New England Psychologist - November 2018

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NOVEMBER 2018

AN INDEPENDENT VOICE FOR THE REGION’S PSYCHOLOGISTS

In the #MeToo era, psychologists adopt strategies to assist sexual abuse victims

By Phyllis Hanlon he #MeToo movement opened a floodgate, giving a voice to victims of sexual abuse and harassment. While public revelations have empowered some women, others are reliving past sexual abuse incidents, leading to recurrence of psychological issues.

In recent years, stigma surrounding sexual abuse has decreased somewhat, according to New York psychologist Julia Vigna Bosson, Ph.D. “It’s not completely gone, but as more come forward, it seems to break down barriers and give survivors courage to seek

help,” she said.

On the other hand, watching a woman talk about her story could be a trigger. “This doesn’t mean the person should put on blinders, but it might mean she should seek support,” said Bosson.

Sexual abuse causes trauma that shakes the belief system and interferes with a person’s understanding of the world.

“It’s important to process the event to make it fit properly into our schema. I see a lot of distortion of memory to fit into a rigid belief system,” said Bosson. “It’s important to process a traumatic experience and come to a more moderate belief of what the event means

“It’s important to do as many different things as possible. Reach out to family and friends, if they are supportive.

In some cases, there might be a referral for medication.”

Catherine Cauthorne, Ph.D, private practitioner, Peterborough, New Hampshire.

in the world.”

Avoidance is common in trauma survivors, and while it can seem to help initially, ultimately the person needs to confront what happened.

Getting the person in the door is a big accomplishment and should be rewarded by validating their courage, Bosson noted.

Bosson emphasized that before beginning any in-depth treatment, the therapist needs to “be present” and make a connection with victims of sexual abuse.

“It’s important that the person feels comfortable. You have to allow the individual to express herself and listen from a non-judgmental stance, provide support and empathy,” she said.

Catherine Cauthorne, Ph.D, private practitioner in Peterborough, New Hampshire, noted in the 1980s, women were not very upfront in reporting sexual abuse.

“Some thought it was to be expected. They were not supported in seeing it for what it was. Sharing it in therapy they learned was not a good thing,” she said.

Campaigns like #MeToo and institutions are more willing to deal with inappropriate sexual behavior. However, the biggest challenge lies with women who are still in contact Continued on Page 8

Blue Cross Blue Shield Rhode Island flawed utilization review process found “clinically inappropriate,” mostly scrapped

By Janine Weisman lue Cross Blue Shield Rhode Island (BCBSRI) stopped requiring prior approval for in-network mental health or substance use disorder services on Aug. 1, a move the state’s largest health insurer said was part of a larger focus on improving access to care.

Out-of-network services, however, will still be subject to requiring prior approval – a process known as utilization review – for behavioral health services.

But left out of the BCBSRI news release when the policy change was initially announced last May was that the discontinuation of utilization review came about during

discussions with state regulators.

That’s after examiners from the Rhode Island Office of the Health Insurance Commissioner (OHIC) documented multiple flaws in BCBSRI’s utilization review criteria for coverage over the course of a detailed review of the insurer’s records that began in January Continued on Page 9

VOL. 26, NO. 9

UNICEF report: Peer-topeer violence in schools is pervasive around the world

By Janine Weisman chool is a safe place — but only for half of the world’s students.

A new UNICEF analysis finds that half of students aged 13 to 15 globally report experiencing peer-to-peer violence in and around school.

That’s about 150 million teens, according to the report “An Everyday Lesson: #ENDviolence in Schools,” which outlines a variety of ways students face violence in and around the classroom.

The report measures peerto-peer violence as the number of children who report having been bullied in the previous month or having been involved in a physical fight.

And, the report’s data shows the prevalence of violence in the U.S. is the same overall as in the other 121 countries examined.

Among the findings: • Slightly more than one in three students aged 13-15 experience bullying, and roughly the same proportion are involved in physical fights.

• Three in 10 students in 39 industrialized countries admit to bullying peers.

• While girls and boys are equally at risk of bullying, girls are more likely to become victims of psychological forms of bullying and boys are more at risk of physical violence and threats.

• Between November 1991 and May 2018, 70 school shootings were documented in 14 countries. By

definition, these shootings involved two or more victims and at least one fatality.

Violence interferes with the necessary ingredients for learning, said Steven Marans, MSW, Ph.D., director of the National Center for Children Exposed to Violence/Childhood Violent Trauma Center at Yale University’s Child Study Center.

Those ingredients include adequate frustration tolerance, the ability to experience pleasure with mastering new knowledge and skills and having one’s basic biological and nutritional needs met.

But there also needs to be a level of structure externally to support the unfolding developmental process taking place as kids learn, added Marans, who was not involved in the study.

“Like in the rest of society, in schools, having rules and structures and predictability are part of the essential ingredients to capitalizing on unfolding capacities of healthy, developing children.” he said.

As the report notes, evidence suggests toxic stress associated with extreme exposure to violence in childhood can interfere with healthy brain development and lead to aggressive and antisocial behaviors, substance abuse, risky sexual behavior and criminal activity.

When children don’t feel safe at school, they can end up deprived of an education and that has lifelong consequencContinued on Page 9

INSIDE

Project GROW strives to help schools in NH navigate adversity ...........................Page 6 Maine to assess behavioral health services for children .................................Page 7 CE listings................................................. Page 11

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New England Psychologist

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November 2018

New England Psychologist

3

Expert weighs in on repressed memories, other timely topics He is more than just a media spokesperson.

Called upon as an expert on a variety of subjects over the years, Richard J. McNally, Ph.D, is a professor and director of clinical training in the department of psychology at Harvard University.

A clinical psychologist and experimental psychopathologist, McNally has conducted research on anxiety disorders and related syndromes. He spoke with New England Psychologist’s Catherine Robertson Souter about his work and some of the bigger topics on which he has given expert input.

Your research touches on a variety of topics including complicated grief, how exercise affects mental health, trauma, stress and memory, and even unusual phenomena like memories of alien abduction and past lives.

How do all these topics link up for you, in your work?

They are all loosely related and intertwined with my clinical work as well.

For example, I began conducting psychophysiological research testing the biological preparedness theory of phobias while doing behavioral and cognitive-behavioral treatment of specific phobias, social anxiety disorder, obsessive-compulsive disorder, and panic disorder with agoraphobia.

These lines of work evolved to embrace cognitive science experiments designed to elucidate information-processing biases and abnormalities in the anxiety disorders, including post traumatic stress disorder in Vietnam veterans and rape survivors.

I subsequently studied cognitive functioning in adults reporting histories of childhood sexual abuse, including individuals who believed they harbored repressed memories of abuse and those reporting recovered memories of abuse that had not come to mind in years.

This work, in turn, prompted studies on peo-

ple whose recovered memories were (presumably!) false (for instance, folks who believed they were recalling memories from their previous lives, people who “recalled” having been abducted by space aliens).

because of alcohol consumption.

Brett Kavanaugh reported never having experienced blackouts from drinking, but intoxicated individuals would not necessarily know about their blackouts unless there are other sources of evidence (i.e. less intoxicated friends tell them what he [or she] said or did during the drunken episode).

What are you working on now?

Among other things, I have been working on network analyses of psychopathology.

Can you explain network analyses?

The network approach conceptualizes an episode of mental disorder as an emergent phenomenon arising from causal interactions among its constituent symptoms rather than as an expression of an underlying disease entity.

This approach differs from the traditional categorical and latent dimensional viewpoints.

Looking at psychology through this lens, our understanding of mental health disorders could change drastically. How would this affect treatment?

The chief applied implication of network analysis is that it promises to identify those symptoms most responsible for maintaining an episode of disorder (i.e., those symptoms scoring high on the “out-strength centrality metric”). Reducing such symptoms should hasten recovery.

Of your work over the years, what do you get asked to speak most about?

I have been interviewed about trauma and memory most often, I believe.

You have been asked recently to give the media your expert opinion in the case of Dr. Christine Blasey Ford, who accused Supreme Court nominee Brett Kavanaugh of sexual abuse during their teen years.

She explained that she did not fully remember certain details of the experience. What are we missing about how memory works, especially in cases of trauma?

Nothing in Dr. Ford’s testimony leads me to question the credibility of her account. The release of stress hormones during a terrifying trauma, such as attempted rape, strengthens the encoding and storage of the central details of the experience, rendering them highly memorable, sometimes at the expense of the peripheral details.

Trauma tends to narrow one’s attentional focus on the most threatening and psychologically important aspects of the experience (i.e., fear of rape, fear of suffocating, mocking laughter of one’s tormentors).

So, it would not be odd that she could not recall details like the date of the event or whose house they were visiting?

Memory does not operate like a videotape machine, flawlessly recording every detail of an event.

Hence, it is unsurprising that she does not (apparently) remember the precise date, the street name, how she got to the social gathering, etc.

She mentioned that she had met the alleged assailant several times before this event, thereby diminishing the likelihood of perpetrator misidentification.

On the other hand, he does not remember any of this happening or having blacked out any events

Beyond media relations, what do you think, of all your research, has had the most actual impact?

If I had to guess, I suppose it would be my work on recovered memories of sexual abuse.

At the time, my colleagues, students, and I embarked on laboratory studies on this topic, there were two strikingly different views about recovered memories.

One view held that trauma can be so emotionally distressing that some people encode and store memories of trauma, yet become incapable of recalling them, thanks to a “repression” or “dissociation” mechanism.

In my opinion, there is no convincing evidence for this notion.

The other view was that people must be mistaken if they report recovering memories of trauma, and hence, such memories must be “false.”

Some people most certainly do develop false memories of trauma. However, our work suggests yet a third view that pertains to another group of people. We studied individuals who reported having been molested in the early school-age years by adults they knew (fondling on one or several occasions). Violence and threats of violence were absent.

They reported being frightened and confused, but not terrified. They said they had forgotten these episodes for many years, but then recalled them upon encountering reminders during adulthood.

Understanding the experience from an adult per-

spective, they realized that they had been abused by trusted others.

Did these events have long-term negative results for them if they had been forgotten?

About one-third of them reported sufficient symptoms to qualify for (delayed) PTSD. What seems to have happened is that they failed to think about their abuse for many years, but not because it was so traumatic that they repressed it.

Rather, they failed to think about it because it was not traumatic, despite its moral reprehensibility.

Because they were too young to grasp what was happening, they did not experience PTSD symptoms until after remembering it and understanding it years later.

Hence, although there is no convincing evidence for repressed memories of trauma, not all recovered memories are false memories; one can “recover” memories of events that were not experienced as traumatic when they originally occurred.

You wrote about the rise of diagnoses of mental illness in a book, “What is Mental Illness?”

(Belknap Press, 2011). You argue that diagnoses have increased, in part, because of the need to codify mental health complaints for insurance purposes What is the most important message people have gotten from the book, or that you wish people would get from it?

How we conceptualize and diagnose mental disorders is certainly informed by science (or should be), but extra-scientific values and norms are inevitably involved. 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

November 2018

EDITORIAL

Another chance to get it right

By Alan Bodnar, Ph.D. s much as anything, fall offers us another chance to get it right and another chance to think about what that really means.

In this time of endings and beginnings, we put the garden to bed for the winter, gather up and dispose of summer’s answer to springtime’s promise, and once again prepare the earth for a new carpet of green that we can only hope will cover the bare spots in the lawn.

Done right, these chores should produce a tidy landscape where nature can work her magic over the long, cold New England winter just so the cycle can begin all over again in the spring.

Our yard is a small plot of land, thick with pine, oak, and maple trees around the edges of a patch that we leveled with the fill from the basement of a family room that we added many years ago.

Despite its small dimensions, the land has always produced 100 bags of leaves every year no matter how many trees were lost to storms and our more deliberate plans to change our environment.

You would think that fewer trees would produce fewer leaves, but I am not one to argue with nature’s miracles of abundance, so I just buy more leaf bags.

When I started tending this patch of land 40 years ago, getting it right meant gathering all of the leaves and carting them off to the town dump. The result was a neat, clean, almost surgically pure yard and muscles pleasantly sore from use in the bracing air.

One year we piled the leaves on tarps and dragged them to the curb where a man we hired collected them and hauled them to the dump.

Getting it right became just a bit easier by eliminating the half dozen or more trips across town that it took to bring the leaves to their final resting place.

Before long, we did away with hauling altogether and piled the leaves in a far corner of the yard where nature’s slow, silent fire turned them into rich, brown earth that we used to enrich the soil for plantings in other parts of the yard.

For many years, this solution was perfect until we lost the will to keep up with the growing compost pile, and it became more of an eyesore than a benefit. Now, 40 years later, we are getting it right by going back to our original strategy of bagging and hauling our leaves away – all 100 bags every year, no matter how many trees are remain to produce them.

When it comes managing the autumn leaves, getting it right is clearly a moving target. It is not so much a matter of finding the single right way to accomplish the task as it is a question of discovering what is right for us at a particular time under a particular set of circumstances.

No matter what strategy we use, the outcome is the same. The fallen and scattered leaves are collected and put out of sight, leaving a clean workbench where nature’s alchemy will produce new growth in the spring.

We hope that this new growth will be grass – a thick, luxurious, verdant carpet – the perfect backdrop for our spring flowers. Here’s where getting it right becomes a bit trickier, when the right method is measured by the right outcome. By the time fall comes around, whatever grass we had in the front yard has been overwhelmed by a progression of various weeds and crabgrass.

Our efforts to control these invaders with chemicals and old-fashioned weed pulling have left wide swaths of empty soil that need to be replanted if we have any hope at all of ever getting the lawn right.

We need the right seed, the right fertilizer, and the right amounts of sun and rain at precisely the right time for any of this to work. If it doesn’t, we can always try again in the spring, unless of course

we choose to apply crabgrass preventer, which also prevents new seed from germinating.

This year, as I water my newly planted lawn, I am encouraged to see green shoots of new grass sprouting from the mix of seed, mulch, and fertilizer. But I have been here before, and I know there is a long way to go before I can begin to think that I finally got it right. So, I think instead about what getting it right means.

I recall a recent conversation with a family friend about the heartbreak of parents whose children choose a path in life at variance with their family’s values. She knows exactly why things like this happen and says she would like to meet parents in this situation so she can tell them how to prevent such heartache.

Like so many others, she is convinced that she has discovered the simple answer to a complex problem, and she is happy to share the secret of getting it right.

A colleague tells me about a patient who politely cancelled his second appointment because he did not feel they were a good match. My colleague thinks about what he might have done differently in their first meeting to make a better connection, but concludes that despite our best efforts, sometimes these things just don’t work out.

Psychologists and professionals of every kind have an obligation to get it right, at least in the sense of knowing and using the best practices of their trade.

I hope our air conditioning specialist got it right when he installed our new system last fall and that my doctor is right about his recommendations to keep me healthy, but there are no guarantees.

When it comes to getting it right, the only thing we can rely on is the knowledge that we are doing our best for the right reasons. As for the outcome, we can only hope for success, be ready to try again if we fail, and be thankful for as many chances as we can have to get it right. NEP Alan Bodnar, Ph.D. is a psychologist formerly at the Worcester Recovery Center and Hospital.

Public still confused about memories of sexual assault If the U.S. Senate hearings of now-confirmed Supreme Court Justice Brett Kavanaugh taught us anything, it’s that the public has a very poor understanding of the science behind trauma and memory.

Republican senators convinced themselves that the victim – Dr. Christine Blasey Ford, who accused Kavanaugh of sexual assault back in high school – must have mixed up Kavanaugh’s face with her actual attacker.

Of course, psychologists know that such a belief flies in the face of all the science, research, and thousands of victims’ stories that have been documented over more than the past five decades.

Sadly, psychologist and other scientific voices were drowned out in the politics of the hearing. The science clearly demonstrates that a victim’s memory of a sexual assault or rape is quite clear when it comes to the face of the attacker.

That is something very few victims will ever forget. It is a tableau that they carry with them throughout the rest of their entire lives.

If you’re interested in learning more about how memories work in sexual assault and rape victims, I’d encourage you to read this article for further information: https://psychcentral.com/blog/memories-can-be-distortedbut-not-in-the-way-that-you-think/ Psychologists need to work harder to inform our clients, politicians, and policy makers about these issues of basic science. The surprising statements of respected U.S. senators about this topic made many of them look ridiculous and ignorant, stuck in unscientific, sexist, patriarchal belief systems of a bygone era.

This most recent episode in U.S. politics should act as a cautionary tale about how, when it’s politically expedient to do so, people can suddenly throw science to the wind.

Science doesn’t care for a person’s politics. Politicians should, however, care about the immutable facts and data of science.

By John M. Grohol, Psy.D.

Publisher:

Editor-in-Chief:

Contributing Writers:

Graphic Designer:

John M. Grohol, Psy.D. Psych Central Susan Gonsalves Alan Bodnar, Ph.D. Phyllis Hanlon Catherine Robertson Souter Margarita Tartakovsky 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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November 2018

New England Psychologist

BOOK REVIEW

THE PRACTICAL PRACTICE

Book on forensic issues is useful for all clinicians

By Stan Rockwell, Psy.D. uthor Ezra E. H. Griffith is a professor emeritus of psychiatry and of African-American studies at Yale. He has

son came up in the chapter on objectivity and boundaries of competence. I first came across Grigson back in 1991 in a book called, “Travels With Dr. Death,” by Ron Rosenbaum.

Grigson earned the nick-

“Ethics Challenges in Forensic Psychiatry and Psychology”

By Ezra E. H. Griffith Columbia University Press, March 2018

brought together 31 psychiatrists, psychologists, and professors with expertise and a wealth of experience in a variety of ethical situations clinicians face in forensic cases.

The authors look at 20 different problem areas ranging from role conflicts (care versus forensic evaluation), to corrections, work with minors, sex offenders, mandated video recording of forensic evaluations, involuntary outpatient commitment, issues with neuroscience, feminist ethics, violence risk assessment, asylum seekers, testing, the Internet and media appearances, boundaries, collaboration and more.

Griffith has done an excellent editing job in that all of the chapters follow a consistent format making for a consistent experience throughout the book.

There is background on the issue addressed in the chapter, often with vignettes, discussion of the cases, and conclusions to help bring each together. Some are academic in examining ethical decision-making models, and most have scenarios clinicians will empathize with immediately. You get lessons in the relevant history of issues, as well as research tied to the issue.

The story of James Grig-

5

name “Dr. Death” by testifying in more than 160 death penalty trials in Texas from the 1970s into the 1990s. His expert opinion in more than 100 cases was that the defendant “would pose a continuing threat to society if not given a sentence of death.”

He was expelled by the American Psychiatric Association in 1995 but continued doing competency evaluations for prosecutors for another eight years. The chapter provides guidance on how to mitigate adversarial allegiance.

I found all of the chapters fascinating and enlightening. I also thought about the evolution of ethics in mental health overall and in forensic work, in particular.

The role of psychology in developing “enhanced interrogations” at Guantanamo is examined, as well as dilemmas in evaluating Guantanamo detainees.

Mefloquine was given to all detainees as a malaria prevention protocol even though it was not given to Haitians quartered there years before.

The issue is that there are newer drugs with less side effects.

Mefloquine can cause anxiety, confusion and hallucinations, and the effects continue after use ends. And that is on

Continued on Page 10

Avoidance of triggers may have negative consequences

By Catherine Robertson Souter ith the public testimony and accusations around sexual assault in the national spotlight in recent months, there has been increased attention paid to how these reports may be triggering psychological responses in the general public.

Reportedly, reading about or hearing testimony from Christine Ford Blasey, Ph.D, a professor of clinical psychology at Palo Alto University and a research psychologist at the Stanford University School of Medicine, has led women and men around the country to experience their own emotional and physiological responses.

Ford testified about her accusations of sexual assault perpetrated during their teen years by Judge Brett Kavanaugh.

It may not be surprising that a very public discussion of what would be a traumatic situation for a 15-year-old child could trigger responses in anyone who has suffered this type of trauma.

And, if someone has never spoken about or sought treatment for the trauma, the image of a woman telling her story to a less-than-sympathetic audience as she testified in front of Senate Judiciary Committee may bring up a variety of symptoms for those witnessing the event.

In some ways, the public airing of accusations can be very helpful to people who have experienced trauma, said Brian Pilecki, Ph.D, a staff psychologist at Rhode Island Hospital and clinical assistant professor at Brown University, “There are signs that it was a positive experience,” he said. “There were reports that in the days after Dr. Ford’s testimony, there was a huge increase in calls to trauma lines with people coming forward. The message that women are to be respected and listened to is encouraging.”

“Although,” he added, “because of the outcome, maybe the message was that it didn’t really matter what she said.”

Psychological triggers, according to Pilecki, are stim-

Mary Kay Jankowski, Ph.D, a clinical psychologist at Dartmouth-Hitchock Medical Center and assistant professor of psychiatry at Dartmouth College’s Geisel School of Medicine. uli that evoke an emotional or physical reaction. The term, however, is often over-used both within and outside of therapeutic settings.

“People in the general public use the term in a variety of ways when something gets them upset,” he said.

“Clinically, people talk about triggers doing things that, say may evoke an urge to drink.

It is used in many different ways.”

Typically, psychological triggers specifically reference an earlier traumatic event.

People can experience a psychological trigger from something occurring internally or externally and a trigger can be very personal.

“For example, a child who witnessed a bad incident of domestic abuse that happened during dinner, so the smell of spaghetti sauce cooking on a stove could be an issue later,” said Mary Kay Jankowski, Ph.D, a clinical psychologist at Dartmouth-Hitchock Medical Center and assistant professor of psychiatry at Dartmouth College’s Geisel School of Medicine.

The most potent triggers tend to be from sensory input, smell, touch and sound, she added and triggers can last a long time if the underlying trauma is not addressed.

The standard of treatment for psychological triggers would be exposure therapy, said Jankowski.

“In general, we would recommend people not try to avoid triggers,” she said. “For one thing, it is almost impossible because things come all the time. Avoidance is one of the symptoms of PTSD.” Avoidance also leads to a limited life, said Monnica Williams, Ph.D, an associate professor at the University of Connecticut, and clinical director of the Behavioral Wellness Clinic in Mansfield, Connecticut.

“That fear can generalize to other things and may grow out of proportion,” she said.

Williams also warns that therapists need to recognize the many forms that trauma can take.

“Some things are not on the radar of most clinicians,” she said. “Most time when we think of trauma, we think of rape or assault or combat.”

Medical traumas often go under the radar, she explained, along with the trauma faced by immigrants both here and in their home countries and racism routinely faced by minorities.

The use of trigger warnings on college campuses has come under fire recently. Therapists are cautious about commenting on their efficacy.

“It’s contentious topic and hard to make a blanket statement,” said Pilecki, “but in general, some content in a classroom is evocative and it can be a good thing to warn students. But it can also feed into further avoidance.” 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

Common challenges for the senior patient and how psychologists can help

By Marie HartwellWalker, Ed.D hose of us who work with seniors know that the last quarter of life has its own richness, delights, and challenges. The “golden years” can indeed be golden.

Those fortunate to have good health, to be surrounded by family and friends who are physically well and who have a good enough retirement income can enjoy an active social life, travel, and activities that may have been put off when time was limited by work and raising a family.

But those are not generally the people we see in treatment.

For seniors who make it to a therapist’s door, the golden years aren’t all that golden. To serve them well, Millennials, Generation Y, and Gen Next (those who are now between ages 24 – 38) who haven’t had the opportunity to personally know elders, need to educate themselves and be specifically supervised to be effective with senior patients.

The following challenges are common for all seniors.

But seniors in distress often don’t have the internal resiliency or the external supports they need to manage them well.

Physical limitations My 90-year-old friend George told me that any gathering of his peers starts with an “organ concert.”

“How’s your kidney?”

“How’s your heart?” “My stomach is bothering me.” It’s not morbid. It’s usually not just a litany of complaints. It’s an attempt to manage health concerns with humor while at the same time updating each other on their vulnerabilities.

Treating elders means supporting them while they deal with the normal and difficult physical limitations that come at some point to everyone.

Memory and cognitive decline People with advancing dementia talk about the frustration and fear that accompanies a gradual loss of memory, common skills of everyday living, and ability to communicate.

Some are very worried

about what will happen if their families find out. Will they lose their license? Will they be infantilized? Clinicians need to educate themselves about the various forms of dementia and how best to support clients and their families as the disease progresses.

Change in identity Those who retire from a career, even a career they didn’t like, often suffer from a loss of the identity that came with it.

Those whose career was raising children and being active in the community sometimes don’t quite know who they are when those roles are dramatically reduced or over.

Our clinical work includes redefining the source of self-esteem and supporting efforts to find new activities that are meaningful and pleasurable.

Loss of friends and family Sometimes our patient is the last of a friend and family circle. As one of my clients said, “I’m the last one standing.” She was 95.

As the youngest of eight siblings, she had attended funer-

Project GROW strives to help schools in NH navigate adversity

By Margarita Tartakovsky, MS t’s very difficult to focus on learning when there’s stress or significant changes at home. Sadly, this situation is a reality for many students in New Hampshire.

Like other parts of the U.S., New Hampshire has been shattered by the opioid crisis. A lot of students are living with parents who are actively struggling with addiction. Some are being raised by their grandparents, said Kelly Untiet, the communications coordinator at the Office of Student Wellness at the state Department of Education.

Because most of New Hampshire is rural, students also don’t have access to services, and there’s a shortage of mental health professionals, Untiet said. Consequently, students in need of support turn to their school, she said.

Project GROW – Generating Resilience, Outcomes, and Wellness – aims to help students, families and educators

effectively navigate trauma and adverse experiences. As Untiet said, “We have to get students ready to learn first.”

Project GROW is a partnership between the New Hampshire Department of Education Bureau of Special Education, Office of Student Wellness and Antioch University New England’s Center for Behavioral Health Innovation.

Currently, it serves six school districts in New Hampshire: Bethlehem, Concord, Hampton, Hopkinton, Laconia, and Merrimack.

Science has identified resilience factors educators can focus on to promote learning for all students, said Cassie Yackley, Psy.D, the director of Project GROW and a psychologist at the Center for Behavioral Health Innovation at Antioch University New England.

For instance, just one caring relationship can positively impact a student’s life. It’s this kind of rigorous research that’s informing the initiative.

“Project GROW isn’t a

cookie-cutter approach,” Untiet said. Each school selects an area that fits its staff and students’ specific needs and implements and adapts evidence-based strategies.

There are five categories or “buckets” schools can choose from: relationship building and wellness; classroom approaches; specialist interventions; school district leadership; and family and community connections.

In Concord, the focus is on creating community and helping everyone to feel safe and welcome, said Margie Borawska, Ph.D, a school psychologist at Concord High School.

School counselors are surveying both teachers and students to understand what they’re already doing to build a sense of community, she said. Subsequently, this information is used to create pamphlets for educators with a variety of helpful tools.

In some classrooms, students play “two truths and

November 2018 als of all of her sibs, all of her sibs’ spouses, and most of her nieces and nephews. All of her closest friends were already gone. The few who were left had dementia and were sick.

She felt alone and lonely.

Even those fortunate enough to still have peers who are alive and well know that the situation can change in a moment. Our job is to help our clients grieve those they have lost, find ways to be there for friends who are sick and dying, and find new social relationships.

Letting go of “stuff” The kids have grown. The house gets too big. The stuff accumulated over 40 or so years begins to be overwhelming – and the kids make it clear they don’t want most of it.

Sometimes, it’s liberating to start downsizing. Sometimes it’s very difficult to realize that things they’ve treasured aren’t valued by others. Senior clients may need help to sort out their feelings as they sort out their material possessions.

Family tensions More than a few seniors have been brought to me by their adult children. “Maybe you can talk sense into him!” they say. Or: “She’s always been difficult. Make her change.”

Changing an 80+ year old’s

a dream,” where they share, aloud or in written responses, two truths about themselves and a goal, Borawska said.

Teachers can then incorporate students’ goals into their curriculum (i.e., writing a paper about becoming a nurse), she said.

Also, every week, for 18 weeks, Borawska and other school counselors spend 15 minutes teaching mindfulness to ninth-grade students.

They’ve adapted the curriculum from Mindfulschools.org.

Some districts have chosen the specialist intervention category and will be trained in the evidence-based interventions Bounce Back for elementary students and the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program for middle and highschool students, Yackley said.

Yackley noted that most districts are reviewing their disciplinary policies. “The research is abundantly clear that even one experience with expulsion or suspension [leads to] a cascade of negative outcomes,” such as dropout, she said.

This trend is why many districts are moving to restorative justice programs, which help students re-enter the commu-

personality and behavior is unlikely. Changing the family dynamics isn’t. Although I’m happy to have a session or two with the senior, I want the family to join us to try to make peace with each other. Often members in a conflicted family are willing to give it a try as they understand it’s a “last chance.”

Mortality Seniors who come for therapy usually want to talk about end of life. No matter how physically and mentally fit they are, they know death is inevitable.

Some respond with fear, some with depression, some with a basket of “should ofscould ofs-would ofs” that only make them feel bad. Some react with acceptance and even some relief.

Their challenge – and ours – is to find ways to heal the things that can be healed and to make peace with those that can’t; to let go of old hurts and pain and to embrace the parts of their history that have been well-lived. NEP Marie Hartwell-Walker, Ed.D. is licensed as both a psychologist and marriage and family counselor in Amherst, Mass. She specializes in couples and family therapy and parent education.

nity and have restorative conversations, she said.

Other districts are partnering with caregivers to identify adverse experiences their kids are struggling with, so educators can support them, Yackley said.

She’s created a measure that serves as a conversation starter for caregivers to express their concerns. After all, caregivers know their kids best, she said.

Untiet noted that they’re in the process of compiling the Student Wellness Toolkit, which will feature online tools, templates, and interactive modules. They’re also identifying how to sustain and expand Project GROW, she said.

Complex trauma plays a powerful role in students’ lives. Yackley stressed the importance of understanding that trauma can often look like mental illness – even though it’s not.

It’s imperative psychologists learn to distinguish between diagnosis and distress, she said. NEP Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.

November 2018

New England Psychologist

7

Maine to assess behavioral health services for children

By Catherine Robertson Souter ooking to address issues of long wait times and limited access to mental health care, the state of Maine has initiated a system-wide assessment of its behavioral health services for children.

With a series of surveys geared towards stakeholders including children and families, providers, law enforcement and corrections personnel, advocacy service providers, educators and behavioral health providers, the state hopes to gather a wide range of feedback about the system, its strengths and areas where corrections are needed.

“The review will examine the service array, regulatory structure, and operational processes across Children’s Behavioral Health Services or CBHS,” said Emily Spencer, spokesperson for the Maine Department of Health and

Human Services (DHHS).

“The information gathered will be analyzed and coupled with research regarding best practices and industry examples to identify solutions to areas requiring improvement,” she said.

Spencer noted that the review will culminate in the development of short- and long-term recommendations regarding the CBHS system of care.

The survey asks stakeholders for input on the strengths and weaknesses of the system of care along with suggestions for solutions. The questions were designed to address each aspect of the system with questions around education, juvenile justice, and access to care.

“This review was developed in partnership with Disability Rights Maine, and seeks input from a broad range of stakeholders, children and families, key agencies, field staff, supervisors, providers, MaineCare, OCFS, CBHS, and others –

ensuring we gather a comprehensive understanding of current needs from those on the front lines,” Spencer added.

After being approached

by Disability Rights Maine (DRM), an advocacy group for people with disabilities, regarding several concerns with the current system, the state hired an independent consulting firm to conduct the surveys.

“We became aware and concerned about the wait list for home and community-based services and access to services,” said Katrina Ringrose, the children’s advocate for DRM. “In addition, many services have become non-existent in rural communities. There are pockets where families cannot access any services at all.”

“We approached the state,” she added, “to begin discussions about what their obligations are and after months of discussion, we came to an agreement that we needed

to bring in the experts to do an assessment and provide recommendations around access to services.”

According to Ringrose, some children are put on wait lists for one to two years before receiving mental health care services. When a lack of in-home or community-based services leads to a need for acute care, children are often held for extended period in psychiatric or emergency rooms and/or sent to treatment facilities outside of the state.

“We have 55 youths who are out of state in residential programs,” she said. “These kids need to be with their families and with their communities.”

In addition to the surveys, the DHHS also reached out to a number of people for individual telephone interviews.

“We provided the contacts for the DHHS to speak to well over 75 stakeholders,” said Ringrose.

Access to the online surveys

closed on October 14. The consulting firm is currently preparing an initial report that will be presented at several town hall-style meetings in late October or early November in order to get further feedback.

A final report with recommendations should be finalized by the end of the year.

“The time frame is pretty fast,” said Ringrose. “We have families and children in crisis and not getting what they need. We are hoping to get the final report and recommendations so that the state can create a strategic plan to help deliver services and make sure that the services are effective to keep kids in their homes and communities.” 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.

Massachusetts law aims to combat opioid crisis

By Eileen Weber n states with the highest rate of opioid-related overdose deaths, Massachusetts ranks in the top 10. Deaths attributed to overdoses are more than twice the national average. Not surprisingly, the state is taking the opioid crisis seriously.

Thanks to the Joint Committee on Mental Health, Substance Use and Recovery, legislation has been passed to prevent, treat, and expand healthcare for opioid addiction. This law is the second major opioid addiction legislation since the Baker-Polito administration took office in 2015.

At the signing of the legislation in August, Governor Charles Baker acknowledged the pervasiveness of opioid addiction throughout the state.

“If it’s not in your family, God bless and be grateful because it could be,” he said at the STEPRox Recovery Center in Roxbury. “Massachusetts has in many ways led the nation in its efforts to deal with this terrible issue and this horrible epidemic.”

Senate President Karen Spilka (D-Second Middlesex + Norfolk) praised the legislation in how it addressed

certain issues for those with chronic pain.

“I am proud that the Senate added a number of provisions to address the needs of those suffering from chronic pain to the final opioid bill signed by the governor,” she said. “This final legislation was the result of the Senate listening to those affected and fighting to ensure they were not left out of the final bill.”

In 2016, a combined Senate and House committee limited

first-time opiate prescriptions to seven days. That provision is also included in the most recent legislation. However, an exception is allowed for chronic pain management, cancer, or palliative care.

According to a 2017 study in the Journal of Pain, the longer opioids are taken as a prescription, the more likely an addiction will develop, which is the strongest predictor of long-term use.

Emergency rooms are often

on the front line in opioid care. Patients admitted to emergency departments for an overdose will now be evaluated for substance abuse addiction within 24 hours before discharge.

Another stipulation in the bill is protection for healthcare providers and “Good Samaritans” from liability. If they give a patient any life-saving drug at the time of overdose like naloxone, they are protected from any civil litigation.

When prescribing an opioid, healthcare providers are expected to check with the Commonwealth’s Prescription Monitoring Program while also allowing for a “partial fill,” in which doctors can prescribe less medication to prevent overuse.

Patients can even request a notation to be put in their files that opiates should not be administered.

Continued on Page 10

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New England Psychologist

November 2018

In the #MeToo era, psychologists adopt strategies for sexual abuse victims Continued from Page 1 with their abuser.

If the person is a relative, the woman is constantly retriggered. “She thinks she doesn’t have the right not to see the person. It’s very hard to divorce yourself from family,” Cauthorne said.

Furthermore, sexual abuse that occurred in childhood

can affect the sense of self and trust later in life. Children expect parents to take care of them; when they don’t, self-esteem suffers, according to Cauthorne.

Cauthorne uses “flash,” a therapy that prepares the patient for EMDR (Eye Movement Desensitization and Reprocessing), which is sometimes too intense for patients.

“It’s useful to encourage women to work with a provider of a different gender who respects appropriate boundaries.

It may result in an emotionally corrective experience.”

Martin R. Pierre, Ph.D, member of the Massachusetts Psychological Association (MPA) Board of Directors.

How about a little

EXTRA

Flash invites the client to “…think of something so powerful, engaging and enthralling that it eradicates the horror of a situation.”

Cauthorne also uses sensory motor psychotherapy, some cognitive behavioral therapy (CBT), self-regulation, meditation, journaling, and noted that yoga often helps.

“It’s important to do as many different things as possible. Reach out to family and friends, if they are supportive.

In some cases, there might be a referral for medication,” she said.

Megan Turchetti, Psy.D, who treats outpatients with trauma in a New Hampshire clinic, pointed out that it’s not uncommon for a long-time patient to reveal incidents of childhood sexual abuse months or even years after they occur.

She cited ACEs (Adverse Childhood Events Study) that found a wide-range of mental and physical health issues as a result of childhood abuse.

This study “…created a ripple effect in clinical psychologists who understand that trauma is more prevalent than

otherwise thought,” she said.

“Now, various human service fields are striving to attain a ‘trauma-informed approach’ to care.”

During the last 10 years, child advocacy centers have become a bridge between the criminal justice system, social workers and mental health professionals for concerns about childhood sexual abuse.

Children are also gaining support from trauma-informed classrooms in which trained individuals can recognize and address trauma, and The National Child Traumatic Stress Network offers 20 to 30 evidence-based approaches for treating those who have been traumatized, according to Turchetti.

Turchetti believes that a prevention mindset would enable psychologists and society to reach out to young people and empower them to speak up about sexual abuse as soon as it occurs without fear of shame or judgment.

Historically, society has become aware of trauma, but in time the attention fades, Turchetti said. “I feel we’ve reached a critical mass with

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our awareness of trauma, especially inasmuch as it has spread to other social structures.”

Women may hesitate to seek counseling from a male therapist, and with good reason, according to Martin R. Pierre, Ph.D, member of the Massachusetts Psychological Association (MPA) Board of Directors and staff psychologist, Brandeis University Counseling Center.

Pierre, who is also co-founder of Ashmont Counseling Associates, LLC., said that some women may have concerns about their safety and ability to self-disclose to a male therapist. It may affect the willingness to engage in therapy.

“As a function of sexual trauma, the woman felt she had no choice in the matter,” he said. So, he provides the power of choice by giving women the option of working with a male or female therapist.

He said that the outcome could be a healthy therapeutic relationship with a male.

“It’s useful to encourage women to work with a provider of different gender who respects appropriate boundaries. It may result in an emotionally corrective experience,” Pierre said.

In addition to EMDR, Pierre uses strength-based therapy that focuses on what is right with the woman.

“Women have unique strength and recourse. I ask them to think about what allows them to survive and cope. If they use that same strength, it will help them heal and recover. It is profoundly affirming and helps validate the woman’s feelings. They see themselves as survivors.”

Pierre also develops a therapeutic alliance and provides a safe, sacred space for exploration of healing. This affirms and validates the woman’s experience and acknowledges that it took great deal of courage and strength to come to therapy and share her life narrative.”

Citing the problem of sexual abuse as a “cultural issue,” Turchetti advocates for a “… prevention model that would direct energy in well-funded outreach and education programs.”

However, she admits that this proposal “…circles back to the larger system of government and what gets funded or not.” NEP

November 2018

UNICEF Continued from Page 1 es. Lack of education has been recognized as a root cause of poverty.

“The schools have not focused on social-emotional

New England Psychologist Borders, which runs group programs that teach assertiveness, problem solving and conflict resolution skills for 5th- through 7th- graders attending low-income schools in the District of Columbia and Montgomery County, Maryland.

Students who participated in the group Resilience Build-

“The schools have not focused on social-emotional learning, so that’s my big beef, and it’s not just the U.S., it’s everywhere.”

Psychologist Mary K. Alvord, Ph.D. learning, so that’s my big beef, and it’s not just the U.S., it’s everywhere,” said Maryland psychologist Mary K. Alvord, Ph.D. She is the founder of the non-profit Resilience Across

er Program reported a significant increase in their emotional control and a significant decrease in negative emotion in a study Alvord co-authored that was published online last July in the International Jour-

nal of Group Psychotherapy.

“It could be considered a violence prevention program,” added Alvord, who serves as the American Psychological Association’s public education coordinator for Maryland.

She also has a private practice in Rockville and Chevy Chase and wrote a popular workbook for counselors and parents published in 2011.

Titled “Conquer Negative Thinking for Teens,” the book offers a curriculum on how to overcome the common thinking habits that feed anger.

Alvord says free time and transition time are when children are at the most vulnerable for bullying and fighting because there’s less structure and there’s less supervision.

And if children haven’t learned problem solving skills at home, they are at risk of being the victim or the aggressor in bullying at school.

She called the UNICEF report “very impressive” and agreed with its broad definition of violence to include emotional abuse and bullying in addition to actions causing physical harm.

A United Nations agency headquartered in New York City, UNICEF provides humanitarian and develop-

BCBSRI flawed utilization review process Continued from Page 1 2015.

OHIC is conducting market conduct examinations of all four of Rhode Island’s major insurers to measure compliance with the Affordable Care Act. The law requires that insurers offer mental health and substance use disorder coverage comparable to that for general medical and surgical care.

The BCBSRI review was the first to be released on Sept. 17.

Clinicians from the Law and Psychiatry Service at Massachusetts General Hospital provided expertise for the review of a random sample of 444 cases, most from 2014.

OHIC’s report found that BCBSRI’s used “clinically inappropriate” review criteria and that documentation of the criteria was “inadequate.”

The examiners concluded that different utilization review staff “reached very different conclusions based on similar facts and clinical circumstances.” Additionally, the insurer “conducted frequent, short-term reviews of coverage…without an objective or clinical basis” and that

utilization review procedures were “unreasonable and inequitable” and “did not properly consider patients’ welfare and safety.”

The examiners also found BCBSRI’s practices for prior authorization of prescription drugs used to treat behavioral health conditions “led to impeded or delayed care or potential impeded or delayed care.”

Instead of a penalty, however, regulators reached a settlement to establish a $5 million fund – with BCBSRI contributing $1 million per year over the next five years – to improve access to care and treatment for individuals with mental health and substance use disorder conditions.

The fund will be administered by the Rhode Island Foundation. The process of soliciting proposals for prevention and early intervention programs was expected to start by the end of October, foundation spokesman Chris Barnett said.

“Blue Cross was extremely cooperative,” OHIC Commissioner Marie Ganim said in an interview. “One of the reasons why the settlement was agreed

to was that they have agreed to discontinue utilization review for in-network behavioral health providers.”

Ganim also noted that BCBSRI had started to correct deficiencies to improve the mental health system even before the report was released.

Among other policy changes BCBSRI had announced, effective Jan. 1, 2019, all its insured plans will provide coverage for all mental health and substance use disorder office visits, including medication-assisted treatment (MAT), at a copayment consistent with primary care office visits instead of specialist visit copays, which are often higher.

Last spring, BCBSRI partnered with the Addiction Services Center at Roger Williams Medical Center to provide MAT to Rhode Islanders struggling with opioid use disorder.

It announced its support of Bradley Hospital’s Mindful Teen Program, a six-month evidence-based Dialectical Behavior Therapy treatment for adolescents (DBT-A) ages 13 to 18 years old to help them Continued on Page 10

9 mental assistance to children and women in developing countries.

UNICEF has worked with government policymakers, teachers, administrators, parents, students and others in more than 70 countries across the world to end violence in schools.

Its work has ranged from student-led bullying-prevention programs in Indonesia, which has seen an almost 30 percent reduction in bullying in schools, to mediation centers in El Salvador schools where children are trained in how to settle disputes peacefully and teachers are trained in the use of art therapy to create peaceful environments.

Cornelius Williams, MA, associate director and global chief of child protection for UNICEF’s Program Division, said societies bear the high costs related to health care and social assistance for victims of violence, as well as the loss of economic productivity because of violence.

He cited one estimate that put the annual global cost of the consequences of violence against children are as high as $7 trillion.

“To end violence in schools, we’re working with partners to call for urgent action in key areas,” Williams said via an email.

The areas include strengthening prevention and response measures in schools, supporting students as they speak up about violence and work to change the culture of classrooms and communities, and making targeted investments in proven solutions that help students and schools stay safe.

Williams said UNICEF is organizing a number of #ENDviolence Youth Talks around the world to hear from young people about their experiences of violence and what they need to feel safe in and around school. The talks will inform a set of recommendations to global leaders. NEP

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10

New England Psychologist

November 2018

Study gives insight into how people experience emotion

By Phyllis Hanlon motions run the gamut, from sadness and grief to happiness and euphoria and many others in between. But little is known about how and why those emotions change at different times and during different stages of life. A team of researchers at Harvard University recently conducted a study to explore these questions.

Leah Somerville, Ph.D, associate professor psychology, and director, Affective Neuroscience and Development Lab, oversaw the study, which involved 143 subjects between the age of five and 25.

Clinical psychologist graduate student Erik Nook, the “resident expert” on this work – according to Somerville – has long been interested in “…how language and emotion

BCBSRI Continued from Page 9 avoid crises that might lead to inpatient hospitalization.

Rhode Island Psychological Association Director of Professional Affairs Peter M. Oppenheimer, Ph.D., welcomed the market conduct studies and looked forward to seeing the outcome of the other three reviews still pending.

“It has long been my experience with utilization review agents that the rules were often arbitrary, and the agent’s application of the criteria

interact…” and what might influence a person’s ability to regulate emotions.

This study investigated a process known as emotion differentiation, which refers to how specifically people experience their emotions. Somerville reported that Nook took the lead in the research.

As part of the study, all subjects viewed 20 disturbing images that included oilslicked birds mired in greasy water, war scenes involving guns and a raging house fire.

The team collected data related to the intensity level of emotions the images evoked.

Nook admitted that one of the challenges the team faced was how to assess emotions across a wide age range. He pointed out though, that using different images for the different age groups could complicate, rather than aid, interpretation of results.

The research team had two competing hypotheses for their results. According to one hypothesis, their findings would be linear, suggesting that emotion differentiation would improve with age.

“But there was a quadratic effect,” Nook said. The ability to distinguish between emotions increased in childhood, declined in adolescence and rose again in adulthood, he explained.

“We were surprised to find that children had high [emotion differentiation] scores.

But when you look deeper at other studies, you find that kids have a strong tendency to express one feeling at a time,” Nook said.

As children become adolescents, they are more likely to experience emotions simultaneously, and this leads them to struggle to differentiate their emotions. In other words,

adolescents are less successful at interpreting several emotions at the same time.

According to Nook, identifying one’s emotions has raised many questions and hypotheses in the scientific community.

“One popular idea is that to be successful at regulating your emotions, it’s important to know what you are feeling,” he said. “If you are confused, it’s hard to come up with solutions to work through an experience.”

Nook added that once a person identifies the emotion, he or she might then be able to employ the right tool to get through a situation. He emphasizes that there is “no clear scientific proof” for this theory.

The subjects in this study were primarily healthy individuals, according to Nook.

“But we know that emotion

differentiation decreases in people with mental health issues and that adolescents have an increased risk of developing mental health disorders,” he said.

Putting these two concepts together raises the question of a connection between reduced emotion differentiation and an increased risk of mental illness in teens, Nook added.

More research is needed in this area, as it’s important to have scientific backing for work done in the clinic, according to Nook. NEP

arbitrary or inconsistent,” Oppenheimer said, adding he was pleased that BCBSRI was cooperating with regulators.

“I don’t think that complaints about BCBSRI were more frequent or egregious than the other companies operating in Rhode Island,” Oppenheimer said.

The reviews of UnitedHealthcare, Neighborhood Health Plan of Rhode Island and Tufts Health Plan will be forthcoming, Ganim said. NEP

Opioid crisis

Critics of the bill point out that opioid addiction is only one part of the problem. The other part is chronic pain, which often leads to opioid addiction. When opioid prescriptions run out, many patients seek out cheaper options.

Heroin is often the chosen culprit. The National Institutes of Health indicated heroin use was 19 times higher in previous opioid users. Heroin is sometimes cut with the synthetic opioid fentanyl, making it more potent and potentially fatal.

Representative Denise Garlick (D-13th Norfolk)

addressed those burdened by the weight of addiction.

“At no point did this bill ever lose its focus,” she explained, “that it is about the individuals who are suffering, the families who are struggling, and the communities who are straining to provide services and save lives.” NEP

drug to soldiers serving in Afghanistan. One contributor points out, “U. S. military authors have subsequently concluded that the lasting psychiatric effects of the drug, even at the lower doses used to prevent malaria, can confound the diagnosis of PTSD among U. S. military personnel.”

Throughout the book, the authors examine responsibilities and research, including ecological validity (whether findings based on someone’s behavior and brain scan activity applies to real world situations), problems with opposing cultural beliefs in the research on the effectiveness of involuntary outpatient commitment, and much more.

Issues about roles and how to deal with being pushed into more than one role, and conflicting roles and the difference between forensic and clinical ethics are discussed.

Repeatedly, the authors return to the process in ethical decision-making including guidance from professional organizations.

I highly recommend this book for any one working with forensic cases. I also highly recommend it for clinicians, in general, for the probability is that at some point you will be drawn into a case involving the court system.

This book will help guide you, make you think, and even change your own behavior. NEP

Janine Weisman is a journalist based in Newport, Rhode Island, who frequently writes on mental health. Find her on Twitter at @ j9weisman.

Continued from Page 7 Additionally, the legislation proposes a two-year pilot program to treat prison inmates with methadone and other similar medications.

It also paves the road to certifying recovery coaches, requires all private healthcare facilities to accept MassHealth coverage, and electronically tracks opioid prescriptions from pharmacies while also ensuring unused medications are safely disposed.

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. She also serves as writer/editor for custom publications.

Eileen Weber has been a freelance writer based in Fairfield, Conn. for several years with a master’s degree in journalism and a professional background in publishing. She has written numerous articles for magazines, newspapers, and web sites.

BOOK REVIEW Continued from Page 5

t

u o k c e Ch

pro.psychcentral.com

top of the effects of enhanced interrogation techniques such as waterboarding.

There is already ample evidence that torture does not get good intelligence. Add drug induced psychological problems into the mix and that degrades the outcome even further.

The military also gave the

New England Psychologist Direct to your email box every month! eepurl.com/dfBalr

November 2018

November Nov. 3: Nurturing Resilience in Children and Families: A Shift from Deficits to Strengths. Newton, MA. 9-4:30 pm, $150, 6 CEs. This conference takes a strengthsbased stance and examines theories, factors, and processes that promote resiliency in children, parents, families and systems. Speakers will provide examples of their work promoting resilience using a strengths-based approach in various settings with diverse populations. Sponsored by William James College. Contact www.williamjames.edu/academics/lifelong/ce/

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 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.

Nov. 7, 2018 - May 1, 2019: Monthly Master Series in Couple Therapy: Seven More Approaches to Interviewing.

Newton, MA. 7 pm-9:40 pm, $775, 18 CEs. On the first Wednesday of each month, observe and dialogue with seven senior couple therapists about

New England Psychologist

their ideas about couple therapy (includes live role playing).

Topics include using humor, paradox, and camaraderie to facilitate change; producing deep change quickly; using solution-oriented questions to deepen the conversation; examining your own relational style as a therapist; fostering collaboration in couples work; accessing the couple’s resources for love, compassion, acceptance, and forgiveness; and creating the safety necessary to create an increased depth of understanding. Sponsored by Therapy Training Boston. Contact 617-924-9255 or register at www.therapytrainingboston.com.

Nov. 9: Rise Up! Spirituality, Faith, and Social Justice. Newton, MA. 8:30-5 pm, $130, 6 CEs. This Conference aims to engage agents of social change who are grappling with contemporary social issues that affect vulnerable and oppressed groups in the U.S. It seeks to promote greater awareness of the need for more socially conscious and spiritually sensitive mental health providers who can pursue a social justice agenda.

Sponsored by William James College. Contact www.williamjames.edu/academics/lifelong/ ce/

Nov. 29: Neuropsychological Assessment with Attention to Developmental Trauma and Learning Disorders.

Newton, MA. 8:30-5 pm, $140, 6 CEs. We will cover the use of the WISC-V, BRIEF-2 and BRIEF-A. Co-Sponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College. Contact www. williamjames.edu/academics/ lifelong/ce/

CONTINUING Education 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

Nov. 30: Assessment of Youth with the MMPI-A-RF and the R-PAS: Including Aspects of Developmental Trauma and Psychodynamically-informed Cognitive Assessment. Newton, MA. 8:105 pm, $155, 7 CEs. Data will be presented demonstrating the validity and reliability of the measures presented as well as their application to the target patient population. Co-Sponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College. Contact www.williamjames.edu/academics/lifelong/ce/

December Dec. 1: Integrated Assessment of Youth. Newton, MA. 8:30-5 pm, $155, 7 CEs. Case presentations highlighting the role of developmental trauma; including how we measure adulthood and its forensic implications; ethical issues in assessment of youth; and the trajectory of adolescent social and neurological development.

Co-Sponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College.

Contact www.williamjames. edu/academics/lifelong/ce/

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Dec. 5: Functional Neuroanatomy Review. Shrewsbury, MA. 8:30-4:30 pm, $250 BIAMA members, $275 non-members, 6.5 CEs. Participants will review the structures and functions of the central nervous system (CNS), including the cerebral hemispheres and subcortical structures (brain stem and spinal cord). The organization of the motor, sensory, vascular and ventricular systems within the CNS will also be presented and discussed. Participants will also learn the basic neuropathology of CNS lesions and the common associated functional sequelae, related to both congenital and acquired

disorders. Sponsored by Brain Injury Association of Massachusetts. Contact biama.org/ abitraining2 to register.

Dec. 6: Movie + Dialogue Night showing the film 13th.

Watertown, MA. 7-10 pm, $55, 3 CEs. The title of Ava DuVernay’s documentary refers to the 13th Amendment to the Constitution. With a potent mixture of archival footage and testimony from a dazzling array of activists, politicians, historians, and formerly incarcerated women and men, DuVernay creates a

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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.

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New England Psychologist

work of grand historical synthesis. This film will be used as a vehicle to become aware of and learn more about the impact of political and legislative decisions on African Americans and the prison system, as a legacy and continuation of slavery in modern times. Contact 617-924-9255 or register at www.therapytrainingboston. com

January 2019 Jan. 7: Assessment of Youth with the MMPI-A-RF and the R-PAS: Including Aspects of Developmental Trauma and Psychodynamically-informed Cognitive Assessment. Newton, MA. 8:10-5 pm, $155, 7 CEs. Data will be presented demonstrating the validity and reliability of the measures presented as well as their applica-

tion to the target patient population. Co-Sponsored by The Department of Psychology, Massachusetts Mental Health Center and William James College. Contact www.williamjames.edu/academics/lifelong/ ce/

Jan. 7-Feb. 3: Post Certificate Course: Advanced Parenting Coordination (Online Only Option) 2019. Newton, MA. $475, 12 CEs. Advanced Parenting Coordination is a post-certificate course offered in a blended learning format.

Participants in this advanced training will learn advanced strategies and techniques to work effectively with difficult clients including those with personality disorders, and manage cases where children resist contact with a parent and where young children are involved. See website for details

and pre-requisites. Sponsored

by William James College.

Contact www.williamjames. edu/academics/lifelong/ce/

Jan. 28–Feb. 24, Mar. 1-2: Mental Health and Juvenile Justice 2019. Newton, MA. $1100, 28 CEs. Mental Health and Juvenile Justice is designed for professionals engaged in providing services to youth and families involved in the juvenile justice system who aspire to improve outcomes for youth and families through enhancing their programs and services, and by more effectively partnering with public and private agencies and providers (state, local, tribal or other). Sponsored by The Center of Excellence for Children, Families and the Law at William James College. Contact www.williamjames.edu/academics/lifelong/ce/ NEP

November 2018

THE QUICK FIX

F O R C O M P R E H E N S I V E 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.

weekend. Wheelchair accessible. Some offices suitable for groups. Please contact: 617332-6755 or cea.newton@ yahoo.com QUINCY: Space available in beautiful suite - Mon’s.

Professional building.

Excellent location. Easy access to Rte 93 & 3. Short walk

to bus or ‘T.’ Contact Barbara Mordini at bmordini@comcast.net or 617-471-6322.

WATERTOWN, MA: Sublet hours available in large, sunny first floor office in beautiful Victorian building. Easy on-street parking. Contact Claire at claire_levine@yahoo. com or 617-924-7920.

Help Wanted PART-TIME PSYCHOTHERAPIST CAMBRIDGE / BOSTON PRIVATE PRACTICE Seeking independently licensed psychotherapist (LICSW, PhD, PsyD) with solid psychodynamic and/or cognitive-behavioral experience to join private practice

with offices in Cambridge & Boston. Competitive compensation, excellent colleagues & beautiful office setting. Prefer candidates with Friday or Saturday availability.

Email cover letter/resume to clinicalallianceservices@ gmail.com

Classified Form All classified advertising runs in the next available print edition and on nepsy.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.

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.

NEWTON CENTRE – Attractive, professional office spaces, near T, parking. Furnished, day/evening/

Address: ___________________________________ ____________________________________________ Phone: ___________

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: __________________________________________________________________________________________________ Email:

________________________________________Payment of $_____ is enclosed.

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