02 Oct 2017

Using Objective Data to Improve Performance

Using Objective Data to Improve Performance

Psychologists are using biofeedback to help clients identify and change their physical responses to stress and more

When Denver sport and performance psychologist Steve Portenga, PhD, first started providing therapy to athletes, he taught them breathing and relaxation exercises to practice at home. But he often doubted whether the athletes were doing their homework correctly, if at all.

"I'd ask them how their relaxation went over the past week and was getting answers like, ‘Oh, yeah...right.'" he says. The replies left him thinking, "You didn't do it, did you?"

Then Portenga learned about biofeedback—a tool that provides empirical evidence of physiological activity, such as heart rate, breathing rate, muscle tension, skin temperature and brain wave patterns. Using sensors connected to displays, he and his clients could see how their bodies reacted to stress and to stress-reduction exercises. Athletes can also train with biofeedback apps at home and these sessions can be tracked, to see not only that they do their homework, but how well it works.

Portenga says he appreciates not just biofeedback's ability to provide accountability, but the way it has helped his athletes learn to handle competitive pressure. He has used the technique with athletes in every major professional sport, including at Super Bowls, world championships and the Olympics.

Biofeedback is an umbrella term covering several types of therapies. Common ones include heart-rate variability (HRV) biofeedback, which looks at the interval between heartbeats; electroencephalograph (EEG) biofeedback, also called neurofeedback, which focuses on brain wave activity; and electromyography biofeedback, which concentrates on muscle activity.

During biofeedback training, clients can see the response that's being measured while under simulated stress—such as by viewing a competition video or playing a challenging computer game. Biofeedback therapy holds that as people practice different responses to stress (slower breathing, for example), they can see how effective these are and adjust accordingly, which helps them learn how to better manage stress.

While large-scale research covering biofeedback's efficacy remains scant, studies have indicated biofeedback's potential in treating a variety of physical and psychological conditions. Research led by Poppy Schoenberg, PhD, now at the Vanderbilt University Osher Center for Integrative Medicine, examined 63 studies on various types of biofeedback used to treat psychiatric disorders. She found that about 81 percent of participants showed some level of improvement, with 65 percent demonstrating "statistically significant" symptom reduction (Applied Psychophysiology and Biofeedback, 2014). A meta-analysis by Richard Gevitz, PhD, a health psychology professor at Alliant International University, examined HRV biofeedback's effectiveness in treating both psychological and physical disorders. Gevitz's review of more than 55 studies found that it shows promise in treating many disorders, including asthma, cardiovascular conditions, hypertension, depression, anxiety and insomnia, and has potential for improving performance (Biofeedback, 2013).

Today, Portenga, a founding member of APA's Coalition for the Psychology of High Performance, focuses his practice on adolescent athletes and nonathletes who may be faced with stressful situations that involve being judged or evaluated, including sports competitions and school tests. A session typically includes a mix of biofeedback and psychotherapy. As such, he says, he doesn't bill separately for biofeedback, in the same way a therapist wouldn't bill separately for mindfulness training. Portenga provides detailed invoices to clients to use for insurance filing, and is paid out-of-pocket by clients.

Portenga recommends clients use biofeedback apps at home—such as Respiroguide Pro—to help them visualize their breathing, like with an image of a ball rising with each inhalation and dropping with each exhalation. This helps clients adopt slower, synchronized breathing and heart rates to evoke a calmer state of mind, which is part of HRV biofeedback training. Over time, clients become accustomed to breathing at the slower rate and have less need to use apps, Portenga says. "To be able to track this to see what's going on, to see when things are progressing and when they're not, has just been fantastic."

Beyond stress management

Leah Lagos, PsyD, a performance psychologist in private practice in New York City, has been using biofeedback in her practice for about 10 years. She has used HRV biofeedback to help post-concussion syndrome patients alleviate headache, problems concentrating and other symptoms. She is working with New York University on a study exploring the use of HRV biofeedback with this syndrome, which she explains is linked to an injury to the autonomic nervous system. "I've treated over 100 athletes [with post-concussion syndrome] and they have very similar trajectories of experience: At week four their headaches dissipate, by week seven they can focus again," says Lagos.

She's also used biofeedback to help a patient end persistent vomiting after other medical interventions didn't work, and reduced incidence of migraines in other patients.

In addition, Lagos provides biofeedback to PGA tour golfers, dancers, Olympic rowers, soccer players, track athletes, basketball players and others. She typically meets patients once a week for about 10 weeks, with sessions lasting 45 minutes to an hour, during which time she uses biofeedback as well as cognitive-behavioral skills such as mindfulness training. She also insists clients do homework: two 20-minute sessions where they practice heart-rate variability using apps, such as Heartmath and Breath Pacer.

Biofeedback can also foster other benefits, says Lagos, including improved mood, reduced anxiety, lower muscle tension and improved attention.

While she doesn't accept insurance, she has had patients tell her that sometimes they are able to get insurance coverage for their biofeedback, particularly if they are being treated for headaches, she says. One of the aspects of this training that she most treasures, she says, "is seeing how it develops the patient's confidence."

Helping Olympians master their nerves

Lindsay Thornton, EdD, is a sport psychologist and a senior sport psychophysiologist at the U.S. Olympic Committee in Colorado Springs, Colorado, working with Olympic-bound athletes in sports such as track and field and swimming. "What I'm mainly working on is managing pressure, anxiety and stress around performance," Thornton says.

Thornton counsels athletes when needed, but the bulk of her work is helping athletes prepare to compete, which often entails using biofeedback. She claims that biofeedback can provide a "faster learning curve" for athletes to learn pressure-management skills.

"Sometimes in talk therapy, we can talk, talk, talk" without being able to change behaviors, she says. "But for me, using psychophysiology as a tool has been really powerful to teach athletes skills" in ways that would be difficult to do using words alone—with a sensor on the muscle, the client can visualize what's happening and see the impact of various exercises.

Thornton primarily uses HRV biofeedback and EEG biofeedback, also called neurofeedback, which focuses on brain waves. When Thornton first sees athletes, she does a "full-cap" assessment with 19 sensors on an athlete's head to allow her to see brain-wave patterns under different conditions. For example, she'll have athletes work on virtual tasks, which enables her to see their physiological responses to stress.

With neurofeedback, clients are able to see their brainwaves displayed and to differentiate between those that occur when they are stressed or losing concentration and those that happen when they are calm and focused. Through neurofeedback training, athletes learn to modify their brainwaves and states of mind, which helps improve performance, says Thornton.

"The goal of neurofeedback training is to create an awareness over what certain mental states feel like and then to develop strategies to recreate that state under pressure or in the face of distraction," she says.

Thornton creates routines for each athlete that are rehearsed repeatedly under simulated stress conditions. Athletes may practice pre-performance rituals, for instance, that can include visualizations of their performance, breathing exercises and use of code words associated with what they expect to do (an archer may say, "smooth, shoulder, through" to reinforce upcoming actions to take).

Thornton became attracted to biofeedback during her training in sport psychology. "I wasn't sure I was always doing the right things with athletes," she says. "We were talking about muscle relaxation and visualization. The athlete might believe they were doing it correctly and I might think they were doing it correctly, but I wanted some type of assurance that we were achieving our goal." Biofeedback helps provide that objective evidence, she says.

Olympic-level athletes are fascinated by peering inside their bodies—by seeing the responses her sensors display. "They enjoy that type of feedback," she says.

Thornton has her athletes practice outside her lab with apps such as Stress Doctor, which reinforces their heart-rate variability training. But she doesn't want her clients to rely on technology, pointing out that "they can't pull out their phone on the field." So, she gradually weans them from visual and auditory feedback to just audio to no feedback at all, using only their own now-heightened body awareness.

The payoff, she says, is seeing athletes master these strategies and witnessing "the pride and comfort and confidence they have." And when the hard work she and her athletes have put in results in Olympic medals, as happened in the 2016 Rio Olympics? "It's really exciting," says Thornton.

"No Insurance Required" is a Monitor series that explores practice niches that require no reimbursement from insurance companies. To read previous installments, go to www.apa.org/monitor/digital and search for "No Insurance Required."

For a more extensive look at the research on biofeedback, visit our digital edition at www.apa.org/monitor/digital and search for "Positive Feedback" in the March 2016 issue.

Resources

Biofeedback Certification International Alliance 
BCIA.org

The Association for Applied Psychophysiology and Biofeedback Inc. 
AAPB.org

By Lorna Collier


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

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29 Sep 2017

How Did You Get That Job? A Q&A with Sports Psychologist Dr. Nyaka NiiLampti

The knowledge, skills and experience gained through your psychology training can transfer successfully to a variety of jobs. Dr. Nyaka NiiLampti is the director of player wellness for the NFL Players Association (NFLPA), the union for professional football players. In her role, NiiLampti ensures that players are educated about the NFL’s policies for substance abuse, and provides education, resources and guidance to players in multiple areas of wellness, including mental health support.

Learn how you can apply your psychology education in a similar career path.

Nyaka NiiLamptiSpeaker:
Dr. Nyaka NiiLampti is a sports psychologist with over 15 years of experience in the field. A collegiate athlete, her senior thesis explored the psychological impacts of sports on women. She holds an M.A. in exercise and sport science (sport psychology) and a Ph.D. in counseling psychology. Before joining the NFLPA, NiiLampti worked in college counseling centers and a large group private practice, and was an assistant professor of psychology at Queens University of Charlotte in North Carolina.


Garth Fowler, PhDHost:
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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27 Sep 2017

How to Tackle Tough Topics in the Classroom

How to Tackle Tough Topics in the Classroom

In an age of polarized opinions, psychology educators are amplifying their efforts to promote more understanding

The day after the 2016 presidential election, assistant psychology professor Evelyn Hunter, PhD, knew she had to be prepared for different types of discussion in the three classes she was teaching that day at Presbyterian College, a small, mostly white liberal arts college in Clinton, South Carolina.

"I realized it was going to be hard for me to concentrate on just lecturing, and that students would be activated by the results, too," says Hunter, who is African-American and says that she was concerned about how the election results might affect people of color.

Fortunately, Hunter was armed with techniques that allowed her to safely introduce the topic of difficult dialogues for discussion, which she had gleaned from co-writing a paper on the topic as a graduate student, and later watching others conduct difficult dialogues and then conducting them herself. She grouped the students in circles, first emphasizing the importance of respecting and valuing everyone's opinions, then inviting them to air their thoughts and concerns. A biracial student said she felt hated by other students and that no one seemed bothered by that. White students revealed they felt that others unfairly viewed them as racists for voting for Donald J. Trump.

The conversation appeared to enlighten some, while leaving others uncomfortable—and that is part of the process, says Hunter, now an assistant professor at Auburn University. "Earlier in my career, I thought that a good dialogue meant everyone left happy and feeling great about it, but that's not always realistic," says Hunter. "If the dialogue is truly difficult and it's really a necessary conversation, maybe it's not the best thing if we all stay in our comfort zones."

Leaving things unsaid does not mean they do not exist, she adds. "I believe we give things more power to do harm when we allow them to remain unexposed."

Hunter's approach to such discussions is just one of many ways that psychology educators are helping students address tough social issues. Known by terms like "difficult dialogues" and "challenging conversations," the work can take myriad forms, including brief discussions about current events, classes dedicated to key themes, and planned events that focus on hot-button topics within local communities. The work isn't easy, but it's highly rewarding, says Sue C. Jacobs, PhD, a professor at Oklahoma State University and fellow of APA Div. 17 (Society of Counseling Psychology), who has been training others in difficult dialogues since 2009.

"We live in a world of bullet points," Jacobs says, "but to have truly difficult dialogues, you have to go underneath the bullet points and listen to other people."

Preparing students

For two main reasons, colleges and universities are key places to hold such exchanges, adds psychologist Beverly Daniel Tatum, PhD, president emerita of Spelman College and author of "Why Are All the Black Kids Sitting Together in the Cafeteria? And Other Conversations about Race," slated for a 20th-anniversary edition this year. For one, universities are one of the few places that young adults from diverse backgrounds come together and share the same spaces. For another, they're settings where these dialogues can take place in a safe and structured way, with positive, educational outcomes as the goal.

"From an educator's viewpoint, it seems a shame not to take full advantage of this unique opportunity to prepare the next generation for effective leadership"—in this case, by fostering the ability to successfully engage with a wide range of people, Tatum says.

Not surprisingly, this work can meet with opposition. Administrators and fellow faculty may consider such discussions too political or too removed from what they see as the central aim of education, namely, imparting objective information to students. And for their own reasons, faculty may be leery of getting involved—fearing the disapproval of colleagues, a diminished shot at tenure or even ignorance about the subject matter. But in an increasingly complex world where personal aspects of identity are ever more salient at school, work and in other contexts, facilitators believe these difficult dialogues are essential.

"Most of our students have never thought about why they think the things they think," says Oklahoma State University professor and APA Div. 2 (Society for the Teaching of Psychology) fellow Shelia Kennison, PhD, who infuses difficult dialogue strategies into her undergraduate courses. The conversations allow the students to learn about themselves and other people "in a way that is more uniting than dividing," she says.

A starting point

The term "difficult dialogues" was first used in 2005 by the Ford Foundation to support work that would address a national concern: growing racial and religious tensions on U.S. campuses in the wake of 9/11. Through a competitive process, the foundation awarded 27 colleges and universities up to $100,000 to launch relevant projects in the area, for a total of $2.5 million.

That same work continues today, with more relevance than ever, many say. Although the foundation's funding ended in 2008, many campuses have continued to make creative and sustained efforts to address the plethora of challenging social issues that seem to arise on a daily basis. The pros and cons of gun control, environmental versus economic concerns, racial profiling, gender identity and sexual orientation issues, religious versus scientific belief systems, issues related to climate change—almost any charged social topic provides fodder for deeper discussion, says Libby Roderick, who directs the Difficult Dialogues Initiative at the University of Alaska Anchorage (UAA), which received some of the original Ford Foundation funding.

Given psychologists' expertise in human behavior and motivation, they are particularly strong players in this arena, as are sociologists and social workers, Tatum adds. That said, she'd like to see more faculty involved.

"I think every instructor can benefit from developing their capacity to facilitate what might feel like an uncomfortable conversation," Tatum says.

Only by imagination

Educators are incorporating difficult dialogues in a variety of creative ways. They can be a small but integral part of classroom activity, as with Hunter's election-related forum. They may be mandated adjuncts to traditional classes, per an Indiana University initiative called "Community Conversations," developed by psychologist and assistant professor Kerrie G. Wilkins-Yel, PhD. The effort requires students who are taking sections of the same class to meet in small groups once during the semester, and engage for two hours in a difficult dialogues process.

The format has the unique benefit of engaging a large number of students while maintaining the fundamental tenets of effective group dialogue, says Wilkins-Yel. At least two students in each group are of "marginalized identities," ensuring that the discussion is truly diverse, as opposed to simply including one "token" member of a minority group who might feel put on the spot, she says.

In other cases, entire classes are devoted to difficult dialogues. Last year, for instance, the counseling psychology department at the University of Missouri—another institution originally funded by the Ford Foundation—launched a graduate-level program focused entirely on helping students practice difficult dialogue skills and gain the tools to facilitate such discussions.

Other universities, like UAA, have centered on faculty development: Trainers there have taught difficult dialogue techniques to some 150 faculty members who are using the skills in a variety of ways.

These conversations are happening outside the classroom, as well. In Anchorage, UAA's Center for Advancing ­Faculty Excellence hosts a popular annual debate and faculty forum that's open to the public. There, students who are part of an internationally acclaimed debate team introduce a contentious topic—a recent example is whether the state's limited budget should go toward investing in the university or an oil and gas pipeline—and debate it for 40 minutes. They're followed by four faculty members who add their disciplines' perspectives to the conversation. After that, community members are invited to participate. 

"People come out of these things lit up," Roderick says. A common response: "‘This is what we're supposed to be doing; this is what higher ed is for,'" she says.

Stepping stones

Whatever form the work takes, there are several basic guidelines to keep in mind, educators involved in this work say. In general, preparation is key—it can include gaining specific training in the area; learning from manuals and other materials designed to walk educators through the process and its challenges; and attending conference and workshop presentations. At this year's APA Annual Convention in Washington, D.C., for example, Webster University psychology professor Linda Woolf, PhD, chaired a symposium on methods for addressing intolerance and hate on campuses, including difficult dialogues. Also, the biennial National Multicultural Conference & Summit regularly includes material on difficult dialogues. The Difficult Dialogues National Resource Center—created by facilitators to continue the work started by the Ford Foundation—hosts a biennial conference specifically on difficult dialogues; the next is slated for sometime in 2018 (see Resources below for more).

Once educators have received the training to start such conversations, it's important to lay a strong foundation for the discussion at the beginning of the conversation—one that emphasizes students' rights to express their thoughts and opinions and to respectfully disagree, no matter how intense a session becomes, says Wilkins-Yel. She also highlights expectations of how students should behave: They should actively listen to fellow students, talk in the first person and enter dialogues with a spirit of curiosity, for example.

Tiffany G. Townsend, PhD, senior director of APA's Office of Ethnic Minority Affairs, urges educators to underscore that everyone has biases—­educators included—a tack that ­lowers defenses and gets students into a more receptive frame of mind for dialogue. To this end, it's also important that educators examine their own beliefs: Doing so "ensures that their biases don't color the conversation or inadvertently instill the very divisions that they are trying to address with the conversation," Townsend notes.

It helps to infuse relevant research into these conversations as often as possible, says Woolf. For instance, if a topic involves sexual orientation and gender identity, a discussion host can showcase research demonstrating the misinformation about and the effects of discrimination and violence against LGBTQIA people, which can help expand students' viewpoint on the topic.

To meet fellow educators who want to foster more of these discussions, psychologists may want to contact Div. 17's Subcommittee on Social Action, Jacobs recommends. Educators can also form groups with other interested faculty on their campuses.

Those who teach difficult dialogues say the work is like planting seeds—it may not ­produce immediate results, but it eventually bears fruit. "Students tend to come back long after the fact and say these dialogues were a formative experience for them," Kennison says. 

Resources

Difficult Dialogues National Resource Center 
Holds a biennial conference on difficult dialogues. www.difficultdialogues.org

University of Alaska's Difficult Dialogues Initiative 
Free handbooks and other information. www.difficultdialoguesuaa.org/handbook/landing

Promoting Student Engagement: Vol. 2, APA's Div. 2 (Teaching of Psychology) 
Chapters on infusing diversity, peace-related and other relevant material into difficult dialogues. Free download. http://teachpsych.org/ebooks/pse2011/vol2/index.php

By Tori DeAngelis


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

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27 Sep 2017

Coping with Challenging Clients

Coping with Challenging Clients

What to do with clients who yell at you, question your competence or just sit silently seething

Even though Seattle-area private practitioner Kirk Honda, PsyD, had been a psychotherapist for 15 years, it only took a hostile client a few minutes to make him question his own competence.

He was working with two parents and their daughter, when the father started attacking Honda, making hostile comments about his abilities as a therapist. The daughter soon joined in. "Within 15 minutes, they had completely torn apart my self-esteem," says Honda, who chairs the couple and family therapy program at Antioch University in Seattle. "I started having a mini anxiety attack. I started to sweat. I couldn't think straight. I almost ran out of the office."

Although the mother stepped in to defend Honda and they eventually repaired their therapeutic relationship, the experience left him shaken. He's not alone. Psychologists sometimes face clients who have personality disorders that prompt them to lash out, for example. Other clients may just be rude. Some — whether they're in court-mandated treatment or pushed into therapy by spouses or parents — just don't want to be in therapy. Challenging clients aren't just a problem for clinical and counseling psychologists, either. Forensic psychologists, such as those working as postdivorce parenting coordinators, can also face hostility.

Responding the wrong way — whether by pushing back at the client or withdrawing — can derail the client's progress, say Honda and others. But, they add, there are ways to use uncomfortable interactions to actually improve treatment.

How can psychologists respond effectively to challenging clients? Here's advice from practitioners who have eased stressful encounters with their clients:

Calm yourself. When faced with a challenging client or situation, you don't want to escalate the situation by reacting to it in kind, says Honda. Instead of fighting back, be aware of your emotional and physical state, such as a racing heart, surging adrenaline, confusion and dread, he says. When the father and daughter started yelling at him, for example, Honda put his head in his hands and asked them to stop talking for a few minutes so he could calm down. Without that time out, he says, "I knew I wasn't going to be able to be constructive."

Mindfulness meditation can help psychologists prepare for the anxiety, frustration and anger that challenging clients provoke, says psychologist Mitch Abblett, PhD, executive director of the Institute for Meditation and Psychotherapy in Boston. Through daily practice of mindfulness, clinicians can learn to notice sensations arising in the body and thoughts arising in the mind without judgment. They can also keep in mind the core values that undergird therapy. "If you connect with those values, it can pull you through some of these charged moments," says Abblett.

Express empathy. Don't argue or make excuses, says Honda. Instead, validate the client's feelings by saying, "You're angry with me because …." and asking "Am I hearing you right?" And even if it doesn't feel fair, says Honda, apologize, telling the client you're sorry that something you did has made them angry or that they feel you're not competent to provide the services they need. "That can not only help de-escalate the situation, but can also further the ultimate goal of providing therapy," he says.

But keep in mind that expressing empathy has to be done right or challenging clients may see it as phony, says Stanley L. Brodsky, PhD, a professor emeritus of psychology at the University of Alabama in Tuscaloosa, who also has a private practice. "Difficult, suspicious clients may be put off by expressions of empathy," he says. "One has to earn the right to be empathic with such clients and to avoid clichéd expressions."

Compassion for the client should also be accompanied by consequences, adds Abblett. "This is not a rainbows-and-unicorns passive approach," he says. Acknowledge the emotion that is driving the client's behavior, then emphasize that it's not acceptable for him or her to make threats or swear, refuse to pay for services or simply not show up, he says.

Reframe resistance. "Some clients say they really want to change, then fight every inch of the way to make sure they don't," says Fred J. Hanna, PhD, who directs the counselor education and supervision program at Adler University in Chicago and is also a faculty associate at Johns Hopkins University. But don't resist resistance, says Hanna. "When the client is resisting the therapist and the therapist starts getting irritated with the client, then you have two people resisting each other," he says. "That's not therapy; that's called war." Instead, suggests Hanna, praise the client's resistance. "I say, 'If you worked as hard to make your life better as you do to make sure nothing changes, you could be extraordinarily successful,'" he says. If a client curses at him, Hanna expresses his admiration for the client standing up for him- or herself. Doing so, he says, helps clients see that their therapists understand them.

At least rudeness gives you something to work with, adds Brodsky. Say a client attacks the way a psychologist looks. Don't react negatively, Brodsky says. Instead, encourage the client to say more about why you're so unattractive. "Once you do that, you're actually talking," says Brodsky. Plus, if clients are rude with therapists, they're often rude with others in their lives. "It lets you explore what they've done to put off other people," says Brodsky.

Cultivate patience. Psychologists should strive to be patient not only with challenging clients, but also with themselves, says Sarah A. Schnitker, PhD, an associate professor of psychology at Fuller Theological Seminary in Pasadena, California. Her research has uncovered two strategies that can help psychologists cultivate more patience. One is loving-kindness meditation, in which practitioners direct well wishes to themselves, friends and family, even their enemies. The other strategy is re-appraisal, or thinking about situations in new ways. If a client is frustrating you, remember the bigger picture — that therapy is helping to bear the burden of another person's pain, says Schnitker. "You might think, 'This is helping to test me as a clinician' or 'This is helping me develop patience, a virtue I can use in my own life.'"

Seek support from your peers. Psychologists can feel a lot of shame when they're having trouble with clients, says Honda. "A big reason for that is because people don't talk enough about their difficulties," he says. "They think they're the only ones." Sharing tales of challenging clients with other mental health professionals — while respecting confidentiality — can not only help end that isolation but also lead to constructive suggestions about how to deal with such challenges.

It can also be helpful to get a second opinion by consulting on specific cases with colleagues who are "outside the fray," says Matthew J. Sullivan, PhD, a private practitioner in Palo Alto, California. "You can touch base with them when you're feeling rattled or insecure about something you've done," he says. Even a quick phone call with a colleague can help.

Consider terminating the relationship. Clients who think a psychologist is terrible at his or her job have every right to question credentials, challenge therapeutic decisions or even decide to end the relationship, says Honda. Sometimes, he says, "it just isn't a good match."

It's also OK for a psychologist to end the relationship, says Abblett. "I talk about how it seems like we're not on the same page about our expectations of the work and our mutual responsibilities," he says. Abblett outlines what he believes his own responsibilities are toward a client, then asks the client if he's meeting them. He then tells the client what he needs from him or her. "If that can't happen, we may need to talk about a referral to someone else," says Abblett.

Additional reading

Patience and Self-Renewal 
Schnitker, S.A., Blews, A.E., & Foss, J.A. 
In the book: Clinician's Guide to Self-renewal: Essential Advice from the Field, 2014

Strategies for Working with Difficult Clients 
Sullivan, M.J. In the book: Parenting Coordination in Post-Separation Disputes: A Comprehensive Guide for Practitioners, 2014

The Heat of the Moment in Treatment: Mindful Management of Difficult Clients 
Abblett, M., 2013

Treating Reluctant and Involuntary Clients 
Brodsky, S.L., &, Titcomb, C.R. In Psychologist's Desk Reference: Third Edition, 2013

By Rebecca A. Clay


This article was originally published in the July/August 2017  Monitor on Psychology

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25 Sep 2017

Game: Disc Battle

Get ready to test your reflexes. In this air hockey game you will need to compete with the computer to shoot the disc into each other's base and avoid the other side from doing so. Both of you will hit the disc by using a round pad so the direction of the disc may not be easily controlled.

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22 Sep 2017

Open Opportunities to do Collaborative Research

Open Opportunities to do Collaborative Research

Psychologists can find rewarding opportunities to work with other disciplines within NIH's major research initiatives

The National Institutes of Health is the world's biggest public funder of biomedical research, investing more than $32 billion each year—and a sizable amount of that money can be tapped by mental health and behavioral science researchers, especially those who are interested in collaborating with other disciplines.

Several major initiatives welcome a transdisciplinary perspective, even if on the surface they don't sound terribly psychological. Among them are the All of Us/Precision Medicine Initiative, the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, Environmental influences on Child Health Outcomes (ECHO) and the Big Data to Knowledge (BD2K) program.

"There are lots of opportunities, if the medical side becomes aware of the skills and content knowledge we psychologists have," says psychologist Leonard Bickman, PhD, a research professor of psychology at Vanderbilt University.

His research, focusing on how to encourage people to participate in clinical trials, receives funding from the NIH Clinical Translational Science Awards Program through Vanderbilt University Medical Center's Recruitment Innovation Center.

"If you're interested in applying theory, it's a wonderful world to work in," he says.

High-impact science

Among the initiatives where psychologists are finding opportunities is the All of Us program, which offered $55 million in awards in fiscal year 2016 to build the partnerships and infrastructure to get the program off the ground. All of Us is recruiting its million-plus participants and plans to release funding announcements once the project is launched. Those participants, representing a diversity of ages, races and backgrounds, will share biological samples, genetic data, lifestyle information and health records. Ultimately, those data will help researchers advance a more personalized approach to medicine by identifying biological markers for disease, identifying why people respond differently to medications, developing new ways to measure disease risk and creating a platform to test new targeted therapies.

The project will also collect large amounts of data on factors relevant to psychology, including stress, mood states, health risk behaviors and family and social network dynamics, says William Riley, PhD, director of the Office of Behavioral and Social Sciences Research at NIH.

"As this builds up to over a million participants, there will be a lot of opportunities for behavioral and social scientists to access those data. They'll also be able to apply to add other variables of interest to them," he says. "The longitudinal nature and sheer size of the sample will make a big difference for behavioral research."

Another important initiative for psychology research will be the BRAIN initiative, Riley says. BRAIN began funding researchers in 2014 and continues to accept new applications, awarding more than $70 million to research teams at 60 institutions in fiscal year 2016. The first stages of the project have mostly been focused on building tools that enable scientists to map the connectivity and circuitry of the brain.

"But all of that work is ultimately to understand behavior," Riley says. "As we move into the next five years, the goal will be to take some of those tools and map that circuitry onto specific behaviors. I expect we'll be seeing even more things coming out of BRAIN that have increasing relevance to psychology."

Sterling Johnson, PhD, a clinical neuropsychologist at the University of Wisconsin–Madison, has funding from BRAIN for a project that aims to develop better methods to detect small but meaningful structural changes in the brains of healthy adults that could predict the onset of Alzheimer's disease. He's also funded through the large BD2K initiative for another project that applies computational neuroscience to Alzheimer's disease. Launched in 2012, BD2K aims to develop tools to integrate data science and vast data sets (often called "Big Data") with biomedical research.

Those projects are succeeding thanks to the close collaboration between the Wisconsin Alzheimer's Disease Research Center and the University of Wisconsin's Department of Computer Science, he says. "This kind of research is much more powerful when you can do it in a multidisciplinary way," he says. "It's not a new concept to do team science, but initiatives like BRAIN really incentivize thinking about a problem from multiple angles, and really allow for high-impact science."

Speak a common language

Leslie Leve, PhD, who trained as a developmental psychologist and is now a professor in the College of Education at the University of Oregon, is also beginning to reap the benefits of transdisciplinary research, thanks to her work with Environmental influences on Child Health Outcomes (ECHO). Launched in 2016 with $157 million in awards, the seven-year initiative will study the effects of a broad range of early environmental influences on child health and development. 

The program was a perfect fit for Leve, who for more than a decade has followed birth and adoptive families in an effort to separate the effects of genes and parenting on child development. Under a new grant from ECHO, Leve and her colleagues will enroll new children to build upon their existing data.

In the process, she's collaborating with psychologists, physicians, psychiatrists, social workers, geneticists and environmental scientists. "Everyone is coming from different philosophical backgrounds. In the end, that produces really novel, innovative science," she says.

Yet it can be challenging, too. Openness to ideas and willingness to learn from others is key to succeeding, Leve says. "We're learning to speak a common language and find the best way forward. You have to be willing to hear other perspectives, other paradigms and consider them in your research methodology."

It's not the right path for everyone. In addition to good communication and willingness to learn, thriving in this space requires patience, Bickman says. "It's so much easier to run a study with college students, hand out a questionnaire and be done in a semester. These large-scale projects often don't bear any fruit for years," he says. "It's a very different career path, and it has to be considered carefully." But for the right personality, the rewards can be significant, he adds.

Interested in diving in? Riley, Johnson and Leve all recommend starting by learning the basics of other fields relevant to your research interests. Read up on basic genetics. Learn to use electronic health records. Talk to computer scientists and learn their lingo. "Do some initial work to set yourself up to be competitive for a project like this," Riley says.

You probably don't have to go far to make those connections, Leve adds. "It's a tight-knit science world. Most likely, I know somebody who knows somebody who's an expert in a particular discipline, whether at my own institution or elsewhere."

She recommends building those connections in natural ways, by collaborating on a paper or sharing a draft of a grant you're working on to get the perspective of someone from a different field. "Those things can provide a really good training ground for this kind of experience," she says.

Ultimately, if you want to be a part of a major research initiative, you have to be willing to look beyond the traditional boundaries of psychology to collaborate and innovate in bold new ways, says Johnson. "It's hard to get funded by NIH these days doing individual lab research. NIH is looking for high-impact science that's really going to move the needle," he says. "They're looking for things with clear translational relevance that are going to make the world a better place."

Resources

All of Us Research Program
www.nih.gov/research-training/allofus-research-program

The BRAIN Initiative
www.braininitiative.nih.gov/index.htm

Environmental influences on Child Health Outcomes Program
www.nih.gov/echo

Big Data to Knowledge
https://datascience.nih.gov/bd2k

By Kirsten Weir


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

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22 Sep 2017

Women Outnumber Men in Psychology, but Not in the Field’s Top Echelons

Women Outnumber Men in Psychology, but Not in the Field’s Top Echelons

A new APA report recommends ways to boost women's status and pay

Even as women have come to dominate psychology in terms of numbers within the educational pipeline, workforce and APA, they continue to lack equity with their male colleagues when it comes to money, power and status, according to a new report from APA's Committee on Women in Psychology (CWP).

"The Changing Gender Composition of Psychology: Update and Expansion of the 1995 Task Force Report" reviews the data and offers recommendations in such areas as education and training, employment and professional activities.

What's most surprising about the findings is how little has changed in the more than two decades since the first report, says lead author Ruth Fassinger, PhD.

While female psychologists have made gains in some areas, they have seen increasing disparities in other areas, such as salaries (see chart), which the report suggests could be partly due to the influx of young women joining the workforce for the first time.

"Women [in psychology] are still experiencing inequity," says Fassinger, a professor emerita at the University of Maryland's College of Education. "You see it everywhere: in training, in the jobs that women have and the patterns of workforce participation, and in APA itself."

Pervasive inequities

Drawing on data from APA's Center for Workforce Studies (CWS) and a literature review and analysis Fassinger conducted as a visiting scholar at APA, the report notes the dramatic growth of women's representation within psychology that began in the 1970s and 1980s. Take psychology education. Of the 70,311 students enrolled in psychology graduate programs in 2014, according to CWS data, 75 percent were women. And up to 80 percent of students in training programs focused on health service provision are women. But by the time they finish their training, the report notes, female doctoral students are already at a disadvantage, with significantly higher debt levels than their male peers, according to a CWS analysis of pooled data from 1997 to 2009.

Unequal Pay Continues

As women psychologists enter the workforce, they encounter lower salaries than men regardless of subfield. The average wage gap in starting salaries for recent doctoral grads is almost $20,000, the report points out, citing National Science Foundation (NSF) data from 2010.

One bright spot is jobs at government agencies, where women psychologists predominate and the wage gap is much smaller than in other settings. According to the NSF data, women with psychology PhDs who were working in government in 2010 made almost 92 percent of what their male counterparts made. But even that sector has seen a drop in equity along with other sectors; in 1993, women's government salaries were 94 percent of men's.

"The fact that women are accruing greater debt yet are being paid less is alarming," says Alette Coble-Temple, PsyD, chair of APA's CWP and a professor of clinical psychology at John F. Kennedy University in Pleasant Hill, California. Women who are ethnic and racial minorities and women with disabilities can face even greater disparities, she adds. Minority students finish their doctoral training with significantly more debt than white students, for example. The difference is especially pronounced among PsyD students, the report notes, citing data from 1997 to 2009 that show an average $95,000 debt for minority PsyD recipients versus $84,000 for white PsyD recipients.

Women in academia face particular challenges, the report emphasizes. It typically takes women a year longer to achieve tenure than men, for example. And even though women are flooding into the discipline, they are still underrepresented as associate professors, full professors and institutional leaders.

According to CWS data, 46 percent of all male psychology faculty in the academic year 2013–14 were full professors compared with 28 percent of female faculty, for instance. Just 16 percent of male academics were assistant professors compared with almost 28 percent of female academics. Women were also overrepresented among adjunct, nontenure-track lecturer and other temporary positions, with almost 17 percent of female faculty in these roles compared with 11 percent of male faculty. These patterns have held steady over the last two decades despite the influx of women into psychology departments.

The inequities play out within APA itself. Women now make up 58 percent of APA's membership and hold more than half of governance positions. Yet women are underrepresented when it comes to the association's top honors, participation in divisions and editorial roles. While 40 percent of those involved in the review process of APA journals are women, for instance, most are ad hoc reviewers. Just 18 percent of editors of APA journals are women.

The report acknowledges that women's choices account for some of the disparities. Women are more likely to seek PsyDs, for instance, and graduates of these programs accumulate almost twice as much debt as those of PhD programs. In addition, women practitioners are more likely to work part time, limiting their income. But, says Fassinger, these choices must be viewed within a sociocultural context that constrains women's options. "It's almost impossible to talk about things as free choice when you have all this socialization that propels people into certain directions," she says, noting that women may choose part-time work because of child-rearing obligations.

To address the disparity, the Committee on Women in Psychology recommends in the report that APA work to raise awareness and advocate for equity, pushing policies that encourage salary transparency and monitoring progress.

The report also calls for researching students' decision-making processes and interventions that could influence their decisions, such as making students at all levels aware of the wide range of meaningful careers beyond health service provision so that they can take advantage of other employment sectors where there are opportunities. Other recommendations include continuing to advocate for federal funding for trainees and early career psychologists, creating a task force to identify barriers to advancement within academia, and facilitating more mentorship for women.

The report should spur research exploring the factors that make psychology careers less attractive to men, says Paola Michelle Contreras, PsyD, of APA's CWP and an assistant professor of counseling at William James College in Newton, Massachusetts. "This is a good take-off point to get more data and learn more about the nuances," she says.

To read the full report, visit www.apa.org/women/programs/gender-composition/index.aspx.

By Rebecca A. Clay


This article was originally published in the July/August 2017 Monitor on Psychology

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19 Sep 2017

Practice Management Insights Booklet

Practice Management Insights Booklet

Too few psychology training programs offer guidance on the nuts and bolts of opening and running a practice, such as how to find office space, choose an electronic records system and protect against malpractice claims. “Practice Management Insights” seeks to fill those knowledge gaps by giving psychology practitioners the support they need to provide high-quality services in today’s increasingly competitive marketplace.

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11 Sep 2017

Game: A Maze Race

Beat the computer and get out of the maze first! You are the green player, and the computer is the red. Finish the maze as fast as you can because when the red player gets to the flag first, then the game is over. Train your eye to track down all dead ends and avoid them as swiftly as you can to save time and so that you can get to the flag quicker. Remember that the number of points incurred, upon reaching the flag, depends on how far the red player is from the finish line.

Instructions:

  • Click on start with mouse and cursor to begin the game.
  • Direct your green ball to the flag using the arrow keys. Holding them down will make your ball travel farther in one move.
  • Find the shortest path and outrun the red ball. You win if you reach the flag first. Look out for walls that block your path!
  • The further distance the red ball is from the flag when you reach the flag, the more points you will get.
  • If the red ball gets to the flag first, your game is over!

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23 Aug 2017

How Did You Get That Job? A Q&A with Chief Clinical Officer Dr. Dennis Morrison

The knowledge, skills and experience gained through your psychology training can successfully transfer to a variety of jobs. Dr. Dennis Morrison is the Chief Clinical Officer at Netsmart Technologies, the largest provider of electronic health records and related technologies and services to behavioral healthcare and other human services organizations. In his role, he helps make sure customers are using tools that meet their needs and are clinically appropriate and psychometrically sound. Learn how you can apply your psychology education to a similar career path.

Dennis MorrisonSpeaker:
Dr. Dennis Morrison has worked in the behavioral health field since 1969. Academically, he holds two Masters degrees in Psychology and Exercise Physiology from Ball State University. His doctorate is in Counseling Psychology also from Ball State University. He is a prolific author, frequent presenter (including a TEDx talk), and is co-inventor on a patent for a behavioral healthcare outcomes software product.

 

Garth Fowler, PhDHost:
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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