02 Oct 2017

Kit Yarrow is Unlocking Consumer Shopping Behavior

Kit Yarrow is Unlocking Consumer Shopping Behavior
Kit Yarrow
APA Fellow Kit Yarrow is a well-known researcher on consumer behavior.

Kit Yarrow, PhD, does not believe retail is dead, far from it. Consumer psychology has changed dramatically in the past decade, though, and Yarrow predicts the retailers who survive will be those who appreciate their shoppers’ potent desire for an engaging and validating experience in the marketplace.

Yarrow is a well-known researcher on consumer behavior, a popular speaker, a longtime academic and the author of two books: “Gen BuY: How Tweens, Teens and Twenty-Somethings Are Revolutionizing Retail” (Jossey-Bass, 2009) with Jane O’Donnell and “Decoding the New Consumer Mind: How and Why We Shop and Buy” (Jossey-Bass, 2014). She has blogged for magazines like Money, Time and Psychology Today, among other publications; her most popular article was for Money magazine in 2016, The Science of Why We Buy Clothes We Don’t Wear.

Yarrow identifies “three shifts in our world, three ways in which we as people have changed noticeably in the past 5 years or so, and, because of those shifts, how our needs have changed in terms of what we feel we need to add to our lives.”

First, technology is now embedded in daily activities, our phones and laptops tether us to one another in ways that are captivating but superficial, and ultimately unsatisfactory. “We feel more disconnected, so we use brands and products to feel seen and heard, and to reconnect with others,” she says.

Second, “there’s more emotionality, with elevated levels of anger and anxiety,” in part because people may not feel as safe or accepted as they once did. “People shop differently and want different things when they are more emotional. A hassle feels doubly so.” Retailers and manufacturers both need to make it easier for shoppers to understand the benefits of their products, and to streamline the purchasing process, Yarrow says.

Third, the past several years have seen a “trend toward individualism,” which means people are no longer as likely to make purchases as part of a group. Even young people are more willing to pass up “the cool item,” Yarrow says, taking the time to find one-of-a-kind pieces, sifting through thrift stores to put together a distinctive look.

“There’s no way to succeed in retail today without understanding consumer psychology,” she says. “Consumers actually don’t want to shop online. They want to go to stores, but not the way they are now.” Shoppers like to feel connected with other people like themselves, but “they don’t want to trawl through a mall and see the same thing in every store.” Yarrow says stores mostly run by “nimble younger retailers” willing to display interesting items, not necessarily keeping them in stock, and engaging their customers at every turn are where things are headed. Shoppers can touch and feel things in these stores, try them on, photograph and post them on social media, and then have them delivered from the warehouse to their homes. Yarrow singled out Betabrand, an online retailer with a store in San Francisco, where designs are often crowd-sourced and crowd-funded. Fans who vote for a design that makes it into production get a discount on the finished product.

Does this mean the end to department and traditional retail stores is at hand?  “These stores are part of our American culture, and I’m rooting for them, but they are going to have to change or die.” They must understand, Yarrow says, the consumer is in charge now.

As for online retailers, they need to “make it easy to navigate their sites, and offer opportunities to see what other shoppers are looking at and buying to create a more social environment,” she says.

In her research, Yarrow does not use focus groups, where people are invited to share their opinions of products, because she believes the real decision making about what to buy or not to buy does not occur at the conscious level.

“It’s more about how people feel than what they think,” she says.

Instead, Yarrow conducts a type of ethnography, spending time with people she often recruits through social media, going through their closets, “shopping along” on trips to stores and riding home with them after a successful, or not-so-successful, shopping trip.

“That’s where I get the goods—in the car,” she says. “People say the most wonderful things when they’re done shopping and they’re focused on the road. That’s when they can go inside themselves and help me understand why they passed this up, or bought that, how it’s related to the rest of their lives, what it all means.”

Marketers and manufacturers often fund Yarrow’s research, and sometimes are surprised that she is advising “the enemy,” but she says, “I have never worked for a company that has bad intentions. They want to make better products, and I can easily support what they are doing. No company lives on one-time purchases. If they don’t deliver, they will fail. I don’t think marketers are the enemy, and I never will.”

As Yarrow sees it, her training in clinical psychology is alive and well in her work. “I yearn to talk to consumers,” she says.

Yarrow did not set out to be psychologist.  She studied journalism in undergraduate school before deciding to become a clinical psychologist. She went to graduate school at the Wright Institute in Berkeley, Calif., where the need to keep up with tuition pushed Yarrow to teach an undergraduate marketing class as an adjunct at nearby Golden Gate University (GGU) in San Francisco—the serendipitous start to her life’s work.

“I was finishing up my psychology internships when I realized I loved the research, the teaching, the assessment. That’s where my heart was,” she says. “All of a sudden, I switched.”

When a full-time position opened in the GGU marketing department, Yarrow jumped at it. “I found a way to bring in psychology by doing research in consumer behavior.” She also taught undergraduate psychology classes.

In 1992, with the encouragement of the administration, Yarrow and six colleagues founded GGU’s graduate psychology department, which Yarrow chaired for nearly 25 years. She is a professor emerita now and exploring publishing her latest research in articles or another book.

“Just like everybody else I know, I did not follow a direct path,” she says.

Yarrow started her research and writing career 20 years ago—only after she was told she would have to start publishing if she wanted to get tenure at GGU.

“I’m so grateful for that admonishment,” she says. “I had to go deep. I started it, and then I got a nice grant to do more research, and now it’s the thing I do most. I live to know why. If you look at ‘the glass of Kit,’ it’s three-quarters ‘why.’ That’s the reason I’m a professor instead of a clinical psychologist.”

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13 Sep 2017

Dorothy Carter Explores a Mission to Mars

Dorothy Carter Explores a Mission to Mars
APA member Dorothy Carter snagged a $1 million NASA grant to research team dynamics during long-duration space exploration missions.

It is human nature to turn to people in our inner circle when we are in trouble.

But what if that trouble occurs 128 million miles from Earth while you are hurtling toward Mars in a spacecraft? And what if the person you most need is the one you least trust?

These questions are at the center of new research by APA member Dorothy Carter, an assistant professor of industrial/organizational psychology at the University of Georgia (UGA). Just one year after completing her Ph.D., Carter snagged a $1 million NASA grant to research team dynamics during long-duration space exploration missions.

The three-year, collaborative study, called Project FUSION (Facilitating Unified Systems of Interdependent Organizational Networks), aims to help NASA successfully complete a mission to Mars by the year 2030 by accelerating knowledge of multiteam systems (MTSs).

“Astronauts on a mission to Mars are very likely to run into challenging and unexpected situations,” explains Carter. “The people involved—on Earth and in outer space—may have the natural human inclination to turn to similar others, such as teammates. However, in order to save lives of the people on the mission, NASA personnel may need to be prepared to seek help from dissimilar others.”

MTS research is a growing area of psychology that deals with intergroup dynamics in complex organizational settings. These networks of interdependent teams work on proximal goals in service of a common, overarching goal—like disaster-response efforts, global healthcare initiatives, and even pharmaceutical launches.

The human pitfalls of such tentacled organizations are obvious: potential competition among teams, inadequate communication and collaboration, hierarchical obstacles, and leadership challenges, to name a few.

NASA’s task in putting together an MTS for the Mars mission will be complicated. Not only will astronauts operate at the intersection of multiple teams doing highly specialized tasks, membership in those teams will rotate over time.

Additionally, “communication with family and coworkers on Earth will be severely limited and conducted entirely via technologies that have inherent communication delays,” Carter says.

To pinpoint what Carter’s research proposal terms the “hard truths and inherent complexities about teamwork,” Project FUSION is building a sophisticated agents-based mapping system that predicts the social networks that are likely form among MTS members across a variety of situations during space missions.

This computer-modeling approach allows Project FUSION to program a set of behavioral rules for stand-in human “agents” to see how their relationships play out in different circumstances. Who will interact with whom? Who will be trusted? Who will accept influence from whom? What are the basic human tendencies that will lead them to behave in a particular way?

“We call these explorations ‘virtual experiments’ . . . and it’s how we are speeding up the science,” says Carter. “We want to be able to identify the different factors that are going to have the most impact on the formation of affective, behavioral and cognitive relationships. And we don’t have the luxury of being able to study this for the next 100 years.”

The project has processes to ensure they are accurately feeding NASA-specific information into the models. They use qualitative interviews with NASA personnel, such as managers, mission control members and former astronauts from the International Space Station, to get a better handle on common disconnects that occur, as well as instinctive responses to unexpected events.

Project FUSION also is conducting laboratory studies at UGA and Northwestern University that include role-playing sessions between student subjects and professionals at HERA , NASA’s analog-simulation habitat for studying and training humans for extreme space environments.

“The students act as mission control,” says Carter. “Hopefully the professionals who are in HERA for several months will play our game three or four times with ‘mission control.’”

Ultimately, the project is expected to identify likely patterns of group dynamics and behavior and help NASA develop best practices for optimal team functioning during many situations that can go right—and very wrong—during long-distance space exploration.

Carter’s launch into teams and leadership research—and into academia at all—followed a unique trajectory.

Originally from Houston, Carter desired to be a ballerina. She left high school to be part of a professional dance training program, completing her degree through correspondence. After pursuing dance professionally for several years, she decided to go to college at age 21.

“My initial plans did not involve college,” she says. “I ended up at Wright State University (WSU) in Ohio where they had an open-door policy. I walked in a week before classes started and signed up. . . . However, this was one of the best decisions of my life. As an undergrad, I received fantastic one-on-one mentoring in research from the faculty at WSU.”

Excited by the psychology classes she took, Carter was encouraged by her mentors to pursue research. She says was drawn to study leadership and MTSs to some degree because of her background in dance.

“Large groups of people, made up of different teams, having to coordinate their behaviors to achieve a common goal. Hmmm . . . sounds like a ballet company!” she exclaims.

Once she got to graduate school at Georgia Institute of Technology, Carter was able to work with Leslie DeChurch a leader in MTS research, with whom she copublished several articles on the topic. Her award-winning dissertation research, advised by DeChurch, leveraged social network approaches to understand leadership in MTSs. 

Her work on the FOCUS grant builds on this prior research, as well as other NASA projects led by members of the Project FUSION research team.

“We’re expanding on these previous projects that I had the pleasure of working on in grad school,” Carter says. “It’s not like, ‘Oh Dorothy Carter independently developed all these ideas by herself and got a million dollar grant just out of grad school!’ Project FUSION is a collaboration across a big team of incredible researchers who are at both senior as well as more junior stages in their careers.”

“I think my personal experiences reflect the way that science is actually conducted these days,” she reflects. “It’s a group effort across multiple laboratories. Understanding multiteam functioning doesn’t just apply to the organizations we’re studying, it applies to the researchers ourselves. A lot of scientists work in MTSs, so science itself can be advanced by this research.”

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24 Aug 2017

Sian Beilock Wants to Help People Perform at Their Best

Sian Beilock Wants to Help People Perform at Their Best
Sian Beilock
APA Fellow Sian Beilock is the new president of Barnard College in New York City. (Photo: Jason Smith)

Sian Beilock, PhD, a psychologist, fellow of the American Psychological Association and the brand new president of Barnard College in New York City, sees her move into the top job at a "stellar" liberal arts college for women as a natural progression in a career that has focused on "helping people perform at their best."

Beilock was previously at the University of Chicago for twelve years as a psychology professor and the principal investigator with the Human Performance Lab there. By the time she left, she was an officer of the university as well. As a researcher, Beilock says she will "continue to collaborate with folks in Chicago. I'll always be a cognitive scientist."

She has written two popular books on the mind–body connection, Choke (2010, Free Press) and How the Body Knows Its Mind (2015, Atria Press). Her work has explored questions raised by her own early experience with "choking" during important performance events, and now represents a whole array of investigations into how to help people — from small children to parents to elite athletes — harness their potential to learn and excel.

In 2014, Beilock took on the additional role of vice provost for academic initiatives at Chicago, moving up last year to executive vice provost, a "high-striving leadership role, and I loved it," she says. In that role, in 2015, she created UChicago Grad, which offers graduate students and postdocs a variety of programs, events, workshops, and one-on-one coaching on presentation skills and interviewing, with an eye to helping them find good jobs not only in academia, but also in industry, nonprofits and government. Last year, she was named  the Stella M. Rowley professor of psychology.

"There's this false dichotomy, this idea that students need one set of skills for an academic career and another for industry,” she says. “They're a lot of the same skills, which we work to help our students acquire — to articulate a viewpoint, listen, take in new information and adjust their thinking based on what they've learned, to write and understand data — skills that are important no matter what endeavor they pursue."

Beilock says the same is true for undergraduate students like her new charges at Barnard, which was founded in 1889, one of the original Seven Sisters, elite women's colleges associated with the once all-male Ivy League. Barnard, with about 2,500 students, is affiliated with Columbia University.

"The liberal arts span across the humanities, the social sciences, the biological and natural sciences, and what this type of education gives students is the ability to think. The world is changing, and our role is to get them out with the tools they need in their first job, second job, eighth job, and graduate school," she says.

Beilock thinks her background in psychology will help her. She received her bachelor’s degree in cognitive science from the University of California, San Diego, and doctorates in kinesiology and in psychology from Michigan State University in East Lansing. Success in life depends, she says, "not just on knowledge or skills in a particular area, but also on having the psychological tools to put your best foot forward when it matters most. I hope that idea has influenced some to think about not just the math lesson but also how you feel about that lesson, and not just how you're practicing that swing on the golf course but how you're training your mind. That's what I've tried to work on throughout my research career, and I think a lot of those lessons will be helpful in the next chapter."

She has "always been interested in women and girls" in her research, "in understanding some of the psychological barriers that keep them from achieving up to their potential," she says. Research shows that seeing women in leadership roles encourages girls to be optimistic about their own chances to succeed in those pursuits, and that's something Beilock says she will be happy to represent and foster at Barnard.

"Barnard is the best of both worlds, a stellar, small women's liberal arts college working in tandem with a large research university,” she says. “Our women take classes with Columbia students. Our faculty members are tenured" at both institutions. "Students have the ability to choose the path they want to take. It's really a singular experience."

Another initiative she worked on in the provost's office at Chicago was the oversight of UChicago Urban, a pan-university effort that seeks to enhance engagement between the academy and the city that surrounds it. Beilock, whose role at Barnard also carries the title of dean at Columbia University, hopes to reflect that experience in her new job as well — investigating "how research around urban education is actually implemented in urban schools, and what we learn from teachers and others in urban schools about the types of research questions we should be asking. That was fascinating work for me. I'm thinking of Barnard too as a part of the great city of New York."

She is also excited about her own research over the last few years on how to cut through young students' math anxiety. As a researcher, she uses "converging methodologies" in her work — behavioral performance measures like reaction time and accuracy, concrete stress markers like salivary cortisol, and neuro-imaging.

Parents who are anxious about math can transmit those anxieties, she says. "Anxious parents also tend not to want to do math with their children, and don't talk about it as much. We've published work over the past couple of years that shows that giving parents opportunities to do math in a fun and interesting way with their young children — maybe not just bedtime stories, but also bedtime math — can change how much children learn in math across the school year. It's especially true for parents who tend to be most anxious about math. I think it's really exciting that we can provide tools for children, and for parents to support their children in achieving up to their ability," Beilock says.

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09 Aug 2017

David Schwebel Taps Virtual Reality to Keep Kids Safe

David Schwebel Taps Virtual Reality to Keep Kids Safe
David Schwebel
APA Fellow David Schwebel not only studies the effects of mobile technology on pedestrian safety, but also harnesses virtual reality to help prevent injuries caused by distracted walking.

A young girl prepares to cross a busy street, her face plastered to a smartphone. Will she step off the curb and run for it or wait for a gap?

It may sound like a phone-happy, distracted pedestrian but it’s actually the reverse: The girl is using a smartphone—coupled with virtual-reality technology—to help her learn how to cross the street safely.

The experiment is the latest brainchild of APA Fellow David Schwebel, a leading researcher in child-injury prevention and professor of psychology at the University of Alabama at Birmingham (UAB), where he directs the UAB Youth Safety Lab.

Schwebel has created a sophisticated street-crossing training application that runs using software for a smartphone retrofitted with Google Cardboard—an inexpensive virtual-reality platform.

The user just places a phone into a cardboard or plastic viewer, and looks through its plastic lenses into a virtual world of traffic—complete with sounds and passing cars. The “traffic” moves at different speeds, with variances for car distances and gap sizes. When students judge it safe, they click a button and step off the virtual curb to cross the street.

“We record absolutely everything,” says Schwebel. “We know exactly when they choose to cross the street, their speed of walking, the speed of vehicles, which gaps they’re choosing, whether they enter soon after a car passes or if there’s a delay—which is a good proxy of their cognitive processing.”

The simulator lets Schwebel and his students study a dangerous task without putting children at risk—and it gives participants great practice for the real world.

While the intervention may be fun, the imperative for his work is deadly serious: Pedestrian fatalities in the U.S. leaped 11 percent to more than 6,000 deaths in 2016. Of the estimated 270,000 pedestrian traffic deaths worldwide, nearly half are youths.

Schwebel is among a surprisingly scant cohort of research psychologists working in the field of youth safety. His Youth Safety Lab is one of the few academic research centers in North America devoted to researching child safety, and is a major locus for research and student training.

“When you take a step back from pedestrian safety and realize that injuries are by a huge margin the leading cause of child death in America—and one of the leading ones globally—it’s pretty remarkable that more psychologists aren’t thinking about the behavioral aspects of it,” notes Schwebel.

Schwebel has published more than 200 peer-reviewed articles and conducts a wide spectrum of research at his lab: pedestrian safety, poisoning prevention, global injury prevention, dog-bite prevention, youth soccer safety, playground safety, lifeguard behavior, car-seat safety, among many others.

It’s enough potential danger to keep any helicopter parent permanently on high spin.

“Clearly at every age there are risks,” acknowledges Schwebel, “. . . but children as young as 18 months can be taught to follow rules and avoid injury.”

Although he has earned a reputation as a technologically innovative researcher, one of his most successful youth-safety interventions was decidedly low tech—and targeted caregivers as much as it did children.

He developed a “Stamp-in-Safety” program to help improve teacher supervision of preschoolers on playgrounds, where nearly 70 percent of preschool injuries occur.

“We said, the teachers are in the shade talking about their weekend and the kids are running around on the playground. How can we change this?” notes Schwebel.

The solution was simple: Give nametags to all kids and equip teachers with self-inking stamps. When teachers see a child playing safely they give him or her an ink stamp as a reward. “On the surface it’s rewarding the child for safe behavior,” notes Schwebel, “but underneath the goal was to change teacher behavior too.”

It was perhaps inevitable that Schwebel would become a psychologist. The son and grandson of psychologists—father Dr. Andrew Schwebel taught at Ohio State University, and grandfather Dr. Milton Schwebel was a dean at Rutgers University—psychology was “the family business.”

“I grew up with psychology as part of my life,” he says. “As a kid, I sometimes even went to APA conventions.”

Schwebel got a taste for applied research as an undergrad at Yale, where he worked with noted psychologist Jerome Singer. His mentor had been hired by creators of the Barney and Friends children’s television show on PBS to evaluate its effectiveness in teaching children.

“As much as parents got sick of the [theme] song, the show actually taught children a lot,” says Schwebel. “We had children watch the show, as well as getting lessons in school. Our research showed that children learned as much from the show as they did from their teachers on the same topics.”

Based on their findings, the show’s creators rewrote some episodes to increase their effectiveness. “That taught me how psychology could really make a difference,” says Schwebel.

He has carried that passion for applied psychology into much of his research, developing interventions that offer real-world tools based on data collected in his lab and in the field. In some cases, his work may have directly saved lives.

Several years ago, for instance, he was approached by an attorney representing a family whose toddler son had died from drinking torch fuel. It became one of several child-poisoning lawsuits against manufacturers.

In a series of studies, Schwebel and his researchers studied the shape, coloring and labeling of a variety of bottles to determine how likely preliterate children were to consider them as something safe to consume—or to avoid.

“We discovered, not surprisingly, that they were more likely to judge an opaque, black bottle as dangerous than a transparent torch-fuel bottle with juice-colored liquid inside,” says Schwebel, adding: “Then the company started packaging the product in a dark-colored bottle. I have to assume that my research played at least some role in that decision.”

Schwebel’s penchant for applied research and social justice also has resulted in many international research partnerships. He has worked with researchers to evaluate kerosene-safety practices in low-income South African communities and in rural Uganda, and conducted extensive research with partners in China.

”I enjoy working with people from other cultures and I also think I have some obligation,” says Schwebel, “because ultimately we conduct science to improve society. There is higher risk of injury in other countries so that’s a priority for me.”

One long-running collaboration with Iranian researchers, which because of political issues was conducted entirely through emails, highlighted self-immolation among young women in Iran.

“It’s devastating, culturally bound, and it tends to be low-educated young wives who . . . often have tough lives,” he says. “It sometimes leads to severe depression, and immolation is in many cases their only means to commit suicide.”

These days, Schwebel is focusing on getting his pedestrian-safety programs to scale big—and even hop continents.

A recent test run with schoolchildren in China was a big hit. The class went wild when the technology was introduced and the trainings netted great results. The PI on several grants from the NIH, Schwebel hopes to expand this work into other rapidly motorizing countries, including South Africa and Iran.

“With Google Cardboard all you need is a smartphone and a $3 piece of cardboard with a couple of plastic lenses and magnets. It’s not a high-priced device. And since smartphones are everywhere, even in low-income communities . . . it’s really feasible anywhere in the world,” he says.

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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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28 Jun 2017

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

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

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

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

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

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

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

Focus on accountability

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

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

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

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

Sustaining evidence-based practice

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

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

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

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

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

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

 

By Amy Novotney


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

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26 Jun 2017

Charlotte Patterson, at the Forefront of LGBTQ Family Studies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Importantly, this work confirmed her earlier findings.

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

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

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

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

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01 Jun 2017

Competent, Affirming Practice with Older Lesbian and Gay Adults

Competent, Affirming Practice with Older Lesbian and Gay Adults

With the number of lesbian and gay older adults expected to swell to nearly 7 million in the next decade, psychologists will increasingly be working with these clients.

"I am gay." A 65 year-old man, newly admitted to a nursing home, scribbled this statement on a piece of paper and slid it across the table to his new psychologist. The man held his finger up to his lips, looked cautiously out into the hallway and whispered "shhh" before taking the paper back and ripping it into tiny pieces.

This incident happened just three years ago, despite significant strides in gay rights in the United States. Fear of stigma and outright discrimination in a variety of health-care, institutional and social service settings continue to be documented among aging lesbian and gay (LG) adults, even among those who live in more socially progressive urban areas.

The number of people facing such discrimination is quite large: Approximately 3 million older adults in the United States identify themselves as lesbian or gay, and that number is expected to swell to more than 7 million by 2025.

And research shows these clients are not getting the care they need. The APA Task Force on Bias in Psychotherapy with Lesbians and Gay Men, for example, found that older LG clients may even be inadvertently mistreated by providers due to a lack of knowledge about this population and heterocentrism — the negative attitudes and behaviors associated with any deviation from heterosexuality. Compounding these challenges is that older LG adults are one of the least empirically studied populations in terms of their mental health needs and adaption of psychotherapy to best address those needs.

Historical and cohort effects

Among the most important concepts to consider when working with LG clients over age 50 is that all of them lived through a time when their sexual orientation was labeled immoral, illegal and pathological. Homosexuality was only officially removed from the Diagnostic and Statistical Manual in 1973. Gay and lesbian people who revealed their sexual orientation in their younger years often suffered significant psychological and physical abuse from the larger community, including verbal harassment and social isolation, as well as sexual and physical assaults. These experiences may present themselves in later life as diffuse anxiety, depression, somatic distress or even post-traumatic stress disorder.

APA Guidelines for Psychological Practice with Older Adults encourage psychologists to take into account the impact of being part of a generational age cohort (e.g., baby boomers) because experience and attitudes vary among age cohorts, including attitudes toward mental health services. LG baby boomers experienced significantly different historical events than did earlier age cohorts. For example, the oldest LG elders came of age in the 1950s when President Eisenhower's 1953 Executive Order #10450 called for homosexuals to be fired from government jobs. Few LG individuals openly discussed their status for fear of discrimination and violence since people who were found to be engaging in same-sex behavior could be and were sent to prison or mental hospitals. No federal or state laws protected LG individuals from victimization. The mental health establishment offered "treatments" to change homosexual orientation through certain psychotherapies, electroconvulsive therapy and hormones.

Previous generations of LG persons clearly experienced enormous social pressure to suppress sexual expression or hide sexual orientation. As a result, earlier generations of LG elders — the now oldest-old LG elders — are more likely to have married opposite-sex partners, and in late life have ex-spouses, adult children and grandchildren when compared with LG baby boomers. Compared with their oldest-old heterosexual peers, however, these oldest LG elders have fewer biological relatives available to assist them with instrumental and financial needs related to long-term health care.

In contrast, baby boomers came of age during the gay rights movement catalyzed by the 1969 Stonewall riot in New York City. These baby boomers grew up with the American Psychiatric Association's (1973) policy statement that homosexuality was no longer regarded as a mental disorder and the repeal of many states' laws that criminalized homosexual behavior. Due in part to these events, LG baby boomers may represent the first LG age cohort to be more inclined to seek mental health care. Future cohorts of LG elders (e.g., the millennials) will likely have different experiences compared with current generations of LG older adults, since they came of age when states began to recognize same-sex marriages. In summary, although every individual's experience of stigma and discrimination in relation to minority sexual orientation is unique, cohort effects remain influential.

Diversity among lesbian and gay elders

Aging LG adults who are members of ethnic and cultural minority groups, conservative religious affiliations or rural communities often face additional social stressors. For example, a 74-year-old black lesbian in Chicago may experience ageism, heterocentrism, sexism and racism, whereas a 62-year-old gay Latino man in rural Pennsylvania may face significant social isolation as well as ageism, heterocentrism and racism. Cultural or ethnic-minority LG elders may face additional forms of heterocentric discrimination within their own ethnic, cultural and religious communities. In contrast, some LG minority elders may be assigned positive qualities; Native American "two spirit" elders were traditionally revered and granted special social status.

Most research on LG adults has been collected from white, highly educated gay men living in urban areas. Very little is known about older LG minority elders, particularly in rural areas, who are black or Hispanic or the oldest-old. As a result, practitioners should never make broad assumptions about an older gay or lesbian adult. Similarly, practitioners should never make global assumptions about any client from any minority group.

The influence of ageism, heterosexism and racism (among other stigmatizing factors) upon aging sexual minority group members is likely to be cumulative and perhaps exponential beyond the negative impact of each individual type of discrimination. A study of older gay black men reported significantly higher levels of perceived ageism than older gay white men, significantly higher levels of racism than younger gay black men, and significantly higher levels of homonegativity (overt negativity and hostility in relation to their gay sexual orientation) than both younger black and white gay men (David & Knight, 2008). Unfortunately, stigma, discrimination and social isolation may substantially contribute to health disparities, barriers in long-term care and legal inequalities evident among LG people.

Physical, mental and sexual health disparities

According to the Centers for Disease Control and Prevention (2011), LG adults experience significant physical and mental health disparities compared with their heterosexual peers. Awareness of such discrepancies is vital when working with older LG clients. Concealing one's sexual identity from health-care providers can lead to ineffective or deleterious health care. Various reports indicate that more than 40 percent of LG adults age 50 and older suffer from at least one disability or chronic illness, and are more likely to smoke and engage in binge drinking than their heterosexual peers.

LG elders are also more likely to delay seeking treatment for physical health problems, and to experience increased risk of elder abuse and neglect. LG elders are two times more likely to live and age alone and four times less likely to have adult children to call upon for help and support. In fact, one in five older LG adults reported having no one to call on in a time of crisis, compared with only one in 50 older heterosexual adults (Brookdale Center on Aging, 1999).

Within the context of such limited social support, older U.S. LG adults appear to experience more mental distress than their same-age, heterosexual peers. Nearly one in three older LG adults from a large-scale study of more than 2,300 LGBT U.S. older adults reported that they lacked companionship and felt lonely, and met criteria for clinical depression on a standardized measure. In addition, nearly one in three older LG study participants indicated that they seriously considered committing suicide at some point in their lives, often in response to concerns about their sexual orientation. A study of older LG Europeans revealed similar findings, in which internalized homonegativity and social stigma contributed to mental health issues.

In terms of sexual health, older women in general often encounter vaginal dryness and older men experience erectile dysfunction and prostate changes. Gay male elders face increased risk of infection for HIV and other STDs, and both older gay men and older lesbian women face challenges in terms of poor or limited preventative screenings and clinical care. Although gay men represent about 2 percent of the general population, they account for nearly half of all AIDS related deaths and new HIV infections. Specifically, more than 17 percent of new HIV/AIDS cases occur among adults over age 50, with older men having sex with men, and older black and Latino men, at greatest risk. In addition, within the last decade, new HIV diagnoses among adults over age 50 increased by more than 30 percent. Regrettably, no national HIV/AIDS education programs exist for older adults, much less an aging gay male population.

Older gay men in committed relationships also are more likely to face the diagnosis and treatment of prostate cancer than older heterosexual men. A committed gay man may have to face both his own and his partner's diagnosis of prostate cancer. Like their heterosexual peers, older gay men often have limited and incorrect knowledge about prostate disease, and older black gay men possess the least accurate knowledge. Therapists can encourage older gay men to discuss their prostate health openly with both their medical providers and their own partners. Education about prostate health, as well as its treatment options, remains essential.

A primary concern for older lesbians is a failure to disclose information about their sexual orientation and history to their health-care providers. Despite prevalent myths held by both older lesbians and health-care providers that lesbians are immune to the transmission of STDs, nearly half of older lesbians report having heterosexual intercourse at some point in their lives, and 20 percent of all women who never had heterosexual intercourse are infected with the HPV virus, the primary cause of cervical cancer. Older lesbians should receive educational messages about their individual risk factors for STDs and screenings when appropriate. Therapists can encourage older LG individuals to discuss concerns about their sexual health, and help them communicate more effectively with their health-care providers, who are unlikely to discuss STDs with their older patients, regardless of their sexual orientation.

Caregiving and long-term care

A survey of more than 1,200 LG adults found that LG elders are twice as likely to serve as a caregiver for a parent, family member, partner, friend or neighbor, and spend significantly more hours per week providing that care, compared with their heterosexual counterparts. This finding supports the notion that older LG adults maintain a "family of choice" well beyond biological and legal boundaries. The psychological, physical and financial demands on this population should not be overlooked.

Significant challenges also exist for LG adults in long-term care facilities. Discrimination, including outright hostility and substandard care, is well documented among LG residents in nursing homes and other institutional settings. Professional caregivers hold significantly more negative attitudes toward sexual activity among same-sex than heterosexual residents. Such negativity and hostility can even take the form of physical abuse.

Challenges to living authentically

Both fear of discrimination and fear of living an asexual lifestyle within a long-term care setting lead the majority of older LG adults to report that they want to live independently in their own homes, for as long as possible. To complicate matters, only 22 states have passed laws that prohibit discrimination based on sexual orientation in public or private housing. In other states, a nursing home or public housing administrator can simply refuse to admit an LG individual with no legal recourse available to that individual.

As a result, many LG residents in long-term care, including those who have lived authentically, feel compelled to "go back into the closet." Some LG partners legally change their last name to match that of their partner's, so they can live in the same room as "brothers or sisters." Other LG residents decide to act straight, while others hide personal photos of partners and other mementos to avoid revealing their LG status. A therapist's knowledge of these unique challenges and information about available resources is essential.

Legal issues and a call for advocacy

It is also vital for psychologists and their LG clients to become familiar with changing federal and individual states' laws regarding same-sex marriage, civil unions and discrimination on the basis of sexual orientation so that they understand the benefits they are entitled to in care facilities as well as through government programs including Social Security and Medicare.

In 2013 the U.S. Supreme Court struck down Section 3 of the Defense of Marriage Act (DOMA; United States v. Windsor, 2013). That ruling granted same-sex married couples access to more than 1,000 federal rights, including 401(k) survivor and hardship withdrawal benefits, coverage under the Family and Medical Leave Act (FMLA), COBRA benefits, savings on federal inheritance taxes, veteran's benefits and green cards for binational couples. The DOMA ruling also granted same-sex married partners access to federal Supplemental Security Income, disability, death and spousal benefits. In addition, the federal provisions for Medicaid spend-downs — which are designed to keep a healthy spouse from losing his or her home and becoming bankrupt when paying for the nursing home care of an ill or disabled partner — also now apply to same-sex married couples. In 2015, the Supreme Court further ruled that individual states could no longer deny same-sex couples the right to become married.

Studies show, however, that lesbian and gay adults who live in states that fail to provide protection against hate crimes and employment discrimination based on sexual orientation were significantly more likely to be diagnosed with depression, dysthymia, generalized anxiety, and post-traumatic stress and alcohol abuse disorders than those living in states that did provide such legal protection. Allowing LG clients to express their anger and frustration in therapy about such legalized forms of discrimination is essential. The need for psychologists to advocate for public policies and state and federal laws that prohibit discrimination based upon sexual orientation is urgent and clear.

Adaptation and resilience

Although LG elders represent a unique, at-risk population, they also display evidence of significant adaptation and resilience. More than 80 percent of LG adults report that they engage in some type of wellness activity. A qualitative study of older LG adults suggests that many learn to cope with a stigmatized identity by developing a strong sense of independence, autonomy and inherent self-worth, as well as by establishing interests outside of their families and careers. Some researchers posit that successful coping in response to the stress of coming out may better prepare LG adults for life in an ageist society.

Social support is a critically important part of life that allows someone to adapt and adjust more easily to life changes and crises. One difference observed between LG and heterosexual elders is that LG elders typically garner more social support from friends and "family members by choice" than legal or biological family members. Although long-standing social norms suggest that family members are expected to provide instrumental support (such as financial help and caregiving), LG individuals have historically developed meaningful, supportive friendship networks, in part because their own families may be unsupportive of their sexual orientation. With a broader social network, LG elders are often better equipped to gather different types of support from multiple sources compared with their heterosexual peers.

Implications for practice, advocacy and research

Clinical settings can help LG elders feel more comfortable and accepted in a variety of ways. For example, therapists can change the language on intake and other forms to ask about one's relationship versus marital status, and about family members by choice. They can also alter the physical environment in offices, waiting areas and websites by displaying or linking to magazines that reflect both LG and aging readership (such as Out More and AARP), or with pictures featuring LG couples and families from a variety of ages, racial, ethnic and cultural backgrounds. Therapists also can celebrate National Coming Out Day, World LGBT Pride Day and other LG-affirming events. For example, psychologists played a key role in U.S. Department of Veterans Affairs efforts to make VA health-care facilities more welcoming for LGBT veterans by working to develop more inclusive hospital visitation policies and establishing a policy on respectful care for transgender veterans.

To provide competent practice, psychologists themselves must examine their own attitudes toward both older and LG adults, particularly if coming from a culture or religious affiliation that does not affirm an LG orientation. Therapists also are advised to train staff and post a nondiscriminatory statement that equal care will be provided to all clients regardless of their age, sexual orientation, ethnicity, race, religion, physical ability and attributes, and gender identity. Simple exposure and familiarity with LG elders can reduce stigma and alert minority clients that options are available for competent, affirming care. Fostering the resilience of LG elders, including the nonfamilial exchange of care, participation in formal and informal LG and aging support groups, and increased health advocacy for HIV/AIDS, is highly desirable.

Consistent with the APA Practice Guidelines for older adults as well as those for LG adults, psychologists are encouraged to engage in advocacy for their clients as well as for LG elders at large to promote social justice and civil rights. Specifically, psychologists can advocate for changes in individual states to pass antidiscrimination laws that benefit older LG adults. Such laws would include protections against hate crimes and discrimination in private and public housing, including both nursing homes and assisted-living facilities. Of course, simply passing an antidiscrimination law does not prevent such discrimination; it only provides legal recourse for those affected.

To provide a safe and welcoming environment for LG elders in long-term care, same-sex couples should be able to share a room. To make this happen, staff training and even resident education are likely to be necessary. The VA training model and a staff training curriculum on LGBT elders developed by the National Resource Center on LGBT Aging are good resources.

Conclusion

Significant physical, sexual and mental health disparities exist among older LG adults when compared with their heterosexual peers. As more egalitarian same-sex laws are adopted by a variety of individual states in the United States, psychologists can play a critical role in advocacy for state and local legislation that prohibits discrimination based upon sexual orientation and will benefit the growing population of aging LG adults. Therapists also are encouraged to seek education and training on the unique challenges often faced by older LG adults, and to provide an LG-affirming practice to better serve this burgeoning, diverse population.

Jennifer Hillman, PhD, is professor of psychology at the Pennsylvania State University, Berks Campus.

Gregory A. Hinrichsen, PhD, is assistant clinical professor in the department of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai and clinical associate professor in the department of psychiatry and behavioral sciences at the Albert Einstein College of Medicine.

By Dr. Hillman and Dr. Hinrichsen, both whom are board certified in geropsychology.


This article is adapted from "Promoting an affirming, competent practice with older lesbian and gay adults" from Professional Psychology: Research and Practice, Vol. 45(4), August 2014, 269–277. The full article, which includes case studies and citations, appears at http://www.apa.org/pubs/journals/affirming-competent-practice.pdf.

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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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26 Apr 2017

Gregory Ball and the Adaptiveness of Behavior

Gregory Ball and the Adaptiveness of Behavior
Gregory Ball
APA Fellow Gregory Ball has spent most of his academic career studying animals and birds, and using the findings to develop understanding about the human brain and behavior.

Growing up, Gregory Ball, PhD, learned a lot about birds from his father, who did his undergraduate and graduate studies in zoology. “He wanted to be an ornithologist,” he recalls, speaking to the American Psychological Association from his office at the University of Maryland, where he is a professor and dean of the College of Behavioral and Social Science and APA Fellow.

That experience helped shape Ball’s own future interest and research on the interrelation of hormones, the brain, and reproductive behavior. By studying nonhuman animals, in Ball’s case birds, “you can study relationships between the brain and physiology in a way that you can’t in primates and humans,” he said.

In his lab at the University of Maryland, his team is studying how the perception of song induces gene expression in the brain of birds and how early experience with different kinds of song might affect that gene expression. They also recently published a study looking at how hormones interact with the dopamine system to affect sexual motivation. “Hormones do their work by modulating neurotransmitters and we’re trying to understand the circuit that they interact with to do that,” he said. According to the study, the projection from the preoptic area of the brain to the ventral tegmental area, where the dopamine of one of four major dopamine systems originates, to the accumbens, which plays a significant role in the cognitive processing of aversion, motivation, reward, and reinforcement learning, is very important in that process.

One of the Ball’s favorite recent findings to come out of his lab is related to steroids. “People think that a steroid has a very general effect on behavior – that it just makes you more motivated, or stimulated to do something,” Ball said enthusiastically.

“And we’ve done experiments where we’ve put tiny amounts of hormones or hormone blockers on the brain and we’ve shown that hormones actually act in multiple parts of the brain in specific ways to modulate behavior. For instance, the desire to sing is controlled in one part of the brain, but the control of how well you produce song in a temporal fashion is modulated in another part of the brain.”

Ball first got swept up in the studies of brain function and behavior in animals while studying at Columbia University. He took his introduction to psychology course with Dr. Herbert S. Terrace, who, among other things, led the famous study of animal language acquisition in the chimpanzee Nim Chimpsky. Ball began working with Terrace, who had studied under B.F. Skinner, the year after he began working with Chimpsky. He was intrigued by the studies of brain function and behavior in animals at Columbia (along with the then-contentious, now-settled debate between behavioral and cognitive psychologists) and began his longtime specialization in experimenting on pigeons.

Under Terrace, they employed the Skinnerian approach, which doesn’t take into the account private events – like thinking, perceptions, and unobservable emotions – as causes of an organism’s behavior. Ball said he sensed something was missing in studying the pigeons this way.

“They didn’t know if they were males or females, they didn’t know anything about pigeons. They were just animals that you put in the box and you saw how the stimuli affected them. And this is that Skinnerian notion that the organism didn’t really matter – that the contingencies of reinforcement were so powerful that the same thing that happens in a pigeon could be programmed to happen in [other animals].”

Despite disagreeing with the Skinnerian approach, he learned in his early work in Terrace’s lab that he could parse and further understand many topics related to the brain and behavior by looking at nonhuman animals. He began to understand the potential for studying animals other than humans and use the findings to develop understanding about the human brain and behavior.

Around that time, he met Dr. Rae Silver, who had just come to Columbia University and was studying the parental behavior of doves in their natural habitat. He became her first research assistant at the university, which he said was a key event in his career as a psychologist.

“It was another milestone in my career because I realized ‘Oh, this is it!’ You study the animal on its own terms, you study the natural behavior of the animal, and try to glean what you can about the general principles of physiology and the brain related to behavior,” Ball said. “And that’s when I sort of saw that by studying these relationships in animals, you can understand the evolution, the adaptiveness of behavior and put it in the broader natural context.”

After his formative years at Columbia, he earned a PhD in psychobiology at Rutgers University, and completed his postdoctoral work in comparative neuroendocrinology and ethology at Rockefeller University. Prior to getting hired by the University of Maryland in 2014, he taught at Rutgers, Boston College, and Johns Hopkins University.
Today, as dean of the College of Behavioral and Social Science, much of his time is filled with administrative tasks, but he still finds time to pop over to the lab and check on his staff’s research while sharing encouraging stories to inspire the next generation of academics to follow their dreams.

One story he always enjoys retelling is about growing up right down the street from the University of Maryland and how on one summer break from his studies at Columbia, he took a job cutting the institution’s grass.

 “[I tell them] I used to mow the lawn of the building that I’m now dean of,” he says with a chuckle.

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