23 Jun 2017

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

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

Matthew McMahonSpeaker:

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

Garth FowlerHost:

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

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20 Jun 2017

Stop Wasting Time: Keys to Great Meetings

Stop Wasting Time: Keys to Great Meetings

Whether it's a gathering of health-care providers, faculty, students or a mix, here's how to make your meetings productive

Meetings that start late, last too long and accomplish little can stress attendees far beyond that lost hour, says Steven Rogelberg, PhD, of the University of North Carolina at Charlotte who studies meeting science. Research shows bad meetings can lead to job dissatisfaction, employee fatigue and what he calls "meeting recovery syndrome"—time spent cooling off after a frustrating meeting, which often includes destructive commiseration with colleagues.

"The next thing you know, the weight of the crappy meeting is higher, and it can spill over into other areas of work," he says.

How can everyone make meetings more effective, even enjoyable? The best gatherings happen when meeting leaders view themselves as stewards of everyone else's valuable time, says Rogelberg. Good stewards plan meetings thoughtfully, manage group dynamics, find out in advance why people want to meet and promote other people's contributions rather than their own.

Here is more wisdom from experts for attendees and leaders on how to meet-up better.

Be on time. Arriving late to meetings undermines productivity from the start—and upper management members are often the worst offenders, says Daniel Post Senning, co-author of "The Etiquette Advantage in Business" and great-great-grandson of manners guru Emily Post. "Often, they believe the rules don't apply to them."

Lateness may cause more than irritation: In a paper under review, Rogelberg and Joseph Allen, PhD, found that when a person showed up less than five minutes late for a meeting, productivity didn't suffer. But when an attendee or leader showed up five to 10 minutes late, "satisfaction, effectiveness and productivity of the meeting dropped dramatically," says Allen, an associate professor of industrial-organizational psychology at the University of Nebraska at Omaha.

Wallace Dixon, PhD, psychology department chair at East Tennessee State University, leads by example by starting and ending his monthly faculty meeting precisely on time. "If you don't, you insult the people who got there on time, reward the people who got there late and convey to everyone their time isn't that important," he says.

Be prepared. Arriving "late, frazzled, with nothing but a leaky coffee cup doesn't leave a good impression," Senning says. Bring something to take notes with and a steady attention span. Complete any assigned reading in advance. "Nothing is worse than showing up to the meeting and finding that no one has read the documents that [you sent, and] you then have to explain to everyone what they should have read," says Allen.

Make your phone (mostly) invisible. Despite the leave-the-device-at-the-door practice made popular by President Obama and Amazon, in most settings it is considered OK to bring your smartphone to meetings if you keep your attention on the speaker, says Senning. He recommends telling people in advance if you plan to use your phone to take notes or images of PowerPoint slides. But if people are gravitating to their devices in meetings, it may be a sign that the meeting needs to be more engaging, says Rogelberg. "Devices are signals," he says. "Psychologically, the person is trying to regain control of the time."

Diversify the discussion. No one attendee should monopolize the conversation—and no good facilitator should let anyone do it. Dixon says he will pull faculty aside later if they are talking too much in meetings because it bothers other staff and "they will lose faith in you as a leader if you don't handle it," he says. All attendees can share in that responsibility by making an effort to contribute even if public speaking isn't their forte, says Allen. His research has shown that when people make an effort to participate in a meeting—especially when there is a decision-making component—they are happier with the meeting's result and the meeting is more effective.

Move it along. Dixon places a time limit on each discussion item when he plans his faculty meetings and enforces those limits with his smartphone's timer. Another way to prevent run-on discussions and create a sense of urgency, Rogelberg says, is to switch from hourlong weekly or monthly meetings to shorter, more frequent "huddles": 10- to 15-minute meet-ups designed to save time and boost efficiency. If a leader has a difficult time staying on task, any attendee can help move a meeting forward by tactfully redirecting his or her attention to the agenda, says Allen.

Be constructive. Meetings can unravel when attendees cut one another off, dismiss each other, hold side conversations or argue. Avoid such tension, such as by saying, "I agree with some of what you're saying" instead of a short-tempered, "I just don't agree with you," says Brenda Fellows, PhD, of the Haas School of Business, University of California. Along those lines, Dixon advises the department chairs he mentors never to put a contentious issue to a vote in a meeting because it makes people uncomfortable. "Voting only divides, it never unites," he says. "When you resort to a vote, you have stopped talking."

Additional reading

Participate or Else! The Effect of Participation in Decision-Making in Meetings on Employee Engagement
Yoerger, M., Crowe, J., & Allen, J.A. Consulting Psychology Journal: Practice and Research, 2015

Meeting Design Characteristics and Attendee Perceptions of Staff/Team Meeting Quality
Cohen, M.A., Rogelberg, S.G., Allen, J.A., & Luong, A. Group Dynamics: Theory, Research, and Practice, 2011

"Not Another Meeting!" Are Meeting Time Demands Related to Employee Well-Being?
Rogelberg, S.G., Leach, D.J., Warr, P.B., & Burnfield, J.L. Journal of Applied Psychology, 2006

By Jamie Chamberlin


This article was originally published in the December 2016 Monitor on Psychology

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20 Jun 2017

Psychology Offers Many Options When It’s Time to Take a Different Direction

Psychology Offers Many Options When It’s Time to Take a Different Direction
Patricia Arredondo, EdD, had been working as an assistant professor for three years at Boston University when she realized she had to re-route her career plans. Even though she had a strong track record of publications and was leading a three-year federally funded grant, a professor told her she was not going to get tenure.

The news rattled her confidence, but also fueled her motivation to seek out alternatives. So, she attended career planning workshops and evaluated her interests and skills. At a guided meditation at one of the workshops, Arredondo imagined what she wanted to be doing in 10 years, and envisioned a job that would allow more creativity and interaction with the public.

That reflection led her to launch Empowerment Workshops Inc., a consulting business focused on helping companies create and implement a diversity strategy in the workplace, often working to increase the presence of women and ethnic minorities. "Each time it was like working with a new client in therapy because every organization had a different narrative to tell, and the variety gave me an opportunity to be creative and adaptable," she says.

Arredondo later returned to academia when she was ready for another transition, and eventually moved into administrative roles at several universities. Her latest position was president of the Chicago School of Professional Psychology, Chicago campus.

Arredondo's story is just one example of a psychologist who for one reason or another decided to make a career change.

"We all experience some type of work transition whether we choose it or not," says Patrick Rottinghaus, PhD, an associate professor of counseling psychology at the University of Missouri in Columbia. "The occupational landscape is different now than in the past. Most people shift careers multiple times."

Some are forced to make changes involuntarily when there are layoffs, an organization closes or senior workers are asked to retire, says Nadya Fouad, PhD, chair of educational psychology at the University of Wisconsin–Milwaukee. Some make subtle changes by, for example, moving from one practice specialty area to another. Others retire and take on psychology-related volunteer work. Others voluntarily opt to revamp their careers when they start feeling restless or want to gain new expertise.

"Most people who choose to make a change voluntarily have been thinking about it for a long time," says Sue Motulsky, EdD, associate professor of counseling and psychology at Lesley University in Massachusetts. "They may start noticing signs of burnout, such as loss of interest in what they're doing, mistakes and lack of judgment or increased impatience."

Whatever the reasons may be for contemplating a new direction, the prospect of making a career shift can be daunting. Here's some advice from experts in vocational psychology and psychologists who have successfully navigated a transition.

See a career counselor

The process of career transition is not easy, and it is especially difficult to do in isolation, says Motulsky, who maintains a private practice in career counseling in addition to her work as a professor. "This is almost impossible to do by yourself, and a counselor will help you start the journey of exploring your options."

A counselor can provide self-assessment inventories that will tease out vocational interests, skills, values and life roles, which all come into play when making a career change, explains Rottinghaus. Motulsky also encourages psychologists to consider seeing a career counselor who has a doctorate because he or she will understand what is involved in earning this degree and how that investment of time and money can influence career decisions.

Listening to your frustration can be good

Sherry Benton, PhDSherry Benton, PhD, felt overwhelmed by the demands of directing a university counseling center, but her frustration took her in a different direction.

"I really liked doing therapy and working with students, but I found it intolerable that we didn't have the capacity to treat everyone who needed help," says Benton, who directed the Counseling & Wellness Center at the University of Florida. "If we made students wait a month for an appointment, that could have a significant impact on their well-being."

She searched for models to increase access and capacity, and discovered a tool in Australia that used brief phone contact with a therapist and online educational modules to teach cognitive behavioral strategies. She created her own version of the program, which included interactive online education and a dashboard that enabled therapists to track a patient's progress. For example, therapists could see details of patient entries in the interactive exercises and how patients were rating their behavioral health at different points in time. She tried the new model at the wellness center, and it was so successful that she started a business to market the product.

Benton hired four employees, and TAO (Therapist Assisted Online) officially launched in July 2015. TAO offers online tools for client education, interaction, accountability and progress assessment. For example, the modules include animation and real actors portraying situations that clients can relate to as well as interactive exercises.

"It's really scary and completely worth it," Benton says. "It's satisfying to pursue your dream and make it happen, but it's not easy. I would describe it as a mix of elation and terror."

Be honest with yourself

Robert Youmans, PhD and familyRobert Youmans, PhD, started his career as an assistant professor specializing in applied cognition, but he slowly discovered that the world of academia what not what he had envisioned. Although he enjoyed teaching—first at California State University, Northridge, then at George Mason University in Virginia—it was difficult to find funding in his area of interest, design thinking and processes.

Living on a faculty salary was also trying, and he started consulting on the side to supplement his income. He founded Human Factors Design Consulting and worked with companies that needed his expertise in user experience research. The work was lucrative, and he enjoyed building new products. "It was an odd experience," he says. "On one hand, I had more work offers coming in from companies than I had time to accept, but at the same time I had trouble getting funding to study those areas within academia."

He made numerous contacts through his business, and they would often suggest that he apply for full-time positions at their companies, but he wasn't ready to leave academia. Finally, in 2013 he was open to a career change. He and his wife were expecting their first child, which elevated his sense of financial responsibility. In 2014, he accepted a position as a user-experience researcher in a product area called Streams, Photos and Sharing at Google.

"When I was younger I had these romantic notions of what it meant to be a professor, but the day-to-day of being a professor wasn't always what I had hoped it would be," Youmans says. He knew he would miss teaching, and was nervous about leaving his colleagues and job security, but he hasn't looked back. "Now I'm doing interesting and rigorous science research—and I earn many times what I earned in academia," he says.

Be open to change

Andrew Adler, EdD, had worked as a school psychologist in Nashville, Tennessee, for 28 years when he started considering retirement. He was surprised when a recruiter called to see if he was interested in a job as a mental health clinical director contracted to the Tennessee Department of Correction. He had experience working with students whose parents were incarcerated, and had previously consulted as a psychologist in the Tennessee prison system. So, recognizing he had the right background, he accepted the job in 2012.

"School psychology set me up well for working in a prison," Adler says. "Prisons, like schools, serve all of society and have people with a range of social problems and diagnoses. Inmates are ripe for remedial and rehabilitative support."

Like Adler, Joyce Jadwin, PsyD, started working in the prison system a few years ago. Unlike him, it was her first full-time job as a psychologist. She managed a program for female sex offenders in Ohio, but after a year in the role she realized the work was not a match with her interests.

"I wanted to use skills beyond being an individual provider," says Jadwin, who had worked as a college administrator before she earned her doctorate in psychology. "I was used to making independent decisions and influencing policy and procedure."

Jadwin applied for a role as assistant director of faculty development in the medical school at Ohio University, and got the job. "My psychology training allows me to bring a clinical perspective to my role, which gives me credibility with physicians because I understand what they are going through in the medical world."

Start now

Although it's natural to implement many of these strategies when a job transition is imminent, Rottinghaus urges psychologists to take time to nurture career development each year. He often uses Jane Goodman's "Dental Model," which advises people to conduct a career check-up annually, like a regular visit to the dentist. Taking time regularly to evaluate job satisfaction and reiterate long-term goals can reduce the chances of frustration later, he says.

"Strategically engage with mentors over time, even when times are good," Rottinghaus says. "Once you get out into the workforce, nurture those mentoring relationships so you can articulate your professional objectives. Mentors are there to provide support, and they may have connections if you need to transition into another role or setting."

Without such strategies and an overall plan to guide them, people are at risk of letting others define their career trajectories and reacting to events rather than defining their own future, he says. In fact, most people who make a career transition wish they had done it sooner, says Motulsky.

"If you let yourself explore different options that you are drawn to, you may discover something that will make life more satisfying and meaningful," she says. "I've seen many people go through the career process and find a job that makes them far happier, which is important because most people spend a lot of time at work."

Ready for a change?

  1. Talk to a career counselor to guide you through self-assessment.
  2. Listen to your frustrations since they can lead you to new paths.
  3. Do a gut check. Is this really what you want in your life?
  4. Don't wait. Most people who make a switch wish they had done it sooner.

By Heather Stringer


This article was originally published in the September 2016 Monitor on Psychology

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20 Jun 2017

New Licensure Test on the Horizon

New Licensure Test on the Horizon

A new licensure test is on the horizon. What is it and why is it necessary?

The Association of State and Provincial Psychology Boards (ASPPB) announced in March that its board of directors had approved a plan to develop an additional licensure exam that would complement the existing test. The new exam, called the EPPP (Examination of Professional Practice in Psychology) Step 2, would focus on assessing skills, while the existing EPPP would continue to test knowledge.

The announcement about the EPPP-2, which may become a requirement as early as January 2019, is evoking mixed responses in the psychology community.  

"I can definitely support the idea that there is a need to test skills because there are inconsistencies in training, but I'm worried that it will be expensive and yet another hoop that students are going to have to deal with," says Christine Jehu, PhD, chair of the American Psychological Association of Graduate Students (APAGS).

For others, the announcement was primarily welcome and perhaps long overdue news. "The competency movement has been going on for 30 years in psychology, and this new test is very consistent with a number of initiatives APA has been involved with," says Catherine Grus, PhD, deputy director of APA's Education Directorate.

In 2004, for example, APA formed a task force that studied then-current practices in competency assessment within psychology and other health professions. Two years later, the group released a report recommending that psychology develop a mechanism to test knowledge, skills and attitudes. The EPPP tests knowledge, but not skills and attitudes, Grus says.

"There are hundreds of different psychology training programs and practicum and internship sites, all with different supervisors and no common standard," says ASPPB CEO Stephen DeMers, EdD. "We have to find a way to keep the process of education credible and the profession relevant."

While APA accreditation holds schools to a certain standard of education, relatively few states have licensing laws that require psychologists to graduate from an accredited school. Even if all states required graduation from an accredited program, the field still needs to develop a method of screening candidates for licensure, DeMers says. "Accreditation evaluates an entire program, but licensure depends on competency of an individual," he says.

A test of skills is also in line with competency testing models used for other medical professionals such as MDs, says Eddy Ameen, PhD, director of APA's Office on Early Career Psychologists. "Proper competency assessment is an important part of what it means to be a psychologist. It ensures that all who treat the public have a minimum universal skill set."  

DeMers hopes that the EPPP Step 2 ultimately will help psychologists increase their clout when lobbying third-party payers for reimbursement coverage and government agencies for federal programs. "I think we lose opportunities in these areas when we are not demonstrating a maintenance of competence," he says. "For that reason, I think this change is exciting and also necessary." 

The path to a new test

The ASPPB initially explored the idea of developing a skill-based exam in the 1990s when it investigated an approach called latent image testing that was touted as a method of evaluating an applicant's decision-making process during a practice scenario. It was a paper-and-pencil version of today's electronic adaptive testing, which tracks the number of correct responses and how efficiently people move through a test. ASPPB abandoned the idea because it was cumbersome and did not seem to adequately assess the complex decision-making involved in psychology treatment scenarios, DeMers says.

ASPPB revisited the concept of competency testing about eight years ago, and in 2010, appointed a task force to review the literature on the topic. The group started gathering information from other professions (such as medicine, nursing and pharmacy) that were already involved in skill-based assessments and surveyed licensed psychologists to determine the criteria for the skills testing.

The task force suggested that ASPPB move forward with developing a skill-based test that would assess competency in the following areas: scientific orientation, professional practice, relational competence, professionalism, ethical practice and systems thinking.

Who, when and how much?

While there may be advantages to updating the licensing process, ASPPB recognizes another expensive test may seem daunting to new graduates. Many new graduates already carry considerable debt and are paying multiple fees for state boards where they are applying to practice, Jehu says.

ASPPB's goal is to keep the cost of Step 2 comparable to the EPPP, which is about $700, DeMers says. This will be challenging because the new test will likely use more expensive technology than Step 1, such as computer-based simulation, taped scenarios and possibly avatars.

"There will be a lot of upfront costs, but this has to happen and it's our job to make it as low-cost as possible," DeMers says.

In addition to cost concerns, some early career psychologists question whether it is wise to wait until the conclusion of training to weed out potentially incompetent psychologists. "If the goal is to be consistent with other degree programs, then why would we wait until so much later than medical programs, which test individuals throughout their training program as a uniform national standard?" says Samantha Rafie, PhD, an early career psychologist at Bay Area Pain and Wellness Center in California.

DeMers says that once the EPPP-2 is available, it may be possible to begin offering Step 1 before internship. This would mean the first test could be given immediately following coursework when knowledge is easier to recall. This could potentially reduce the need for people to spend money on expensive test preparation materials, he says.

"Moving the first test earlier could also allow students to use loan money to help cover the cost of the test," Jehu says. "There would also be more peer support when studying for the test if students are still at school."

Another question within the psychology community is who will be required to take the test. Rafie is already licensed, and she is concerned that she would have to take EPPP-2 if she wanted to move outside of California to practice. ASPPB will recommend that its member jurisdictions not require Step 2 for previously licensed psychologists with no record of complaints or discipline, DeMers says. For those who will be seeking a license after Step 2 is required, ASPPB will recommend to its member groups that psychologists only take it once to work in any state or Canadian province.

What's next

Before ASPPB will be ready to start offering the test, the organization needs to develop a blueprint for the exam, train psychologists to write the questions and conduct beta testing. They welcome help from psychologists who are interested in writing questions for the test or beta testing it. People interested in helping can email ASPPB Chief Operating Officer Carol Webb at cwebb@asppb.org.

Although the Step 2 is a costly and time-consuming endeavor for both ASPPB and graduates of the future, Grus is optimistic that advantages of updating the testing process will be felt throughout the psychology community.

"ASPPB has to be responsive to a society that trusts psychology to be a profession that is populated by individuals who are well trained," Grus says. "I think Step 2 will establish that psychologists are holding themselves accountable and we value our profession."

By Heather Stringer


This article was originally published in the July/August 2016 Monitor on Psychology

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20 Jun 2017

What Do Superheroes and Psychologists Have in Common? monitorLIVE Event Explores the Intersection of Passion and Profession

Much like superheroes, psychologists often have origin stories—impactful events that have shaped their professional identity and defined their mission. This was a major theme of the June 1st monitorLIVE event in Los Angeles, during which clinical psychologist and superhero enthusiast Andrea Letamendi, PhD, shared her origin story that began as a graduate student.

As Dr. Letamendi explained, her origin story was marked by an experience of, “psychic disequilibrium," which occurs when individuals do not see their own identities reflected in their environment. As a graduate student, Dr. Letamendi rarely saw herself represented in her chosen field of psychology—she met few psychologists who shared her cultural background, history of immigration and discrimination, or passions and hobbies, including comics.  This struggle activated her personal supervillain, “Imposter Syndrome.” The villain resurfaced during stressful times such as during comps and dissertation research, making her feel like she did not belong in graduate school or in the field.

She was finally able to defeat the Imposter Syndrome villain with the antidote of being her true professional and personal self. She had been ignoring her love of comic books, which was a large part of her authentic identity. She did not know that the field of psychology offers a variety of career options and many ways to incorporate hobbies and interests into professional careers. She became a true superhero when she combined her passion for comics with her background in psychology to create her side hustle, an extra income stream that allows people to pursue an interest while keeping their full-time job.

Dr. Letamendi shared that side hustles can restore the professional identities of practitioners, helping them remember why they were initially drawn to the psychology field. Side hustles also help with daily burnout and compassion fatigue. She now connects her identity with her psychology background through her podcast, “The Arkham Sessions,” where she analyzes every episode of “Batman: the Animated Series” through the lens of a clinical psychologist. She examines characters and analyzes their behaviors and personalities. Dr. Letamendi’s childhood dream came full circle when DC Comics made her Batgirl’s psychologist in one of its published stories.

The point to a side hustle is not only to make money, but also to fulfill one’s creative passion. This is why Dr. Letamendi’s podcasts are free, in the spirit of “Giving Psychology Away.”

Dr. Letamendi’s mission, shaped by her origin story, is to increase public knowledge of mental health and to encourage help-seeking among people who would not otherwise seek treatment. Although she accomplishes this mission through her daily work, her side hustle gives her the opportunity to live and work authentically.

monitorLIVE events connect psychology professionals and thought leaders to learn about and discuss issues that impact and elevate the discipline. Keep an eye out for future monitorLIVE events coming to a city near you.

Review photos from monitorLIVE: Los Angeles. This networking event from APA brings together psychology professionals and thought leaders to learn about and discuss issues that impact and elevate the discipline. The featured speaker in Los Angeles was clinical psychologist and superhero enthusiast, Andrea Letamendi, PhD. Dr. Letamendi offered her perspective on fusing a psychology background with a passion to open career opportunities one may never have considered.

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19 Jun 2017

Managing Staff and Organizations in Support of Practice Excellence

Whether you have one part-time clinical or administrative staff member, or you are an owner of a large inter-disciplinary group, you are an employer. Having employees (or independent contractors) adds complexity and responsibility. This webinar focuses on addressing these demands to promote excellence in service delivery via employment contracts, policies and procedures, and mentoring to promote staff development. During this presentation you will learn the following:

• Your practice as an employer
• Are you a "family"? - The importance of contracts, policies and procedures
• Integrating your vision into management decisions
• Hiring staff (challenges, 1099 or W-2, compensation and benefits)
• Ethical and regulatory compliance (HIPAA, 1099, interviewing, sexual harassment, etc.)
• Mentorship and staff development (administrative and clinical)

Learning Objectives 1
List the advantages of having contracts as well as policies and procedures as part of the administrative structure of their practice.

Learning Objective 2
Describe the intersection of running a practice with professional ethics and regulatory obligations.

Learning Objective 3
Discuss the importance of effectively mentoring staff and promoting staff development.

*This program does not offer CE credit.

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

 

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05 Jun 2017

Research-Based Strategies for Better Balance

Research-Based Strategies for Better Balance

1. Practice mindfulness. Numerous studies have demonstrated that mindfulness has benefits for body and mind, reducing stress and depression and even boosting immune function. It can also be instrumental in maintaining work-life balance. In a study of working parents, psychologist Tammy D. Allen, PhD, found people with greater mindfulness reported better work-family balance, better sleep quality and greater vitality (Journal of Vocational Behavior, 2012). "Cultivating a habit of self-awareness is vital," says John Christensen, PhD, past co-chair of the APA Advisory Committee on Colleague Assistance. "One of the best things we can do is to develop a reflective habit of checking in with ourselves at least a couple times a day, taking note of the emotional ‘weather' without judgment."

2. Look for silver linings. H. Shellae Versey, PhD, a psychologist at Wesleyan University, found that when working adults looked for benefit in negative situations, they experienced fewer negative psychological effects from work-family conflict. The finding was especially strong for women. During stressful periods, for instance, it can help to think of work-family conflict as a temporary strain, and to focus on the payoffs, such as higher salaries and better opportunities. But lowering expectations and downgrading one's goals did not have that protective effect, she found (Developmental Psychology, 2015). The difference, she believes, is that positive reappraisal is a way of taking control, while downgrading goals can feel like giving up. "Lowering aspirations without having another goal or Plan B in mind could be detrimental," she says.

3. Draw from positive psychology. The principles of positive psychology can aid in psychologists' self-care, as Erica Wise, PhD, and colleagues described in an article on psychologist well-being (Professional Psychology: Research and Practice, 2012). Positive emotions can broaden cognitive, attentional and behavioral repertoires, she explains, which boosts resilience and facilitates well-being. One evidence-based way to boost positive emotions is to practice expressing gratitude on a regular basis.

4. Take advantage of social support. Seeking support from other people is critical to well-being. Geertje van Daalen, PhD, at Tilburg University in the Netherlands, and colleagues found that social support from spouses and colleagues can be especially important for reducing conflict from family obligations spilling over into the workday (Journal of Vocational Behavior, 2006). Connecting with professional colleagues can be especially important for psychologists, Christensen adds. "Many psychologists work in their own silos and have little contact with professional peers," he says. "That isolation can be a risk factor for burnout."

5. Seek out good supervisors. Unsurprisingly, sympathetic bosses can also be helpful — something to keep in mind if you're on the hunt for a new job. David Almeida, PhD, at Penn State University, and colleagues found people had more negative emotions and greater stress on days when work obligations interfered with family responsibilities. But those negative effects were buffered by supportive supervisors (Journal of Marriage and Family, 2016).

6. Get moving. A robust body of research has shown that exercise can boost mood in the short term, and in the long term can improve symptoms of depression, anxiety, addictive disorders and cognitive decline.

7. Go outside. Spending time in nature has been linked to improved cognition, attention, mood and subjective well-being. It also appears to reduce symptoms of stress and depression, as Roger Walsh, PhD, a psychologist at the University of California, Irvine, described in a review of lifestyle changes and mental health (American Psychologist, 2011).

8. Make your life meaningful. In his American Psychologist article, Walsh also described the benefits of seeking meaning — whether through religion, spirituality or volunteer service. "We do our best work and live our best lives when we have a sense of meaning — a feeling that what we do extends beyond us and brings good to others," says clinical psychologist Sandra Lewis, PsyD.


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05 Jun 2017

Expanding Opportunities in Women’s Specialty Care

Meet three practitioners who work hand-in-hand with medical professionals to keep new mothers, military veterans and other women healthy

The expectant mothers at Denver's Presbyterian/St. Luke's Hospital—a regional center for high-risk pregnancies—often have such high blood pressure that both they and their babies are at risk of complications or even death. On bed rest at the hospital for weeks or even months, they have little to do but worry—which can send their blood pressure soaring even higher.

That's where consulting psychologist Jennifer Harned Adams, PhD, comes in. She teaches the women visualization, breathing exercises, progressive muscle relaxation and other strategies they can use while they're stuck in bed. She'll also help them find relaxation apps on their cellphones or tablets so they can use the techniques whenever they need them.

"These moms are facing all these potentially scary outcomes for themselves and their babies, but can't do a whole lot physically to manage that anxiety," says Adams. "Being a part of the team is great so we can think about these moms in a more holistic fashion."

Adams's work with pregnant women is just one example of how psychologists are working with physicians and other medical providers to improve women's overall health. Adams and other psychologists are helping women transition to motherhood, overcome chronic pain, heal from sexual assault and explore their gender identities.

The Monitor spoke to Adams and two other psychologists working in integrated settings focused on women's health.

Jennifer Harned Adams is assisting new mothers

Dr. Jennifer Harned Adams specializes in treating pregnant women on hospital bed rest. Presbyterian/St. Luke's and the affiliated Rocky Mountain Hospital for Children brought Adams on two years ago, and she spends a quarter of her time consulting with patients at the hospitals. "They were seeing the need for greater support for families," says Adams, who spends the rest of her work week at her private practice. "They saw how having a psychologist would help improve the quality of the hospital stay and the transition into parenthood."

Her training prepared her well. After earning her doctorate in clinical psychology from the University of Houston in 2003 and doing an internship at the University of Texas-Houston Health Sciences Center, she had three years of postdoctoral training in reproductive health and psychosocial oncology at The University of Texas-MD Anderson Cancer Center.

On the antenatal side, Adams now spends most of her time helping women cope with extended bed rest. In addition to boredom, they're facing worries about their babies, the work they're missing and their families back home. They may be mourning past miscarriages or—in the case of multiple babies—the death of a twin or triplet. "Of course, they're also bringing in whatever was going on with their lives to begin with—relationship or financial difficulties or previous histories of depression, anxiety or substance abuse," says Adams.

And since patients come from as far away as Wyoming and Nebraska, many are also isolated. Adams helps the women problem-solve and helps prepare them and their families for potentially bad outcomes. If their stay is long enough, she might even delve into more traditional psychotherapy.

Adams also works with mothers and other family members in the neonatal intensive care unit. For many patients, ending up in the unit is a traumatic surprise following an unexpectedly premature birth or delivery complication. "Women and families can be overwhelmed," says Adams. "It can be very unsettling to feel out of control." Adams helps them find a sense of control where they can, settle into a routine and work through the trauma.

The work is fluid and fast-paced, says Adams. "I love being able to walk down a hall and have a nurse tell me she's feeling worried about a mom and being able to troubleshoot or help make a plan," she says, adding that rounds and case planning meetings offer more formal collaboration opportunities.

Adams also helps educate nurses and other health-care professionals, offering trainings on understanding grief and loss in their patients and themselves and on preventing compassion fatigue and burnout in their professional roles. "I urge them to look for opportunities for self-care for themselves and others just in the course of their day and also to make aggressive self-care—exercise, massage or other practices—a regular part of their lives," says Adams, who has also worked with the Wishbone Foundation to train more than 300 nurses in nine hospital systems how to support families who've lost their babies.

The training also helps nurses work more effectively with patients, adds Adams. Often, she says, there are communication problems because patients and their families are interacting angrily with nurses and other providers. "I help providers reframe that anger as fear, which helps them respond differently," she says.

Kelly Huffman is helping patients overcome pelvic pain

Dr. Kelly Huffman specializes in treating pelvic painKelly Huffman, PhD, specializes in another type of care for women: treating pelvic pain. "Women are overrepresented in chronic pain populations," says Huffman, a psychologist at a pelvic pain clinic "by and for women" within the Cleveland Clinic's Center for Neurological Restoration.

Pelvic pain can have many causes. No matter what the etiology, it can leave women depressed or anxious about what's wrong with them. Pelvic pain can also cause sexual dysfunction and thus relationship problems.

And psychological distress can make pain worse, says Huffman, who did a postdoctoral fellowship in psychology and pain medicine at the Cleveland Clinic after earning her doctorate from the University of Wisconsin–Madison in 2008.

"If you have a lot of stress, depression, anxiety and other things going on in your life, it can amplify pain perception," she says. The opposite is true, too. "If you don't have a lot going on in your life, pain can become front and center in your life because you have nothing else to focus on."

When patients with pelvic pain come to the clinic, they consult with Huffman, plus a physician, physical therapist, occupational therapist and other team members who create individualized treatment plans. For some, that might mean surgery; for others, pelvic floor therapy, a type of physical therapy designed to rehabilitate pelvic floor muscles. The clinic also weans patients off opioid analgesics, if necessary. For patients who need more help, the clinic runs a three-week, full-time rehabilitation program.

Huffman's role on the team is to address any psychological issues. She might counsel couples on relaxation techniques they can use to enhance sexual functioning, for instance. Or she might help a sexual assault survivor work through the trauma that's contributing to her pain.

Working collaboratively can prevent unnecessary medical interventions, says Huffman. One patient, for example, had such severe pain with intercourse that she was scheduled for a vestibulectomy—surgical removal of some flesh at the vagina's opening. When Huffman talked with the patient, however, it turned out that it wasn't a physical problem that was holding her back but instead uncertainty about her sexual orientation. "If you don't have a partner you're attracted to, of course it would make intercourse difficult," says Huffman. The surgery was canceled.

Because many patients are convinced they need opioids to manage their pain, Huffman also provides psycho-education. "The common perception is, ‘If I have pain, the answer is to take opioid analgesics,'" says Huffman. Addiction isn't the only danger of opioid use: Opioids can also make pain worse. "Most patients don't know about acute versus chronic pain," says Huffman. "Opioids are actually contraindicated for chronic pain."

This kind of integrated approach works, Huffman and her colleagues have found. In a study of 36 patients with pelvic pain, Huffman and co-authors found that interdisciplinary treatment including medication management, occupational and physical therapy, and individual, group and family therapy significantly improved pain severity, disability, depression, anxiety and "catastrophizing" (Journal of Pain, 2016).

And word is getting out, says Huffman. "The pelvic pain clinic has only been open for about a year," she says. "At this time, we have more volume than we can handle."

Rosalie C. Diaz is helping veterans heal

Dr. Rosalie C. Diaz treats female veterans in a women’s healthcare clinicIn the military, seeking mental health care can be especially stigmatizing. That's one reason why psychologist Rosalie C. Diaz, PsyD, is happy to be treating female veterans in a stand-alone women's clinic at the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center. "Having a psychologist be part of their primary-care team isn't seen as stigmatizing by our veterans," says Diaz. "I'm just part of the team."

The VA began emphasizing coordinated, co-located care in 2010 as a way of decreasing stigma and improving access to care, says Diaz, who did her predoctoral internship at Louis Stokes in 2003 and started her current position in 2013. "It's also seen as cost-effective because you're being more preventive," she says. A physician or other provider might be worried about a patient's depression, substance use or cognitive capacity, for example, so Diaz meets with the patient, screens for the problem and works with the provider on treatment recommendations. Other patients may have mood disorders, insomnia or difficulties with medical compliance. Infertility, pregnancy loss and post-traumatic stress disorder are also common.

Military sexual trauma—and the wide range of psychological emotions that often accompany it—is another big issue. "If you review their records before they see you, they'll sometimes deny to a provider that there has been any assault," says Diaz. "Then you're seeing them for therapy, and they'll share something that they've never confided before."

On an individual level, a veteran might also need Diaz to accompany her to gynecological exams to help her cope and avoid panic, for example. More broadly, Diaz and others are also working to raise awareness of military sexual trauma among patients and providers alike with an annual monthlong education campaign. For the veterans, she says, the campaign emphasizes that they're not alone and that there's an advocate for them. For providers, the message is that trauma is often hidden. "The provider might see anger in the forefront, but underneath there's fear or vulnerability," says Diaz. By working alongside the physician or other provider, Diaz can help ensure the patient gets the care she needs.

Diaz also works with the center's transgender clinic, which addresses physical, social and mental health issues. As part of that interdisciplinary team, she helps patients manage their transitions and explore their gender identity. She also helps screen patients to see if they're candidates for hormone therapy. Many of these patients have experienced bullying and harassment and may feel depressed, anxious or just uncertain. "We're looking at stability, support and their use of coping skills," says Diaz, who works alongside a primary-care physician, a psychiatrist, nurses, a social worker and another psychologist.

The biggest challenge with providing collaborative, multidisciplinary care that involves so many specialty providers in the same place at the same time is that it requires a good amount of time and space for them to collaborate on the best plans of care for their patients, says Diaz. "We have a lot of providers ready and willing to see veterans, but sometimes it's hard to coordinate with all the different disciplines and find rooms because we're growing," she says. "That's probably a good problem to have."

More on integrated care

Every 2016 issue of the Monitor features a profile of a psychologist on an integrated-care team. To access the full series, visit our digital edition at www.apa.org/monitor/digital.

By Rebecca Clay


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05 Jun 2017

Brighter Horizons for Rural Psychology

Brighter Horizons for Rural Psychology

APA's focus on rural communities continues to improve access for underserved populations.

Rural clients face barriers that can make accessing behavioral health services particularly challenging — not just tangible ones like physical distance and lack of time, transportation and insurance, but a stoical culture that emphasizes self-reliance and a related stigma about using mental health care. 

"Their personal needs tend to get put on the back burner," says Emily Selby-Nelson, PsyD, a clinical psychologist who works at Cabin Creek Health Systems, a federally qualified health center with several locations in rural West Virginia.

Thanks to her rural psychology training, though, Selby-Nelson is well versed in the nature of these problems — and the system she works in helps to effectively address them.

Cabin Creek Health Systems uses integrated primary-care services, a patient-centered approach, integrated electronic medical records and an understanding that behavioral factors can play a major role in health outcomes. As a consequence, patients see Selby-Nelson as a health-care professional who can help them sort out their problems in a brief chat after a visit with their primary care physician, rather than as a stranger intent on analyzing their mental health issues.

What's more, because the system receives federal funds and grants to serve underserved populations, Selby-Nelson's clients aren't as worried about payment or billing concerns. And thanks to technology's ability to connect people and resources, she participates in a full range of professional activities — conducting research, training future rural integrated-care psychologists, and serving in professional leadership roles.

Selby-Nelson's practice is a striking example of how far rural psychology has come in the last few decades. While rural practitioners still face challenges like professional isolation and navigating multiple relationships, mental and behavioral health are becoming a more vital and embedded part of rural health care, thanks in part to psychologists' efforts (see sidebar for a short history).

In fact, rural practice has sometimes led the charge toward more progressive forms of health care, says Paul L. Craig, PhD, a neuropsychologist in Anchorage, Alaska, and longstanding advocate for improved mental health care in rural areas.

"Rural settings have been in the vanguard of demonstrating the viability and efficacy of integrated care," he says.

Expanding care 

Perhaps the greatest boon to rural health care has been the National Health Service Corps, or NHSC, the federal program that repays the student loans of health-care providers who work in underserved areas. Since 2002, 263 psychologists have completed the program.

Today, there are 3,277 NHSC mental health providers in service nationwide. A 2012 survey found that 82 percent of all health-care providers stayed on for at least a year after completing their service commitment, while 61 percent of mental health providers continued to work at the site four years after service completion.

"The program gives people access to mental health services and help they would otherwise not have received," says Darryl Salvador, PsyD, a former chair of the APA Committee on Rural Health who now serves on the national advisory committee for the NHSC. "The presence of these providers has probably saved lives and prevented the higher use of services, like hospitalizations." Such services can be especially costly, he adds, if people have to be flown to external facilities because their own community lacks such services.

Salvador worked as an NHSC loan repayment clinician for a federally qualified health center in rural Hawaii from 2007 to 2011, treating depression, anxiety, substance abuse and post-traumatic stress related to familial abuse. Before coming to the center and learning that a behavioral health clinician was available to treat them, many of these clients had never been treated or had been treated inadequately for such conditions, he says.

"I felt like I was really making a difference," says Salvador.

Innovative programs 

Rural psychologists also have been responsible for adding behavioral components into rural health efforts. Salvador, for example, helped his rural clients learn behavioral strategies to better manage their diabetes and to stop smoking. Diana L. Prescott, PhD, of Hamden, Maine, also a former chair of the APA rural health committee, developed the integrated behavioral health portion of the pediatric obesity program The Way to Optimal Weight, or WOW. Preliminary data show it has helped obese children lose weight and improve their quality of life.

At the Southcentral Health Foundation in Anchorage, Alaska, psychologists have taken an even broader view of helping the community. The facility offers a combination of integrated health and social services to improve family and community well-being, including programs on domestic violence, abuse and neglect, among other issues. The foundation reports that its outreach has helped to reduce emergency room visits by 53 percent and specialty care visits by 65 percent — all while earning a 90 percent consumer satisfaction rating.

Rural psychologists are also leading the way in the use of technology to expand care. In a 2015 article in Training and Education in Professional Psychology, for example, Matt J. Gray, PhD, of the University of Wyoming, and colleagues reported that providing videoconferencing sessions to victims of sexual assault or domestic violence was just as effective as providing in-person sessions. The intervention led to about a 60 percent drop in post-traumatic stress symptoms and a 50 percent drop in depressive symptoms from before to after treatment, as well as consistently high treatment satisfaction, the team found.

The technology helped all of the parties involved, Gray says, adding, "It's a really symbiotic relationship." His students who provide the teleconferencing sessions have a chance to use their treatment skills with more people; off-site clients receive free expert interventions they otherwise wouldn't have gotten; and the staff at crisis centers — who are often overextended and underfunded and whose first expertise is practical rather than psychological help — can link their clients with needed services, he says.

Rural psychologists were also the lead authors of another recent study that supports telehealth's ability to expand access to quality care. A 2015 pilot project found that children in rural Kentucky whose parents participated in an evidence-based group parenting program via videoconference and telephone improved to the same extent as kids whose parents received the program in person. The children improved on measures of internalizing symptoms, such as depression and withdrawal, and externalizing ones, such as aggression and hyperactivity (Psychological Services, 2015).

"The technology does not seem to alter or disrupt the factors or processes that make any psychological intervention helpful," says the study's lead author, Robert J. Reese, PhD, of the University of Kentucky.

Forward thinking 

Psychologists also are weighing in on new challenges in rural areas. One example is hydrofracking: APA's Committee on Rural Health is starting to examine the psychological toll industry practices may be having on small, underserved communities. Anecdotal reports suggest that a variety of ills can accompany the financial gains of fracking, including contaminating water and overcrowding schools and other infrastructures that are unable to properly accommodate new arrivals, says Iva GreyWolf, PhD, a member of APA's rural committee who is spearheading the group's hydrofracking effort.

"When you have people with high poverty and you're offering them an oil lease, it's hard for them to say no," despite the unknown consequences, she says.

Similarly, new drug problems are cropping up in rural areas, with heroin a dangerous and increasingly ubiquitous arrival, and psychologists are working to determine the best treatments (see the February Monitor).

Working to address such problems and improve care for underserved people is "a beautiful opportunity for psychologists," says Prescott.

By Tori DeAngelis


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05 Jun 2017

Should You Attempt Early Retirement as a Mental Health Professional?

Should You Attempt Early Retirement as a Mental Health Professional?

It seems like almost every day there's a new story popping up about a person that figured out a way to retire years ahead of schedule! While it's definitely not a mainstream idea yet (and probably won't be anytime soon), the thought of early retirement is becoming increasingly more popular in our culture.

The financial details and strategies for each case of early retirement vary greatly. Some early retirees are ultra-frugal, while others hit massive paydays early in their careers and just so happened to invest right at the beginning of the most recent economic recovery.

The two most important factors that any mental health professional should consider before attempting early retirement are:

  1. Does early retirement even make sense for you?
  2. How can you make it happen?

This article deals with the first question (the second will be answered in a later article).

What does early retirement actually look like?

Until recently, retirement was most often thought of as the total absence of work around the age of 65. The idea was that you work hard for the majority of your life, stash away money into retirement accounts, and then leave your career to play golf (or do nothing at all) once your nest egg becomes large enough to sustain you to the end of life.

Unfortunately, the great recession in 2008 put a wrench in millions of Americans' retirement plans. Investment portfolio values plummeted, jobs were lost, and retirement simply became out of reach for many people (at least temporarily until the economy began to recover).

Younger generations have reacted to the realization that retirement may not fully be under their control by attempting to achieve it even sooner. With that also came a shift in how millennials and Gen Xers actually view retirement itself.

Rather than the complete absence of work while maintaining a high-quality lifestyle, early retirement enthusiasts have adopted a far more "minimalist" lifestyle, along with aggressively investing to create a large nest egg at an early age. It's very common for early retirees to continue working in some capacity, but typically through smaller income streams like part-time jobs or very small side hustles.

Why would you want to retire early?

If you are considering a path toward early retirement, you need to evaluate a few things first. While early retirement sounds incredible on face value, it's not for everyone. There is an immense level of sacrifice that has to take place to actually achieve early retirement.

Here are some traits that might make you a good candidate for retiring early:

1) Time is your main focus

Almost every early retiree that I've come across cites "time" as the number one reason they chose the path toward early retirement. Whether they want to spend more time with their family every day, or do more traveling/relaxing earlier in life, it all comes back to wanting more control over their available time in life.

2) You don't need to be "fancy"

One of the main components of early retirement is avoiding the consumerism that is the backbone of American culture. Many early retirees opt to drive older cars, do maintenance work of all types on their own, and live as far below their means as possible.

There are different extremes of course, but it's not uncommon to find stories of early retirees that live in an airstream trailer full time, or ride a bicycle instead of owning a car. The reality is that you need as much of your money available for saving and investing as possible to actually retire early, and the easiest way to create that situation is to spend less.

3) Pursuit of your passions is more important than your income level

Hopefully, you entered the mental health profession because it is your absolute passion in life to help others! The reality of any career, however, is that sometimes your degrees don't end up equating to your passion.

Many early retirees experience burnout earlier than normal in their careers and decide to pursue passion projects instead. If you are more interested in following your passions instead of maximizing your earning potential, early retirement may be for you.

What could go wrong with retiring early?

As a personal finance blogger, this is an aspect of early retirement that is never discussed enough (in my opinion). Of course retiring early sounds like a great lifestyle, but there is inherent risk there that many early retirement enthusiasts either don't account for or leave out altogether when discussing their strategy.

Here are a few potential drawbacks of leaving a career too soon:

1) You run out of money!

The elephant in the room for early retirement is that you completely gut your ability to earn good money when you leave your job. Many of the nest eggs that early retirees are relying on are $1,000,000 or less! A million dollars may sound like a ton of money, but when you are hoping to stretch that amount for 30 plus years, it may not cut it.

What happens if you or a family member becomes sick and has astronomical medical bills? What if the market completely tanks and your investment accounts drop substantially, or dividends you rely on to live are cut?

2) You change your mind

Careers take time to build, and there is no getting around that fact. If you leave in year 10 of a potentially 30-year career, what kind of opportunities down the road are now unavailable to you?

You may be able to get a similar job again if you leave for early retirement and then change your mind, but there's no recouping the same opportunities that you had when you left.

3) You want to start or grow your family

Kids are expensive. According to Time, the average child now costs $233,610 to raise from birth to 17 years old on average. If your plan is to retire when you reach a million dollars, a child in the future could cost almost a quarter of your nest egg.

That's not to say that there aren't early retirees that have children, but anticipating the costs of children moving forward is an essential element to leaving a career early.

Early retirement is possible, but you need to be skeptical

Any time that you see a story about early retirement from one of the major news outlets, you need to understand that those stories tend to create a lot of buzz (and revenue in the form of clicks and shares for the media outlet).

The issue is that the stories are typically told in a way that leaves out the struggles and pitfalls of early retirement. Understand that retiring early is certainly possible and will become more popular in the coming years, but it's not as easy as it may seem.

-- Bobby Hoyt is a former high school teacher who paid off $40,000 of student loan debt in a year and a half. He now runs the personal finance site MillennialMoneyMan.com full-time, and has been seen on CNBC, Forbes, Business Insider, Reuters, Marketwatch, and many other major publications.

The opinions and advice expressed in this article are those of the author and do not necessarily reflect those held by the American Psychology Association (APA).

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