting new patients with a handshake can compromise trust, says psychologist Rehman Abdulrehman, PhD, co-author of an online guide called "Working with Refugees from Syria and Surrounding Middle Eastern Countries," published by the Public Mental Health Initiative he directs.

"Some Muslims believe that any kind of cross-gender contact is disrespectful," says Abdulrehman, an assistant professor of clinical health psychology at the University of Manitoba and a member of APA's Committee on International Relations in Psychology. Let Muslim patients make the first move, he suggests. If they don't offer their hands, you could put your hand over your heart and nod instead.

Noting that most psychologists don't get training in working with refugees, asylum-seekers and asylees, Abdulrehman and others offer several tips for working with those who have fled their homelands:

Learn about patients' contexts. You'll need to learn about your patients' culture, religion and other factors, says Abdulrehman. Without that insight, it can be easy to mistake normal activities for pathologies, such as mistaking Muslims' pre-prayer washing ritual for obsessive-compulsive disorder. Build competence by reaching out to members of the particular community, he suggests. In addition, be sure to understand the sociopolitical context of the country people have fled as well as the country where they've resettled, says Rita Chi-Ying Chung, PhD, a professor of counseling and development at George Mason University who has worked with nongovernmental organizations to serve refugees. Also, find out about laws affecting refugees, the asylum process, family reunification policies and how to connect patients to medical, legal and social services, she says.

Emphasize trust building. Seeking help from a psychologist is not something many refugees and asylum-seekers are comfortable with. "The notion of coming to a stranger you've never met and spilling out your most embarrassing, shameful secrets is very foreign," says Adeyinka Akinsulure-Smith, PhD, a senior supervising psychologist at the Bellevue/New York University Program for Survivors of Torture. Chung agrees. When she goes into a refugee community, she doesn't want to be seen as an expert. Many refugees come from countries where psychologists could be seen as part of the government and intake questions seen as disturbingly intrusive. "They might perceive it as, ‘Oh, my gosh, I might suddenly disappear the next day,'" says Chung. Instead, she asks community leaders how she can help, then engages in active listening while working with people on everyday tasks. "I might be working with women in the kitchen, with difficult topics coming up," she says.

Focus on symptoms. Some refugees and asylum-seekers, especially Muslims, come from countries where talking about feelings isn't as accepted as it is here, says Abdulrehman. That's why he uses cognitive-behavioral therapy with his Muslim clients. In addition to focusing on symptoms, cognitive-behavioral therapy also has a practical, solutions-oriented approach that helps restore clients' sense of control over their lives, he says.

Build strong relationships with professional interpreters. Bringing another person into the therapy session introduces potential new complications, says Akinsulure-Smith. The patient may worry about confidentiality; an interpreter from the same country may have their own issues when hearing about the patient's experiences. Spend some time with the interpreter before the session, be clear that you expect word-for-word translation and debrief afterward, she suggests.

By Rebecca Clay

This article was originally published in the January 2017 Monitor on Psychology

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27 Jun 2017

Work-life Balance Still a Struggle for Most Psychologists

Work-life Balance Still a Struggle for Most Psychologists

When Pamela Hays, PhD, began her psychology career, she tried to do it all: clinical work, writing, research and teaching. But she couldn't sustain it. After a decade of going full tilt, she developed neck problems and carpal tunnel syndrome so severe she had to start using a voice-activated computer system.

"I was driven," she says. "But I drove myself into health problems I couldn't ignore anymore."

Hays, now a clinical psychologist practicing in Soldotna, Alaska, might be an extreme case. Or maybe not. Work-life balance is something that many psychologists struggle with.

The unfortunate irony is that psychologists know better than anyone the importance of making time for self-care. "We talk about it a lot with patients, but we don't practice what we preach," says Chelsi Day, PsyD, a behavioral health provider at Windrose Health Network in Indianapolis.

Psychologists might even have a false sense of invulnerability, says John F. Christensen, PhD, a psychologist in Corbett, Oregon, and past co-chair of the APA Advisory Committee on Colleague Assistance (ACCA). "We study burnout and think that applies to the people we're trying to help," he says. "In fact, health is on a continuum, with well-being at one end and burnout at the other. And most of us, during a professional career, slide back and forth on that continuum depending on what's going on in our lives."

Finding balance, however, is easier said than done. "The sin of the early 21st century is being nonproductive," Christensen says. "We're conditioned by our culture to equate value with productivity."

Of course, as psychologists well know, no one is as productive as they can be when they are exhausted and overworked. Burnout is a legitimate phenomenon, marked by feelings of emotional exhaustion, depersonalization and a diminished sense of accomplishment. "When we move into burnout, we get impatient, we treat others as objects, and we start treating ourselves as task-processing machines," Christensen says. "Our empathy tank has run dry."

For psychologists in clinical practice, neglecting well-being can even impair professional competence, making the matter an ethical concern. As Erica H. Wise, PhD, a psychologist at the University of North Carolina at Chapel Hill and current co-chair of the ACCA, argues in a recent article, it's much harder to stay competent when you're burned out. "Competence … is an essential ethical obligation and provides a critical link between ethics and self-care," Wise and her colleagues conclude (Professional Psychology: Research and Practice, 2012).

Practical balance

Unfortunately, there's no one-size-fits-all strategy for achieving personal-professional equilibrium. Stressors and obligations are different for everyone, and they also change over the course of an individual's life. "It is important for psychologists to stay attuned to these issues throughout their professional life span, since personal and work-related stressors tend to shift over time," Wise says. "Work-life balance isn't a once-and-done thing."

Some people start by establishing a career with some balance built in. Day, a sport psychologist, recently decided not to pursue an opportunity that she described as a dream job — building a counseling and sport psychology center at a Big 10 school. Although the opportunity thrilled her, after she factored in the long commute, the fact that she'd be on call 24 hours a day and her desire for personal and family time, the job didn't sound quite so dreamy. "Work-life balance is important to me," she says. "I don't want to burn out in 10 years."

After working herself into physical health problems, Hays left academia and moved back to her home state of Alaska to start a clinical practice. She joined a yoga class and a book group, started spending more time with family, and wrote the 2014 book "Creating Well-Being: Four Steps to a Happier, Healthier Life."

But finding balance doesn't necessarily mean you have to change jobs (or move to Alaska). You can start by taking a critical look at your commitments.

Wise recommends doing either formal or informal self-care assessments, which can remind you of your goals and help you figure out which daily activities energize you — and which feel like a slog. "From that, you have critical information that you can factor into your choices about your personal and professional activities," she says.

Jim Davies, PhD, a faculty member at Carleton University in Ottawa, says that for him and many of his colleagues, a lot of work commitments are self-imposed. "They are projects we are passionate about and take on whether we have the time to commit to them or not," he says. "We're too busy because we're overcommitted, not because our jobs are too onerous."

Davies uses a rigid strategy to balance personal and professional time. Every morning, he fills in a detailed spreadsheet with activities for each half hour of his waking day. "Crucially, I also schedule in my breaks," he says — including lunch, coffee breaks and even daily naps. "For me, prioritizing life means putting it in the schedule like all the other important things."

Still, for many people, time management isn't really the problem, says Sandra Lewis, PsyD, a clinical psychologist at Montclair State University in New Jersey and founder of The Living Source, a company that helps clients improve well-being and achieve their goals. "People focus a lot on time management, but I think in terms of personal energy management. If you have enough energy, you make better use of your time," Lewis says. "In the same way we charge our cellphones, we need to charge ourselves."

Yet when we're overextended, even activities that energize us can feel like one more item on an endless to-do list. So Wise suggests taking advantage of smaller moments. You might not have an hour to go to the gym, but you could take a 10-minute lunchtime walk. If you can't fit in a yoga class, take five minutes between appointments to breathe or stretch or meditate. "Find self-care strategies that you can integrate in rather than add on," she says. "Honor the smaller things."

While such strategies are helpful, more needs to be done to change the culture of workplaces from the top down, says Christensen. Too many organizations value busyness and productivity at the expense of their employees' well-being, he says. "Often in this kind of professional workplace, when you're working with other smart, committed people, the way to excel is to overwork."

Christensen has been collaborating with health-care systems in Oregon to measure well-being among clinicians, including physicians and psychologists. He's optimistic that many such organizations are starting to realize that helping employees avoid burnout is not only good for employees, but also for patients and the financial bottom line. That kind of sea change is crucial for making work-life balance more attainable, he says. "The things we as individuals can do will take us only so far."

Meanwhile, Wise argues that instead of focusing only on reducing stress, the field of psychology should do more to promote and maintain well-being broadly. "We need a more positive vision," she says. "As a profession, whether we practice or do research, whether we're being mentors or treating patients, we need to be aware that keeping ourselves healthy is important."

Further reading

  • Hays, P. H. (2014). Creating well-being: Four steps to a happier, healthier life. Washington, DC: American Psychological Association.
  • Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579–592. DOI: 10.1037/a0021769
  • Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Ethics, self-care and well-being for psychologists: Reenvisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43(5), 487–494. DOI: 10.1037/a0029446

By Kirsten Weir

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26 Jun 2017

Charlotte Patterson, at the Forefront of LGBTQ Family Studies

Charlotte Patterson, at the Forefront of LGBTQ Family Studies
Charlotte Patterson
APA Fellow Charlotte Patterson has done groundbreaking research on child development, most notably on the topic of children of lesbian and gay parents.

It was her career on the line. Could the publication of one paper “taint” a reputation built on 20 years of child development research? It was the question Charlotte Patterson asked herself when she went to work at her University of Virginia (UVA) office one morning in the 1980s.

“I can still remember walking up to this building, looking up and thinking, well, who else is going to do it if not me?” says Patterson, PhD, APA Fellow, Stanford grad, noted developmental psychology researcher. And lesbian.

The paper in question was her landmark work, “Children of Lesbian and Gay Parents.” It was among the first research that debunked then-prevalent beliefs that children with lesbian or gay parents showed compromised psychosocial development relative to children from heterosexual parents.

Published as the lead article in Child Development in 1992, it blew open doors for mainstream lesbian and gay studies and became a crucible for public and legal discourse about LGBTQ family issues for decades to come.

“In those days, and still today, if you write something on a LGBTQ topic as a professional research psychologist people will assume you have some connection to the topic,” Patterson says. “I was frankly worried that . . . it would be a real problem for my career. Would people let me work with their children?

“A lot of people were shocked that I wrote it,” she continues. “People saw that article as a kind of professional coming out. That won me some friends and lost me some, as you can imagine.”

Since then, Patterson has been at the forefront of LGBTQ family studies, worked as an expert witness on landmark child custody cases involving lesbian parents, and been party to changes in state recognition of gay marriage that paved the way for Obergefell v. Hodges (same-sex marriage ruling by the U.S. Supreme Court).

A major challenge for Patterson and other early LGBTQ researchers was the dearth of available data on lesbian and gay families. In statistics, as in life, these families remained hidden. To amass a review of the scant literature that existed in the 1980s, Patterson literally drove from campus to campus in search of doctoral dissertations.

“Information was strewn across many fields—some in social work, psychology, psychiatry—a few people here and there who didn’t seem to know one another. It wasn’t a coherent field at that point in time. I realized there were lots and lots of interesting things that nobody had studied, to put it mildly.”

As if to emphasize this, Patterson glances at a bookshelf full of gender studies texts at her UVA office, where she has spent her entire academic career. (“I arrived here at 25, when I didn’t even own a couch!” she laughs.) An entire row of publications are her own, including Handbook of Psychology and Sexual Orientation, the 2013 APA Division 44 Book of the Year. “In those days, it was this sense of seeing an open frontier in front of you and wondering where to begin.”

Patterson started by studying what she knew: the relatively large group of lesbians raising children in the San Francisco Bay area in the 1980s, where she was then living on sabbatical.

“This was the perfect place to try to do that work,” recalls Patterson, who later had children with her own partner-then-wife. “It was the only place in the world at that time with a large concentration of lesbian families who had kids together. So it was my great good luck to begin research there . . . to meet families and to interview them.”

Much of the early work highlighted data on similarities between same-sex and opposite-sex parented households.

“The first findings of primary importance to policy issues were that [same-sex] parents in general were pretty well-adjusted people. That doesn’t seem surprising to people today but it did then. A second conclusion was, in general, that the children were also well adjusted, pretty much like their neighbors and peers in school.”

One study that gained wide media attention presented data suggesting that same-sex parents have a more equal division of household labor than their heterosexual counterparts do, findings corroborated by other studies internationally.

“The division of labor was the first big difference we saw,” recalls Patterson. “It’s so dramatic. A lot of people have taken up the finding and said, ‘Look! This is same-sex couples leading the way into a less gendered world!’”

But that was just the beginning of the story as far as she was concerned. Patterson wanted to understand the nuances of family systems—the distinctive qualities of experiences in families of lesbian and gay parents—and the differences among them.

She embarked on wide-reaching research that yielded significant findings: sex-role identity among children of same-sex headed families; adoption issues among gays and lesbians; division of household labor among gay and lesbian parents; and LGBTQ family issues within the context of changing legal and social policy environments.

Interestingly, it was the cross-examination by a prosecutor in her first of many appearances as an expert witness in lesbian-gay family legal battles that prompted Patterson to take her research to the next level.

“There was a 1993 trial that took place in Henrico Co., Va., not far from here,” recalls Patterson. “It involved a lesbian mom being sued for custody of her little boy by her own mother. It was a dramatic case, a sordid tale.

“Testifying as an expert, I was asked by the opposing attorney, ‘This research you’ve done, isn’t it about some crazy people in Berkeley?’ And of course, the research was about people who lived in Berkeley, not people who lived in Henrico. I thought his point was well taken actually, and it led me to want to know more about other groups and more carefully selected samples. It really made a huge impact on me.”

To obtain a more objective sample, Patterson teamed up with a sperm bank that had extensive records of all clients seeking help in getting pregnant. “It made a wonderful sample—singles, couples, straight, gay. We were able to invite every single woman who had come to this clinic to participate.”

A resulting paper in Child Development in 1998, “Psychosocial Adjustment Among Children Conceived via Donor Insemination by Lesbian and Heterosexual Mothers,” showed that these children were developing normally, and that their adjustment was unrelated to parental sexual orientation or the number of parents in the household.

Later, Patterson was able to tap into a large national data set—the National Longitudinal Study of Adolescent Health—to develop a methodological innovation in the study of child development in households headed by same-sex couples. The study didn’t ask parents if they were lesbian or gay. But by teasing out details among their answers—Are you in a marriage-like relationship? What is the gender of your partner?—Patterson was able to identify families with same-sex parents.

“It was very challenging to do that,” she recalls. “There were lots of technical challenges; we were trying to discern the signal from the noise.”

Importantly, this work confirmed her earlier findings.

Patterson takes satisfaction in the role of her work in expanding knowledge and public policy about what determines a family, but expresses something more personal about its effects on her own community: “I sometimes see that my research has made an impact when people tell me that they used the work in many ways when they were considering having children.

“Most people my age in the gay community grew up assuming they wouldn’t have kids. A lot of us were affected with what I would call internalized homophobia,” she explains. “If you’ve heard people around you forever telling you that you’d be a terrible parent you wonder, maybe I shouldn’t have children. A lot of people told me they read my articles and said, ‘Hey, maybe I could be a good parent!’ Or they used the findings to reassure worried grandparents-to-be.”

She looks at a photo of her grinning children on her desk, reflecting on the wonderful adults each has become.

“There are so many stories!” she marvels. “This work on families continues to rivet my attention. I think families are the most interesting thing in the world.”

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23 Jun 2017

How Did You Get That Job? A Q&A with NIH Technology and Innovation Executive Dr. Matthew McMahon

The knowledge, skills and experience gained through your psychology training can successfully transfer to a variety of jobs. As the Director of the Office of Translational Alliances and Coordination at the NIH’s Heart, Lung, and Blood Institute, Dr. Matthew McMahon uses his psychology background to help academic researchers convert their laboratory discoveries into therapies and cures through entrepreneurship and product development training, seed funding for projects, and mentoring by business and industry experts. Learn how you can apply your psychology education to a similar career path.

Matthew McMahonSpeaker:

Matthew McMahon, PhD, leads the Office of Translational Alliances and Coordination to enable the development and commercialization of research discoveries funded by the Heart, Lung, and Blood Institute. Dr. McMahon previously created and led the National Eye Institute’s Office of Translational Research to advance ophthalmic technologies through public-private partnerships with the pharmaceutical and biotechnology industries. His previous experience includes service as the principal scientist for the bionic eye company Second Sight Medical Products and as a staff member on the Senate and House of Representatives committees responsible for science, technology, and innovation policy.

Garth FowlerHost:

Garth A. Fowler, PhD, is an Associate Executive Director for Education, and the Director of the Office for Graduate and Postgraduate Education and Training at APA. He leads the Directorate’s efforts to develop resources, guidelines, and policies that promote and enhance disciplinary education and training in psychology at the graduate and postdoctoral level.

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