A PUBLICATION OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION MARCH 2017

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 monitor on
psychology
A PUBLICATION OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION

PRESIDENT
Antonio E. Puente, PhD

PRESIDENT-ELECT
Jessica Henderson Daniel, PhD

INTERIM CHIEF EXECUTIVE OFFICER

Cynthia D. Belar, PhD

EXECUTIVE DIRECTOR OF MEMBERSHIP RECRUITMENT AND ENGAGEMENT

Ian King, MBA

EDITORIAL

EDITOR
Sara Martin

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MARCH 2017|VOLUME 48|NUMBER 3 Please recycle this magazine

Features MARCH 2017

COVER STORY

(DIS)CONNECTED
Smartphones may keep us connected, but they can also mess with our
sleep, stress us out and monopolize our attention. Psychology may hold
the key to helping people take control of this technology to prevent its
negative effects and even enhance our well-being. See page 42
COVER: 2017 ROBERT NEUBECKER/THEISPOT

50 BRIGHTER FUTURES
FOR ANXIOUS KIDS
Anxiety disorders are the most common
mental health disorders among children and
adolescents, yet anxiety has been woefully
underdiagnosed. Now, psychologists
research has begun to paint a clearer
picture of anxiety in kids, including the role
that family plays and which interventions can
help to treat it.

56 HEALING BY DESIGN
Psychologists who study design offer
insights on how to design practitioners
offices to best support their clients. Their
research suggests that offices be painted
in light and neutral colors, be lit with
windows or lamps (not fluorescents), offer
comfortable chairs, feature a connection
with nature and include such distractions as
fish tanks, among other findings.

M O N I TO R O N P S YC H O LO G Y M A R C H 2 0 1 7 3
Departments MARCH 2017

Treating ADHD is CE CORNER

a successful niche
for psychologists. HOW SHOULD A PSYCHOLOGIST
Page 68 ADVISE A HETEROSEXUAL MAN WHO
HAS SEXUAL THOUGHTS ABOUT MEN?
Several times a year, CE Corner asks ethical experts to offer insights
on ways to address an ethical issue. This month, we explore the case of a
married 62-year-old Mexican-American, who identifies as a heterosexual
male and has recently had bariatric surgery. He is concerned by his sexual
thoughts about men. See page 38

6 PRESIDENTS COLUMN
7 FEEDBACK

RESEARCH
9 IN BRIEF
1 5 DATAPOINT
80 BY THE NUMBERS

NEWS
1 6 ARTHUR C. EVANS JR. IS NAMED
APAS NEW CEO
1 8 ADVOCACY IN ACTION
20 WILL NIMH HAVE A
BROADER MISSION?
22 NEW LEASE ON LIFE FOR
TROUBLED INMATES
26 PERSONALIZED MEDICINE
TO HELP SMOKERS QUIT
28 COLOMBIAN AND U.S. RESEARCHERS
PARTNER TO FOSTER HEALING
36 JUDICIAL NOTEBOOK

PEOPLE
33 4 QUESTIONS FOR ALISON GOPNIK
7 1 PSYCHOLOGISTS IN THE NEWS

CAREER
62 TAKE CHARGE!
66 HOW DID YOU GET THAT JOB?
68 NO INSURANCE REQUIRED

CLASSIFIEDS
73 CLASSIFIED ADS

Teens sleep more How to get

when schools leadership
start later. experience.
Page 11 Page 62

4
Presidents Column

CELEBRATING 125 YEARS psychology are conferred each year and

over 250,000 people take the Advanced
The 125th anniversary of the American Psychological Placement exam in high school. Not only
have we grown and diversified, but our
Association represents an important milestone
pipeline remains strong.
BY ANTONIO E. PUENTE, PhD, APA PRESIDENT As we celebrate this year, it is import-
ant to acknowledge that many pillars still
stand:
Psychology is a science.

I
n this era of chaos, incivility, self-centeredness and decreased
focus on diversity, one has to dig deep to determine what is of
125 years is one of the longest tenures
of any scientific, pedagogical or profes-
sional society in the world.
APA and psychology evolve. For exam-

value and what has stood the test of time. APA has done just that.
There is no question that APA has experienced some dark periods,
such as our Independent Review, but we have always learned and
eventually prospered.
When APA was founded 125 years ago, a group of individuals decided
that the status quo was no longer viable. They first met at Clark Univer-
ple, we had been mostly men, now we are
mostly women. We were mostly academ-
ics, now we are mostly practitioners.
Regardless of challenge, we have always
transformed and expanded our vision and
mission.
We are only as good as our future. We

sity in the summer of 1892 and subsequently as a small convention at the must feel comfortable in this time of
University of Pennsylvania in Philadelphia in December: 31 men from chaos, as we will not only survive but will
also prosper and lead.
various backgrounds came together to develop a new psychology.
And, as we move forward to embrace
Since then, we have gone from 31 membersall men, all white, all the future, here are some activities and
academicsto 117,675, of which over 60 percent are women, with a ideas central to APAs rebirth:
majority being clinicians. Today, more than 100,000 bachelors degrees in APAs internal management group is
being rebuilt.
APA is diversifying and expanding,
demographically, intellectually and
internationally.
APA is thinking in new ways. One
exciting activity is the Memorandum
of Understanding between APA and
IBM Watson to study the creation of
new models of artificial intelligence for
behavioral health and psychology.
We are focusing efforts not only to
make our role in mental health stron-
ger, but also to build our presence and
impact all of health care. From seeking
inclusion in the definition of physician in
Medicare to helping shape new health-
care policy, APA will be at the table and
results will be achieved.
Let us celebrate our history and
BROWNIE HARRIS

APA President expand our horizons: An APA for all

Dr. Antonio E. Puente members and a psychology for all of
society.

6 M O N I TO R O N P S YC H O LO G Y MARCH 2017
 Feedback

LETS CONSIDER SPIRITUALITY

In regard to your January article, Forgiveness Can Improve
Mental and Physical Health, while I am encouraged the
concept of forgiveness is being researched, I was disappointed
that other than a brief mention of religion, spirituality was
generally disregarded. Forgiveness, in my professional and
personal experience of dealing with
years of military service members
returning from war, is a vital com-
ponent to members overcoming
their symptoms guilt, grief and loss.
As psychologists, we often focus on
symptoms, but forgiveness is more
than a sum of symptoms. At the core
of forgiveness is a spiritual center. To
minimize this reduces forgiveness to an incomplete checklist.
This may be helpful in research but is lacking when evoking
real change. After a motorist ended my sons life I now know
how lacking psychological protocols can be when it comes to
the spiritual concept of forgiveness.
Andy M. Davidson, PsyD
Emerald Isle, North Carolina
NOW THAT YOUVE
FOUND YOUR CALLING,
MEET YOUR MENTOR.
At the College of Clinical Psychology at Argosy University,
youll nd more than just faculty, youll discover mentors.
Our professors share a deep commitment to you, the
next generation of professional psychologists. With
our integrated curriculum, youll go beyond books and
classrooms and receive the real-world clinical experience
that can help prepare you to be an effective and ethical
practitioner capable of providing diagnostic and
therapeutic services to a diverse population of clients.
And were proud to say that the Doctor of Psychology in
Clinical Psychology (PsyD) program at each of our ten schools
has received accreditation from the APA, certifying that they
meet their rigorous standards.
We are now accepting applications for Fall 2017 for the
Doctor of Psychology (PsyD) in Clinical Psychology
program.
Contact us today and start working toward your rewarding
career in clinical psychology.

MOVING IN THE RIGHT DIRECTION Learn more at clinical.argosy.edu/monitor

The Monitor continues to rock! The January Monitor cover
story, The Growing Refugee Crisis, really captures the
readers attention and focused on a relevant, mission-based
problem where psychologists can make a positive difference.
When I look at it, it speaks to APA moving in a positive,
mission-based direction. Great job!
Diana L. Prescott, PhD
Hampden, Maine

ON THE STAND
Having been trained by numerous judges to be a good witness,
I have one thing to add to your January article, Take the
Stand: In your testimony stick to the facts and, if asked,
how you arrive at your conclusions. Do not try to editorialize
or steer the judge to do what you think should happen. The
witnesss job is to state facts and conclusions, the judges job is
to render judgment about the case at hand. Whether theyre
The Doctor of Psychology in Clinical Psychology Program at Argosy University, Atlanta, Chicago, Hawaii,
told directly or indirectly, judges strongly dislike being told by Orange County, Phoenix, San Francisco Bay Area, Schaumburg, Tampa, Twin Cities and Northern
Virginia is accredited by the Commission on Accreditation of the American Psychological Association
witnesses what determination they should make about a case. (APA). Questions related to the programs accredited status should be directed to the Commission on
Accreditation: Office of Program Consultation and Accreditation, American Psychological Association,
Damon Tempey, PhD 750 1st Street, NE, Washington DC 20002 Phone: (202) 336-5979 / E-mail: apaacred@apa.org / Web:
www.apa.org/ed/accreditation
Lebanon, Oregon
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edited for space and clarity.
Argosy University is accredited by the Senior College and University Commission of the Western Association
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credential levels, technology, and scheduling options are subject to change. Not all online programs
are available to residents of all U.S. states. Administrative office: Argosy University, 333 City Boulevard
West, Suite 1810, Orange, CA 92868 2017 Argosy University. All rights reserved. Our email address is
materialsreview@argosy.edu
See auprograms.info for program duration, tuition, fees and other costs, median debt,
salary data, alumni success, and other important information.

M O N I TO R O N P S YC H O LO G Y M A R C H 2 0 1 7 7
AU-4024_PsyD_MonitrOnPsych-F1tm.indd 1 12/16/16 2:24 PM
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 In Brief
Research
Art Appreciation
W
hen evaluating art, laypeople are more likely
to rate a painting highly when they believe
that the work is worth a lot of money or
that other, high-status, people have deemed it good,
SYOLACAN/ISTOCKPHOTO
finds a study in Psychology of Aesthetics, Creativity and the
Arts. In two experiments, researchers asked 187 under-
graduates who had no prior art training to rate how
COMPILED BY LEA WINERMAN
much they liked 90 unfamiliar paintings. In the first,
participants who were told that a work had sold for a
lot of money rated it more highly than a control group
that had no information about its monetary value. In
the second experiment, students who were told that art
curators or fellow students liked a painting also rated
it more highly compared with a control group.
M O N I TO R O N P S YC H O LO G Y M A R C H 2 0 1 7 9
In Brief
PARTIAL TRUTHS truthful statements that none-
More than 50 percent of theless deceive the listener by
business managers admit to creating a mistaken impres-
paltering in negotiations, sionfor example a car seller less likely to feel gratitude in
according to research in the who says this car drives very
Journal of Personality and Social well, just last week it started
Psychology. Paltering is making up in 5 degree weather, but
neglects to mention that the car
failed to start two other times in
cold weather. In a series of two
pilot studies and four exper-
iments with a total of 1,750
participants, the researchers
found that palterers believe that
their actions are more ethically
acceptable than making factu-
ally untrue statements, but that
people who are deceived by pal-
tering judge it just as harshly as
any other deception.
BASHFUL KIDS
Shy children can face loneliness,
depression and difficulties in
school, but a good teacher-child
relationship may provide some
protection, suggests a study
of Chinese schoolchildren in
School Psychology Quarterly.
Researchers studied 1,275 third-
through seventh-grade students
in Shanghai. They looked at
self-reports from the children,
Teachers can
help protect peer reports, teacher ratings
shy children and school records to measure
from loneliness, the childrens shyness, popu-
depression and
difficulties in larity with peers, teacher-child
school. relationship quality, and aspects
of school adjustment includ-
ing depression and loneliness.
Shy children were less likely to
rate highly on peers popular-
ity ratings, and this association
predicted poorer academic
achievement, loneliness and
depression. But shy children
with a better relationship with
their teachers had fewer nega-
tive outcomes.
UNGRATEFUL
People who value autonomy
and independence may be
response to a gift or favor, which
could interfere with their bonds
with others, suggests research
in Cognition and Emotion. In
a study with more than 500
participants, researchers found
that people who self-reported a
higher level of autonomy (not
wanting to depend on others
or be depended on) reported
feeling less gratitude after receiv-
ing a hypothetical gift from a
friend. In a follow-up study,
they found that people higher
in autonomy focused more on
presenting themselves well and
less on supporting others in their
relationships, and that the lower
value they attached to grati-
tude was linked to their goals in
relationships.
ABORTION AND
MENTAL HEALTH
LEFT: TI-JA/ ISTOCKPHOTO; RIGHT: THE MACX/ ISTOCKPHOTO
Having an abortion does not
harm womens mental health, but
being denied access to abortion
does cause temporary psycho-
logical distress, finds a study in
JAMA Psychiatry. For five years,
researchers followed 956 women
who sought abortions at 21
clinics. They then compared the
women who had the abortions

Its the rule, not the
exception: Most people
will experience a mental
health disorder at some
point in their lives.
with those who were denied
them because they were past the
clinics gestational limit. Women
who had abortions did not expe-
rience more depression, anxiety,
low self-esteem or life dissat-
isfaction than those who were
denied them. In fact, women
who were denied the abortion
initially experienced more anx-
iety and lower self-esteem, but
the differences evened out by
six months later, regardless of
whether the women eventually
received an abortion elsewhere or
had the baby.
TOP: MARTIN-DM/ ISTOCKPHOTO; BOTTOM: CHONESS/ ISTOCKPHOTO
STAYING WELL
Most people will experience a
diagnosable mental health disor-
der at some point in their lives,
while those with lifelong mental
health are actually a minority
of the population. Thats the
finding of a review in the Jour-
nal of Abnormal Psychology that
examined data from national
health registries, epidemiolog-
ical retrospective studies and
prospective cohort studies. In
follow-up work, the researchers
examined data from a cohort
study in New Zealand to inves-
tigate factors that helped predict
enduring mental health. They
found that people with lifelong
mental health did not tend to be
born particularly wealthy or have
unusually good physical health
or unusually high intelligence.
However, they did have certain
helpful temperament/personality
styles and less family history of
mental disorder.
SLEEPING IN
When high schools start later
in the morning, teens get
more sleepa change with
potential safety benefits, finds
a meta-analysis in the Jour-
nal of Clinical Sleep Medicine.
Researchers analyzed 18 studies
and found that when comparing
students at schools with different
start times, students at schools
that started up to an hour later
got an average of 19 minutes
more sleep per night than their
peers at earlier-starting schools.
Teens benefit When schools started more
from an extra
hour to sleep in, than 60 minutes later, students
a review finds. average sleep duration increased
by 53 minutes. Later start times
were also associated with fewer
car accidents and less daytime
sleepiness.
A GOOD READ
Scientific papers arent typ-
ically known for the quality
of their prose, but a narrative
writing style may help papers
gain influence in their field,
finds an analysis in PLOS
ONE. Researchers analyzed
the abstracts of 732 papers on
climate change, coding each
for aspects of narrative style,
including setting (mention-
ing time and place), sensory
language and more. Papers
with a greater number of such
M O N I TO R O N P S YC H O LO G Y MARCH 201711
In Brief
Depression in airline pilots
may be underreported.
narrative elements were cited in
the literature more often, and the
higher-impact journals tended to
publish more narrative papers.
PILOT DEPRESSION
More than one in 10 airline
pilots report symptoms of
depression and 4 percent have
had recent suicidal thoughts,
finds a study in Environmental
Health. In an anonymous survey,
researchers asked more than
1,848 airline pilots to complete a
depression self-assessment. They
found that 233 (12.6 percent)
met the depression threshold and
75 (4.1 percent) reported sui-
cidal thoughts. Those who used
sleep-aid medication and those
who had experienced harassment
were more likely to be depressed.
The researchers suggest that
pilot depression is underreported
and that many pilots go without
treatment because airline rules
require them to be grounded if
they report symptoms andthey
fear it will hurt their careers.
12 M O N I TO R O N P S YC H O LO G Y
FALSE MEMORIES
Up to half of people can be
convinced to believe in a false
childhood memory, according
to a paper in Memory. Research-
ers recoded and analyzed eight
studies in which false memo-
ries were suggested to a total of
423 participants. Thirty percent
came to remember the ficti-
tious autobiographical event,
such as taking a hot air balloon
ride or playing a prank on a
teacher, even going so far as to
describe details of the memory.
MARCH 2017
Meanwhile, another 23 percent
showed signs that they accepted
the suggested event to some
degree and believed it really
happened.
WHO NEEDS
INTERVENTIONS?
A 45-minute test given at age 3
can predict which children will
grow up to consume a larger
share of societys resources, finds
an analysis in Nature Human
Behaviour. Researchers analyzed
data from a 35-year study of
more than 1,000 New Zea-
landers. They found that at age
38, one-fifth of participants
accounted for 81 percent of
criminal convictions, 78 percent
of prescription drug use, 66
percent of welfare benefits, 57
percent of hospital visits and
40 percent of obesity in the
cohort. The researchers also
found that a 45-minute test the
Memory is participants had taken at age
malleableup to 3which measured intelli-
half of adults can
be convinced to gence, receptive language and
believe in a false motor skills, restlessness and
autobiographical impulsivitycould predict who
memory.
would end up in the high-cost
group. Such a test could be used
to figure out which children
would benefit most from early
TOP: AD_DOWARD/ ISTOCKPHOTO; BOTTOM: ALUBALISH, OZGUR COSKUN/ ISTOCKPHOTO
childhood interventions, the
researchers say.
HEAR WHAT?
Children as young as age 4
incorporate expectations and
background knowledge to help
them interpret ambiguous
speech, finds research in Psycho-
logical Science. Researchers asked
43 children to look at pictures of
two scenes, one plausible (my
cat has three kittens) and one
implausible (my cat has three
 hammers) while a recorded
speaker described either the
plausible or implausible scene.
The children were asked to
choose which scene matched the
sentence they heardwhich they
did accurately. In subsequent
trials, the sentences describing
the plausible and implausi-
ble scenes were phonologically
similar (I eat carrots and peas
versus I eat carrots and bees).
If the speaker had described
an implausible scene in earlier
trials, the children were now
TOP: STURTI/ ISTOCKPHOTO; BOTTOM: HALFPOINTI/ ISTOCKPHOTO
more likely to correctly choose
the implausible scene when it
matched the sentence (bees).
But if the speaker had described
a plausible scene earlier, the
children were now more likely
to choose the plausible scene
even when it did not match the
sentenceas if they were correct-
ing for mispronunciation by the
speaker.
ALCOHOL AND TEENS
Heavy drinking during adoles-
cence is associated with changes
in brain structure, even in teens
without a diagnosed alcohol use
disorder, suggests research in
Addiction. Researchers used MRI
to image the brains of 65 partic-
ipants35 heavy drinkers and
27 controlsthree times over 10
years. Participants were ages 13
to 18 when the study began, and
none had a diagnosed alcohol use
disorder. All were academically
successful. However, among the
heavy-drinking participants, gray
matter volume was decreased in
the anterior cingulate cortex and
in the right insula, suggesting that
heavy drinking could disrupt mat-
uration in the teen brain.
PREGNANCY BRAIN
Pregnancy can cause long-last-
ing changes in womens brain
structure that may enhance the
mothers parenting skills, suggests
a study in Nature Neuroscience.
Heavy drinking Researchers used MRI to scan
could disrupt brain the brains of 25 first-time moms
maturation in
teens. before their p
regnancies and again
soon after they gave birth. In the
post-pregnancy scan, the research-
ers found significant reductions
in gray matter volume in corti-
cal regions associated with social
cognition. Scans done two years
later found the changes remained.
The researchers did not find any
changes related to the womens
Its not just a womans
body that changes
during pregnancy
researchers have found
evidence of long-lasting
brain changes, too.
M O N I TO R O N P S YC H O LO G Y MARCH 201713
In Brief
memory or other cognitive skills.
They hypothesize the brain
changes may reflect synaptic
pruning that increases the
efficiency of mothers brains
at, for example, detecting their
babys emotional state and
assessing threats to the baby
from others.
HEALTHY VALUES
Affluent teens fare better when
their parents emphasize kind-
ness and other prosocial values
at least as much as academic
achievement, finds a study in
the Journal of Youth and Adoles-
cence. Researchers studied 506
teens at a predominantly white,
upper-middle-class middle
school, asking them about their
perceptions of what their parents
value most, as well as about
parental criticism, psychologi-
cal symptoms and self-esteem.
The researchers also gathered
data on grade-point averages
and teacher-reported classroom
behavior.Children whose par-
ents placed greater or the same
level of emphasis on prosocial
behavior as on achievement
had higher school perfor-
mance, higher self-esteem and
fewer psychological symptoms
than children whose parents
placed greater emphasis on
achievement.
MONKEY SAY
The limits of monkeys brains
not their vocal cordskeep
them from speaking, suggests
research in Science Advances.
Nonhuman primates are not
able to produce human speech
sounds, and researchers have
generally believed that is
because their larynx, tongue
14 M O N I TO R O N P S YC H O LO G Y
Deaths from drugs,
alcohol and mental
disorders nearly tripled
in the United States
since 1980.
and lips are not flexible enough
to do so. But in a new study,
researchers used X-ray video to
study the mouths and throats
of macaque monkeys, then used
the video to build a computer
model of the monkeys vocal
tract. Acoustic simulations with
the computer model indicate
the vocal tract could produce
speech sounds, which suggests
MARCH 2017
that human speech evolved due
to changes in the brain, not the
vocal anatomy.
Monkeys could
talk if only CAUSE OF DEATH
they had the
brainpower to The death rate from drugs,
do so, a study alcohol and mental disorders
suggests. in the United States nearly
tripled from 1980 to 2014, but
there were substantial vari-
ations by geographic area,
finds a county-level analysis of
death registration data from
the National Vital Statistics
System, published in JAMA.
A total of 3,110 counties or
clusters of counties were exam-
TOP: KAREN MASSLER/ ISTOCKPHOTO; BOTTOM: 4FR/ ISTOCKPHOTO
ined. More than 2,000 counties
saw increases of 200 percent
or more, and some clusters of
counties in Kentucky, West
V irginia and Ohio saw increases
greater than 1,000 percent, the
researchers found.
For direct links to the research cited
in this section, visit our digital edition
at www.apa.org/monitor/digital.
 Datapoint

NEWS FROM APAS CENTER FOR WORKFORCE STUDIES

RETIRED
PSYCHOLOGISTS: FIGURE 1
Psychologists Who
FIGURE 2
Hours Worked by
DO THEY REALLY Return to Work After Previously Retired
STOP WORKING? Retirement Psychologists
In 2013, about 24 percent of all Mean hours per week, by age
U.S. psychologists (those whose
< 50 40 hours
highest degree was a doctorate or
professional degree in psychology) 24 In 2013, % of psychologists*
5054 40
had previously retiredthats who had previously retired
approximately 53,000 retirees.1
Of these retired psychologists ... 5559 29
But 42 percent of them were
still working, and 1 percent were ... % not working ... % still working
6064 29
looking for work. Fifty-seven 57 42
percent were retired and not ... % looking for work: 1 6569 26
working. (Figure 1)
* Includes individuals whose highest degree is a doctoral
Of those psychologists who or professional degree in psychology > 69 21
were working after having retired,
80 percent were working in a
psychology-related field, and 45 FIGURE 3
percent were working 35 hours
or more per week. Psychologists
Psychologists Age at Full Retirement
worked fewer hours as they 48.2
became older. (Figure 2) 44.9

Of those psychologists who were

retired and not working, the median
age at full retirement was 61. % of MALE psychologists 33.1
Women tended to retire at earlier % of FEMALE psychologists 30.1
ages than men. (Figure 3) % of ALL psychologists

19.3
18.0 17.2
15.8 15.3 15.1
12.4 12.3
9.1
7.0

0.3 0.1 1.8

0
AGE: < 50 5054 5559 6064 6569 > 69
Source: National Science Foundation, National Center for Science and Engineering Statistics. (2013)

By Luona Lin, MPP, Karen Stamm, PhD, and Peggy Christidis, PhD
For more information, contactcws@apa.org.
BILL WEBSTER

National Science Foundation, National Center for Science and Engineering Statistics. (2013). National Survey of College Graduates Public Use Microdata File and Codebook.
1

Retrieved from https://sestat.nsf.gov/datadownload/. Examples of retirement include mandatory retirement, early retirement or voluntary retirement. Respondents over age 75
were not included in this survey. The use of NSF data does not imply NSF endorsement of the research, research methods or conclusions contained in this report.

M O N I TO R O N P S YC H O LO G Y MARCH 201715
News Feature
ARTHUR C. EVANS JR.
IS NAMED APAS NEW CEO
The former Philadelphia commissioner is known for his
transformational and trailblazing leadership style
BY KIM I. MILLS
P
sychologist Arthur C.
Evans Jr., PhD, has
been named APAs chief
executive officer. Evans, who
assumes the post on March 20,
comes to APA after 12 years
as commissioner of Philadel-
phias Department of Behavioral
Health and Intellectual dis-
Ability Services, a $1.2 billion
health-care agency that is the
behavioral health and intellectual
disabilities safety net for 1.5 mil-
lion Philadelphians. While there,
he realigned the agencys treat-
ment philosophy, service-delivery
models and fiscal policies to
improve health outcomes and
increase the efficiency of the
system.
His broad experience will be
a tremendous asset for APA, say
association leaders. Dr. Evans
will take the helm of the Amer-
ican Psychological Association
at a critical juncture, as we mark
APAs 125-year anniversary,
says APA President Antonio E.
Puente, PhD. He is a trailblazer
who has relied on the strength of
his background in both research
and clinical practice to create
transformational change in each
16 M O N I TO R O N P S YC H O LO G Y
of the mental health systems he
has led. We look forward to Dr.
Evans vision and inspirational
leadership skills to promote the
association as the pre-eminent
organization advancing psycho-
logical science, education and
practice in the public interest,
and supporting psychologists in
the United States and beyond.
Evans says he is honored to Dr. Arthur C.
be selected as APAs next CEO. Evans Jr. officially
takes the CEO
The American Psychological post on March 20.
Association has a long, distin-
guished history of developing
the best psychological science
and applying it to benefit society
and improve peoples lives. I
hope to bring to this position not
only a passion for psychology,
but the leadership experience to
help move the associationand
the disciplineinto the next era
of excellence and contribution to
our society.
Evans holds a doctorate in
clinical/community psychology
from the University of Maryland
and a masters degree in experi-
mental psychology from Florida
Atlantic University, where he
MEL EVANS
also completed his undergrad-
uate work. Before his work in
MARCH 2017
 Philadelphia, he was deputy
commissioner of the Connecti-
cut Department of Mental
Health and Addiction Services,
where he led major strategic
initiatives in the states behav-
ioral health-care system. He
also developed a thriving private
practice.
Evans is the author or
co-author of 40 peer-reviewed
research articles and of
numerous chapters, reviews and
editorials. He has served as an
associate clinical professor in the
department of psychiatry at Yale
University School of Medicine
and as a clinical associate at
the University of Pennsylvania
Perelman School of Medicine.
He has been recognized
nationally and internationally as
an innovative and effective pol-
icymaker. Among his numerous
awards, he was named by the
White House Office of National
Drug Control Policy as an
Advocate for Action in 2015. In
2013, he received the American
Medical Associations top gov-
ernment service award in health
care, the Dr. Nathan Davis
Award for Outstanding Govern-
ment Service, for his leadership
in transforming the Philadelphia
behavioral health system, partic-
ularly around the adoption of a
public health framework.
Evans will also serve as CEO
of the associations companion
organization, the APA Practice
Organization, which supports
and promotes the interests of
practicing psychologists. He
succeeds Norman B. Anderson,
PhD, who resigned at the end
of 2015. Cynthia D. Belar, PhD,
has been serving as interim
CEO since that time.

M O N I TO R O N P S YC H O LO G Y MARCH 201717
Advocacy in Action
APA CONTINUES ITS WORK
TO ADDRESS POVERTY
The association is working to protect access to mental health care, boost
the minimum wage and defend other programs that help low-income people
P
overty brings with it
a heavy psychologi-
cal burden, according
to a growing body of
research. Socioeconomic
scarcity has been linked
to such negative emotions as depression
and anxiety. We all have limited atten-
tion, which restricts how much we can
focus on at any one time. Low-income
people are forced to focus on daily
stressors such as a lack of money or even
food, which can undermine their cog-
nitive functioning and ability to make
helpful decisions. And, as a new study
by Cornell University psychologist Gary
Evans, PhD, finds, adults who grew up
in impoverished families exhibit more
chronic physiological stress, more defi-
cits in short-term spatial memory, more
feelings of helplessness and more anti-
social conductsuch as aggression and
bullyingthan those of middle-income
families (Proceedings of the National
Academy of Sciences, 2016).
What this means is, if youre born
poor, youre on a trajectory to have
more of these kinds of psychological
problems, says Evans, a professor of
environmental and developmental psy-
chology at Cornell.
APA has long recognized the role
that poverty plays in all aspects of health.
Now, in light of the agendas put forth by
President Donald J. Trump and the 115th
Congress, the psychology organization is
redoubling its advocacy for key policies
that affect low-income Americans. The
most recent efforts include:
18 M O N I TO R O N P S YC H O LO G Y
Poor children exhibit more chronic stress
and more feelings of helplessness than
children of middle-income families.
Protecting
Medicaid and the
Affordable Care Act (ACA). A significant
threat to economically disadvantaged
Americans is the possibility of a repeal
of the ACA, which has given health-care
coverage to over 15 million previously
uninsured Americans. A new report from
the nonpartisan Congressional Budget
Office found that if Congress repealed
the act, 18 million Americans would
lose their insurance in the first year, and
individual insurance premiums could
double in 10 years. On Jan. 6, APA and
the Practice Organization urged their
Federal Action Network and Federal
Advocacy Coordinators, respectively,
to tell Congress not to repeal the ACA
MARCH 2017
without simultaneously replacing the law
with legislation that fully protects access
to care and coverage of mental health and
other essential benefits. So far, psycholo-
gists have sent more than 7,000 messages
to Congress.
APA and the Practice Organization
also sent a letter to Speaker of the House
Paul Ryan (R-Wis.) and Senate Majority
Leader Mitch McConnell (R-Ky.)
expressing that many ACA provisions
have improved Americans access to
health care and mental health treatment
and noting that any future legislation
should continue to include such key
provisions as coverage of people with
pre-existing conditions.
In addition, as members of the
Mental Health Liaison Groupa
coalition of over 60 national orga-
nizationsAPA and the Practice
Organization sent a letter to U.S. House
and Senate leaders, asking them to
safeguard mental health parity, the ACA
and the recently enacted 21st Century
Cures Act, which includes mental health
reform legislation.
Fighting for child nutrition. APA
has worked to oppose legislation that
would eliminate free school meals
for economically disadvantaged chil-
dren. Specifically, the Improving Child
Nutrition and Education Act of 2016
would have eliminated 7,000 of the
OLESIABILKEI/ ISTOCKPHOTO
18,000 low-income schools currently able
to provide free breakfast and lunch to all
their students through the Community
Eligibility Provision. The bill would also
have weakened evidenced-based school
nutrition standards for meals, snacks and
beverages. If the legislation had been
enacted, many low-income children
would no longer have had access to the
nutritious meals they need for health and
learning. Thanks in part to advocacy by
APA and its coalition partners, the bill
died in the 114th Congress.
Supporting paid family medical leave.
The United States is the only industri-
alized nation in the world that does not
guarantee paid family leave, and only 13
percent of U.S. workers have access to
paid family leave through their employ-
ers. This leaves many Americans with
the painful choice of either taking care
of their newborn or paying their bills. In
an effort to better support all American
families, APA strongly supports the
Family and Medical Insurance Leave
(FAMILY) Act, recently re-introduced
in the 115th Congress. It would create
a national paid family and medical leave
insurance program that would enable
employees to earn paid leave for preg-
nancy, childbirth, serious health issues, or
caring for a family member.
Raising the minimum wage. The cur-
rent federal minimum wage of $7.50
an hour is not enough to lift a full-time
worker with a child above the poverty
line. Research shows that even a modest
income increase for poor families leads
to better long-term outcomes for their
children, including more education, less
criminality, less substance abuse, and
fewer emotional and behavioral disorders.
Thats why APA has supported the Raise
the Wage Act, which would increase the
minimum wage to $8 an hour with an
annual increase of $1 until it reaches $12.
Speaking out against discrimination of
unemployed people. Americans who have
been out of workespecially those who
have been unemployed for six months or
longermay face discrimination arising
from the belief that poverty and unem-
ployment are personal moral failings,
rather than a result of structural factors.
APA has confronted that stigma by sup-
porting the Fair Employment Opportunity
Act (later incorporated into the Jobs! Jobs!
Jobs! Act), which would prevent employers
from discriminating against job seekers
because of unemployment.
To participate in APAs public policy advocacy
efforts, join the Federal Action Network at http://
cqrcengage.com/apapolicy/apaactionalerts.
M O N I TO R O N P S YC H O LO G Y MARCH 201719
News Feature
WILL NIMH HAVE
A BROADER MISSION?
Psychologists are asking the new director of the
National Institute of Mental Health to increase the
agencys support for psychosocial research
BY LEA WINERMAN
O
ver the past decade,
the National Insti-
tute of Mental Health
(NIMH)the primary source of
federal funding for mental health
researchhas shifted many of its
research dollars from psychoso-
cial and clinical research toward
neuroscience. Now, as Joshua
Gordon, MD, PhD, begins
his tenure as the agencys new
director, psychologists and other
behavioral scientists are asking
him to consider rebalancing the
agencys more than $1.4 billion
budget to increase support for
psychosocial and clinical research.
The request comes after a
decade of increased spending on
neuroscience. According to an
agency review, between 2005 and
2014, the budget for NIMHs
Division of Neuroscience and
Basic Behavioral Research
(which primarily funds neuro-
science and genomics research)
increased by 28 percent, while the
budget for its Division of Ser-
vices and Intervention Research
decreased by 12.8 percent.
In addition, an analysis by
Fordham University psychology
professor Dean McKay, PhD,
found that in 1997, funding was
split nearly evenly between bio-
medical and psychosocial studies,
but that by 2015, psychosocial
20 M O N I TO R O N P S YC H O LO G Y MARCH 2017
research had shrunk to just
under 30 percent of the NIMH
portfolio.
To raise awareness of the
issue, APA held a briefing in
October for more than 100
congressional staff and federal
agency officials to discuss the
benefits of a diverse NIMH
research portfolio.
Overall, its a trend that many
psychologists and other social
scientists find worrying.
Basic research is very
important and may lead to appli-
cations in the future, but often
these applications take years or
decades to reach, says Gordon
Nagayama Hall, PhD, a profes-
sor of psychology and director
of the Center on Diversity and
Community at the University of
Oregon. Meanwhile, there are
urgent mental health needs of a
nation, and particularly commu-
nities of color, that are not being
addressed.
Hall and other advocates are
taking advantage of the agencys
change in leadership to make
their case, in both public forums
and private conversations, on
several intertwined issues. In
June, for example, 20 current and
former members of the agen-
cys National Advisory Mental
Health Council published an
editorial in the British Journal of
Psychiatry discussing the tradeoff
between the long-term potential
of neuroscience research and the
potential short-term benefits of
research on prevention and treat-
ment strategies.
In a Washington Post op-ed
in October, one of those former
council members, Columbia
University psychiatry professor
Roberto Lewis-Fernandez, MD,
wrote Such a disproportion-
ate emphasis [on neuroscience]
is as unwise an investment
approach as a retirement port-
folio made up only of high-risk
investments.
What the scientists want to
NIMH make clear is the necessity of
FUNDING psychological science for NIMH
The NIMH budget to achieve its goals.
remained fairly flat
We are not advocating for
(from $1.42 to $1.45
million) between psychological science as some
2005 and 2014. kind of guild issue, or to protect
But some divisions our turf, says Bethany Teachman,
saw an increase PhD, chair of the Coalition for
while others saw a
the Advancement and Appli-
decrease:
cation of Psychological Science
Neuroscience and (CAAPS), an advocacy group for
Basic Behavioral clinical science. To effectively
Research reduce the burden of mental
+28% illness, its essential to recognize
the role of psychosocial, cultural
Translational
and behavioral research.
Research
For his part, Gordon, who
-12.8% was previously a psychiatry
Services and professor at Columbia Univer-
Intervention sity and is the agencys first new
Research director in 13 years, says that he
-16.7% does not foresee any immediate
large changes in funding strategy,
but hopes to spend his first year
in the job hearing from those
doing research out in the field.
I want to get out there and
listen and learn, to figure out
what are the questions that are
really affecting care delivery right
 NIMH shifted funding
to neuroscience from
psychosocial and
clinical research in
the last 10 years.
now ... so that we can hit that
short-term pay dirt, he says.
Among the concerns that
psychologists and others have
already shared with Gordon
about care delivery is a short-
age of research on diversity and
mental health disparities in the
NIMH portfolio. In December,
Hall and two colleagues sent a
letter co-signed by 17 profes-
sional organizations, including
three APA divisions, underscor-
ing the importance of clinical
research with communities of
color and other underrepresented
groupswhich McKays analysis
found comprised less than 7 per-
cent of the agencys grants.
Other researchers are con-
cerned that aspects of the way
NIMH evaluates grant pro-
ILEXX/ ISTOCKPHOTO
posals make it difficult for
psychosocial researchers to
receive fundingand may even
discourage them from applying.
For example, three years ago, the
agency changed its guidelines
for clinical trials to an experi-
mental therapeutics approach,
in which researchers must
demonstrate that their inter-
vention works through an effect
on a specific molecular, cellu-
lar, circuit or behavioral target.
Many researchers say that this
approach is not always possible
with psychosocial interventions.
It makes it very difficult for
researchers to submit propos-
als, when something has a lot
of promise, but doesnt fit the
guidelines, says Patricia Aren,
PhD, a professor of psychology
at the University of Washing-
ton who just finished a term on
the National Advisory Mental
Health Council.
Gordon says that he would
like to explore this and other
issues in more conversations.
He believes, for example, that
the experimental therapeutics
approach will help researchers
get more useful data out of even
failed clinical trials. But, he says,
I need to learn more about why
its more difficult [for psychoso-
cial interventions], and what we
need to do at NIMH to make it
more straightforward to figure
out what target youre trying to
hit when you do a psychosocial
intervention. If we cant do that,
then yeah, we need to make
exceptions. But I think its too
early to say it doesnt work.
More broadly, he says, he
is looking forward to more
For more on APAs
recent congressional
discussions with psychologists
briefing on the and others to help figure out
benefits of a diverse
the ideal balance of research at
research portfolio,
go to www.apa. the agency. Thats an important
org/science/about/
psa/2016/10/funding-
question to ask and a very, very
priorities.aspx. challenging one to answer.
M O N I TO R O N P S YC H O LO G Y MARCH 201721
News Feature
NEW LEASE ON LIFE
FOR TROUBLED INMATES
Psychologists are leading efforts to improve the mental and
emotional health of seriously mentally ill, violent offenders
BY TORI DEANGELIS
J
ust one year ago, Allen-
wood, Pennsylvania, inmate
Shawn Jackson, 41, would
not have been allowed to go
anywhere outside his cell without
handcuffs or leg restraints.
Convicted at age 15 of
manslaughter and placed in a
high-security facility for juveniles,
Jackson has since spent much
of his time in maximum-secu-
rity settings for other offenses
including assaulting a correctional
officer. With the added difficulty
of a serious mental illness, prison
officials deemed it too dangerous
to give him unrestricted access to
staff or other inmates.
APA WORKS TO IMPROVE CONDITIONS FOR INMATES
A PA has been advocating for
prison reforms that aim to
reduce high recidivism rates, including
humane and effective programming
for seriously mentally ill offenders.
In December, for example, APA
and the National Association of Social
Workers launched the Consensus
Workgroup on Behavioral Health
Issues in Criminal Justice, a coalition
of 16 organizations that will work col-
laboratively on policy, research and
practice issues related to the role of
behavioral health in criminal justice.
22 M O N I TO R O N P S YC H O LO G Y MARCH 2017
Today, not only does Jackson
attend events outside his cell
without restraints, but hes help-
ing fellow inmates work on the
behavioral problems that landed Thanks to a
them in prison.One of my goals new program,
Shawn Jackson
is to be a role model, to help (pictured at
[my fellow inmates] overcome right) is no
behavioral issues and mental longer strictly
confined or
illness issueswhatever the sit- restrained.
uation may be that theyre going
through, Jackson says.
This remarkable turnaround
is the result of a bold experiment
launched by the U.S. Bureau
of Prisons in 2013 for violent,
mentally ill inmates who had
previously been confined to
The event, held at APA headquarters,
featured such top speakers as Sen.
Al Franken (D-Minn.) and representa-
tives from federal and state prisons,
the New York City jail system and the
U.S. Department of Justice, as well
as homeless service providers and a
former inmate. health care they need only after they
Last year, APA urged Congress to
approve funding for 130 new psychology
and mental health staff positions in the
U.S. Bureau of Prisons. Some of those
positions would be aimed specifically at
improving restrictive housing conditions
cells nearly full time. Inmates
in a Secure Mental Health
Step-Down Units or STAGES
program (depending on the type
of mental health condition the
inmates have), are housed for
at least 16 to 18 months in a
treatment-oriented environment
that fosters psychosocial and
emotional growth. There, they
engage in up to 20 hours a week
of group and individual therapy
sessions, peer bonding, recreation,
shared meals and work and other
activities, with the aim of moving
to less restrictive environments
when they are well enough.
Its a much richer, more
intensive experience than typical
prison life, says Alison Leuke-
feld, PhD, chief of the bureaus
mental health services, who
oversees the programs.
TAILORED PROGRAMS
The units were created as a result
of a class action lawsuit filed
in 2012 by inmates at the U.S.
Penitentiary, Administrative
for inmates with serious mental illness,
including creating more secure men-
tal health step-down units staffed by
psychologists and other mental health
workers.
Far too many Americans receive
the physical, mental and behavioral
COURTESY OF FEDERAL BUREAU OF PRISONS
become involved in the criminal jus-
tice system, says APA Senior Policy
Associate Micah Haskell-Hoehl. We
need to ensure and sustain the best
outcomes for these individuals and for
society.Tori DeAngelis
One of my goals is to be
a role model, to help [my
fellow inmates] overcome
behavioral issues and
mental illness issues.

M O N I TO R O N P S YC H O LO G Y MARCH 201723
News Feature
Maximum Facility, a super-
max prison for male inmates in
Florence, Colorado. In addition,
audits initiated by the agency
recommended expanding mental
health care services for mentally
ill inmates in restrictive housing.
In response, the bureaus exec-
utive staffalong with input
from a number of disciplines
including correctional services,
psychology, health and oth-
ersworked to tailor programs
that were successful in other
prison settings to this popula-
tion. The first secure step-down
program was launched at the
U.S. Penitentiary in Atlanta in
2013, followed by a STAGES
program at the U.S. Penitentiary
in Florence in 2014 and a secure
step-down program at the U.S.
Penitentiary in Allenwood in
2015.
Due to the complexity
of inmates issues, each unit
has an inmate-to-treatment
provider ratio of six to one.
(By contrast, typical restricted
environments receive men-
tal health services as needed
from psychologists who also
IS A PRISON-BASED INTERNSHIP FOR YOU?
W hen Maegan Malespini, PsyD,
did a practicum at a state
prison as a graduate student, she was
surprised at how much she loved the
work. Seeing every conceivable men-
tal health problem was like being in a
learning laboratory, and when inmates
made progress, it was extremely grat-
ifying. Today, she heads a Secure
Mental Health Step-Down Unit at
the Federal Corrections Complex in
24 M O N I TO R O N P S YC H O LO G Y
serve the larger institution.)
To oversee the 30 inmates at
the Allenwood site, for exam-
ple, psychologist and program
coordinator Maegan Males-
pini, PsyD, heads a staff that
includes three licensed clinical
psychologists and two mas-
ters-level mental health staff.
Inmates at Atlanta and Allen-
wood tend to have psychotic
and mood disorders including
schizophrenia, bipolar dis-
order, major depression and
post-traumatic stress disorders,
while those at STAGES have
personality disorders including
borderline personality disor-
der and antisocial personality
disorder. An inmates violent
behavior may or may not be
related to his mental illness,
and many of these offenders
have long-standing histories of
trauma, further complicating
diagnosis and treatment plans.
Theyve certainly done a lot
of harm to others in the course
of their lives, says Patti But-
terfield, PhD, deputy assistant
director of the Bureau of Prisons
re-entry services division, but
Allenwood, Pennsylvania, where she
oversees interventions with violent,
seriously mentally ill inmates.
In fact, the U.S. Bureau of Prisons is
a rich source of internships and prac-
tica for psychology doctoral students,
offering a chance to gain assessment,
research, consulting and clinical skills,
says Phil Magaletta, PhD, who heads
the bureaus psychology internship
program.
MARCH 2017
many have had a lot of harm
done to them, as well.
Teamwork with other staff
membersespecially correc-
tions staffis likewise a vital
component of the program, says
psychologist Phil Magaletta,
PhD, the bureaus chief of clin-
ical education and workforce
development. They tend to know
the inmates better than any-
one, and inmates are often more
comfortable communicating
with them than with treatment
providers or other staff. As such,
they can and do provide valuable
feedback on inmates behavior,
he says.
Given the shared experience
of 40-hour weeks working with
difficult clientele, [mental health
staff and corrections officers]
learn its in their best interests
to understand that theyre on
the same team, he says. These
days, theyre also trained to learn
the basics of the others roles,
so communication tends to be
good, he adds.
A central focus of inmates
activity time is group therapy
sessions, where psychologists
The bureau sponsors 12 accred-
ited, paid internship programs, each
with several internship slots. The latest
addition is at Allenwood, and includes
rotations through the secure step-
down unit. The bureau also sponsors
paid and volunteer practica at several
locations nationwide.
To find out about Bureau of Prisons
internships, visit www.bop.gov/jobs/
psychology_intership.jsp.
 and other treatment specialists
teach cognitive-behavioral and
other strategies to help inmates
manage their mental illnesses,
regulate their emotions, develop
social skills, and address thinking
that can lead to violence and
criminality, such as aggressive or
antisocial behavior.
Opportunities to address
these thinking errors come up
regularly, allowing inmates to
practice their responses, says
Butterfield. Two inmates may
fight over who gets to use the
telephone first, while another
may lash out at his case man-
ager when he receives bad news.
Inmates are taught how to ana-
lyze the thought patterns that
led up to their reactions and to
consider more rational, prosocial
alternatives. Theres group input,
too, with inmates actively help-
effective at engaging partici-
pants in the program, she says.
The Bureau of Prisons
has been impressed by the
programs success: At Allen-
wood, for example, 18 of the
30 participants had clear
conduct for the year, receiving
not a single incident report,
Malespini says. For a lot of
them, thats never happened
in their prison careers, she
says.In fact, says Leukefeld,
the programs are becoming a
key part of the bureaus plan
for providing mental health
treatment to inmates with
serious mental illness.
For his part, Jackson likes to
tick off the strategies that have
helped him improve his own
thoughts and actions: breathing
deeply, using respectful words
to make feelings and needs
known, helping others, and when
something upsets you, distract-
ing yourself and thinking about
something else.
I like to think of it this way:
When you see that an accident is
about to occur, before it happens,
look ahead and get into another
lane, he says.
Im still a work in progress,
Jackson admits. But as a unit,
were striving to get better. Its a
climb up the mountain, but we
can make it.

YOUR
ing each other better understand
their problems.
Peers also assist through a
peer companion program that

NEW
enables inmates like Jackson,
who are working to recover, help
those who are not as far along.
These companions become
experts in the core therapy cur-

CAREER
riculum and use their skills to
support fellow inmates by meet-
ing regularly to talk, attending

HERE
activities with them, modeling
good behavioreven bunking
STARTS
with their companions if an
inmate has progressed suffi-
ciently to enable him to move
through the unit unrestricted, a
gradual process that entails gain-
ing sufficient skills, confidence
and trust with treatment staff,
Leukefeld explains. www.PsycCareers.com
TIERO/ ISTOCKPHOTO

While the peer companions

dont provide mental health
services per se, theyre very

M O N I TO R O N P S YC H O LO G Y MARCH 201725
News Feature
PERSONALIZED MEDICINE
TO HELP SMOKERS QUIT
A simple test could help doctors match the right smoking
cessation medication to the right patient
BY LEA WINERMAN
A
lmost 70 percent of
U.S. smokers want to
quit, according to a
Centers for Disease Control and
Prevention survey, but each year
only a small percentage of those
who try to kick the habit succeed.
Even among smokers who are
prescribed a smoking- cessation
medication, quit rates range from
just 7 percent to 30 percent, one
review found.
Researchers are working to
help health-care providers improve
those rates by figuring out which
patients will respond best to which
medications. Theyve found that
a biomarker called the nicotine
metabolite ratiomeasured by a
simple blood or saliva testcan
help determine which of the two
main types of FDA-approved
smoking-cessation medications
will work best for an individual
smoker.
Our goal is to understand
how we can modify the use of
existing medications in ways that
make them more effective, says
Robert Schnoll, PhD, a psychol-
ogist and associate professor in
the department of psychiatry at
the University of Pennsylvania.
He and his colleagues have
found, for example, that people
whose bodies metabolize nico-
tine more quickly do better on
varenicline, a dopamine agonist
26 M O N I TO R O N P S YC H O LO G Y
that can reduce cigarette crav-
ings. Slow metabolizers, on the
other hand, do just as well with
nicotine-replacement therapy
(like a nicotine patch)a far less
expensive medication that gener-
ally has fewer side effects.
Now, researchers are working
to better understand the reward
pathways in the brain that may
underlie the differences between
faster (sometimes called nor-
mal) metabolizers and slower
ones, and to move their findings
from the laboratory to clinicians
offices, where more patients can
benefit from them.
FROM LIVER TO BRAIN
The nicotine metabolite ratio is
simply a measure of how quickly
a persons body breaks down
nicotine. One of the primary
drivers of that process is a liver
enzyme called CYP2A6. By look-
ing at the ratio of a longer-lasting
CYP2A6 metabolite called
cotinine to a shorter-lasting one
called 3-hydroxycotinine, the
nicotine metabolite ratio can
indicate whether a person is a
slower nicotine metabolizer or a
faster one.
Neal Benowitz, MD, and
colleagues at the University of
California, San Francisco, and
University of Toronto first devel-
oped the nicotine metabolite
MARCH 2017
ratio test more than a decade
ago. In a series of studies, they
found that the ratio is related
to smokers smoking behavior.
Normal metabolizerswho
likely need to take in more
nicotine to maintain the same
level in the bodysmoke more
cigarettes per day (Clinical Phar-
macology and Therapeutics, 2006),
inhale larger volumes of smoke
(Cancer Epidemiology, Biomark-
ers and Prevention, 2011) and
smoke their first cigarette earlier
each day, on average, than slow
metabolizers do.
Building on that work,
researchers began studying how
the nicotine metabolite ratio
might affect smokers ability
to quit and reaction to smok-
Even among ing-cessation medications.
In a randomized prospective
smokers study published in 2015, Univer-
who use a sity of Pennsylvania psychologist
smoking- Caryn Lerman, PhD, and Uni-
cessation versity of Toronto pharmacology
medication, professor Rachel Tyndale, PhD,
quit rates with Schnoll, Benowitz and
other colleagues, assigned 1,246
range smokers (662 slow metabolizers
from just and 584 normal metabolizers)
7 percent to to receive either the nicotine
30 percent. patch, varenicline or a placebo
treatment. Immediately after the
treatment and at a six-month
follow-up, they found that
normal metabolizers were much
more successful with varenicline
(22 percent remained abstinent
after six months) than the patch
(13.6 percent). Among slow
metabolizers, however, there was
no significant difference between
the two treatments (The Lancet
Respiratory Medicine, 2015).
The researchers also found
that slow metabolizers had more
side effects (including nausea,

insomnia and diarrhea) on vareni-
cline than on the patch, but that
normal metabolizers did not.
That means using the nic-
otine metabolite ratio to sort
smokers into slow versus normal
metabolizers could help smokers
minimize side effects and max-
imize their chances of quitting
when choosing medication.
Why does it work? Research-
ers arent yet entirely sure, but
brain-imaging studies are begin-
ning to provide some answers.
They suggest that the rate at
which people metabolize nicotine
may, over years of smoking, lead
to differences in the brains of
normal- and slow-metabolizing
MARKFGD/ ISTOCKPHOTO
smokers that could affect behavior.
In one study, Eliot Stein,
PhD, chief of the Neuroimaging
Research Branch at the National
Institute on Drug Abuse (NIDA)
intramural research program, used
fMRI to image the brains of 23
smokers and 23 nonsmokers
all of whom were temporarily
abstinent from cigarettes before
the experimentwhile they
anticipated a reward in a game.
Half of the participants were
normal metabolizers and half
were slow (Tyndale, who collab-
orated on the research, measured
this by testing their genotype,
because different variants of the
CYP2A6 gene are associated
with being a slow versus normal
metabolizer). The researchers
found that for nonsmokers, there
were no differences between the
normal and slow metabolizers in
how the brain responded to the
game. But among smokers, those
with the slow CYP2A6 variant
had less response in the ventral
striatum, an area of the brain
related to reward, than those with
the normal gene (Biological Psy-
chiatry, 2016).
This is important because
it suggests that these smok-
ers have changed their brains in
a very specific way, not just by
smoking but by the interaction
of smoking and having a differ-
ent genotype, Stein says.
FROM LAB TO CLINIC
This kind of personalized
medicine may be the future of
treatment, but there are sev-
eral hurdles to overcome before
health-care providers can ask
patients to take a blood test
before they try to quit smoking.
First, while NIDA is funding
some commercial development,
so far there are no commercial
test kits for the nicotine metabo-
lite ratio, explains Tyndale.
Second, she says, more work
is needed to ensure the findings
apply in community settings out-
Personalized
medicine may side a clinical trialincluding in
be the future of patients such as pregnant women
smoking-cessation and those with serious mental
treatment,
but there are illness or opiate dependency.
several hurdles Finally, Schnoll and other
to overcome researchers have also applied for
before health-care
providers can ask funding for a study that would
patients to take a introduce nicotine metabolite
blood test before ratio testing into primary-care
a quit attempt.
practices to evaluate how it
affects the doctors prescribing
rate and patients medication
utilization and quit rates.
Right now, for a variety of
clinical problems, you see your
physician, and then youre asked
to give blood, and then the results
are reported back to your physi-
cian, he says. Thats the model
we are looking to emulate.
M O N I TO R O N P S YC H O LO G Y MARCH 201727
News Feature
COLOMBIAN AND U.S. RESEARCHERS
PARTNER TO FOSTER HEALING
Researchers from both countries are identifying interventions that work to improve the
mental health of the millions of Colombians harmed by the decades-long civil war
BY TORI DEANGELIS
W
hen the government
of Colombia and the
rebel group known
as the Revolutionary Armed
Forces of Colombia (FARC)
finally reached a peace accord in
November, it signaled the official
end to a 52-year conflictthe
worlds longest-running civil war.
The five-decade war was marked
by widespread violence toward
citizens, political tumult and
the displacement of 6 million
peopleroughly an eighth of the
countrys population. But the end
of the war is just the beginning of
what promises to be a long road
ahead: the healing and reinte-
gration that Colombia needs to
survive and thrive as a nation.
The war was the result of
numerous groupsleft-wing
guerrilla groups, most notably
the FARC, as well as para-
military groups and crime
syndicatesfighting for territory
and political influence. A par-
ticularly sought-after prize was
land used to grow coca, the prin-
ciple ingredient in cocaine and a
major income source for various
factions. A peace deal that was
in the works for nearly five years
almost collapsed in October, but
eventually passed in Novem-
ber. The conflict has claimed at
least 220,000 lives since 1958,
according to a Colombian
28 M O N I TO R O N P S YC H O LO G Y
government commission.
Not surprisingly, Colombi-
ans mental health has been an
enormous casualty of the war,
with depression, anxiety and
trauma reactions at levels that
arent yet completely determined
but are likely extremely high,
says Leonidas Castro-Cama-
cho, PhD, professor of clinical
psychology at the University of
Los Andes, one of the countrys
premier research institutes. Yet,
he says, few psychologists or
other mental health professionals
are adequately trained to treat
the nations high rates of anxiety,
depression, fear and trauma
all of which are exacerbated by
social tensions, like those created
by resettling victims and former
combatants in the same under-
served areas of major cities.
The situation resembles that
of the United States following
World War II, when thousands
of veterans were returning from
the war, many with post-trau-
matic stress disorder, and there
werent nearly enough qualified
professionals to treat them,
Castro-Camacho says.
This major gap is now attract-
ing talented psychologists and
other researchers to fill it. One
new effort is the creation of the
Center for Emotional Health
(Centro de Salud Emocional), a
MARCH 2017
research, training and imple-
mentation-dissemination center
at the University of Los Andes
that started as a collaboration
between Castro-Camacho,
Fabio Idrobo, PhD, also of the
University of Los Andes, and
renowned U.S. psychologist
David H. Barlow, PhD, founder
of the Center for Anxiety and
Related Disorders at Boston
A supporter of University. The center will act
the peace deal as a sister organization to the
signed between
the Colombian Boston center, and will focus on
government and evidence-based practices to treat
the rebels of the the range of anxiety, depression,
Revolutionary
Armed Forces trauma and other mental health
of Colombia in conditions triggered by conflict.
Bogota, Colombia, Many victims of the war
on Oct. 3, 2016. A
final peace deal dont have just one mental
was signed on health problem, they have a
Nov. 24. diversity of emotional prob-
lems, Castro-Camacho says.
He is currently conducting a
randomized clinical trial with
100 participants who are vic-
tims of armed conflict, testing a
cultural adaptation of Barlows
unified protocol for transdiag-
nostic treatment of emotional
disorders. The protocol uses
FERNANDO VERGARA/ ASSOCIATED PRESS
cognitive-behavioral techniques
to treat co-morbid conditions
with common psychological
and emotional rootsdepres-
sion, anxiety and PTSD, for
instanceby targeting underly-
ing aspects of temperament such
 as neuroticism. Partway into the
study, participants are showing
reduced anxiety and depression,
as well as more positive affect,
Castro-Camacho is finding.
As the center ramps up, it will
also adapt, test and disseminate
other protocols that have shown
evidence of success in other war-
torn countries, says Idrobo, who
is the centers science director.
In a related vein, a task force
of the Colombian College of
Psychologiststhe countrys
equivalent of APAis assisting
Colombias Ministry of Health
in setting the standards of core
competencies for psychologists
who work in war-affected set-
tings. The competencies pinpoint
the specific training psychologists
need in such areas as identify-
ing the psychological and social
problems of war victims, eval-
uating and diagnosing clients,
and designing and implementing
evidence-based programs to help
them. This is an opportunity to
develop the skills that psychol-
ogists need to really contribute
to the needs of the country,
Castro-Camacho says.

STUDYING WHAT WORKS

Other researchers are also testing
protocols to help war-affected
citizens. One such interven-
tion is the common elements
treatment approach, or CETA,
developed by researchers at Johns
Hopkins Universitys Bloomberg
School of Public Health to help
people who have experienced
violent trauma. Its similar to
Barlows transdiagnostic pro-
tocol, but is geared specifically
for use by lay providers in low-
and middle-income countries.
Another is narrative community

M O N I TO R O N P S YC H O LO G Y MARCH 201729
News Feature
PSYCHOLOGISTS WORK FOR PEACE
T hanks to the power of international
collegiality, two U.S. psychologists
had a unique opportunity in 2015 to
share psychological insights pertaining
to the Colombian peace process with
President Juan Manuel Santos and his
staff. (Santos received the 2016 Nobel
Peace prize for his efforts at forging the
peace.)
During a visit to the country that
year, David H. Barlow, PhD, of Boston
University, and Steven A. Pinker, PhD, of
Harvard Universityboth of whom have
ties with colleagues at the University of
Los Andes in Bogota, Colombiawere
invited to share information and ideas
from their respective areas of clinical and
political psychology in a one-hour meet-
ing with the Colombian leader. Barlow
talked about ways that evidence-based
psychological protocols could be adapted
and disseminated to help people recover
from war traumawork that Colombian
psychologists are beginning to implement
30 M O N I TO R O N P S YC H O LO G Y MARCH 2017
at a new Center for Emotional Health
at the University of Los Andes (see
main article). Pinkerwell-known for
his work demonstrating that the world-
wide incidence of war and violence has
declined since 1945shared strategies
shown to be effective in achieving peace
in high-conflict areas. In particular, he
discussed findings that peacemaking
often requires people to compromise
on their desire for vengeancea notion
that Santos later advocated for and that
eventually helped cement parliaments
approval for the peace plan.
I did not give him the idea, or change
his mind, says Pinker, but I did empha-
size that there was a literature from
psychology and political science behind
his strategy.Tori DeAngelis
From left to right: Dr. Steven Pinker of
Harvard University, Colombian President
Juan Manuel Santos, Dr. David H. Barlow
of Boston University, and Dr. Fabio Idrobo
of the University of Los Andes in Bogota,
Colombia.
group therapy, a community-
based approach designed by
researchers at the CISALVA
Institute at the University of
Valle under the direction of
Maria I. Gutierrez-Martinez,
MD, PhD, that encourages
participants to propose problems
theyd like to solve with the help
of the group. Both interven-
tions were tested separately in
two cities heavily affected by the
warBuenaventura and Quibdo,
on Colombias west coast. The
researchers results were then
compared with a control group
on a wait list.
Project data show that each
approach has different strengths.
In both cities, participants who
received CETA had reduc-
tions in depression, anxiety and
trauma symptoms at the end of
12 weeks, while those in the nar-
rative groupintervention showed
minor changes in mental health
but significant improvements in
daily functioning, such as caring
for themselves and their chil-
dren. In addition, outcomes were
different in each of the two cit-
ies, suggesting that interventions
need to be specifically tailored
for conditions in particular
areas, says one of the researchers,
Francisco Javier Bonilla-Escobar,
MD, who notes the team is now
writing up the project.
In another project, Univer-
sity of Los Andes economists
Andres Moya, PhD, and Arturo
Harker, PhD, are testing an
intervention aimed at helping
mothers develop stronger bonds
with their young children. Thats
important, Moya says, because
research shows that the more
traumatic events people experi-
ence during early childhood, the
worse outcomes they have later
in life, but that healthy attach-
ments can mitigate such effects.
In war-affected Colombia,
mothers have difficulty attaching
with their children because they
themselves are so traumatized.
We have 800,000 children age 5
and under who are officially cat-
alogued as victims, Moya says.
So, its a time bomb.
To help this population, the
team sought input from Alicia
Lieberman, PhD, who heads the
Child-Trauma Research Program
at the University of California,
San Francisco. Together, the
U.S. and Colombianresearchers
adapted a group intervention
developed by Lieberman that
integrates trauma and attachment
theories and cognitive-behav- looking at them more in the eyes,
ioral intervention strategies. taking them to the park more
They tested it with 75 displaced often, and so on, says Moya.
mother-child pairs, randomizing The team eventually wants to
half to the protocol and half to test and implement the inter-
a control group. In addition to vention in 30 sites around the
helping mothers connect better country, he adds.
with their children, the 13-week If these kinds of tailored,
intervention provided tools to evidence-based practices help
help the mothers address their citizens recover from war-
own trauma, such as mindfulness related trauma, Idrobo hopes the
and breathing techniques. research will eventually contrib-
The preliminary results are ute to the overall well-being of
encouraging. We found a sig- Colombiansnot just to war-
nificant reduction in symptoms Learn more about related symptoms. Over time,
psychologists
of psychological trauma both in work on the world
Id like our center to address the
moms and their children, says stage from APAs psychological effects of climate
International Affairs
Moya. In addition, the relation- Office at www.apa.
change, gender violence and
ships between the mothers and org/international other issues affecting our
and APAs Div. 52
children are improving. Moms (International) at
populationto plan for the
are playing with their kids more, https://div52.org. future, he says.

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 [ THE POWER OF ]

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 Conversation
4 QUESTIONS FOR ALISON GOPNIK
The developmental psychologist explains why we cant raise monoculture kids
BY LEA WINERMAN
U
niversity of California,
Berkeley, psychol-
ogy professor Alison
Gopnik, PhD, has
spent nearly four
decades figuring out
that children are inventive and omniv-
orous learners, gaining the knowledge
they need through creative play as well
as simply observing the world around
them. During those same decades,
Gopnik has also watched the rise of par-
enting culturein which parents search
for just the right parenting techniques to
ensure theyll raise successful adults.
But those two strainsthe science
of learning and the culture of parent-
ingare at odds with each other, says
Gopnik. In her new book, The
Gardener and the Carpenter,
she argues that parents should
not aim to be carpenters who
shape their children to turn
out in a particular way, but
instead gardeners who create a
nurturing environment so that
their children can flourish in
unpredictable ways.
Where did parenting culture
come from, and why do you
believe its a problem?
Parenting became really
popular in the 1970s
when for the first time
in human history, many
people who had never taken
care of children before were having
ROD SEARCEY
Gopnik with her grandson
children. Before that, by the time you
had children yourself, youd had lots of
experience in caring for your younger
siblings, cousins and other children.
Meanwhile, those same parents who
hadnt been taking care of children had
been going to school and work. So, its
natural that when they became parents
they approached it the same as school or
work: They worked to achieve a particular
outcome. The term parenting encapsu-
lated that shift.
[Todays parenting cultural has]
caused a lot of unnecessary anxiety and
guilt for parents, and for children as well,
because it shifted the focus of
being a parent from what we intuitively
know is importanthaving enough
resources to be able to create a loving,
protected environmentto these very
small differences in the details of what
parents do, like whether you co-sleep or
dont co-sleep, or have your stroller fac-
ing front or back. The data suggest that
those small differences that middle-class
parents obsess about really dont make
any difference in the long run, and they
shift attention away from the things that
we do know scientifically are import-
ant, like creating a secure and loving
environment.
You say that even if you could
mold a child to come out the way
you wanted, it would defeat
the evolutionary significance of
childhood. Why?
Human beings have a much
longer childhood than any other
species. I argue in my book that
such a long period gives us the
space for innovation.
That innovation comes about
because there are individual
differences among children,
and also because children
themselves are designed
to think of the world in
new ways and to master
new tools. Childhood is all
about having this protected
period that allows individual
differences to develop [and
that is how the human species
as a whole adapts to changing
environments].
M O N I TO R O N P S YC H O LO G Y MARCH 201733
Conversation

One of the analogies I make is to
growing potatoes. It might seem like the
best thing farmers could do is to find
the right variety of potato thats going
to be the best, highest-yield potato, and
then figure out how to give it the most
fertilizer and the most pesticides and
get fields of [only] those potatoes. Thats
kind of what the parenting culture is. But
one of the things that we know is that
if the environment changes, then those
kinds of monocultures are very fragile.
You want something thats much more
diverse. So parenting is kind of like try-
ing to raise monoculture potatoes.
Is there a good model for gardener
schools to help children flourish?
We have some great models of how to
support early childhood learning, like
the Reggio Emilia program or the Early
Childhood Study Center here at Berke-
ley. But unfortunately, those models arent
influencing other schools. Instead, pre-
schools are under pressure to look more
like schools [for older children], and thats
going in exactly the wrong direction, from
what we know from the science.
If you want to think of an ideal context
for children, it would probably mean more
mud, livestock and relatives than we can
usually give our children in an urban set-
ting. But if you dont have mud, livestock
and relatives, then having a sandbox and
a guinea pig and an attentive preschool
teacher is probably the next best thing.
Why is this area so important to you?
For my entire career, my sense of my
vocation has been that our relationships
with children, on any objective measure
that you can think ofevolutionary
biology, neuroscience, politics, philoso-
phyare absolutely essentially important
to who we are and who we become. And
yet, historically those questions havent
been taken seriously in the general intel-
lectual and scientific worldand even in
psychology itself. Its getting better, but
just like everything that traditionally has
to do with women, children have been
really intellectually devalued.
So, thats really what I want to convey
to the world at largejust how import-
ant the whole topic of children and our
relationship to children is. How morally
deep, how complex it is, how much it
has to tell us about being human. And
how much the science itself over the last
30 or 40 years has become an incredibly
productive, exciting, methodologically
complex, and intellectually challenging
subject matter.

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Judicial Notebook
SHOULD FAMILIES BE ABLE
TO SUE NURSING HOMES?
When they admit a family member, many people sign documents affirming
they will not sue over disputes that may arise over care. But should they?
BY KATHERINE KARGL AND JENNIFER K. ROBBENNOLT, JD, PhD, UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
T
hree patientsVan Buren Adams, Olive Clark
and Joe Paul Wellnerdied while residents of
Kentucky nursing homes or rehabilitation cen-
ters. Before they were admitted to a facility, each
patient designated a family member as his or her
attorney-in-fact, authorizing them to make decisions on their
behalf. At the time of their admissions, each attorney-in-fact
signed a document agreeing to resolve any disputes in private
arbitration rather than in court. But after the patients deaths,
each attorney-in-fact sued the facilities for negligence, statutory
violations and wrongful death. Each facility argued that the
documents required the case to be resolved through arbitration.
Pre-dispute arbitration clauses are a popular
tool for companies desiring to limit their liability
in court. Under the Federal Arbitration Act (FAA)
these clauses are valid, irrevocable, and enforceable.
The U.S. Supreme Court has repeatedly articu-
lated a strong federal policy favoring arbitration of
disputes, stating that the FAA pre-empts state laws
that attempt to ban arbitration of certain claims and
routinely uphold pre-dispute arbitration agreements
(for example, see AT&T Mobility v. Concepcion, AT ISSUE
2011). The court reinforced this policy in Marmet Do consumers
understand the
Health Center, Inc. v. Brown (2012), holding that
consequences of
the FAA prohibits a categorical ban on arbitration waiving their right
clauses in nursing home admission agreements. to arbitration?
Despite these rulings, the Kentucky trial courts
denied the nursing homes motions to dismiss the
lawsuits and compel arbitration; the facilities appealed.
The Kentucky Supreme Court held that they would
not infer delegation of power to an attorney-in-fact to
waive the right to trial without a clear and convincing
manifestation of the principals intention to do so. The
court found that none of the power-of-attorney docu-
ments involved in these cases demonstrated clear intent
to allow the attorney-in-fact to agree to pre-dispute
36 M O N I TO R O N P S YC H O LO G Y MARCH 2017
arbitration and concluded that the arbitration agree-
ments were not validly formed (Extendicare Homes,
Inc. v. Whisman, 2015). The facilities appealed to the
Supreme Court, which agreed to hear the case (Kindred
Nursing Centers Limited Partnership v. Clark, 2016).
In a parallel development, a Center for Medicare
and Medicaid Services (CMS) rule banning the use
of compulsory pre-dispute arbitration agreements
in nursing home contracts was to go into effect in
November, but a federal judge granted a prelimi-
nary injunction to delay the rule while challenges
to its validity are resolved (American Health Care
Association v. Burwell, 2016).
The pending case and CMS rule raise the issue
of consumer contracts that require arbitration and
consumers ability to understand and meaningfully
consent to waiving their right to raise claims in court.
Consumer arbitration mandates also raise questions
about how these issues affect the people admitted
to nursing homes and other long-term care facili-
tiespeople who may be sick, disabled or dependent,
and making decisions under significant stress. Other
concerns raised by the CMS rule include unequal
bargaining power, the potential for coercion, the
possibility of inadequate explanation of the nature
and consequences of the agreement, and the inher-
ent conflict of interest in the facility providing such
explanations. Given the 1.4 million residents of nurs-
ing homes in the United States (National Center for
Health Statistics, 2014), dispute resolution processes
and procedures for ensuring the appropriate waiver of
rights in this context have the potential for widespread
impact. Research by psychologists comparing litigation
and arbitration and the contractual decision-making
ROMZICON/THE NOUN PROJECT
and expectations of those admitted to long-term care
will increase understanding of these decisions.
Judicial Notebook is a project of APA Div. 9 (Society for
the Psychological Study of Social Issues).
 The 2012 APF Visionary Fund Grant
was indispensable. It allowed me to
expand my research on stigma to
military personnel, which is a group
in need of additional focus.

David Vogel, PhD

2012 APF Visionary Grant Recipient

About the American Psychological Foundation

The American Psychological Foundation (APF) provides financial support for innovative research and
programs for students and early career psychologists working to make a difference in peoples lives.
APF grantees work on issues of pivotal concern, including preventing violence, helping children,
fostering the connection between behavior and health, fighting stigma and prejudice, and helping with
the long-term effects of disaster. An APF grant can unlock discoveries, lead to federal funding, and help
solve some of societys thorniest problems. APFs work would not be possible without the generosity of
psychologists from around the world.

For more information about APF programs and how you can support the future of psychology,
please call (202) 336-5843 or visit www.apa.org/apf.

APF03

Vogel Grantee APF Ad_APF03.indd 1 6/3/16 4:21 PM

While Mr.here
Caption Muoz
in some
is
lines
a fictional
caption
example,
here in
some
the ethical
lines and
Caption
here in some lines
psychological issues
Caption herehis
surrounding in some
case
linesconcerns most
are
clinicians will confront
at some point.
 CE Corner
CE
devil is getting the best of me.
He requests therapy to learn
how to cope with his sexual
thinking about men, with the
eventual goal of removing
these thoughts.He feels
strongly that he can either
remove these thoughts, regain
his weight as self-protection
or endure spiritual conse-
quences and lose his marital
CONTINUING EDUCATION relationship.
HOW SHOULD A PSYCHOLOGIST
ADVISE A HETEROSEXUAL MAN While this patient, Mr. Muoz, is
WHO HAS SEXUAL THOUGHTS a fictional example, the ethical
ABOUT MEN? and psychological issues sur-
rounding his case are concerns
BY AMY NOVOTNEY
most clinicians will be faced
with at some point in their
careers, says W. Brad Johnson,
PhD, a psychology professor
Several times a year, CE Corner will present a hypothetical in the department of leader-
ethical situation and ask psychologists who are ethics experts to ship, ethics and law at the U.S.
offer insights on how to address it.Here is this months vignette: Naval Academy. Practitioners
G
need to anticipate clinically
abriel Muoz is a 62-year-old Mexican-American,
relevant religious conflicts and
married, self-identified heterosexual male, who
be ready to help clients work
has had bariatric surgery within the last year. In a
them through, he says.
visit with his primary-care physician, he states that he has
For this case, the most
experienced sexual thoughts about men, some of which
obvious guidance for psy-
he has acted on, during his marriage. He reports that
chologists comes from the
he gained weight prior to surgery in an attempt to be
APAs Ethics Code Principle
less sexual. Now that he has begun to lose weight and
A: Beneficence and Non-
feel better about himself physically, he is finding sexual
maleficence, which instructs
thoughts of men returning. He clearly describes his
psychologists to only do things
thoughts as the devils work, indicating that his pastor
that are of benefit to their
has worked me through this before, but now I feel the
patients, and have little or no
risk of harm, a concept also
CE credits: 1 addressed in Standard 3.04:
Learning objectives: After reading this article, Avoiding Harm.
CE candidates will be able to: However, says APA Ethics
1 . Identify the Ethical Principles and Ethics Code Standards involved Committee member Nicole
in helping religious clients address sexual orientation concerns. Najar, PsyD, in Mr. Muozs
2. Describe interventions that may help clients dealing with case, there is no simple
SOUMEN NATH/ ISTOCKPHOTO
these issues. answer to the do-no-harm
3. Discuss the importance of allowing for patient autonomy guidance. This is a tricky one
in therapy. because avoiding harm can
For more information on earning CE credits for this article, come from two directionsthe
go to www.apa.org/ed/ce/resources/ce-corner.aspx. patient himself, who is saying it
M O N I TO R O N P S YC H O LO G Y
is too harmful for him to have
these thoughts, and from any
sort of treatment that focuses
on changing ones sexual
orientation, which is neither
scientific nor appropriate,
says Najar, who is a clinical
health psychologist at the Bat-
tle Creek VA Medical Center
in Battle Creek, Michigan.
Judith Glassgold, PsyD,
chair of APAs 2009 Task Force
on Appropriate Therapeutic
Responses to Sexual Orien-
tation, agrees, noting that
the task force report found
insufficient evidence to sup-
port the use of psychological
interventions to change sexual
orientationand even found in
some circumstances that these
practices harmed the client.
Instead, practitioners should
focus on things that the patient
can changeprioritizing his
physical health, reducing
stress, identifying conflicts,
and getting rid of irrational
thoughts, she says.
Practitioners also need
to be competent, both in
understanding the science
and approaches to helping
someone address his or her
sexual orientation, as well as
in the psychology of religion
and faith, says Glassgold, who
is a visiting research scholar at
the Center for Health and Well-
being at the Woodrow Wilson
School of Public and Inter-
national Affairs at Princeton
University.
PRIORITIZING
PHYSICAL HEALTH
Given this patients very
recent bariatric surgery, from
a clinical health perspective,
MARCH 201739
CE Corner
Najar says she would first work
with Mr. Muoz to address the
connection hes made between
his weight loss/gain and sexu-
ality. Id want to unmarry these
two because we need to focus
on making sure that this client
is successful in maintaining
his weight loss, she says. She
suggests using Acceptance and
Commitment Therapy (ACT) to
work with him on identifying how
his thoughts about his weight
and his sexual attraction are
intertwined, and then help him
figure out which are thoughts and
which are behaviors, and focus
their discussions on his control
over behavior, independent of his
thoughts.
Empowerment comes in iden-
tifying a behavior as controllable
and removing the power from the
thoughts or attempts to control
the thinking, Najar says. The
purpose of unpairing [his sexual
thoughts and weight thoughts is
to help him] maintain a healthy
weight regardless of his process
with his sexuality.
Jennifer Kelly, PhD, a clinical
health psychologist at the Atlanta
Center for Behavioral Medicine,
agrees, noting that she would
also recommend that Mr. Muoz
enroll in an aftercare program
designed to help him obtain and
maintain weight loss after surgery,
as well as deal with any weight-
loss challenges postsurgery.
Addressing issues regard-
ing protection versus risk in
this clients sexual behavior is
also important, says Clinton
Anderson, PhD, acting executive
director of APAs Public Interest
Directorate and Lesbian, Gay,
Bisexual and Transgender Con-
cerns Office.
40 M O N I TO R O N P S YC H O LO G Y
EXPLORING
RELIGIOUS BELIEFS
After some short-term work with
this patient to ensure his physical
health is stabilized, Najar and
Kelly say they would then refer
this patient for additional consul-
tation with a psychologist who
not only specializes in people
questioning their sexuality, but
also has training and experience
in working with religious clients in
ABOUT CE order to be in line with Standards
CE Corner is 2.01: Boundaries of Competence
a continuing
and 2.04: Bases for Scientific
education article
offered by the APA
and Professional Judgments.
Office of CE in Its clear in this case that there
Psychology. are some religious beliefs sur-
rounding sexual attraction that are
To earn CE credit,
working at cross purposes with this
after you read this
article, purchase
clients mental and physical health,
the online exam at says Johnson, and his beliefs need
www.apa.org/ed/ to be addressed sensitively. This
ce/resources/ce- work should be guided by the
corner.aspx.
APA Ethics Codes Principle E:
Upon successful
completion of
Respect for Peoples Rights and
the testa score Dignity, which promotes practi-
of 75 percent or tioners awareness of and respect
higheryou can for cultural, individual and role
immediately print
differences, including those based
your CE certificate.
on age, gender, gender identity,
The test fee is race, ethnicity, culture, national
$25 for members origin, religion, sexual orientation,
and $35 for disability, language and socioeco-
nonmembers.
nomic status and consideration of
For more
information, call
these factors when working with
(800) 374-2721. members of such groups.
Unfortunately, says Johnson,
some practitioners interpret
respect to require hands-off
avoidance. Religion and other cul-
tural variables can make otherwise
effective practitioners timid, even
immobilized, he says, adding
that it is important to balance the
principles of respect and benefi-
cence. Remember that culturally
competent confrontation can be
executed quite respectfully. In this
MARCH 2017
clients case, we have to honestly
address the fact that his cultural/
religious beliefs are linked to anx-
iety and depression.
It may make sense to first
develop a greater understand-
ing of this clients religion, in
partnership with him, Anderson
says. Latinos are predominantly
Roman Catholic, but the use of
the concept of the devil suggests
perhaps he is evangelical or Pen-
tecostal, he says. I also think his
guilt and shame about breaching
his marriageand the possibility
that he may feel he has betrayed
his wife or even duped her if
those feelings go back before his
marriage are important elements
of the situation.
While some psychologists may
feel more comfortable referring
Mr. Muozs case to a member
of the clergy or mental health
professional with expertise in
integrating a clients religious
worldview into psychotherapy,
Johnson says that psychologists
have some ethical obligation to
be thoughtful about such refer-
rals. A poorly considered referral
might perpetuate or even exacer-
bate the clients distress. Instead,
he advocates for competent
clinicians to consider conduct-
ingwith informed consenta
respectful exploration of beliefs
and behavior with this client,
including a supportive discussion
of the ways his interpretation of
scripture or beliefs about God are
entwined with his current psycho-
logical distress.
Johnson also says that if
the client is reluctant to speak
with a local clergy member (for
fear of people in his community
finding out about his feelings), a
psychologist might recommend a

In this case there are some religious
beliefs surrounding sexual attraction that
are working at cross purposes with this
clients mental and physical health.
pastor that the client could email
or telephone to clarify some of
his concerns, or provide him with
some recommended reading.
There are a lot of different
ways Id try and open the door
for this client to explore his own
cultural beliefs about sexual
attraction; I am concerned there
might be some selective interpre-
tation of religious scripture going
on for this man, Johnson says.
If a referral appears appropriate,
Id like to be able to recommend
some clergy or pastoral practi-
tioners who are likely to be as
concerned as I about ameliorating
the clients emotional pain.
IDENTITY EXPLORATION
STEVANO VICIGOR/ ISTOCKPHOTO
No matter what evidence-based
treatment is pursued in this
case, whats most important is
for clinicians to allow for patient
autonomy, says Fred Milln,
PhD,vice-chair of the APA Ethics
Committee and a psychology
professor at SUNY Old Westbury,
who specializes in cross-cultural
and diversity issues.
Milln says hed work with Mr.
Muoz to explore what may be
behind these thoughts and what
they mean for him. Hed also
play out some of the worst-case
scenarios that might be running
through the patients mind if he
ever acted on such thoughts
such as that hed lose his family
or be excommunicated from the
church. Such a discussion could
help the client figure out how
reasonable they may or may not
be and begin a process of sorting
out his options.
The fantasy of many patients
is that were going to give them
a pill or other type of treatment
to make it all go away, when
obviously thats not the way
this works, Milln says. The
work here isnt to remove those
thoughts from his mind. Its really
to help him come to terms with
themthat is, to understand how
they came to be, what they mean
for him and work them through
enough to integrate them into an
identity that makes sense for him.
Glassgold notes that in these
types of cases it can also be help-
ful to share information with the
patient on the scientific basis of
ADDITIONAL homosexuality and sexual attrac-
READING tion, pointing to research showing
that it is thought to be primarily
APA Guidelines biological.
for Psychological
Identity exploration is a key
Practice with
Transgender element in treatment, and Mr.
and Gender Muoz may benefit from explor-
Nonconforming ing his sexual orientation and
People faith in an environment of affir-
2015
mation and acceptance, being
APA Guidelines able to talk about it and accept
for Psychological all of himself can be a crucial
Practice With part of his treatment, she says.
Lesbian, Gay, Then a clinician can move on to
and Bisexual
Clients helping the client discover what
2012 feels the most authentic to him.
He may decide that his faith and
Report of the his marriage are most important
APA Task Force and provide him with the most
on Appropriate
Therapeutic fulfillment, or he may decide that
Responses to he wants to explore an alternative
Sexual Christian faith, one that is more
Orientation accepting of same-sex attractions
2009
and same-sex relationships.
These are all decisions Mr.
Muoz has to face, and its good
for him to go through that in an
environment where he does not
feel pressured to any particular
outcome, consistent with the
ethical principle of autonomy and
self-determination, she says.
To directly access the citations in
this article, go to our digital edition at
www.apa.org/monitor/digital.
M O N I TO R O N P S YC H O LO G Y MARCH 201741
 (DIS)CON

42 M O N I TO R O N P S YC H O LO G Y MARCH 2017
NECTED

PSYCHOLOGISTS RESEARCH SHOWS HOW

SMARTPHONES ARE AFFECTING OUR HEALTH
AND WELL-BEING, AND POINTS THE WAY TOWARD
FILADENDRON/ ISTOCKPHOTO

TAKING BACK CONTROL BY KIRSTEN WEIR

M O N I TO R O N P S YC H O LO G Y MARCH 201743
Cover Story
A
APPLE INTRODUCED its iPhone in 2007 and the world has never
been the same. Though the iPhone wasnt the first internet-enabled
smartphone, its touchscreen technology and built-in app library
made it the first to gain mass-market appealand it sparked a rev-
olution. Now, wireless mobile devices have found their way into
millions of pockets, functioning not just as phones but as internet
browsers, messaging services, calendars, cameras, alarm clocks, road
maps and video players. By 2015, 72 percent of U.S. adults reported
owning a smartphone, according to a study by the Pew Research
Center (Pew, 2016). Smartphones undoubtedly make our lives
easier, says Elizabeth Dunn, PhD, a psychology professor at the
University of British Columbia, who studies the ways that mobile
technology can support or undermine well-being. Having the
entire store of human knowledge at our fingertips is pretty useful,
she quips. But there may be trade-offs for that convenience. Mobile
technology also has the power to negatively influence our health and
happiness, she says. Our lab
has gone looking for pros, but in
general we keep finding cons.
At their worst, research
finds smartphones can mess
with our sleep, stress us out and
monopolize our attention. But
psychology may hold the key
to helping people take control
of this technology to prevent
such negative effects and even
enhance our well-being. Tech
developers arent in the business
of promoting well-being, Dunn
says, but that does fall under the
purview of psychology. I think
we need to devote a lot more
attention to this, she says.
SLEEP STEALERS
So far, research on the effects
of smartphone use on our
44 M O N I TO R O N P S YC H O LO G Y MARCH 2017
behavior and our functioning
has not crystallized into broad
conclusions, in part because its
all happened so fast, says Karla
Klein Murdock, PhD, a psy-
chology professor who heads the
Technology and Health Lab at
Washington and Lee University.
The technology is constantly
changing. Its hard to quantify
the important aspects of smart-
phone use when the qualitative
aspects are changing all the
time, she says.
Nevertheless, some patterns
are emerging. Some of the most
established evidence centers
around sleep. I think we have a
critical mass of research [indi-
cating] that cellphone use at
nighttime is best avoided, says
Murdock.
She followed 83 college
students for a week and found
that students who were more
attuned to their nighttime phone
notifications had poorer sub-
jective sleep quality and greater
self-reported sleep problems
(Behavioral Sleep Medicine, 2016).
While smartphones are often
touted as productivity-boosting
devices, their ability to interfere
with sleep can have the oppo-
site effect on getting things
done. Russell E. Johnson, PhD,
a professor of management at
Michigan State University, and
colleagues surveyed workers
from a variety of professions.
The researchers found that when
people used smartphones at
night for work-related pur-
poses, they reported that they
slept more poorly and were less
engaged at work the next day.
Those negative effects were
greater for smartphone users
than for people who used lap-
tops or tablets right before bed
(Organizational Behavior and
Human Decision Processes, 2014).
One explanation for the
smartphones interference with
sleep is the blue light that
smartphones and other tech
devices emit. Such light affects
the production of the sleep-
regulating hormone melatonin.
But laptops and tablets also emit
blue light, suggesting other fac-
tors are at play.
Smartphones are even more
portable than laptops or tablets,
and are all too easy to bring
into bed, notes Murdock. In
fact, many people use them as
alarms and keep them within
arms reach all night. Reading a
text or email at bedtime can stir
your emotions or set your mind
 buzzing with things you need to
get done. Your mind becomes
activated at a time when its
really important to settle and
have some peace, she says.
Even after the lights go out,
it can be hard to resist the lure
of your phone. Sue K. Adams,
PhD, and Tiffani Kissler, PhD,
at the University of Rhode
Island, asked college students
to keep sleep diaries for a week.
They found that 40 percent of
the students reported waking
at night to answer phone calls,
and 47 percent woke to answer
text messages. Students who
were more likely to use technol-
ogy after theyd gone to sleep
reported poorer sleep quality,
which in turn predicted symp- ONE STUDY FOUND THAT 40 PERCENT OF
toms of anxiety and depression STUDENTS REPORTED WAKING AT NIGHT
(CyberPsychology, Behavior and
Social Networking, 2013).
TO ANSWER PHONE CALLS, AND 47 PERCENT
WOKE TO ANSWER TEXT MESSAGES.
THE FOMO PHENOMENON
Anxiety and smartphone use
seem to often go hand in hand, phone users showed increased People of all generations seem
says Larry Rosen, PhD, a pro- anxiety after just 10 phone-free to have succumbed to the phe-
fessor emeritus of psychology minutes, and unlike the mod- nomenon known as FOMO, or
at California State University, erate users, their anxiety levels fear of missing out, on experi-
Dominguez Hills, who has stud- continued to climb throughout ences and information that other
ied the psychology of technology the hour (Computers in Human people are involved in at any
for more than 35 years. In one Behavior, 2014). given moment. We have created
study exploring this idea, he and Rosen has found that younger a system where we feel com-
his colleagues took phones away generations are particularly likely pelled to check in all the time,
from college students for an hour to feel anxious if they cant check Rosen says.
and tested their anxiety levels at their text messages, social media Constant contact with the
various intervals. and other mobile technology digital world isnt necessarily
Light users of smartphones regularly. But people of all ages healthy or helpful, however. In the
didnt show any increasing have a close relationship with same study in which he reported
anxiety as they sat idly without their phones. He found 76 per- how frequently people checked
their phones. Moderate users cent of baby boomers reported their phones, Rosen and his col-
began showing signs of increased checking voicemail moderately leagues explored the relationships
anxiety after about 25 minutes often or very often, and 73 between technology-related atti-
MARIO GUTI/ ISTOCKPHOTO

without their phones, but their percent reported checking text tudes and a variety of mood and
anxiety held steady at that mod- messages moderately or very personality disorders. They found
erately increased level for the often (Computers in Human numerous links. Some were
rest of the hourlong study. Heavy Behavior, 2013). positivehaving more Facebook

M O N I TO R O N P S YC H O LO G Y MARCH 201745
Cover Story
friends combined with frequent
phone conversations predicted
fewer signs of depression, for
instance. But many others were
negative. For example, anxi-
ety about not checking in with
text messages and Facebook
predicted symptoms of major
depression, dysthymia and bipo-
lar mania.
Dunn has also studied the
effect of being perpetually
engaged with ones phone. On
the bright side, her research
suggests that tweaking the way
you interact with technology can
make a difference to your health.
In one study, she and her for-
mer doctoral student Kostadin
Kushlev, PhD, followed 124
adults over two weeks. During
46 M O N I TO R O N P S YC H O LO G Y
one week, the participants were
free to check their email contin-
ually throughout the day. During
When you scroll the other, they were limited to
through Facebook checking email messages (both
instead of talking
to someone face- work and personal) just three
to-face, you can times per day. Participants
lose the benefits of reported less daily stress
human interaction.
during the week when their
email access was limited. That
reduced stress was associated
with positive outcomes includ-
ing greater mindfulness, greater
self-perceived productivity and
better sleep quality (Computers in
Human Behavior, 2015).
In a similar two-week study,
Dunn and Kushlev looked at
smartphone notificationsthe
beeps and buzzes that alert users
about incoming texts, emails and
MARCH 2017
social media updates. During
one week, the participants were
asked to keep their phones
within reach and turn on all
notifications. During the other,
participants were asked to turn
notifications off and keep their
phones tucked out of sight. At
the end of each week, partici-
pants completed questionnaires
to measure attention. During the
week of notifications, partici-
pants reported greater levels of
inattention and hyperactivity
compared with their alert-free
week (Proceedings of the 2016
FRANCK REPORTER/ ISTOCKPHOTO
CHI Conference on Human Factors
in Computing Systems, 2016).
Those feelings of inatten-
tion and hyperactivity were
directly associated with lower
levels of productivity, social
connectedness and psychological
well-being, Dunn found. Theres
a domino effect from having
your attention scattered by fre-
quent interruptions, she says.
REAL-LIFE CONNECTIONS
Unfortunately, turning notifi-
cations off can be easier said
than done, especially in our
FOMO culture. After all, it can
be very rewarding to use your
phone, Murdock points out. Its
designed to feel good in your
hand. It provides a sense of
security that you can access the
information you need, when you
need it. When you use it, youre
often getting valuable informa-
tion or connecting with someone
you care about. Its reinforcing
at almost every level, she says.
One concern among experts
is that the smartphones rein-
forcing qualities might train
people to favor their phones over
important people and events in
their lives. The technology is so
phenomenal, its not surprising it
causes us to be distracted all the
timebut were missing out on
the real world, Rosen says.
And real-world interactions
are extremely important for our
social species. Real, face-to-face
interactions are very much asso-
ciated with emotional benefits,
Dunn says. Conversations by
phone or video can also be posi-
tive. But when you scroll through
Facebook instead of chatting with
your seatmate on a train, or check
out Instagram instead of talking
to your spouse at dinner, you
can lose out on the benefits of
genuine human interaction. You
might be missing easy opportu-
nities for social connection and
the emotional boost that comes
with them, she says.
Then again, much of the time
we spend on our mobile devices
is devoted to social networking,
which allows us to connect with
others through platforms such as
Facebook or Twitter. Yet digital
networking isnt quite the same
as connecting in real life.
Ethan Kross, PhD, a professor
of psychology at the University
of Michigan, studies social media
and well-being. Hes found that
when people use social network
sites passivelyscrolling through
their Facebook newsfeed, reading
other peoples posts, consuming
informationthey report lower
levels of well-being. When peo-
ple use Facebook passively, they
feel worse from one moment to
the next, he says.
Thats in contrast to active
users, who produce and upload
information, engage in conver-
sation and comment on others
posts. Such active use does
not appear to harm subjective
well-being, he says, though the
research so far is split on whether
active use actually promotes
well-being or is simply neutral,
as Kross describes in a recent
review (Social Issues and Policy
Review, in press).
The difference, Kross says, is
that merely consuming social
media often provokes people to
make social comparisons, which
can lead to feelings of envy.
Actively participating in social
media, on the other hand, seems
to stimulate feelings of social
connectedness.
But the relationship between
social media and emotional
well-being is complex and
doesnt always map neatly onto
real-life behavior.
For instance, Kross says, its
been shown that people with
depression receive less sup-
port from their real-life social
networks, and they accurately
perceive themselves as lacking
FURTHER in support. But he and Jiyoung
Park, PhD, at the University of
READING
Massachusetts, Amherst, and
Do Online Social colleagues have shown that in
Network Sites the digital world, people with
Make Us Happy? depression actually receive more
A Critical Review
support from their Facebook
Verduyn, P.,
Ybarra, O., friends than do people without
Jonides, J., depression. Yet they inaccu-
& Kross, E. rately believe they are receiving
Social Issues and less support from their digital
Policy Review,
connections (Journal of Affective
in press
Disorders, 2016).
The Distracted That finding sets the stage
Mind: for interventions that could help
Ancient Brains people tap into the support avail-
in a High-Tech
able to them on social media,
World
Gazzaley, A., & Kross says. Im optimistic these
Rosen, L.D. networks could be harnessed to
MIT Press, 2016 improve well-being.
Is Facebook
TAKE BACK CONTROL
Creating
iDisorders? Indeed, smartphone use isnt
The Link Between inherently bad. Smartphones can
Clinical Symptoms help increase feelings of belong-
of Psychiatric ing and closeness with friends.
Disorders and
For example, Kate Magsamen-
Technology Use,
Attitudes and Conrad, PhD, at Bowling Green
Anxiety State University, and colleagues
Rosen, L.D., found that among people who
Whaling, K., tend to be private and withhold
Rab, S., Carrier, L.M.,
personal information, technology
& Cheever, N.A.
Computers in Human can help them foster interpersonal
Behavior, 2013 relationships and increase their
overall well-being (Computers in
Human Behavior, 2014).
But with technology, as with
so many things, moderation is
key. Its about getting the best
from the technology, but at the
same time making sure its not
controlling you, Rosen says. Its
M O N I TO R O N P S YC H O LO G Y MARCH 201747
Cover Story
time to take back control.
That control can come from
various quarters. People can take
steps to minimize the pitfalls
of smartphone use. (See sidebar
below.) Psychologists, too, can
play a role, both by studying
technology and by providing
support to clients who have
trouble disconnecting. APAs
Div. 46 (Society for Media
Psychology and Technology)
has established a new Device
Management Committee that
will focus on issues related to
healthy use of smartphones and
SEVEN WAYS TO OVERHAUL
YOUR SMARTPHONE USE
Want to minimize the pitfalls of smart-
phone use? Research suggests seven
good places to start.
1 Make choices. The more we rely
on smartphones, the harder it is to
disconnect. Consider which functions
are optional. Could you keep lists in
a paper notebook? Use a standalone
alarm clock? Make conscious choices
about what you really need your
phone for, and what you dont.
2 Retrain yourself. Larry Rosen,
PhD, advises users not to check
the phone first thing in the morning.
During the day, gradually check in
less oftenmaybe every 15 minutes
at first, then every 20, then 30. Over
time, youll start to see notifications as
suggestions rather than demands, he
says, and youll feel less anxious about
staying connected.
3 Set expectations. In many ways,
our culture demands constant
connection. That sense of responsibil-
ity to be on call 24 hours a day comes
48 M O N I TO R O N P S YC H O LO G Y
related technologies. We hope and withhold alerts about
people from across APA, from social media updates and other
all divisions, will be involved, nontime-sensitive information.
says Don Grant, PhD, a media We didnt evolve to be con-
psychologist in Santa Monica, stantly battered by notifications.
California, who chairs the In smartphones weve totally
committee. changed the way we do every-
Dunn is also hopeful that thing in eight years, Dunn says.
technology developers will take a Yet psychology can help
proactive approach, such as creat- improve technology, she says
ing programs that make it easier tech companies have already
to control what notifications users begun sending representatives to
receive, and when. She imagines psychology conferences to learn
sensors that could detect when a from that research. The compa-
person is out to dinner or playing nies are listening, she says, but
with their children, for example, we need to be talking.
Buck the trend
toward constant
connection.
with a greater psycho-
logical burden than many
of us realize, says Karla
Klein Murdock, PhD. Try
to establish expectations
among family and friends
so they dont worry or feel
slighted if you dont reply
to their texts or emails
immediately. While it can
be harder to ignore messages from
your boss, it can be worthwhile to have
a frank discussion about what his or
6 Be active. When interacting with
social media sites, dont just
absorb other peoples posts. Actively
her expectations are for staying con- posting ideas or photos, creating con-
nected after hours. tent and commenting on others posts
4 Silence notifications. Its tempt-
ing to go with your phones default
is associated with better subjective
well-being.
settings, but making the effort to turn
off unnecessary notifications can
reduce distractions and stress.
7 And, of course, dont text/email/
call and drive. In 2014, more
than 3,000 people were killed in dis-
5 Protect sleep. Avoid using your
phone late at night. If you must
use it, turn down the brightness. When
tracted driving incidents on U.S. roads,
according to the U.S. Department of
Transportation. When youre driving,
SJALE/ ISTOCKPHOTO
its time for bed, turn your phone off turn off notifications and place your
and place it in another room. phone out of reach. Kirsten Weir
MARCH 2017
RENEW
Your 2017 APA Membership Today

From new career and professional development tools to the latest

information in your subfield, APA continues to enhance the various
ways in which your APA membership serves you.

Stay connected to your benefits and your colleagues.

Renew online today at: on.apa.org/2017renew

50 M O N I TO R O N P S YC H O LO G Y MARCH 2017
 BRIGHTER
FUTURES
FOR
ANXIOUS
KIDS
Psychologists are
homing in on the
best ways to treat
and prevent the most
common mental
health disorder
among children and
adolescents
BY KIRSTEN WEIR
SOLSTOCK/ ISTOCKPHOTO

M O N I TO R O N P S YC H O LO G Y MARCH 201751
Brighter Futures for Anxious Kids

One reason for that might While childhood anxiety is

be that anxiety symptoms are so
variable. Kids with generalized
anxiety often feel overwhelmed
with worry, and some have
physical symptoms such as head-
aches or stomachaches. Others
Clinging to moms leg have intense social phobias that
prevent them from doing things
at preschool drop-off, like going to birthday parties or
fearing monsters participating in extracurricular
activities. Some have specific
still underdiagnosed, research
over the last couple of decades
has begun to paint a clearer pic-
ture of anxiety in kids, including
the role that family factors play
in the development of anxiety,
and what interventions can help
to treat it. We know a lot more
than we knew in the 1980s and
1990s, Silverman says.

under the bedworries phobiasfear of the dark or of WARM BUBBLE WRAP

are a common part dogs, for instancewhile still

others experience obsessive-
of childhood. But for compulsive disorder.
Often parents, teachers and
many children, worries even some health-care profes-
are something more. sionals dont realize the severity
of a childs anxiety or recognize
Anxiety disorders are that it should be treated, says
A variety of factors, both biolog-
ical and environmental, increase
the risk of anxiety disorders in
children and adolescents. On the
biological side, genetics, gender
and temperament contribute to
childhood anxiety risk. Anxiety
runs in families, and girls tend to

the most common psychologist Wendy Silverman,

mental health disorders
among children and
adolescents. Nearly 32
percent of adolescents
in the United States
have an anxiety disorder,
according to national survey data
reported by Kathleen Meri-
kangas, PhD, at the National
Institute of Mental Health,
and colleagues (Journal of the
American Academy of Child and
Adolescent Psychiatry, 2010).
Yet anxiety is woefully
underdiagnosed, say multiple
experts who treat children with
the disorders. The majority
of children with anxiety never
receive treatment, says Golda
Ginsburg, PhD, a psychologist
and professor at the University
of Connecticut Health.
PhD, director of the Yale Child
Study Center Program for Anx-
iety Disorders at Yale School of
Medicine. Theres this idea that
kids will outgrow these problems
[related to anxiety], but the evi-
dence doesnt support that.
Without treatment, child-
hood anxiety is likely to persist,
negatively affecting a childs
social and family function-
ing and overall quality of life.
Anxiety disorders increase the
risk of adult disorders, including
future anxiety as well as depres-
sion, substance use disorders and
suicide, according to data from
more than 9,000 respondents
in the National Comorbidity
Survey Replication, reported by
Ronald Kessler, PhD, at Har-
vard University, and colleagues
(Archives of General Psychiatry,
2005).
Anxiety is often viewed as
a gateway problem, Silverman
says.
be more susceptible than boys.
A body of research pioneered by
Harvard University developmen-
tal psychologist Jerome Kagan,
PhD, shows that infants and
toddlers who are behaviorally
inhibitedclinging to parents,
hiding, failing to explore their
environmentsare more likely
to exhibit anxiety later in child-
hood. Environmental factors
such as childhood trauma, abuse
and early life stressors also boost
the risk of developing an anxiety
disorder.
Among children, separation
anxiety, social anxiety and gener-
alized anxiety are the three most
common types of anxiety, Silver-
man says. In adolescence, panic
disorder is relatively common as
well. The median age of onset for
childhood anxiety is about 11,
according to Kesslers data.
Some of the most significant
risk factors for anxiety appear
to be family-related. We know
children whose parents struggle

52 M O N I TO R O N P S YC H O LO G Y MARCH 2017

OFTEN PARENTS, TEACHERS AND EVEN SOME
HEALTH-CARE PROFESSIONALS DONT REALIZE
THE SEVERITY OF A CHILDS ANXIETY OR
RECOGNIZE THAT IT SHOULD BE TREATED.
with anxiety are at elevated risk,
Ginsburg says.
While genes likely have
something to do with that link,
anxious parents are also more
likely to model fearful behav-
iors for their children, Ginsburg
explains. Parents can interact
with kids in ways that increase or
decrease their anxiety, she says:
Consider the difference between
a parent who says, Dont forget
the bug spray, versus the one
who yells, Dont go outside,
theres a mosquito! Youll get
Zika virus!
MACTRUNK/ISTOCKPHOTO
Even if parents dont model
anxious behaviors, they can
inadvertently accommodate their
childs anxiety, which research
shows can make symptoms
persist and worsen. Often, that
behavior comes from a place
of good intention. When you
see your child frightened, your
natural instinct as a parent is to
protect them and reassure and
comfort them, Ginsburg says.
But sometimes, parents go
too far in trying to protect a
child from any situation that
might provoke anxietynever
leaving them with a babysit-
ter, for example, or constantly
getting involved with a childs
teacher in an attempt to make
the childs life stress free. In such
cases, the child never develops
the skills to overcome challenges,
says psychologist Anne Marie
M O N I TO R O N P S YC H O LO G Y
Albano, PhD, director of the
Columbia University Clinic for
Anxiety and Related Disorders.
When parents are doing a lot of
negotiating to remove anything
that upsets the child, that child is
at greater risk of anxiety.
Kenneth Rubin, PhD, a psy-
chologist and founding director
of the Center for Children,
Relationships and Culture at
the University of Maryland, and
colleagues have shown how such
parental behaviors can combine
with child temperament factors
to increase anxiety. In a highly
regarded longitudinal study, he
and his colleagues found that
behaviorally inhibited toddlers
were more likely to become
socially wary preschoolers if their
mothers were intrusive (Child
Development, 2002). In the lab,
he watched those parents intrude
in their childrens play, often
smothering them with hugs and
kisses to a degree that prevented
the kids from exploring their
environment and engaging in
age-appropriate play. It was like
they were covered in warm bub-
ble wrap, he says.
A DOSE OF PREVENTION
While parental behavior cer-
tainly isnt the only factor that
contributes to a childs anxiety,
its a useful one to target. Paren-
tal anxiety and accommodating
behaviors can be treated and
changed. Furthermore, because
anxiety runs in families, its
relatively easy to identify which
children might be at a greater
risk of developing the disorders.
With that in mind, Gins-
burg and colleagues tested a
family-based model aimed at
preventing the onset of anxiety
MARCH 201753
Brighter Futures for Anxious Kids

in children of anxious parents.

They recruited 136 families with
children ages 6 to 13. At least
one parent in each family had an
anxiety disorder, but the children
did not.
Half of the families partici-
pated in an eight-week program
that taught techniques to iden-
tify and reduce anxiety, as well as
parenting and problem-solving
strategies. The control group
received pamphlets with infor-
mation about anxiety disorders.
One year later, 5 percent of chil-
dren in the intervention group
had developed an anxiety disor-
der, compared with 30 percent of
the children in the control group
(American Journal of Psychiatry,
2015).
Rubin and his colleagues
at the University of Maryland MANY CHILDREN WITH ANXIETY CYCLE THROUGH
are also exploring prevention PERIODS OF WELLNESS FOLLOWED BY RELAPSE.
strategies in younger children. TRANSITION POINTS, SUCH AS STARTING SCHOOL,
He and psychologist Andrea
Chronis-Tuscano, PhD, have
ARE KNOWN TO BE PROBLEMATIC.
developed and are testing an
intervention for preschoolers who
are socially inhibited and have that when compared with LASTING EFFECTS
trouble engaging with their peers, children in a waitlist control Researchers are also exploring
in hopes of preventing social group, kids who participated in the best ways to help children
anxiety disorders down the line. the program had lower levels of and adolescents who are already
During the eight-week parent-reported behavioral inhi- experiencing anxiety disorders.
program, educators help the bition, and lower levels of anxiety In a large multisite trial known
children practice interacting symptoms as reported by both as the Child/Adolescent Anxiety
with one another in small group parents and teachers (Journal of Multimodal Study (CAMS),
settings. They work on skills such Consulting and Clinical Psychol- Ginsburg, Albano and colleagues
as introducing themselves, mak- ogy, 2015). compared treatments among
ing eye contact, playing games Rubin and colleagues are 488 children ages 7 to 17 who
together and expressing their hopeful that with further evi- suffered from social anxiety,
feelings. Meanwhile, clinically dence, such programs could be separation anxiety or generalized
trained specialists meet with the adapted for preschool and Head anxiety disorder.
childrens parents across the hall, Start settings to help quash Children in the study received
coaching them on strategies to early anxiety before it becomes either the drug sertraline, cogni-
MO MORAD/ ISTOCKPHOTO

support and encourage their anx- socially debilitating for a child. tive-behavioral therapy (CBT),
ious children in healthy ways. Children need to interact with a combination of the two or a
The study is ongoing, but a other children to become socially pill placebo. About 60 percent of
preliminary evaluation found cognitively aware, he says. children who received sertraline

54 M O N I TO R O N P S YC H O LO G Y MARCH 2017
alone or CBT alone showed
significant improvement, com-
pared with about 20 percent of
the placebo group. And about 80
percent of children who received
the combination therapy had a
significant reduction in anxiety
symptoms (NEJM, 2008).
While those improvements
were encouraging, Ginsburg says,
only 46 percent to 68 percent of
participants receiving combina-
tion therapy achieved remission
during the study, depending on
the measure used (Journal of
Consulting and Clinical Psychol-
ogy, 2011). And in a naturalistic
follow-up six years later, nearly
half of the children who initially
responded to treatment during
CAMS had relapsed (JAMA
Psychiatry, 2014).
But from the glass-half-full
perspective, about half of the
sample was in remission six years
later. Those who responded well
to their initial treatment during
CAMS were significantly more
likely to be in remission, and
have lower anxiety symptoms
and higher functioning six years
later, regardless of the type of
treatment they initially received.
(Children who received placebo
were later offered treatment, so
a placebo group wasnt evaluated
in the follow-up study.)
Those results suggest that
interventions to treat childhood
anxiety can have lasting effects.
Still, Ginsburg says, more work
is needed to figure out how to
help more children recover from
anxiety, and how to make sure
that recovery sticks.
Silverman is hopeful that
future treatments for child-
hood anxiety will become more
targeted and personalized. One
focus of her research is trying to
pinpoint individual differences,
such as which children might be
more responsive to medications,
or whether a particular child is
more likely to benefit from indi-
vidual therapy or a family-based
intervention. There are proba-
bly certain children and families
that will do better in one type of
approach than another, she says.
Meanwhile, theres room for
new treatments and new combi-
nations of treatments, Silverman
adds. In one effort to identify
such therapies, shes testing an
intervention known as attention-
bias modification training in
children and adolescents. The
approach builds on the evidence
that adults and kids with anxiety
are overly attuned to potentially
threatening stimuli in their envi-
ronments, such as angry faces.
Silverman is testing a game-
like computer-based training
program that helps kids learn to
ignore threatening stimuli and
focus instead on neutral stimuli.
Research is also needed to
figure out how best to combine
and sequence possible treatments,
Silverman adds. For instance,
should attention-bias modifica-
tion be done before CBT? At the
same time? Or only after other
treatments have failed? You can
have all these different permu-
tations, she says. The idea is to
develop a few evidence-based
treatments, refine them and
figure out which children would
benefit most from them.
For now, there are still big
questions about how best to help
children overcome anxiety over
the long term. Many children
with anxiety cycle through
periods of wellness followed by
relapse, Ginsburg says. Tran-
sition points, such as starting
middle school, are known to be
FURTHER problematic for anxious children.
READING So psychotherapists, for example,
The Burden of
could do more to prepare kids to
Anxiety Disorders anticipate and prepare for those
in Pediatric upsets. In dentistry, we go for a
Medical Settings: checkup every six months. We
Prevalence, have well baby checkups for
Phenomenology,
and a Research
kids. We dont do that in mental
Agenda health, and I dont think that
Ramsawh, H.J., serves the families that need it,
Chavira, D.A., & Ginsburg says. Waiting until
Stein, M.B. theres a crisis and then going for
Archives of Pediatric
Adolescent
help is problematic.
Medicine, 2010 Albano adds that psycholo-
gists must ensure that children
Naturalistic are receiving evidence-based
Follow-up of treatments specific to anxiety. A
Youths Treated for
Pediatric Anxiety
lot of times we see kids who have
Disorders been in therapy for several years,
Ginsburg, G.S., but issues like school functioning
Becker, E.M., or family functioning have taken
Keeton, C.P., et al. the focus, and anxiety was never
JAMA Psychiatry,
2014
directly addressed. Kids should
be getting the direct CBT-
Stepping Toward based intervention to deal with
Making Less More that anxiety, she says. Im not
for Concerning slamming other forms of psy-
Anxiety in Children
and Adolescents
chotherapy. Rather, psychologists
Silverman, W.K., have to partner with one another
Pettit, J.W., & to help kids with anxiety.
Lebowitz, E.R. Albano also urges her fellow
Clinical Psychology clinicians to think beyond their
Science and
Practice, 2016
offices to figure out how best to
help children. As psychologists,
Remission After we have to think out of the box
Acute Treatment and go where the kids are, she
in Children and says. That could mean reaching
Adolescents With
Anxiety Disorders:
out to schools or afterschool
Findings From the programs, leading camp-style
CAMS summer programs for children or
Ginsburg, G.S., et al. offering weekend hours con-
Journal of Consulting venient for more families. We
and Clinical
Psychology, 2011
have to meet the kids where
theyre comfortable and make it
easier for them to get treatment,
Albano says.
M O N I TO R O N P S YC H O LO G Y MARCH 201755
 HEALING BY
Nix the glass table
and fill the room with
light. These and other
research-based
design insights for
therapists offices can
reap client benefits
BY TORI DEANGELIS

Natural light is a
big mood booster,
so when possible,
incorporate windows
or skylights.

56 M O N I TO R O N P S YC H O LO G Y MARCH 2017
DESIGN

LOOKSLIKE/ ISTOCKPHOTO

M O N I TO R O N P S YC H O LO G Y MARCH 201757
Healing By Design

office from scratch or redo a

space thats seen better days?
Specifically, therapists should:

As clients enter the Keep it light. The color of

the office walls sets a tone.
Portland, Oregon, office Wall colors in light, soothing
colors like sage green or dusty
of psychologist Thomas Joseph Doherty, PsyD, they are greeted by the blue promote a sense of calm
majestic sight of Mt. Hood out an east-facing window, a profusion of and relaxation, environmental
healthy green plants, comfortable, supportive chairs and nature-based designers say.
artwork. Diplomas hang in a corner to advertise Dohertys expertise, and Go with the grain. For reasons
his clean, clutter-free desk adds to the feeling of openness and space. that arent entirely clear, people
Ideally your office should have a clean, living, generative senseone prefer natural-colored wood with
that fosters a renewed sense of physical vitality, alertness and creativity a grain rather than nongrain sur-
for your clients and yourself, says Doherty, whose practice centers on faces, research finds. People also
feel more comfortable with wood
helping his clients develop what he calls sustainable habits like rest, than with slicker options like
exercise, social support and connection with naturestrategies that help glass and chrome, Augustin says.
maintain health and performance over the long term. That said, theres a limit to
how much wood you should
Dohertys space is a good Nasar, PhD, of The Ohio State use: Research shows that when
example of todays direction in University. In their research natural wood surfaces like floors
health-care design, which uses examining peoples reactions and walls exceed 45 percent of a
research on human behavior and to 30 photographs of actual rooms surface, they start losing
design principles to promote therapy offices, the more a space their stress-busting effects.
positive interactions between exhibited those characteristics
therapists and clients. cozy elements like comfortable Let the sun shine in. Natu-
A space should be something chairs and soft pillows, attrac- ral light is a big mood booster,
that supports you as you try to tive touches like artwork, and so when possible, incorpo-
achieve specific goals, explains neatnessthe better people felt rate windows or skylights, says
Sally Augustin, PhD, an applied about the offices and the ther- Dawn Gum, director of interior
environmental and design psy- apists who worked there, they architecture at the national firm
chologist and founder of Design found (Professional Psychology: EwingCole. If windows are at eye
with Science, an international Research and Practice, 2012). level, the best viewslook out on
consulting firm. For therapy In addition, good therapy calming, natural scenery, not onto
offices, that means creating a office design should take into bustling sidewalks or roads with
calm and refreshing environment account the human instinct distracting sights and sounds.
to balance the rigorous mental to protect ourselves and our If your office lacks win-
and emotional work of therapy, territorya feature that may dows, use floor and table lamps
she says. be particularly important to with soft lighting rather than
Well-designed therapy offices consider with vulnerable therapy overhead fluorescent lighting to
also exude softness, personal- clients, Augustin says. We are promote a feeling of comfort
ization and orderliness, finds animals, after all, she says. We and coziness, says Gum. Some
research by environmental psy- do our best mental work when lightbulbs even simulate natural
chologist Ann S. Devlin, PhD, of we feel a little bit protected. light, which can boost the pos-
Connecticut College, and urban So, given such insights how itive ambience of windowless
planning researcher Jack L. should practitioners design an offices.

58 M O N I TO R O N P S YC H O LO G Y MARCH 2017
 Embrace the natural. Bringing
nature into the officewhether
with plants, nature embodied
in artwork, decorative objects
or views of plant-filled court-
yards and landscaped areascan
enhance the healing quality of
a space. Just looking at land-
scaping has been shown to lower
blood pressure, Gum says.
The right nature-based art-
work can also give clients a way
to muse on life situations, these
experts add. Images of a path-
way through a serene landscape
or a bench in the middle of a
pleasingly landscaped garden can
foster relaxation or allow clients
to make mental associations with
the imagery. But, Augustin cau-
tions, avoid nature imagery thats
confusing, chaotic or complex.
You want to look at a scene that
would be comfortable to enter,
she says.
A GLANCE INTO A FISH TANK, OR AT
HOWARD OATES/ ISTOCKPHOTO
OTHER INVITING SIGHTS LIKE ART OF
PASTORAL LANDSCAPES, CAN PROVIDE
A REFRESHING INTERLUDE FROM
TALKING ABOUT WEIGHTY ISSUES.
Use positive distractions.
Fish tanks in medical offices are
somewhat clich, but they may
have empirical merittheyre
an example of so-called posi-
tive distractions, a phenomenon
noted in many research studies
(see Resources). A glance into
the tank, or at other inviting
sights like art of pastoral land-
scapes, can provide a respite from
talking about weighty issues.
You want views that draw you
in and give the part of your brain
that has to focus a mini break,
Augustin says.
Promote your expertise.
Displaying your credentials
might seem self-serving, but
clients want to see signs of your
expertise, research also finds. In
a study by Devlin and her stu-
dents, participants looked briefly
at photos of therapy offices with
zero, two, four or nine diplomas
on the wall. People rated thera-
pists who worked in offices with
four and nine credentials most
favorably, with little difference
between the two (Journal of
Environmental Psychology, 2009).
Have your clients back. An
evolutionary perspective can help
you make intelligent decisions
on what is arguably the most
important element in your office:
the client chair.
To support peoples need for
control, consider having chairs
RESOURCES that can be moved or are large
enough to let people shift to one
Center for
side or the other and adjust the
Health Design
The knowledge distance between themselves
repository of research and the therapist. If any of your
and resources clients have histories of being
on health-care physically violent, make sure
design topics.
chairs are heavy enough that
www.healthdesign.
org/search/articles they cant be easily picked up and
thrown. Likewise, chairs with
Transforming backs at shoulder height can
the Doctors Office facilitate a feeling of protection,
Devlin, A.S. environmental design researchers
Routledge, 2014.
Includes a section on add. Other ways to promote a
therapists offices. sense of personal safety include
placing a plant behind the chair
and positioning chairs so clients
can see the door.
A related suggestion: Place
small tables next to client chairs,
which can enhance clients sense
of territory by giving them a
place to put personal items. Your
clients will appreciate that youve
attended to their comfort and
convenience, says Lynn Bufka,
PhD, APAs associate executive
director of practice.
Fostercommunication. If
you use tables in your office for
individual or family sessions,
research shows that round tables
M O N I TO R O N P S YC H O LO G Y MARCH 201759
Healing By Design
support better communica-
tion and sense of control than
square or rectangular ones, says
EwingColes director of research,
environmental psychologist
Nicholas Watkins, PhD. Also,
the presence of computers is
shown to impede communi-
cation, particularly when the
client perceives that the pro-
vider is paying more attention
to the computer than to him or
her. Screen-sharing strategies
technology that enables you to
project information onto a table,
for example, or simply facing the
screen toward clientscan pro-
mote clients sense of trust and
inclusion, Watkins notes.
Go with the flow. Anything
that promotes flow and efficiency
in your immediate and larger
office space is worth addressing,
according to research compiled
by APAs Practice Organization.
Keeping a clean, uncluttered
desk and placing the items you
need closest to youcomputer,
phones and appointment book,
for instancecan help you keep
a clear head and feel in charge of
your space.
Experts also recommend
walking through the functions of
your day to identify areas of inef-
ficiency for yourself, your staff
and your clients. Fixes can be
small and no costmoving the
location of your assistants desk,
for exampleor more extensive,
like knocking out a wall to create
better traffic flow.
Not too fancy, not too shabby.
When selecting furniture and
finishes for your office, keep cli-
ent demographics in mind, adds
Gum. In general, people feel
60 M O N I TO R O N P S YC H O LO G Y
chairs that are the right size. Be
sure that chairs are comfortable
TAPPING DESIGN HELP for people of all sizes.
Including art that
W hen considering an office redo, seek
architects or interior designers with expe-
rience in health care and medical offices, advises
demonstrates your openness
to different cultures can also
be a plus, particularly if you
Dawn Gum, director of interior architecture at serve multicultural clients,
EwingCole, an integrated architecture, engineer- finds research by Devlin
ing, interior design and planning firm. and colleagues (Professional
For architects, seek professionals certified with Psychology: Research and Practice,
EDAC, the Evidence-Based Design Accreditation 2013). When the team compared
and Certification, the certification for members of reactions of white college
the Center for Health Design. students and mainly ethnic
For interior designers, find someone certified minority adult community
by the NCIDQ, the National Council for Interior members to photos of a
Design Qualification. Look for designers who work therapists office, the community
in commercial spaces with a health-care focus. group rated the therapist more
favorably when the art was more
ethnic in flavor than Western.
most comfortable with a middle If all of the artwork clients see
range of furnishingsthose that ... represents a tradition different
arent overly fancy or expensive, than their own, it is possible for
but not cheap or shabby, either. them to feel unwelcome, the
If youre putting in very authors write.
expensive materials but your cli-
entele is not at the upper end of Hire a pro. Finally, consider
the socioeconomic spectrum, you hiring a professional to help you,
can alienate people, says Gum. preferably a qualified architect or
Conversely, old or poorly made interior designer who specializes
furnishings can make it look in health care (see box). He or
like youre not doing wellthe she can help you map out how
wrong message to send clients. you actually work and how
you want to work, and craft
Put your client first. Remem- your space accordingly. They
ber that youre designing your also know whats available in
office more for your client than furniture and finishes, and about
for yourself, Gum empha- the changing landscape of health
sizes. Including some personal care, including new technologies.
Interested in the
elements can be subliminally link between psy-
Investing in good office
comforting to clients, but make chology and design? design isnt just about creating
Check out the work of
sure they dont overpower a sense APA Div. 34 (Society for
an attractive space, its about
of neatness and calm, she advises. Environmental, Popula- investing in your business and
tion and Conservation
On a related note, make sure Psychology), which
professional calling, adds Gum.
your furniture addresses the spe- among its foci explores If its designed right, she
behavior and the built
cific needs of your clients, says environment. Learn
says, your office can help you
Bufka. If children are among more about Div. 34 deliver care in ways that really
at www.apadivisions.
your clientele, make sure you org/division-34/index.
do promote your clients well-
have age-appropriate toys and aspx. being.
MARCH 2017
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Career
TAKE CHARGE!
Are you a student or early career psychologist who wants
leadership experience, but arent sure how to get it? Heres
advice from leaders who stood in your shoes not long ago.
BY HEATHER STRINGER
W
hen Jerrold Yeo
moved from Singa-
pore to the United
States to start graduate school in
clinical psychology, he was sur-
prised to find that there were lots
of leadership opportunities for
students at APA, such as serving
on boards and committees and
advocating on behalf of psychol-
ogy on Capitol Hill.
In my own country, there
were a lot of barriers to getting
student voices heard and imple-
menting changes, says Yeo, now
a fifth-year graduate student
at the University of Denver. I
wanted to make use of the free-
dom to be heard in this country.
Yeo initially assumed his
chances of being selected for
a leadership role were slim
because he had little experience,
but he applied anyway. He was
delighted when he was chosen to
be a member of the Convention
Committee for the American
Psychological Association of
Graduate Students (APAGS),
a position he held from 2013
to 2015. As he made connec-
tions within the organization,
he started getting invitations for
other leadership positions, such as
serving as an APAGS representa-
tive to the Global Approaches to
Integrated Health Care Summit,
where he met psychology leaders
62 M O N I TO R O N P S YC H O LO G Y
from China, England, Norway
and the United States. Now as a
member-at-large with a practice
focus on the APAGS Committee,
Yeo is one of nine elected offi-
cers who advocate for graduate
students and discuss new policies
within APA.
The experience has been
invaluable for his career growth,
he says. These leadership roles
have taught me to be more confi-
dent, to be a better speaker and to
negotiate, Yeo says. Its a great
way to find your own voice and
learn what its like to be a leader.
Yeos advice to others who are
considering leadership is to start
by trying. If you dont try, youll
never know where you might be
successful, he says. And dont
let rejection discourage you. Yeo
was rejected from multiple posi-
tions throughout his journey, and
initially he took these experiences
personally. But now I under-
stand that its not about whether
Im good enough or have a flaw
in my character. If Im not the
best person at that moment, there
is probably another position for
me that is a better fit.
The Monitor asked psychol-
ogists involved in leadership to
share tips about how graduate
students and early career psy-
chologists can break into these
roles. Here are their suggestions.
MARCH 2017
Determine what excites you.
Look for leadership opportu-
nities in an area that deeply
interests you, says Sandra
Shullman, PhD, a managing
partner of the Executive Devel-
opment Group, an international
leadership development and
consulting firm. Effective lead-
ership involves having a passion
for what you are doing, she says.
You will meet like-minded souls
you can learn from, and some of
those people may become role
models. Pursuing leadership in
an area of interest can also help
leaders grow during stressful
times. For example, shes seen
newer leaders struggle when they
make decisions that displease
certain people. They learn how to
find the courage to do some-
thing, even if its unpopular, and
they are more likely to do that
in an area they have passion for.
Startsmall. Look for leader-
ship opportunities at state and
regional psychology associations,
says Daniel Reimer, PhD, who
recently earned a doctoral degree
in behavioral psychology from
the University of Nevada, Reno.
He started learning how to
organize conventions by joining
a committee with the Nevada
Psychological Association. That
experience helped him land a
 two-year position as chair of the
APAGS Convention Commit-
tee in 2013. Another entry point
could be serving as a student rep-
resentative for an APA division,
a state, provincial and territorial
psychological association or the
APAGS Advocacy Coordinating
Team, anetwork of graduate stu-
dents who engage in legislative
advocacy and awareness, he says.
For those who enjoy working on
projects, serving on a task force
or special project within an orga-
nization is another way to get
experience and to observe how
others lead, says Shullman, who
is also a member of the APA
Board of Directors.
PEOPLE IMAGES/ ISTOCKPHOTO
Do it well. Once you get a
volunteer leadership position,
follow through on everything
you are asked to do, says Nadine
J. Kaslow, PhD, a former APA
president and a professor in the
department of psychiatry and
behavioral sciences at Emory
University. You get a reputation
quickly as someone who follows
through or not, she says. She
served in leadership roles on var-
ious APA committees earlier in
her career and was always careful
not to take on more tasks than
she could do well.
Find leadership mentors.
Kaslow encourages psycholo-
gists to find mentors who can
provide guidance, feedback and
connections. Potential mentors
may surface in a variety of places,
such as psychology departments,
postdoctoral programs, state
psychology associations and
APA divisions and committees.
Shes also seen the benefits of
peer mentoring. Kaslow and
her colleagues recently surveyed
graduate students and early
career psychologists who had
served as chair of APAGS or
of APAs Committee on Early
Leadership roles Career Psychologists during the
help to build last seven years and found that a
confidence,
speaking skills, combination of peer and senior
negotiation mentoring seems to be the ideal
abilities and more. plan because they have differ-
ent strengths. A senior mentor
can help mentees understand an
organizations system, introduce
them to people and share past
experiences. But a peer can say,
I just tried doing something
similar, and here is how it went,
Kaslow says.
Findareas of need. Keith
Micoli, PhD, was a postdoctoral
fellow when he started feeling
isolated because he wasnt part of
M O N I TO R O N P S YC H O LO G Y MARCH 201763
Career
a cohort or department like the
graduate students at his school.
After talking to other fellows,
he quickly discovered he wasnt
alone. To solve this problem,
Micoli decided to launch a
postdoctoral association at the
University of Alabama at Bir-
mingham. When he approached
the university with the idea, he
shared how a group for postdocs
would benefit the institution by
increasing postdoc satisfaction.
If you want to solve a problem,
youll increase your chances of
support if you go beyond your
personal need and consider the
value to the institution, Micoli
says. This experience led to con-
nections on a national level, and
now hes the director of postdoc-
toral affairs at the NYU School
of Medicine.
Say yes. Melanie Lantz, PhD,
an assistant professor of coun-
seling psychology at Louisiana
Tech University, wasnt looking
for leadership opportunities
during her first year of grad-
uate school. But then several
professors started encourag-
ing students to apply for the
Student Affiliates of Seventeen,
or SAS, an organization for
students associated with APAs
64 M O N I TO R O N P S YC H O LO G Y
Div. 17 (Society of Counseling
Psychology) and Lantz applied.
She ended up co-chairing SAS,
which included serving on the
Div. 17 executive board. Through
the experience, she learned about
LEADERSHIP APAs governance structure and
RESOURCES the professional issues in the
IN A field. Now shes chair-elect of
NUTSHELL Div. 17s Early Career Profes-
sionals Committee and chair of
1 the divisions Hospitality Space
Go to www.apa.
org and search Committee for the next conven-
for leadership tion. If someone hadnt tapped and the Executive Leadership in
opportunities for a me to apply for a leadership
wealth of ideas and
role when I was a new graduate
resources.
student, I probably wouldnt have
2 gotten involved, Lantz says. If
Contact your you are tapped to lead or serve,
state and regional take those opportunities.
association
for leadership
opportunities. Attend conferences. Confer-
ences and conventions are critical
3 for networking, psychology lead-
Attend
conferences ers say. Introduce yourself and
to meet other get yourself out there, Yeo says.
leaders, including When I attended conventions
APAs Annual and division conferences, I met
Convention,
people who encouraged me to
Aug. 36, in
Washington, D.C. apply to certain leadership posi-
tions that were open. Its also
important to develop and prac-
tice a 30-second elevator speech
to introduce yourself to new peo-
ple, says Helen L. Coons, PhD,
president and clinical director of
MARCH 2017
Health Psychology Solutions in
Colorado and a member of APAs
Board of Directors. Although
the speech will vary depending
on the audience, in general its
effective to share your name,
your specialty and your interest
in learning more about leader-
ship opportunities, she says.
Seek out training. Look for
leadership training programs
offered by APA, state psychology
associations and other organi-
zations. Div. 17, for example,
offers the Society of Counseling
Psychology Leadership Academy
for students and early career psy-
chologists. When Kaslow started
getting involved in leadership,
she knew she needed to develop
a new set of competencies, which
prompted her to apply for lead-
ership training programs offered
by her university, the American
Association of Medical Colleges
Academic Medicine program.
She also secured fellowships
through organizations like the
U.S. Public Health Service to
learn about public policy and
other aspects of leadership.
Ask for feedback. While
securing a leadership position is
valuable, you can make the most
if it by gathering input along
the way, Shullman says. After
leading a meeting, check in with a
colleague to learn what went well
and what could be improved. Let
people know that if something is
bothering them, you would like to
hear from them, she says. Cre-
RAPID EYE/ ISTOCKPHOTO
ate an environment that invites
feedback so you can gauge how
youre doing and make midcourse
corrections, Shullman says.
NEW RELEASES
from the American Psychological Association
A Practical Guide
to Cultivating
Therapeutic Presence
Shari M. Geller
2017. 248 pages. Hardcover.
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CognitiveBehavioral
Therapy
SECOND EDITION
Michelle G. Craske
2017. 224 pages. Paperback.
Series: Theories of Psychotherapy Series
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The Psychology of Juries
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Activities for Teaching
Statistics and
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A Guide for
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Edited by Jeffrey R. Stowell
and William E. Addison
2017. 192 pages. Paperback.
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ISBN 978-1-4338-2714-3 | Item # 4316177
TO ORDER: 800-374-2721 www.apa.org/pubs/books
APA Handbook
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in Knowledge
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Helping Couples on
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William J. Doherty
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AD3137
How Did You Get That Job?
RISKY BUSINESS:
MIXING MONEY AND KIN
As a strategic wealth coach, Kristen Armstrong helps
families see money as a way to enhance family
relationships and make a social impact
BY HEATHER STRINGER
M
any psychology
practitioners
help families talk
through their
issues with money,
but psychologist
Kristen Armstrong, PhD, has a par-
ticularly focused tack: helping wealthy
families deal with the impact their
money has on the family, the commu-
nity and the world.
Armstrong is a strategic wealth coach
on an interdisciplinary national team of
advisors at Ascent Private Capital Man-
agement in San Francisco, which is part
of U.S. Bank. About half of her clients
own businesses, and the other half have
sold businesses and are figuring out how
to manage the money that remains. The
Monitor talked to Armstrong about her
career and how she got that job.
What do you do as a strategic
wealth coach?
I typically take families on a retreat to
help them clarify their shared values and
the purpose and meaning of their wealth.
Before the retreat, I interview each fam-
ily member to gather information about
their relationships with the business and
one another. Then I get them together
to discuss the themes picked up in the
interviews and to do temperament and
values assessments. This helps them bet-
ter understand each other and how they
66 M O N I TO R O N P S YC H O LO G Y
each fit in with the financial and business
enterprise. The conversations that follow
can be very deep. For example, older gen-
eration family members seeoften for
the first timewhat really inspires and
motivates younger ones. Once their val-
ues, vision and goals have been clarified,
families often will then pursue a longer-
term program of meetings, retreats and
individual coaching with me to help
them put some legs on their aspirations.
At the moment, I am working with a
family of 39 members. The family busi-
ness is growing internationally and they
want to prepare the younger generation
for leadership roles. One branch of the
family wants to get out of the business, families about the sorts of emotions and
but wants to maintain the financial ben- mindsets that are very typical of people
efits and keep their family relationships who, for example, want to let go of the
strong. I will help everyone define what is reins but are not sure how to do it. They
in the best interest of the extended fam- are coming to terms with the loss of an
ily and the business. identity, so I teach them how they can
also begin building a new one as mentor
How do you use your psychology for the next generation.
training?
People sometimes seek me out after a How did you get the training and
conflict has erupted and they need help experience needed for this job?
repairing relationships. I use family I earned a degree in clinical psychology
systems and communications models to at the graduate school of psychol-
help them unpack the history related to ogy at Fuller Theological Seminary in
the conflict, devise better ways to manage California. I worked in clinical practice
their differences and navigate their way for several years, and then someone Id
through change. These large, multigen- known from graduate school approached
erational enterprises evolve and become me after he started a consulting practice.
more complex over time. I educate these He was offering executive coaching and
MARCH 2017

team development to Fortune 500 com-
panies internationally, and he wanted to
find a female coach to work with some of
the female executives. In response, I took
some CE courses in consulting psychol-
ogy and I completed a two-year coaching
certification program for licensed men-
tal health professionals offered by the
College of Executive Coaching in Arroyo
Grande, California. I started by working
with women who were being groomed
for higher levels of leadership. Then I
became aware of the need for leadership
development in the myriad tech startups
in Silicon Valley. People were launching
businesses who had never managed peo-
CATHERINE KARNOW
ple before, and I found my team training
and executive coaching skills very useful
there. At the same time, leaders in family
businesses began asking for my consult-
ing services within their families.
How did you find out about the job?
I got a call from a headhunter who told
me that U.S. Bank was developing a fam-
ily education and wealth management
program. They wanted psychologists on
staff to help them build and execute a
program around the idea that wealth
is more than money. Its a holistic
approach based on the idea that financial
wealth is best managed within the larger
view of the familys values, purposes,
concerns, dreams and opportunities. I
had experience in both the clinical and
business worlds, and had advised family
businesses for over a decade, so the job
was a perfect match for my skills.
I love seeing families
come alive around
the good their
wealth can do, says
Dr. Kristen Armstrong.
What is challenging about the work?
It can be challenging to get face time
with the clients. The family attorneys,
financial advisors and I need to be very
aware of a familys time because they can
be busy people, so any contact must be
highly valuable.
What do you enjoy most?
I love seeing families come alive around
the good their wealth can do.
One family I worked with has a
foundation, and the younger generation
was interested in seeing places they were
donating money to. They are getting to
know the people and the needs in these
settings, and as a result, the entire family
has gotten excited about what else they
could do to help.
M O N I TO R O N P S YC H O LO G Y MARCH 201767
No Insurance Required
COACHING ADULTS, STUDENTS
AND YOUNG KIDS WITH ADHD
Coaching helps clients cope with attention-deficit/hyperactivity disorder
while helping psychologists flourish without relying on insurers
BY REBECCA A. CLAY
In this new Monitor series, No
Insurance Required, we look
at the ways psychologists are
providing services that dont
require reimbursement from
insurance companies.
C
hildren, adolescents
and adults with atten-
tion-deficit/hyperactivity
disorder (ADHD) dont neces-
sarily need psychotherapy, says
psychologist Abigail Levrini,
PhD. What they often do
need is help getting themselves
organized and reaching their
goalscoaching, in short.
To fill that niche, Levrini
founded an ADHD coach-
ing business called Psych Ed
Connections in 2008. Demand
for her services has been so
great that the company now has
three offices in two states. And
whats good for consumers with
ADHD has also been good for
Levrini by allowing her to fulfill
her dream of building a prac-
tice independent of insurance
companies.
I had heard many unfor-
tunate horror stories about
psychologists not getting reim-
bursed for the clients they had
seen and worked with, says
Levrini. Fortunately, I have never
had to go that route and have
68 M O N I TO R O N P S YC H O LO G Y
been able to make it without it.
Whether ADHD coaching
is a full-time business or just
a small supplemental income
stream, its a real growth area,
says Frances Prevatt, PhD, the
Florida State University psychol-
ogy professor who developed the
evidence-based ADHD coach-
ing intervention that forms the
basis of former student Levrinis
coaching practice. More and
more people are being diag-
nosed, says Prevatt. And there
arent that many people who
specialize in treating those with
ADHD.
A SPECIALIZED BUSINESS
Prevatt developed the coaching
intervention 14 years ago when
she realized she had no place to
send students she was diagnos-
ing with ADHD as director of
Florida States Adult Learning
and Evaluation Center. Other
Whether ADHD
coaching is a
full-time business
or just a small
supplemental
income stream,
its a real
growth area.
MARCH 2017
than recommending medication
and accommodations, we didnt
really have anything good to
offer them, says Prevatt.
Grounded in cognitive-
behavioral therapy principles,
the intervention she developed
is an eight-week program that
matches clients with doctoral
ADDITIONAL psychology students who serve as
READING coaches as a practicum experi-
ence. Working one-on-one, the
ADHD Coaching:
coaches and their clients identify
A Guide for
Mental Health two or three goals to tackle, such
Professionals as improving time-management
Prevatt, F., & strategies, managing long-
Levrini, A. term projects, passing a specific
APA, 2015
class or even learning to do
ADHD Coaching laundry. Each week, the pair
With College identifies intermediate steps and
Students: Exploring brainstorms how to overcome
the Processes obstacles, with rewards and
Involved in
consequences built in to boost
Motivation and
Goal Completion motivation. Were not telling
Prevatt, F., et al. them what to do, says Pre-
Journal of vatt. Were teaching them the
College Student problem-solving process.
Psychotherapy,
Levrini was one of Prevatts
2017
coaches at Florida State and
studied the intervention for her
dissertation. Once she graduated
and launched her own practice,
she took that model, tweaked
GBH007/ ISTOCKPHOTO
it and established it in Ponte
Vedra, Florida; Alexandria,
Virginia; and Ashburn, Virginia.
One key difference is that
 ADHD coaching
helps children
and adults alike
identify their
strengths and
weaknesses.
the coaches are all licensed
psychologists and other mental
health professionals. Because
the Florida office is located in
an underserved area, it offers
services beyond coaching, but
coaching represents at least half
its business.
Educating children and adults
about the difference between
coaching and therapy is a crucial
first step, says Levrini, who often
compares being an ADHD
coach to being an athletic coach
for kids. Youd never expect to
be able to just put on a uniform
and go out onto a sports field
and play effectively on your
own, so why should people with
ADHD expect that they should
just be able to figure out ways
to stay organized or manage
their lives effectively without
help? she says. A coach can
help you learn the rules of the
game, see where your strengths
and weaknesses are and help you
M O N I TO R O N P S YC H O LO G Y MARCH 201769
No Insurance Required
play more effectively, in sports
or in life.
Coaches and clients then
meet each week to outline baby
step actions and track progress
on two to four overall goals.
These goals must be specific,
measurable, action-driven,
realistic and time-sensitive, says
Levrini. They should also focus
on the process of achieving them
as well as the outcomes, she adds.
A student with ADHD might
procrastinate, stay up until 3 in
the morning to work on a project
and still get a good grade, she
points out. But doing so gener-
ates a lot of stress and anxiety in
the process, so its important not
to encourage positive outcomes
that are not a result of healthy
processes. As in the Florida
State program, Levrinis coaches
also use external rewards and
consequences to help clients who
need an extra dose of motivation.
Another twist on the original
program is that coaches and
clients dont necessarily meet
face to face, thanks to Psych Ed
Connectionss online coaching
option. That expands the poten-
tial client base to include the
entire country or even the whole
world, says Levrini.
A HELPFUL SIDELINE
For psychologist Peter C.
Thomas, PhD, of Atlanta, a small
ADHD coaching sideline rep-
resents a way to help his clients
while bringing in a little extra
income.
In his practice, Thomas
focuses on evaluating chil-
dren for ADHD and learning
disabilities and providing
psychotherapy to children,
adolescents and families. About
70 M O N I TO R O N P S YC H O LO G Y
Helping with organization and
structuring their time are among
the skills that ADHD clients need
the most help with.
20 years ago, he realized his
clients needed something more:
ADHD coaching.
What people with ADHD
need most is help structuring
their time, says Thomas. Having
someone to check in with helps
them stay focused on what they
want to accomplish, he says,
adding that his clients tend to
be disorganized college students
and adults. Coaching can help
them learn to develop the habits
that theyre having trouble devel-
oping on their own.
To get the training he needed
to launch his coaching business,
Thomas attended a three-
day workshop conducted by
child psychiatrist and ADHD
expert Edward Hallowell, MD,
EdD, founder of the Hallowell
Centers, which offer ADHD
treatment in Boston MetroWest,
MARCH 2017
New York, San Francisco and
Seattle. Conducted by Hallowell
and other coaches, the workshop
focused on the intervention as
well as the business aspects of
coaching.
As a result of that training,
Thomas developed a simple
coaching intervention he dubbed
FOCUS (From Organized
Coaching Ultimate Success).
The process begins with coaches
interviewing new clientswho
come to the service via refer-
rals from other psychologists,
psychiatrists, word of mouth and
Thomass own practiceabout
their problems and goals.
Clients then call their coaches
each morning during the work
week to discuss the three main
goals they want to accomplish
that day. Together clients and
their coaches discuss how to
accomplish those goals and make
a plan. The process takes from five
to 10 minutes. Clients renew their
contracts and prepay with credit
cards every two weeks as long as
they need, which may be several
months or even years. As clients
internalize these problem-solving
skills, the calls taper off. To
help keep the service affordable,
Thomas doesnt provide coach-
ing himself. Instead, he trains
psychology graduate students
to offer coaching services and
monitors their work on an
ongoing basis. He then splits the
proceeds from the coaching with
his coaches.
Its not a big money maker,
but its slow and steady, says
AG-CHAPEL HILL/ ISTOCKPHOTO
Thomas, who estimates that
ADHD coaching represents
1 percent of his income. It
brings a little extra into the
revenue stream.
People
Allen Pfeiffer
PSYCHOLOGISTS IN THE NEWS
The Alexander von Humboldt Founda-
tion has presented its research prize to
John Allen, PhD, a distinguished profes-
sor of psychology at the University of
Arizona, in recognition of his contribu-
tions to the field of psychophysiology.
Allen is studying how transcranial ultra-
sound can treat and prevent depression
and how activity in the brains frontal
lobe can be used as a biomarker of
depression risk.
Daniel J. DeWitt, PhD, is now senior
vice president of human resources at the
telecommunications company Telephone
and Data Systems Inc. DeWitt has been
providing assessments and coaching
to executives for more than 30 years.
Before joining TDS he was the executive
psychologist at Shields Meneley Partners,
an executive placement firm, and a psy-
chologist at PsychOne.
The Italian Parliament invited S teven
I. Pfeiffer, PhD, to testify before the
Commission on Culture in Rome in
November on behalf of the unmet
educational and psycho-social needs of
high-ability children in Italian public
schools. Italys public schools do not
currently offer specific services for gifted
children.Pfeiffer is a professor in the
department of educational psychology
DeCou Rosenberg
and learning systems at Florida State
University who conducts research on the
social and emotional needs of the gifted,
and talent development.
The International Society for Traumatic
Stress Studies has given Idaho State
University psychology graduate student
Chris DeCou its Outstanding Student
of the Year Award for his work with
trauma-exposed incarcerated women.
DeCou has been studying risk and pro-
tective factors for these women with his
mentor, psychology professor and depart-
ment chair Shannon Lynch, PhD.
Forbes magazine has named Yale
University psychology graduate student
Monica Rosenberg to its The 30
under 30: Science list for her work
in cognitive neuroscience. Rosenberg
studies how people sustain attention
and lose focus. She is building models to
predict differences in attention through
brain patterns in hopes of finding ways
to improve peoples ability to focus.
Rosenberg is a member of Yales Visual
Cognitive Neuroscience Lab and earned
her undergraduate degree at Brown
University.
Students at the Army-Baylor Univer-
sity Graduate Program in Health and
Mangelsdorff
Business Administration have named A.
David Mangelsdorff, PhD, its Educator of
the Year. Mangelsdorff has been a profes-
sor at Baylor for 22 years and an adjunct
instructor with the Army-Baylor program
for 21 years. He is a Fulbright faculty
scholar, a retired colonel in the Army
Reserves and a six-time winner of Baylors
Faculty Researcher of the Year award.
Max Wachtel, PhD, is serving as the
behavioral profiler on the reality compe-
tition television show Hunted, which
is airing on CBS. The series follows nine
teams of two in a real-life manhunt as
they try to disappear while being tracked
by intelligence and law enforcement
experts. Wachtel developed a personality
profile for each participant on the show,
each of whom was screened for medi-
cal and psychological concerns prior to
participating, and helped the intelligence
analysts use that information to predict
how each participant would behave in
stressful situations and where he or she
might travel next. Wachtel is a clinical
and forensic psychologist in Denver,
where he conducts evaluations of crim-
inal offenders for the courts and private
attorneys. He is also a former instructor
in the counseling psychology program in
the College of Education at the Univer-
sity of Denver.
M O N I TO R O N P S YC H O LO G Y MARCH 201771
Deeper and
Deeper.
The Monitor on Psychologys interactive format hyperlinks
to all of the research cited throughout the issue.
Now thats deep.

DOWNLOAD THE APP AT APPLE, GOOGLE PLAY AND AMAZON STORES

OR VISIT US ONLINE AT WWW.APA.ORG/MONITOR/DIGITAL

monitor on
psychology
A PUBLICATION OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION
PsycCareers
Search Hundreds of Psychology Jobs on PsycCareers.com

CALIFORNIA
POSTDOCTORAL RESIDENCY
CHILD ABUSE & TRAUMA: The
Child & Family Guidance Cen-
ter, is seeking motivated, qualified
applicants for our post-doctoral
residency program. The post-doc-
toral residency is from Septem-
ber 1, 2017 to August 31, 2018
(40-hour/week). The Center pro-
vides comprehensive training and
supervision on interventions with
an ethnically diverse population
of children and families who have
experienced sexual/physical abuse,
neglect and/or domestic violence.
Opportunities include individ-
ual/family/group psychotherapy,
psychodiagnostic assessments,
sexual abuse evaluations, commu-
nity outreach, crisis intervention,
school-based therapy, family ther-
apy, early intervention and parent/
child interaction therapy. Fellows
receive training on evidence-based
treatment and participate in sev-
eral weekly seminars includ-
Take Charge!
CAREER Are you a student or early career
INSIGHTS psychologist who wants leadership
ing: Advanced Psychodiagnostic
assessments, Countertransfer-
ence and the Therapeutic Process
and Assessment of Sexual Knowl-
edge. Bilingual (English/Spanish)
speaking applicants are strongly
encouraged to apply. Postdoc-
toral stipends are available with
additional benefits. Send letter of
interest, curriculum vitae, a copy
of a recent child psychodiagnostic
assessment evaluation and three
letters of references to: Jennifer
Vargas Pemberton, PhD, Direc-
tor of Training, Child & Fam-
ily Guidance Center, 8550 Balboa
Blvd., Suite 150 Northridge, CA
91325. Additional information
can be obtained at our website:
www.childguidance.org.
FLORIDA
FLORIDA LICENSED PSYCHOLO-
GIST: Associates in Family Psy-
chology (Fort Myers, FL) seeks
a full-time FL licensed psychol-
ogist to join our expanding prac-
tice located on the beautiful Gulf
Coast of Florida. Generalists hav-
ing experience providing psycho-
therapy to children, adults and
families preferred, and experi-
ence with psychoeducational eval-
uations desired. Provide services
to your clients with benefit of bill-
ing, collections and group mar-
keting in a well-established and
respected practice. Send cover let-
ter and curriculum vitae to: Shari
Chrovian, PsyD at slchrovian@
gmail.com.
GEORGIA
PSYCHOLOGIST POSITIONS
THROUGHOUT GEORGIA: DBHDD
has several opportunities across
the state of Georgia for expe-
rienced Psychologists. Foren-
sic (evaluation and treatment)
and adult mental health (civil)
inpatient positions are available
in facilities located in Atlanta,
Augusta, Columbus, Milled-
geville (forensics only) and Savan-
nah as well as outpatient forensic
evaluator (adult or juvenile) posi-
tions located throughout the state.
Locations range from affluent, but
affordable, family-friendly cities
located among beautiful moun-
tains, beaches, and riverfronts,
to the diverse and fun-filled city
of Atlanta. Compensation is very
competitive and the generous ben-
efits package includes: Health and
life insurance; Dental; Retirement
plan; 401(k) plan; Vacation time;
and more. PsyD or PhD in clini-
cal psychology from an APA-ac-
credited program. Some inpatient
units have opportunities for spe-
cialization in trauma-focused
interventions, sex offender treat-
ment, or habilitation for individ-
uals with intellectual disability.
A limited number of administra-
tive positions are available. Senior
psychologists with excellent lead-
ership skills preferred. Contact
our clinical recruiter Greg.Short@
dbhdd.ga.gov.
PRIVATE PRACTICE OPPORTUNITY
ATLANTA OVERHEAD SHARING:
Join Atlanta Center for Cognitive
Therapy at Lenox Pointe. Great
referral base and collegial support
to grow professionally. Solid rep-
utation and 30 years in Atlanta.
See cognitiveatlanta.com for more
information and communica-
tion. Send us a letter of interest
and curriculum vitae to acct1772-
search2017@yahoo.com.

IN THIS
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M O N I TO R O N P S YC H O LO G Y MARCH 201773
PsycCareers
ILLINOIS
PSYCHOLOGIST WITH ILLINOIS
LICENSE: Davken Associates has
been in operation for over two
decades and has established an out-
standing reputation for its ethical
and clinical practices in the long-
term care industry. We are seek-
ing Illinois-licensed psychologists
for full- and part-time employment
in Chicago and surrounding coun-
ties as well as several other parts of
the state and Indiana. Full training
is provided and days and hours are
quite flexible so that this job blends
well with those who teach, have a
private practice, or have young chil-
dren. Our forms are highly struc-
tured and streamlined, allowing
you to spend less time with paper
and more time with the clients. We
have excellent relationships with
our providersseveral who began
in the 1990s are still with us. If you
are interested or have any ques-
tions, email artoffugue16@gmail .
com or call (773) 259-0261.
CLINICAL PSYCHOLOGIST: Wexford
Health Sources, Inc. has excep-
tional opportunities for Clinical
Psychologists to provide services
to patients within the Illinois State
Correctional Institutions. For more
information, contact Liz Ingles
at lingles@wexfordhealth.com or
(618) 977-5936.
PSYCHOLOGIST POSITION IN AN
EXPANDING GROUP PRACTICE:
Gersten Center for Behavioral
Health, a thriving and established
group practice with five locations
in Chicago, Evanston, Skokie,
and Melrose Park, is expanding
and hiring licensed clinical psy-
chologists. We are interested in
candidates with a broad range of
experience to work with patients of
all ages and clinical needs as well
as to provide psychological test-
ing if interested. The position offers
excellent pay and benefits such
as: secure earning potential up to
$120,000 per year; medical, dental,
vision coverage; flexible spending
account (FSA); 401K retirement
plan with company match; liabil-
ity insurance coverage and sick pay;
W-2 employee status; weekly clini-
cal consultation; in house continu-
ing education program; highest
reimbursement rates in the indus-
try; over 300 practice referrals per
month allowing for quickly devel-
oping and easily maintaining a
stable practice; outstanding bill-
ing and administrative support; a
warm and supportive environment
with a beautiful work space; flexible
74 M O N I TO R O N P S YC H O LO G Y
work hours; no weekends required;
unlimited vacation; 24/7 emer-
gency call backup. Gersten Cen-
ter for Behavioral Health is proud
to be a setting that promotes work-
place longevity and long-term sta-
bility. We encourage you to visit
us at www.gerstencenter.com to
learn more about our practice and
the reasons for our success. If inter-
ested, submit your curriculum
vitae to Dr. Deborah Liebling at
dliebling@gerstencenter.com.
POST-DOCTORAL POSITION IN
AN EXPANDING GROUP PRAC-
TICE: Gersten Center for Behav-
ioral Health, a thriving and well
established group practice with
five locations in Chicago, Evan-
ston, Skokie, and Melrose Park, is
offering three post-doctoral posi-
tions for the upcoming year to
begin in September of 2017. We
are interested in candidates with a
broad range of experience to work
with patients of all ages and clini-
cal needs as well as to provide psy-
chological testing if interested.
The annual salary is $35,000 and
includes full medical, dental, and
vision coverage; vacation and sick
time; flexible spending account
(FSA); liability insurance coverage;
W-2 employment status; weekly
individual and group supervision;
in house continuing education pro-
gram; outstanding billing and
administrative support; a warm,
supportive, and friendly environ-
ment with a beautiful work space;
flexible work hours; no week-
ends required; and 24/7 emer-
gency call backup. Gersten Center
for Behavioral Health is proud to
be a setting that promotes work-
place longevity and long-term sta-
bility. We encourage you to visit us
at www.gerstencenter.com to learn
more about our practice and the
reasons for our success. The dead-
line for applying for the post-doc-
toral positions is April 30th, 2017.
If interested, we encourage you to
submit your curriculum vitae to Dr.
Deborah Liebling at dliebling@
gerstencenter.com.
MASSACHUSETTS
PSYCHOLOGIST: Developmen-
tal Medicine CenterHarvard
Medical School: The Develop-
mental Medicine Center (DMC)
and the Department of Psychia-
try at Boston Childrens Hospi-
tal seeks a full-time psychologist
to provide outpatient evaluation
and treatment services in a mul-
tidisciplinary setting. The DMC
is one of the largest clinical pro-
MARCH 2017
grams for the diagnosis and treat-
ment of neurodevelopmental
disorders in the United States, and
is dedicated to promoting research,
teaching and service innovations
designed to improve the lives of
children, adolescents and fam-
ilies. The DMC provides ser-
vices for children from infancy
through adolescence who pres-
ent with complex neurodevelop-
mental disorders, including autism
spectrum disorders, medical and
genetic conditions, intellectual
disabilities, and learning, atten-
tional, behavioral and regulatory
disorders. Active participation in
clinical and/or basic research is
strongly supported and encour-
aged for applicants with research
training and experience. Psychol-
ogists are actively involved in edu-
cation of psychology post-doctoral
fellows, developmental and behav-
ioral pediatric fellows, and med-
ical students. Applicants must
possess a Massachusetts health
service provider license in psychol-
ogy prior to assuming the posi-
tion and have completed two to
three years post-doctoral experi-
ence. Academic appointments at
Harvard Medical School at a level
commensurate with clinical and
research experience most likely at
the Instructor or Assistant Profes-
sor level. Graduates of APA-ac-
credited doctoral programs and
internships are preferred. In addi-
tion to an application letter, please
enclose a curriculum vitae and
arrange to have three letters of rec-
ommendation sent to the search
committee. Send applications
to: Search Committee, Atten-
tion: Sandra Maislen, Division of
Developmental Medicine, Fegan
10, Boston Childrens Hospital,
300 Longwood Ave., Boston, MA
02115. Boston Childrens Hospital
is an equal opportunity employer
and all qualified applicants will
receive consideration for employ-
ment without regard to race, color,
religion, sex, sexual orientation,
gender identity, national origin,
disability status, protected veteran
status or any other characteristic
protected by law.
MINNESOTA
ship opportunities are available at
PROGRAM IN HUMAN SEXUAL-
ITY POSTDOCTORAL FELLOWSHIP:
The Program in Human Sexu-
ality at the University of Min-
nesota Medical School is one of
the largest clinical, teaching and
research institutions in the world
specializing in human sexuality.
We are inviting applications for
one to three postdoctoral fellow-
ships to join a vibrant team of fac-
ulty and postdoctoral fellows for
a two-year program beginning
Fall 2017. The primary fellowship
opportunity is the Braun-Harvey
Fellowship in Compulsive Sex-
ual Behavior. Other opportunities
involving the Ettner Fellowship in
Transgender Health and a general
human sexuality fellowship are yet
to be determined; those interested
in these fellowships are highly
encouraged to apply. Designated
fellowships are designed to sup-
port a balanced mix of clinical
and research training in the spec-
ified area, with broader experi-
ence in overall sexual health care.
The general fellowship will have
an emphasis in sexual health care,
with a smaller amount of time
devoted to research. Fellows will
provide individual, family, cou-
ple and group psychotherapy for a
wide range of sexual dysfunctions
and problems including: relation-
ship and sexual problems, trans-
gender issues, sexual orientation
concerns, paraphilias and com-
pulsive sexual behavior. The clinic
serves a diverse group of patients
(an average of 1,300 visits per
month), including children, ado-
lescents, minorities, disabled indi-
viduals and clients with chronic
medical or mental health prob-
lems. The training will help the
fellow develop skills in addressing
sexual issues in any clinical setting
and conducting psychosexual eval-
uations. In addition to sex therapy,
treatment addresses a wide variety
of psychiatric disorders. This kind
of diversity makes for an excit-
ing and stimulating fellowship!
Fellows complete a research proj-
ect that is tailored to their own
interests. Applicants must have
their PhD, PsyD or MD The fel-
lowship helps individuals gain
licensure. Our fellows enjoy a
competitive salary, excellent ben-
efits, and a professional travel sti-
pend. Interested candidates should
send inquiries to: Eli Coleman,
Professor and Director, 1300 S.
2nd St., Suite 180, Minneapolis,
MN 55454 or colem001@umn.edu.
Application instructions and more
information regarding fellow-
http://z.umn.edu/phsfellowships.
The University of Minnesota rec-
ognizes and values the impor-
tance of diversity and inclusion in
enriching the employment experi-
ence of its employees and in sup-
porting the academic mission, and
is proud to be an Equal Opportu-
nity Employer.
PsycCareers

MONTANA
THERAPIST/CLINICAL SUPERVISOR:
Montana Academy seeks a thera-
pist for a team of 912 students,
providing individual, group and
family therapy as well as clinical
supervision to a multi-disciplinary
treatment team. Montana Acad-
emy is a fully accredited therapeu-
tic boarding school for teenagers
(14 to 19 years) who present with
a variety of Axis I diagnoses that
are best resolved by also addressing
each students immaturity and the
developmental and familial obsta-
cles that have led to their present
symptoms. We have 90-plus stu-
dents who are all intelligent, with
excellent family support, and from
throughout the United States as
well as a number of foreign coun-
tries. Virtually all of our students
go on to college after graduating
from our program. The success-
ful candidate will possess a masters
or doctoral degree in social work,
clinical or counseling psychology;
be eligible for Montana licensure
within a year; and have clini-
cal experience with adolescents
and families. Montana Academy
offers a rich milieu for both stu-
dents and staff on a 500-acre cam-
pus located near Glacier National
Park in beautiful Northwest Mon-
tana, employing 85 staff, including
psychologists, psychiatrists, social
workers, mental health counsel-
ors, predoctoral clinical psychol-
ogy interns, teachers, medical
staff, administrative staff and clin-
ically minded direct-care staff. For
more information about Montana
Academy, visit our website: www.
montanaacademy.com. Compen-
or an LCPC. Five years experi-
ence in a Social Services Counsel-
ing Position, a Case-Management
Position, or a Correctional Pro-
gram Administration is preferred.
Application materials are avail-
able online at http://www.cccscorp.
com/job_openings.
NEW JERSEY
POSTDOCTORAL RESIDENCY: Post-
doctoral Residency in Clini-
cal Neuropsychological (pediatric
and adult). Start Date: Septem-
ber 1, 2017 or earlier. This posi-
tion is within a multi-hospital/
medical school affiliated pri-
vate practice in the metro NJ/NY
area and involves the examination
and treatment of patients suffer-
ing from a broad range of neu-
rological disorders (n.b., mostly
TBI) of varying degrees of sever-
ity. A significant portion of the
residents time will involve: super-
vised patient examination, review
of records, report writing, didac-
tic interaction, attending medical
rounds and research. Interested
candidates must have completed
all of the course work in fulfill-
ment of a doctoral degree in Clin-
ical Psychology with a dissertation
focus in Neuropsychology (ABDs
considered). Successful candi-
dates must possess the follow-
ing qualifications: course work
in neuropsychology; experience
with administration and scoring
of neuropsychological test bat-
teries; internship and/or extern-
ship training in neuropsychology;
and strong report writing skills.
Excellent starting salary (i.e.,
$37,000 - first year, $42,000
second year), health benefits and
possibility of later advancement.
Fax or email curriculum vitae,
two letters of recommendation,
and two redacted reports to Dr.
DM Mahalick: (973) 313-1666 or
braindoc1@comcast.net.
NEW HAMPSHIRE
NEUROPSYCHOLOGIST/ CLINICAL
PSYCHOLOGIST/POSTDOCTORAL
FELLOW: Portsmouth Neuropsy-
chology Center has an immediate
opening for a psychologist or post-
doctoral fellow to provide evalua-
tions, psychotherapy of children,
adolescents, and adults at grow-
ing private practice in Ports-
mouth, NH. Full details: www.
portsmouthneuro.com/contact-us/
careers.
NEW YORK
CLINICAL PSYCHOLOGIST, PHD,
PSYD, NYS LICENSED: Comple-
ment your private practice or pri-
mary job. Work part-time with
older adults in metro NYC area
(Bronx, Brooklyn, Long Island,
Westchester, Connecticut) at
Aging Matters Psychological Ser-
vices, P.C. We provide quali-
ty-focused treatment, collegial
atmosphere, rewarding popula-
tion, flexible schedule, and sup-
portive supervision (as needed).
Contact Dr. Pat Tomasso:
ptomasso@agingmattersny.com.
OREGON
DIRECTOR OF TRAINING AND CLIN-
ICAL OPERATIONS: Portland Psy-
chotherapy is seeking a Director of
Training and Clinical Operations
to manage our evidence-based ther-
apy clinic at an innovative research
and training clinic. Position is 25
percent admin and 75 percent clin-
ical. Applications are ongoing until
filled. For a complete description
and application information, go to:
http://bit.ly/ppcdir.
TEXAS
LICENSED PSYCHOLOGIST, NEURO-
PSYCHOLOGIST, LCSW, LPC: The
Ludden Group, P.C., a Christian
private practice group of indepen-
dent contractors in Rockwall, TX
with over 30 years experience is
seeking a part or full-time clinician
to provide psychological assess-
ments, testing, and psychother-
apy. Our biggest need is in nursing
home work. Email curriculum vitae
to lindaluddensivils@gmail.com.
VIRGINIA
PSYCHOLOGIST SENIOR: South-
western Virginia Mental Health
Institute (SWVMHI), part of
the Commonwealth of Virgin-
ias behavioral health system, is
seeking qualified candidates for a
clinical psychologist position (Psy-
chologist Senior), to collaborate
as a member of an interdisciplin-
ary team providing care to persons
with a variety of types of mental

Join our team!

sation includes a competitive sal-
ary, medical insurance, simple IRA
plan, and paid time off. Send cover
letter and resume to Amy Zink at
amyz@montanaacademy.com. For Samaritan Health Services is In this position, you will:
more information about Montana offering opportunities for full-time Consult and collaborate on a multidisciplinary team,
Academy, visit our website: www. health psychologists at several providing integrated on-site care, recommendations
montanaacademy.com. outpatient primary care clinics and feedback to medical providers and staff
in Oregon. Independently practice in a BHC model to deliver brief
MENTAL HEALTH PROFESSIONAL: These openings are for an integrated consultation-based services with a focus on general
Community, Counseling and Cor- health psychologist to provide brief behavioral health services in a primary care context
rectional Services, Inc. is accepting behavioral health services in
applications for the following posi- Youll enjoy many benefits, including:
a fast-paced primary care Competitive compensation and benefits
tion: Mental Health Professional environment.
at the Nexus Treatment Facility Medical malpractice and CME
in Lewistown, Montana. Nexus Relocation assistance and starting bonus
is a modified therapeutic commu-
nity treating methamphetamine
and other addictions. The Men-
tal Health Professional is responsi-
ble for psychological programming
for Nexus residents. The posi-
tion requires a Masters Degree in For more information, please visit samhealth.org/DocJobs
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76 M O N I TO R O N P S YC H O LO G Y MARCH 2017
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 AN INTRODUCTION TO CONSULTING PSYCHOLOGY
Working With Individuals, Groups, and Organizations
Rodney L. Lowman
Consulting psychology is
rapidly growing yet sometimes CONTENTS
underappreciated discipline whose Series Editors Foreword,
Rodney L. Lowman
goal is to apply psychological science Chapter 1. The Work of Consulting
to consultation at three levels: Psychologists
individual, group, and organizational. Chapter 2. Consulting at the Individual
This foundational volume of Level
Chapter 3. Consulting at the Group
the Fundamentals of Consulting and Team Level
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and research into a concise, easy- Organizational Level
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and Levels: The Case of Leadership
Case examples help to illustrate the
Chapter 6. Multicultural and
rewarding and important work of International Issues in Consulting
consulting psychologists, which includes coaching individuals, Psychology
assessing and improving work group dynamics, and enhancing Chapter 7. Ethical and Professional
Standards in the Practice of
organizational systems and processes. Consulting Psychology
2016. 192 pages. Paperback. Chapter 8. The Road Ahead
Series: Division 13Fundamentals of Consulting Psychology References
Index
List: $34.95 | APA Member/Afliate: $29.95 | ISBN 978-1-4338-2178-3 | Item # 4317403 About the Author

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By the Numbers BY LEA WINERMAN

THE COST OF TREATMENT

Depression ranks among the most costly health conditions in the United States

$2.4 trillion

MIXMIKE/ ISTOCKPHOTO
The amount spent on health-care treatment in the United States in 2013,
including individuals out-of-pocket costs as well as spending by
private and government insurance programs.

4
The rank of mental health and substance
abuse disorders in the cost category,
with $187.8 billion in spending in 2013.
They rank behind cardiovascular diseases
($231.1 billion); diabetes, urogenital, blood and
endocrine disorders ($224.5 billion); and other
noncommunicable diseases ($191.7 billion).
Neurological diseases, including Alzheimers
disease, cost another $101.3 billion.

3.7%
The annual rate of increase
in spending on mental
health and substance
abuse disorders between 1996 and 2013. This
is more than the 1.2 percent rate of increase for
cardiovascular disorders but less than the
5.1 percent rate of increase for diabetes,
urogenital, blood and endocrine disorders.

$71 billion
The amount spent to treat depressive
disordersthe most costly among
mental health and substance abuse
disorders. Depressive disorders were
the sixth-most-costly health condition
overall, behind diabetes mellitus
($101.4 billion), ischemic heart
disease ($88.1 billion), low back
and neck pain ($87.6 billion),
hypertension ($83.9 billion)
and injuries due to falls
($76.3 billion).

Source: Dieleman, J.L., Baral, R., & Birger,

M. (2016). U.S. Spending on Personal Health
Care and Public Health, 19962013. JAMA.
doi:10.1001/jama.2016.16885
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