Traversing the landscape from graduate student to early career psychologist can be challenging. This two-volume series offers useful tools and advice for those on the journey. The first volume includes articles on how to succeed in the early years of graduate school, including how to find a mentor, how to pay for graduate education, and how to improve your writing and presentation skills. The second volume focuses on the later years of graduate school, with advice on how to ask for more responsibility, how to earn research funding and how to make the transition into the workforce.
The Department of Veterans Affairs and APA are working to improve treatment for veterans in new ways
Hiring 1,000 more mental health professionals and increasing the number of private-sector mental health providers who are culturally competent in military issues are among the new priorities at the Department of Veterans Affairs (VA), according to VA Secretary David J. Shulkin, MD, who testified in March to the House Veterans Affairs Committee.
Shulkin also emphasized the need to strengthen suicide-prevention programs and announced his intention to open up access to treatment to veterans with other-than-honorable discharges.
APA is helping to ensure that the secretary's goals become a reality by pushing Congress to expand resources for VA mental health care and research. "We are thrilled that Dr. Shulkin was named VA secretary," says Heather O'Beirne Kelly, PhD, who in March was named APA's first-ever director of veterans and military health policy. "And we applaud all his newly announced priorities."
The number of veterans committing suicide has dropped to roughly 20 a day, the secretary told Congress. But when it comes to suicide prevention, he said, "What we are doing now—and we are doing a lot—is not enough." The VA is seeking new approaches, he said. "We are reaching out to the very best and brightest from the academic world and the community to come in and tell us what else we can do."
As part of Shulkin's suicide-prevention effort, he plans to make emergency mental health care accessible to the 500,000-plus veterans who have other-than-honorable discharges, which render them ineligible for VA care. "Our goal is simple: to save lives," said Shulkin, explaining that the suicide rate among veterans who don't use VA facilities is increasing at a greater rate than that of veterans receiving care within the VA.
Shulkin's proposal would give veterans with other-than-honorable discharges access to VA emergency departments, vet centers and the Veterans Crisis Line at (800) 273-8255. The secretary plans to meet with members of Congress, Department of Defense officials and representatives of veterans service organizations before finalizing his proposal this summer.
Veteran Thomas Burke, who received an other-than-honorable discharge after being booted from the Marines for smoking hashish to manage post-traumatic stress disorder (PTSD) in Afghanistan, supports the proposal. "When people think of ‘less-than-honorable' discharge, they think of dishonorable; to get a dishonorable discharge, you have to rape or murder someone," says Burke, now treasurer of High Ground Veterans Advocacy and a master's degree candidate at Yale Divinity School. But, he says, other-than-honorable discharges are often the result of behavior related to PTSD, traumatic brain injury, military sexual assault and other mental health problems. Of course, says Burke, the secretary's proposal is just a proposal. That's why he and other veterans in High Ground support the Honor Our Commitment Act, which seeks to transform the proposal into legislation requiring the VA to provide mental and behavioral health services to veterans with other-than-honorable discharges.
APA supports the secretary's proposals, says Kelly. APA generally supports the proposed legislation, too, although Kelly wants to keep a close eye on implementation details. There have been calls to retroactively assess veterans' discharge statuses, for example, and it would be critical to understand how and by whom those assessments would be performed and interpreted and how they would be used by the VA for health-care decision-making, Kelly says.
Of course, the secretary will also need resources to fulfill his vision for the VA. APA called for that increased funding along with other requests in testimony to the House Appropriations Committee's Subcommittee on Military Construction, Veterans Affairs and Related Agencies in March:
- Suicide prevention. APA supports Shulkin's commitment to enhanced suicide prevention efforts. In terms of other clinical priorities, Kelly urged Congress to support the hiring of more psychologists, increase support for integrated care and hold community providers to the VA's high standards.
- Prescriptive authority. Kelly also urged Congress to grant prescriptive authority to appropriately trained psychologists in the VA.
- Research funding. As part of the Friends of VA Medical Care and Health Research, APA asked for $713 million in fiscal year 2018 for VA research. "A strong VA psychological research program provides the scientific foundation for high-quality care within the VA system," Kelly told Congress.
One concern is the VA's push toward privatization, with more care being provided outside of VA facilities, adds Kelly. While many veterans groups were happy to hear the secretary talk of eliminating the rule requiring veterans who live close to VA facilities to get their care there, she says, APA is concerned that community providers may lack the preparation and capacity to handle the increased demand. Plus, says Kelly, having psychologists embedded into primary-care settings is vital to ensuring high-quality care for veterans.
"We will continue to work with Secretary Shulkin and the VA about what they mean by community care to ensure that the VA is strengthened as an integrated-care provider for veterans and not just as a funder of outside care," Kelly says.
To read Dr. Heather Kelly's full testimony to the House Subcommittee on Military Construction, Veterans Affairs and Related Agencies, go to www.apa.org/about/gr/issues/military/testimony_va_research.pdf.
By Rebecca A. Clay
This article was originally published in the June 2017 Monitor on Psychology
Did you find this article useful?
The latest salary report from APA finds that psychologists in the middle of the country outearn their peers
In May, APA's Center for Workforce Studies (CWS) released its most comprehensive salary report to date. The report finds that the median annual salary for U.S. psychologists in 2015 was $85,000, but that salaries varied widely by subfield and geographic region.
Most psychologists (57.4 percent) earned between $60,000 and $120,000, 20 percent earned less than $60,000, and 22.7 percent earned more than $120,000. Those in industrial/organizational psychology were at the top of that range—the median annual salary for I/O psychologists was $125,000. Those with a degree in educational psychology, at the other end of the spectrum, earned a median salary of $75,000.
Want to earn more? Move to the Middle Atlantic region, where psychologists earned, on average, $108,000 per year. Psychologists in the East South Central region, in contrast, earned $59,000 per year.
Meanwhile, women continued to earn less than men ($80,000 compared with $91,000), white psychologists earned more ($88,000) than racial/ethnic minority psychologists ($71,000), and those with a PhD earned more ($85,000) than those with a PsyD ($75,000). (To read more about the gender pay gap, see the article "Women Outnumber Men in Psychology, But Not in the Field's Top Echelons" in the July/August Monitor.)
The new salary report is APA's most representative look yet at psychologists' earning power, according to Luona Lin, a CWS research associate. In previous reports, the association's salary data came from member surveys, but APA members skew older and less racially and ethnically diverse than the profession as a whole.
The new report instead analyzes data from the 2015 National Survey of College Graduates, a nationally representative survey conducted every two years by the U.S. Census Bureau on behalf of the National Science Foundation's National Center for Science and Engineering Statistics. The CWS report pulls the survey's data on full-time working psychologists—those with a doctorate or professional degree in psychology who work at least 35 hours per week.
The NSF survey was revised with a new sample design in 2010, adding a fresh level of detail for CWS to examine.
"Because this is a new data set to look at salaries in psychology, we have a lot of variables that weren't available before," Lin says. For example, for professional service positions, she and her colleagues were able to analyze salaries by employment sector (public, private, nonprofit) and employer size. For psychologists in management, they could break out salaries by a person's number of direct reports. And for researchers, they could examine salaries by type of institution and research activity.
There were a few surprises in the data. For example, salaries were highest in the Middle Atlantic region, which includes cities with a high cost of living, such as New York and Philadelphia. But salaries were also relatively high in the Midwest—$92,000 in the West North Central area (which stretches from Kansas to Minnesota), and $91,000 in the West South Central area (which includes Texas, Arkansas, Oklahoma and Louisiana).
"That was kind of surprising at first glance," Lin says.
But, she adds, the explanation might lie in a 2014 CWS report on job ads, which found a high concentration of open positions in the center of the country.
"We haven't done a causal analysis for this, but we think it might be highly relevant—the salaries [in the Midwest] could be driven higher by demand."
Lin says that interest in the report has been high, and that CWS staff plan to produce new salary reports biannually when NSF releases new survey data.
To read the full report and access the underlying data, go to www.apa.org/workforce/publications/2015-salaries/index.aspx.
By Lea Winerman
This article was originally published in the September 2017 Monitor on Psychology
Did you find this article useful?
Out of all the things I've encountered in running a personal finance site and helping people tackle their student loan debt, one of the most frustrating is hearing stories of readers who have been charged outrageous fees or have had money stolen from them by student loan scammers.
Americans currently hold over $1.3 trillion in student loan debt, and the average student loan balance for borrowers has grown from $20,00 to $34,000 in just ten years, according to an April study by the Federal Reserve Bank of New York.
While most people see this as a major problem, the unfortunate reality is that others see it as an opportunity to make or steal money from good, hard-working people.
Fortunately, there are ways that you can spot student loan scammers from a mile away and avoid the headache altogether.
Before we go on, it is important to understand that there are legitimate consolidation companies and loan forgiveness programs out there.
Consolidation is always free through the Department of Education (which we will discuss below). Always. However, there are companies out there that offer to handle the process for you as a service.
If you are someone that doesn't have time to fill out your own application or feel overwhelmed by the process, there are legitimate companies that will complete the Department of Education paperwork for you while charging an application fee.
What's the difference between student loan consolidation and forgiveness, and do you need either one?
Many student loan holders mistakenly mix these two terms up, but they have very distinct implications for your student loans. Let's start by defining the two below:
Student Loan Consolidation
This is the process of combining all of your existing student loans together into a larger loan with one payment. Your interest rate will be the average of all the loans included in the consolidation. Consolidations are available for most types of federal student loans, and many private lenders offer consolidation options as well.
Federal Student Loan Forgiveness
This is the process of having your remaining student loan balance erased after a specific amount of time and regular loan payments while working in a particular field specified by the Department of Education.
The most common programs are the Public Student Loan Forgiveness program (often called the "Obama Student Loan Forgiveness program”) and the Teacher Loan Forgiveness program.
Federal student loan forgiveness programs are designed to entice student loan borrowers to work in areas of high need and in government jobs that may not be as desirable as public sector jobs.
Common types of student loan scams and how to identify them
The most important thing to understand about student loan scammers is that they are trying to prey on borrowers who are desperate and feel trapped by their debt. Typically, consolidation and forgiveness scams center around being able to provide instant "relief" for borrowers.
Here's the reality—nothing is fast about either one of these processes. If you ever come into contact with a suspicious company that wants to provide an instant solution for your student loans, walk away and don't look back.
Student loan forgiveness programs can take as long as ten years and require 120 consecutive payments. Consolidation typically takes anywhere from 30–90 days.
If it says instant, it's probably a scam.
Fake government seals
In an effort to build trust with potential scam victims or just flat-out confuse them, it's very common for student loan scam companies to include seals in their company logo that look very similar to a government seal.
Another trick they use is to create website URLs with a .us at the end or "federal" somewhere in their company name.
While it can be tricky to wade through what is legitimate and what isn't on the internet, here are a few things to note:
- If the site you are looking at seems like it could be a federal website, but you aren't sure, look for fine print. You'll usually be able to find language that explicitly states that the company is not a federal entity or related to the government in any way.
- If the website looks like a federal entity but doesn't have a ".gov" domain name, it's probably a scam. ".gov" domains are extremely hard to receive and require special applications and an approval process.
- If they are charging money, they aren't a federal entity. Again, consolidation and forgiveness programs are always free through the Department of Education.
While this doesn't always mean that the company in question is a scammer, it does mean that the fees they will charge for filling out consolidation paperwork for you could be exorbitant (Google ads aren't cheap on highly competitive terms like "student loan consolidation companies”).
It's important to remember that Federal entities do not advertise consolidation or forgiveness programs on any of the major search engines like Google or Bing.
Auto calls or texting
This approach has been around for a few years, but in the past six months or so has ramped up tremendously. You may get a phone call or text that says your loans have been "flagged for forgiveness" and that you need to call right away to take advantage of the opportunity.
I get these messages all the time, and I paid off my student loans years ago.
Most likely, the company contacting you is doing it illegally. The goal is either to charge you a crazy fee, get your money, and then disappear—OR to steal private information from you like your social security number or bank account information.
The government will not call or text you about "flagged" student loans. Never give your personal information to anyone that contacts you about your student loans without digging deeper and researching first.
Where to go for legitimate information on student loan forgiveness and consolidation?
If you don't get anything else out of this article, please remember this:
The federal government does not, has not, and will not charge you to apply for student loan consolidation or loan forgiveness programs. The best source for official consolidation and forgiveness information is always the Department of Education's website, Studentaid.ed.gov.
The Department of Education’s website is packed with useful information about the various student loan forgiveness programs, consolidation forms, and even a page to report scams and fraudulent activity here.
If you're ever in a desperate situation with your student loans, don't panic, and be skeptical of any offers for quick help. It may take time and probably won't be an easy process, but there are always legitimate ways to get your debt under control without giving out your personal information or large sums of money.
-- 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.
Did you find this article interesting?
Research identifies small changes that lead to big improvements in performance
While this may not be plausible for everyone, Rosen's studies have shown how being distracted can become a bad habit that ultimately decreases our effectiveness at work or in school.
Fortunately, he and other psychology researchers have identified new ways to help people overcome the hurdles that stand in the way of their productivity, whether they are personal habits or environmental challenges. Here are some of those findings.
Grow your attention span
Even though technology can empower us to accomplish things faster, Rosen has found that those benefits can disappear when digital distractions are so readily available.
In one study, Rosen asked 260 middle school, high school and university students to study for 15 minutes in their homes. He found that participants averaged less than 6 minutes of studying before switching tasks, most often due to technology distractions—phones vibrating, new email alerts or instant message notifications, as well as students' "self-interruptions" to check electronic devices (Computers in Human Behavior, Vol. 29, No. 3, 2013).
While it can be tempting to think that dealing with these messages is productive, Rosen says this is a false sense of effectiveness. "We may think we are multitasking, but we are really task-switching," he says. "These interruptions take us away from the task at hand." The original task becomes less salient in our brains, and when we return, we waste time trying to remember what we were thinking when we left, Rosen explains.
To increase attention span and productivity, one of Rosen's solutions is the "technology break." He encourages students and workers to give themselves a couple of minutes to check alerts, texts and other messages after 15 minutes of undistracted work. The best way to stay focused is silencing the phone, turning it face down to avoid seeing visual notifications, turning off email alerts and closing distracting websites, Rosen says.
"Once you learn how to work for 15 minutes, start increasing the time before taking a technology break," Rosen says.
Taking short breaks not only satisfies the technology fix, but it also allows us to maintain focus, according to a study conducted by Alejandro Lleras, PhD, a psychology professor at the University of Illinois at Urbana–Champaign. He found that participants who took a short break while focusing on a visual task maintained the same level of performance for 40 minutes, but performance declined for those who didn't take any breaks (Cognition, Vol. 118, No. 3, 2010).
"We know that after about 30 minutes, concentration starts to decrease, so it's important to take small breaks to stay focused on your main task."
The results also showed that the breaks can be surprisingly short—only a couple of seconds for some tasks—to achieve this effect.
Write out your goals
Many people who work are familiar with the idea of setting goals for themselves, but achieving those goals can be elusive. Research is showing that establishing a habit of writing about goals can boost performance.
Cheryl Travers, PhD, a professor at the School of Business and Economics at Loughborough University in Leicestershire, England, asked students to identify areas where they needed to improve, such as raising a grade in a class or increasing concentration while studying. The students were asked to visualize desired outcomes and outline how they could put their goals into practice.
Then the students kept diaries for three months to reflect on their goal progress. For example, students could write down what happened as they attempted to make a change in a particular situation, what worked well or not well, what could have been done better and actions they could take going forward. Travers found that the reflective goal-related writing had a significant impact on their ability to perform better academically (British Journal of Educational Psychology, Vol. 85, No. 2, 2015).
"The act of writing something down seems to make us accountable to a goal," Travers says. "It also helps people to write their way through a problem when they encounter barriers."
By writing about successes and failures and thinking about strategies to overcome difficulties, students gained confidence in themselves and developed academic self-efficacy, Travers says. What was particularly interesting was the evidence showing that academic performance improved even for students who set nonacademic, "softer" goals, such as "increase my assertiveness" or "decrease stress."
Travers is now collecting diaries for managers in organizations, and she will be studying whether this reflective goal setting improves their effectiveness as leaders. "This process allows people to essentially become self-coaches because they are continually evaluating goal outcomes and becoming more self-aware about leader behaviors."
The idea of fitting in another meeting may seem counter-productive for people working in group settings, but research suggests that taking time to debrief as a team can improve productivity in the long run.
Michaela Schippers, PhD, a professor of behavior and performance management at the Rotterdam School of Management at Erasmus University, studied teams working in a health-care environment. She found that the groups that met regularly to evaluate work processes were much more likely to come up with innovative solutions to problems than groups that did not meet regularly. Her work has shown how this team reflexivity (reflecting on team functioning) can significantly improve work performance levels (Journal of Management, Vol.41, No. 3, 2015; Journal of Organizational Behavior, Vol. 34, No. 1, 2013).
"Workers should have regular debriefings, like in the military, but the purpose is not to point out what people are doing wrong," Schippers says. "Instead, the group can brainstorm how to improve as a team, ideally with a facilitator who is leading the meeting."
In the study, the reflexive teams talked about issues such as decreasing waiting times for patients, improving patient record systems and developing a more effective appointment system.
"Our work showed that it was very important for teams that are particularly busy to meet regularly to debrief, because these teams benefited most from the innovative improvements," Schippers says. "The meetings gave them space to think collectively about what could be changed."
Get out of the chair
Researchers are finding that employees with stand-capable workstations may be more productive than their seated counterparts. Mark Benden, PhD, a professor in the department of environmental and occupational health at Texas A&M School of Public Health, studied two groups of call center employees over six months. One group sat at traditional desks and the other group at stations that enabled workers to elevate their tables whenever they wanted to stand. Benden found that those with stand-capable workstations stood about 1.5 hours longer per day and were 42 percent more productive than those who worked at seated desks. Productivity was measured by how many successful calls the workers completed per hour (IIE Transaction on Occupational Ergonomics and Human Factors, Vol. 4, No. 2-3, 2016).
"By being up more of the time, we improve blood flow to the brain and circulation to the body, and these things combine to make the brain more active and engaged," Benden says.
Research also suggests that it is important for people to avoid "static standing" in one place, he says. The best stand-capable workstations have foot rails that allow workers to take weight off of one side of the body. If it's not possible to get this type of workstation, workers should take breaks to walk around and get out of the chair, Benden says.
Gazzaley, A., & Rosen, L., 2016
Managing Motivation: A Manager's Guide to Diagnosing and Improving Motivation
Pritchard R.D., & Ashwood, E.L., 2008
Evidence-Based Productivity Improvement: A Practical Guide to the Productivity Measurement and Enhancement System
Pritchard, R.D., Weaver, S.J., & Ashwood, E.L., 2012
Future Time Perspective and Promotion Focus as Determinants of Intraindividual Change in Work Motivation
Kooij, D.T., Bal, P.M., & Kanfer, R., Psychology and Aging, 2014
By Heather Stringer
This article was originally published in the September 2017 Monitor on Psychology
Did you find this article interesting?
The knowledge, skills and experience gained through your psychology training can transfer successfully to a variety of jobs. Dr. Jerome Pagani works as an analyst in the global health sector of professional services firm EY Knowledge. In his role, Pagani monitors and reports on trends in health around the globe. Learn how you can apply your psychology education in a similar career path.
Speaker: Dr. Jerome Pagani is the senior analyst in the global health sector at EY Knowledge, a global professional services firm, in an area called “core business services.” He follows global health trends and how they might impact the company’s service offerings as well as the overall market. He spent his early career in the lab at NIH but decided to switch to consulting. Prior to joining EY Knowledge, he spent time at Booz Allen, working with federal agencies like NIH, DoD and the military. Pagani has a Ph.D. in behavioral neuroscience and a master's degree in cognitive psychology.
Host: 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.
Did you find this webinar useful?
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.”
Did you find this article interesting?
Psychologists are using biofeedback to help clients identify and change their physical responses to stress and more
"I'd ask them how their relaxation went over the past week and was getting answers like, ‘Oh, yeah...right.'" he says. The replies left him thinking, "You didn't do it, did you?"
Then Portenga learned about biofeedback—a tool that provides empirical evidence of physiological activity, such as heart rate, breathing rate, muscle tension, skin temperature and brain wave patterns. Using sensors connected to displays, he and his clients could see how their bodies reacted to stress and to stress-reduction exercises. Athletes can also train with biofeedback apps at home and these sessions can be tracked, to see not only that they do their homework, but how well it works.
Portenga says he appreciates not just biofeedback's ability to provide accountability, but the way it has helped his athletes learn to handle competitive pressure. He has used the technique with athletes in every major professional sport, including at Super Bowls, world championships and the Olympics.
Biofeedback is an umbrella term covering several types of therapies. Common ones include heart-rate variability (HRV) biofeedback, which looks at the interval between heartbeats; electroencephalograph (EEG) biofeedback, also called neurofeedback, which focuses on brain wave activity; and electromyography biofeedback, which concentrates on muscle activity.
During biofeedback training, clients can see the response that's being measured while under simulated stress—such as by viewing a competition video or playing a challenging computer game. Biofeedback therapy holds that as people practice different responses to stress (slower breathing, for example), they can see how effective these are and adjust accordingly, which helps them learn how to better manage stress.
While large-scale research covering biofeedback's efficacy remains scant, studies have indicated biofeedback's potential in treating a variety of physical and psychological conditions. Research led by Poppy Schoenberg, PhD, now at the Vanderbilt University Osher Center for Integrative Medicine, examined 63 studies on various types of biofeedback used to treat psychiatric disorders. She found that about 81 percent of participants showed some level of improvement, with 65 percent demonstrating "statistically significant" symptom reduction (Applied Psychophysiology and Biofeedback, 2014). A meta-analysis by Richard Gevitz, PhD, a health psychology professor at Alliant International University, examined HRV biofeedback's effectiveness in treating both psychological and physical disorders. Gevitz's review of more than 55 studies found that it shows promise in treating many disorders, including asthma, cardiovascular conditions, hypertension, depression, anxiety and insomnia, and has potential for improving performance (Biofeedback, 2013).
Today, Portenga, a founding member of APA's Coalition for the Psychology of High Performance, focuses his practice on adolescent athletes and nonathletes who may be faced with stressful situations that involve being judged or evaluated, including sports competitions and school tests. A session typically includes a mix of biofeedback and psychotherapy. As such, he says, he doesn't bill separately for biofeedback, in the same way a therapist wouldn't bill separately for mindfulness training. Portenga provides detailed invoices to clients to use for insurance filing, and is paid out-of-pocket by clients.
Portenga recommends clients use biofeedback apps at home—such as Respiroguide Pro—to help them visualize their breathing, like with an image of a ball rising with each inhalation and dropping with each exhalation. This helps clients adopt slower, synchronized breathing and heart rates to evoke a calmer state of mind, which is part of HRV biofeedback training. Over time, clients become accustomed to breathing at the slower rate and have less need to use apps, Portenga says. "To be able to track this to see what's going on, to see when things are progressing and when they're not, has just been fantastic."
Beyond stress management
Leah Lagos, PsyD, a performance psychologist in private practice in New York City, has been using biofeedback in her practice for about 10 years. She has used HRV biofeedback to help post-concussion syndrome patients alleviate headache, problems concentrating and other symptoms. She is working with New York University on a study exploring the use of HRV biofeedback with this syndrome, which she explains is linked to an injury to the autonomic nervous system. "I've treated over 100 athletes [with post-concussion syndrome] and they have very similar trajectories of experience: At week four their headaches dissipate, by week seven they can focus again," says Lagos.
She's also used biofeedback to help a patient end persistent vomiting after other medical interventions didn't work, and reduced incidence of migraines in other patients.
In addition, Lagos provides biofeedback to PGA tour golfers, dancers, Olympic rowers, soccer players, track athletes, basketball players and others. She typically meets patients once a week for about 10 weeks, with sessions lasting 45 minutes to an hour, during which time she uses biofeedback as well as cognitive-behavioral skills such as mindfulness training. She also insists clients do homework: two 20-minute sessions where they practice heart-rate variability using apps, such as Heartmath and Breath Pacer.
Biofeedback can also foster other benefits, says Lagos, including improved mood, reduced anxiety, lower muscle tension and improved attention.
While she doesn't accept insurance, she has had patients tell her that sometimes they are able to get insurance coverage for their biofeedback, particularly if they are being treated for headaches, she says. One of the aspects of this training that she most treasures, she says, "is seeing how it develops the patient's confidence."
Helping Olympians master their nerves
Lindsay Thornton, EdD, is a sport psychologist and a senior sport psychophysiologist at the U.S. Olympic Committee in Colorado Springs, Colorado, working with Olympic-bound athletes in sports such as track and field and swimming. "What I'm mainly working on is managing pressure, anxiety and stress around performance," Thornton says.
Thornton counsels athletes when needed, but the bulk of her work is helping athletes prepare to compete, which often entails using biofeedback. She claims that biofeedback can provide a "faster learning curve" for athletes to learn pressure-management skills.
"Sometimes in talk therapy, we can talk, talk, talk" without being able to change behaviors, she says. "But for me, using psychophysiology as a tool has been really powerful to teach athletes skills" in ways that would be difficult to do using words alone—with a sensor on the muscle, the client can visualize what's happening and see the impact of various exercises.
Thornton primarily uses HRV biofeedback and EEG biofeedback, also called neurofeedback, which focuses on brain waves. When Thornton first sees athletes, she does a "full-cap" assessment with 19 sensors on an athlete's head to allow her to see brain-wave patterns under different conditions. For example, she'll have athletes work on virtual tasks, which enables her to see their physiological responses to stress.
With neurofeedback, clients are able to see their brainwaves displayed and to differentiate between those that occur when they are stressed or losing concentration and those that happen when they are calm and focused. Through neurofeedback training, athletes learn to modify their brainwaves and states of mind, which helps improve performance, says Thornton.
"The goal of neurofeedback training is to create an awareness over what certain mental states feel like and then to develop strategies to recreate that state under pressure or in the face of distraction," she says.
Thornton creates routines for each athlete that are rehearsed repeatedly under simulated stress conditions. Athletes may practice pre-performance rituals, for instance, that can include visualizations of their performance, breathing exercises and use of code words associated with what they expect to do (an archer may say, "smooth, shoulder, through" to reinforce upcoming actions to take).
Thornton became attracted to biofeedback during her training in sport psychology. "I wasn't sure I was always doing the right things with athletes," she says. "We were talking about muscle relaxation and visualization. The athlete might believe they were doing it correctly and I might think they were doing it correctly, but I wanted some type of assurance that we were achieving our goal." Biofeedback helps provide that objective evidence, she says.
Olympic-level athletes are fascinated by peering inside their bodies—by seeing the responses her sensors display. "They enjoy that type of feedback," she says.
Thornton has her athletes practice outside her lab with apps such as Stress Doctor, which reinforces their heart-rate variability training. But she doesn't want her clients to rely on technology, pointing out that "they can't pull out their phone on the field." So, she gradually weans them from visual and auditory feedback to just audio to no feedback at all, using only their own now-heightened body awareness.
The payoff, she says, is seeing athletes master these strategies and witnessing "the pride and comfort and confidence they have." And when the hard work she and her athletes have put in results in Olympic medals, as happened in the 2016 Rio Olympics? "It's really exciting," says Thornton.
"No Insurance Required" is a Monitor series that explores practice niches that require no reimbursement from insurance companies. To read previous installments, go to www.apa.org/monitor/digital and search for "No Insurance Required."
For a more extensive look at the research on biofeedback, visit our digital edition at www.apa.org/monitor/digital and search for "Positive Feedback" in the March 2016 issue.
Did you find this article useful?
The knowledge, skills and experience gained through your psychology training can transfer successfully to a variety of jobs. Dr. Nyaka NiiLampti is the director of player wellness for the NFL Players Association (NFLPA), the union for professional football players. In her role, NiiLampti ensures that players are educated about the NFL’s policies for substance abuse, and provides education, resources and guidance to players in multiple areas of wellness, including mental health support.
Learn how you can apply your psychology education in a similar career path.
Dr. Nyaka NiiLampti is a sports psychologist with over 15 years of experience in the field. A collegiate athlete, her senior thesis explored the psychological impacts of sports on women. She holds an M.A. in exercise and sport science (sport psychology) and a Ph.D. in counseling psychology. Before joining the NFLPA, NiiLampti worked in college counseling centers and a large group private practice, and was an assistant professor of psychology at Queens University of Charlotte in North Carolina.
Garth 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.
Did you find this webinar useful?
What to do with clients who yell at you, question your competence or just sit silently seething
He was working with two parents and their daughter, when the father started attacking Honda, making hostile comments about his abilities as a therapist. The daughter soon joined in. "Within 15 minutes, they had completely torn apart my self-esteem," says Honda, who chairs the couple and family therapy program at Antioch University in Seattle. "I started having a mini anxiety attack. I started to sweat. I couldn't think straight. I almost ran out of the office."
Although the mother stepped in to defend Honda and they eventually repaired their therapeutic relationship, the experience left him shaken. He's not alone. Psychologists sometimes face clients who have personality disorders that prompt them to lash out, for example. Other clients may just be rude. Some — whether they're in court-mandated treatment or pushed into therapy by spouses or parents — just don't want to be in therapy. Challenging clients aren't just a problem for clinical and counseling psychologists, either. Forensic psychologists, such as those working as postdivorce parenting coordinators, can also face hostility.
Responding the wrong way — whether by pushing back at the client or withdrawing — can derail the client's progress, say Honda and others. But, they add, there are ways to use uncomfortable interactions to actually improve treatment.
How can psychologists respond effectively to challenging clients? Here's advice from practitioners who have eased stressful encounters with their clients:
Calm yourself. When faced with a challenging client or situation, you don't want to escalate the situation by reacting to it in kind, says Honda. Instead of fighting back, be aware of your emotional and physical state, such as a racing heart, surging adrenaline, confusion and dread, he says. When the father and daughter started yelling at him, for example, Honda put his head in his hands and asked them to stop talking for a few minutes so he could calm down. Without that time out, he says, "I knew I wasn't going to be able to be constructive."
Mindfulness meditation can help psychologists prepare for the anxiety, frustration and anger that challenging clients provoke, says psychologist Mitch Abblett, PhD, executive director of the Institute for Meditation and Psychotherapy in Boston. Through daily practice of mindfulness, clinicians can learn to notice sensations arising in the body and thoughts arising in the mind without judgment. They can also keep in mind the core values that undergird therapy. "If you connect with those values, it can pull you through some of these charged moments," says Abblett.
Express empathy. Don't argue or make excuses, says Honda. Instead, validate the client's feelings by saying, "You're angry with me because …." and asking "Am I hearing you right?" And even if it doesn't feel fair, says Honda, apologize, telling the client you're sorry that something you did has made them angry or that they feel you're not competent to provide the services they need. "That can not only help de-escalate the situation, but can also further the ultimate goal of providing therapy," he says.
But keep in mind that expressing empathy has to be done right or challenging clients may see it as phony, says Stanley L. Brodsky, PhD, a professor emeritus of psychology at the University of Alabama in Tuscaloosa, who also has a private practice. "Difficult, suspicious clients may be put off by expressions of empathy," he says. "One has to earn the right to be empathic with such clients and to avoid clichéd expressions."
Compassion for the client should also be accompanied by consequences, adds Abblett. "This is not a rainbows-and-unicorns passive approach," he says. Acknowledge the emotion that is driving the client's behavior, then emphasize that it's not acceptable for him or her to make threats or swear, refuse to pay for services or simply not show up, he says.
Reframe resistance. "Some clients say they really want to change, then fight every inch of the way to make sure they don't," says Fred J. Hanna, PhD, who directs the counselor education and supervision program at Adler University in Chicago and is also a faculty associate at Johns Hopkins University. But don't resist resistance, says Hanna. "When the client is resisting the therapist and the therapist starts getting irritated with the client, then you have two people resisting each other," he says. "That's not therapy; that's called war." Instead, suggests Hanna, praise the client's resistance. "I say, 'If you worked as hard to make your life better as you do to make sure nothing changes, you could be extraordinarily successful,'" he says. If a client curses at him, Hanna expresses his admiration for the client standing up for him- or herself. Doing so, he says, helps clients see that their therapists understand them.
At least rudeness gives you something to work with, adds Brodsky. Say a client attacks the way a psychologist looks. Don't react negatively, Brodsky says. Instead, encourage the client to say more about why you're so unattractive. "Once you do that, you're actually talking," says Brodsky. Plus, if clients are rude with therapists, they're often rude with others in their lives. "It lets you explore what they've done to put off other people," says Brodsky.
Cultivate patience. Psychologists should strive to be patient not only with challenging clients, but also with themselves, says Sarah A. Schnitker, PhD, an associate professor of psychology at Fuller Theological Seminary in Pasadena, California. Her research has uncovered two strategies that can help psychologists cultivate more patience. One is loving-kindness meditation, in which practitioners direct well wishes to themselves, friends and family, even their enemies. The other strategy is re-appraisal, or thinking about situations in new ways. If a client is frustrating you, remember the bigger picture — that therapy is helping to bear the burden of another person's pain, says Schnitker. "You might think, 'This is helping to test me as a clinician' or 'This is helping me develop patience, a virtue I can use in my own life.'"
Seek support from your peers. Psychologists can feel a lot of shame when they're having trouble with clients, says Honda. "A big reason for that is because people don't talk enough about their difficulties," he says. "They think they're the only ones." Sharing tales of challenging clients with other mental health professionals — while respecting confidentiality — can not only help end that isolation but also lead to constructive suggestions about how to deal with such challenges.
It can also be helpful to get a second opinion by consulting on specific cases with colleagues who are "outside the fray," says Matthew J. Sullivan, PhD, a private practitioner in Palo Alto, California. "You can touch base with them when you're feeling rattled or insecure about something you've done," he says. Even a quick phone call with a colleague can help.
Consider terminating the relationship. Clients who think a psychologist is terrible at his or her job have every right to question credentials, challenge therapeutic decisions or even decide to end the relationship, says Honda. Sometimes, he says, "it just isn't a good match."
It's also OK for a psychologist to end the relationship, says Abblett. "I talk about how it seems like we're not on the same page about our expectations of the work and our mutual responsibilities," he says. Abblett outlines what he believes his own responsibilities are toward a client, then asks the client if he's meeting them. He then tells the client what he needs from him or her. "If that can't happen, we may need to talk about a referral to someone else," says Abblett.
Schnitker, S.A., Blews, A.E., & Foss, J.A.
In the book: Clinician's Guide to Self-renewal: Essential Advice from the Field, 2014
Strategies for Working with Difficult Clients
Sullivan, M.J. In the book: Parenting Coordination in Post-Separation Disputes: A Comprehensive Guide for Practitioners, 2014
The Heat of the Moment in Treatment: Mindful Management of Difficult Clients
Abblett, M., 2013
Treating Reluctant and Involuntary Clients
Brodsky, S.L., &, Titcomb, C.R. In Psychologist's Desk Reference: Third Edition, 2013
By Rebecca A. Clay
This article was originally published in the July/August 2017 Monitor on Psychology