New England Psychologist - August/Sept. 2018

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Isolation and LGBTQ youth: Social, psychological and financial implications

By Phyllis Hanlon This project was supported by a grant from the American Society of Journalists and Authors (ASJA) and the National Institute of Health Care Management (NIHCM) Foundation. n a 2017 Washington Post article, former Surgeon General Vivek H. Murthy cited loneliness as one of today’s big public health worries.

While the average American might experience isolation and disconnectedness at various times during their lives because of intense career involvement, age discrimination, geographic remoteness or for other reasons, many youth who identify as LGBTQ endure isolation, broken relationships and disconnections on an ongoing basis, sometimes with devastating results.

According to David Ober-

“I think in some parts of the country it may feel ‘safer’ for LGBTQidentified youth to come out, but for many, the issues remain the same.”

Nicole Issa, Psy.D, founder, Center for Dynamic and Behavioral Therapy, New York City

leitner, Ph.D, chair, department of psychology, University of Bridgeport in Connecticut, isolation, or the perception of isolation, can be either an active or passive process.

He explained that exclusion might entail directly being ignored or actively discriminated against by others, limiting access to social activities and school groups.

“It can be less direct as well when the individual perceives that others do not respect them or do not want them around,” Oberleitner said, noting that the perception that others do not “see” or hear you can be just as powerful as being actively ignored.

The perception of isolation, whether correct or not, is just as damaging as true or active exclusion.

Categorizing isolation In 2013, then doctoral student Michael J. Johnson, MSN, RN, and Elaine J. Amelia, Ph.D, RN, FAAN, professor at the Medical University of South Carolina, conducted an analysis that identified five socially constructed dimensions of isolation in LGBT youth: “social, emotional, Continued on Page 10

Conversion therapy ban prompts different results in three NE states

By Catherine Robertson Souter n a movement that seems to be growing, a ban on mental health professionals providing conversion therapy for people under 18 has been signed into law in 15 states.

There have been five bans this year alone.

In June, New Hampshire Governor Chris Sununu signed a bill banning the practice in that state.

“There has been a real cultural shift,” said Shannon

Bader, Ph.D, A.B.P.P., the legislative chair for the New Hampshire Psychological Association. “We were the 14th state with an outright ban.”

Historically, conversion therapy has included everything from instruction on why and how to change to shaming the subject to physical punishment or inducing nausea to create aversion.

Supporters of these bans point to a lack of research showing that the practice actually works, along with fears that it causes harm to

youth.

“There is no credible evidence that conversion therapy can change a person’s sexual orientation or gender identity or expression,” said Stephen Peters, senior national press secretary and spokesperson for the Human Rights Campaign.

“To the contrary, research has clearly shown that these practices pose devastating health risks for LGBTQ young people such as depression, Continued on Page 9

VOL. 26, NO. 7

CDC Report: Suicide prevention goals will be difficult to accomplish

By Janine Weisman he World Health Organization wants to reduce the suicide rate by 10 percent by 2020.

The American Foundation for Suicide Prevention’s Project 2025 wants to reduce it 20 percent by 2025.

The Zero Suicide movement aims to prevent 100 percent of suicides in the first 30 days after a patient is discharged from inpatient or day treatment.

Are these goals realistic when new federal data show the reverse has actually been happening?

Twenty-five states saw their suicide rates rise by more than 30 percent between 1999 and 2016, including four of the six New England states.

That’s according to a study the U.S. Centers for Disease Control and Prevention published in the Morbidity and Mortality Weekly Report on June 8, the same day celebrity chef Anthony Bourdain died by suicide in France and three days after fashion designer Kate Spade took her own life at her home in New York.

“It shows we’re not winning, we’re not as a society yet reducing the rate but part of that is because the data is better,” said Robert W. Turner, the private sector chair of the National Action Alliance for Suicide Prevention.

The alliance embraced the goal of Project 2025. Count

Turner among the optimists who believe it is within reach.

That’s partly because he thinks what happened to him when he recently ended up in a hospital emergency room with a serious skin infection on his hand would not have happened just five or six years ago.

“It’s 1:30 in the a.m. and the admitting nurse in my room is asking me mental health suicide questions: Have I ever thought about suicide? Have I been depressed?” said Turner, a Massachusetts native and a retired senior vice president of Union Pacific Corporation.

The CDC report’s findings reinforced the need to address suicide prevention through a comprehensive and coordinated approach that combines health care system efforts with community efforts.

The study examined suicide rates using data from the National Vital statistics System for 50 states and the District of Columbia. Additionally, data from 27 states covered in the National Violent Death Reporting System - including all six New England states – showed that 54 percent of suicide victims had no known mental health condition.

Relationship, substance use, physical health problems and job, money, legal or housing stress were all identified as contributing factors.

Vermont’s rate jumped 48.6 Continued on Page 11

INSIDE

Mass. high court upholds drug free sentencing ..........................................Page 6 Gender identity added to NH anti-discrimination law...............................Page 7 CE listings.................................................Page 13

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New England Psychologist

August/September 2018

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Developmental trauma disorder is focus of research It would surprise no one that children who have been mistreated or have been subjected to another form of trauma would experience repercussions. It makes sense that trauma can result in symptoms that look like behavioral disorders, oppositional defiant disorders, anxiety, depression, or ADHD. Yet, for many children the symptoms are treated as not being related to their traumatic experiences.

As part of an on-going research project, Julian D. Ford, Ph.D, A.B.P.P., professor of psychiatry and law at the University of Connecticut and director of the Center for Trauma Recovery and Juvenile Justice, and colleagues Joseph Spinazzola, Ph.D. and Bessel van der Kolk, M.D., have developed a questionnaire aimed at pinpointing a disorder known as developmental trauma disorder, or DTD. They have been conducting an on-going research study on its efficacy.

Ford spoke with New England Psychologist’s Catherine Robertson Souter about the study and the need to understand that children’s reactions to trauma should be both more fully understood and addressed.

Tell us about DTD. The idea is that children who experience traumatic stress and adversity often develop symptoms that go beyond or don’t quite meet diagnostic criteria for post traumatic stress disorder (PTSD).

Those children and adolescents often are diagnosed as having other psychiatric and behavioral disorders, sometimes multiple diagnoses.

We really needed to have a way of helping clinicians and families to recognize when kids are experiencing trauma-related symptoms that don’t fit PTSD and not just try to treat them for other disorders.

In this study, we are testing out this potential syndrome.

We found that there

are certain kinds of trauma experiences that are particularly related to developmental trauma disorder and not so much to PTSD, including exposure to violence in the family or community and disruptions in bonding with primary caregivers.

It does indeed look like there is a subset of kids who can best be understood and probably, and this is the next step in our research, can be best treated for these symptoms of developmental trauma disorder either in addition to PTSD or separately from PTSD. Does it matter if symptoms that look like, say depression, are treated as depression?

There is evidence-based treatment for childhood trauma that would be more suitable for these children.

What phase are you in now and what is next with the study?

It is a two-phase study and we are currently reporting on the results of the first phase, which is about half of the sample.

We will be reporting soon on the second phase to see if the findings hold up, so basically a replication. That will bring us up to about 500 kids total.

We have developed an interview with questions about 15 symptoms of developmental trauma disorder. If we find that DTD syndrome has some utility in addition to what PTSD can provide for clinicians who are assessing and treating children, the next step will be to find ways for clinicians to be able to use this questionnaire.

We will disseminate the interview we developed and start research on where it can be used in addition to PTSD interviews to assess the outcome of different forms of treatment.

That is the goal, to be able to see if a variety of traumafocused treatments are beneficial in terms of not just improving PTSD symptoms but also helping kids over-

come these developmental trauma symptoms.

In some ways this seems obvious that kids would have effects of trauma even if they don’t strictly define as PTSD. Is it something that was understood but not formalized before?

Yes, I think that’s a very good way to put it: it’s been understood but not formalized. We now just need a way to describe it carefully and really identify what are the key symptoms so we are not just saying any problem could be related to trauma but we are honing in on specific symptoms.

One reason why this is happening now is because the National Child Traumatic Stress Network (NCTSN) was first funded by the federal government in 2001.

Over the last 17 years, there have been several hundred centers nationally that have been funded to provide treatment and services to children who have experienced trauma.

As that network has grown, it has become increasingly evident that there are hundreds of thousands of children who experience traumatic stress every year just in this country and millions in the world and only a small fraction get the treatment that enables them to recover.

The separation of children from families by the US government would you care to comment?

I don’t have any direct contact with children or families who have been separated at our borders but what I know from colleagues and through the media is that this kind of coercive, unexpected separation is deeply frightening for children of all ages.

It cuts them off from their primary source of care and protection and that is a traumatic shock. Most of these kids will probably not develop PTSD as a full diagnosis but will develop signs of post-traumatic stress difficulties and should be provided with help so those reactions, which are normal healthy reactions to cope with the shock of separation, do not become PTSD. That is the responsibility we have as a community and society to these children and their families.

In some cases, these kids have already experienced trauma, from a situation that they left behind. Wouldn’t it be beneficial for the people on the front lines at our borders to have this information in any and all cases?

I do know there are centers in the NCTSN that are located near or in border communities or are working in communities where these people have been sent after they arrived in the U.S. Those centers are making massive efforts to get information out to the families and to the frontline workers so that they understand traumatic stress reactions and how to help children recover.

You are also the director of the Center for Treatment of Developmental Trauma Disorders (CTDTD). How is this related to the NCTSN? A couple of years ago we were funded through NCTSN to start the CTDTD, a virtual center with reach all over the country. It involves a rich array of expertise focused on helping

therapists and counselors recognize DTD and develop the skills needed to provide individualized treatment for children.

One of our major projects is a webinar series which can be accessed at no cost through the learning center of NCTSN. The series is designed to inform mental health providers about the issues they may face when they are working with kids experiencing DTD and ways to be prepared so they can understand why it is happening, how it is an outgrowth of developmental trauma reaction and what they can do about it.

Why is this work important?

Because there are tens of thousands of children and adolescents who are experiencing posttraumatic stress reactions who are not receiving the best available treatment.

We need to make sure we are reaching those children.

I think we have responsibility to help kids and families and communities understand that posttraumatic stress reactions are not a pathology or a disease.

PTSD is a healthy adaptation to extreme adversity that then has to be gradually shifted once the adversity is no longer an immediate threat.

That is the challenge of DTD and PTSD, helping kids and families to not stay in survival mode.

People deserve to have a road map on how to shift back to ordinary, safe, day-to-day living.

It is a difficult shift but one that can be done if the right education and skills are provided. NEP Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

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New England Psychologist

IN PERSON

August/September 2018

EDITORIAL

What’s in a name?

By Alan Bodnar, Ph.D ou’re sitting in your doctor’s waiting room when the receptionist calls the name of the next patient. No one responds, she calls the name again, and prompted by curiosity, you look up from your magazine to meet her puzzled gaze.

She repeats the name, this time adding the surname, and you wonder why she is calling your father. No, wait, Dad is long gone, and then you realize the receptionist is calling you.

If you’ve ever had this happen to you, then, like me, you were given a name at birth that no one ever used.

In my case, my parents named me after my father but never called me by that name.

When I was old enough to handle the truth, they explained that they wanted to make sure no one in our small family of three would become confused about who was being addressed when my mother spoke.

They used my middle name instead and it stuck. These things have a way of taking on a life of their own, so when my mother registered me in school, she registered me as Alan, once again so I would not become confused when my teachers called me by my father’s name.

In my mother’s mind, confusion was evidently one of the great evils, second only to polio, that children must be protected from at all costs.

It didn’t take a career in clinical psychology to teach me that she had this one right.

Common sense alone would be enough to imagine the disorientation of a five-year-old on his first day of school in an unfamiliar setting with lots of other kids and an unfamiliar adult calling the shots – and the names.

I grew easily into my short middle name – four letters and two of them are a’s. It doesn’t get any easier than that, and without a trace of confusion, I entered my teen years and got my first Social Security card when I started a summer job cutting the grass at the town park. In this, situation my first brush with government bureaucracy, I used the name I always used with no questions asked.

The problem came later when more and more docu-

ments required my full legal name – first, middle, and last. Applications for college admission, financial aid, a driver’s license, new jobs, bank accounts, a marriage license, a mortgage, a professional license, health insurance, and tax forms all wanted to know that I carried my father’s name.

So, I told them, except when I could get away with leaving it out or, better yet, signing with the first letter of his name followed by my middle name in the style of J. Paul Getty.

With all of these documents to sign over a lifetime, it was getting hard to remember which version of my name I had used on which document.

In spite of my mother’s best efforts to protect me from this scourge, I was becoming – dare I even write the dreaded word?

– confused.

There’s nothing like the enforcement branch of the Internal Revenue Service to snap a person out of confusion, and that’s just what happened when they came calling to find out why I had never paid my federal income taxes.

Of course, the guy with my middle name on his Social Security card paid his, but the IRS didn’t know that because he filled out the form with his full legal name – first, middle, and last.

I was at work when they came to the house to make the arrest, and it was only my wife’s quick thinking and photocopies of the disputed tax forms that saved my neck.

It doesn’t take the IRS to tell us that our names are important. Our names connect us to our families, the people and values they hold dear, or to our ethnic, religious, or cultural heritage.

They may reflect deeply held moral principles or nothing more than current trends in popular culture. Sometimes principles and culture meet as in Puritan New England where fashionable names included Prudence, Charity, Patience, Justice, and Temperance.

Biblical names are still popular among certain religious groups, and movements of every kind generate their own lexicon of baby names.

If you happen to be called Dharma, Rainbow, Hendrix, or Monterey, it’s a good bet your parents came of age and cherished the values of the sixties, or perhaps they just wanted you to stand out with a name that is unique.

For some, originality is an important factor in choosing a name, and many parents just want a name that pairs well with their family name, something that sounds good together.

Because our parents do the naming, our names at first reveal more about them than us. This changes over time as we crystallize our identities around the kernel of our names. Our likes and dislikes, talents, temperaments, and ways of relating to others – virtually all aspects of our personalities – come to be signified by our names.

For those who know us well, our names become a shorthand for who we are, a way of grasping our essence or, to use the slang expression, our handles.

For those who don’t know us at all, our names tell nothing about us, one James is the same as another, one Jill no different from all the others that we’ve never met.

Now in my retirement years, I have a Medicare card in my father’s name and I am, yes, once again confused when I hear him called in the doctor’s waiting room. It makes no difference to the doctor whose head, shoulders, knees, or toes he examines, but it matters to me. My father would want it that way. He carried his name with dignity, and I can only hope I’m doing the same with mine. NEP

Alan Bodnar, Ph.D. is a psychologist formerly at the Worcester Recovery Center and Hospital.

Emphasizing psychosocial treatments for ADHD It’s difficult to keep focused on outcomes that are likely to result in the greatest long-term success for your clients. One such example is in the treatment of attention deficit hyperactivity disorder (ADHD) in children.

It’s becoming increasingly less common for clinicians to even see children who present with ADHD, because of the emphasis of medication treatment – stimulants – for this concern.

According to 2016 U.S. Centers for Disease Control & Prevention data, 62 percent of children receive medication for treatment, while only 47 percent received a behavioral intervention.

The number of children who receive behavioral interventions decreases significantly with age – from 60 percent in ages two to five, to 51 percent in ages six to 11, down to a measly 42 percent in ages 12-17.

We know, however, that according to the research data, psychosocial treatments offer a lot of benefits over medication alone.

Psychosocial treatments – ones that combine behavioral, cognitive behavioral, and skills-training techniques – can help teach invaluable skills to children to help manage ADHD symptoms even if they stop taking medication.

Such treatments can result in improvements in academic and organizational skills such as homework completion and planner use, as well as co-occurring emotional and behavioral symptoms.

Psychosocial treatments can also help in interpersonal functioning more than strictly medication use. In short, psychosocial treatment for ADHD in children appears to be the gold standard.

We do a disservice to parents who dismiss talk of such psychosocial treatments, and who instead turn to the pill bottle because of its ease, inexpensiveness, and efficiency.

The benefits of psychosocial treatment will stay with children for the rest of their lives. The benefits of taking a stimulant medication only extend to the relief of ADHD symptoms while taking the medication.

Stimulant medications have their place in the treatment of ADHD in children. But we should always emphasize to parents the value and importance of trying a psychosocial intervention first, because it will likely result in a better outcome for their child.

If such an argument fails, suggesting psychosocial treatment alongside medication can also benefit a child.

By John M. Grohol, Psy.D.

Publisher:

Editor-in-Chief:

Contributing Writers:

Graphic Designer:

John M. Grohol, Psy.D. Psych Central Susan Gonsalves Pamela Berard Alan Bodnar, Ph.D. Phyllis Hanlon Catherine Robertson Souter Eileen Weber Janine Weisman Karen H. Woodward

New England Psychologist is published 11 times a year (no August issue) by New England Psychologist, P.O. Box 5464, Bradford, MA 01835. It is mailed at no charge to all CT, ME, MA, NH, RI, and VT licensed psychologists. Distribution of this publication does not constitute an endorsement of products and services. The publisher reserves the right to reject any advertisement or listing considered inappropriate.

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August/September 2018

New England Psychologist

THE PRACTICAL PRACTICE

BOOK REVIEW

Treatment resistance is challenge for clinicians

By Catherine Robertson Souter atient X doesn’t show up for an appointment-again. He calls and explains that his dog was sick/mother needed a ride/car broke down. Client J is late for nearly every appointment.

Patient K offers every excuse she can think of for why a particular solution will not work for her – no matter the solution. Patient N, a teenager, is openly critical of you, your clothes, your hair, and your skills as a therapist.

No one said that life as a therapist would be easy.

No matter the population – younger, older, more or less seriously ill, there are at least one or two in every practice.

These are the patients that may make you cringe when you wake up the day they are on your schedule. At times, you may want to walk out the door or react in some other seriously “non-professional” way. You may think of them as your “difficult” patients or as “angry,” “troubled,” or “offensive.”

Treatment resistance happens in nearly every practice and there are ways to address the problem. Experts all over the internet offer valuable suggestions like stepping away if a session gets over-whelming; encouraging the client to offer solutions, to be the expert of their own treatment; or seeing a roadblock as a key to eventual success.

These experts agree that these patients may be “difficult” but they are not, in most cases, “impossible.”

(Caveat: some patients may be better with another therapist if a relationship seems too fraught with emotion or rebellion).

Two experts provided novel ways to look at how to handle treatment resistance.

Jeremy Ridenour, Psy.D, is the director of psychological testing and associate director of admissions and a staff therapist at Austen Riggs Center, an open psychiatric hospital in Stockbridge, Mass.

Although many of the clients he works with have complex psychiatric problems,

Jeremy Ridenour, Psy.D., director of psychological testing and staff therapist, Austen Riggs Center, Stockbridge, Mass. he believes that the steps to understanding and working with resistance to therapy are the same for every level of client.

The first step is understanding that symptoms are, in part, adaptive, and provide support in some way.

“Symptoms are an effort to manage life’s problems,” Ridenour said. It is when those symptoms are no longer helping or are getting in the way of living a full life that a client may come looking for help. Still, that doesn’t mean they have resolved the reason they developed the symptoms.

A key to understanding resistance is understanding how clients benefit from the symptoms and helping them find another way to provide themselves the same thing, but in more healthy ways.

It’s important to see your own role in the relationship especially when you are feeling frustrated. “If you are finding yourself in a position where you need to push a client, maybe it’s time to step back and see if you are too invested in a certain direction,” Ridenour said.

Keeping the client’s stated goals at the forefront of treatment can help keep the focus on the client’s journey.

“Make the patient’s agenda preeminent and allow it to set the stage,” he said. “Make sure to engage them and work towards their agenda to promote their sense of agency.”

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‘We are not respectful enough of what our patients care about,” he said. “A lot of resistance might go away if we take seriously the patient’s agenda.”

Mitch Abblett, Ph.D, is a clinical psychologist in Wellesley, Mass., and the executive director of the Institute for Meditation & Psychotherapy. Among other books for the general public, he wrote one for clinicians, “The Heat of the Moment in Treatment: Mindful Management of Difficult Clients” (W. W. Norton & Company, 2013).

He believes understanding clients starts with understanding oneself.

Start, he explained, by recognizing that you will have emotional and/or physical responses to certain patients.

“We are trained to maintain empathy, to be a blank slate and focus on the client’s struggles, reactivity, pathology, but when we are working with patients who push our buttons for one reason or another, we have to understand that we are going to have emotional reactions,” he said.

“It seems like common sense but a lot of therapists need that reminder to understand that it is universal.”

The next step is to practice mindfulness, both in and outside of the office.

“The ability to be in the moment can help a therapist better understand what lies behind the behavior for the client, compassionately, and be able to be more effective at pulling out tools from your own tool kit to deal with a situation.”

Practicing mindfulness throughout the day is the key, he said. In addition to setting aside time daily for a 10-15 minute meditation, set up certain markers to remind yourself to take a moment, breathe and center yourself.

“Notice what arises as it arises without judgment,” he said. “Maybe you have a reaction when seeing one client’s name in your appointment book. Watch it and let it move through you which, in turn,

Continued on Page 6

Well-researched book is useful resource for practitioners

By Stan Rockwell, Psy.D

have had friends and clients who had dissociative identity disorder. I’ve come across therapists who diagnosed virtually every client they saw as DID. I wish

how to communicate with different identities.

One thing that stands out in the case studies and in the authors’ experiences is how many years it can take for a person to be properly diagnosed. The diagnosis may not be particularly easy because

“Treating TraumaRelated Dissociation: A Practical, Integrative Approach” Kathy Steele, Suzette Boon, and Onno Van Der Hart W. Norton and Company

this book had been available back in those days.

The authors have been working with trauma and dissociation for a long time. One is a past president of the International Society for the Study of Trauma and Dissociation (Steele), another a co-founder and past president of the European Society for Trauma and Dissociation (Boon), and another a past president of the International Society for Traumatic Stress Studies (Van Der Hart).

This book comes from their work with many patients over the years, as well as experience with supervision of and consultation with other therapists. They guide us on to how to work collaboratively, for “a collaborative model likely provides the most effective paradigm for adult growth, change, and development.”

I appreciate this book on many levels. The authors have put an incredible amount of thought into the comprehensive content and have organized it in a highly useful way.

This book is useful for any therapist, whether they work with people with dissociation or not. The authors include case studies throughout to help us learn how to diagnose and treat people, including

some of the identities may be phobic of each other or they may not trust the therapist, for example.

Trust and boundaries are extensively discussed. There will be transference and counter transference, particularly in work with folks with dissociation. The authors tell of cases where those issues were handled well, and some where they were not.

Also, they address the process of dissociation. The authors give a clear understanding of just what dissociation is and how it manifests, and that it is not the same in every individual.

The authors’ research of the literature is extensive, as is their ability to synthesize and present it in a cohesive and understandable way.

They start at the beginning with the concept of “realization” and the effect of trauma on a person physically, mentally, emotionally — really in every sense of being — with dissociation “perhaps the most profound type of non-realization.”

Each dissociative part develops its own reality, and dissociation could be called “multiple reality disorder.”

Continued on Page 6

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New England Psychologist

August/September 2018

Mass. high court upholds drug free sentencing

By Janine Weisman merging scientific consensus that defines addiction as a chronic disease that changes the brain failed to sway the Massachusetts Supreme Judicial Court (SJC) to end the longstanding practice of jail time for offenders who relapse while on probation.

A unanimous decision by the high court’s seven justices on July 16 affirmed that judges have discretion to order into custody defendants who violate a probation condition to stay drug free.

The 27-page ruling involved a case that had drawn national attention for its potential to usher in sweeping changes on drug sentencing.

The defendant in Commonwealth vs. Julie A. Eldred was placed on probation for one year on a felony charge of larceny in 2016. Her probation conditions required her to remain drug free and submit to random drug screens and attend outpatient treatment.

A drug test administered by her probation officer on the Friday before Labor Day tested positive for fentanyl.

At a detention hearing in Concord District Court that same day, a judge determined there was probable cause to believe Eldred violated

the drug free condition and ordered her held in custody until a bed opened up in an inpatient treatment facility.

Eldred spent 10 days in jail before a treatment center could admit her.

Eldred’s lawyer, Lisa Newman-Polk, wrote in an email that she would not be discussing with the news media whether her client would appeal the decision.

“The decision is a massive blow, and I believe, on the wrong side of history,” Newman-Polk stated.

“The SJC had the opportunity to do something groundbreaking in view of the science in the Surgeon General’s report on substance use disorder and instead rubber-stamped the status quo, dysfunctional way in which our criminal justice system treats people suffering from addiction.”

Prosecutors had argued that substance use disorder may affect someone’s urge to use substances but does not render them without free will.

The National Association of Drug Court Professionals submitted a friend of the court brief supporting the drug free condition, contending that a combination of treatment, monitoring, and sanctions is needed to set drug users straight.

Prosecutors had also noted

that Eldred never objected to the condition that she remain drug free before accepting the terms of her probation.

Friend of the court briefs filed by the Massachusetts Medical Society (MMS) and

“Part of the argument was because she had the disease of addiction, she really didn’t have any will as it related to her relapse and I think that’s a challenging concept for laypeople to understand.”

Michael Botticelli, executive director of the Grayken Center for Addiction, Boston Medical Center

other organizations had argued that stress caused by the requirement to remain asymptomatic can compound an offender’s risk of relapse.

MMS President Alain A. Chaoui, M.D., expressed disappointment in the high court’s ruling in a statement.

“This decision runs counter to established and continually reaffirmed scientific knowledge that opioid use disorder is a chronic medical condition, and a symptom of that

The authors give guidance on how to do therapy when it becomes almost a negotiation process among parts and their relationship with each other. They also give examples of how a person can get better even without insight.

The book provides “core concepts,” or fundamental ideas that are snap-shots of the work’s principles or a summation of the ideas presented in those pages. These

those struggling.”

Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center, which had been among supporters submitting briefs for the defendant, saw disagreement over the disease model of addiction as similar to the way people talk about whether human activity causes climate change.

“Part of the argument was because she had the disease of addiction, she really didn’t

have any will as it related to her relapse and I think that’s a challenging concept for laypeople to understand,” Botticelli said.

Botticelli said the Eldred case illustrates the need for more education for those who work in the criminal justice system on the circumstances of relapse.

Newman-Polk said her client, now 30, is “doing okay” and has finally been in recovery for the last year and a few months because she was able to restart suboxone with an excellent doctor.

She said Eldred is living with her fiancé and does pet care.

“The ruling itself was pretty narrow to this specific case and still gave judges a significant amount of discretion in terms of how they consider relapse as part of someone’s probation violation and clearly seems like they’ve left the door open for further cases like this in the future,” Botticelli said.

“There are many Julie Eldreds out there for whom this is happening on a daily basis,” he added. NEP Janine Weisman is a journalist based in Newport, Rhode Island, who frequently writes on mental health. Find her on Twitter at @ j9weisman.

THE PRACTICAL PRACTICE

BOOK REVIEW Continued from Page 5

disorder is relapse,” Chaoui stated.

“We believe that taking punitive measures to address the symptom of relapse tied to opioid use disorder does not serve the best interests of

are bold and set apart in the text, as are the subheadings in the chapters and case studies.

The physical structure of the book makes it very user friendly. There is a summary at the end of each chapter and questions to make you think called “Further Explorations.”

Other features are an appendix with sources for screening and assessment instruments, prognosis/treatment/progress rating scales, and a sample safety plan.

The authors spend time

discussing the collaborative therapeutic relationship at the beginning of the book, then progress to triaging the best treatment place for the person, and move on to how to assess, treat, and continue to build on the relationship while also taking care of yourself and the client.

What shines through to me throughout is the authors’ passion for their work and their compassion for the people with whom they work.

NEP

Continued from Page 5 will help to create more presence when the person walks into the room.”

One last tip, he offered, is to use that mindfulness to notice how you speak, with yourself or others, about certain difficult clients or disorders and what message you are sending with your words.

“I hear people say, ‘I don’t treat borderlines,’ or ‘That person is manipulative.’” He said. “It’s not that we have to

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treat people with borderline personality disorder, but can we hold these people in our minds with compassion? How we frame our clients says so much.” NEP Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

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August/September 2018

New England Psychologist

7

Gender identity added to NH anti-discrimination law

By Pamela Berard iscrimination in employment, housing, or places of public accommodation on the basis of gender identity is now prohibited in New Hampshire.

House Bill 1319 was signed into law in June and added gender identity to the state’s existing anti-discrimination legislation, along with age, sex, race, color, marital status, physical or mental disability, religious creed, national origin, and sexual origin.

The legislation defines gender identity as “a person’s gender-related identity, appearance, or behavior, whether or not that gender-related identity, appearance, or behavior is different from that traditionally associated with the person’s physiology or assigned sex at birth.

Gender-related identity may be shown by providing evidence including, but not limited to, medical history, care or treatment of the genderrelated identity, consistent and uniform assertion of the gender-related identity, or any other evidence that the genderrelated identity is sincerely held as part of a person’s core identity provided, however, that gender-related identity shall not be asserted for any improper purpose.”

Teresa Johnson, Ph.D, chairperson for the Committee for Women, Minorities, and Diverse Communities for the New Hampshire Psychological Association (NHPA), said the NHPA is in support of this law.

Johnson said New Hampshire was the last New England state to offer such protection.

“I’ve had clients move out of state after transitioning, trying to find other states where they feel like they have more protection, where they feel safer, where they feel like it would be more possible for them to continue to be employable,” Johnson said.

“I know that we have lost long-time New Hampshire residents for this reason.”

The passage of the legislation should offer some relief to her clients.

“I think they feel more recognized as human beings and knowing that it’s as important for them not to be discriminated against as everybody else,” Johnson said.

Even with the law’s protec-

tion, Johnson said New Hampshire is still an employmentat-will state, so an employer could still let an employee go without cause.

The legislation gives the individual recourse, she said.

“I think the passage of a bill like this can be a wakeup call to cisgender people to look at our own biases. Ultimately, that’s the core of it. The legal protection is really important but the real impact is on how people treat each other, and how they judge each other.”

Johnson said she has had transgender clients who were transitioning, and were trying to understand the protocols that their employer had around disclosure.

Some clients have had problems with issues such as notifying employers about timeoff for medical procedures; and how to go about presenting with a different name and gender at work.

“Not having any protection around discrimination leaves so much vulnerability in so many different areas,” she

said, adding that she’s had clients lose their jobs following transition.

ultimately getting a UTI. Johnson said she’s heard from employers, including

“The legal protection is really important but the real impact is on how people treat each other, and how they judge each other.”

Teresa Johnson, Ph.D, chairperson for the Committee for Women, Minorities, and Diverse Communities, New Hampshire Psychological Association

She spoke of another client wo felt he didn’t have safe restroom access at work so avoided liquids and bathrooms,

medical providers and hospital administrators, who’ve asked her about education for their staff on how to provide

care to transgender patients.

Questions have centered on how to make patients feel safe and meet their needs as well as the use of preferred pronouns and a person’s chosen name, even if it’s not yet their legal name.

Johnson said this fall the NHPA will offer continuing education training for psychotherapists on how to support transgender clients from a compassionate perspective.

One of the next steps, Johnson said, is contacting all insurance companies to cover medical care for transition services. “I think having that requirement in New Hampshire would be a great service to our transgender residents,” she said. NEP Pamela Berard has been a contributing writer for New England Psychologist for almost two decades. She is also senior editor for a technology publishing and events company, and was previously city editor at several daily New England newspapers.

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New England Psychologist

August/September 2018

Goldwater Rule is focus of NE panel discussion

By Phyllis Hanlon n 1964, presidential candidate Barry Goldwater issued some alarming “extremist” statements, drawing criticism from the general public and some mental health professionals.

The uproar prompted FACT

lash following the release of the survey results, the American Psychiatric Association (APA) passed the “Goldwater Rule,” which made it unethical for a psychiatrist to issue a statement on the mental health of a public figure without first conducting a full clinical examination.

Part of the Bradley Hospital Seminar Series. “The Intersection of Ethics and Politics in Clinical Care in a Polarizing Environment” featured a panel of mental health providers who discussed the Goldwater Rule and how politics might enter the therapy room.

Plante indicated that psy-

and political figures’ psychological condition.

The public might view comments as representative of the field of psychology as a whole, Plante said. When speaking on behalf of the field, psychologists have to back up comments with science and note the limits of their knowledge

“I would not feel comfortable if someone was making a determination about my psychological status without evaluating me and knowing all the context.”

“Ethics also asks us to communicate personal biases.”

Wendy Plante, Ph.D, director of outpatient services for children, Bradley Hasbro Children’s Research Center, Rhode Island Hospital

Emily Mohr, Ph.D, public education coordinator, Massachusetts Psychological Association

magazine to survey 12,356 psychiatrists regarding Goldwater’s mental health status.

While none of the respondents had personally spoken with or examined Goldwater, they provided negative opinions on his psychological health, deeming him unfit to serve as president of the United States.

In the wake of serious back-

Wendy Plante, Ph.D, director of outpatient services for Children at Bradley Hasbro Children’s Research Center at Rhode Island Hospital reported that a panel recently re-visited this matter.

Plante is also a member of the Rhode Island Psychological Association’s (RIPA) Ethics Committee.

chologists do have some responsibility “to enter the fray to educate the public about how psychology informs political decisions.” However, she emphasized, “Ethics also asks us to communicate personal biases.”

Psychologists need to be responsible when making statements about celebrities’

and competencies, she said.

Making judgments based on what is seen in the media is not a good idea, she added. “We haven’t done testing, interviewed them or their family or used other tools.”

Furthermore, care should be taken not to further stigmatize mental illness. Plante said, “Hopefully we’ve reached a

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point where we aren’t implying that people with mental health diagnoses cannot hold public office. If their behavior makes them unfit, that’s the crux of the matter.”

Emily Mohr, Ph.D, public education coordinator for the Massachusetts Psychological Association (MPA), pointed out that relying on reports of behavior, motivation, tone and intent, which might be coming from a biased source, is not a good idea.

“You don’t fully understand why someone is doing what they do,” she said. Rather, several independent tools, strategies and interviews are needed to arrive at a diagnosis.

Psychologists are entitled to private opinions, but when making public statements, Mohr urged caution, since comments might be misperceived.

“When speaking in a public manner, words may be taken and used in a way you didn’t intend,” she said. Any psychologist making public statements should offer explicit details and clearly explain that the comments are not a diagnosis.

“I would not feel comfortable if someone was making a determination about my psychological status without evaluating me and knowing all the context,” she said.

Elaine Ducharme, PhD, ABPP, said, “The Goldwater Rule really governs how we as psychologists work in/with the media. I know some psychiatrists will go beyond this.

But, in general, we really see this as a very dangerous practice.” NEP Phyllis Hanlon has been a regular contributor to New England Psychologist since 1999. As an independent journalist, she has also written for a variety of health, medicine and business consumer and trade publications.

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August/September 2018

New England Psychologist

9

Border separation takes emotional toll on children

By Eileen Weber eports of family separations by the U.S. federal government officials at the Mexican border set off a recent firestorm.

Video and audio demonstrated the conditions in which the more than 3,000 children lived. An estimated 1,600 parents are still in the custody of Immigration and Customs Enforcement.

With reunification underway, the Trump administration recently admitted that

more than 450 immigrant parents separated from their children may have been deported.

“I find Trump’s policy of separating children from parents shocking, appalling, and extremely cruel,” said Richard McNally, Ph.D, professor and director of clinical training in the department of psychology at Harvard University.

McNally has focused much of his research on post-traumatic stress disorder (PTSD).

“It would be very surprising if many of these youngsters do not suffer long-term

emotional harm,” he said.

Julian Ford, Ph. D, ABPP is a professor of psychiatry and law at the University of Connecticut Health Center. He is also director of the Center for Trauma Recovery and Juvenile Justice.

Ford believes children who are still developing are strongly affected by this type of experience.

“I think instead of a policy of ‘zero tolerance,’” he remarked, “we need a policy of ‘zero family separation.’”

He explained that before

Conversion therapy ban results Continued from Page 1 decreased self-esteem, substance abuse, homelessness, and even suicidal behavior.

The harmful practice is condemned by every major medical and mental health organization, including the American Psychiatric Association, American Psychological Association, and American Medical Association.”

Across New England, a similar bill has had some suc-

turn the veto.

Governor LePage’s office did not reply to a request for comment but in his written veto, the governor said that the bill “attempts to regulate professionals who already have a defined scope of practice and standard of care per their statutory licensing requirements and that, as it is written – ‘any practice or course of treatment’ – can call into question a simple conversation.”

He said that the broad lan-

“I am confident that the vast number of voters in Maine believe this is the right thing to do.”

Representative Ryan Fecteau (D-Biddeford)

cess, being signed into law in Rhode Island and Connecticut in 2017, and Vermont in 2016.

In Massachusetts, a bill introduced by Representative Kay Khan (D-11th Middlesex District) was passed by the state’s House of Representatives but stalled in the Senate.

According to Khan’s office, there is still potential for the bill to be passed during the state’s informal session, which runs through December.

In July, Governor Paul LePage of Maine became the first state governor to veto a bill banning conversion therapy after it had passed the state’s legislature. Proponents of the bill did not have enough support in the legislature to over-

guage of the bill could limit a professional’s ability to provide expertise to a client seeking counseling.

“The governor is just wrong,” said Representative Ryan Fecteau (D-Biddeford), sponsor of the bill.

“Professional associations that represent a variety of professionals have spoken in favor of many versions of this law.

They would not have testified in favor if they felt that their members would be restricted in their ability to practice. The language is very clear. It is a matter of a professional crossing a line into trying to change someone’s sexual orientation.”

In his written statement, LePage also pointed to a law he

championed several months ago that would have banned the practice of female genital mutilation [FGM] calling it a “disgusting double standard” that the earlier bill was not passed by the legislature while this one was.

He wrote that that he was vetoing the bill because he believes that “we should apply consistent standards when passing legislature to protect our vulnerable young people.”

“The governor makes a comparison with it,” said Fecteau, “but, for one thing, FGM is already illegal under federal law and conversion therapy is not. That bill was pushed by an anti-immigration group.”

The state of Maine has term limits for governors and this will be LePage’s last term, ending with the election in November. A similar bill will be introduced after that time, said Fecteau, with hopes that a new governor and legislature will support the ban in the future.

Maine is also a referendum state, he explained, meaning that there is potential to bring the bill directly to the voting public.

“I am confident that the vast number of voters in Maine believe this is the right thing to do,” said Fecteau. “If we sent it to the ballot as a referendum I believe it would pass.” NEP Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.

arriving in this country, these kids have already undergone traumatic threats. Family sep-

Sera Bonds, founder and CEO of Circle of Health International (COHI) based in Aus-

“It would be very surprising if many of these youngsters do not suffer long-term emotional harm.”

Richard McNally, Ph.D., professor and director of clinical training, Harvard University aration further activates anxiety, depression, and what he called a “hypervigilant survival mode,” which interferes psychologically and socially.

They no longer explore and learn like other kids their age.

Instead, they concentrate on self-protection.

tin, TX, agreed that the danger isn’t gone once children arrive in the U.S. It’s just continued trauma.

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New England Psychologist

Isolation and LGBTQ youth Continued from Page 1 cognitive, recognition that self is different and identity concealment.

Nicole Issa, PsyD, founder, Center for Dynamic and Behavioral Therapy in New York City, further explained that LGBTQ youth who are unable to talk to anyone about his or her sexuality suffer social isolation, a concept that

cognitive isolation, Issa said.

“Much of the information they are exposed to is negative and harmful, and thus only reinforces the feeling of isolation.”

Also, pressures to be “normal” prompt some LGBTQ youth to “…try to conform to heteronormative expectations,” according to Issa. She reported that these youth isolate themselves from others who appear outwardly to be

“You tip the scales with LGBTQ individuals who are more isolated and have higher rates of mental illness.”

Laura M.I. Saunders, Psy.D, ABPP, clinical coordinator, The Right Track/LGBTQ Specialty Track, Institute of Living in Hartford, Connecticut comprises four sub-dimensions, including lack of social support, no contact with the LGBTQ community, social withdrawal and victimization.

Issa added that separation from social networks, including family, could have a negative impact. “[Youth] are often guarded about their sexuality, which may heighten the feelings of emotional isolation,” she said.

In many instances, LGBTQ youth have no access to relevant information or role models, which may lead to

LGBTQ to avoid being “discovered.”

Finally, Issa said that when LBGT youth acknowledge their own sexual identity and/ or gender identity, they probably recognize they are different from societal expectations. She said, “Knowing that oneself is `different’ can be an extremely isolating feeling.”

The very act of “coming out” can create feelings of isolation, according to Laura M.I. Saunders, Psy.D, ABPP, clinical coordinator, The Right Track/ LGBTQ Specialty Track, at the

Border separation Continued from Page 9 in disaster-ridden and wartorn regions.

COHI partnered with a clinic in McAllen where many of their patients have crossed the border from Mexico. Cuts and scrapes, headaches, stomach aches, and respiratory illnesses are typical. But, they also see a fair number of patients with some degree of PTSD. “McAllen is similar to two years ago when we were in

Greece with all the migrants washing up in boats on shore,” she said. “They’ve been on the road so long – months. This is all to give their kids a better life. What they’re experiencing is America doesn’t want you.”

In a 2017 study, researchers from NYU’s Program for Survivors of Torture at Bellevue showed that prolonged detention appears to contribute substantially to the risk of depression, PTSD, and other

Institute of Living in Hartford, Connecticut.

“The self-identity creates a feeling of being different. If the person is seemingly not accepted in the family, community and town, the process stays internalized and creates a feeling of isolation.”

Saunders reported that youth who identify as LGBTQ face three critical stressors: minority stress, which could be racial in nature; social stigma, i.e., the expectation of being rejected; and family rejection.

“You tip the scales with LGBTQ individuals who are more isolated and have higher rates of mental illness,” she said.

Oberleitner reported that research on this topic is robust.

“We see that psychologically, those who experience or perceive social isolation/social exclusion may have lowered self-esteem, lessened feelings of control, as well as increased depressive symptomology,” he said.

Additionally, research has found that perceptions of social isolation and loneliness are associated with physical repercussions, such as increased blood pressure and impaired sleep.

Interestingly, social exclusion has been found to induce similar patterns of brain activation as the experience of physical pain, Oberleitner said.

“As such, it can easily be stated that experiencing exclusion or perceiving loneliness and social isolation can be exceptionally negative and impactful to the individual.”

Psychological interventions Addressing the issue of isolation begins with social connection, according to Saunders. She uses a three-pronged approach with clients in The mental health disorders in refugees and asylum seekers.

Additionally, they found children and families “appear particularly vulnerable to the traumatizing, unpredictable environment of immigration detention.”

Chris George, executive director of the Integrated Refugee & Immigrant Services (IRIS) in New Haven, Conn., has an alternate solution for the detention centers that have been set up along the border.

He has seen his fair share of immigrants from war-torn areas like Syria, Sudan, and

August/September 2018 Right Track, an outpatient program at the Institute of Living out of Hartford Hospital.

The program addresses topics like “Basic Needs and Mental Health,” and creates an “Affirming Community.”

The Right Track focuses on “…the unique needs of the LGBTQ population who are at greater risk for psychosocial stressors, negative coping and family rejection along with cooccurring mental health difficulties.”

Saunders reported that the program aims to help “…

LGBTQ young adults develop skills to identify and modulate stress and stigma; strengthen family and family-of-choice connections; expand coping skills and capitalize on personal strengths.”

A critical component of the program is “Witnessing and Mirroring,” which involves psychologically engaging with others.

Saunders explained that “Witnessing” refers to validating the youth’s selfidentity, e.g., “I hear your story,” and “Mirroring” helps the youth see oneself in the eyes of others who are similar, e.g., “I can relate to you.”

Both constructs complement each other. “Witnessing without Mirroring leaves one feeling profoundly alone/isolated,” said Saunders.

A second important step involves helping the individual identify the micro-aggressions that take place during the coming-out journey, according to Saunders.

Matthew Kobs, Psy.D, school psychologist and private practitioner in Manchester, New Hampshire, uses motivational interviewing for his clients who identify as LGBTQ, noting that this technique provides a way for youth to “reflect how

they view themselves” and thus helps prevent isolative behavior.

“One of the biggest traps is lack of adequate knowledge and misinformation,” he said.

Motivational interviewing occurs in a series of stages, according to Kobs, which begins when the individual recognizes ambivalence and then reflects on ways to respond.

He added that each stage also takes place within the parameters of developmental appropriateness.

“There is a certain trajectory when working with youth who identify as LGBTQ,” he said. “A conversation with a 10-year old will differ from that with a 17-year old.”

Kobs also reported that including parents in the intervention process is imperative, especially if some discord exists that might cause isolation.

Afghanistan.

“When you are on the run escaping persecution, all you have is your mother or father,” he said. “When you have that taken away in a foreign land [and] inflict that kind of trauma when they arrive in this country – it’s unforgiveable.”

As a result, IRIS has put a proposal together to use the existing national network of nonprofit refugee resettlement agencies to temporarily host immigrant families seeking asylum while they wait for courts to adjudicate their cases.

Placing them in a temporary home setting means access to food, shelter, health care, and education. The cost per person per day would be $22 and within three months, agencies could place up to 3,000 refugees. NEP

Potential for suicide Suicide is a much more serious problem for youth who identify as LGBTQ. According to the Centers for Disease Control and Prevention (CDC), LGBTQ youth are two to five times as likely as their straight peers to attempt suicide, and young transgender people are also at heightened risk.

Oppression and marginalization are cited as leading contributing factors to suicidality. Additionally, LGBTQ youth whose families have rejected them are 8.4 times as likely to attempt suicide.

Megan C. Lytle, Ph.D, cochair, Children, Youth, and Families Committee of the American Psychological Association’s (APA) Society for the Psychology of Sexual Orientation and Gender Diversity, Continued on Page 11

Eileen Weber has been a freelance writer for several years with a master’s degree in journalism and a professional background in publishing.

Based in Fairfield, Conn., she has written numerous articles for magazines, newspapers, and web sites.

August/September 2018

New England Psychologist

11

CDC report on suicide prevention Continued from Page 1 percent, the second highest increase after North Dakota at 57.6 percent. New Hampshire was close behind with the third highest increase at 48.3 percent.

The suicide rate in Massachusetts rose 35.3 percent while Rhode Island’s rate increased 34.1 percent and Maine’s rate increase was 27.4 percent. Connecticut saw a 19.2 percent rise.

The data came as no surprise to Thomas V. Delaney, Ph.D., assistant professor in the department of pediatrics at the University of Vermont Larner College of Medicine and a long-time suicide prevention advocate. Delaney holds a doctorate in research psychology.

“How I describe it is that not only are Vermont suicide rates higher over time than the U.S. and higher than most of the other New England states, it’s that we’re actually getting worse faster,” Delaney said.

Vermont’s rural character and the higher percentages of whites and military veterans among its nearly 624,000 residents compared to other states are driving the trend. So

LGBTQ youth Continued from Page 10 said that her primary concern is suicidal tendencies and ideation.

She supports research that describes how rejection/feeling disconnected is a risk factor of suicidal behavior, while acceptance/feeling connectedness is protective.

Lytle embraces the interpersonal theory of suicide and minority stress model that both highlights the benefits of connectedness and suggests that lack of connection is linked to poor outcomes.

She added that the sourcesof-strength program, a schoolbased effort to fight against suicidal behaviors, helps to enhance social networks and the relationships between youth leaders and trusted adults.

Lytle recommends parents consult with the Family Acceptance Project for strategies to help minimize risk of suicide for a child who identi-

is the fact that until this year, the state had few gun control laws.

Vermont only recently passed laws requiring background checks for private gun sales, raising the minimum age to purchase firearms to 21 and allowing courts to issue extreme protection orders so that police can seize guns from people considered at risk of harming themselves or others.

States with higher suicide death rates in the West and in the Northeast tend to have fewer restrictions of firearm purchases, Delaney said.

In contrast, Massachusetts has a low suicide rate (ranking 48th in the U.S.) and among the strictest gun control laws in the country.

‘We have this subpopulation of older white males and they tend to be rural and they tend to own firearms,” Delaney said.

“I kind of think of it as like a perfect storm situation where you have these individual factors that seem to be correlated with higher rates of suicide and they all converge over northern New England and then really over Vermont.

These are trends that have

been holding for 20 years at least which was what the CDC report was really focusing on.”

Delaney believes the trend of increasing suicide rates will eventually be reversed. Vermont is working to expand its Zero Suicide pilot project initiative beyond the three community mental health centers

where it is now being implemented.

The data-driven initiative aims to better train health care staff to identify persons at risk for suicide and get them into treatment.

An April 2016 case study in the New England Journal of Medicine outlined how Zero Suicide depression care

fication in cognitive behavioral therapy. The initiative also included partnering with patients and families to remove access to weapons.

“In general, we’re going to bend the curve,” Delaney said.

“It may be the case that it happens because Vermont at one point becomes younger or we become more diverse or may-

fies as LGBTQ.

tions on labor supply often lead to lower productivity and output.

The study also reported that fewer employment opportunities and lower incomes for those who identify as LGBTQ

countries have found that isolation leads to joblessness, food insecurity, and poverty. The report determined that discrimination against LGBTQ individuals can cost an economy the size of India’s

Financial implications Isolation also imposes a financial burden on society, Saunders said. She noted that LGBTQ youth who have depression and anxiety, (which are symptoms of isolation), as well as increased stress and suicidal ideation or tendencies, are less able to function in the workplace.

As a result, they are unable to be productive members of society.

Furthermore, LGBTQ youth who don’t feel safe in schools have a higher dropout rate and lower academic scores, she pointed out. “This affects a person economically throughout life.”

Issa pointed to a 2014 World Bank Study that explored the cost of stigma and exclusion of LGBTQ people in India.

She said that these statistics could be applied to a broader geographic population. The report cited a “conceptual model” that links exclusion of those who identify as LGBTQ with economic development.

For instance, employment discrimination and restric-

efforts in a primary care and the general hospital setting reduced suicides by 80 percent between 1999 and 2009 and even by 100 percent in the year 2009.

New models of care included drop-in visits, same-day evaluations by a psychiatrist and department-wide certi-

“How I describe it is that not only are Vermont suicide rates higher over time than the U.S. and higher than most of the other New England states, it’s that we’re actually getting worse faster.”

Thomas V. Delaney, Ph.D., assistant professor, University of Vermont Larner College of Medicine

“As such, it can easily be stated that experiencing exclusion or perceiving loneliness and social isolation can be exceptionally negative and impactful to the individual.”

David Oberleitner, Ph.D, chair, department of psychology, University of Bridgeport in Connecticut

increases the demand for antipoverty programs and other public services.

Additionally, studies in 39

$32 billion.

The current social climate for LGBTQ youth differs, depending on geographic

be we’re able to fully transform our mental health care system to be better at prevention, be more responsive and provide better treatment.”

Turner noted that suicide is an everyday occurrence in the rail industry where he spent the last 15 years of his career.

Suicide not only disrupts the flow of goods at great cost to business, it also traumatizes the employees who witness it, he said.

He believes the private sector will come to view committing resources to preventing suicides the same way it did so for smoking cessation programs over the last three decades.

“Theoretically, zero is the goal, but let’s get a goal we can rally around and work towards and measure against,” Turner said.

“When we reduce the rate by 20 percent by 2025, we won’t be done. We’ll set another aspirational goal and we’ll go after that.” NEP Janine Weisman is a journalist based in Newport, Rhode Island, who frequently writes on mental health. Find her on Twitter at @ j9weisman.

location, according to Issa.

“I think in some parts of the country it may feel ‘safer’ for LGBTQ-identified youth to come out, but for many, the issues remain the same.”

Issa recommended psychologists seek training on diversity and affirmative therapy and allow LGBTQ individuals to explore their feelings in a safe environment.

She also suggested validating and recognizing the influence that homophobia and prejudice have on one’s identity development.

Increased awareness and education is just the initial step in achieving acceptance for youth who identify as LGBTQ. Finding an effective solution to the problems LGBTQ youth face continues to be challenging but is of paramount importance. NEP Phyllis Hanlon has been a regular contributor to New England Psychologist since 1999. As an independent journalist, she has also written for a variety of health, medicine and business consumer and trade publications.

12

New England Psychologist

Retirement planning: Pay yourself first

By Marie HartwellWalker, Ed.D hen someone suggested I start thinking about setting up an account for my retirement, I put it on my list for “later.” Later didn’t come until much, much later when I finally woke up to the fact that unless I prepared for a retirement someday, I’d be working until the day I died.

Actually, even that didn’t scare me much. Several of my role models were women in their 70s and 80s who were sharp as ever and maintaining private practices. It didn’t occur to me at the time that doing so should be a choice, not a necessity.

Eventually, I got it. Eventually I realized that social security income wouldn’t be enough and that just maybe I wouldn’t want to be seeing 30 or more clients a week when I’m 85.

But having put it off until “later” meant that contributions had to be bigger if they were going to add up to anything useful. With several kids about to go to college, that was a strain.

If you have already started a retirement program for yourself, you can skip the rest of this article. You obviously are smarter than I was and listened to some good advice. I pass this story on to my younger colleagues who haven’t done so in the hope that it will encourage you to take care of yourself.

Retirement may seem like a long, long way off. But time goes faster than we would like to think. The things you push to the bottom of your to-do list because they can happen “later” are vulnerable to being the things that are too late to do.

Retirement Planning Basics: embrace the fact that you are an employer: A big plus of working for someone else is that that they offer such things as health insurance, paid vacation time, and a retirement account for you.

Being in private practice means that you are your own HR department. There is no one but you to make sure you have the “benefits” you need to thrive. Be the enlightened employer that you always wished you had. Create a

dream benefit package for your most valued employee – you.

Calculate your retirement needs: Think about when you will want to retire or at least cut back on your work hours.

Think about what you hope to do in your senior years. What’s it likely to cost?

The website for the American Association of Retired Persons, or AARP has a retirement calculator that will help you determine what you need to save for retirement. Click on “Retirement Planning” in the “Work & Retirement” section.

In addition, calculate what you are likely to receive as social security income. It probably won’t be enough to maintain the style of living you enjoy. If so, figure out what you will need to add in a retirement account to make up the difference.

Educate yourself: Local community colleges and adult education programs often offer classes in financial planning. Take advantage of them.

You want to be an educated consumer if you decide to work with a financial advi-

August/September 2018 sor. If finances excite you, you may decide that an investment project is something you can do yourself.

Consider hiring a financial advisor: Financial advisors help people figure out their financial needs and then recommend investments (stocks, bonds, mutual funds, precious metals, etc.) that will help them meet both short term goals (like vacations or a large purchase) and long term goals (like your kids’ educations or your retirement).

Some advisors focus on managing investments you make. Some sell specific investment products. Some do both. Find a professional who is more interested in helping you create a diversified portfolio than in selling you certain stocks.

Pay yourself first: When starting out, your cash flow may be limited. Fixed expenses like rent, utilities and insurance eat up a fair share of what you bring in. What’s left for a salary for you may be quite a bit less than you would like or even what you need.

Nonetheless, consider what is available for a paycheck after you have paid your bills, including your personal retirement “bill.” Your retirement

contribution is one of those fixed expenses.

Even if all you can afford is $10 a week for now, you will be building a savings habit. As your practice becomes more financially stable, increase that contribution to an amount that will compensate for a slow start.

Periodically review: Don’t let your retirement account go on auto-pilot. If you decide to continue to work with a financial advisor, take advantage of those services. If you decide to go it alone and manage your own portfolio, discipline yourself to regular reviews.

Your retirement goals may change. The economy will definitely change. You may need to distribute your money differently because of changes in your family’s needs.

You are getting older and closer to retirement every day, whether you want to think about it or not. Start small but keep adding to it on a regular schedule. If you do, your retirement account will be ready when AARP brochures start to appear in your mailbox and the face in the mirror reminds you that maybe it’s time to think about retiring.

NEP

RI police group concerned about mental health training

By Eileen Weber he Rhode Island Police Chiefs Association backed late-session legislation in June that attempted to overturn a 2016 law requiring mental health training for police officers.

Complying with the National Council of Behavioral Health’s flagship program, Mental Health First Aid USA, it teaches the skills to recognize mental illness, helps assess the risks, and connect individuals with the necessary care.

“Mental health training is

Check out Psych Central Professional pro.psychcentral.com

targeted in how to respond and deescalate the situation,” said Beth Lamarre, executive director of the National Alliance on Mental Illness of Rhode Island.

With nearly two million mentally ill individuals booked into jails every year, the law was meant to decriminalize them. It is not meant to diagnose or treat the mental illness.

Several sources claimed that police departments balked at the individual cost of training for each officer – around $50 to $60. Some legislators criticized the departments for their failure to seek out alternative payment options in the form of grants, as many other states have done.

According to Jamestown Police Chief Ed Mello, who is also treasurer of the Police Chiefs Association, that is untrue.

“The issue is that two years ago, there was a legislative mandate that officers would have to be trained by a particular U.S. brand of men-

tal health training,” he said.

“There was no input from police officials about the curriculum nor was there any review of the curriculum by the police force.”

Mello estimated approximately 20 percent of the calls Jamestown receives involve mental health issues. Any time a call comes in for disorderly conduct, someone suspicious, or a domestic dispute, mental illness usually plays a factor.

But when it came to this particular program, it was a specific brand of training being required without the proper vetting, he believes.

There was also no provision to follow if the curriculum should change in the future.

Those in the field of mental health training disagreed.

Joe Coffey, former chief of police in Warwick and president of BlueAid Consulting, Inc., a mental health training and advocacy group, said the Police Chiefs Association selected the Mental Health First Aid program and has been utilizing it since 2008.

Rhode Island was one of the first states to implement it.

“It wasn’t until it was mandated [in 2016] that they suddenly wanted a choice,” he said. “The feedback on the program has been great for years.”

Charlie Feldman, the communications director of Oasis Wellness and Recovery Center and chairperson with the Mental Health Recovery Coalition of Rhode Island, thought the issue was more likely the cost plus the hours of training per officer.

“If they want more input,” he said, “we’d love to work with them if they’d like to work with us.”

Ruth Feder, executive director of the Mental Health Association of Rhode Island, said outside of cost, flexibility in the choice of curriculum was the problem. She said it was very important to have a standard that all departments follow.

“I understand wanting the flexibility,” she said, “but leaving it to individual munici-

palities to choose which model they want doesn’t make sense.”

Coffey agreed. Consistency in training is essential. Flexibility in course offerings allows departments to cut corners, which means something is missing in the education.

“It’s just like CPR,” he said.

“You can’t do CPR 10 different ways and say, `let’s skip the choking part.’”

He said that the program only takes one day to complete and the International Police Chiefs Association fully endorses it.

“We deal with mental health issues every day,” said Coffey. “Every department should have mental health training – 100 percent.” NEP Eileen Weber has been a freelance writer for several years with a master’s degree in journalism and a professional background in publishing.

Based in Fairfield, CT, she has written numerous articles for magazines, newspapers, and web sites.

August/September 2018

New England Psychologist

August

CONTINUING Education

Aug. 13-17: Enhancing Your Therapeutic Impact: Advanced Techniques of Therapy. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Jeffrey Zeig. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

Aug. 13-17: Transforming Trauma: Using the AEDP Therapist’s Bold, Embodied Presence. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by SueAnne Piliero. Sponsored by the Cape Cod Institute.

Learn more at: www.cape.org

Aug. 13-17: Positive Psychology: The Science of Happiness and Well-Being. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Jonah Paquette.

Sponsored by the Cape Cod Institute. Learn more at: www. cape.org

Aug. 20-24: Bad Stuff: Fear, Greed, Shame, Hatred, and Guilt. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Salman Akhtar. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

Aug. 20-24: Healing the Fragmented Selves of Trauma Survivors: Overcoming SelfAlienation. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Janina Fisher. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

September Sept. 6: Movie + Dialogue Night showing the popular film The Florida Project. Watertown, MA. 7-10 pm, $55, 3 CEs. The Florida Project follows six-year-old Moonee and her rebellious mother Halley over the course of a single summer. We will discuss the impact of poverty on children’s lives in Florida, where the exuberant exploration of children living near Disney World exists side by side with the struggles of parents living with threats to safety, security, and well-being in their families. Sponsored by Therapy Training Boston. Contact 617-924-9255 or register at www.therapytrainingboston. com

New England Psychologist prints as many continuing education conferences as space allows.

Listings with incomplete information will not be printed. CE credits listed are for psychologists. Deadline for submission is the 1st of each month for the following month’s issue. CE Listing correspondence to: New England Psychologist Attn: Continuing Education P.O. Box 5464 Bradford, MA 01835 ce@nepsy.com

emdr or call 413-774-2340.

Sept. 6-7, Oct. 8-11, Nov. 5, Dec. 3: EMDRIA-Approved training in EMDR Therapy.

Greensboro, NC. $1,590, 49 CEs. Hands-on clinical skills training for using EMDR and integrating it with your psychotherapy approach -- with adults as well as children. Sponsored

by Trauma Institute & Child Trauma Institute; co-sponsored

by R. Cassidy Seminars. Learn more at: www.childtrauma. com/training/emdr or call 413774-2340.

Sept. 14: Intensive Certificate Program in Family Systems Therapy: Working Well with Individuals, Couples, Families and Larger Systems. Watertown, MA. 8:304:30 pm, $3250, 81 CEs. This course improves participants’ confidence and capacity to hold effective meetings using practices from enduring and cutting-edge theories. Focus is on finding a balance between providing therapeutic leadership and empowering clients.

Twelve Fridays from September to June and a weekend retreat in October on Chappaquiddick Island. Sponsored

by Therapy Training Boston.

Contact 617-924-9255 or learn more at www.therapytrainingboston.com

Sept. 10-11, 24-27; Nov. 1, 29: EMDRIA-Approved training in EMDR Therapy. Olean, NY. $1,650, 49 CEs. Hands-on clinical skills training for using EMDR and integrating it with your psychotherapy approach -- with adults as well as children. Sponsored by Trauma Institute & Child Trauma Institute; co-sponsored by R. Cassidy Seminars. Learn more at: www.childtrauma.com/training/

Sept. 20-21, Oct. 9-12, Nov. 9, Dec. 14: EMDRIA-Approved training in EMDR Therapy.

Northampton, MA. $1,590, 49 CEs. Hands-on clinical skills training for using EMDR and integrating it with your psychotherapy approach -- with adults as well as children. Northampton, MA. Sponsored by Trauma Institute & Child Trauma Institute; co-sponsored by R. Cassidy Seminars. Learn more at:

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www.childtrauma.com/training/ emdr or call 413-774-2340.

Sept. 21: Working with Children Creatively and Relationally. Auburndale, MA. 9-4:30 pm, $175, 6 CE hours. Participants will explore ways to use storytelling in family life, both with client families and in our own families. Based on these insights, we look at how we can help parents and grandparents share narratives in the form most likely to foster resilience in their children and grandchildren.

Participants

will also learn to use the tool of “Playlistening” from Hand in Hand Parenting. Since we all played, or tried to, we will explore how our own experiences with play were successful at times and hurtful at times and release some of our own tensions around our personal history of play to free us to be more able to play with children.

Sponsored by Therapy Training Boston. Contact 617-9249255 or register at www.therapytrainingboston.com

Continued on Page 14

TWO PROGRAMS, ONE STANDARD OF EXCELLENCE THE CENTER FOR BEHAVIOR DEVELOPMENT • Autism • Severe Maladaptive Behavior • Dual Diagnosis of Mental illness/Intellectual Disability/Traumatic Brain injury • Postraumatic Stress Disorder • Physical Disability • Ages 6-21 THE CENTER FOR BASIC SKILLS • Autism • Intellectual Disability • Physical Disability • Sensory Impairments • Medical Needs • Ages 6-21 For over 30 years, Evergreen Center has provided living and learning environments for persons with autism and intellectual and developmental disabilities including physical disabilities, behavior disorders and complex health needs. Evergreen Center offers a highly competitive salary commensurate with local and national standards, an excellent benefit package, a retirement plan with company contribution, and tuition support/educational loan repayment programs.

C

ar

thr g n i

ough Compe

ten

ce

For More Information Contact The Director Of Family Services & Admissions Evergreen Center Inc., 345 Fortune Boulevard, Milford, MA 01757 Phone: (508) 478-2631 • Email: Services@evergreenctr.org www.evergreenctr.org Equal Opportunity Employer Our Partners in Education Masters Degree or Post Masters BCBA Course SEQUENCE

Masters Degree in Education Cambridge College.edu

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New England Psychologist

Sept. 29-30 & Oct. 13-14.

68th annual Basic Workshop in Clinical Hypnosis. Auburndale, MA. $650 before Aug. 31, $750 thereafter. Student/ trainee: $399 with proof of student status. 26 CEUs/CMEs. Intensive, in-depth training in both the theory and practice of clinical hypnosis from some of New England’s leading clinical hypnotherapists, with a full 14 hours of guided skill practice.

Participants will be able to use hypnosis immediately in their practices. Open to psychologists, physicians, doctoral or master’s level licensed healthcare professionals including dentists and physical thera-

pists. Please see www.nesch. org or call Lorna McKenziePollock, LICSW at 617-7345042 .

October Oct. 3-4: Acquired Brain Injury Clinical Continuing Education Certificate. Shrewsbury, MA. 8:30-4:30 pm, $500 BIAMA members, $550 non-members, 13 CEs. This two-day continuing education program is designed to provide participants with a comprehensive overview of major categories of

Selling out a conference just got easier With New England Psychologist CE programs can be promoted to licensed psychologists cost effectively.

Reach 100% of psychologists in all six New England states.

Why pay the cost of direct mail pieces when you can reach the same audience at a fraction of the cost?

Contact New England Psychologist today at ce@nepsy.com.

acquired brain injury (ABI), including neoplastic, trauma-tic, vascular, metabolic and infectious disorders of the central nervous system. Epidemiology, factors affecting outcome, and the potential long-term consequences, focusing on neurobehavioral, neurocognitive and sensorimotor sequelae, will be reviewed. Sponsored by Brain Injury Association of Massachusetts. Contact biama.org/ abitraining2 to register.

Oct. 4: Parent-Child Interaction Therapy (PCIT): An Overview. Warwick, RI. $120, 4 CEs. This workshop will provide a theoretical, empirical, and clinical overview of the Parent-Child Interaction Therapy (PCIT) model. Sponsored by the Rhode Island Psychological Association. Contact 401-732-2400 or ripsych.org

Oct. 5-6: Spiritual Diversity and Psychotherapy: The 2018 Merle Jordan Conference. Boston, MA. $275. Experience two days of rich clinical presentations and stimulating conversations with leading theorists of spiritually integrative psychotherapy, each with deep expertise in the close connection between spirituality and psychotherapy across diverse approaches and traditions. Sponsored by the Albert & Jessie Danielsen Institute at Boston University. Contact www.bu.edu/danielsen/2018merle-jordan-conference/

Oct. 11: Movie + Dialogue Night showing the popular film Call Me By Your Name.

Watertown, MA. 7-10 pm, $55, 3 CEs. In the summer of 1983, in the north of Italy, Elio Perlman, a 17-year-old American, spends his days in his family’s 17th century villa.

One day Oliver, a 24-year-old

August/September 2018 graduate student working on his doctorate, arrives as the annual summer intern. Soon, Elio and Oliver discover a summer that will alter their lives forever. We will discuss the experience of adolescent desire and love from the viewpoint of a time when same-sex relationships were less acceptable than today, recognizing the powerful role of family acceptance of samesex sexual orientation in promoting young peoples’ wellbeing. Sponsored by Therapy Training Boston. Contact 617924-9255 or learn more at: www.therapytrainingboston. com

Oct. 12: Overview of Neurodiagnostic Procedures and Neurological Effects of ABI. Shrewsbury, MA. 8:30-12:30 pm, $150 BIA-MA members, $175 non-members, 3.5 CEs. Participants will learn the pathophysiological mechanisms in acquired brain injury and the common acute neurological sequelae of ABI, including post-concussion syndrome, seizures, hydrocephalus and cognitive disorders. Late neuropsychiatric effects of ABI (e.g., psychosis, mood disorder and personality change) will also be described and discussed. An overview of neurodiagnostic tests (e.g., EEG, CT, MRI, SPECT, PET, fMRI, and DTI) and approaches to interviewing persons with ABI will be presented. Sponsored by Brain Injury Association of Massachusetts. Contact biama.org/ abitraining2 to register.

Oct. 20: Before It’s Too Late: Treating Substance Abuse and Process Addiction in Couple Therapy. Newton, MA. 9-4:30 pm, $120 (members before 10/3)/$140 (non-members before 10/3), 5.5 CEs. Presented by David Treadway, Ph.D.

Sponsored by Psychodynamic Couple and Family Institute of New England (PCFINE).

Contact: www.pcfine.org, pcfine1934@gmail.com,or call 781-433-0906.

Oct. 26: Shifting Families Toward Acceptance and Connection: Strategies for Helping When A Youth Comes Out as Transgender or NonBinary. Waltham, MA. 9-4:30 pm, $140, 6 CEs. Considering the vulnerabilities of trans and non-binary youth, it is critical for therapists to have a sophisticated understanding of gender identity/expression. It is also critical to have a solid framework to hold the work and support these youth and families. We will start the day with a focus on a deepening understanding of gender, gender identity development and gender dysphoria. Next, a framework for working with families will be discussed which is relevant to providers who see individual youth, parents and families. Sponsored by Therapy Training Boston. Contact 617924-9255 or register at www. therapytrainingboston.com

Oct. 26: Dr. Donald Moss: Heart Rate Variability: Applications to Common Medical and Emotional Disorders.

Montreal, Quebec. 9:30-4:30 pm, $350, 6 BCIA hours. This workshop describes what heart rate variability (HRV) biofeedback is, explores its importance, and introduces potential uses for HRV training. Sponsored by Thought Technology Ltd. Contact bit.ly/2xyb5hO

November

Continued on Page 15

August/September 2018 Nov. 7: Substance Abuse and Acquired Brain Injury (ABI). Shrewsbury, MA. 8:304:30 pm, $250 BIA-MA members, $275 non-members, 6.5 CEs. The clinical criteria for substance abuse disorders and their relationship to the occurrence of acquired brain injury, as well as their neurocognitive impact, will be reviewed and discussed. Participants will learn recommended approaches for recognizing, assessing

New England Psychologist and treating persons who present with the combined challenges of ABI and substance abuse, including misuse/overuse of prescribed and OTC medications (e.g., analgesics).

Sponsored by Brain Injury Association of Massachusetts.

Contact biama.org/abitraining2 to register. NEP

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THE QUICK FIX For comprehensive CE listings check out

Classifieds Office Space

BACK BAY (Boston): Parttime furnished psychotherapy office with stunning Boston views. Shared waiting areas, bathrooms, kitchen & free gym access. Many referrals and optional administrative/ billing support available. Free private practice start-up or expansion business consultation. $176 + /month per 4-hour/week block. Parking for additional fee. Please contact: backbayalliance@gmail. com or 617-230-3002 BROOKLINE, MA: 1093 Beacon at Hawes. Sunny, bay windows, hardwood floors, old world charm. Flexible PT hours. Outstanding location.

Please contact Martin Pildis at: mpildismd@gmail.com or 617-731-2678.

CAMBRIDGE, MA: Harvard Square office with use of dedicated parking space.

Available Mondays until 2 p.m., possibly Fridays. Call 617-492-1561.

CAMBRIDGE, MA: Large furnished office space to sublet in Harvard Square area in beautiful Victorian building.

Available September 1, 24 hours desired. Please contact 401-829-8491 or email dr.lisacoyne@gmail.com CAMBRIDGE, MA: Brand new office space for sublet in Cambridge between Porter and Davis Square. Newly painted, newly furnished.

Rent is $250/month for 1 day per week. Flexible with adding more days. Please contact 617-209-9866 or dr.naomiazar@gmail.com

HARVARD SQUARE (Cambridge): Furnished part-time psychotherapy office sublet in Victorian house/ office building. Shared waiting area/bathrooms/kitchen.

Many referrals and optional administrative/billing support available. Free private practice start-up or expansion business consultation. $176 + month per 4-hour/ week block. Please contact: harvardsquarealliance@gmail. com or 617-230-3002 NEWTON CENTRE Attractive professional office spaces, near T, parking.

Furnished part-time day/evening/weekend. Wheelchair accessible. Some offices suitable for groups. 617-3326755 cea.newton@yahoo. com

NEWTON, MA: Beautiful office space along the Charles River in Newton Upper Falls.

PT/FT available, email: jotham@think-diff.com QUINCY, MA: Space available in beautiful office suite on Mondays. Professional building with easy access to Rte 93 & 3. Short walk to bus & ‘T’. Contact 617-471-6322 or bmordini@comcast.net WELLESLEY/NEWTON LINE: Well furnished office and waiting room in a professional building with onsite parking. Available Mondays or Fridays $350 a day OR $180 4 hour block per month.

CONVENIENT TO 90, 95, ROUTE 9. Contact drrobindeutsch@gmail.com

r e b o t c g in O

Comin

will publish the 26th annual Residential School Directory

advertising@nepsy.com

Classified Form All classified advertising runs in the next available print edition and on NEPsy.com Deadline is 12th of every month (except for Aug./Sept. issue, which is Aug. 1).

For all other advertising deadlines and rates, including Help Wanted and CE ads, please email us at: advertising@nepsy.com.

Office space/groups forming: $65 per column inch ($55 if submitted online).

Products/services: $160 per column inch ($140 if submitted online).

A column inch contains approximately 20 words; minimum of 1 inch for all ads.

Save money by submitting online! http://www.nepsy.com/classifieds/ Please fill out the below form completely and legibly. Payment must accompany ad (make check payable to New England Psychologist) and mail to: Classified Ads, New England Psychologist, PO Box 5464, Bradford, MA 01835.

Town & State: __________________________________________________________________________________ Ad Copy: _____________________________________________________________________________________ ______________________________________________________________________________________________ Name: ________________________________________________________________________________________ Address: ___________________________________ __________________________________ Phone: ___________ Email: ________________________________________Payment of $_____ is enclosed.

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New England Psychologist

August/September 2018

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