27 Jun 2017

Cultural Competence is Key

Cultural Competence is Key

When working with refugees or asylum-seekers, something as seemingly straightforward as greeting new patients with a handshake can compromise trust, says psychologist Rehman Abdulrehman, PhD, co-author of an online guide called "Working with Refugees from Syria and Surrounding Middle Eastern Countries," published by the Public Mental Health Initiative he directs.

"Some Muslims believe that any kind of cross-gender contact is disrespectful," says Abdulrehman, an assistant professor of clinical health psychology at the University of Manitoba and a member of APA's Committee on International Relations in Psychology. Let Muslim patients make the first move, he suggests. If they don't offer their hands, you could put your hand over your heart and nod instead.

Noting that most psychologists don't get training in working with refugees, asylum-seekers and asylees, Abdulrehman and others offer several tips for working with those who have fled their homelands:

Learn about patients' contexts. You'll need to learn about your patients' culture, religion and other factors, says Abdulrehman. Without that insight, it can be easy to mistake normal activities for pathologies, such as mistaking Muslims' pre-prayer washing ritual for obsessive-compulsive disorder. Build competence by reaching out to members of the particular community, he suggests. In addition, be sure to understand the sociopolitical context of the country people have fled as well as the country where they've resettled, says Rita Chi-Ying Chung, PhD, a professor of counseling and development at George Mason University who has worked with nongovernmental organizations to serve refugees. Also, find out about laws affecting refugees, the asylum process, family reunification policies and how to connect patients to medical, legal and social services, she says.

Emphasize trust building. Seeking help from a psychologist is not something many refugees and asylum-seekers are comfortable with. "The notion of coming to a stranger you've never met and spilling out your most embarrassing, shameful secrets is very foreign," says Adeyinka Akinsulure-Smith, PhD, a senior supervising psychologist at the Bellevue/New York University Program for Survivors of Torture. Chung agrees. When she goes into a refugee community, she doesn't want to be seen as an expert. Many refugees come from countries where psychologists could be seen as part of the government and intake questions seen as disturbingly intrusive. "They might perceive it as, ‘Oh, my gosh, I might suddenly disappear the next day,'" says Chung. Instead, she asks community leaders how she can help, then engages in active listening while working with people on everyday tasks. "I might be working with women in the kitchen, with difficult topics coming up," she says.

Focus on symptoms. Some refugees and asylum-seekers, especially Muslims, come from countries where talking about feelings isn't as accepted as it is here, says Abdulrehman. That's why he uses cognitive-behavioral therapy with his Muslim clients. In addition to focusing on symptoms, cognitive-behavioral therapy also has a practical, solutions-oriented approach that helps restore clients' sense of control over their lives, he says.

Build strong relationships with professional interpreters. Bringing another person into the therapy session introduces potential new complications, says Akinsulure-Smith. The patient may worry about confidentiality; an interpreter from the same country may have their own issues when hearing about the patient's experiences. Spend some time with the interpreter before the session, be clear that you expect word-for-word translation and debrief afterward, she suggests.

By Rebecca Clay


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

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27 Jun 2017

Work-life Balance Still a Struggle for Most Psychologists

Work-life Balance Still a Struggle for Most Psychologists

When Pamela Hays, PhD, began her psychology career, she tried to do it all: clinical work, writing, research and teaching. But she couldn't sustain it. After a decade of going full tilt, she developed neck problems and carpal tunnel syndrome so severe she had to start using a voice-activated computer system.

"I was driven," she says. "But I drove myself into health problems I couldn't ignore anymore."

Hays, now a clinical psychologist practicing in Soldotna, Alaska, might be an extreme case. Or maybe not. Work-life balance is something that many psychologists struggle with.

The unfortunate irony is that psychologists know better than anyone the importance of making time for self-care. "We talk about it a lot with patients, but we don't practice what we preach," says Chelsi Day, PsyD, a behavioral health provider at Windrose Health Network in Indianapolis.

Psychologists might even have a false sense of invulnerability, says John F. Christensen, PhD, a psychologist in Corbett, Oregon, and past co-chair of the APA Advisory Committee on Colleague Assistance (ACCA). "We study burnout and think that applies to the people we're trying to help," he says. "In fact, health is on a continuum, with well-being at one end and burnout at the other. And most of us, during a professional career, slide back and forth on that continuum depending on what's going on in our lives."

Finding balance, however, is easier said than done. "The sin of the early 21st century is being nonproductive," Christensen says. "We're conditioned by our culture to equate value with productivity."

Of course, as psychologists well know, no one is as productive as they can be when they are exhausted and overworked. Burnout is a legitimate phenomenon, marked by feelings of emotional exhaustion, depersonalization and a diminished sense of accomplishment. "When we move into burnout, we get impatient, we treat others as objects, and we start treating ourselves as task-processing machines," Christensen says. "Our empathy tank has run dry."

For psychologists in clinical practice, neglecting well-being can even impair professional competence, making the matter an ethical concern. As Erica H. Wise, PhD, a psychologist at the University of North Carolina at Chapel Hill and current co-chair of the ACCA, argues in a recent article, it's much harder to stay competent when you're burned out. "Competence … is an essential ethical obligation and provides a critical link between ethics and self-care," Wise and her colleagues conclude (Professional Psychology: Research and Practice, 2012).

Practical balance

Unfortunately, there's no one-size-fits-all strategy for achieving personal-professional equilibrium. Stressors and obligations are different for everyone, and they also change over the course of an individual's life. "It is important for psychologists to stay attuned to these issues throughout their professional life span, since personal and work-related stressors tend to shift over time," Wise says. "Work-life balance isn't a once-and-done thing."

Some people start by establishing a career with some balance built in. Day, a sport psychologist, recently decided not to pursue an opportunity that she described as a dream job — building a counseling and sport psychology center at a Big 10 school. Although the opportunity thrilled her, after she factored in the long commute, the fact that she'd be on call 24 hours a day and her desire for personal and family time, the job didn't sound quite so dreamy. "Work-life balance is important to me," she says. "I don't want to burn out in 10 years."

After working herself into physical health problems, Hays left academia and moved back to her home state of Alaska to start a clinical practice. She joined a yoga class and a book group, started spending more time with family, and wrote the 2014 book "Creating Well-Being: Four Steps to a Happier, Healthier Life."

But finding balance doesn't necessarily mean you have to change jobs (or move to Alaska). You can start by taking a critical look at your commitments.

Wise recommends doing either formal or informal self-care assessments, which can remind you of your goals and help you figure out which daily activities energize you — and which feel like a slog. "From that, you have critical information that you can factor into your choices about your personal and professional activities," she says.

Jim Davies, PhD, a faculty member at Carleton University in Ottawa, says that for him and many of his colleagues, a lot of work commitments are self-imposed. "They are projects we are passionate about and take on whether we have the time to commit to them or not," he says. "We're too busy because we're overcommitted, not because our jobs are too onerous."

Davies uses a rigid strategy to balance personal and professional time. Every morning, he fills in a detailed spreadsheet with activities for each half hour of his waking day. "Crucially, I also schedule in my breaks," he says — including lunch, coffee breaks and even daily naps. "For me, prioritizing life means putting it in the schedule like all the other important things."

Still, for many people, time management isn't really the problem, says Sandra Lewis, PsyD, a clinical psychologist at Montclair State University in New Jersey and founder of The Living Source, a company that helps clients improve well-being and achieve their goals. "People focus a lot on time management, but I think in terms of personal energy management. If you have enough energy, you make better use of your time," Lewis says. "In the same way we charge our cellphones, we need to charge ourselves."

Yet when we're overextended, even activities that energize us can feel like one more item on an endless to-do list. So Wise suggests taking advantage of smaller moments. You might not have an hour to go to the gym, but you could take a 10-minute lunchtime walk. If you can't fit in a yoga class, take five minutes between appointments to breathe or stretch or meditate. "Find self-care strategies that you can integrate in rather than add on," she says. "Honor the smaller things."

While such strategies are helpful, more needs to be done to change the culture of workplaces from the top down, says Christensen. Too many organizations value busyness and productivity at the expense of their employees' well-being, he says. "Often in this kind of professional workplace, when you're working with other smart, committed people, the way to excel is to overwork."

Christensen has been collaborating with health-care systems in Oregon to measure well-being among clinicians, including physicians and psychologists. He's optimistic that many such organizations are starting to realize that helping employees avoid burnout is not only good for employees, but also for patients and the financial bottom line. That kind of sea change is crucial for making work-life balance more attainable, he says. "The things we as individuals can do will take us only so far."

Meanwhile, Wise argues that instead of focusing only on reducing stress, the field of psychology should do more to promote and maintain well-being broadly. "We need a more positive vision," she says. "As a profession, whether we practice or do research, whether we're being mentors or treating patients, we need to be aware that keeping ourselves healthy is important."

Further reading

  • Hays, P. H. (2014). Creating well-being: Four steps to a happier, healthier life. Washington, DC: American Psychological Association.
  • Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579–592. DOI: 10.1037/a0021769
  • Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Ethics, self-care and well-being for psychologists: Reenvisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43(5), 487–494. DOI: 10.1037/a0029446

By Kirsten Weir


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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

6 Steps for Actually Achieving Early Retirement

6 Steps for Actually Achieving Early Retirement

Early retirement sounds incredible, right? Imagine being able to walk away from your nine-to-five job at 45 years old, and then spend the rest of your life doing whatever you want!

While the idea of early retirement is gaining a lot of traction in the media and in the personal finance space, the reality remains that retiring at any age is a process that takes sustained discipline for years.

In a nutshell, the most common strategy for retiring earlier than the standard age of 65 requires two key components. The first is to maximize your investment portfolio to create a large enough nest egg to support decades without working. The second is to live as minimally as possible during the early years of your career.

Before we dig in to real strategies that can be used to retire early, please understand that early retirement simply isn't for everyone. There is a significant financial risk to cutting any career short, and many early retirees still work in some capacity to support their lifestyle.

It's also important to remember that the traditional path to retirement is still very much the norm! There's nothing wrong with having a long, fulfilling career in a field that allows you to contribute to society in a meaningful way.

Here's what you need to do to retire early:

1. Understand the 4 percent rule (aka Safe Withdrawal Rate)

Over the years, the most common guideline found in the early retirement community for determining the amount needed to sustain life outside of a career is "the 4 percent rule." The idea behind the 4 percent rule is that early retirees can safely withdraw 4 percent from their overall investment portfolio every year to live on and never run out of money.

The reasoning is fairly simple. If you assume average returns of at least 6 percent on your investments, your portfolio will never decline with only 4 percent being withdrawn yearly. Depending on the source you use, the stock market rate of return averages anywhere from 6-12 percent over time (it's important to note that returns in the market are not guaranteed! These are just based on what has happened historically).

2. Find out how much income you will need

The biggest component to early retirement is figuring out what type of lifestyle you are hoping to achieve. A safe rule of thumb is to assume that you'll need 80 percent of your current income to live comfortably in retirement, but depending on what type of life you envision for yourself postcareer, the numbers may be higher or lower.

Right now, the trend for younger people who have "retired" is minimalism. The idea is that if you drastically reduce the amount of money it takes to survive on a yearly basis, the earlier you can actually leave traditional work.

This usually equates to drastic changes in lifestyle. Many younger retirees opt to downsize their homes or sell them altogether and live in RVs (yes . . .  seriously). There is actually a fascinating trend happening with travel trailer manufacturers where millennials are propping up the entire RV industry!

Another common sacrifice is the type of cars that early retirees drive. Because the cost of financing new cars that rapidly depreciate is very high, those in early retirement tend to drive older paid-off cars and learn to do much of the maintenance themselves.

All of these factors should go into your calculations for how much income you will need in a potential early retirement scenario. It's important to be realistic with how you will approach your lifestyle, and it never hurts to pad the numbers.

3. Calculate how large your portfolio needs to be

Using the safe withdrawal rate detailed above in step 1 and then determining what type of lifestyle you'll live as a retiree in step 2, you can calculate how much money you will need in your portfolio to effectively retire without running out of money.

Let's say that you determined that your ideal retired lifestyle will cost $50,000 per year. Multiplying that amount by 25 (4 percent of your portfolio is 1/25) will give you the total nest egg you need to achieve before you can effectively retire.

In this scenario: $50,000 x 25 = $1,250,000

Again, assuming average market returns over time (not guaranteed), you can withdraw $50,000 per year from a $1.25 million retirement portfolio and never actually run out of money. In the perfect scenario, your nest egg would continue to grow even with the $50,000 per year taken out.

Obviously, you would also need to anticipate any future large purchases for the 4 percent rule to actually work. If you are planning on living out the rest of your life in a sailboat that costs $25,000, you'll need to build that into your nest egg along with all future estimated maintenance costs.

4. Account for inflation

It's important to understand that a nest egg of $1,250,000 won't actually be worth that amount in the future. Inflation is constantly eating away at your money's purchasing power, and the effects can be substantial.

Unfortunately, it's literally impossible to calculate exactly how much bigger your portfolio will need to be years from now to battle future inflation. But, we can use past numbers to at least get close!

Using an inflation calculator like this one from the Bureau of Labor Statistics, you can see how inflation might change the amount you need to retire over the coming years.

Let's say you want to retire 20 years from now. All you need to do is take the $1,250,000 number that we calculated earlier and plug in that number for a previous 20-year period.

From 1997 to 2017, $1,250,000 would actually need to be $1,907,958.80 to maintain the same purchasing power. So you can roughly assume that you'll actually need almost $700,000 more than the initial $1,250,000 nest egg to effectively retire early.

Again, these are just estimates, but they will allow you to plan properly for early retirement.

5. Find new income streams

If you want to comfortably retire early, you will probably find that it's a good idea to find extra sources of income when you step away from your career for good. The traditional idea of retirement is the complete absence of work, but if you want to do it early, that might not be realistic.

It may be necessary to find some type of part-time employment to avoid digging in too far to your nest egg. Another option is to start a small business, but it doesn't have to be complicated. Even something as simple as flipping old furniture or buying and selling items on eBay might be enough to provide a nice buffer.

6. Plan for the worst

My biggest concern for early retirees is unexpected costs that might come up later in life. If you planned for the absolute bare minimum amount needed to retire, all it could take is one major accident or sickness to completely derail your retirement plans.

Similar to inflation, it isn't possible to specifically plan for a future issue. However, it should be part of your approach in deciding if early retirement is even possible or worth it in the long run.

The bottom line on early retirement

Just remember—early retirement sounds great in theory. There is a large amount of risk to consider when making this type of financial decision. That's not to say it isn't possible, but you should absolutely proceed with caution.

-- 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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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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