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AN INDEPENDENT VOICE FOR THE REGION’S PSYCHOLOGISTS

VOL. 26, NO. 4

Psychologists weigh benefits, challenges of Should states bring back asylums? working in inpatient hospital settings

By Phyllis Hanlon sychologists today have opportunities to pursue several different professional career paths. New England Psychologist spoke to psychologists who practice in inpatient settings and found that this venue offers both rewards and challenges.

Before retiring, Robert J. Kamman, Ph.D, of Raymond, Maine, spent 32 years working at the Buffalo Psychiatric Center in New York, where he conducted initial screenings on every admission and determined the necessity for assessments.

His responsibilities also included administering tests, running group therapy sessions, collaborating with the art and music therapist, occasionally treating patients on an individual basis and frequently working with families.

David Prescott, Ph.D has held several positions at Acadia Hospital over the years.

In spite of these challenges, he would encourage early stage psychologists to consider inpatient work for this underserved population.

Kamman emphasized the importance though of finding a supportive supervisor and

“If psychiatrists support psychologists, life is good.”

David Prescott, Ph.D, consultant, inpatient department, Acadia Hospital Throughout his career, the hospital provided a collegial setting and enabled Kamman to serve as mentor and supervisor to interns.

Inpatient work also served as a learning experience as he was invited to take part in grand rounds and seminars. “I also had the freedom to take a position as an adjunct faculty and maintain a small private practice,” Kamman said.

Although Kamman would follow the same career path given the chance, he pointed out that by the time he retired, the hospital environment had become more restrictive, governed by federal mandates and managed care.

engaging in activities outside the hospital to maintain your energy.

When David Prescott, Ph.D, moved from Indiana to Maine in 1994, his timing was perfect, career-wise; the state was building Acadia Hospital and he landed a job as director of the day treatment program.

Through the years, he has held a number of positions that involved inpatient and outpatient care and also worked in the quality and performance improvement departments.

To be effective in an inpatient setting, Prescott said that experience working with patients who have severe, persistent mental illness, such as

schizophrenia, bipolar disease, severe depression or a diagnosis on the autism spectrum, is very helpful. Experience and comfort conducting group therapy are also key qualities.

On a personal level, Prescott indicated that psychologists working in an inpatient setting must be comfortable “not being at the top of the hierarchy” as therapy has to be directed by physicians.

Moreover, good relationships between psychologists and psychiatrists are critical.

“If psychiatrists support psychologists, life is good,” he said.

However, Prescott pointed out that while hospitals are mandated to hire physicians, nurses, social workers and other professionals, they do not have to staff the facility with psychologists.

“The psychologist has an uphill battle of showing value in a hospital setting,” he said.

Working in an inpatient setting can be a valuable learning experience, according to Prescott. He explained that you have a chance to interact with smart, talented people who can teach you things you wouldn’t otherwise learn.

“You are exposed to other disciplines and can see new techniques in action,” he said.

The fast-pace, rewarding environment and opportunity to work with a multi-disciplinary team in a hospital setting drew Alysha Thompson, Ph.D, to inpatient work.

She is the attending psychologist in the Adolescent Inpatient Unit at Bradley Hospital in Providence, Rhode Island. Although patients are usually at their most acute state, the chance to manage and treat aggressive behavior, suicidal tendencies and other psychologically challenging behaviors can be professionally satisfying, she said.

At the same time, dealing Continued on Page 11

By Janine Weisman resident Donald Trump has acknowledged what once might have been done about the volatile behavior of the 19-year-old suspect before the Feb. 14 mass shooting at a Parkland, Florida high school that left 17 people dead: “In the old days,” Trump told state governors attending a meeting on gun safety at the White House on Feb. 26, “you would put him into a mental institution.”

The old days would have been 1953 when the number of state psychiatric hospital beds in the United States peaked at 559,000. That was before new antipsychotic medications and the rise of the civil rights movement led to a shift toward communitybased outpatient treatment for individuals previously considered lifelong hospital cases.

Today, there are only an estimated 40,000 state and county psychiatric hospital beds, according to a 2017 report by the National Association of State Mental Health Program Directors.

Deinstitutionalization emptied hospitals but ultimately filled prisons, jails, and the streets with people with serious mental illness when adequate funding for community mental health care never materialized.

Trump’s public comments mirror renewed interest in the role of mental institutions in American society, despite the

history of abuses like those portrayed in the classic film, “The Snake Pit.” Among those advocating for a rethinking of asylums is Dominic Sisti, Ph.D., an assistant professor in the Department of Medical Ethics & Health Policy at the University of Pennsylvania where he directs the Scattergood Program for Applied Ethics in Behavioral Health Care.

Sisti published a paper in JAMA in 2015 titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” arguing that “safe, modern and humane” psychiatric asylums make both financial and moral sense.

The original meaning of asylum was a place of refuge where people with mental illness could live and heal and receive humane treatment, Sisti said.

“The idea isn’t to rebuild Willowbrook or the awful snake pits that were in documentary films in the 1950s and ‘60s at all,” Sisti said in a recent phone interview. “It would be extraordinarily foolish for anyone to say we should go back to those places. They were not asylums. They were snake pits.”

Initial reaction to the paper was negative as people got hung up on the subtitle, Sisti said. Then he started hearing from others who were more favorable.

“People didn’t really read the paper. They saw screenshots and tweets and things Continued on Page 11

INSIDE

Brattleboro Retreat expands telepsychiatry services .............................Page 7 Vermont searches for solutions to increase bed capacity................................Page 8 CE listings.................................................Page 13

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May 2018

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3

Theory of ‘multiple intelligences,’ research on higher education at forefront of acclaimed psychologist’s career With the internet and media abuzz with discussions of college acceptances and concerns about how schools choose potential candidates, questions of what constitutes intelligence and potential for future success take center stage.

But, it’s a question that educators grapple with all year.

That question has defined the career of Howard Gardner, Ph.D, best known for his theory of “multiple intelligences,” a method of cataloging various strengths that may not correlate to traditional IQ tests and school grades.

With this theory, first published in 1983, Gardner posits that IQ tests are limited in identifying the breadth of types of intelligence. He identified several intellectual areas including linguistic, mathematical, and spacial intelligence along with athletic ability, emotional skills, selfknowledge, and artistic or musical ability.

Named one of the most influential psychologists in the world by The Best Schools for his work on multiple intelligences along with work on childhood development and the psychology of education, Gardner is currently the John H. and Elisabeth A. Hobbs Professor of Cognition and Education at the Harvard Graduate School of Education and an adjunct professor of psychology at Harvard University.

Gardner recently spoke with New England Psychologist’s Catherine Robertson Souter about his work, the recognition he has received, and his take on the current path of higher education.

You have won numerous awards, including a MacArthur Prize Fellowship, been awarded honorary degrees from 31 colleges and universities, been named to many lists, including one of most influential psychologists in the world, the second most influential education thinker in a 2018 (RHSU Edu-Scholar Public Influence Rankings), and one of

100 most influential public intellectuals in the world

by Foreign Policy and Prospect magazines.

Why do you think you have received so much attention throughout your career?

Certainly, my work on multiple intelligences is my principal claim to wider fame but it’s part of a much longer arc, dating back over the decades to my research and writings in developmental psychology, and extending to studies and books on creativity, leadership, changing minds, cognitive science, and even the “app generation.”

I like to move on to new topics, I enjoy writing, and I’m fortunate to have lived a lengthy life, with more opportunities and fewer obstacles than are afforded most people.

In a set of phrases, I am curious, like to research and write, and have had good luck.

lect), together created, if not a “perfect storm,” at least my proverbial “15 minutes of fame.”

In previous interviews, you have said that the idea of multiple intelligences has been in the public realm for a long time and it is not your idea. Tell us how it developed for you?

As you note, the idea that humans have various talents, and the idea that IQ (the psychologist’s operationalization of intelligence) is composed of various factors, are not new.

Over thirty-five years ago, I embarked on a study of human talents and abilities, surveyed many bodies of literature, ranging from anthropology to brain science, developed a set of criteria for what counts as a separate human capacity, and then somehow decided to call my research-based conclusions “multiple intelligences.”

This combination of contributions, put together in a 400-page book, emanating from a respectable institution, and that ‘old devil’ of timing (the intelligent reader was ready for a critique of the standard view of intel-

What should psychologists appreciate about multiple intelligences?

If we group together research psychologists and clinicians, there are two main take-aways from my work on intelligence.

First of all, do not assume that what is measured in IQ tests encompasses all of intellect. The IQ test is really a test of the ability to master work in certain kinds of schools.

The more one deviates from standard schooling, the less useful the IQ language and measures.

Secondly, it is very difficult to increase a person’s measured IQ and so IQ remains primarily a sorting mechanism – “she’s smart, he less so.”

In contrast, one’s various intelligences can be enhanced if they are valued by the surrounding culture, if they are well taught, and if the individual is motivated to improve.

You have also said that psychologists seemed less interested in the idea of multiple intelligences than educators. What did you mean?

Individuals trained in psychological research learn about the standard views of intelligence and the standard ways of measuring them. These trained psychologists are very reluctant to consider perspectives that are disruptive to what they have learned.

My experience has been similar to that of Robert Sternberg, who is much more of a “straight psychologist” than I am. Sternberg has garnered considerable empirical support for his “triarchic theory” of intelligence and yet mainstream psychologists continue to hover around the IQ test.

You are currently working on a project that aims to prove the value of liberal arts and sciences in higher education. Does it worry you that a Wisconsin school is talking about cutting liberal arts education to meet a budget deficit?

You are certainly right that I value the liberal arts and sciences. My colleagues and I have spent the last five years studying their implementation in 10 quite distinctive institutions.

One of the things that we’ve learned is that the phrase “liberal arts and sciences” is typically not understood and, when it is, it resonates only with a small proportion of the population. Indeed, people value exactly the same education less if the words ‘liberal arts’ are used! So, the label itself is not helpful.

Many people more eloquent than I am have made the case for an education in the liberal arts and sciences.

But if you want a society in which individuals can think complexly, communicate effectively in various languages and symbol systems, understand and support democratic institutions, and deal effectively with disruptive changes, you need to have a liberal arts and sciences education, whether or not you use that terminology.

Alas, in the U.S., public education used to be seen as a public good. It is now seen as a private good. That is inimical to all education which is not strictly vocational and all education that does not immediately yield high paying jobs.

By a public versus private good, do you mean that educating the individual used to be thought of as a way to lift the entire population versus helping that individual make more money?

Yes, you get the point. In a system in the vein of Thomas Jefferson or John Dewey, we think about

developing a broadly educated set of citizens, who appreciate democracy and work for the common good.

When I went to school in the 1950s, this was widely accepted, though some groups, notably blacks, were treated as marginal.

Nowadays, fewer and fewer Americans worry about “other people’s children.”

They/we focus on our own children to the exclusion of others. I don’t see how any country can long survive with so selfish an attitude.

As an education researcher, most of your work has been with elementary through high school ages but I understand that you have been starting to look at the college level more recently.

The bulk of my time over the last five years and going forward is devoted to making sense of the terrain of higher education in America. My partner in this work is Wendy Fischman.

One study is of professional ethics: what is happening to the professions, and how can we ensure that their practitioners act in an ethical way?

Colleagues and I have just launched another large study of quality secondary school education in this country and abroad.

All this work is carried out under the aegis of Harvard Project Zero, where I’ve had the privilege of working since its founding 50 years ago.

Not that you have not done enough already, but what are your goals for the future?

I am basically a book writer, but I have not published a single authored book since 2011 nor a coauthored book since 2013.

Emanating from the various projects just described will be several books — if my colleagues and I can find the time and energy to think them through systematically and write them effectively. n

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New England Psychologist

IN PERSON

May 2018

EDITORIAL

Submitted for your approval, a reunion in the Twilight Zone

By Alan Bodnar, Ph.D. ur son and his wife were flying to Tokyo and we had just taken them to Newark airport. They were starting a 14-hour flight that would take them 11,000 miles from home, by any measure an enormous distance.

I never suspected that a brief detour on our way back would take me even farther, not just to my childhood home but, through the corridors of memory, to the core of childhood itself.

Neither did I expect that, when I arrived, I would be drawn to the house of a friend who, at that very moment a thousand miles away, was trying to remember what it looked like.

It is a short distance from the Newark airport exit on the New Jersey Turnpike to the off ramp to the factory town where I grew up and, with time to spare, there was no reason not to visit.

When we arrived, the town seemed smaller, with blocky new buildings crowding what was left of familiar roads and structures. The route I used to walk from home to St. Joseph’s Grammar School was intact but altered in appearance by the changes in the houses, businesses, and public buildings that lined the streets.

When we got to the school, it looked pretty much the same though the playground had become a high-rise parking lot for a performing arts center scheduled to be completed in the fall on the site of the old Ritz theater.

After a brief stop at the church next to the school, we walked out into the sunshine of a crisp spring day to face a large house on an oversized lot where I once spent many happy hours with my friend, Jack.

A group of us boys would play basketball on the school playground and then grab a cool drink of water at Jack’s house. There we made big plans for our lives and the next day.

When we didn’t make our seventh-grade basketball team, it was Jack who came up with the idea of starting our own

team, getting Frank Brown’s Department Store to sponsor us, finding a coach and playing hard enough to win the league championship. And that’s exactly what happened.

As long as I can remember, Jack had a passion for art and, on Columbus Day of 1960, he and I took the bus to Newark where he bought his first supply of professional art materials. The day stands out in my memory because, on our way back from the art store, we found our route blocked by the Columbus Day parade where John F. Kennedy, a month away from his presidential victory, passed in his open car.

He was close enough to touch with his broad smile as bright as the October sun and his thick red hair ruffled by the breeze — a demigod among mortals to a pair of hero-seeking boys.

Back home again, Jack drew everything that was important to him from characters in our favorite TV show, The Twilight Zone, to the face of the girl who captured his heart at a highschool dance.

We went to different high schools and lost touch with one another as we got involved with different circles of friends and pursued different paths in life. Jack did a variety of things but never lost his love of art and is now a successful painter.

I didn’t know any of this until we met again in 2001 when someone organized a 40th grammar school reunion.

Since that reunion, Jack and I exchange the occasional email, have talked once on the phone, and are friends on Facebook, a platform I rarely use.

When I came out of the

church and saw Jack’s house, I just had to take a picture and send it to him. It was Sunday and I was intending to send the email on Monday morning, though I didn’t get around to it until Wednesday.

Jack replied immediately and I am still pondering the significance of what he said.

He told me he was amazed and explained that he woke up Monday morning with the memory of a dream he had about the house where he grew up.

He recalled the good times he had there and tried to imagine what it might look like now, the same essential structure but updated and modernized. “And today I see this picture! Just incredible…just what I pictured!”

Struck by what Jung would have called the synchronicity of these events, I imagined an even stronger connection that would have occurred if I had sent the picture on Monday and Jack had awakened from his dream about his house to see it’s picture in his email.

Now that would have really been something!

When I shared this thought with Jack, his reply smacked of mystery and mischief and I could see the twinkle in his eye when I read these words.

“Well, perhaps you did send the picture on Monday morning, and maybe we just didn’t need the camera or the email.”

It was a line right out of The Twilight Zone and I could almost hear Rod Serling, the program’s creator, summing up the plot of our little story in his closing comments.

Submitted for your approval, the case of two childhood friends, separated by a lifetime and the width of a continent, brought together again on a day when they found themselves thinking about the house where they once played and talked about the twilight zone, “a dimension not only of sight and sound, but of mind. A journey into a wondrous land of imagination.”

Farther away than Tokyo is from Newark, farther even than childhood from our senior years, yet the twilight zone is always there, as close at hand as our willingness to believe. n

Striking a digital balance

By John M. Grohol, Psy.D., Publisher Technology is only going to keep invading the nooks and crannies of our lives. We can help ourselves and our clients by treating it like a tool that needs our active guidance rather than passively welcoming it into our lives as the enemy.

Facebook, Instagram, Twitter – these are all services designed not only to gain your attention and brain cycles, but to keep them for as long as possible. They are designed from a neurocognitive perspective to take advantage of the stimulusreward system – and they work wonderfully in keeping you captive.

The solution to technologies designed to take advantage of the psychology of attention is to use those technologies in a more mindful, attentive manner. Turn off alerts and check them on your own schedule. Nothing is so important on any of these services that it can’t wait.

Too many of us become hostages of the technology that is supposed to not only help improve our lives, but also make us feel better. Research shows that when we allow these kinds of social media to interrupt the natural flow of our lives, it can actually make us more distracted, lonely, and less happy.

Doing things in small batches throughout the day is another helpful technique to try. Instead of answering every email as it comes in, check it once in the morning, afternoon, and evening – on your schedule. Same with Facebook.

You can get a handle on technology in your life. But just as we counsel our clients, you need to make an active effort to change your relationship with it in order for things to change.

Start a little bit at a time and get used to the new routine slowly over time. Before you know it, you may find your relationship to technology becoming healthier and less stressful.

One of the things I love about publishing Psych Central and New England Psychologist is the ability to share these wonderful platforms with each of you. Got an opinion or something you’d like to get off your chest? Please keep us in mind, as we’re always looking for new voices. Email us your submissions to: pro.editor@psychcentral.com.

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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May 2018

New England Psychologist

5

THE PRACTICAL PRACTICE

GUEST EDITORIAL

Why a public health approach is the approach to gun violence

By Robert Kinscherff, Ph.D, JD and Paul Block, Ph.D We know what to expect after a mass shooting makes the headlines. Gun rights advocates search for mental illness in the shooter. Mental health advocates call for stricter gun controls. Gun owners rush out to buy more guns. Mental health budgets are increased marginally at best, while leaders promise to make changes so that “this never happens again.”

Then, typically little is done, although both Connecticut and now Florida have passed bills in response to the school shootings in Newtown and Parkland. However, this age-old gun control versus mental health debate distracts us from working together using a scientific public health approach to actually do something about gun violence.

Our polarized arguments stall progress. Second Amendment supporters argue that “the mentally ill” should not have access to weapons. Yet only one to two percent of Americans have severe mental illnesses and are no more likely to kill others than Americans who aren’t coping with mental illness.

There may be a higher incidence of severe mental illness among mass shooters, but that doesn’t mean the mental illness is what drives all mass shootings. But, universally, mass shooters are in acute emotional turmoil and feeling desperate− and our current mental health responses are not aligned to respond to them.

If “mental illness” is really to be blamed for mass shootings, then action is needed to fix and fully fund a readily accessible mental healthcare system.

But a “mental health fix” alone won’t work. About one in five of us suffer from diagnosable mental disorders each year - approximately 45 million Americans, almost none of whom commit violent acts.

Therefore, policies to reduce gun violence among people with “mental illness” would affect far more people and be more intrusive than most Americans would accept and it’s unlikely mass shootings would be noticeably reduced.

After a mass shooting, there is always focus on banning automatic rifles, yet handguns account for the vast majority of gun homicides. Mass shootings account for only about one half of one percent (0.5%) of all gun deaths. If mass shootings were eliminated, we would still be living with 99.5% of the gun deaths we currently suffer.

There are many suggested approaches in the gun control and mental illness debate. These include age limits on purchasing firearms, limits on rifles and magazines, arming teachers, placing police in schools, and more mental health services.

But, taken alone, these are “one-lane” approaches to address a multifaceted problem.

There is not one “gun violence problem” in America, but several “problems.” Reducing suicides, homicides, mass shootings, and accidental injuries and deaths all require different steps. There are almost twice as many suicides each year involving guns (about 22,000) as homicides (about 13,000), including mass shootings (averaging about 123 deaths a year between 2006 – 2017).

The risk factors for gun death also vary. Suicide is the only type of gun-related death for which mental health disorders are major risks, especially when accompanied by alcohol and drug abuse.

“Means restriction” is one approach for reducing suicide. This involves limiting use of guns through mechanical barriers like

Continued on Page 10

How to prepare for patient violence in the workplace

By Catherine Robertson Souter he very nature of a therapeutic relationship lends itself to a close, emotional bond between therapist and patient. But, what happens when that bond leads to a release of negative emotions or a physically violent reaction from a patient?

According to an article published by the American Psychological Association, the risk of confrontations with patients during therapy is more common than is often thought.

“Estimates vary,” said author Elizabeth Winkelman, JD, Ph.D, director of professional affairs for the California Psychological Association, “but as of 2012, studies suggested that almost half of psychotherapists will at some time experience at least one incident of physical attack, verbal abuse, or other harassment by a client.”

Not all of these confrontations, of course, lead to injury.

“In a 1990 study, only about 10 percent of the assaults were serious where people had some injury,” said Philip Kleespies, Ph.D, a clinical psychologist at a VA hospital in Boston.

He wrote a book on the topic called, “The Oxford Handbook of Emergencies and Crises (Oxford University Press, 2017).

Still, even though most confrontations do not result in injury, it is assumed that most psychologists would prefer to avoid situations where they feel physically or verbally threatened.

According to Kleespies, problems often arise because a therapist in a small practice is not prepared to handle issues of violence. Whereas, in larger settings, such as hospitals or long-term care facilities, there are procedures regarding aggressive behavior.

One problem with being prepared in advance, Kleespies pointed out, is the lack of training in risk management in psychology programs.

“The 1990 study found that there was very little training of psychologists for assessing and managing potential violence,” said Kleespies. “Another more recent study in 2005 surveyed graduate students and found that the majority did not feel prepared to manage patient violence.”

In his practice, Kleespies has found several tools to be useful in identifying potential violence in patients.

“There are some decision support tools that are a bit more advanced in assessing risk of violence,” he explained.

“They are not psychological tests, but these decision support tools combine actuarial factors and clinical judgment.

Actuarial methods outperform clinical judgment, but they also have problems.”

He added that the combination of actuarial factors and clinical judgment appears to result in better prediction.

Even with testing and using good clinical judgment, what one psychologist calls your “third ear,” a therapist can still find herself in a difficult situation.

“In some cases, there are

patients with no known history of violence who can have an emotional release within the confines of the office that can lead to a disintegration before your eyes,” said John Daignault, Psy.D, a Massachusettsbased forensic psychologist.

“It is not that common for a therapist to be injured in terms of a physical assault,” Daignault added, “but having said that, if you are the .01% who gets the brunt of it, statistical factors don’t really matter.”

Tips on avoiding violence: 1. When arranging an office, be sure that the therapist cannot be locked inside with a client and that he/she has access to the door at all times.

2. With potentially violent or abusive clients, schedule appointments during daytime office hours when others can be present.

3. If possible, ask another therapist to be present in therapy sessions or to pop in during a session if a client is potentially violent. The addition of another person often helps to deter outbursts.

4. Consider installing a “panic button” set to notify office staff of a situation or even to contact a local police department directly.

5. Require patients be “buzzed in” to the waiting room by keeping outside door locked.

6. Provide lockers for patients to store personal items, such as purses or bags and jackets to reduce ability to introduce weapons to the inner office.

7. Exit a room if a situation is getting too confrontational. n

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

A: Place a help wanted ad in... adve @nepsrtising y.com

6

New England Psychologist

May 2018

BOOK REVIEW

Book on play is research-based, practical

By Tina Arnoldi n “Play and Creativity in Psychotherapy,” Terry Marks-Tarlow, Marion Solomon, and Daniel J. Siegel demonstrate that play can have a significant role in the healing process. Taking the time to relearn how to play as an adult can help build resilience, creativity, and spontaneity for both clients and therapists.

As children, it is natural to explore and use play as a way of learning. But as adults, we are supposed to be more serious. We are often overly concerned with how we appear to others, and too often move through life with the logical parts of our brains.

Fortunately, it is possible to retrain ourselves to explore the world with play, and to use it in counseling sessions.

Each of the contributors to this book emphasizes the importance of play throughout life, and how it can help foster empathy.

They also share experiences from their clinical practices.

The backgrounds of the writers are varied, including contributions not only from psychotherapy but also neurobiology, psychiatry, and interpersonal neuropsychology.

They succeed at discussing the practice of play in clinical settings without diminishing the seriousness that categorizes many types of therapy.

When there is significant trauma being worked through, for instance, it may not be the right time to be playful, but play can fit into therapy for many clients “Within psychotherapy, the task of self-creation and the coconstruction of the self become emergent relational processes,” the authors write. Creativity is discussed in terms of the creation or re-creation of a person’s self-understanding.

Since I have taken improv lessons, I was especially interested in the chapters on com-

“Play and Creativity in Psychotherapy” Terry Marks-Tarlow, Marion Solomon, and Daniel J. Siegel Norton & Company

edy, creativity, and theater. As a participant in improv, I stepped out of my comfort zone and did some risk-taking as I engaged in different scenes during the class, similar to what clients may be asked to do in therapy.

Just like in the therapeutic process, improv is dependent on people supporting one another in the process and as a clinician, I supported the roles expressed by clients in session.

“When we make ourselves vulnerable and feel supported, it builds our trust and allows us to shift, change, and expand.

We are encouraged to make mistakes and suspend judg-

ment of ourselves and others,” write the authors.

For play to happen, there needs to first be a healthy attachment. A safe environment opens the door to using imagination in play and feeling free to create and discover.

Play can also be used when addressing specific concerns such as ADHD self-awareness, and depression and throughout different points in treatment.

“Play and Creativity in Psychotherapy” is an academic book written for professionals and not necessarily for the layperson. Someone looking for a self-help guide with ideas for incorporating play into his or her everyday life would not find this book to be an easy-touse manual.

Clinicians, however, will appreciate that it is researchbased while also including practical applications for use with clients.

The diversity of the contributors’ experiences makes

this book valuable for therapists who work from different theoretical perspectives and in a range of settings.

“Play and Creativity in Psychotherapy” is a good resource for clinicians who may be skeptical about the concept of play in psychotherapy yet may be burned out on traditional ways of doing therapy day after day.

It provides a framework to approach the work from a different mindset, and perhaps breathe new life into clinical sessions.

With clients that do not seem to make progress, this book offers new techniques for shifting gears to make more headway. Those outside the mental health profession may also be interested in learning how play can be used across the lifespan and across cultures.

At the very least, the book should open the eyes of all readers to the value of play across the lifespan. n

Vertical development: How to grow personally and professionally

By John C. Panepinto, PsyD, LPCS, NCC ith the required continuing education for practitioners, a great deal of the available offerings focus on ethics, skills, modalities, or new information gleaned from

research. One’s professional development can resemble graduate course work, and this type of learning can be predominantly informative or horizontal in nature.

With the number of therapies in the hundreds and the demands for evidence-based practice, what seems lost are

the most robust indicators of positive outcomes. More than three decades’ worth of empirical research suggests these are the individual therapist differences and the quality of the therapeutic relationship. Therefore it makes sense to continuously develop and refine the instrument of influ-

ence: the self.

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where they are, we must first know who and where we are.

This process is lifelong and includes learning and adapting personally and professionally.

Vertical growth honors the tenets of developmental theory that suggests that, at some point, for adults, growth is optional. This freedom of choice matters for research reveals a full 58 percent of the general population who have not developed to the point of self-authorship and conscious responsibility for one’s inner life.

Further, principles of vertical development establish the following: each stage of development is qualitatively different; we have the potential towards deeper understanding, wisdom and effectiveness in the world; the depth, breadth and complexity of what we can notice can increase with development; and our capacities for dealing with complexity increase while our defenses decrease.

Vertical development is the on-going process of bringing Continued on Page 9

May 2018

New England Psychologist

7

Brattleboro Retreat expands telepsychiatry services

By Pamela Berard ollowing the successful launch of a pilot inpatient telepsychiatry program, the Brattleboro Retreat in Vermont has expanded its telepsychiatry services.

In early 2017, a psychiatrist on the medical staff at the Retreat — a not-for-profit specialty psychiatric and addiction treatment hospital — moved out of state but wanted to stay involved.

Brattleboro Retreat developed an inpatient model of telepsychiatry for the staffer to provide remote, real-time video consultation with patients.

“It was very well received early on by patients as well as our staff and the physician involved,” said Mark McGee, M.D., chief medical officer.

The Retreat has since hired several additional staff members to offer telepsychiatry services for adult inpatient and partial hospital programs.

The practitioners work fulltime from other states including Florida, New York, and Rhode Island.

McGee said southeastern Vermont is not unlike other

rural communities in that recruiting for healthcare workers can be challenging. “Many young professionals want to live and work in urban areas,” he said.

“Telepsychiatry offers a unique opportunity for us to connect highly qualified physicians with patients in our healthcare system,” McGee said.

Also, “it allows physicians a great deal of flexibility and autonomy to choose where they wish to live and spend their time, but not be limited by geography in terms of their practice opportunities.”

Patients have reported positive experiences, McGee said, noting that real-time video conferencing services are nearly ubiquitous these days.

“Everybody has some experience, Skyping with their grandparents, for example,” McGee said. Young people have grown up with technology.

“Even older individuals who we may have expected might be reluctant find that it’s a high-quality service. The video feeds are broadband, very high definition. I think

the acceptability is really quite high and the quality of services really quite excellent.”

McGee said.

Research shows that teleservices are equivalent in acceptability. He said in some instances, a teleconference might be a preferred method of interaction, for example, with patients who experience anxiety sitting with an individual in a confined space.

McGee said not only are remote employees utilizing teleconference services – but the entire medical staff has access to them.

“All of our medical staff who need to evaluate patients after hours are now able to do so through telepsychiatry,” McGee said.

Many physicians live a good distance away from the Retreat, and some patients request discharge after hours.

The medical staff can now evaluate patients for afterhours discharge without having to leave their homes and families and disrupt their personal life. “So (teleservices) can also improve work satisfaction of existing staff,” McGee said.

Brattleboro Retreat is also on the cusp of using telepsychiatry services in another way to help serve the needs of Vermont residents. It has an agreement in place with Brattleboro Memorial Hospital to provide telepsychiatry consultation to Emergency Department patients to help expedite treatment plans and reduce the number of psychiatric patients waiting long hours in hospital emergency rooms.

In April, Brattleboro Retreat was in the process of finalizing arrangements and hoped to kick off the program soon.

In many communities, small acute hospitals are often the primary entry point of individuals in the community experiencing a medical or psychiatric crisis. Yet, McGee said, of the 14 acute hospitals in Vermont, only three have any psychiatrists on staff.

McGee said the intent of collaborations such as the one with Brattleboro Memorial Hospital is to provide psychiatric assessments quickly in the ED and provide a detailed treatment plan that can be initiated there.

Those who need inpatient

care can move through the system of care more effortlessly.

“There’s a tremendous amount of potential to get patients evaluated and treated much more quickly when they present,” McGee said.

McGee said Vermont is ahead of the curve in providing the necessary legislative supports for telemedicine.

In 2017, the state passed legislation specifying that all health insurance plans provide coverage for health care services delivered by health care providers at a distant site to the same extent that the services would be covered if they were provided through in-person consultation.

The legislation specifies that this requirement applies “whether or not” the patient is accompanied by a health care provider at the time services are provided by a health care provider through telemedicine.

The patient’s location can include a health care provider’s office, a hospital or health care facility and also may include a patient’s home or another non-medical environment such as the patient’s workplace or a school-based health center. n

Mass. increases beds, facilities while other states remain stable

By Phyllis Hanlon he psychiatric care landscape has shifted in recent years from an inpatient setting to community placement and back to in-hospital treatment. New England Psychologist surveyed the New England states to assess the current inpatient situation.

Kathleen Remillard, public information officer (PIO) at New Hampshire’s Department of Health and Human Services, reported that the state has had no psychiatric unit closures in the past year.

Rather, New Hampshire has gained 20 new transitional housing beds for patients recently released from New Hampshire Hospital or other designated receiving facilities.

Vermont has also added 20 youth psychiatric beds; and four mobile crisis apartments as an alternative to inpatient care for individuals in crisis that have been assessed by a mobile crisis team.

Maine, which has two private and two public psychiatric hospitals as well as seven

community hospitals with psychiatric beds, has seen no significant changes recently, according to Jeffrey A. Austin, vice president of government affairs for the Maine Hospital Association.

“The biggest development here in the past few years is

the state’s proposal to build a step-down facility in Bangor,” he said, adding that the goal is to have a facility where forensic patients who no longer need hospital-level care, but are still committed to DHHS custody, can transfer.

The Rhode Island Medical

Society reported “no change” in the psychiatric bed situation. However, Sara Brandon, senior marketing manager for Butler Hospital, pointed out that the facility has reorganized its inpatient units to allow for more capacity for substance use disorder beds

and has also expanded its intensive outpatient programs.

Diana Lejardi and Mary Kate Mason, public information officers for Connecticut’s Department of Mental Health and Addiction Services, indiContinued on Page 9

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New England Psychologist

May 2018

Vermont searches for creative solutions to increase bed capacity

By Janine Weisman he Vermont House of Representatives Committee on Health Care has already come out against funding a temporary 12-bed forensic unit at the Northwest State Correctional Facility in Gov. Phil Scott’s proposed fiscal 2019 state budget.

But during the appropriation process in early April, Senate members appeared more receptive toward the facility proposed to alleviate the demand on emergency rooms and psychiatric facilities around the state.

“That’s a showdown between the Senate and the House that we get caught in the middle of,” said Department of Mental Health (DMH) Commissioner Melissa Bai-

ley. “They’ve got to figure out where they’re going to go from there.”

Adding psychiatric inpatient capacity to the state’s mental health system remains a complicated puzzle with a lot of pieces. After damage from Tropical Storm Irene led to the closing of the 54-bed Vermont State Hospital in 2011, the state now only has 45 Level 1 inpatient beds.

According to an AHS Facilities Report Overview, 25 are at the Vermont Psychiatric Care Hospital in Berlin, 14 at Brattleboro Retreat and six at Rutland Regional Medical Center.

It’s about to get more complicated. Influencing the outcome of budget deliberations will likely be a nearly $38.3 million fiscal 2017 surplus for the University of Vermont

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(UVM) Medical Center, more than half of it in net patient revenue collected above budget projections.

The Green Mountain Care Board, which regulates hospitals, has suggested the money could be invested in the state’s

regulatory action that would allow UVM Medical Center to retain the surplus funds to create more acute inpatient capacity, said board member Jessica Holmes, Ph.D. “Nobody has agreed that this is the right plan or this

“There is also pretty strong consensus that we need something in the interim (other than the forensic unit) and I think the state is actively looking for alternatives.”

Rep. Anne Donahue (R-Northfield), vice chair of the House Committee on Health CareHealth Systems (MABHS) mental health system. One idea that surfaced is using the money to establish an acute inpatient mental health facility on the Central Vermont Medical Center campus in Berlin.

That could also mean converting the Vermont Psychiatric Care Hospital into a secure residential setting.

The secure seven-bed Middlesex Therapeutic Community Residence (MTCR) remains in use even though it was supposed to be a temporary facility when it opened in 2013 to house psychiatric patients displaced by the closing of the Vermont State Hospital.

“It’s two trailers put together. It’s not a therapeutic setting,” Bailey said of MTCR. If the Legislature ultimately rejects the 12-bed unit, she said the state should look for a building that can be used for secure residential treatment to help with some of the flow of inpatients.

“I think we should continue to explore that until we’re told otherwise,” she said.

The Green Mountain Care Board was scheduled to vote as early as April 11 on possible

is what we should do,” Bailey said. “Everything’s sort of a moving target right now and people keep calling it a plan.

There’s not really a plan. It’s an idea that’s put out there.”

The Scott administration’s nearly $240.5 million proposed fiscal 2019 DMH budget includes spending requests for $2.9 million to repurpose an existing building at Northwest into a 12-bed hospital setting and another $1.5 million in operating costs for when it could go online in the last quarter of the fiscal year.

The unit would house inpatients who entered the treatment system through the criminal justice system.

The entire Northwest site, however, would eventually close along with the Chittenden Regional Correctional Facility under a major plan by the Agency of Human Services (AHS) to build a 925bed prison complex over 10 years. AHS oversees both the Department of Corrections and DMH. “We looked at a bunch of different places and this was the most feasible and the most they could do would be 12 beds. What we ultimately

wanted was 20 beds,” Bailey said. The 925-bed proposed prison complex would include a 20-bed forensic unit.

A Feb. 27 memo from the House Committee on Health Care to the House Committee on Appropriations on the proposed mental health budget called the proposed 12-bed unit an “unwise expenditure of significant state dollars for a temporary facility.”

Committee members were dismayed that the proposed 12-bed unit may not be fully occupied until fiscal year 2020 and recommended that DMH identify an alternative plan for temporary expanded capacity at an already existing inpatient facility that might be arranged more quickly and at less expense.

“I think a lot of fingers are crossed hoping that the UVM proposal gains traction,” Rep. Anne Donahue (R-Northfield), vice chair of the House Committee on Health Care, said via email.

“There is also pretty strong consensus that we need something in the interim (other than the forensic unit) and I think the state is actively looking for alternatives.”

State Sen. Peg Flory (R-Rutland), who chairs the Senate Institutions Committee, said the committee is keeping an open mind as it examines the immediate and long-term needs of Vermont’s mental health system.

“We’re continuing to explore all possibilities recognizing that there is a definite current need and it can’t wait four or five years. We need to come up with some interim measures,” Flory said.

Bailey said they may also explore the potential for Brattleboro Retreat to add some beds. “But that’s a conversation that hasn’t gotten any further than, ‘Hey it’s an idea, can we talk about it?’” n

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New England Psychologist

Vertical development Continued from Page 6 subjective being into objective awareness. Uncovering the psychological structures that give rise to our way of knowing is an intentional process, as we willingly examine our choices, beliefs, and actions.

The stages and transitions of adult development are welldescribed and provide the path to higher levels of selfawareness.

Here are five ways to enlist the process of vertical development: 1. Reflective practice.

Planning time in your day to observe your thoughts, feelings, and actions regarding significant events is a powerful tool. Commit to making space between the actions and the outcomes and notice the process.

Are you present? Are your roles balanced? Is there reciprocity in your relation-

ships? How are you making meaning in your day-to-day life? Consider the emotional and motivational aspects of your choices.

2. Examine assumptions: Our minds take a lot of shortcuts and often we react from habits, values, and beliefs that haven’t been examined in a while. The cascade of “Why?” questions is a great exercise to clarify if we are acting from principles or need to look at our perception in a new light.

Also, rigidity is a sign that assumptions and expectations are blocking a wider view of a particular situation.

3. Set developmental goals: The gap created by these goals creates discomfort for they involve examining our sense of identity. A developmental goal involves increasing your capacities at the boundaries of who you are

and becoming more able and aware.

These goals spring from the basic needs of autonomy, belonging, and competence, and are the fundamental motivation for self-determination.

If you work in a system (such as public mental health, university, etc.) or are not too far from your formal training, developmental goals include inquiring what you have psychologically accepted in these settings without question.

Developmental goals require ownership for your internal life and authoring your sense of self. These goals require you to ask the challenging questions, such as: What is it like to be in a relationship with me? How can I add more value in the work I do? How am I meeting my needs? How can I take more ownership of my time?

4. Challenge your mindset: If we do the same things each day, with the same people, we tend to get locked into a particular mindset. A growth

cated that the Constitution State has robust services for supporting people in the community and has no plans to close or open any facilities, although they added that the situation is fluid.

A 2016 study revealed that Connecticut has 611 stateoperated/funded beds and four state hospitals with additional psychiatric units in 23 general hospitals. The state also has three free standing hospitals, bringing the total inpatient psychiatric bed capacity to 1570; approximately 162 beds are designated for pediatric use.

Unlike most of the other New England states, which are basically status quo, Massachusetts has experienced a significant uptick in psychiatric bed capacity, according to David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems (MABHS).

Matteodo acknowledges that some closures have taken place. For instance, Westwood Lodge Hospital closed its doors in August 2017, representing a loss of 90 psychiatric beds and the 41-bed Lowell Youth Treatment Center shuttered doors this February.

But he pointed out that in

some cases, patients are being relocated to other facilities.

More importantly, Massachusetts has added beds since June 2015 and opened four new psychiatric hospitals, Matteodo said.

In June 2015, High Point Hospital had 16 existing beds and added 54 new ones for a total of 70 beds.

In August 2015, Southcoast Behavioral Health Hospital in Dartmouth assumed 90 beds from St. Luke’s Hospital in New Bedford, when the latter facility closed its psychiatric unit, making Southcoast a 120-bed hospital, Matteodo said.

Additionally, Tara Vista Behavioral Health Center opened a 108-bed facility in Fort Devens in November 2016 and the Westborough Behavioral Health Care Hospital launched a 152-bed psychiatric facility in October/ November 2017, according to Matteodo.

“This facility is owned by Signature Healthcare, a California group, but run by local professionals,” he said.

In February 2016, McLean Hospital added 31 beds and more recently, Harrington HealthCare System boosted its Webster location by 16 beds and MetroWest in Natick increased its Mental Health

mindset focuses on improvement, effort, and attitude rather than talent or fixed abilities.

There are numerous ways to expand and challenge your thinking: learn a new skill; read something outside your field; think systematically about a challenge you are facing; enlist a mentor or coach; start a new hobby; volunteer; mentor.

Changing roles or taking on a new one, even short-term, is a powerful way to expose aspects of your current mindset.

5. Integrate self-awareness: Just as we try to help clients create a coherent narrative, there is nothing more powerful than making sense of our own lives. Being clear on who we are, where we came from, and where we are heading, is the ultimate in vertical development.

This process highlights the flow of personal differentiation and integration based on a deeper understanding of our story. Journaling is an effective way to monitor and explore this process.

Whether you choose one or many of these vertical paths, you are sure to find as you grow, your capacity for the demands you face grows as well. It’s a process that requires consistency and time, for you are pushing the boundaries of self, and riding the cycle of complexity to simplicity—and back again.

Vertical growth introduces us to the edges of our current way of knowing and how we construct meaning. Committing to reflecting on the challenges, assumptions, and actions at these boundaries, opens the door to the wider lens of vertical development. n

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and Behavioral Health Treatment unit by 38 beds, Matteodo added.

The increase in psychiatric beds and facilities can be attributed to a number of factors, Matteodo said.

He explained that demand created by the opioid crisis as well as excessive emergency department boarding are two driving reasons.

“Also venture capital companies see behavioral health as a growth area and have been willing to front money,” he said.

Growing compliance with parity laws and lack of discrimination in the state is also prompting the surge in beds.

Furthermore, Massachusetts does not require a certificate of need, meaning the state is a free market and anyone can open a hospital without submitting this documentation, Matteodo explained. n

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May 2018

Autism Center at the Hospital for Special Care

New behavioral units designed to enhance care

By Eileen Weber

By Pamela Berard

ne in every 68 children has Autism Spectrum Disorder (ASD), according to the Centers for Disease Control and Prevention. In Connecticut, that means more than 5,000 children and adolescents under the age of 21 have been diagnosed with the condition.

Problems with social interaction, communication, and repetitive behaviors can vary widely from child to child.

While children can be identified as early as age two, ASD is often determined at later ages, making early detection an important element of care.

For nearly six years, Hospital of Special Care (HSC) in New Britain, Conn., has been a support system for children and adolescents in the autistic community. In 2012, they opened an outpatient unit. In 2015, they opened an inpatient unit with the help of a $500,000 grant from the Connecticut Department of Developmental Services.

Today, the Autism Center is poised to expand with a Partial Hospital Program and educational day center funded by a $150,000 grant from the American Savings Foundation (ASF).

The center provides resources in areas such as psychology and psychiatry, developmental pediatrics, speech and language therapy, and occupational therapy.

The program expansion serves to further complement the existing eight-bed inpatient unit and an outpatient unit that provides close to 6,000 visits annually.

Expected to decrease wait time for inpatient care, PHP may also help divert an inpatient stay or emergency

department admission for a child who needs more intensive intervention to remain at home safely.

“The urgent need for additional resources to meet the unique needs of patients with autism spectrum disorders is front page news in Connecticut and across the country,” Lynn Ricci, HSC president and CEO, said in a statement.

“Our commitment to these patients and their families remains a top priority and we are extremely grateful to the American Savings Foundation for leading the way and helping us leverage the resources necessary to meet these needs.”

Researchers have tracked autism for nearly two decades and its prevalence has increased substantially over time. That increase is believed to come from a growing awareness of the condition as well as better diagnostic methods.

But, the rise in prevalence and awareness is exactly what fueled the need for HSC’s facility. Emergency room consultations and admissions for ASD patients have also risen.

According to the Agency for Healthcare Research and Quality, patients seen by medical staff nearly doubled nationally in the five-year period from 2009 to 2014. HSC has made it clear the need for care far exceeds the resources available.

The HSC Autism Center is the first of its kind in Connecticut and one of only 10 facilities of this nature in the country.

Because of its growth, the center also recently added two medical directors, a psychiatrist, and psychiatric nurse practitioner to its clinical team. n

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t. Mary’s Regional Medical Center in Lewiston, Maine, opened its new pediatric behavioral unit in early 2018 and is on track to open a new adult behavioral unit in 2019, as part of a three-year, $12 million improvement project.

Project funding was partially funded through a capital campaign. Improvements include the relocation and remodeling of the pediatric and adult behavioral units, which will move to the main hospital; as well as renovations and expansion for the building supporting oncology, rheumatology, infusion, and other outpatient services.

The new 13-bed pediatric behavioral unit provides specialized care for children and adolescents. It features 11 private rooms and one double room, complete with disability accessibility.

The old pediatric unit had more beds (18) but all of the rooms were doubles, and many beds were empty because of the difficulty in matching a child with a roommate.

Reasons included infectious disease; agitated patients; age differences; or if a girl needed a room and the only available roommates were boys, for example.

“We blocked so many rooms back then,” said Michael Kelley, M.D., chief medical officer

of behavioral health.

He noted that the single rooms would rectify that problem and anticipates the daily number of discharges to remain the same.

Kelley said the old pediatric unit averaged a daily census of 10-11, and on the new unit, in early April the census was about 12-13 daily.

The old units had shared dorm-style bathrooms (currently, the adult unit has two showers for the entire floor).

In the new pediatric unit, each room has a bathroom/shower.

The new unit kept one double room, Kelley said, because occasionally there are patients who do better in a double room.

Similarly, the adult unit will go from mostly double rooms in the current 24-bed unit, to mostly single rooms in a 22-bed unit. It should be similar in design to the pediatric unit, Kelley said.

Kelly described the old adult unit as “ancient,” noting it is the oldest of its type in the state.

Age brought issues such as hot water radiators that bang and clank, poor lighting, inconsistent room temperatures, and less accessibility.

“It made you feel like you were in an institution rather than a hospital,” Kelley said.

In the old pediatric unit, Kelley said “almost monthly, we would have a family bring a child onto the unit and

immediately ask to leave, just because of how it looked.”

The new pediatric unit is designed for a completely different look and feel.

In addition to being “light, bright, modern, and clean,” the nursing station has direct lines of sight for most of the rooms, rectifying a problem with the previous unit, according to Dylan McKenney, M.D., associate medical director, Inpatient Pediatric Behavioral Services.

“We feel like we have the opportunity to have a more well-regulated environment here,” McKenney said.

Having single rooms may also benefit a patient’s treatment. McKenney said rooming teens together can be delicate, as roommates sometimes form very close and not necessarily therapeutic bonds that can be a distraction.

“Kids at this age can really quickly form kind of a treatment-resistant kind of relationship with one another pretty quickly, or just get distracted in someone else’s story,” McKenney said.

The new pediatric unit has many added safety features, including doors that open in such a way that a child cannot block a door to barricade him/ herself into a room.

The new units are also closer to medical units, so medical staff can respond to codes faster; and can offer more modern equipment.

“We always prided ourselves on treating the most medically needy patients in the state, and this will really improve our ability to do that,” Kelley said. n

Guest Editorial: Gun violence Continued from Page 5 trigger locks or restricting gun access when actively suicidal.

Like suicide, people who commit domestic and workplace vioence are commonly experiencing “intense emotional distress.” Few have major mental illnesses.

The small number of people with severe mental illness who present imminent risk can be hospitalized involuntarily. “Red flag laws” allow relatives, close friends, and police to ask judges to issue “gun violence restraining orders” when a person is in “intense emotional distress.” Local police gun permitting may have greater impact on crime-related homicides.

Better treatment for mental illness and substance abuse is likely to lower incidents of gun violence, especially suicide. But broad, strict limits on gun ownership for people who have ever received mental health treatment would unfairly undermine their rights and may deter some from seeking treatment at all. It’s unlikely these limits would have a meaningful effect on mass shootings.

Restrictions placed on the Centers for Disease Control and other efforts to research gun violence need to be lifted. A public health approach to gun violence would let the federal government, states, and local jurisdictions adopt approaches to reduce gun deaths but also allow us to research which approaches effectively reduce gun violence.

Historically, public health approaches issues have reduced car crash fatalities, child deaths from toxic household products, HIV infection, and tobacco-related deaths. But sadly, we know more now about the next wave of the flu than we do about gun injuries and deaths.

A public health approach would allow us to work together to decide which strategies to adopt for effectively reducing gun violence while balancing financial and human costs, civil and constitutional rights, and the quality of life in our communities.

May 2018

New England Psychologist

11

Challenges of working in inpatient hospital settings Continued from Page 1 with “life and death scenarios” on a regular basis can lead to burnout, which the psychologist must self-manage, Thompson noted.

In such cases, working with other team members to whom you can vent is extremely helpful.

Thompson has found that working in a hospital, particularly one that is affiliated with an academic institution – Bradley Hospital is associated with Brown University – offers a chance to conduct research.

“Part of the role at Bradley is to develop cutting edge therapy based on evidencebased practice and see if it works,” she said.

While she serves as supervisor to trainees, she also does clinical work and research.

Thompson and her supervisor

Asylums?

Continued from Page 1 without actually reading the actual rationale,” he added.

“Over the months, I started to hear from family members and patients and even judges and law enforcement folks saying this is exactly right.”

Asylums alone are insufficient but represent one component of a continuum of care, Sisti said. He cited the 320-bed Worcester Recovery Center and Hospital which opened in 2012 in Massachusetts as an example of a full range of treatment services.

The facility is located on the campus of the old Worcester State Hospital that closed in 1991 and consolidated beds lost when the state of Massachusetts closed the Westborough State Hospital in 2010.

Deinstitutionalization, Sisti argues, really became transinstitutionalization as patients with chronic mental illness were moved to nursing homes and general hospitals where they received short-term treatment and at much higher cost.

Many ended up homeless while an estimated 20 percent of the U.S. incarcerated population are now individuals with serious mental illness.

The suicide rate in the U.S. increased 22 percent between 1999 and 2013, while the number of psychiatric beds

have created a four-module intervention based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). She noted that findings show if the patient completes the therapy, he is less likely to be readmitted.

When James C. DeGiovanni, Ph.D, director of psychology and training at the Institute of Living (IOL)/Hartford Hospital, completed an internship and fellowship at IOL, he discovered he had a “gift” for inpatient work.

He was interested in and understood the role of the team dynamics in the care of the individual patient. With a penchant for group therapy, he assumed oversight of that program and became director of training. He now serves as system-wide consultant to the inpatient and ambulatory departments.

While DeGiovanni believes inpatient work is more satisfying than solo or group practice, he admits that challenges do exist. As health care has evolved, patient length of stay

has gotten significantly shorter, so treatment options have changed, he said.

At IOL, psychologists identify a few core treatment areas on which to work. “You don’t often see to what degree the

lenges that include poverty, violence, and trauma for both the clinician and the patient, according to DeGiovanni.

“You can take a beginning look at problems, but can’t deal extensively with them on

decreased from 34 to 22 beds per 100,000 residents during that 15-year span, according to an August 2017 paper by University of Chicago researchers published in JAMA Psychiatry.

The non-profit Treatment Advocacy Center estimated the number of last-resort psychiatric hospital beds in the U.S. fell to 11.7 per 100,000 population in a June 2016 report. The Arlington, Virginia- based center said 50 per 100,000 are necessary to provide treatment to individuals who need inpatient care.

Among New England states, Connecticut has 17.1 state hospital beds per capita,

followed by Rhode Island at 12.3, New Hampshire at 11.9, Maine at 10.8, Massachusetts at 8.9 and Vermont at 4.0.

Clearly, the numbers don’t show a trend toward reversing de-institutionalization any time soon. The numbers do show the prison system continuing to absorb a large and significant number of mentally ill patients.

For example, in Rhode Island in October 2011, an average of between 10 and 15 percent of state Department of Corrections inmates were moved to the Eleanor Slater Hospital because they were found incompetent to stand

trial, according to the state figures. By March 2018, 46 percent of patients were found incompetent.

“I think this number’s very striking to show that’s what happened with state hospitals limiting the number of beds across the country,” said Louis Cerbo, Ph.D., a clinical psychologist and director of behavioral health at the Rhode Island Department of Corrections.

Devoting resources to adding more state psychiatric beds makes sense in states that have very few of them, Cerbo said. “There are some states in the country that might look at

N

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work you’ve done has taken root,” DeGiovanni said. “You need to learn to take satisfaction for micro-level changes.”

The complexity of the community also imposes chal-

“You don’t often see to what degree the work you’ve done has taken root.”

James C. DeGiovanni, Ph.D, director of psychology and training, The Institute of Living (IOL)/Hartford Hospital

the inpatient side.”

DeGiovanni routinely has conversations with interns about working in a hospital and readily admits that the career path is challenging and involves some safety risks, particularly for the patient.

However, he pointed out that there are opportunities for making contributions with the team and the patients. “It’s a great environment in which to feel effective in various roles and to provide direct care,” DeGiovanni said. He added that psychologists can experience “…lots of moments to feel effective. In a private practice you can’t do that. “ Additionally, inpatient work can be the first step in learning about the inner workings of the hospital system, which can lead to opportunities in program management positions and the creation of care planning processes, DeGiovanni noted. n

bringing back certain types of state institutions,” Cerbo added. “It’s a state by state issue.”

But he doesn’t consider more state hospital beds the answer to improving longterm psychiatric care. Rather he said the focus should be on strengthening community mental health centers, diversion programs and supportive housing.

There is a critical need for group homes, especially for hard to place populations like sex offenders and those with a history of arson, Cerbo said.

“In the long run, those programs can be cheaper than a state hospital,” Cerbo said. n

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May 2018

Plymouth’s Child and Family Services redesign creates stir

By Susan Gonsalves arlier this year, there was an outcry when word got out that the Emergency Services Program (ESP) operated by Child and Family Services in Plymouth was about to change.

Executive Director Anne Sampaio, LICSW, noted that people feared the closure of the current office space on Long Pond Road in June would mean that people in 10 communities would be left without `walk-in’ aid or have to travel to the New Bedford site for help.

The program provides crisis intervention for a variety of mental health and substance use disorders.

The services include facilitating a placement in a treatment facility, assisting with appropriate referrals to outpatient treatment and providing

brief, solution-focused crisis counseling to help with immediate relief of stressors.

In addition to Plymouth, communities served include Carver, Duxbury, Halifax, Hanover, Hanson, Kingston, Marshfield, Pembroke and Plympton.

Sampaio said that the New Bedford site has been well established for more than 20 years, while the Plymoutharea office opened in 2009 to help handle the volume of patients in crisis.

However, she noted that while about 6,000 people annually seek services in New Bedford, only about 2,000 individuals make use of the Plymouth offerings.

Also, less than five percent of the people served are actually seen in the office.

Instead, staff travels to the emergency room, doctor’s office, school or home to assist

people in need.

“We want to help consumers more and meet them where they are at,” Sampaio said. “In the long run, it’s best practice and that was our reason for doing the re-design.”

The director said that in New Bedford, the walk-in site is a popular resource open 24/7, all year that helps free up space in emergency rooms.

People in crisis are routinely brought there by emergency personnel if there is not a medical need.

However, Plymouth responders take people directly to emergency rooms, primarily at Beth Israel Deaconess Hospital and have not been as willing to use the alternative site Child and Family Services provides, Sampaio said.

She said, after June, ESP staff will move to an alternative, smaller location in

Plymouth and the change will result in one more clinician out in the field because he or she will no longer be “manning” an office.

The crisis team will continue to provide outreach for consumers insured with MassHealth and expand services to clients who are privately insured with commercial carriers with whom Child and Family Services is contracted.

Sampaio is relieved that critics of the re-design appear to be more on board with the plans.

Back in February, Rep. Mathew Muratore (R-Plymouth) circulated a letter in favor of postponing the move which was signed by seven other legislators. Members of the Department of Mental Health ‘s Plymouth Advisory Board and National Alliance

on Mental Illness (NAMI) Board also expressed strong objections.

The letter prompted Health and Human Services Secretary Marylou Sudders to schedule a public forum to hash out concerns at the end of that month.

A spokesperson for the Executive Office of Health and Human Services said the agency is closely monitoring how the change in operation affects the timeliness of access to medical crisis intervention and emergency services in the Plymouth region.

Any clients requesting to meet a staff person at the new Plymouth office (after June 30) location can do so by appointment only.

As part of the re-design, the intake and triaging of phone calls and requests for evaluations all will be done at the New Bedford site. n

Transitional housing bridges gap for people with mental illness

By Eileen Weber or a number of years, New Hampshire Hospital, the only psychiatric hospital in the state, has been massively overcrowded with too many patients and not enough beds. Patients had little choice but to leave the hospital only to find themselves living on the streets or seeking treatment in already crowded emergency rooms.

“There needs to be an array of treatment that used to exist,” said Ken Norton, M.D., executive director of the New Hampshire chapter of the National Alliance on Mental Illness. “Right now, when patients are discharged, there’s

very little step-down.”

That’s starting to change.

Legislation was recently passed to fund more beds. In his State of the State address, Governor Chris Sununu spoke about the implementations necessary for people with mentally illness.

“We provided funding to establish 60 new beds for community-based transitional housing and created a fourth rapid response mobile crisis unit to divert hospitalizations for mental health issues,” he said.

“It is unacceptable for citizens in mental health crises to be waiting for treatment for weeks on end.”

How about a little EXTRA help filling an open position?

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By Phyl

INSIDE

Contact us at advertising@nepsy.com

As Sununu pointed out, bed space isn’t the only solution.

Transitional housing bridges the gap between hospital care and living independently.

Harbor Homes in Nashua

need it and put the people in that do. It helps everyone.”

Harbor Homes, a non-profit organization established in 1980 provides low-income, homeless, and disabled

“It is unacceptable for citizens in mental health crises to be waiting for treatment for weeks on end.”

New Hampshire Governor Chris Sununu

recently opened a 14-bed transitional housing unit with another six-bed unit scheduled to open in Bradford through NFI North. Harbor Homes has also contracted with another property for an additional 20 units within the next few months.

This kind of program is an essential element to end the overcrowding of hospitals.

Without it, it’s a vicious cycle says Eliza Blondeau, psychiatric registered nurse supervisor at Harbor Homes.

“Patients that don’t need that much care have nowhere else to go,” she explained.

“People that do need that care get stuck in the ER. The goal is to get the people out that don’t

community members with affordable housing, primary and behavioral health care, employment and job training, and supportive services.

It is one of a six-partner organization in the Partnership for Successful Living, which also includes Keystone Hall, Healthy at Home, Milford Regional Counseling Services, Southern NH HIV/AIDS Task Force, and Welcoming Light, Inc. The expectation for the patients in the transitional housing program is to become independent within two years, allowing room for new patients.

Kathryn Byrne, program director at Harbor Homes,

said patients from New Hampshire Hospital get discharged directly into their care, which is staffed every day around the clock.

“We work with [patients] to get state, federal, and local benefits like food stamps,” she said. “We help with cooking, budgeting, connecting with a local church, tenant’s rights, and generally how to run a household.”

Byrne said the types of mental illness they usually see in the program are schizophrenia, bipolar disorder or border personality disorder.

But, they have to be medically certified in order to be placed in the Harbor Homes housing.

She said these are people who need some level of care. A hospital stay is too much but they aren’t stable enough to be independent.

Both women are excited about the program’s future progress and its initial success. They acknowledge it’s a big adjustment for patients to leave, in some cases, longterm care to a state of near independence.

“These patients come out on conditional discharge and that discharge could be revoked. No one’s had to go back up.” said Blondeau.

“They’ve got a roof over their heads and head-to-toe health care. I’m quite proud of it.” n

May 2018

May May 3: Movie + Dialogue Night showing the popular film Lady Bird. Watertown, MA. 7-10 pm, $55, 3 CEs. A mom works tirelessly to keep her family afloat after her husband loses his job. She also maintains a turbulent bond with her teenage daughter. This film will be a vehicle to help us learn about complexities in mother/daughter relationships.

Sponsored by Therapy Training Boston. Contact 617-9249255.

May 3-5: NHPA Three-Day Addictions Symposium. Topics include: Cybersex Use and Abuse, Key Elements in Chronic Pain and Addiction, and a Modern Perspective of Addiction. Hampton, NH. Sponsored by NHPA. Contact 603-415-0451.

May 4: Master Series in Clinical Practice: Treating Challenging Kids: The Collaborative Problem Solving (CPS) Approach. Newton, MA. 9-4:30pm, $225, 6 CEs. Sponsored by William James College. Learn how CPS addresses the needs of challenging youth. Contact www. williamjames.edu/ce or 617244-1682.

May 5: “Poto Mitan:” Change Agents that Promote WellBeing in the Haitian Community. Newton, MA. 8:30-5 pm, $130, 6 CEs. Identify assets that exist within the Haitian community, and raise awareness of individuals and organizations that serve as “Poto Mitan” or agents of social change. Sponsored by William

New England Psychologist

James College. Contact www. williamjames.edu/ce or 617244-1682.

May 11: Annual Conference on Mental Health and AgingEnd of Life: Clinical Care, Concerns and Challenges.

Newton, MA. 9-4:30pm, $130, 6 CEs. Sponsored by William James College. Topics include: palliative care, hospice & comfort measures, public policy on end of life, caregiving, ethics, and more. Contact www.williamjames.edu/ce or 617-2441682.

May 12: The Brain-Gut Connection: Evidence-Based Psychological Strategies for Treatment of Gastrointestinal Symptoms in Children, Adolescents, and Young Adults.

Boston, MA, $100, 4 CEs. Learn about evidence-based treatments for clients presenting with a variety of GI symptoms and disorders including chronic pain, nausea, IBS, IBD, and ARFID. Sponsored

by Boston Children’s Hospital.

To register: https://bostonchildrens.cloud-cme.com/Aph. aspx?P=15&EID=733#.

Additional information: 617-9199982.

May 12: Divorce Matters - Next Step. Waltham, MA. 9-Noon, $30. Nonprofit The Divorce Center professionals will show you how to untie the knot of legal, financial, family and personal issues associated with divorce. Sponsored by The Divorce Center. Visit http:// www.thedivorcecenter.org/ public-education to register.

May 15: The Crisis in Masculinity. Auburndale MA. 10-

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

4:30 pm, $175, 5 CEs. This workshop will help work with the negative effects of patriarchy on men, women and relationships, and introduces therapists to Relational Life Therapy. Sponsored by Therapy Training Boston. Contact 617-924-9255.

May 18: Master Series in Clinical Practice: Self-Compassion: An Antidote to Shame.

Newton, MA. 9-4:30 pm, $225, 6 CEs. Learn the ways selfcompassion can be an antidote to shame. Sponsored by William James College. Contact www.williamjames.edu/ce or 617-244-1682.

13

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: Insurance Trust Program: Sequence VIII: Ethics and Risk Management in a Digital World 2.0. Warwick, RI. 8:30-4:30pm, $195, 6.5 CEs. This workshop is a

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

June June 1: Master Series in Clinical Practice-Erotic 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 617-2441682.

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.

For over 30 years, Evergreen Center has provided living and learning environments for persons with autism and intellectual and developmental disabilities including physical disabilities, behavior disorders and complex health needs. Evergreen Center offers a highly competitive salary commensurate with local and national standards, an excellent benefit package, a retirement plan with company contribution, and tuition support/educational loan repayment programs.

C

ar

thr g n i

ough Compe

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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

14 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. 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: Offering Family Life Education for Stepfamilies as Primary Prevention.

Newton, MA. Sponsored by William James College. Contact www.williamjames.edu/ce or 617-244-1682.

New England Psychologist 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.

June 18 - Aug. 24: Cape Cod Institute workshops. Nauset Regional High School, Eastham, MA. 15 CEs. A varied and diverse summer-long series of week-long workshops. Sponsored by the Cape Cod Institute. Learn more at: http://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 William James College. Contact www.williamjames.edu/ce or 617-244-1682.

June 25-29: New Frontiers in Mindfulness and Psychotherapy: A Retreat for the Heart and Mind with Ronald Siegel. Eastham, MA. $549 before 3/30; $599 after, 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 England Education Institute.

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

May 2018

June 25-29: Becoming a Master Clinician: Diagnosis, Drugs and Existential Psychotherapy with S. Nassir Haemi. Eastham, MA. $549 before 3/30; $599 after, 15 CEs. Participants will learn advanced clinical approaches to diagnosing and differentiating clinical presentations of anxiety, depression, bipolar, and personality disorders. Emphasis will be placed on a little understood and used approach: existential/humanistic methods of psychotherapy. 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. $549 before 3/30; $599 after, 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.

June 29: Master Series in Clinical Practice-Assessment and Effective Treatment of Alcohol and 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.

Aug. 8-12: American Psychological Association Annual Convention. Hilton San Francisco Union Square Hotel, 333 O’Farrell Street, San Francisco. The annual meeting of psychologists offers many CE opportunities and workshops.

Sponsored by the American Psychological Association.

Learn more at: http://convention.apa.org/ce

July 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. $549 before 3/30; $599 after, 15 CEs. Symposium participants will learn: techniques for enhancing empathy and our own “stress hardiness”; the components of motivation and a “resilient mindset”; the importance of identifying and reinforcing “islands of competence”; how to change “negative scripts” and “negative mindsets” 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.

August

informational interview at 617924-9255.

October Oct. 26: Shifting Families Toward Acceptance and Connection: Strategies for Helping When A Youth Comes Out as Transgender or NonBinary. Waltham, MA. 9-4:30 pm, $140, 6 CEs. Considering the vulnerabilities of trans and non-binary youth, it is critical for therapists to have a sophisticated understanding of gender identity/expression. It is also critical to have a solid framework to hold the work and support these youth and families. We will start the day with a focus on a deepening understanding of gender, gender identity development and gender dysphoria. Next, a framework for working with families will be discussed which is relevant to providers who see individual youth, parents and families. Sponsored by Therapy Training Boston. Contact 617-924-9255. n

September Sept. 14: Intensive Certificate Program in Family Systems Therapy: Working Well with Individuals, Couples, Families and Larger Systems. Watertown, MA. 8:304:30 pm, $3150, 81 CEs. This course improves participants’ confidence and capacity to hold effective meetings using practices from enduring and cutting-edge theories. Focus is on finding a balance between providing therapeutic leadership and empowering clients.

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

by Therapy Training Boston.

Contact us to attend a group

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May 2018

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Office Space BELMONT CENTER: Fulltime office available in two office suite with shared waiting room. Spacious office.

Accessible professional building. Contact Susan at 617-489-3870 or sjm@susanjmillerpsyd.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.

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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 FRAMINGHAM, MA: Furnished office available full or part-time in lovely, renovated Colonial. Shared waiting area, bathroom, and kitchen.

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ARLINGTON: Full or parttime office sublet available in suite with waiting room, bathroom, WIFI. Shared playroom with toys, ideal for child therapist. Contact Lou at 781-646-6306 or lou@eckart-phd.com

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

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

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

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

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

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New England Psychologist

May 2018

Income Protection Insurance Becoming disabled during your working years happens more than you might imagine. If you are seriously injured or become ill and cannot work, can your loved ones continue to pay the bills and still live comfortably?

Trust Endorsed Income Protection (Disability Income) Insurance* is the key to providing you and your family with income and financial stability while you get well and get back to what you do best.

Apply for this coverage with rates often lower than similar insurance available to the general public. If you already have disability insurance, compare the rates of The Trust’s Income Protection Plans against what you already own at trustinsurance.com. You may achieve substantial savings.

Choose the plan that fits your needs!

Sample rates: $2,500 Monthly Benefit – LifeStyle 65 Plan, 90 Day Waiting Period Age

Quarterly Premium

35

$55.25

40

$70.50

45

$103.00

50

$121.25

55

$141.00

1-800-477-1200

Watch the Q&A video What You Need to Know About Income Protection Insurance at trustinsurance.com. * Coverage is individually underwritten. Policies issued by Liberty Life Assurance Company of Boston, a member of Liberty Mutual Group. Plans have limitations and exclusions.

For costs and complete details, call The Trust or visit www.trustinsurance.com

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