11 Jul 2017

Nancy Sidun Wants Psychology to Help Prevent Human Trafficking

Nancy Sidun Wants Psychology to Help Prevent Human Trafficking
Nancy Sidun
APA Fellow Nancy Sidun's clinical work has covered international relations and women's issues as well as working with the military.

What Nancy Sidun, PsyD, loves about being a psychologist is that she gets to help people attain a better life than they might otherwise have—her patients, her colleagues and the subjects of her research.

"It's hokey but true," Sidun says. As a girl, "I saw that movie, The Miracle Worker, and I was so taken by the fact that Annie Sullivan didn't give up on Helen Keller. I wanted to be like Annie Sullivan. I wanted to spend my life investing in people others thought were disposable. That's the great thing about clinical psychology. Your job is trying to empower people to be the best they can be." 

 In her own career, Sidun has followed that goal into some tough areas. In 2014, she co-chaired the APA's Task Force on Trafficking of Women and Girls after chairing a similar investigation for Division 52. "They were the ones who gave me voice" for pursuing the issue, Sidun says of the  APA’s Division of International Psychology, but "it became clear that we needed the support of the full APA" to effect any real change. She first got involved with the issue a decade ago, in part because she had adopted a daughter from China. "My God, what if her life had taken a different path?" Sidun says.

She's excited about the influence organized psychology may eventually bring to bear on human trafficking, which the task force report defines as the "economic exploitation of an individual through force, fraud or coercion."

The International Labor Organization has estimated that 12.3 million people worldwide are now living in some kind of forced servitude. Far and away, most victims are women. While many are forced into agricultural work and urban industries like sweat shops, nail salons and domestic service, the overwhelming majority are exploited sexually. In the United States, when women are trafficked for sex, the coercion is most likely psychological, a "grooming" process whereby a woman is lured into a seemingly caring relationship with a man who will put her to work for his benefit in the commercial sex trade, Sidun says.

"Psychology can do so much to help, but we're very late to the table. Every other discipline has been attending to trafficking," Sidun says.

Psychologists can help prevent trafficking by backing empowerment programs for vulnerable women, working to change the public's perceptions about the commercial sex trade to reduce demand, championing the rights of victimized women and identifying at-risk individuals in schools and other settings. Psychologists can also develop effective therapeutic interventions that will address the "extensive and complex" needs of women for whom the very concept of trust has been shredded, and evaluate governmental and nonprofit programs that have been set up to intervene.

One of the most important roles for psychologists is to educate the public and officials in the criminal justice system. People need to know how to recognize trafficking when they see it, and how to follow up with appropriate action that will lead to freeing the women and prosecuting the traffickers. When coercion is psychological, it's not always easy to understand the dynamic without some familiarity with research that has been done on the topic, which psychologists can make available and digestible. They can also testify in court.

U.S. citizens are among both the victims and the perpetrators in the trade, and American Indian women are the most disproportionately trafficked of any U.S. group, Sidun says.

Research on trafficking can be "challenging" to conduct, as there is "no typical case," according to the task force report. What traffickers have in common is their utter willingness to exploit the vulnerable. Any instability creates an opportunity for them, notably poverty, natural disasters and political conflict. Orphans are at particular risk. Only about 6 percent of individuals trafficked into the commercial sex trade in the United States are male.

Sidun says trafficking "runs the gamut from mom and pop operations to organized crime," from sophisticated international enterprises to teenaged boys pimping out their girlfriends. One study that looked at 25 pimps in Chicago found that they often have been "born and raised in an environment where people were exploited. Trafficking is safer and more lucrative than the drug trade, and [pimps] are less likely to get arrested. They often think of themselves as the good guys, protecting the girls. It's quite disturbing," Sidun says.

A New Jersey native, Sidun spent most of her adult life in Chicago, but 17 years ago moved to Hawaii. In Chicago, Sidun taught at a number of colleges, but Hawaii didn't offer the same opportunities. She worked for several years in administration and direct service with Kaiser Permanente, and then went into "telehealth." In a state with a large military presence, Sidun now treats "100 percent" of her clients remotely, via secure clinical video-teleconferencing (VTC) systems. "Most of my clients are in Korea," others are in Japan, Guam, American Samoa, Alaska, and the far-flung islands of Hawaii. Virtually all are military dependents or personnel on active duty she treats through the Pacific Regional Tele-Behavioral Health Hub at Tripler Army Medical Center in Honolulu, Sidun says.     

"For the younger generation, it's the normal way of communicating," she says. "And some of the service members are not as comfortable with emotions, so they don't mind being in an office by themselves during a session. In some ways, for them, that [remote aspect] can enhance treatments. I don't get to read the full body language, but I really like working this way."

She finds the "military culture fascinating. You have to be aware of the culture to be effective [with military clients], and I've enjoyed getting to know about that. I'll say one thing: If I give my military clients homework, it's going to get done!" she says.

In the past, some active-duty personnel may have been concerned their careers might stall if they sought help for such work-related conditions as post-traumatic stress disorder (PTSD), but Sidun thinks that now, "the military is trying to change that mindset. There are good treatments for PTSD," including prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR). "They can help people," she says, adding that military officials definitely are beginning to recognize and encourage active-duty personnel to get the help they need.

Sidun is a past president of the Hawaii Psychological Association. She thinks activity in associations is "critical in protecting psychologists' interests. We watch bills in the legislature very closely, and advocate if we think we need to," she says.

Sidun also trains psychologists in self-care, and she's returning to using her early training in art therapy in this sideline. "We psychologists are bad at self-care," she says. "We take care of our patients, not so much of ourselves."

You could say Sidun is pursuing the role that led her into psychology, that of the dauntless teacher.

"I love supervision. I love training. It's my favorite thing," she says. "I think I'm a good clinician, but I have an opportunity to touch more people if I'm teaching."     

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23 May 2017

Crossing Cultural Borders with Kenneth Wang

Crossing Cultural Borders with Kenneth Wang
Ken Wang
APA Fellow Kenneth Wang's interests include perfectionism, cross-national psychological adjustment, cross-cultural and multicultural psychology, and Asian and Asian American mental health.

Kenneth Wang, PhD, now based in Pasadena, Calif., struggled to navigate two cultures growing up. Born and raised in Taiwan, he spent five years in Tuscaloosa, Ala., as a young boy. Even today, Wang says, "I'm not 100 percent comfortable" in either China or the United States.

From his experience, Wang is convinced that leaving one culture behind to live in another, even temporarily, can shake a person's identity. His sense of the potential impact of that common transition has shaped his work. An associate professor in the School of Psychology at the Fuller Theological Seminary in Pasadena, Calif., Wang specializes in educational counseling, and he does much of his research with students. He also has a private practice.

"I've conceptualized crossing cultural borders as experiencing loss — the loss of relevant knowledge and a sense of belonging," he says. "This is not an original idea, but I draw on my own experience and observations of that."

Wang and his colleagues have specifically addressed the adjustment trajectories of hundreds of international students in the United States, as well as factors that might affect their transitions, like perfectionistic tendencies. He's also studied the constellation of traits that can help students find their feet, which has been dubbed cultural intelligence, or CQ. His research shows that some students fret most before they ever leave home; others are blindsided by culture shock, then adjust. ​​Yet another group suffers psychological distress that's more about them as individuals than their transition to another culture.

"International students are not all alike in the way they adjust" to new situations, Wang says. He'd like to be part of an effort to identify and encourage supports to help students and other visitors, refugees and immigrants achieve "belongingness" quickly in their new societies.

Wang is also known for his work assessing perfectionism among individuals in different groups. These are not necessarily people from other countries; for example, he has looked at perfectionism and identity issues in African-American and religious students as well.​ Still, these people can experience a tremendous amount of stress when mainstream values conflict with those of the subculture they grew up in.

The child of professor parents, Wang lived in Tuscaloosa between the ages of 5 and 10 while his father pursued a PhD at the University of Alabama. Wang was the first Asian student ever to attend his Tuscaloosa elementary school. When soccer teams formed along racial lines, the white kids versus the black kids, it was up to him to decide which team to join. He felt he didn't fit in, and he experienced some bullying, he says. His struggles continued even after his return to Taiwan. While he looked like everyone else, "I felt different. I didn't know the songs or games, and I struggled to learn to read and write Chinese, to fit in, to function in that cultural context. I thought there was something wrong with me," he says.

A number of basic values were different as well, Wang says. "Self-promotion is critical in the United States," for example, but humility is important in Taiwan. And always, Wang was held to tough standards, no matter where he was.

For Asians and Asian-Americans, perfectionism is "not just individual but collectivistic," he says. Instructors in Asian schools tend to "focus on where people have gone wrong, where they can improve," in contrast with mainstream American society, which may try to reinforce "feeling good about yourself," even if a student's performance is below par. Asian students have a "more realistic view" of how they're doing and "where they fit in," Wang says, but the Asian approach can take a toll. Even if the culture views the student's distress as constructive, the individual may not get much satisfaction from his or her own success, which can lead to anxiety and depression.

As an adult, Wang worked for years in business, first in marketing and then in planning, until he noticed he was more interested in a colleague's marital problems than in his work. The most frustrating part of that for Wang was that he wasn't able to offer any helpful advice.

His future wife was taking a counseling class as part of her education curriculum, and introduced him to the idea of empathy, "of being in another person's shoes, and reflecting," he recalls. That changed his life. Wang decided to go into a helping profession and came back to the United States, to Wheaton College, a small Christian school in Wheaton, Ill. Deciding against the ministry, he got a master's degree in counseling. When he finished, he returned to Taiwan and went to work in the Disability Resources Center at National Dong Hwa University in Hualien.

But counseling in Taiwan was not what it might have been in the United States. Wang had few clients and his time was taken up with administrative work. "I might as well have stayed in business," he says. Restless again, looking at various PhD programs, he noticed that at Pennsylvania State University in State College, some professors were studying perfectionism, including Robert Slaney, PhD, who had created the influential Almost Perfect Scale–Revised.

"That resonated with me," Wang recalls. The high standards he had grown up with, the "constant striving and pressure to perform well" made him want "to learn more about how that impacts a person." Wang's first publication, in 2006, was a paper he wrote with Slaney on perfectionism among Taiwanese students.

For Wang, his present job at the seminary affords him the opportunity to continue to explore cross-cultural differences, but with the added benefit of being able to travel to China several times a year. Fuller has strong ties to China and Taiwan through its China Initiative ministry, and that connection offers research and other collaborative opportunities.

Wang says, "Psychology encourages us to be who we are, and accepting of who we are. I've come to accept that I'm a cross-cultural person."

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28 Mar 2017

Jeremy Wolfe Wants to Understand How We See Things

Jeremy Wolfe Wants to Understand How We See Things
Jeremy Wolfe
APA Fellow Jeremy Wolfe's research looks into how people use sight to process information that's out there in the world.

After four decades of investigating how the human eye works, Jeremy Wolfe, PhD, still finds plenty to keep him curious.

“I never get bored,” says Wolfe, head of the Visual Attention Lab at Harvard Medical School (HMS) and Brigham and Women’s Hospital, in Boston, Mass., and an APA Fellow. “There’s always something new to consider. My elevator speech is that for the last 25 years, most of my lab’s work has involved studying visual search. Or, how do you find what you’re looking for? We move back and forth between basic science issues and real-world problems.”

How do you locate the mustard in the refrigerator, pick out the weeds from the posies in your garden, or home in on the cereal you like best from the dozens arrayed on the shelf in your local supermarket? Because your eye conveys so much information in a glance, according to Wolfe, professor of ophthalmology and radiology at HMS, that information has to be processed to make perceptual sense. “If we want to know if a specific object is present, we will often need to search for it, even if it is easily visible,” Wolfe says.

The mechanics of those quotidian quests have fascinated Wolfe for his whole career. In 1989, he first published his influential analysis of the process, which he called Guided Search, building on “the two-stage architecture” — preattentive and attentive — of Anne Treisman’s pioneering feature integration theory, and other works. Guided Search tracks the complex process, conducted in fractions of seconds, by which we find “targets” among the “distractors” in our field of vision by applying certain fairly coarse criteria, such as color, shape, size, orientation and curvature, and then “binding,” or assembling, those traits into a “single representation of an object,” according to Wolfe. Some objects are fairly easy to find, while others, like the proverbial needle in a haystack, can take quite a bit of time and attention.

 “The core of GS was the claim that information from the first (preattentive) stage could be used to guide deployments of selective attention in the second (attentive stage),” Wolfe wrote. He is now tinkering with the fifth iteration of Guided Search, to incorporate new data.

Wolfe’s latest research studies some of the limitations on our ability to see what’s in front of us, specifically problems that arise when people are tasked with looking for “rare events,” or things they are not likely to find — the radiologist examining X-rays for breast cancer, or the airport inspector looking for weapons or bombs in luggage. Radiologists miss 20 to 30 percent of visible cancers; for security purposes, the government doesn’t like to share how airport scanners are doing, Wolfe notes. One of the things that happens to expert “searchers” over time is that their vigilance flags, because most of the time what they’re looking for isn’t there.

“There are really profound limits on the human search engine,” Wolfe says.

Computers do much better, typically finding 100 percent of tumors, for example. However, a very high false positive rate is the computers’ downfall (and also for programs designed to improve searchers’ find rate). That’s a serious problem, because identifying nonexistent cancers activates an expensive, irksome and, for the patients, a terrifying recall process, to no useful end. So, people are better prospects for these jobs than computers, at least for now, and Wolfe’s research is aimed at figuring out how to improve humans’ overall performance on screening for rare events.

What Wolfe calls his own “origin story,” or how he got his start in visual research, begins when he was in high school in New Jersey, at a summer job his solid-state physicist dad got him at his workplace, the Bell Labs facility in Murray Hill, N.J.

“He sold me to his tennis buddy, who was a color vision researcher,” Wolfe recalls. He spent stretches of that summer immobilized in a chair, “looking at barely visible spots of light. My job was to say what color they were. What was cool about that was that I didn’t think I could tell. I thought [I]was guessing,” he says, but the experiment showed that he was able to identify the colors more often than he would have if he were merely guessing. On his many necessary breaks from the tedious work, Wolfe roamed the labs’ halls. He spent hours that summer talking to scientists he later discovered were famous in their fields.

“Many of the issues that have been important to my career I was introduced to then,” he recalls. That exposure was so important to him that Wolfe himself now has “an absolute commitment” to bringing high school students into his own lab, providing internships for half a dozen of them every summer.

Wolfe went on to graduate summa cum laude from Princeton in 1977. His doctorate, in 1981, was from the Massachusetts Institute of Technology, where his doctoral thesis was entitled, “On Binocular Single Vision.” Wolfe taught at MIT for 10 years and won the Baker Memorial Prize for teaching there in 1989. He was denied tenure the following year.

 “I was not the first person to win that prize and the following year lose a tenure battle,” he recalls. “It was seen as a zero-sum game, that if you were devoting the kind of time to your teaching to be winning that prize, you couldn’t really be a serious researcher.”

That episode ended with Wolfe moving his lab to Harvard in 1991 (though he was also a popular lecturer at MIT for 25 years; the podcast version of his “Introduction to Psychology” has been a top offering on iTunes U), and he’s had “quite a nice career, but a rather different career” from the one he had in mind. He’s a medical school professor, not a psychology professor, and “I live entirely on grant money, which is an exciting way to live. I’ve done basic research and use-inspired basic research. I’ve gotten grants every which way.”

Wolfe doesn’t mind that his scientific research is expected to lead to useful applications. He says, “When we’re working on the public dime, we ought to be able to make a decent case for why this is a sensible use of taxpayers’ hard-earned money."

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14 Feb 2017

Thomas Plante Investigates the Ethical Life

Thomas Plante Investigates the Ethical Life
Over his career, APA Fellow Thomas Plante has studied various social issues through the prism of ethics.

Thomas G. Plante, PhD, a San Francisco Bay–area psychologist and Fellow of the American Psychological Association, writes often about the practicalities of living an ethical life.

“Treat everybody with respect and compassion, even if you don’t like them or agree with them,” says Plante. “That’s certainly how I organize my life.”       

Plante is the Augustin Cardinal Bea, S.J. University Professor in psychology at Santa Clara University (SCU) in Santa Clara, Calif., a researcher, clinician and author of 21 books and more than 200 scholarly professional articles and chapters.

Plante says our society has moved away from endorsing positive practices such as “goodness,” which he defines as behavior that is not only respectful and compassionate, but also “civil and gracious, working for the benefit of the whole, acknowledging that we all have a part to play.” He thinks we need to bring goodness back into style.

Plante’s latest book, Graduating with Honor: Best Practices to Promote Ethics Development in College Students, written with his wife, Lori G. Plante, PhD, also a psychologist, centers on interviews the two did with students at SCU, a Jesuit school where ethics is a required course for every student, and Dartmouth College, a secular Ivy League school in Hanover, N.H., where their son is an undergraduate.

What the Plantes found was that “students at both places can see that ethics could be helpful to them,” but the Dartmouth students, who are not required to take ethics courses, were “like a dry sponge” on the topic, “excited” to hear about how they might operate decently and meaningfully in the world, Plante says. He found that heartening, and would love to see all students at all educational levels receive ethics training. He doesn’t envision ethics training as telling them what to do, but rather as giving them the tools to make “thoughtful” decisions.

“Ethics are just the tools, a way to be intentional about who you become. In our heart of hearts, we all want to strive toward goodness,” he says.

Ethics is only one of Plante’s specializations. His dissertation was on the psychological effects of aerobic exercise, and he is still professionally interested in health. Religion has become a major focus, though. Psychology and religion have had “a tumultuous relationship,” but religion has a role to play in an ethical life, Plante says. “How does that impulse get nurtured? Where do you go when you struggle? How are you inspired? It’s harder to do when you’re all by yourself,” he says.

Plante is a leading expert on one of the most demoralizing scandals of our time—the sexual abuse of minors by members of the clergy. In 1989, when Plante was a fledgling ethics instructor at Stanford University, he fell into the assignment that would impact his career for decades to come.

“A Catholic priest friend who knew I was a psychologist called and said, ‘We have some guys who are being accused of being sexually inappropriate. Can you see if there’s anything to this?’” he recalls.

Plante quickly got to work and found that sexual abuse by priests was real, and that it was not rare. He also realized there wasn’t a body of research on the topic. He rounded up several other psychologists around the country who were also looking into the issue, and by the late 1990s, they had enough collective knowledge to put together a book, Bless Me Father For I Have Sinned, which Plante contributed to and edited. By that time, Plante and his colleagues could estimate with some confidence that between 2 and 6 percent of Catholic clergy members had had a sexual experience with a minor. “The actual figure wound up at 4 percent,” he says.

The research team thought their book would create a sensation when it came out in 1999, but only two low-level reporters even attended the press conference they hosted. Only when “the stars aligned” in a “confluence of factors” that included the fact that Boston, Mass., was a “Catholic-dense area” did clerical abuse finally get the attention it deserved, after the Boston Globe’s 2002 Pulitzer Prize–winning Spotlight investigation. “It should have hit the press in a big way before then,” Plante says.

Once clergy sexual abuse came to the attention of the public, though, for a while “I did nothing but talk to the media [about the topic], teach classes and see my patients,” he says.

Plante has written two more books on the sexual abuse scandal in the Catholic Church, one in 2004 and one in 2011. Even now, it’s a “hot, hot topic,” he says. Plante points out that many people still feel tremendous anger toward the church, not only for the fact of the abuse, but also for the avoidant way bishops and other church officials handled it. “Hard data” shows that sexual abuse among the Catholic clergy, while “horrific,” is roughly what occurs among the clergy of other faiths, and is significantly lower than for the adult male population at large, Plante notes; he treats many clerics for issues like alcohol and pornography addiction, depression and anxiety. “We forget that those [clerics] are very human people, with the problems and issues anybody has.”

Plante himself is an “engaged” Catholic, “more of a Vatican II, peace, social justice, Dorothy Day Catholic.” His family belongs to both a Catholic parish and a Jewish congregation (his wife is Jewish). He grew up in Providence, R.I., in a latticework of light and dark, as he remembers it, created in large part by the “interesting juxtaposition” of the Catholic Church and organized crime in the city’s life.

“Everybody went to church,” but quite a few of them were criminals, too, he says. Like most people he knew, Plante’s family was Catholic, of Irish and French Canadian stock. His father was a builder, “but he only built in certain towns outside the circle of Providence, the ones that weren’t influenced by the mob,” he recalls.

The influence of this “quirky place” may be one reason Plante is not surprised when he finds the bad and the good jumbled together in the same institution, or the same person. People want to be good but sometimes “lose their way,” he says.

“It keeps coming back to this question: How do you want to be in the world?” he says. In a time when “everything has turned tabloid, ethics could be a terrific tool to get ourselves back on course.”

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20 Dec 2016

Michael Hendricks Uses Research to Advocate for LGBT Community

Michael Hendricks Uses Research to Advocate for LGBT Community
APA Fellow Michael Hendricks has done pioneering work with transgender people, and as a gay psychologist, he's also fought some tough battles within the profession.

Washington, DC, psychologist Michael Hendricks, PhD, has worked for decades to move our society to extend a more dignified and healthy life to lesbian, gay, bisexual and transgender individuals, and has advocated for the LGBT community both within and outside of the APA.

A clinician, researcher, Fellow of the American Psychological Association and a gay man himself, Hendricks has been involved his whole career in developing and improving models of care, especially for LGBT people. He came into the profession during the HIV-AIDS crisis of the mid-1980s to mid-1990s, and has never lost his sense of urgency about the need to create a rigorous scientific basis for addressing LGBT issues.

"One of the great things that distinguishes psychology is its ability to do solid research and then stand on that research to advocate for something that needs to change," he says.      

Most recently, Hendricks has been involved in pioneering studies of the experiences and health care needs of transgender individuals, whose gender identity and expressions do not conform to the sex they were assigned at birth. Hendricks was a member of the APA Task Force that developed the Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, passed by the APA Council in August 2015.

Hendricks is also a suicidologist, an expert in what he calls “the sentinel event of mental health. Keeping people alive is the most important thing we do.” In his private practice, he combines clinical and forensic work. His psychotherapy clients tend to be LGBT individuals and couples; individuals with moderate to severe depression, anxiety or mood disorders; or individuals who have considered or attempted suicide. In his forensic work, he serves as a clinical evaluator or, less often, as a "content expert" in suicide, psychopharmacology or other issues.

He worked on the 2005–2006 Virginia Transgender Health Information Study (THIS), which revealed, among other findings, that transgender individuals had higher rates of suicide ideation and attempts than any other population examined to that point. Hendricks contributed a key timeline methodology that helped establish those results. For him, especially given his expertise in suicidology, the new understanding of the vulnerability of transgender individuals was a call to action. He set to work disseminating the study's results, and also creating tools for therapists working with transgender clients, "charting a course through the therapeutic process that would foster resilience to stress."

In 2012, Hendricks teamed with Rylan Testa, PhD, a research affiliate at the Center for LGBT Evidence-based Research (CLEAR) at Palo Alto University, Palo Alto, Calif., to adapt Ilan Meyer’s LGB Minority Stress Model for a transgender population. This new "conceptual framework" was designed to help clinicians understand the impact of a lifetime of discrimination, isolation and often violence on transgender individuals, so they can assist their clients in developing strategies to deal with those stressors. In 2015, Hendricks was awarded the APA Presidential Citation.        

For Hendricks, working with the LGBT community comes naturally. Growing up gay in a small town in conservative western Michigan was “a stealth existence,” a life informed not even by real shame but by “quasi-shame,” the understanding that many of the people living around him would never understand or accept him for who he really was. Now Hendricks is “very out,” he says, and is a past president of Division 44, the Society for the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues. Presently, he represents Division 44 on the APA Council.

Hendricks was a premed student at Michigan State University in East Lansing when he took his first psychology class. He loved it so much he abandoned the study of medicine and started pursuing a degree in social psychology.

"I enjoyed focusing on how people behave in groups, on questions like, when do people decide to help other people?" he says. But social scientists mostly worked in academia, and that didn't feel right to Hendricks, so he went instead in to American University's graduate program, training to be a clinician in the Boulder Model — "heavy on the science."

Hendricks' career was touched early by the HIV-AIDS crisis. Until effective treatments emerged, the deadly viral disease decimated communities of gay men and created an emotional havoc of grief and fear. Both his master's thesis and doctoral dissertation dealt with HIV.

"In my age cohort, a huge number of psychologists were doing research on HIV, all across the country," he says, and many LGBT psychologists became openly active in the APA, often first in Division 44.

"We all realized we had something to contribute. We were very much invested in getting our research out there. If we wanted to change what psychology said about LGBT people, we had to be in the governing body," Hendricks says.

He was also a founding and longtime member of the Virginia HIV Community Planning Committee (VHCPC), which oversaw expenditures of federal funds for HIV prevention. VHCPC committed 5 percent of its budget to research on groups most affected by HIV, and to assess what prevention strategies might work best with specific populations. That led to the Virginia THIS study, which Hendricks participated in as then-chair of the VHCPC Research Subcommittee.

The emancipation of LGBT people arguably began in 1957, when Evelyn Hooker PhD, a Los Angeles, Calif., psychologist, published "The Adjustment of the Male Overt Homosexual," a science-based study of gay men, in the Journal of Projective Techniques. At the time, gay men were considered mentally ill; gay sex was against the law and could lead to prison sentences and horrific medical interventions geared toward "curing" homosexuality. Hooker's work helped depathologize the movement, and showed that science could fight the misinformation that had been used to justify discrimination against gays, Hendricks says.

The American Psychiatric Association removed homosexuality from its list of mental disorders in 1973; in 1975, the APA did the same. Science had opened the door. In 2003, in Lawrence v. Texas, the Supreme Court of the United States struck down the remaining state criminal sodomy laws.

Hendricks says, "You're not just advocating for someone's rights on principle. It has to be grounded in science. Nobody is surprised to hear that discrimination causes psychological harm, but a study can show what kind of harm it inflicts, and the negative impact."

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26 Oct 2016

Member Profile: Kristin Krueger Introduces Improv to Therapy

Member Profile: Kristin Krueger Introduces Improv to Therapy
APA Member Kristin Krueger, is exploring how improv can be used to improve mental health outcomes as well as improv as a cognitive activity.
APA Member Kristin Krueger is exploring how improv can be used to improve mental health outcomes and as a cognitive activity.

Chicago psychologist Kristin Krueger took her first class in improvisational theater at the famed The Second City Theater and Training Center in Chicago in 2006 for fun, but she soon realized improv's tenets and techniques could be useful in her work as well. Today, you might say Krueger has come full circle.

Not only does she employ improv in her group therapy and conduct research into how the use of improv techniques in therapeutic settings can affect mental health outcomes, but she is also a member of the Therapy Players, a professional improv group made up entirely of therapists.

"Being part of an improv community is therapeutic in itself," she says.

For Krueger, the key to improv, a form of live theater in which actors create scenes without prior preparation, is "to be yourself, and to be comfortable with that." That’s therapy's goal as well, she notes. Krueger is by no means the first psychologist to notice the commonalities between the two. "A lot of people are using improv in therapy, but as far as I know, nobody else is measuring it," she says.

Krueger was already a psychologist, and working as a waitress to help pay the bills in her hometown of Chicago a decade ago, when a co-worker suggested they take improv classes together. Krueger thought improv might help her with public speaking, but she mostly went along "just for fun." She suggested taking classes nearby, in their North Side neighborhood, but her friend said, "No way. It's Second City or nothing," Krueger recalls.

It was a serendipitous choice, because The Second City, founded in 1959, stands in a direct line back to Viola Spolin, who developed the system of games and exercises that are the bones of improv. In the 1920s, Spolin trained to be a settlement house worker with Neva Boyd, a pioneer in recreational therapy who was using games and groups in revolutionary ways in education. Spolin eventually moved her career into the performing arts, and took exercises she had developed herself into classes she taught for prospective actors, first in a crossover program in Chicago for the federal Works Progress Administration's Recreation Project during the Great Depression. Spolin's son, Paul Sills, was one of the founders of The Second City.

Krueger went through a good chunk of the improv training series at The Second City, and later took classes at different centers in San Antonio, Texas, and San Francisco, Calif. When she returned to Chicago in 2012, she retook the basic course at The Second City and went on for advanced training there. Meanwhile, she held a number of professional research and clinical positions, notably at Rush University Medical Center, where she coordinated the adaptation for a Spanish-speaking population of two large NIH-funded, longitudinal studies on aging, and served as a staff neuropsychologist for the Veterans Administration and the Cook County Health and Hospitals System in Chicago.

While at Cook County’s John H. Stroger, Jr. Hospital, Krueger introduced some small weekly groups for patients with anxiety and depression that employed exercises she had learned in improv classes. She evaluated the effectiveness of the games on improvements in her patients’ mood and functioning, based on self-reporting. The findings on that work have been submitted for publication.

Krueger now has a private practice in a Chicago suburb with an emphasis on issues of aging. She conducts neuropsychological evaluations in an aging population, leads groups, teaches healthy aging classes, and maintains collaborations at Rush. She finds therapy groups to be a good place to use the interactive games and exercises designed to help improv practitioners become comfortable enough to engage with one another.

One problem with traditional therapy groups can be that some members tend to talk more than others, she says, "but improv exercises are timed and concrete. Everybody can talk equally, and the exercises give people the structure they need to manage their own emotions." Krueger says she thinks improv has a lot in common with that aspect of cognitive-behavioral therapy that encourages patients to "celebrate who you are."

Krueger is following two threads of research into the use of improv in therapy. One thread explores how improv can be used to improve mental health outcomes. For this study, patients engage in a series of psychotherapeutic improv sessions. After the sessions, the patients rate their symptoms of depression and anxiety, self-esteem, perfectionism and ability to relate to others socially.

The second thread looks at improv as a cognitive activity. In this area, Krueger is working with Clifton Saper, PhD, at Amita Health, and Jeff Winer, a PhD candidate, to put together a panel of neuropsychologists who will categorize improv games according to the cognitive domains they align with.

She says she believes "improv can make a big contribution to making people feel better about themselves, live more collaboratively and improve their mental health."

Krueger performs as often as she can with The Therapy Players, which she joined shortly after it began in 2013. This is founder Dave Carbonell's second improv group; he founded The Freudian Slippers in graduate school 30 years ago. The Therapy Players are all full-time therapists, and about half their routines are based in some way on their work, says Carbonell, a clinical psychologist who specializes in anxiety disorders. Members practice for two hours every Sunday morning and typically perform more than a dozen dates a year, at mental health conferences and other meetings, and at clubs like The Den Theater and Stage 773 in Chicago, where, Carbonell says, "We get really good crowds, they come back and, boy, do they have a good time."

Kristin Krueger, center, is a member of the Therapy Players, a professional improv group made up entirely of therapists. (Photo: Ellen Carbonell)
Kristin Krueger, center, is a member of the Therapy Players, a professional improv group made up entirely of therapists. (Photo: Ellen Carbonell)

Of Krueger, Carbonell says, "She's coming at improv from both ends. She's generating research in an area where there's hardly any. She's going to make a big mark—and, she's funny as all get out."

When she was growing up, psychology was "the only thing I wanted to do," Krueger says, but she took several years off between college at the University of Wisconsin and the graduate work that culminated in a PhD degree from the Illinois Institute of Technology in 2004.

"I wanted to have a lot of life experience before I tried to help people. Otherwise, I thought, anything I had to say wouldn't have much weight," she says. That life experience included getting a master's degree in linguistics, extensive travel, and numerous diverse jobs. She is fluent in Spanish, Portuguese and German.

Early on, Krueger was attracted to the role of the therapist as portrayed in popular culture. Her mother's cousin, Dan Kiley, in 1983 wrote the best-selling, popular-psychology book The Peter Pan Syndrome, based on his own research with boys and men who resisted accepting adult responsibilities. Krueger met Kiley as a girl and was impressed. She also was intrigued by the television miniseries Sybil, about a woman with dissociative identity disorder, in which the actress Joanne Woodward portrayed the real-life clinician Dr. Cornelia Wilbur. And she was a big fan of educator, author and motivational speaker Leo Buscaglia, long a popular lecturer on public television.

"He was so present in my childhood," she recalls. "He embodied unconditional positive regard in so many ways."

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