New England Psychologist - June 2018

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AN INDEPENDENT VOICE FOR THE REGION’S PSYCHOLOGISTS

Private practice: Not for the faint of heart

By Phyllis Hanlon n a perfect world, running your own private practice would provide psychologists with a balance of just enough clients with plenty of time for leisure activities, family and educational pursuits as well as a healthy bank account.

While the dream might be possible, there are some aspects of private ownership a practitioner should consider before taking this career step.

Jennifer L. Cantor, Ph.D, a clinical psychologist and psychoanalyst practicing in Wilder, Vermont, said she was an idealistic graduate student, envisioning a career in a public hospital helping the community.

She completed her externships, internship and licensing hours in inner-city hospitals in New York City, and found those experiences immeasurably valuable for building clinical acumen and confidence.

Robert C. Vilas, Ph.D., private practitioner, Brunswick, Maine.

and with advanced training in psychoanalysis under her belt, she encourages early career psychologists to develop as much expertise as they can before opening a private practice, to strive for depth of knowledge as well as breadth.

She also emphasizes the importance of cultivating relationships with others in the

“I set the tone of my practice.

You can’t do that in an agency.”

Robert C. Vilas, Ph.D. private practitioner, Brunswick, Maine

But ultimately, she bristled at the restrictiveness of the hospital setting. After obtaining licensure, she decided to go solo.

Fortunately for Cantor, she had a supportive mentor who provided office space at a reasonable cost as well as professional guidance. She spent 13 years in New York as a private practitioner before moving to the Green Mountain state.

Cantor enjoys the autonomy and flexibility of private practice but warns the inevitable fluctuations in income and relative lack of structure might be difficult for some clinicians to tolerate.

Now more experienced,

field. can allay the isolation of “Some of the most helpful advice came from former supervisors,” she said, noting relationships with colleagues solo practice.

After working for 14 years in an academic setting, Robert C. Vilas, Ph.D, private practitioner in Brunswick, Maine, decided he had used up his “institutional half life” and needed to move on.

Unlike early career psychologists who go the solo route, Vilas did not face serious risk; he had extensive experience and ready-made clients from Bowdoin College, where he had previously worked.

Vilas has found that, unlike

working in an institution, whether that might be a school or a hospital, as a private practitioner he can screen clients and accept those who suit his strengths. “I set the tone of my practice. You can’t do that in an agency,” he said.

Before going solo, Vilas urges practitioners to do extensive research regarding location, available resources in the area, and number and type of other private practitioners in the community.

“You should do careful research around the market, see what other psychologists are facing and what referral sources are available,” he said.

Private practitioners need to cultivate referral sources and determine how they will attract clients and advertise their practice.

For those who are leaving an agency, academic position or hospital setting to set up private practice, the loss of benefits can be a challenge.

At Bowdoin, Vilas had health and disability insurance, a retirement fund and other benefits that disappeared when he decided to leave the school.

He recommends creating a plan that takes into account how much money you want to make and then weigh out what you are losing when you leave a corporate or agency job.

Vilas cautioned against taking on too many patients to compensate for lost benefits.

“It’s hard to turn down a client. There is anxiety about the wolf at the door,” he said.

It’s tempting to accept a large number of patients, but it can have adverse consequences for both you and the client, he warned.

Jonathan Gershon, Ph.D, owner Gershon Psychological Associates LLC in Greenville, Rhode Island is president of the Rhode Island Psychological Association (RIPA).

He is also a clinical assistant professor at Brown UniContinued on Page 11

VOL. 26, NO. 5

Vermont braces for loss of psychiatric bed Medicaid funding

By Janine Weisman special waiver exempts Vermont from a decades-old restriction prohibiting states from using Medicaid funds to cover services for non-elderly adults with mental health conditions in hospital settings with more than 16 beds.

But Vermont’s waiver is set to expire starting in 2021 and phase out completely in 2025.

That would leave the state on the hook for the $23 million in federal dollars being used to provide treatment for patients ages 21 to 64 at the Vermont Psychiatric Care Hospital (VPCH) in Berlin and Brattleboro Retreat, said Department of Mental Health (DMH) Commissioner Melissa Bailey.

A proposal among an assortment of bills in Congress to address the nation’s opioid crisis offers a glimmer of hope.

But it might not develop fast enough to matter to Vermont.

The bill sponsored by Rep. Greg Walden (R-Ore.), chairman of the House Committee on Energy and Commerce, would lift the so-called “institution for mental disease” (IMD) exclusion and allow for Medicaid to cover inpatient services for non-elderly adults with a substance use disorder for up to 90 days per year.

Some groups are pushing for amended language to include coverage for psychiatric disorders too. The bill would require that patients be

assessed after the first 30 days of treatment to determine if continued care is necessary.

Simple math shows the IMD exclusion would mean the loss of nine of the 25 state-run beds at VPCH. But Vermont can ill afford to lose them.

After damage from Tropical Storm Irene led to the closing of the 54-bed Vermont State Hospital in 2011, the small rural state now only has 45 Level 1 inpatient beds. That has led to pressure on hospital emergency rooms where psychiatric patients are often stuck waiting for days for a bed to open up elsewhere.

Bailey was not optimistic when asked how she saw the chances of the IMD exclusion changing or the state’s 1115 waiver granted in 2005 by the Centers for Medicare and Medicaid Services (CMS) being extended.

“I’d say very, very unlikely,” Bailey replied.

The IMD exclusion would mean the loss of about 50 beds at the Brattleboro Retreat, said President and CEO Louis Josephson, Ph.D. The private psychiatric hospital has 119 beds in use though it is licensed for 149.

A total of 89 beds now in use are for adults, including 14 reserved for patients in state custody under a contract reached with the state after the closure of the state hospital in Continued on Page 11

INSIDE

Survey shows firefighters have widespread mental health issues ............Page 7 Legislation to prohibit conversion therapy is pending......................................Page 8 CE listings.................................................Page 13

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New England Psychologist

June 2018

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June 2018

New England Psychologist

3

Helping others with personal growth is at core of Randy Kamen’s career If becoming one’s best self is what the field of psychology is all about, it should surprise no one that a psychologist would wish to continue to evolve over the course of her own career.

For Randy Kamen, Ed.D., a psychologist, educator, author and speaker who has held positions at Boston University’s School of Medicine and Spaulding Rehabilitation Hospital, the beaten path is not always the right one.

In helping others find their path, she has turned her own career from clinical psychology and education towards running online group sessions on personal growth.

Kamen, who is also a guest faculty member at Harvard Medical School, spoke with New England Psychologist’s Catherine Robertson Souter about the choices she has made, some with regret and others with relief, and how her work with clients at retraining the brain has become her own next chapter.

You did a media interview in 2014 with advice for therapists just starting out in practice. As you yourself have transitioned away from traditional practice, is there anything you would have changed?

No, not really. It was all in the service of what I do now. Had I not done what I did for so many years, I would never be able to do what I do now. It is an interesting journey for psychologists who want to morph into something else later in their careers.

Tell us a little bit about that journey.

I started out with a clinical practice. I was at Spaulding Rehab, where I did my dissertation and I ran the stress management department and the biofeedback program there. At the same time, I was also doing clinical and group work. I have always felt that group work is a very powerful way to practice.

I left there and I was in private practice for six months and someone overheard me talking about my work and invited me to become faculty at BU. I developed a program there and became an assistant professor and I did that for 11 years.

And then I had babies and, well, the professorship, it was so sad, but I just had to cut it loose. I loved working at BU because I worked with so many international students. It was the best job ever.

But it was a choice between, ‘Do I have awesome children or let them fly for themselves and continue this professorship?’ I was very sad about it, but I made the right choice. I do have amazing children.

And your practice now?

I speak around the country and I run live online women’s groups about personal growth and leadership.

Everybody is the leader of themselves no matter what they do, not just those who are in a CEO or leadership role. We all ultimately have to take responsibility for our lives and how things play out.

Mostly what I speak to people about are skills and strategies to retrain the brain for positivity and success. I teach how to get out of your own way, away from your own limiting beliefs or from all the self-talk that can be so destructive.

I teach skills that are part mind/body medicine and part psychology but I take it further into the realm of personal development and leadership.

I work to help people clarify their vision. I started a group last night of 10 women for the year. We will go on this journey together on how to retrain the brain in a way that is going to help them create an extraordinary next chapter in their lives.

Do you also work with men in this area? Who is more open to this message?

Everyone is open to it and hungry for it and there are not that many people teaching it, at least not who are trained psychologists.

I will be starting another online session that will be mixed male and female but I had a group of women who wanted to build female friendships so I thought I would do one for just women.

Doing this instead of clinical practice - is this your own extraordinary next chapter?

This is my legacy time so I am completely committed to making as big a difference as I can. I plan to be doing this for a long time to come but I also want to make

a real contribution. I want to make a living, of course, but also do it philanthropically.

Many of the people I work with will tell me that they got my book and have shared it with their children or talked to them about one particular aspect or sent my videos to people.

I also do summits every year where I interview leaders in the field of mind body medicine/positive psychology and I interview them about their areas of expertise. This adds a lot of value too. I offer a tremendous amount of free content for people who are interested in learning.

What don’t you miss about your former work situation?

I have to say, I stopped working with insurance companies a while back.

Towards the end of working with insurance companies, I was just so turned off by the health care system and it breaks my heart to see what doctors are going through now. I work a lot with burned out physicians and it is not pretty.

Any advice for other psychologists about branching out into areas beyond clinical practice?

Was it a leap of faith?

It took a while. First, I gave up insurance and that was scary but so liberating. Then I stopped working with really challenging patients. That was a gradual process. I realized that I didn’t want to do this anymore. I realized that I want to work with people who are ready to move forward in

Q: What is the most cost effective way to recruit psychologists?

A: Place a help wanted ad in...

their lives and who want to be able to create their best personal lives rather than looking backwards and rehashing their history.

Plus, I never stopped with my own personal growth. I am always in a growth and leadership program myself.

For instance, I want to become a leader in my field and I have been working very diligently and in a committed way for that to happen.

It is not left to coincidence. I am not just going to stumble into becoming a leader.

Why is this work important?

If you are living consistently with how you want to be living and planning it so that your inside is matching your outside, you will be a happier person.

Most people just let life happen day by day without having a focused intention about what they want to create. But, you won’t go anywhere without it. You say, “I want to go there with my life.

I want to create this; I want to have a certain lifestyle, make a difference in other people’s lives, or whatever it is.” If it just a thought but without a plan, it doesn’t happen.

I teach other people about being focused and driven and how to strategically plan their lives by the year, the month, the day. So, it is not just a coincidence when it all works out. If you leave it up to chance, that is what you will get. If you plan for success, that is what you will get. n

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New England Psychologist

IN PERSON

June 2018

EDITORIAL

The power of hard stories

By Alan Bodnar, Ph.D. s I sat listening to a discussion on the topic of writing hard stories at the recent Newburyport literary festival, I thought of my colleagues in psychology and wished you could hear the message the panel came to deliver. Perhaps some of you were in the audience and heard what the presenters had to say, but for those of you who had better things to do on a springtime Saturday, this one is for you.

Psychologists, like writers, are all about the story. When we listen to our patients telling us about the challenges in their lives, we are listening to their stories and trying to understand how they make sense of their particular situations.

We hear about parents, siblings, children, significant others, friends and enemies, co-workers, and acquaintances and listen to tales of how these players affect the lives of the narrator.

We are there to listen and understand the story from the teller’s point of view. This practice is the foundation of empathy, the indispensable first step on a shared journey where therapist and client collaborate to write a more satisfying narrative.

We can’t change the hard realities of our clients’ lives any more than we can erase the heartaches of our own.

What we can do is to enlarge the narrator’s point of view to include his own hidden thoughts, feelings, and patterns of behavior as well as the perspectives of the other characters in his life’s drama. We might also be able to identify and help people change common styles of thinking that can lead to a distorted view of their circumstances that keeps them stuck in unhelpful cycles of thought and behavior.

When we hear a story about trauma of any kind, we know we are in for a soul-wrenching ride that will call upon all of our therapeutic arts. The therapist uses her art to heal trauma; the writer uses her trauma to make art.

And so, on a spring morning, four writers came together in the nave of a pretty New

England church to share with the audience their experience of writing hard stories and shaping art from trauma. The panel, moderated by Melanie Brooks, included Alysia Abbott, Mark Doty, and Andre Dubus III. Melanie Brooks teaches writing at Northeastern University, Merrimack College, and Nashua Community College. Her work has appeared in the Washington Post and other newspapers and literary magazines.

After introducing her colleagues, she began the panel by sharing her own hard story about the death of her father, a prominent physician, from AIDS contracted in a blood transfusion, and the impact of keeping the secret of his illness during her adolescent years.

The challenges she faced when she decided to write about her experiences made her wonder how other writers had responded to their own call to write the hard stories of their lives. That question led her to interview 18 people who had written about their personal experiences of trauma. Three of them joined her for the panel discussion.

Mark Doty, the winner of the 2008 National Book Award for Poetry, shared the story of caring for his partner through his illness and death.

Alysia Abbott, the author of “Fairyland: A Memoir of My Father,” described what it was like to write her story of growing up in San Francisco with her gay father after her mother died in car accident.

Abbott was called home from college to care for her dying father and it was not until many years later that she realized the impact of the life

they shared and the loss she experienced at his passing.

Andre Dubus III, an awardwinning novelist and author of the memoir, “Townie,” described his complicated relationship with his father and the impact of realizing that, although he visited regularly after he and Dubus’ mother divorced, he was largely absent from the writer’s life.

Listening as a psychologist, I heard many familiar themes and had a few unexpected insights. Melanie Brooks spoke of the generosity of the 18 writers she interviewed and their willingness to share their experience of writing the hard stories of their lives. There is nothing like realizing that our suffering is shared, that we are not in this alone, to make life’s trials and challenges more bearable.

Mark Doty told how hard it was to write, not from a reflective distance, but in the present moments of his grief and anguish. You write a sentence one word at a time and, if it rings true, you keep it. It becomes one strand among many that you will weave into a basket to contain your sorrow.

Alysia Abbott did write from a reflective distance after she was well launched into her own life many years after her father’s death. It was only when she got away from her daily routine to spend time at a writer’s retreat that the full impact of her life with her father washed over her in an outpouring of solitary tears.

Andre Dubus III reminded us of the important difference between the facts and the truth. The facts of a situation are immutable. A parent spends long hours away from home working to provide his family with the good things in life. Those are the facts. The children feel neglected and unloved. That is their truth.

The writer and the psychologist both know that we must start by acknowledging our truth and that when we learn the facts, something might change to make the hard stories just a little easier. n

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

Playing to our strengths

Psychologists may make the best therapists out there, but it doesn’t mean we’re the best profession to serve psychotherapy to everyone. Psychologists are more expensive than other types of professionals who engage in psychotherapy, making their services unaffordable to some people.

One could argue that’s for good reason – because psychologists provide a higher-level quality of therapy services.

For better or worse, there’s little empirical evidence to support this belief.

Psychologists would do well to play to their strengths. These strengths include a strong background in understanding and implementing empirically-backed treatments and the ability to perform complex psychological assessment. When we stray away from these core strengths, we weaken our profession.

Take, for instance, the issue of prescription privileges for psychologists. Over the course of more than 35 years, the American Psychological Association (APA) has spent tens of millions of dollars in lobbying efforts to gain these privileges for our profession.

The result? Only a measly five states allow such privileges.

One of them – Louisiana – decided to move all psychologists under the purview of the state’s medical board. How’s that for an unintended consequence?

Had the APA instead spent that time, money, and effort on bolstering the case that psychologists offer a higher-level quality of care resulting in better, more timely outcomes for their patients – backed by newly funded scientific research – they may have obtained higher insurance reimbursement payments for the profession.

Focusing and building upon the strengths of the profession seems to make more sense than delving into a whole different area of healthcare provision.

When psychology as a profession pursues these misguided efforts, psychologists unintentionally weaken the profession – trying to be something they’re not uniquely qualified to be.

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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Reproduction of any part of this publication by any means without permission is prohibited. Back issues of New England Psychologist may be obtained by sending payment of $25.00 along with name and address to:

New England Psychologist P.O. Box 5464 Bradford, MA 01835 Tel. 978-225-3082 www.nePsy.com

June 2018

New England Psychologist

GUEST EDITORIAL

What President Trump should have said about the opioid crisis Imposing the death penalty for opioid drug dealers, cracking down on immigrants, broadcasting scary TV commercials about drugs and allocating a mere $6 billion to combat the opioid epidemic...

That’s the plan President Trump recently proposed to combat the national opioid epidemic during a visit to New Hampshire.

The opioid crisis in America claims the lives of 116 people a day and continues to ravage the nation, especially in New Hampshire.

Those who are trapped in this cycle of addiction and their families who suffer deserve leadership and an effective vision.

Mandatory sentencing and an extreme focus on drug dealers is a tried and failed method. Past “War on Drugs” campaigns did little to help sufferers and they did serious damage by imprisoning thousands of poor and sick people from communities of color.

This crisis needs a dramatic increase in access to care and preventive education. A death penalty for selling drugs is ridiculous.

While it is laudable that President Trump and Congress have appropriated $6 billion in a two-year budget deal to address the opioid crisis, by all accounts it is a woefully insufficient amount.

Experts estimate that the allocation should be closer to $60 billion over five years to fund: workforce development; treatment centers; preventive education; family support; and an informational network of data and services to facilitate continuous care.

Opioid addiction is caught in a Catch 22. It takes months of treatment to turn around an addiction, yet the current system only offers days or weeks and only to those who can afford it.

And, people often need to wait months to get those few days.

Spending a lot of money on great commercials showing how bad [the opioid crisis] is will be as ineffectual as those that presented the critically ill ‘Marlboro Man’ to discourage smoking.

Young people will turn the channel. Less than 1% of the money spent on substance use disorders is given to wellresearched preventive education programs, yet every dollar spent there saves $18.

The evidence-based solutions to the opioid crisis have been well outlined. That they are being met with the tired, punitive, xenophobic, and hostile speechmaking does not serve the families and people who are suffering.

Very little of what was offered in the president’s speech in New Hampshire was informed by health care, public policy or educational research. With access to some of the best experts in the world, it is disappointing to hear about choking the supply rather than treating the people with the demand.

This is not a time for campaign rhetoric. The people who suffer from drug dependency and addiction and their families who live with chaos, anger, fear, and unspeakable loss deserve better leadership.

By Nicholas Covino, Psy.D president of William James College

5

THE PRACTICAL PRACTICE

Marketing is key to building practice – but must be done with careful planning

By Catherine Robertson Souter n today’s competitive world where everything from the pens floating around at the bottom of a laptop bag to the mugs sitting on the kitchen counter has a brand on it, most businesses prioritize a marketing plan.

If a psychological practice is also a business, with rent to pay, staff to hire, and a “product” to sell, does it follow that psychologists should also consider instituting a marketing plan?

The answer is, yes, but also within certain parameters and with careful planning.

There has long been some hesitation within mental health towards marketing, with the idea that, in order to “sell the product,” one must engage in less-than-dignified practices.

“Many people do feel a certain stigma around marketing themselves,” said Jeffrey Zimmerman, Ph.D., ABPP, a clinical psychologist in Waterbury, Ct., and Westchester, NY and founding partner and president of The Practice Institute, a consulting organization for therapists to build their practice, “but you don’t have to ‘sell out’ or compromise your values to have a successful, viable practice that incorporates your vision.”

Of course, there are some basic housekeeping tasks to take care of before kicking off a marketing, Zimmerman pointed out. Making sure that the business itself is well run, that appointments are scheduled properly, billing handled professionally, and staff is well-trained are all necessary pieces that must come first.

A quick search online will bring up a number of articles that will provide an overview of tools that can be used for marketing a therapy practice.

Most contain basic advice from crafting a website to listing a practice on an online directory.

Other suggestions include: networking with other professionals, reaching out to

PRACTICE RESOURCES: thepracticeinstitute.com www.practiceofthepractice.com www.zynnyme.com pro.psychcentral.com/kickstart www.therapytribe.com

local groups to speak about a specialty, writing articles for online or print publications, and being willing to speak to media when contacted or even reaching out to local media with suggestions for articles.

But, according to Zimmerman, not everything should be about putting your name out there. So, what is the most important way to market yourself?

“Building strong relationships,” he said. “If your community knows you are a psychologist in private practice and you are kind, courteous, friendly, whether at the health club or church or synagogue, and you are a good citizen in your community, you may not be ‘marketing’ your practice by handing out business cards or putting your name on a placemat in a restaurant, but you get known.”

“Then,” he added, “when a conversation comes up where someone is having an issue, a friend or colleague may recommend you just by knowing who you are and respecting you. It is all about you being part of your community.”

The next best advice he gives clients would be to put time and energy into understanding the tools available.

Psychologists spend years learning evidence-based techniques but often do not put in the time when setting up their own practice to learn evidence-based strategies for building a solid environment in which to practice.

“So much of his is about getting the information about what works and not just winging it,” he said.

Of the practical tools available, the best place to start is with a website. Like an oldschool Yellow Pages listing, a website may be the first-place

potential clients will go.

“The internet is providing thousands of referrals each day for people looking for a therapist,” said Ryan Fitzgerald, CEO and founder of WebTribes, Inc., an online directory that provides websites free along with membership.

“It’s quite logical as most people that need to see a therapist are not going to ask their friends for concern over telling their friends they need to see a therapist.”

Fitzgerald warns against paying too much monthly for a website along with search services and postings that are generated by a third party.

“Having a third party write a couple of posts per month on your social media pages may get you a couple likes, but not likely any new clients,” he said. “What we recommend is therapists write good content for their websites with 500-1,000 words per page and create unique pages per each specialty. The trend with Google is quality content.”

Zimmerman recommends crafting a site with the reader in mind. Rather than listing what the therapist has to offer, instead explain what needs of the client’s will be met.

“For example, many people essentially say, ‘I do these three things to help adolescents’ and then they list the types of therapy they offer,” Zimmerman said. “Contrast this with more directly addressing the concerns of the reader by saying, ‘I can help your child face the difficult course of adolescence.’”

The biggest no in a marketing plan? Using gimmicks like coupons or discount pricing.

“If I have coffee in the waiting room, is it a gimmick?

Or if I have a buffer between patients so that they don’t run into each other in the waiting room, is that a gimmick? No, maybe it is value added.” ” It is very different than saying call Dr. Zimmerman

by May 15 and get 20% off your first visit,” he added. “To me that is moving across the line.” n

6

New England Psychologist

June 2018

BOOK REVIEW

Book on change should appeal to varied audience

By Stan Rockwell, Ph.D. he dust jacket of “How People Change” is a mirror image of two people; black and white on the left, and in color on the right. When I saw it, I thought about clients I’ve worked with who described the depths of depression as “all the color gone out of the world.” The colors began to return as the depression lessened.

The title also reminded me of the trans-theoretical model of change developed by James Prochaska and his colleagues.

Their model describes the spiraling stages that people go through over the course of change.

But how does that change occur? And, how does it occur in therapy?

In “How People Change,” editors Marion Solomon and Daniel J. Siegel sought to examine the question of how people change in the therapeutic relationship.

This book is a part of the Norton professional series on interpersonal neurobiology

and is geared to helping clinicians learn and incorporate the latest in scientific research into their practices for helping people change.

This book is fascinating.

Its 13 contributors across 11 chapters talk about how people change in a range of therapies with differing approaches.

There are approaches for individuals, for couples, and for group work.

One constant throughout the book is an emphasis on the relationship of those involved in therapy, including the therapist. The work of Allen Shore, Stephen Porges, William James, Donald Winnicott, J. H. Jackson, Hans Selye, and many others is cited and built upon.

The approaches vary from psychoanalytic, to psychobiological, to attachment-focused.

I found the somatic-based chapters particularly interesting.

“We still don’t understand the origins of mind, but it probably had something to do with groups of brains coming together to form the superorganisms we call tribes… At

“How People Change: Relationships and Neuroplasticity in Psychotherapy”

Edited by Marion Solomon and Daniel Siegel W. Norton and Company

this current point in evolution, our best guess is that the human brain is a social organ and the mind is a product of many interacting brains,” write Louis Cozolino and Vanessa Davis in their chapter.

Philip Bromberg cites his own work and that of Allan Schore about the “phenomena of and concept of ‘state sharing’ — that is the right-brain to right-brain communication process through which each person’s states of mind are known to the other implicitly.”

In our relationships we have the potential to heal and be healed.

The chapters build upon each other, with the authors

Four tips for staying present in sessions

By Jessica Dore eing a therapist is hard work that requires an incredible amount of mindfulness, whether

you have a formal practice or not. We are trained to be good listeners, space holders, unconditional validators, growth-facilitators, case managers, and sometimes entire

support systems, all at once.

For some of our patients, the time they spend with us is the only time they have ever been seen, heard, and validated for being exactly who they

giving an overview of both the art and the science of their individual methods. Brain plasticity, epigenetic changes over generations, the role of our mutual emotion regulation, and even defining emotions are all addressed.

“When presented as dogma, each perspective in psychotherapy is simultaneously right and wrong…Each works, or doesn’t, depending on the client and the quality of the therapeutic relationship,” Cozolino writes.

This book is excellent not only for therapists, but also for those who study the philosophy of mind, for those looking at policy in societal

are. It’s a big responsibility.

But because our work is so demanding, it’s inevitable that we will occasionally zone out in the therapy room. It might be that the patient tells the same story over and over again, or that we’re simply

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change, insurance companies, and those who teach and practice body work such as yoga, tai chi, qigong, dance therapy, and more.

Pat Ogden’s chapter “Beyond Words,” and Peter Levine’s chapter “Emotion, the Body, and Change” are very enlightening, particularly if you have been focused inside your head and in the world of words. We are communicating to ourselves and to the world constantly, and mostly nonverbally.

As I read this book, I thought about the work of Wampold and Imel (2005).

In this age of forcing specific evidence-based practices in therapy, it has been refreshing to read the different ways that extremely competent therapists work and in a variety of ways. The common factors underlie the effectiveness of how people change.

This book supports the importance of paying attention to the therapeutic relationship, to what clients want, and their own theory of how change occurs for them. It’s well worth your time. n

tired or emotionally exhausted from whatever might be going on in our own lives.

Either way, there will be times when we will be anything but present in the room.

Luckily, there are things we can do to improve our capacity to be more present in both our work with clients and our day-to-day lives.

There are countless ways to practice mindfulness and present awareness that can be easily built-in to the things we do every day, while strengthening our capacity for concentration and real time connection with our patients. The following are just a few ideas, but they can each be easily adapted to fit your own needs.

Be an active listener.

One of the first things we learn as therapists is how to practice active listening. By its very nature, active listening requires that we pay attention to the client and be fully engaged. This practice is a sort of mindfulness in itself, Continued on Page 9

June 2018

New England Psychologist

7

Survey shows firefighters have widespread mental health issues

By Pamela Berard lmost 95 percent of firefighters who responded to an anonymous survey of firefighter mental and behavioral health said they have experienced critical stress on the job. And, more than 76 percent said those experiences have caused lingering or unresolved emotional issues.

The firefighters reported experiences including recurring/unwanted memories, anger or withdrawal, substance abuse, sleep problems, and family issues.

Additionally, almost 20 percent said they had experienced thoughts of suicide.

More than 75 percent said they believe these behavioral health issues are a result of post-traumatic stress.

The survey was a collaboration between the International Association of Fire Fighters (IAFF) and WNBC in New York. Almost 7,000 firefighters from throughout the United States and Canada responded.

Jay Colbert, 3rd District Vice-President, IAFF, said the responses were an eye-opener, and demonstrate the cumulative effect of what firefighters see and experience on the job.

Colbert said he thinks discussions on behavioral health like those that come from the survey results can help create a culture shift among firefighters. “This has really brought it out of the shadows,” Colbert said.

More than 86 percent of respondents said they believe there is a stigma that creates a barrier to seeking help for behavioral health or emotional issues.

They cited various concerns related to that stigma, such as putting their job at risk; being seen as weak or unfit for duty; or that a colleague will not trust their judgment under pressure.

Firefighters take the role of public service seriously, and put their own needs secondary, Colbert said.

“Our main priority is protecting the public,” Colbert said. “We took an oath to protect those people in harm’s way.”

Seeing people lose loved ones or lose their homes may make firefighters feel that their health issues are secondary concerns, but, “The protectors need protectors, too,” Colbert said.

Many departments now

include such education as part of a firefighter’s training.

In the survey, more than 89 percent said they were aware of behavioral health services offered by their employer, but only about 28 percent reported having used their employer’s Employee Assistance Pro-

port service or a fellow firefighter, and almost 77 percent of those who did found it helpful.

Colbert said peer support classes that he runs have been extremely successful. “We can’t run enough peer support classes,” Colbert said.

“It is very difficult to get clinical people that really understand the PTSD/first-responder issues that we have.”

Patrick Morrison, IAFF assistant to the general president

gram (EAP) for emotional or mental health issues related to their job. Only about 36 percent of those said they found it helpful.

Almost 75 percent said they had participated in a Critical Incident Stress Management (CISM) defusing (about 55 percent found it helpful).

Peer supports proved more beneficial in the respondents’ eyes. Just over 42 percent sought help from a peer sup-

Patrick Morrison, IAFF assistant to the general president, Division of Occupational Health, Safety, and Medicine, said that IAFF has increased efforts to address the behavioral health of firefighters in the past several years, including a behavioral health peer instructor program that aims to train peers within all of the fire departments where IAFF has members.

“That’s probably one of our

fastest-growing training programs,” Morrison said. Earlier this year, trained peers responded in the aftermath of the Parkland school shooting in Florida, for example.

The IAFF opened its own treatment facility in March of 2017 in Maryland. The IAFF Center of Excellence for Behavioral Health Treatment and Recovery is a 64-bed inpatient residential facility for IAFF members to treat addiction and other co-occurring disorders such as PTSD. About 350 firefighters have been treated at the facility, Morrison said. Center clinicians have gone through specialized training to understand the firefighter population.

Morrison cited a number of major events in recent months that affect firefighters, including mass shootings, hurricanes, and wildfires.

“With all of these events, what we have found is that what we are missing are clinicians that really understand the culture in some aspects,” Morrison said. “I talk to many firefighters who said they went to seek help but the individual they were taking to was more Continued on Page 9

Vaping: More than just blowing smoke

By Phyllis Hanlon n 2015, the Centers for Disease Control and Prevention (CDC) conducted a National Youth Tobacco Survey and found that 2.39 million teens are “vaping” (i.e., using an electronic smoking device).

As this trend continues to grow, parents, schools and health professionals struggle with ways to effectively address the problem.

William T. Mautz, Ph.D, of Children’s Neuropsychological Services in Andover, Arlington and Newton, Massachusetts and Exeter, New Hampshire, indicated that his practice treats a large teen population from both public and independent schools and the problem of vaping cuts across all settings.

He explained that teens don’t recognize the dangers involved with this practice but are drawn to vaping after watching social media videos of their friends. “When kids

see a friend take a “hit” on Instagram, it piques their interest,” he said.

While these electronic devices were originally mar-

keted to adults seeking to stop using combustible tobacco, the design from companies like Juul attracts the teen set.

Colorful and available in

flavors such as gummy bears, watermelon and tutti frutti, the device resembles a flash drive or a pen that can easily be hidden in a pocket or

between the fingers.

“It’s very easy to take a hit discreetly,” said Mautz.

More troubling is the fact Continued on Page 9

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New England Psychologist

June 2018

Legislation to prohibit conversion therapy is pending

By Eileen Weber welve states have banned conversion therapy in minors with Hawaii added to the list this past April. California, the first state to pass a law in 2012, is working to take it a step further and make advertisements of conversion therapy akin to consumer fraud.

Fourteen other states have pending legislation while another five have passed at least one chamber of their Congressional districts. Massachusetts hopes to join their ranks.

For the Bay State, the bill for a ban on conversion therapy has overwhelming favorability. Brought forward

by Senator Mark Montigny (D-Second Bristol and Plymouth) and Representative Kay Khan (D-Middlesex), it seeks to prohibit licensed health providers from abusive or harmful practices to change sexual orientation and gender identity in individuals under the age of 18.

Currently pending before the House Committee on

Ways and Means, it will only target health professionals and not unlicensed pastoral counselors.

“This bill does not apply to religious or faith-based counselors that engage in conversion therapy efforts, so the legislation will not impact those practitioners,” said Khan. “But, I do hope it shines a light on how ineffective and harmful those practices are for minors.”

According to a recent report from UCLA’s Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy, nearly 700,000 LGBTQ adults have received conversion therapy.

About 20,000 teenagers will undergo conversion therapy before they turn 18. Another 57,000 will go through the practice with a religious or spiritual adviser.

As is often the case, conversion therapy takes place with a youth minister or spiritual leader. But the law cannot interfere with religious organizations.

Conversion therapy, however, has shown little evidence of

success. Self-denial of sexual feelings may result from it, but true sexual orientation change does not take place. Despite condemnation by a number of mental health professionals and associations including the American Psychiatric Associa-

harmful practices by state licensed mental health providers, while protecting First Amendment liberties including freedom of speech,” she said.

“And numerous rulings at the state and federal level

“I do hope it shines a light on how ineffective and harmful those practices are for minors.”

Rep. Kay Khan

tion, it remains a legal practice in 38 states.

With the Massachusetts bill, some have expressed concern that it infringes on the First Amendment. As Khan points out, this law specifically targets conduct, not free speech.

“This bill ensures professional conduct that protects minors from being exposed to fraudulent, ineffective and

illustrate the ways in which legislation such as this does not infringe on First Amendment rights.”

Ben Klein, senior legal counsel at GLAD in Boston, agreed with Khan that in the details of this law, free speech is not compromised.

“It’s a red herring of an argument,” he said. “The law does not prohibit free speech. It’s about conduct. They can say

anything they want. But they can’t do any actions to change someone’s sexual orientation.”

Klein went on to say there are certain baseline issues on equality that should be put into law. When tactics for conversion include everything from shaming to physical harm, even one individual experiencing this kind of practice is one too many.

In passing this kind of legislation, there is nothing more powerful in his estimation than a state taking a stand to say this is not okay.

What about those groups who oppose a ban on conversion therapy?

“To date, the efforts of antiLGBTQ activists to sue and overturn legislation banning conversion therapy on minors in California and New Jersey have failed, as two federal appellate courts have upheld the constitutionality of both bills,” said Rep. Khan.

“Case law and the federal courts rulings affirm the state’s well-established power to regulate healthcare and legislate for the welfare of children.” n

Bill raises issue of licensing art therapists

By Catherine Robertson Souter oining a short list of states who have licensing in place, the state of New Hampshire should soon pass a bill that will provide regulation for those who practice art therapy.

Introduced by Senator David Watters, D-District 4, a bill requiring licensing for the profession was passed by the Senate earlier this year.

After the 400-member House rejected the bill as written, a compromise bill was passed by the Committee of Conference that will require anyone engaged in the practice of professional art therapy or using the title of professional art therapist to have a master’s or doctoral degree in the field.

The bill will allow others to use art therapy within the scope of practice, however.

“I think that this is a huge step forward,” said Watters.

“It is important because it establishes a statute that recognizes the profession. I’m

sure that I will be introducing a full licensing bill again in the next session.”

Watters explained that new licensing procedures can be an uphill battle in New Hampshire. Still, he felt that the positive feedback he has heard on the proposal is a sign that the licensing requirement will be enacted in the future.

“It is difficult to get new licensing in this state,” said Watters. “There is a kind of anti-regulation aspect to it for certain folks. But we had a good hearing in the Senate with art therapists who came and spoke about their business and were very persuasive.

I do think we will be able to pass it next time around.”

A profession that has long been on the outskirts of mental health care, creative art therapy has begun to come into its own recently as an alternative therapy some hope will help in the fight against the opioid crisis.

Second Lady Karen Pence, who is a former art teacher, introduced an art therapy initiative to use her position to

increase awareness of the profession. Pence has been on the board of an art therapy program that works with children with cancer in the Washington, D.C., area since 2011.

Serena Duckrow Fonda

I have been doing this, I have seen a lot of people doing ‘art therapy’ who are not art therapists. If people are working in a mental health field without the training, they can really hurt people.”

“If people are working in a mental health field without the training, they can really hurt people.”

Serena Duckrow Fonda, Ph.D., ATR-BCCS, NCC, art therapist, Sonatina Center, Dover, NH

Ph.D, ATR-BCCS, NCC, an art therapist at the Sonatina Center in Dover, NH, first spoke with Watters about the topic several years ago, explaining what an art therapist is and why there is a need for licensing.

“It is an important protection for both the profession and for the people we support,” she said.

“Over the past 10 years that

Art therapy requires, at minimum, a master’s level education along with clinical supervision.

Six states currently require licensing for art therapists with another five that regulate art therapy under other professional licensing according to the American Art Therapy Association (AATA).

“It is a regulated profession and equal in training to

any master’s level clinician,” said Duckrow Fonda. “There is still a sense of ‘what is art therapy’ and there are professionals using art therapy techniques who really need to be referring patients out to art therapists.”

The move to provide licensing for art therapists has been growing across the country.

“At the national level, we are promoting licensure in each of the states,” said Cynthia Woodruff, executive director of the American Art Therapy Association.

“But we realize that the journey is never linear. We take steps forward and then something will stop the process. But the message is clear, America has woken up to the need for mental health care in the last few years and the more that happens, the more the need for art therapy comes to the forefront.”

The bill will be voted on by the full House and Senate and then, if it passes, put on NH Governor Chris Sununu’s desk to be signed into law. n

June 2018

Vaping Continued from Page 7 that some teens are putting marijuana into the electronic device to achieve a “super high,” according to Mautz.

These teens believe they are getting a “clean high,” i.e., a huge buzz that still allows them to function.

In the past, ads that explicitly showed the dangers of tobacco smoking helped to raise awareness of the dangers. But nowadays, there are no super athletes or rock stars talking about the dangers of vaping, Mautz noted.

However, schools have been aware and on top of the issue for the last two or three years. School districts are implementing regulations and imposing penalties for students who are caught vaping, Mautz said.

Nicholas Chadi, M.D., pediatrician specializing in Adolescent Medicine, and first and only Pediatric Addictions Fellow in North America, is currently involved in the Adolescent Substance Use and Addiction Program (ASAP) at Boston Children’s Hospital. He reported that vaping negatively has serious physical consequences.

New England Psychologist In the past two months, leading pediatric journals have published two studies that show e-cigarettes contain multiple cancer-causing substance and heavy metals that scar the lungs, according to Chadi.

Chadi has noticed that some teens are using e-cigarettes so much that they are experiencing withdrawal symptoms. He pointed out that the Juul pods contain nicotine equivalent to a whole pack of cigarettes.

“Some kids go through up to four pods a day,” he added.

While marketing for these products has been aggressive, having an equally robust education movement is necessary to enlighten public health providers and schools about the risks, Chadi said.

Psychologists with young patients addicted to vaping might want to offer counseling or refer them to specific addiction programs, Chadi suggested.

He noted that pediatricians support the use of nicotine replacement therapy such as lozenges or patches to help the teen cut down or quit. These options have been determined safe for use in adolescents, although there is limited data on how effective they are in this patient population. n

Firefighter mental health issues Continued from Page 7 interested in what the event was than what they needed for the help. They didn’t understand the firefighter culture.”

The IAFF is looking at ways to reach out to associations for behavioral health clinicians, and promoting increased training for clinicians, such as through online programs or

ride-alongs.

“It is very difficult to get clinical people that really understand the PTSD/ first-responder issues that we have,” Morrison said. “I think it is a responsibility for employee assistant programs to develop that, build that cadre of clinicians, and then have those outside resources.” n

ut heck o

C

Four tips Continued from Page 6 because we are paying attention on purpose, and if we’re any good at what we do, we’re doing so with an open mind and non-judgmental stance.

When you’re truly listening in an active way, there is so much to engage with that you may find it easier to stay in the moment. There is an incredible amount of information to take in at any given time— body language, facial expression, affect, and of course, the words that are being said.

If you focus on gathering as much data as possible, you’ll likely be so busy in the present moment that your mind won’t have time to wander.

Pay attention to what’s coming up inside you as you listen.

If listening actively to what the client is expressing isn’t quite enough to keep you engaged (and I’d suggest that if it’s not, you might be doing it wrong), you can turn your attention in on what’s happening inside of you as you listen to what is being shared.

Are you connecting with what the patient is saying on an emotional level? Do you feel it anywhere in your body?

Do you notice any urges to lean in closer or pull away?

All of this information is present moment material that you can use to stay anchored in the moment.

If it’s too distracting to focus on everything that’s happening for you as you listen, try choosing just one thing to focus on. The breath and bodily sensations are two good options.

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MOVING?

9 Practice meditation.

A regular meditation practice can look many different ways and is one of the best things you can do to foster the skills to stay present in your work and daily life. There are many guided meditations available for free online that can help you get started if you’re not sure where to begin.

You can also join a meditation group in your community, or try another mindfulness-based practice, like yoga or qigong. You might even try simply pausing for a minute or two each day and focusing on the breath.

All of these are examples of practices that will foster your ability to focus and stay present in the moment with clients, and you’ll likely experience benefits in your personal relationships and daily activities as well.

Relax.

If you do practice meditation, you may be familiar with the idea that not only is it okay for your mind to wander, it’s actually a natural and normal part of being human that is unavoidable for the vast majority of us — even seasoned meditators.

With brains that are constantly generating thoughts, it’s a noble undertaking to strive to be present for even the majority of the time. So, go easy on yourself and aim to be present as often as you can rather than constantly.

If the mind wanders, bring it back to the moment and if you notice judgmental or selfcritical thoughts coming up, let them pass through without attaching meaning to them.

Remember: you are a human with a human brain doing the best you can. n

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New England Psychologist

June 2018

Revenue to focus on increasing inpatient capacity in Vermont

By Pamela Berard he Green Mountain Care Board (GMCB) gave the go-ahead for the University of Vermont (UVM) Health Network to move forward on a project that would use the Network’s extra revenue from 2017 to increase inpatient mental health capacity in Vermont.

The GMCB, established by the Vermont Legislature in 2011, is charged with reducing the rate of health care cost growth in Vermont while ensuring the state maintains a high-quality, accessible health care system.

Vermont’s hospital budgets are regulated by the GMCB. When health care facilities exceed allowable budgeted net patient revenues, they are subject to review and possible regulatory action, which could include the care board ordering a reduction in rates that hospitals charge for their services.

Or, the Board can approve use of funds for other specific purposes, such as the UVM Health Network’s plan to increase inpatient mental health capacity. UVM Health Network must regularly

report details and updates of its project to the GMCB and is accountable to the board.

Specifics of the plan are still being discussed, but the proposal includes building a new inpatient facility on the Central Vermont Medical Center (CVMC) campus in Berlin (CVMC is one of the hospitals in the UVM Health Network).

The number of beds had not yet been determined as of mid-May, according to Robert Pierattini, M.D., chairman of psychiatry at the UVM College of Medicine.

One of the issues additional inpatient capacity aims to address is alleviating the length of time Vermont residents are waiting in hospital emergency departments for behavioral health treatment, while they wait for an inpatient psychiatric bed.

“We’re seeing a rise in the number of people presenting to the emergency department with a mental health crisis,” Pierattini said. “It’s very noticeable with children and adolescents. Children presenting to the emergency department used to be relatively uncommon and now it’s quite common.”

“The goal is to have the

Pro Bono work matters

By Marie HartwellWalker, Ed.D arketing is rarely talked about in graduate school. But success in building a private practice means developing skills in self-promotion, something that doesn’t come naturally to many of the people who feel called to do human-service work.

For many, trumpeting that we are the best is odious. But doing good work feels congruent with who we are. Pro bono work can be a comfort-

able way to both do good and introduce ourselves to our community as someone who is a good therapist.

Even more importantly, pro bono work gets us out of our offices and into our communities. When working hour to hour with one person after another, our perspective about what goes on out there can get skewed.

Offering our services to local organizations increases our understanding of the very real community problems that are impacting our clients.

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beds available for use in threeto-four years which is a very aggressive timeframe, but we have an emergency in the state because we have so many people waiting in Emergency

a new facility for inpatient psychiatric beds as part of CVMC, Pierattini said the proposal also recommended that the Vermont Psychiatric Care Hospital (VPCH) in Berlin be

“Children presenting to the emergency department used to be relatively uncommon and now it’s quite common.”

Robert Pierattini, M.D., chairman of psychiatry, UVM College of Medicine

Departments on medical surgical units, or at home in the community, or in residential care,” Pierattini said.

“There are so many people waiting for inpatient care who can’t get it.”

The UVM Health Network is collaborating with state agencies and community stakeholders on the project, with one of the initial steps to include calculation of the number of beds that are needed.

In addition to building

converted to a 16-bed secure residential program.

VPCH is state-run, and would remain state-run under the plan, Pierattini said.

VPCH is currently 25 beds.

Federal regulations prohibit Medicaid money from paying for services for adults 18-64 at standalone Institutions for Mental Disease (IMD), which are defined as facilities with more than 16 beds.

Vermont has had a waiver that allowed Medicaid to pay for stand-alone patient ser-

Volunteer vs. Pro Bono Although any kind of volunteer work is helpful for meeting some unmet need in your community, pro bono work is different. Volunteering is any activity where we lend our energy and heart to a community activity without expecting compensation.

Pro bono work, however, is giving away your professional services for free. Your training and experience are invaluable assets to an organization that can’t afford to hire you, even if they desperately need the help.

In addition to the very real personal benefit that comes with doing good for something you believe in, pro bono work also helps you develop professional relationships with people who may become referral sources – and who you may want to refer your clients to someday. When people get to know each other and like each other, they are more likely to call on each other for help.

Your business plan when developing a private practice should include carving out time to do pro bono work.

One caution: Do make sure your professional liability insurance covers work you offer.

Consider These Options Boards of Directors: Follow your own interests. Nonprofit organizations often need professionals to serve on their boards. This service usually involves a monthly meeting, serving on a committee and helping with fund raising.

Consider local services that are congruent with the work of your practice. The board of such programs as a women’s abuse prevention program, a homeless shelter, a half-way house for people in recovery, a home for pregnant teens, or a community charitable funding organization often needs the input of a mental health professional.

Day Care Centers: Small centers are often low budget.

They can’t afford a professional consultant – even when they may need one. Offer, say, an hour per month of consultation to help the staff determine how best to help a child or family when a child is hav-

vices at such psychiatric facilities (see related story), including at the VPCH. However, Vermont’s exclusion to this regulation will be phased out starting in a few years, over the course of about a five-year period.

Facilities that offer multiple types of services, such as general services hospitals, can receive Medicaid funding for psychiatric care as long as less than half of the total number of beds are used for mental health treatment.

Central Vermont Medical Center is a general services hospital licensed for 122 beds, according to its website. By integrating the proposed new psychiatric inpatient unit with a general hospital, “participation for federal Medicaid in that case is allowed to continue, as long as the acute psychiatry beds are a minority of the (total) beds for that hospital,” Pierattini said.

“For that reason, we recommend that this new facility be operated under the license of a general medical hospital and we’re recommending CVMC because it’s centrally located and easily accessible from all over the state.” n

ing adjustment problems or is behaviorally challenging.

A friend of mine has been doing this option for years.

She is clear with both the center and the families that she is not offering therapy. She is providing some parent education to parents and some basic behavior management skills to the staff.

Veterans’ Organizations: Many veterans need more support than local services can provide. Consider offering some free sessions or free workshops. The director can help you determine what would be most useful.

Parent-teacher organizations: The program committees for PTOs are often challenged to find interesting programs they can afford. If you have skills to share that would be useful to teachers and parents who are working to better understand each other and work with each other, consider offering at least a yearly talk or workshop.

I’ve found that talks on discipline, homework issues, Continued on Page 12

June 2018

New England Psychologist

Private practice: Not for the faint of heart Continued from Page 1 versity’s Warren Alpert Medical School and did not initially plan to go into private practice.

He first worked with his father who had a group practice and then opened his own in 2006, where he enjoys flexibility in scheduling and the freedom to accept a certain type of client.

Gershon also finds that working for himself enables him to be creative in developing content and programming.

“I helped other psychologists create an early childhood assessment program,” he said.

Psychologists can expect a steep learning curve when opening a private practice, Gershon advised.

He suggested making a todo list that includes accounting and bookkeeping matters, insurance credentialing issues and appropriate staffing.

Networking is also an important component to consider. “You have to make sure your name is out there,” he said. Attending “meet and

greets” and other networking events can help private practitioners keep in touch with other industry professionals.

Early career psychologists might be better joining a group practice to learn the ropes before setting out on their own, Gershon suggested.

He noted that there are many aspects of private practice of which a new psychologist might be unaware.

He also strongly urged those who start a private practice to join their state psychological association, which can

11 offer support and mentoring.

Of all the challenges Paul W. Frehner, Psy.D, faced when he opened his private practice in Peterborough, New Hampshire, dependence on insurance companies was the biggest.

“Once you sign the contract, you can’t negotiate rates,” he said. For therapists who offer 60-minute sessions like Frehner, appropriate reimbursement can be difficult to obtain; most insurers only pay for 45-minute sessions.

Frehner is seriously concerned about the future of private practice because of insurance issues. The push toward

integrated care and insurance companies’ reluctance to work with private practitioners may herald the end of the solo practitioner, he speculated.

However, he anticipates significant pushback from clients to keep the private practice model alive.

Although owning a private practice might seem like a psychologist’s dream job, this career path holds both perks and pitfalls.

Frehner echoed Gershon’s suggestion that newer psychologists join a group practice to learn about processes and gain some experience before jumping into a solo practice. n

Vermont braces for loss of psychiatric bed Medicaid funding Continued from Page 1 Waterbury in 2011.

“It is an existential challenge for the Brattleboro Retreat,” Josephson said. “I don’t know how the state of Vermont would manage really without those beds at this point.”

Brattleboro Retreat has an annual budget of $70 million, and Medicaid dollars account for 70 percent of inpatient revenue, Josephson said.

The 16-bed IMD limit is a relic of the era of de-institutionalization when the federal government sought to prevent federal dollars from paying for the care of psychiatric patients in state mental hospitals.

“It was a very well-intended rule back in the day when we had large state-run mental hospitals that kept people for a very long time,” Josephson said. “We are not in that position anymore by any means.”

The average stay for adults at Brattleboro Retreat, excluding the 14 beds under state contract, is 7.8 days, Josephson said.

The National Association for Behavioral Healthcare has long supported breaking down the IMD exclusion and is advocating for Medicaid funding to cover non-elderly adults with both psychiatric and substance use disorders, said its president and CEO Mark Covall.

He called the 16-bed limit arbitrary and inefficient, noting that a small facility has much higher costs per day than one with 30 or 40 or 50 beds.

He estimated the chances of Congress modifying the IMD

exclusion as “50/50.”

Hospitals “can’t just wait another year or two and hope something’s going to change,” Covall said, adding Vermont has to operate under the scenario that the waiver will end unless a new arrangement can be worked out with CMS. “We do believe that there’s tremendous progress and bipartisan support for fundamental change to the IMD exclusion,” Covall said, “but you’re never able to make any kind of estimate about when that would occur in Washington.”

In the meantime, Vermont officials are pursuing solutions to address the urgent need to increase bed capacity in its mental health system.

In April, the Green Mountain Care Board, which regulates hospitals, ruled that the Uni-

N

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versity of Vermont (UVM) Medical Center should pursue using surplus fiscal 2017 revenue to increase bed capacity.

Brattleboro Retreat to create an additional 12 acute care state hospital beds. Josephson said those beds should come

“I don’t know how the state of Vermont would manage really without those beds at this point.”

Brattleboro Retreat President and CEO Louis Josephson, Ph.D.

“The waiver expiration is high on everyone’s minds and the state is working hard to address that,” said board member Jessica Holmes, Ph.D. The Vermont Legislature passed a capital bill that included $5.5 million for

online around September 2019 to help reduce the pressure on hospital emergency rooms.

However, Brattleboro Retreat has asked for a Medicaid rate increase because rates have been “basically flat for

the last eight years,” Josephson said.

“We’ve told the state of Vermont that frankly they can give us the capital money, but we’re going to have a nice, shiny new unit without any staff because we’re not able to compete in the marketplace for nurses and others that we need.”

Bailey said planning for how the state will reduce bed capacity at VPCH and Brattleboro Retreat or tap its general fund to offset the loss of federal participation dollars is “a work in progress.”

A plan is due to be filed with CMS by the end of the calendar year.

“There are a few other creative ideas but...they’re not well thought through or vetted yet so I wouldn’t want to share them,” Bailey said. n

Subscription/Change of Address Form

Psychologists licensed to practice in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont automatically receive a free subscription to New England Psychologist. If you are licensed in a New England state and do not receive the publication, please mail or email (addresschange@nepsy.com) a copy of your license to us with the address you want the paper to be mailed to. Paid subscriptions for other professionals or agencies may be purchased by sending a subscription form with a check for $60 to: New England Psychologist, Subscriptions, P.O. Box 5464, Bradford, MA 01835 Please send me a subscription to New England Psychologist. 1 year — $60. Prepayment required.

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New England Psychologist

June 2018

Education about grief can help veteran patients

By Bret Moore, Ph.D. attling loss and grief are normal after suffering a difficult life event.

Whether you have a veteran patient who has lost a loved one to illness or an accident, had his or her sense of safety and security stolen from them after being nearly killed in combat, involuntarily separated from service, or were left feeling vulnerable, worthless, and lonely after a breakup or divorce, it will take time for them to heal.

Feeling depressed and anxious, having problems with sleep and appetite, and feeling angry, resentful, and numb are to be expected in our veteran patients who experience significant loss. It doesn’t mean they are crazy.

And, it is important for us as clinicians to constantly remind them of this fact. Fortunately, for the vast majority of veterans, these problems are time-limited. They will

“bounce back” in most cases, but education about grief can hasten their return to baseline.

As a clinician, it is important to remind your patient that healing takes time. In spite of what the old saying claims, time does not necessarily heal all wounds … but it usually does help.

Educate your patients about the importance of not rushing through the grieving process.

Help them accept the fact that their lives have changed while also remembering that growth can come with change.

Encourage your patients to rely on those who care about them and whom they trust.

Few things in life are done well in isolation. This is particularly true for overcoming emotional struggle.

The collective compassion and wisdom of your client’s immediate social support system can be immense, but he or she must first ask for it and accept help when it is provided.

Make sure your veteran client understands that he or she needs to mourn. Grief can produce a profound sense of emptiness and despair. To overcome these feelings, a person needs to mourn the loss.

In contemporary American culture, this practice is often overlooked. We tend to encourage people to “suck it up,” “move on,” and “think about other things” as strategies for overcoming loss.

This attitude is particularly true in American military culture. Unfortunately, these techniques generally are seen as uncompassionate and nothing more than platitudes.

Encourage your patient to actively mourn the death of a loved one through a wake, a funeral, or a memorial service.

These formal activities allow the individual to remember his or her loved one and start the process of letting go.

The activity does not have to be large, grand, or even shared with other people. All

that is needed is the opportunity to say goodbye in a ritualistic form, a process that is helpful for many different people. This practice is particularly true for those with more religious and spiritual connections.

For someone who has recently divorced, an act of mourning could be donating to charity anything that an ex chose to leave behind. Or, it could consist of burying, burning, or giving away pictures and other visual reminders of the relationship.

A person who narrowly escaped death from combat or suffered sexual assault may hold a “funeral” mourning the loss of his or her previous sense of safety and security while also celebrating the promise for creating a more realistic, yet optimistic view of life.

An activity I’ve found helpful when working with people who are struggling in the aftermath of trauma is to ask

them to become the professional. The ability to look outward and to focus on providing support, guidance, and advice to others is a great way to temporarily separate yourself from distress.

In essence, you are asking your client to become the therapist and role play how he or she would like to be comforted and supported. The use of the “empty chair” technique may be beneficial.

Losing something or someone important to us is a harsh reality that we all must face at some point. And like any service member (or civilian) knows, being prepared is the key to moving through the smoke swiftly and safely.

Our job as clinicians is to help them navigate the process more fully, openly, and efficiently. *A previous version of this article was published in Dr. Moore’s column Kevlar for the Mind, which is published in Military Times. n

Pro Bono work

ences was providing a workshop for young people who were in training to be beauticians. Although the local trade school was operating on a shoe string, the director understood that beauticians are often engaged in very difficult conversations with their clients.

Our workshop focused on listening skills and when and how to gracefully end the conversation and refer someone to a professional.

Disaster Relief: The Disaster Response Network (DRN) is a collaborative effort between the Red Cross and the APA. It deploys psychologists to help a community after crises like a hurricane disaster, massive fire or a school shooting.

Contact the psychological association in your state to learn how to sign up. You will do an important service and you will meet other professionals who may later become references when you apply for grants or other opportunities.

There is enormous personal satisfaction in doing pro bono work in our communities. A bonus is that you will meet people you probably would not have otherwise met and you will develop a place for yourself in the professional network in your community. n

Continued from Page 10

Week News ly lette

r

Want weekly clinical news and updates about everything happening in the field of psychology? www.eepurl.com/gfdTL

Delivered once a week straight to your inbox!

concerns about social media and conflict resolution are popular topics.

Schools: The professionals in some schools are stretched thin by the demands on their time. Consider offering some free evaluations and consultations to supplement existing services. Offer to facilitate a specialized group for kids who need it.

One therapist I know offers a group for sibs of kids with special needs. Other possibilities are a social skills group for children who are struggling with peer relationship or a coping skills group for kids with ADHD. Ask the director of student services what would be most helpful. Running such groups is an effective way to expand the services a school can offer and to get to know school personnel.

Trade Schools: Local trade schools may be delighted to receive an offer for a free workshop. Think about other service providers who are often called upon to give advice but who are ill-prepared to do so, like beauticians, bar tenders, massage therapists or personal trainers.

One of my favorite experi-

June 2018

June June 1: Master Series in Clinical PracticeErotic Transferences: What Countertransferences Can Illuminate.

Newton, MA. 9-4:30pm, $225, 6 CEs. Addresses deficiencies in our literature to encourage more open discussion about erotic transferences in all of their manifestations. Sponsored by William James College. Contact www.williamjames.edu/ce or 617-244-1682.

June 1-2: High Conflict Divorce: Legal Context and Family Work with Parent Child Relationship Problems. Watertown MA. 9-4:45pm, $320, 12 CEs. Two day workshop will address the significant dilemmas of working with children, adolescents and adults caught up in the drama of high conflict divorce. It will provide information and strategies to help individual and family therapists meet the challenges to support healthier relationships among all involved.

Sponsored by Therapy Training Boston. Contact 617-9249255.

June 8: Master Series in Clinical Practice-Developmental Issues Throughout the Life Cycle for Same Sex Oriented Individuals and Couples.

Newton, MA. 9-4:30 pm, $225, 6 CEs. Sponsored by William James College. Contact www. williamjames.edu/ce or 617244-1682.

June 8: Insurance Trust Program: Sequence VIII: Ethics and Risk Management in a Digital World 2.0. War-

New England Psychologist

wick, RI. 8:30-4:30pm, $195, 6.5 CEs. This workshop is a next-generation discussion of digital world issues, providing a review and update on the ethical, legal, and risk management dimensions of technology. Sponsored by the Rhode Island Psychological Association. Contact 401-732-2400.

June 8: Using Brief Standardized Measures in Clinical Practice: The Why, What and How of Routine Screening. Wallingford, CT, 8:45-4:30 pm, Lunch is included. $99 for CPA members, $119 for nonmembers. 6 CE credits including 1 CE that fulfills the military/veteran CE requirement.

Learn the nuts and bolts of measurement-based care and how to access free measures.

Sponsored by the Connecticut Psychological Association.

Contact: 860-404-0333

June 14: Surviving and Thriving in ‘Blended Families’: Clinical Skills for Individual, Couple and Family Therapists. Newton, MA. $240, 6 CEs. Workshop by Patricia L. Papernow, Ed.D. Sponsored

by William James College.

Contact www.williamjames. edu/ce or 617-244-1682.

June 15: Master Series in Clinical Practice-The Healing Power of the Therapist’s Presence: Holding Self-energy even with Triggering Clients. Newton, MA. 9-4:30 pm, $225, 6 CEs. Sponsored by William James College. Contact www.williamjames.edu/ce or 617-244-1682.

June 15-16: Meeting the Challenges of ‘Blended

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

Family’ Relationships: Offering Family Life Education for Stepfamilies as Primary Prevention. Newton, MA. $400, 12 CEs. Workshop by Fracesca Adler-Baeder, Ph.D. Lunch included on Saturday.

Sponsored by William James College. Contact www.williamjames.edu/ce or 617-2441682.

June 18-22: Advancing Inclusion: Turning Us and Them into We. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Deborah Plummer. Sponsored by the Cape Cod Institute.

Learn more at: www.cape.org

June 18-22: Bouncing Back: The Neuroscience of Coping with Disappointment, Difficulty, even Disaster. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Linda Graham.

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

June 22: Master Series in Clinical Practice-A Heart Shattered and the Unlived Life. Newton, MA. 9-4:30 pm, $225, 6 CEs. Sponsored by

13

William James College. Contact www.williamjames.edu/ce or 617-244-1682.

England Education Institute.

Contact 413-499-1489 ext.1 or www.neei.org.

June 25-29: New Frontiers in Mindfulness and Psychotherapy: A Retreat for the Heart and Mind with Ronald Siegel. Eastham, MA. $599, 15 CEs. In addition to exploring new frontiers in the clinical application of mindfulness practices, this workshop will provide guided instruction in different techniques along with the opportunity for personal exploration in a supportive atmosphere. Sponsored by New

June 25-29: Becoming a Master Clinician: Diagnosis, Drugs and Existential Psychotherapy with S. Nassir Haemi. Eastham, MA. $599, 15 CEs. Participants will learn advanced clinical approaches to diagnosing and differentiating clinical presentations of anxiety, depression, bipolar, and personality disorders using existential/humanistic methods of psychotherapy. Sponsored

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.

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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

by New England Education Institute. Contact 413-499-1489 ext.1 or www.neei.org.

June 25-29: Human Connections–Resonant Relationships at Work and Home: Five Conversations that Will Heal the World. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop

by Fran Johnston. Sponsored by the Cape Cod Institute.

Learn more at: www.cape.org

June 25-29: Healing Sleep and Dreams. Nauset Regional High School, Eastham. $675, 15 CEs. Workshop by Rubin Naiman. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

June 25-29: Sanctuary: Reigniting the Servant Soul.

Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Gloria Burgess. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

June 29: Master Series in Clinical Practice-Assessment and Effective Treatment of Alcoholand Substance Use Disorders.

Newton, MA. 9-4:30 pm, $225, 6 CEs. Sponsored by William James College. Contact www. williamjames.edu/ce or 617244-1682.

July July 2-6: The Anxiety Epidemic in Kids and Teens: A Workshop for Clinicians.

Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Paul Foxman. Sponsored by the

Cape Cod Institute. Learn more at: www.cape.org

July 2-6: A Clinical Introduction to Imago Relationship Therapy: Bringing Couples from Rupture to Connection.

Nauset Regional High School, Eastham, MA. $675, 15 CEs. Nauset Regional High School, Eastham, MA. 15 CEs. Workshop by Carol Kramer. Sponsored by the Cape Cod Institute. Learn more at: www.cape. org

July 2-6: The Emotionally Mindful Therapist: Using Your Emotions to Help Yourself and Others. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop

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

July 2-6: Resilience Across the Lifespan: StrengthBased Strategies To Nurture Balance, Self-Discipline, and Hope in Ourselves and Others with Robert Brooks. Eastham, MA. $599, 15 CEs. Symposium participants will learn: techniques for enhancing empathy and our own stress hardiness; the components of motivation and a resilient mindset; and how to promote change in oneself and others. Sponsored

by New England Education Institute. Contact 413-499-1489 ext.1 or www.neei.org.

July 2-6: Clinical Psychopharmacology: Overview and Recent Advances with Ross Baldessarini. Eastham, MA. $599, 15 CEs. Workshop will review the current status of psychotropic drug treatment of psychotic and major mood disorders, with an emphasis on the research base on which

sound clinical practice rests.

Sponsored by New England Education Institute. Contact 413-499-1489 ext.1 or www. neei.org.

July 9-13: Emotionally Focused Therapy: Cracking the Code of Love in Couples and Families. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by George Faller. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

July 9-13: The Optimal Future Self: Overcoming Blocks, Accessing Possibilities. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Nancy Napier. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

July 9-13: Harnessing the Transformative Power of Mindful ACT Therapy. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by John Forsyth & Jamie Forsyth. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

July 16-20: Frontiers of Trauma Treatment. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Bessel van der Kolk.

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

July 16-20: Polyvagal Theory in Therapy: Practical Applications for Treating Trauma. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Deb Dana. Sponsored by the Cape

June 2018 Cod Institute. Learn more at: www.cape.org

July 16-20: Assessment and Intervention for Child and Adolescent Executive Function Difficulties. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop

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

July 17-18: Trauma and the Internal Family Systems Model: Releasing Personal and Legacy Burdens. Auburndale, MA. 9-4:45 pm, $370, 12 CEs. This presentation by the founder of the model will provide a brief introduction to the basics of the IFS Model followed by demonstrations of its use with attachment problems and trauma, including intergenerational and cultural burdens.

Sponsored by Therapy Training Boston. Contact 617-9249255.

July 23-27: Who Do We Choose To Be? Facing Reality, Claiming Leadership, Restoring Sanity. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop

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

July 23-27: Trauma Competency: Neuroscience, Diagnosis, and Best Practices for Successful Treatment.

Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Linda Curran. Sponsored by the Cape Cod Institute.

Learn more at: www.cape.org

July 23-27: Internal Family Systems Workshop. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Richard Schwartz.

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

July 30-Aug. 3: Treating Complex Trauma: Optimal Integration of Treatment Models. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Deborah Korn. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org

July 30-Aug. 3: Working with Mindfulness: Practices and Perspectives for Individuals and Organizations. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Mirabai Bush.

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

July 30-Aug. 3: The Nuts and Bolts of AEDP: Translating Theory into Clinical Practice. Nauset Regional High School, Eastham, MA. $675, 15 CEs. Workshop by Natasha Prenn & Molly Eldridge. Sponsored by the Cape Cod Institute. Learn more at: www.cape.org n

For

comprehensive

CE listings check out

June 2018

New England Psychologist

r e b o t c g in O

Comin

Selling out a conference just got easier

will publish the 26th annual Residential School Directory advertising@nepsy.com

ACTON: Full/Part-time rental in attractive professional office suite. Collaborative private practice with established referral base. Contact 978 263 3677 or ingermaier@comcast. net BOSTON: Interior office in beautiful Newbury St. suite (near Arlington T stop). Partor full-time $11/hour (16+ hours/week). Contact bradspickardphd@gmail.com BOSTON: Back Bay. Full-time (unfurnished) and part-time (furnished) offices available as of April in newly constructed office suite in beautiful Back Bay building, halfblock from Public Garden.

Amazing views of Boston.

Shared waiting area, bathroom and kitchenette. Many referrals available in collegial community of private practitioners. Private practice start-up and expansion consultation available. Assisting with billing-related administrative work also available as (completely optional) add-on service. Part-time sublets may be available as well. Contact 617-230-3002 or backbayalliance@gmail.com

HARVARD SQUARE (CAMBRIDGE): Furnished part-time psychotherapy office sublet in Victorian house available September 1st.

Shared waiting area/bathrooms/kitchen with great community of clinicians.

Referral opportunities & private practice start-up assistance available. $176/month per 4-hour/week block.

te: s!

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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?

Classifieds Office Space

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

Contact harvardsquarealliance@gmail. com or 617-230-3002.

Please check out all of the help wanted ads on Psych Central Professional: https://pro.psychcentral.com/jobs

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.

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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.

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New England Psychologist

June 2018

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