Psychotherapy

OFFICIAL PUBLICATION OF THE SOCIETY FOR THE ADVANCEMENT OF OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION www.societyforpsychotherapy.org B

In This Issue

* SpecIal FocuS SubmISSIon * Social Justice Considerations of a Remote U Admissions Process: Covid -19 Era and Beyond

2021 convention program

professional practice L Multi-Theoretical Training as Responsive Treatment: An international Example

Science and Scholarship Reflections on the Plague Year: Conducting Psychotherapy Research L during the Covid-19 Pandemic

ethics A Clinician’s : Ethical Considerations When Responding to Self-Harm Within a Correctional Context E T I 2021 VOLUME 56, NUMBER 2 N Society for the advancement of psychotherapy n 2021 Governance Structure ELECTED BOARD MEMBERS OFFICERS Domain Representatives Diversity President Public Interest and Social Justice Susan Woodhouse, PhD, 2020-2022 Clara Hill, PhD Rosemary Phelps, PhD, 2021-2023 Department of Education and Human Department of Psychology University of Georgia Services Lehigh University University of Maryland 402 Aderhold Hall 111 Research Drive College Park, MD 20742 Athens, GA Bethlehem, PA 18015 Ofc: 301-405-5791 Ofc: (706) 542-1812 Ofc: 610-758-3269 [email protected] E-mail: [email protected] [email protected]

President-elect Psychotherapy Practice Diversity OPEN Barbara Vivino, PhD, 2019-2021 Manijeh Badiee, PhD. 2019-2021 921 The Alameda #109 Department of Psychology Secretary Berkeley, CA 94707 California State University Stewart Cooper, PhD, 2021-2023 Ofc: 510-303-6650 5500 University Parkway Valparaiso University Counseling Services [email protected] San Bernardino, CA 92407 Ofc: 909-537-7305 1602 LaPorte Avenue, Education and Training [email protected] Valparaiso, IN 46383 Marilyn Cornish, PhD, 2019-2021 Ofc: 219-464-5002 Auburn University International Affairs [email protected] 2084 Haley Center Changming Duan, PhD 2021-2023 Department of Special Education, Dept of Psychology & Research in Education Treasurer Rehabilitation, and Counseling University of Kansas Joshua Swift, PhD, 2020-2021 Auburn University, AL 36849 Lawrence, KS 66054 Department of Psychology Ofc: 334-844-7601 Ofc:785 864-2426 Idaho State University [email protected] [email protected] 921 S. 8th Ave, Stop 8112 Pocatello, ID 83201 Membership APA Council Representatives Ofc: 208-282-3445 Jean Birbilis, PhD, 2019-2021 Lillian Comas-Diaz, PhD, 2020-2022 [email protected] University of St. Thomas 1000 LaSalle Ave., MOH 217 908 New Hampshire Ave NW Ste 700 Washington, DC Past President Minneapolis, Minnesota 55403 Ofc: (202) 775-1938 Jennifer Callahan, PhD Ofc: 651-962-4654 [email protected] UNT Department of Psychology [email protected] Terrill Hall, Room 376 Early Career Gerald Koocher, PhD, 2020-2022 1155 Union Circle #311280 Beatriz Palma, PhD, 2020-2022 Clinical and Denton, TX 76203-5017 University of Virginia - Counseling and 285 Beverly Road Ofc: 940-369-8229 Psychological Services (CAPS) Chestnut Hill, MA [email protected] 400 Brandon Ave. [email protected] Charlottesville, VA 22908 Ofc: 434-243-5150 Student Representative [email protected] Lei Y. Sun, M.S.Ed. (2021-2022) University of Miami Science and Scholarship Dept of Educational & Psychological Studies Patricia Spangler, PhD, 2020-2022 5202 University Drive Center for the Study of Traumatic Stress Coral Gables, FL 33146 Department of Psychiatry Ofc: 305-284-6160 Uniformed Services University E-mail: [email protected] 4301 Jones Bridge Road Bethesda, MD 20814-4799 Ofc: 240-620-4076 [email protected]

STANDING COMMITTEES Continuing Education Finance Professional Awards Chair: Ken Critchfield, PhD Chair : Georita Frierson, PhD Chair: Jennifer Callahan, PhD [email protected] [email protected] [email protected]

Diversity International Affairs Program Chair: Sheeva Mostoufi, PhD Co-Chair: Lauren Behrman, PhD Chair: Astrea Greig, PsyD [email protected] [email protected] [email protected] Associate Chair : Jamie Bedics, PhD Early Career Co-Chair: Maria Del Pilar Grazioso, PhD Chair: Andres Perez-Rojas, PhD [email protected] Psychotherapy Practice [email protected] Chair: Barbara Thompson, PhD Membership [email protected] Education & Training Rosemary Adam-Terem, PhD Chair: Eric Sauer, PhD [email protected] Psychotherapy Research [email protected] Chair: Jenelle Slavin-Mulford, PhD Nominations and Elections E-mail: [email protected] Fellows Chair: Clara Hill, PhD Chair: Robert L. Hatcher, PhD [email protected] Social Justice [email protected] Chair: Linda Campbell, PhD E-mail: [email protected] n pSYcHoTHeRapY bulleTIn pSYcHoTHeRapY bulleTIn official Publication of the Society for the Advancement of Published by the Psychotherapy of the American Psychological Association SocIeTY FoR THe adVancemenT oF pSYcHoTHeRapY American Psychological Association 6557 E. Riverdale Mesa, AZ 85215 602-363-9211 e-mail: [email protected]

edIToR 2021 Volume 56, number 2 Joanna M. Drinane, PhD [email protected] Table oF conTenTS aSSocIaTe edIToR Stephanie Winkeljohn Black, PhD president’s column ...... 2 Shout out to All Those Who Contribute to SfAP conTRIbuTInG edIToRS diversity editor’s column ...... 5 Manijeh Badiee, PhD and Susan Woodhouse, PhD Special Focus Submission ...... 6 education and Training Social Justice Considerations of a Remote Marilyn Cornish, PhD and Psychology Admissions Process: Covid -19 Era Eric Sauer, PhD and Beyond ethics in psychotherapy Apryl Alexander, PsyD professional practice ...... 11 psychotherapy practice Multi-Theoretical Training as Responsive Treatment: Barbara Vivino, PhD and An international Example Barbara Thompson, PhD psychotherapy Research, Science and Scholarship ...... 18 Science and Scholarship Reflections on the Plague Year: Conducting Patricia Spangler, PhD and Psychotherapy Research during the Covid-19 Jenelle Slavin-Mulford, PhD Pandemic public Interest and Social Justice Rosemary Phelps, PhD and ethics ...... 23 Linda Campbell, PhD A Clinician’s Cognitive dissonance: Washington Scene Ethical Considerations When Responding Patrick DeLeon, PhD to Self-Harm Within a Correctional Context early career Beatriz Palma, PhD and Telemental Health care ...... 29 Andres Perez-Rojas, PhD Transitioning to virtual Space: Student Feature Teletherapy in the Time of Covid-19 Sun Lein a Review ...... 35 editorial assistants “The Art of Bohart: Person-Centered Therapy and Salwa Chowdhurry, PsyD and the Enhancement of Human Potential” Kate Axford, MS STaFF Washington Scene ...... 37 central office administrator “The future’s in the Air. Can feel it Everywhere” Tracey Martin Website 2021 convention program ...... 41 www.societyforpsychotherapy.org

1 pReSIdenT’S column Shout out to all Those Who contribute to Sfap Clara E. Hill, Ph.d. Professor, department of Psychology, University of Maryland College Park, Md In this column, I want spent time at the spring Board meeting to highlight all the talking about our hopes and aspirations wonderful work that so for increasing diverse representation and many of our colleagues cultural awareness. Based on this chal- are doing to contribute lenging and stimulating discussion, all to the vitality of the So- domain/committee areas have been ciety for the Advance- tasked with developing plans for what ment of Psychotherapy they can do to make SFAP more inclusive (SFAP). It truly is a labor of love, and I and representative and a home for all. want to thank all of you for your vision and enthusiasm. First, I want to highlight the publications of society. The Publication Board, last We have Domains, Standing Commit- year under Bob Hatcher, and now under tees, ad hoc Committees, and Task Forces Terry Tracey, oversee the diverse of to organize all the activities of the organ- publications that we offer members. Our ization. Domain representatives are journal Psychotherapy flourished under elected, committee chairs and members Mark Hilsenroth’s incredible tenure and are appointed. The domain reps and now is in the capable hands of Jesse committees within each area work Owen. We had another record-breaking closely together. Each of these areas con- year for our journal, with the 9th year in tribute articles to the Psychotherapy Bul- a row with over 200 manuscripts sub- letin highlighting topics that are of mitted! The Psychotherapy Bulletin, under particular interest to their subgroups. In the capable guidance of Joanna Drinane, this column, I am just providing a shout continues to publish exciting, ground- out to all the domain reps and committee breaking articles highlighting the range chairs, and I also want to give a shout out of topics in psychotherapy. Our website, to the typically 5 to 10 division members undertaken by the Internet Editor who serve on each committee. And with Kourtney Schroeder has been revamped continued involvement in the Society, we and is user-friendly and chock full of im- hope to mentor each of these committee portant information. members to move up to becoming com- mittee chairs and domain reps. The Program Committee, with Astrea Greig as Chair and Jamie Bedics as Co-Chair, Before I give shout outs for all the won- have had the huge job of putting together derful work that all of our domains/ the convention program for the August committees are doing, I want to describe APA convention. We have 15 hours of our overall initiative to examine our- outstanding programming for this year’s selves and the SFAP in terms of cultural probably virtual convention. We’ll be awareness. In preparation for a session keeping you more informed about the at our October in-person fall Board program as the time grows nearer. meeting at which Dr. Stephanie Fryberg will be meeting with us for a day, we continued on page 3

2 In the area of Professional Practice, we The Diversity group, with Manijeh have an active group of practitioners Baidee and Susan Woodhouse (Domain headed up by Barbara Vivino (Domain Reps), and Sheeva Mostoufi (Committee Rep) and Barbara Thompson (Commit - Chair, recently held by Lavita Nadkarni) tee Chair, previously held by Daniel have been actively involved in develop - Gaztambide). Their latest project is a se - ing mentoring programs. They have ries of videos on topics relevant to prac - selected and are currently mentoring tice. These appear on the website and two Advocacy and Mentoring Program cover topics such as race, setting fees, for Diversity (AMPD) scholars: Ingrid self-care, and reaching underrepre - Hastedt and Michelle Joaquin, in their sented groups. exciting projects.

The Science and Scholarship area, under In the closely related Public Interest and the of Patricia Spangler Social Justice area, headed up by Rose - (Domain Rep) and Jenelle Slavin- mary Phelps (Domain Rep) and Linda Mulford (Committee Chair), has been Campbell (Committee Chair) in collab - focused on giving out much-needed oration with Susan Woodhouse, there is grants to enhance scholarship related to a major emphasis on psychotherapy for psychotherapy. marginalized populations.

The Education and Training Committee, The International group, with Chang - under the leadership of Marilyn Cornish ming Duan as the Domain Rep (Fred (Domain Rep) and Eric Sauer (Commit - Leong retiring), is incredibly active, with tee Chair), are thinking about some ex - Domestic Committee Co-Chair (Lauren citing possibilities of webinars that we Behrman) and International Committee could offer free for our members. And Co-Chair (Maria del Pilar Grazioso) and relatedly, Ken Critchfield has done a committee members from all over the great job as Chair of our Continuing Ed - world. They are actively involved in ucation Committee. mentoring and encouraging representa - tion at international congresses. The Membership Committee, with Jean The Early Career group, headed by Beat - Birbilis (Domain Rep) and Rosemary riz Palma (Domain Rep, recently Sara Adam-Terem (Committee Chair), have Danitz) and Andres Perez-Rojas (Com - been actively thinking about ways to mittee Chair), have likewise been think - recruit members. Some wonderful ideas ing actively about ways to make SFAP include reduced or free membership warm and welcoming for young profes - for students, who are the future of the sionals. They sponsored the “Gab with organization. the Greats” at the last APA as a way of The Student Development Committee, connecting young professionals with headed by Lei Sun (Domain Rep, re - more seasoned professionals. And they cently Carly Schwartzman) has an active are talking about ways of providing agenda and an incredible list of students mentoring as a way of fostering growth from the various doctoral programs who and development. are active and eager to get more stu - Bob Hatcher has been Chair of the Fel - dents involved. This committee is cur - lows Committee for many years. This rently reviewing applications for our committee is important so that we can four student paper awards and two ac - recognize the talent of our members. tive student awards. continued on page 4

3 We also have had a number of commit - myself and John Norcross for a project tees and task forces busily working on following up on the highly successful hot topics. Lillian Comaz-Diaz (along three editions of Psychotherapy Relation - with Fred Leong) is working to develop ships that Work . This time we are focused a series of books on psychotherapy. more specifically on Psychotherapy Skills Stewart Cooper, with the able help of and Methods that Work . The Task Force is Jeff Barnett, Bea Palma, and Tracey Mar - co-sponsored by the Society for Coun - tin, have developed some needed By - seling Psychology, Society for Psy - changes, that you will be reviewing chotherapy Research, and the Society for and voting on soon. Gerry Koocher the Exploration of Psychotherapy Inte - graciously agreed to chair the Award gration. We have a contract with Oxford Committee and has already ably (in con - University Press for a book and an junction with a committee) handled a agreement to subsequently publish con - round of awards. Armand Cerbone has densed article in Psychotherapy . We are agreed to chair a task force to nominate very excited to have 30 chapters com - more SFAP members to APA Boards and missioned with experts in the field re - Committees. Jennifer Callahan has also viewing the evidence for specific skills thankfully agreed to continue on in 2022 (e.g., challenges, advice) and methods as Past-President so that we have a full (e.g., , mindful - Presidential Trio. ness) used frequently across orientations in psychotherapy. Thanks also to our Secretary Stewart Cooper (replacing Becca Armetrano) who I also want to thank all the Committee diligently keeps minutes of all our meet - members, as it is so important to have so ings, to our Treasurer Joshua Swift who many of you involved. manages all our finances with the help of the Finance Committee (chaired by Georita If you would like to get involved in Frierson), and to our Council Representa - SFAP, we welcome you and encourage tives Gerry Koocher and Lillian Comas- you to contact a committee chair to let Diaz. And a major shout out to Tracey them know about your interest and Martin who really runs the whole SFAP. availability (emails are on the website). What would we do without her? Let’s all work to enhance the science and Finally, for my presidential Initiative, practice of psychotherapy! SFAP approved a task force co-led by

4 edIToR’S column

Joanna M. drinane, Ph.d., Editor Assistant Professor, Counseling & Programs University of Utah – Salt Lake City, UT

“We long to return to tion we provide. With this in mind, we normal, but **normal implore you to write pieces tackling the led to this**.” special focus for the year: “Social Justice — Ed Yong, in Psychotherapy: Bringing Advocacy Science Journalist and Interdisciplinary Perspectives to the for The Atlantic Forefront.” How can we cultivate a new normal that centers the voices of mar - ginalized individuals and groups? What Hello Division 29 and SAP Membership! steps can we take to diversify the mem - In addition to the warm weather and the bership of our Division and increase blooming flowers, spring has been ac - representation in our professional com - companied by the slow reopening of munity? It is through action, advocacy, many spaces and places that we hold and scholarly work that we can use this dear. Our professional lives too will important juncture in history to change begin to feel more engaging as we get the trajectory of the future. opportunities to convene in person for conferences, meetings, and social events. Thank you to all who make The Psy - As we patiently await these chances to chotherapy Bulletin a success (readers, connect personally and intellectually, we authors, Division members, and more!). hope that The Psychotherapy Bulletin will To write for the Bulletin , please visit our continue to serve as a mechanism for website ( http://society forpsychother - you to keep current with the happenings apy.org/bulletin-about/ ). Our remain - of the Division and to disseminate your ing schedule of deadlines for 2021 will work and ideas. be July 15 th , and October 15 th . As a logis - tical note, after discussion with the With the time that remains in 2021, it is Publications Board, it was decided that our intention as an editorial team to re - Bulletin will no longer accept book flect upon and integrate the sentiment reviews. Accordingly, this will be the expressed above in the quote from Ed last issue to contain one. If you have Yong. Many people are celebrating the any questions about this policy change experience of returning to “normal” or anything else, please reach out to (e.g., seeing clients in an office and [email protected] . We look teaching students in a classroom), but it ahead to a productive year with many is essential that we as a Division remain innovative viewpoints communicated! oriented to the ways that our definition of normal has contributed to vast, sys - Thank you, temic inequities in the care and educa - Joanna

5 SpecIal FocuS SubmISSIon Social Justice considerations of a Remote psychology admissions process: coVId-19 era and beyond Stephanie Callan, M.A., M.S. Krista W. Ranby, Ph.d. Sneha Thamotharan, Ph.d. denver, Co

abstract: This paper Keywords: social justice, equity, intern- identifies several advan- ship, graduate students, remote admis- tages and disadvantages sions, COVID-19 of a remote psychology admissions process with The COVID-19 pandemic has presented respect to social justice new challenges on a global scale. The considerations. The virus emerged in late 2019 and has con- authors offer their per- tinued to impact the world and United spectives on how poten- States greatly. Like many institutions, tial disadvantages to a universities were required to transition remote admissions pro - to a work-from-home model. Psychol - cess can be addressed to ogy doctoral programs were impacted promote inclusion and by this change, such that many trainees equity for the graduate began conducting teletherapy and at - student and trainee pop- tending telesupervision for the first time ulation. Specifically, the in their academic careers. Many clinical authors provide sugges- psychology doctoral and internship sites tions regarding high- made similar shifts (Goghari et al., speed internet access, 2020). In response to the pandemic, the addressing biases in the American Psychological Association admissions process fa - and Association of Psychology Postdoc- voring in-person inter- toral and Internship Centers (APPIC) viewees, and enabling applicants to Board of Directors has strongly recom- a ssess program culture and climate. This mended exclusive use of virtual, remote, paper c oncludes with a call to action to and online technology for the entire develop social -justice oriented solutions duration of the 2020-2021 admissions to ensure a safer, mo re inclusive, and eq- interview process (APPIC, 2020). Al - uitable academic pipeline . though a remote interview process may have initially presented challenges, clinical Impact Statem ent: This manu- some believe this is an opportunity script outlines the advantage s and dis - for growth, especially in that it may fa- advantages of a remote admissi ons cilitate a more equitable admissions process from a social justice perspective. process (Bell et al., 2020). In fact, some Specific suggestions to address disad - programs had already moved to a re - vantages of a remote model, in order to mote interview process prior to the pan- promote trainee inclusion and equity, demic either because of their geographic are provided to those who interview, educate, and train graduate students. continued on page 7

6 location or due to a desire to align with ties, exist within and apart from the pan - a social justice model (Bell et al., 2020). demic. Financial instability due to the pandemic may compound financial bur - From a social justice perspective, there den on minoritized trainees who were are several advantages of a remote in - already under-resourced. Remote inter - terview process. First, a remote process views remove the cost of travel, lodging allows clinical trainees and other pro - and other accommodations, a figure that fessionals to follow social distancing re - could easily be in the thousands of quirements. Social distancing maintains dollars. Further the benefits of in-person safety by reducing the likelihood of ac - interviewing is limited, considering quiring the COVID-19 virus. This is par - traditional pre-admission interview meth - ticularly salient for medically vulnerable ods for medical school—a close proxy applicants, applicants from communi - for programs— ties disproportionately impacted by may lack validity (Kreiter & Axelson, COVID-19, and applicants who have 2013). In sum, there are compelling rea - traditionally had limited access to high sons to consider adopting a remote ad - quality healthcare, including Black, In - mission process at the graduate, digenous, and People of Color (BIPoC). internship and postdoctoral fellowship Second, beyond COVID-19 considera - level in future cycles to enhance equity tions, in-person interview requirements and representation throughout the aca - maintain ableism, with disabled trainees demic pipeline. experiencing more travel-related and housing barriers. Third, a remote inter - Despite the advantages of a remote view process would limit scheduling internship interview process pre-pan - conflicts that arise due to multiple inter - demic, students tend to prefer an in-per - view offers or the need to balance com - son format (APPIC, 2016). It is essential peting life demands. Inflexible program to understand why this trend may exist, expectations and scheduling conflicts particularly from a social justice per - are often a barrier to pursuing secondary spective. One possible reason for this ap - education in psychology (Pham et al., parent discrepancy between student 2020). Conceivably, this barrier would preference and the advantages of remote disproportionately affect specific sub - interviews is that a remote internship in - groups of the trainee population, such as terview may not entirely address issues those caring for children, trainees with related to access. For example, students other family commitments, or finan - living in remote areas or unable to afford cially under-resourced trainees who do costly, high-speed internet may not have not have the privilege to take leave from the ability to participate in seamless work. Fourth, a remote interview video-conferenced interviews which not process reduces the financial burden of only disrupts the interview but can attending in-person interviews. Finan - inadvertently reflect poorly on the cial instability of many students has applicant. Therefore, limited access to been heightened as a result of the pan - high-speed internet would disadvan - demic, which has been acknowledged tage students who live in rural areas or by the Council of Chairs of Training are financially under-resourced. A sec - Councils (CCTC) and APPIC (Bell et al., ond reason for why students may prefer 2020). More pervasive economic dispar - an in-person format is that students who ities, including a lack of generational can attend in-person interviews are wealth and multidimensional poverty often perceived (consciously or uncon - experienced by minoritized communi - continued on page 8

7 sciously) to be more committed to and does not mean the model should be viewed more positively by a program. abandoned. Rather, ways to overcome Although financially detrimental or these new barriers within the remote-in - unfeasible, under-resourced trainees terview model should be explored. Po - who are often from minoritized back - tential considerations include: grounds may still prefer in-person interviews given existing biases in the 1. High-speed internet access : admissions process. This may be driven (a) Clearly communicate an expec - by beliefs that in-person interviews may tation to applicants and faculty that help mitigate negative and internet connectivity issues should increase their already lessened chances not reflect poorly on applicants. of acceptance. (b) Provide resource lists, including Thirdly, students may prefer an in-per - local universities or libraries, that son format because it allows them to offer loaner laptops and/or high- gauge the environment, climate, and cul - speed internet access. ture of the site. Minoritized trainees ex - perience prejudice, overt and covert (c) Do no limit remote interviewing racism, and discrimination throughout to videoconferencing and allow their academic careers (Pham et al., applicants to use telephones when 2020). One study interviewed Black needed. graduate students to better understand attrition. These stu - 2. Biases in admission and favoring dents attributed attrition to cultural mis - in-person interviewees : match and microaggressions (Proctor (a) A universal shift to a remote and Truscott, 2012). Thus, minoritized model will remove pressure on trainees may be particularly mindful in minoritized and financially under- how they assess inclusive culture and resourced applicants to attend for their potential quality of life and safety fear it may impact prospects of during training, including how they will being selected. The most impactful be perceived and treated within and out - effect on equity would result from side of the program. For example, suc - all sites embracing a remote model. cessful recruitment of minoritized students is often facilitated when ethnic (b) Transparency, structure, and minoritized faculty and students are standardization in the review pro - well-represented (Muñoz-Dunbar & cess and selection criteria is needed. Stanton, 2009), as this may be one indi - A clear, standardized selection cator of a safe and tolerant environment protocol (which removes other for minoritized applicants. These assess - mechanisms of oppression such as ments of program culture may be more utilizing the GREs) will facilitate difficult in remote interviews, as com - the use of discretion elimination pared to in-person interviews, as they and prevent subjective biases favor - can limit access to broad interactions ing those interviewing in-person with faculty, staff, and students (i.e., in - and non-minoritized applicants. formal social gatherings), thereby limit - Additionally, asking all applicants ing the ability to gauge representation. the same questions, using rubrics to score applicants and their re - Simply because the potential disadvan - tages of a remote interview model exist continued on page 9

8 sponses, and exposing applicants to staff, and students not on their inter - the same places and information view schedule and gauge represen - should be adopted. Some of these tation within the training program. things may be easier accomplished Remote group interactions naturally through remote interviews. For in - lend themselves to more structure, stance, a standard tour of the cam - so ensuring everyone can interact pus or city can be filmed and with each other may be easier shared with all applicants. accomplished remotely than in- person. This may also be more 3. Assessing environment and program inclusive to applicants with social climate and culture : a clear state - anxieties and applicants from ment should be made to applicants cultural backgrounds that do not on a program’s commitment to so - emphasize assertiveness. cial justice followed by an interview experience that thoughtfully inte - (f) Ask applicants if there are partic - grates diversity and inclusion. ular individuals with whom they would like to meet with. (a) Programs should consider a des - ignated time for a diversity panel (g) Provide a contact list of trainees discussion (consider allowing ap - whom applicants can reach out to, plicants to send in anonymous if desired, with regard to inclusion, questions and topics to be ad - climate, and culture (e.g., trainees dressed). Fostering an interviewing who are parents, trainees who iden - culture to support frank discussions tify as gender non-conforming around equity-related issues will and/or LGBTQ+, racially and empower both trainees and inter - ethnically minoritized trainees, view sites to speak candidly about trainees who are in relationships, the climate. trainees who are moving on their own, etc.). (b) Consider highlighting ways to engage in diversity, equity, inclu - (h) Review current procedures and sion, and social justice such as pro - methods with regard to trainees gram, department, or university/ safely sharing feedback, grievances, hospital committees and/or the or concerns and how these would presence of affinity groups. be addressed.

(c) Include discussions around These considerations are not perfect nor mechanisms of inclusive supervi - an inclusive list of solutions. However, sion and fostering multicultural com - as a field that has struggled with repre - petence through outreach efforts to sentation—we can come together to and the treatment of diverse patient develop social justice-oriented solutions populations, as well as the formal di - that make each stage of our academic dactics offered by the program. pipeline more safe, inclusive and equi - table. We must commit ourselves to fos - (d) Applicants should have sched - tering the careers of and retaining our uled meetings with minoritized minoritized trainees, which begins with faculty and students. admissions.

(e) Schedule informal gatherings in which applicants can meet faculty, continued on page 10

9 References Canadian Psychology/Psychologie Cana - Association of Psychology Postdoctoral dienne, 61 (3), 167-189. http://dx.doi. and Internship Centers (2020). org/10.1037/cap0000250 APPiC Recruitment and Selection Kreiter, C. D., & Axelson, R. D. (2013). Guidance for 2021-22. Retrieved from A perspective on medical school ad - https://www.appic.org/News- Arti - mission research and practice over cles/ArtMID/1931/ArticleID/9/AP the last 25 years. Teaching and Learn - PIC-Recruitment-and-Selection- ing in Medicine, 25 (Suppl. 1), S50–S56. Guidance-for-2021-22 https://doi.org/10.1080/10401334.2 Association of Psychology Postdoctoral 013.842910 and Internship Centers. (2016). 2016 Muñoz-Dunbar, R., & Stanton, A. L. APPiC match: Survey of internship (1999). Ethnic diversity in clinical applicants Part 1: Summary of survey psychology: Recruitment and admis - results . Retrieved from https://www. sion practices among doctoral pro - appi c.org/Internships/Match/Matc grams. Teaching of Psychology , 26 (4), h-Statistics/Applicant-Survey-2016- 259-263. Part-1 Pham, A. V., Lazarus, P., Costa, A., Bell, D. J., Self, M. M., Davis, C., Con - Dong, Q., & Bastian, R. (2020). Incor - way, F., Washburn, J. J., & Crepeau- porating social justice advocacy and Hobson, F. (2020). Health service interdisciplinary collaborative train - psychology education and training ing in the recruitment and retention in the time of COVID-19: Challenges of diverse graduate students. Con - and opportunities. The American Psy - temporary School Psychology , 1-14. chologist, 75 (7), 919–932. https://doi. Proctor, S. L., & Truscott, S. D. (2012). org/10.1037/amp0000673 Reasons for African American stu - Goghari, V. M., Hagstrom, S., Madon, dent attrition from school psychol - S., & Messer-Engel, K. (2020). Experi - ogy programs. Journal of School ences and learnings from profes - Psychology, 50 , 655- 679. sional psychology training partners https://doi.org/10.1016/j.jsp.2012.0 during the COVID-19 pandemic: Im - 6.002 pacts, challenges, and opportunities.

10 pRoFeSSIonal pRacTIce multi-Theoretical Training as Responsive Treatment: an International example dana R. falk, Ph.d. Seattle, WA Alexander d. Gronowski, B.A. San francisco, CA context Of course, a client not enjoying therapy Before psychotherapy, doesn’t necessarily mean a poor treat - there often comes a phone ment choice. On occasion, it actually consultation. When I ask indicates a wise, strategic choice. But prospective clients how perhaps more likely, a skilled therapist they felt about prior applied their usual theoretical orienta - therapy, the most com - tion rather than flexing to the individ - mon account is of a ual. Multi-Theoretical (integrative) therapist whom they re - training may have enabled that thera - garded as a kind, non- pist to depart from their usual approach. judgmental listener, but not much else. They Individualizing treatment isn’t easy. wonder if they were We’re introduced to a palette of theoret - properly challenged, if ical orientations early in grad school. In there could have been more guidance, some programs, we learn a few orienta - or if their clues were heard. tions in-depth. In others, we learn a broad spectrum. We then determine the The second most common response I right fit but do not always have struc - hear is that there was a heavy therapist tured help discerning when that ap - focus on solutions; an assumption, they proach would be contraindicated. Good felt, that if their symptoms disappeared, supervision helps tremendously with they’d be “cured.” Some people say developing an ear for what occurs in our they had hoped therapy would be an ex - sessions, but our blind spots may actu - ploration of their personality and ally widen as our identification with one unique circumstances. Instead, it felt theoretical orientation deepens. like an opportunity for the therapist to demonstrate . We are human: our vision is guided by what we’re good at. Therapist adapt - Thirdly, some prospective clients didn’t ability does not guarantee we transcend care for experiential exercises in prior bias, establish rapport or make cultur - therapy. Some were directed to access ally responsive choices. Still, these be - deep , some to practice mind - come more likely when we hear clearly fulness, some to enact relationships. what happens in our sessions. Hall et al. These strategies felt hackneyed, they (2016) as well as Smith and Trimble said, especially when no rationale was (2016) found that interventions adapted made transparent. Clients said they felt to culturally-based issues tend to be cared-for but wondered about therapist more effective than orthodox interven - expertise. continued on page 12

11 tions are. Thus, integrative training reported that the shame underlying this could really bear fruit. practice is felt across socioeconomics.

We encourage graduate and internship One interview was with a Christian, Indo- training that’s quite specific to clinical Chinese woman in her twenties who was choice points; “perceiving forks in the educated and affluent. This woman had road.” Knowing when and how to reach Bipolar I disorder. She explained that her beyond one’s usual therapeutic ap - family knew she saw a psychiatrist, but proach is an advanced skill. Supervisors they insisted her symptoms were a con - are especially valuable with assistance flict between her spirit and her dead expanding therapist repertoire when aunt’s ghost. The family asked her to they’ve heard or observed sessions. frame symptoms this way, too. This woman explained that she believes bipo - Both authors spoke with people in In - lar disorder to be a medical condition but donesia about their attitudes towards finds it easier to preserve her parents’ . Interviewees kindly pro - honor by agreeing that it’s a ghost. vided an international example of how small insights might inspire therapist Preventing shame or “saving face” is so adaptability. vital, she said, that her parents know she abuses benzodiazepines to cope with Indonesian perspectives her symptoms, but they prefer that she Our conversations with people in Indo - continue substance use to her publicly nesia were anecdotal but were - acknowledging illness. ful to our understanding of their experience . Though Indonesia is majority We also learned that it’s fairly common for Muslim, over 6,000 of its 17,000+ islands Indonesians to view emotional concerns are inhabited, so diverse religious and of any severity as quite stigmatizing. ethnic groups exist. We exercise caution Even moderate anxiety and depression about generalizations. That said, some go untreated if these normal, neurotic themes emerged from our interviews. conditions are conflated with something like schizophrenia, which could mean Whether Javanese or Indo-Chinese, shameful pasung (imprisonment). Christian or Muslim, affluent or under - privileged, native to Jakarta, Yo - One interviewee in semi-rural Indonesia gyakarta, or Bali, the people we spoke had lost her son in a volcanic eruption. with agreed that mental illness is often Her auntie made contact with the uni - attributed to the action of an external versity Public Health faculty, requesting force like the will of a spirit. There is outreach. The woman’s panic, self-harm, stigma for families with mental illness. and flashbacks felt unnatural to her, and Explanations for unusual behavior be - she was unfamiliar with post-traumatic yond individual control help families stress. Faculty suggesting a possible way save face. of looking at her symptoms—that anxi - ety is the body’s logical response to a Worries about mental illness as stigma disaster in the natural world, outside of are well-founded in Indonesia. In a prac - her mind—reduced her panic. tice called pasung, people exhibiting bizarre behavior are vilified, impris - Given the risk of minor emotional health oned, and in some cases shackled. issues signaling major mental illness to Though pasung is more common in less developed regions, interviewees continued on page 13

12 the community, therapy utilization in In - dialectical Behavior — Mindfulness to tol - donesia is very low. In fact, even In - erate flashbacks, diffuse self-harm im - donesia’s less economically developed pulses. Discuss flashbacks as emotional neighbor, the Philippines, has twice its re-experiencing. mental health professionals per capita (Sebayang et al., 2018). Such a discrep - dreamwork — Skills for changing the ancy suggests that more culturally rele - ending scenes of dreams, practice lucid vant services might increase utilization. dreaming.

Of course, learning a bit about a group Existential/ — What do you norm cannot describe any one individ - believe happens after someone dies? Do ual’s beliefs. Nagayama Hall and you believe this loss occurred for a rea - colleagues (2021) add that the cultural son? Does love provide meaning in life? relevance of interventions doesn’t nec - essarily mean personal relevance for a Humanistic/Person-Centered — Invitation particular client. Nevertheless, insight to describe son and her relationship increases the likelihood of thoughtful with him. Tell the full story: what hap - choices. pened in the earthquake? Explore c lient beliefs about the meaning of her symp - adaptation brainstorm toms. Remain present for a gradual Practice multi-theoretical treatment alliance. planning. What interventions might you interpersonal/Relational — Express appre - consider for this client: ciation that coming for therapy is not the female, mid-30s, married to a man, identi - norm and requires courage. Model fied with traditional indonesian culture. openness about any therapist/client dif - Grieving the loss of her only son, age 7, in ferences. Ask if she would like the ther - an earthquake, she presents with panic at - apist to direct our focus. tacks, self-harm, nightmares, and flashbacks. Motivational interviewing — Assess client What orientations(s) do your ideas rep - interest in the various ways we might resent? Are these your usual interven - produce change. For example, does she tion choices, or are some adapted to this have the most energy for tell ing her client? story, symptom reduction, interpersonal problem-solving, spiritual meaning, Below is one brainstorm; your own may psycho-education, grieving? Follow look drastically different. client ; roll with resistance.

Acceptance and Commitment — Describe Problem Solving — Invite the client to de - the values you aspire to. Behavioral scribe the problem(s) from her world - activation to help with impulsivity. view. If she’d like, collaborate on what to say to the community that will save Contextual — Discuss parenting identity. face for the family. Is losing a son diminished status? How to be responsive to family and they to you. Psychodynamic — Would feeling better over time make you feel worse? In - Cognitive Behavioral — Skills for manag - quire about survivor guilt. Discuss new ing anxiety, to build alliance. Explore relationships with her living children. self-talk re: fear of future (Indonesia suf - fers many natural disasters.) continued on page 14

13 Systems — Inquire about family multi-theoretical training would be an strengths and expectations of her. Ex - improvement but not a fix. plore family’s beliefs about the root of her symptoms; differ from own beliefs? practice Grid Explore generational issues. One way to begin integrative training is to pose two important questions, ap - Gestalt — Wouldn’t utilize? plying these to as many theoretical ori - Rational Emotive — Wouldn’t utilize? entations as possible until you have object Relations — Wouldn’t utilize? created a long grid. While serving as a Emotion-focused Therapy (EFT)— Training Director, one of the authors fa - Wouldn’t utilize? cilitated this exercise with Pre-Doctoral — Wouldn’t utilize? Interns and Psychology Staff.

EMdR — Am not qualified. Refer? The two questions: Exposure Therapy — Am not qualified. Psychoanalytic — Am not qualified. 1. A ______therapy approach might be Art Therapy — Am not qualified. a good match for a therapist whose Narrative Therapy — Am not qualified. strengths include ______. It might be Hypnotherap — Am not qualified. more of a challenge for a therapist who ______. Some clinicians would choose entirely A few therapist characteristics to con - different therapies for this client. Some sider: comfort with strong emotion, abil - would apply the therapies above quite ity to analyze patterns, sense of humor, differently. Some clinicians would understanding dynamics, knowledge of choose similar interventions but con - stress reduction techniques, diagnostic sider them examples of different thera - skills, interpersonal warmth, bravery, pies. Realizing that the very same understanding of inequity issues, ability intervention may reflect diverse ap - to provide structure, comfort with si - proaches and be applied with different lence, tabooed topics, spirituality, etc. intent is integrative training in a nut - shell. Theoretical orientations are not 2. A ______therapy approach might be categorical, not even close. a good choice for a client who ______. It might be a riskier choice Cultural differences are not categorical, for a client who ______. either. Side-stepping embarrassment is the human condition. For example, we A few client characteristics to consider: heard about parents externalizing men - trauma history, substance use, sense of tal illness (just like in Indonesia) from a humor, verbal vs. cognitive strengths, Euro-American, mid-twenties, coping coping style, attachment style, maturity with Bipolar I Disorder. She is transi - of defenses, understanding of irony and tioning male to female, and her parents metaphor, level of daily functioning, have declared her symptoms to be the need for medication, need for support result of the hormone therapy (despite vs. challenge, psychological-minded - her diagnosis long pre-dating her gen - ness, etc. der transition). Empathy will always be a valuable guide to our treatment The response to this training exercise choices. Indeed, therapist education is was unusually energetic, even apprecia - not sufficient for culturally relevant choices (Nagayama et al., 2021). Clearly, continued on page 15

14 tive. Having “no right answer” makes some left brain and some right-brain the process frustrating for some, but ways of helping. therapist self-awareness of a need for concreteness (or abstraction) is itself use - Recommendations ful for multi-theoretical training. 1. Consider introducing clinical flexibil - ity graduate year two and returning core Skill to it for internship. None of us can be The point of being adaptable clinically, expected to flex our treatment style from our perspective, is not the specific until (1) we have a treatment style and therapies chosen or identifying as “inte - (2) are able to perceive decision points grative,” but rather just having our in the session. bases covered. Think of this core skill as having some left brain and some right 2. Invite discussion in courses and brain strategies to offer our clients. supervision. What’s a bigger risk? Breadth (being multi-theoretical) at Ideally, mental health professionals have the expense of depth, or depth (single enough range to: orientation) at the expense of breadth? These both confer strength; any rea - • Help clients understand relationship son we can’t have both? dynamics and learn to catch irra - tional thoughts. 3. Create some version of the Practice • Help clients feel respected, heard, Grid exercise above. Seminar partici - and whole and teach them to regu - pants articulate the therapist skills late how much they feel when they believe work well with each challenged. theoretical orientation and those they • Help clients understand their needs may need to develop. Repeat the and know how to initiate behavior process, matching approaches to change. client needs. This exercise requires an • Help clients articulate emotion and instinctive feel for diverse therapies, appreciate the impact of injustice. pattern recognition, and some vision. • Help clients develop coping strate - It’s difficult but fun; allow generous gies and grieve disappointments. time for discussion.

We aspire to help clients who are com - 4. Create some version of the Adapta - partmentalized and those who are dys - tion Brainstorm exercise above. regulated. To assist those who love Briefly describe a fictitious client, per - structure and those who rebel against it. haps different from the therapist on To be effective with clients who think some dimension, then imagine treat - the way we do and those who see things ment planning utilizing elements of differently. This ability to stretch is the multiple therapies. core skill. 5. Generate hypotheticals for discussion We don’t propose that graduate training to illuminate the blind spots associ - cover a vast number of theoretical ori - ated with any single theoretical orien - entations. Rather, we can cover our tation. How might a psychoanalytic bases loosely, fostering therapist devel - approach miss opportunities for skill- opment of some emotion-focused, some building? How might a problem-solv - solution-focused, and some insight-ori - ing approach neglect gender issues? ented strategies. If you prefer, that’s continued on page 16

15 How might a cognitive behavioral dynamic benefits approach discourage deep emotion? We hope that multi-theoretical planning How might a person-centered ap - earns a place in the graduate training proach fall short when a client is in curriculum. Learning clinical flexibility crisis? is a dynamic, unfolding process—like therapy itself—that improves our chances 6. Play with interesting therapy combi - of helping a variety of people. Integra - nations. How might Humanistic and tive thought is a rigorous and creative DBT strategies team up to increase undertaking, but we find it engrossing client self-esteem? How might Exis - to teach and to learn. tential and Rational Emotive ap - proaches combine to help clients bear References disappointment? How might Gestalt Beutler, L.E. & Clarkin, J.F. (2014). Sys - and Systems therapies together pro - tematic tre atment selection: Toward duce amazing family insights? targeted therapeutic interventions. Routledge. https://doi.org/10.4324/ 7. In supervision, help advanced stu - 9781315803746 dents develop a secondary or tertiary Brooks-Harris, J.E. (2007). integrative approach that complements their pri - multitheoretical psychotherapy. Cen - mary theoretical orientation. Ideally, gage Learning. any experienced therapist has some Brooks-Harris, J.E. & Gavetti, M.F. comfort with accessing , an - (2001). Skill-based psychotherapy inte - alyzing cognitions, facilitating insight, gration: A practicum handbook of i nter - recognizing patterns, teaching behav - mediate microskills. Counseling Center ioral strategies, and building a mean - Village: www.ccvillage.buffalo.edu/ ingful relationship. It’s about covering training-resources our bases, not about theoretical orien - Castro, F.G., Barrera, M., Jr., & Holleran tation, per se . Steiker, L.K. (2010). Issues and chal - lenges in the design of culturally 8. Avail yourself of fabulous training re - adapted evidence-based interven - sources. Brooks-Harris & Gavetti tions. Annual Review of Clinical Psy - (2001) offer a handbook for practicum chology, 6, 213-219. https://doi.org/ teaching of micro-skills. Norcross & 10.1146/annurev-clinpsy-033109- Popple (2016) wrote a guide to inte - 132032 grative supervision. Comprehensive Hall, G.C.N., Ibaraki, A.Y., Huang, E.R., texts include: Brooks-Harris (2007), Marti, C.N. & Stice, E. (2016). A Prochaska & Norcross (2018) , meta-analysis of cultural adaptations Hawkins & Ryde (2019), Beutler & of psychological interventions. Be - Clarkin (2014), Norcross & Cooper havior Therapy, 47, 993-1014. https:// (2021), and Ingram (2011). doi.org/10.1016/j.beth.2016.09.005 Hawkins, P. & Ryde, J. (2019). integra - 9. Join the Society for the Exploration of tive psychotherapy in theory and prac - Psychotherapy integration . SEPI’s mem - tice. Jessica Kingsley Publishers. bership is international, their discus - Ingram, B.L. (2011). Clinical case formu - sions inter-disciplinary, and their tone lations: Matching the integrative treat - welcoming; this may be your new fa - ment plan to the client. Wiley vorite conference. The SEPI website Publishing. also provides training resources, in - continued on page 17 cluding integrative course syllabi.

16 Jenkins, N. (2016, March 21). Thousands tegration, 3rd edition. Oxford Univer - of mentally ill indonesians are impris - sity Press. https://doi.org/10.1093/ oned in shackles, report says. Time. med-psych/9780190690465.003.0001 https://time.com/4265623/indone - Norcross, J.C. & Popple, L.M. (2016). sia-mental-illness-chains-pasung-hrw/ Supervision essentials for integrative Nagayama Hall, G.C., Berkman, E.T., psychotherapy . American Psychologi - Zane, N.W., Leong, F.T.L., Hwang, cal Association. W., Nezu, A.M., https://doi.org/10.1037/15967-000 Maguth Nezu, C., Hong, J.J., Chu, J.P. Prochaska, J.O. & Norcross, J.C. (2018). & Huang, E.R. (2021). Reducing Systems of psychotherapy: A trans - mental health disparities by increas - theoretica analysis. Oxford Univer - ing the personal relevance of inter - sity Press. https://doi.org/10.1093/ ventions. American 76 (1), med-psych/9780190690465.003.0008 91-101. https://doi.org/10.1037/ Sebayang, S.K,. Mawarpury, M., & amp0000616 Rosemary, R. (2018, November 6). Norcross, J. C. & Cooper, M. (2021). Less than 1,000 psychiatrists for 260 Personalizing psychotherapy: Assessing million Indonesians. The Jakarta Post. and accommodating patient preferences . Smith, T. B., & Trimble, J. E. (2016). American Psychological Association. foundations of multicultural psychology: https://doi.org/10.1037/0000221- Research to inform effective practice. 000 American Psychological Association Norcross, J.C. & Goldfried, M.R. (Eds.). https://doi.org/10.1037/14733-000 (2019). Handbook of Psychotherapy in -

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17 ScIence and ScHolaRSHIp Reflections on the plague Year: conducting psychotherapy Research during the coVId-19 pandemic Patricia T. Spangler, Ph.d. Bethesda, Md

“I had two important demic, psychotherapy practitioners and things before me: the one researchers also are driven to sustain was the carrying on our work, and though we have the safe my Business and Shop, haven of online interactions, the shift to which was considerable, a virtual workspace has presented its and in which was em - own set of challenges, questions about barked all my Effects how the pandemic has altered our in the World; and the other was the processes, and speculations about what Preservation of my Life in so dismal a the new normal will be. Calamity as I saw apparently was com - ing upon the whole City, and which, Although much attention has been however great it was, my Fears perhaps, given to COVID-19’s impact on psy - as well as other Peoples, represented to chotherapy providers, comparatively be much greater than it could be.” little has been written about how the pandemic has affected the conduct of —Daniel Defoe psychotherapy research. Studies that A Journal of the Plague Year, 1722 were under way at the start of the pan - demic have undergone fundamental Marking a full year since the start of the changes as COVID-related restrictions public health emergency and massive at most research institutions have re - social upheaval caused by COVID-19 mained in place over the past year. The led me to read Defoe’s A Journal of the purpose of this article is to provide ex - Plague Year, an account of the 1655 Great amples of adaptations some researchers Plague of London. It details a number of have made, the challenges encountered parallels with our current pandemic: the in amending study methods, and some tracking of the plague’s spread from potential opportunities stemming from parish to parish, the shutting up of the changes. Several colleagues have homes and public places, the grimness generously provided examples from of the rising death count, the weeping their own experiences in sustaining and lamentation upon the death of their research during the COVID-19 loved ones, and both the public’s fear of year, including study pauses, changes in the disease and their resistance to gov - participant recruitment, the shift to vir - ernment measures to contain its spread. tual therapy sessions, the impact on But the passage that’s resonating for me data collection and analysis, and the cre - right now is in the epigraph, above. It ation of hybrid procedures to enable describes the tension Defoe’s narrator biomarker data collection. felt between his desire to stay in his community and maintain his saddlery Research pauses business and his fear of the disease and Most of the colleagues I contacted death he risked by not fleeing the plague-stricken city. In the current pan - continued on page 19

18 reported a pause in their research at the where research assistants can meet po - start of the pandemic, some because tential participants, provide information their institution halted in-person re - about the study, and collect contact in - search or therapy and others because it formation. Our tabling at Walter Reed took some time to manage the logistics National Military Medical Center was of of moving to virtual sessions and data course halted at the start of the pan - collection. All reported that their insti - demic because of the public health risk, tutional review boards were responsive and the current health protection condi - to protocol changes; some experienced a tion level has precluded our return to in- delay but ultimately received approval person recruiting. This has reduced our for COVID-related amendments. The recruiting numbers substantially and length of time research was paused has led us to develop online advertising ranged from no time at all to more than and recruiting approaches, including one year. Harold Chui, assistant profes - use of social media, local intranets, and sor in the de - listservs. In addition to the loss of in-per - partment at The Chinese University of son recruiting, potential participants we Hong Kong and member of Division contact by text or phone seem more re - 29’s Research Committee, reported that luctant to follow up after prescreening he was not able to collect data from his calls or virtual screening visits, causing clinic from March to December 2020. further decline in recruiting numbers. One Division 29 grant recipient had to One other researcher has had similar dif - request two no-cost extensions because ficulties with recruitment, with potential his data collection requires international participants seeming less responsive to travel to an area with high COVID case online recruiting approaches. rates, delaying his data collection by at least one year. My current study, a pilot Other researchers indicated they had no trial of a novel therapy for trauma-re - decrease in recruitment. Joshua Swift, as - lated nightmares, was paused for two sociate professor of clinical psychology at months by the university’s order that all Idaho State University and Division 29 non-COVID-related research be halted. treasurer, reported that he doesn’t believe Once research was allowed to resume, the pandemic harmed recruitment and the university and site IRBs quickly ap - perhaps even improved recruiting for proved our COVID-altered protocol. We their online studies because there were also are requesting a no-cost extension no in-person studies to compete with. on our grant to extend our data collec - Based on these comments, then, one pos - tion time. Thus, having psychotherapy itive impact of the pandemic on partici - research activities halted was common pant recruiting is that it has compelled among those contacted. Some were able researchers to broaden their approaches to resume quickly whereas others re - to recruitment and that these techniques main on hold due to pandemic condi - may have value after the pandemic re - tions at their study sites. strictions are lifted.

Impact on participant Recruitment Shift to Virtual Sessions For some studies, participant recruit - All of the researchers reported shifting ment has been hampered significantly to virtual sessions. The availability of by the pandemic environment. For my Zoom, Google Meet, and other online study, our most productive approach platforms facilitated the logistics of the has been to set up an information table change. Clara Hill, professor of counsel - in a high-traffic area of the hospital continued on page 20

19 ing psychology at the University of having to travel to the study site and Maryland and president of Division 29, having the capacity to reach a geo - reported no pause in research activity at graphically broader pool of participants. the Maryland Psychotherapy Clinic and In addition, being compelled to conduct Research Lab, which she attributes to psychotherapy research virtually has the university switching to Zoom, which created a large population of virtual enabled their smooth transition to vir - therapy dyads, giving us the opportu - tual sessions. Other researchers also re - nity to vastly expand research on virtual ported that the shift was relatively therapy process and outcome. smooth. For my study, the change to vir - tual sessions had some initial glitches, data collection and analysis including one participant lacking broad - Sessions are not the only component of band access in their home and the re - psychotherapy research that have gone search team taking some time in virtual; transitioning to online data col - figuring out how to smoothly transition lection also has forced a steep learning the session from a research assistant curve. Jenelle Slavin-Mulford, associate who does informed consent to the as - professor in the psychological sciences sessor for clinical interviews to the ther - department at Augusta University and apist for treatment and then back to the chair of Division 29’s research committee, research assistant. We have found that stated that their lab missed several weeks giving each team member an estimated of data collection at the start of the pan - time to stand by and then instant mes - demic while they figured out the logistics saging them at the time of transition has of transitioning their study online. Be - worked fairly smoothly. cause her current study will include data from both in-person and virtual sessions, In addition to mastering the logistics of she says she will need to assess whether conducting virtual sessions, developing and how the virtual sessions are different the therapy relationship virtually is more from the in-person and will have to co - challenging than it is in person. The ther - vary those factors out. apists and assessors in our study have noted that it can be difficult to read a par - Harold Chui reported that his research ticipant’s facial expressions and body team uses Zoom’s recording feature to language. The technology also intro - record sessions for future coding and duces an audio time lag, which can cause analysis, and that they are collecting participants and therapists to talk over pre- and post-session self-report data via each other or create unintentional, awk - Qualtrics. He also noted that they have ward silences. There are occasional sig - had a lot more missing data since the nal disruptions, which causes gaps in move to online data collection, which communication and requires the thera - will likely extend his data collection pe - pist to ask the participant to repeat them - riod. Joshua Swift stated that he expects selves. In addition, participants can be his data analysis will be much more distracted when they are in their home because the recorded Zoom by family members, pets, onscreen mes - sessions give a smaller picture of the sage notifications, text messages, and client (typically just head and shoul - other environmental stimuli not present ders), so that coders can’t view the same in an in-person therapy setting. amount of detail as they can in record - ings of in-person sessions, and this The positive aspects of virtual sessions makes it harder to pick up body lan - are, of course, the convenience of not continued on page 21

20 guage and other nuances. In addition, chometric data collection. For the pilot he stated that it’s difficult to tell whether trial my team is conducting, we distrib - pauses are due to connectivity issues or ute wristband devices for continuous just natural pauses in the therapist-client physiologic data collection and collect interaction. For my own study, we had blood samples at three visits for genetic been using digital audio recorders to and inflammatory marker assay. Be - record in-person sessions, and after cause these biomarkers are essential to shifting to virtual sessions, we at - the study, we needed to retain them and tempted using the same recorders but so came up with a hybrid of in-person found that the sound quality was quite and virtual study visits. The study was poor. We have since switched to using originally designed with 10 in-person the Google Meet recording feature, visits, including screening and follow- which has produced much clearer up. We have amended it so that six of recordings, making coding and adher - the visits are now virtual and four are ence checks go much more quickly. completed in-person in our study of - fices. These in-person visits are when lab management participants receive or return the wrist - Given all of the adaptations described band devices and give blood samples. thus far, it’s no surprise that managing To prepare for the visits, all surfaces and lab procedures have changed signifi - equipment are sanitized prior to partic - cantly. Jenelle Slavin-Mulford reported ipant arrival. The research assistant and that her lab manager had to learn their the participant are masked and meet in new online data collection method. person briefly as the research assistant Clara Hill stated that the biggest shift in escorts the participant to a laptop in one her lab was that therapists had to as - room and then goes to their own laptop sume all administrative duties, includ - in another room to conduct equipment ing giving measures, turning on orientation and administer measures recording devices, and uploading virtually. When these are complete, the recordings to the university’s secure sys - therapist enters the video session and tem, which has added considerable time conducts the therapy. When the therapy to each session. She said they also had to session is complete, the therapist alerts implement a different payment system the research assistant, who escorts the because they had previously accepted participant to the phlebotomy clinic for only cash and checks, and since the pan - the blood draw. When the blood draw is demic have had to set up online pay - complete, the research assistant walks ments through the university. the samples to the lab, where they are centrifuged and stored for later assay. biomarker data collection All personnel are masked and observe An increasing number of psychotherapy physical distancing. Although the re - studies are integrating biomarker data vised procedures are more burdensome, collection into their protocols, a compo - we’ve been able carry them out fairly nent that is obviously problematic in a smoothly. In one respect, pandemic re - pandemic environment. Two of my col - strictions have made our procedures a leagues had biomarkers in their proto - bit easier. With most of the therapists in cols when COVID hit. One made the our suite working from home, the addi - decision to simply halt his study, and the tional office space needed to keep the re - other amended his protocol to omit search assistant and participant separate biosample collection and proceeded with virtual therapy sessions and psy - continued on page 22

21 is always available. It isn’t yet clear sult with each other when considering when restrictions will be lifted or how best to adapt their current studies whether we will return to in-person ses - and, as they look to the future, to inves - sions even if they are lifted, given the tigate new topics and constructs that convenience that virtual sessions afford. may arise as a result of the pandemic. The amended procedures have demon - strated that biomarker collection is pos - Acknowledgements: I would like to ex - sible even under pandemic restrictions. press my thanks to Harold Chui, Clara Hill, Jenelle Slavin-Mulford, and Joshua conclusion Swift for sharing their pandemic re - It’s been a long, strange year. Though search experiences. our COVID-19 pandemic experiences differ in many ways from the plague disclaimer: The opinions and assertions year endured by Defoe’s 17 th century expressed herein are those of the author London saddler, we share the uncer - and do not necessarily reflect the official tainty wrought by a public health crisis policy or position of the Uniformed and consequent major changes in how Services University, the Department of we live and how we do our work. It’s my Defense, or the Henry Jackson Founda - hope that relating the challenges that I tion. and some of my colleagues encountered during the pandemic year provides a Reference sense of commonality. I also hope that Defoe, D. (2011). A journal of the plague sharing how we adapted our studies year . Digireads.com Publishing. may stimulate other researchers to con - (Original work published in 1722).

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22 eTHIcS a clinician’s cognitive dissonance: ethical considerations When Responding to Self-harm Within a correctional context Claire Gaglione denver, Co What leads a person to (2012) noted between 7% and 48% of in - engage in self-harm dividuals in correctional settings en - be haviors has long per - gaged in NSSI behaviors—far more than plexed psycho logists. the average 4% of in the general People identify various population. Additionally, the percentage reasons for engaging of those who engage in NSSI behav - in self-harm, which in - iors in correctional settings increases clude transforming their emotional pain when the person also has a diagnosed into physical pain, channeling anger, mental illness (Dixon-Gordon et al., 2012). escaping from recurring traumatic thoughts/feelings, and regulation of Utilizing data from the Bureau of Justice affect (Whisenhunt et al., 2016; White et Statistics, the Prison Policy Initiative al., 2003). Self-harm is commonly con - found that suicide was the leading cause fused with suicidal intent. The American of death in jails for over ten years, with Psychiatric Association makes an im - over a third of all jail deaths in 2013 portant distinction between the two by being attributed to suicide. Additionally, establishing a new term: non-suicidal they found 40% of people who die self-injury (NSSI). NSSI is recognized in by suicide in jail do so within seven days the fifth edition of the Diagnostic and of admission (Prison Policy Initiative, Statistical Manual of Mental Disorders 2015). Therefore, it is important for cli - (DSM-5) and defined as “deliberate self- nicians to recognize those most at-risk inflicted harm that isn’t intended to be for NSSI/suicidality within correctional suicidal” (APA, 2015). Despite the dis - settings. Ramluggun (2011) identifies tinction between self-injury and suicide, those most at-risk as “young, unmarried it is important to note that NSSI and sui - white people who are awaiting sentence cide attempts often co-occur, with NSSI or in their first seven days in prison, or being a precursor to suicidality (Pom - they are people with long sentences and pili et al., 2015). NSSI and suicidality histories of violent offending, sexual occur at an alarming rate in correctional abuse, psychiatric or personality disor - settings, creating not only an ethical ders, or substance misuse” (p. 2). issue for clinicians but also a human Currently, NSSI and suicide attempts are rights issue. It is imperative that self- handled controversially within correc - harm amongst incarcerated populations tional settings. Mental health profes - be examined to initiate systemic change. sionals working in corrections are Self-Harm and Suicide in ethically challenged as the field increas - correctional Settings ingly “deemphasizes treatment and Little research is available regarding emphasizes security and custodial con - NSSI within correctional contexts; how - cerns” (Weinberger & Sreenivasan, 1994, ever, a study by Dixon-Gordon et al. continued on page 24

23 p. 161). This dichotomy creates an envi - tion cells is problematic for many rea - ronment with rigid explanations—cor - sons, one being that this form of “pre - rectional staff typically label behaviors vention” is considered a punishment by as manipulative, whereas mental health those subjected to it. The risk of being professionals consider them a product placed in an observation cell discour - of stress, incarceration trauma, and/or ages incarcerated people from disclosing mental illness. Improper assessment of NSSI and/or suicidal ideation (Bell, the intentions of NSSI and suicide at - 1998). Little empirical research exists as - tempts can be mitigated by proper sessing the efficacy of isolation as a education of all correctional staff (Wein - means of suicide prevention. However, berger & Sreenivasan, 1994). Previous there is substantial research on the ef - studies have demonstrated that these fects of isolation on the general prison behaviors are frequently perceived neg - population. Those who have been sub - atively by correctional staff, especially jected to isolation reported more ad - when the behaviors are infrequent, verse physical and mental outcomes, deemed non-severe, and performed by including measurable changes in brain an incarcerated person labeled “disrup - functioning, depression, memory diffi - tive” (Marzano et al., 2011). The question culties, anxiety, hallucinations, appetite that arises out of this environment and sleep disturbances, hygiene issues, is, should these behaviors be considered disorganization, and social withdrawal a punishable or treatable act? (Gendreau et al., 1972; Haney, 2003; Lovell, 2008; Stuker et al., 1991). In iso - In correctional contexts, NSSI behaviors lation units, “the stress, lack of mean - are too often considered punishable acts. ingful social contact, and unstructured A study by Marzano et al. (2011) found days can exacerbate symptoms of illness that 85% of people incarcerated found or provoke reoccurrence,” with more officers’ responses to self-harm unhelp - suicide attempts occurring within isola - ful, and 67% found healthcare staffs’ re - tion units (Metzner & Fellner, 2013, sponses to self-harm unhelpful. These p. 316-317). If these conditions exacer - negative responses contribute to further bate suicidality in the general popula - and more severe self-harm and inhibit tion, how are they supposed to benefit support seeking, as well as reinforce those who are actively suicidal? low self-esteem and poor self-worth (Marzano et al., 2011). Staff attitudes ethical considerations create an environment where NSSI are When clinicians in correctional settings handled as punishable acts (e.g., obser - are addressing NSSI, the American Psy - vation cells), and the institutional proto - chological Association’s (APA) ethical cols that follow such behaviors reinforce guidelines, specifically principle 3.04 this. Psychiatric correctional staff faces a Avoiding Harm, are important to evalu - “restricted range of therapeutic options ate. It is difficult to wage harm reduction on account of the prison regime,” where within corrections which, at its core, is ethical dilemmas ensue (Bell, 1999, p. intended to inflict harm and be puni - 724). The most common and readily tive. Guideline 3.04 binds psychologists available clinical intervention is the use to a code of conduct in which they avoid of observation cells, which are isolated and minimize harm, as well as “do not cells where people who are incarcer - participate in, facilitate, assist, or other - ated are stripped of regular clothes, wise engage in torture, defined as any bedding, personal belongings, etc., for act by which severe pain or suffering, suicide prevention. The use of observa - continued on page 25

24 whether physical or mental, is inten - duce the high levels of anxiety and dis - tionally inflicted on a person” (APA, tress that are known to trigger self-harm 2017). An American Civil Liberties and suicide, experienced by some pris - Union (ACLU) briefing stated that “the oners in the early days of custody” shattering impacts of solitary confine - (PACT, n.d., para. 1). Upon a person’s ment are so well-documented that arrival to prison, they would be met nearly every federal court...has ruled with a first night worker, who would that placing people with severe mental conduct risk and other mental health as - illness in such conditions is cruel and sessments, as well as address any other unusual punishment in violation of the needs and concerns, such as those relat - U.S. Constitution” (ACLU, 2014, p. ing to children, family members. First 7). Isolation is associated with suicidal - night workers are at the frontline of ed - ity and worsening mental health (Ca - ucating people who have recently been lati et al., 2019; Metzner & Fellner, 2013). sent to prison on their rights and pro - Observation cells teeter on a thin line be - viding available resources. PACT also w tween preventing suicide at all costs orks with the general prison popula - and violating inmates’ basic human tion to select and train certain individu - rights, dignity, and privacy (Bell, 1998). als to become PACT Peers. PACT Peers act as a continuation of the support the Psychologists continued use of observa - first night service provides. A study con - tion cells as a means of prevention ducted by the Prison Reform Trust com - may violate APA ethical guidelines. pared four male and female prisons to Psychologists are advised to stress the determine the effects of first-night serv - urgency of reform upon their profes - ices. Two of the observed prisons imple - sional organizations, emphasizing that mented first-night services, and the other “it is not ethically defensible for health two prisons had not. Findings of the care professionals to acquiesce silently study showed that “emotional distress to conditions of confinement,” as these amongst prisoners was significantly conditions impose direct harm to clients reduced” in the two prisons that uti - (Metzner & Fellner, 2013, p. 319). Pro - lized PACT’s first-night services (PACT, fessional organizations should, in turn, n.d., Figure 2). It is recommended that use their position of authority to mobi - prisons put into practice a first night lize an interdisciplinary, nationwide service to protect an at-risk group. reimagining of isolation. It has never been viable for clinicians to remain com - While the creation of specially trained plicit in the wake of client harm. units is feasible for short-term goals, what is most imperative in creating Recommendations and conclusion meaningful, lasting reform is improved Aside from striving to provide ethically mandatory mental health training for all competent clinical work, psychologists correctional staff. In some settings, cor - should advocate for systemic change. rectional psychologists are required to One recommended alternative to isola - attend training in which there is no dis - tion is the implementation of first-night tinction between mental health and services (Ramluggun, 2011). Prison Ad - other correctional staff. This highlights vice and Care Trust (PACT), a national the omnipotence of the security vs. treat - charity in the United Kingdom that pro - ment model, illustrated by the notion vides numerous services within prisons, that all staff is “considered correctional created a first night service. The goal officers first and foremost” (Weinberger of PACT’s first night service is to “re - continued on page 26

25 & Sreenivasan, 1994, p. 162). If general the therapeutic community (TC). Cur - staff training is the same for all correc - rently, “democratic TCs” are used in tional employees, it is reasonable to sug - some English prisons to assist those gest that all employees receive mental with complex psychological needs, with health training in addition to their regu - the goal of creating an environment lar training. While correctional officers where individuals are empowered to be - have started to receive basic mental come active members for the betterment health training over the past few years, of themselves and the community. In it is not enough. general, TCs share five core qualities: be - longing, safety, openness, participation, Parker (2009) evaluated the benefits of and empowerment (Rawlings & Haigh, providing correctional officers with ade - 2018). Taking this idea one step fur - quate mental health training. Correc - ther are psychologically informed planned tional officers employed through the environments (PIPEs). PIPEs are residen - Indiana Department of Corrections in tial prison services that seek to reduce the special housing (“supermax”) unit in reoffending and “improve psychological the Carlisle facility received mental health and well-being” (Rawlings & health training created by the Indiana Haigh, 2018, p. 344). These environments chapter of the National Alliance on Men - are often run through a designated tal Illness (NAMI-Indiana). This 5-week wing by specially trained correctional, training provided correctional officers medical, and mental health staff. PIPEs with ten hours of specialized mental aim to smooth a person’s transition into health training. In an evaluation of offi - prison life. Rawlings and Haigh (2018) cers’ reactions to the training, results re - noted, “PIPEs work with the most diffi - vealed the training was well-received by and disruptive prisoners from main - participating officers. Furthermore, after stream incarceration and at the same time the first training session, “the total num - offer them the kind of support which can ber of incidents, the use of force by the help them through a pathway of inter - officers, and battery by bodily waste all vention, something which mainstream declined significantly” (Parker, 2009, p. custodial environments are not always 640). This trend continued after the com - psychologically equipped to provide” pletion of the training program. Not (pp. 344-345). Why then, when humane only did providing mental health train - alternatives exist, does the American ing make the prison a safer work envi - prison system continue to rely on ill- ronment for officers, but it also made equipped, punitive, and inhumane modes prison a safer living environment for of NSSI prevention? It is psychologists’ people who are incarcerated. responsibility to advocate for more eth - ically and clinically sound treatment Lastly, it is important to advocate for the methods and prevention protocols. reimagining of isolation as a means of NSSI and suicide prevention. The References negative effects of isolation on physical American Civil Liberties Union. and mental health are well-documented (2014). The dangerous overuse of Soli - and clearly explored in literature. What tary Confinement in the United States. has not been thoroughly considered are American Psychological Association. alternatives to isolation. Rawlings and (2017). Ethical principles of psycholo - Haigh (2018) explored alternatives to gists and code of conduct . http:// this problematic prevention protocol. In the late 18 th century, England created continued on page 27

26 www.apa.org/ethics/code/ (2011). The impact of prison staff re - index.html sponses on self- harming behaviours: American Psychological Association. Prisoners’ perspectives. British Jour - (2015). Who self-injures? Monitor on nal of Clinical Psychology, 51 (1), 4- Psychology, 46 (7), 60. 18. https://doi.org/10.1111/j.2044-8 Bell, D. (1999). Ethical issues in the pre - 260.2010.02007.x vention of suicide in prison. Aus - Metzner, J.L., & Fellner, J. (2013). Soli - tralian and New Zealand Journal of tary confinement and mental illness Psychiatry, 33 (5), 723-728. in U.S. prisons: A challenge for med - https:// doi. org/10.1080/j.1440- ical ethics. In Grodin, M.A., Taran - 1614.1999.00635.x tola, D., Annas, G.J., & Gruskin, S. Calati, R., Ferrari, C., Brittner, M., Oasi, (Eds.) Health and Human Rights in a O., Olié, E., Carvalho, A.F., Changing World . (pp. 316-321). Rout - & Courtet, P.P. (2019). Suicidal ledge. thoughts and behaviors and social Parker, G.F. (2009). Impact of a men - isolation: A narrative review of the tal health training course for correc - literature. Journal of Affective disor - tional officers on a special housing ders, 245 , 653667. https://doi.org/ unity. Psychiatric Services, 60 (5), 640- 10.1016/j.jad.2018.11.022 645. https://doi.org/10.1176/ DeAngelis, T. (2015). A new look at ps.2009.60.5.640 self-injury. Monitor on Psychology, PACT. (n.d.). first Night and Early days 46 (7), 58. in Custody . https://www.prisonad - DeAngelis, T. (2015). Who self-injures? vice.org.uk/first-night-and-early- Monitor on Psychology, 46 (7), 60. days-in-custody Dixon-Gordon, K., Harrison, N. & Pompili, M., Goracci, A., Giordano, Roesch, R. (2012). Non-suicidal self- G., Erbuto, D., Giardi, P., Klonsky, injury within offender populations: E.D., & Baldessarini, A systematic review. international R. J. (2015). Relationship of non-suici - Journal of forensic Mental Health, dal self-injury and suicide attempt: 11 (1), 33-50. https://doi.org/ A psychopathological perspective. 10.1080/14999013.2012.667513 Journal of Psychopathology, 21 (4), 348- Grendeau, P., Freedman, N.L., Wilde, 353. G.J., & Scott, G.D. (1972). Changes in Prison Policy Initiative. (2015, August EEG alpha frequency and evoked re - 4). New BJS report shows suicide in jails sponse latency during solitary con - is a national crisis. https://www.pris - finement. Journal of Abnormal onpolicy.org/blog/2015/08/04/bjs_j Psychology, 79 (1), 54-59. https://psy - ail_suicide/ cnet.apa.org/doi/10.1037/h0032339 Ramluggun, P. (2011). Beyond observa - Haney, C. (2003). Mental health issues in tion: Self-harm in prisons. Mental long-term solitary and “supermax” Health Practice, 14 (9), 16-20. confinement. Crime & delinquency, https://doi.org/10.7748/mhp2011.0 49 (1), 124–156. https://doi.org/ 6.14.9.c8523 10.1177/0011128702239239 Rawlings, B., & Haigh, R. (2018). Ther - Lovell, D. (2008). Patterns of disturbed apeutic communities and planned behavior in a supermax popula - environments for serious offenders tion. Criminal Justice and Behavior, in English prisons. BJPsych Advances, 35 (8), 985–1004. https://doi.org/ 23 (5), 338-346. https://doi.org/ 10.1177/0093854808318584 10.1192/apt.bp.115.015636 Marzano, L., Ciclitira, K., & Adler, J. continued on page 28

27 Sutker, P.B., Winstead, D.K., Galina, Whisenhunt, J.L., Stargell, N., Z.H., & Allain, A. N. (1991). Cogni - & Periessy, C. (2016, July 24). Ad - tive deficits and psychopathology dressing ethical issues in treating client among former prisoners of war and self-injury. Counseling Today. combat veterans of the Korean con - https://ct.counseling.org/2016/07/ flict. The American Journal of Psychia - addressing-ethical-issues-treating- try, 148 (1), 67-72. client-self-injury/ https://doi.org/10.1176/ajp.148.1.67 White, E.V., McCormick, L.J., & Kelly, Weinberger, L.E., & Sreenivasan, S. B.L. (2003). Counseling clients (1994). Ethical and professional who self-injure: Ethical considera - conflicts in correctional psychol - tions. Counseling and values, 47 (3), ogy. Professional Psychology: Research 220-229. https://doi.org/10.1002/ and Practice, 25 (2), 161-167. j.2161-007X.2003.tb00268.x https://doi.org/10.1037/0735- 7028.25.2.161

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28 TelemenTal HealTH caRe Transitioning to Virtual Space: Teletherapy in the Time of coVId-19

Andrew d. Lokai, M.A. Liqiaonan Chen, M.A. Kendra G. M. Terry, M.A. Garden City, NY Catherine f. Eubanks, Ph.d. New York, NY J. Christopher Muran, Ph.d. Garden City, NY

In an effort to curb the ent study addresses how these dyads transmission of the adjusted to treatment while facing un - coronavirus disease precedented global disruption. This study (COVID-19) that involved a semi-structured interview emerged in late 2019, and qualitative analysis with the aim of the use of telehealth exploring how the transition to telether - technology became a apy was experienced by therapists and necessity for individu - patients in this program and how this als in need of healthcare influenced the working alliance. services to communi - cate with their health - method care providers (Wosik participants et al., 2020). Telether - The participants in the study included apy, which is a form of therapists and patients who were par - telehealth, uses online ticipating in the Brief Psychotherapy Re - video conferencing to search Program affiliated with Mount provide interactive psy - Sinai Beth Israel (see Muran, 2002; chological treatment be - Muran et al., 2018). A total of 10 partici - tween therapists and pants were selected for the study, in - patients (Tse et al., cluding five therapists and five patients. 2015). Previous litera - Two of the therapists were psychiatry ture has shown that a residents, and three were advanced doc - good working alliance toral students in clinical psychology. can be virtually estab - Their ages ranged between 29 and 32 lished (Norwood et al., (M=32.4, Sd =1). Four identified as fe - 2018). During the COVID-19 lockdown male and one as “other.” Four identified in March 2020, a psychotherapy re - as White, one Latinx. The patients’ ages search program at a major metropolitan ranged between 20 and 76 ( M=40.4, medical center in New York City began Sd =19.7). Among them, three were to offer teletherapy services. Accord - male, one female, one identified as non - ingly, a large number of patient-thera - binary. Four patients identified as White pist dyads were forced to transition and one as Latinx. abruptly to this virtual setting. The pres - continued on page 30

29 procedures and data collection meetings were held between the re - All participants experienced a transition searchers to ensure agreement on the from in-person psychotherapy to tele - theme clusters. Those that were agreed therapy, having completed at least two upon by at least two of the three mem - in-person sessions before the transition. bers were retained on the final list. Lastly, Only completed cases were selected. all the theme clusters were further exam - Among the 16 identified participants ined and classified in consensus, which (eight dyads), 10 agreed to participate in resulted in a total of 16 higher-order, su - the study. Qualitative data were ob - perordinate themes. These themes were tained through a semi-structured inter - classified into three groups based on their view with each of the participants. Each occurrence: highly common themes (6-9 person was interviewed by one of the re - occurrences), moderately common searchers over the online video confer - themes (3-5 occurrences), and unique encing platform Zoom for a duration themes (1 occurrence). ranging between 15 minutes and 40 min - utes. The interview questions were Results developed collaboratively by the three Highly common Themes researchers, who were all doctoral students in clinical psychology. Each in - Teletherapy did not affect the working terview began with a standard introduc - alliance tion, an orientation question about the More participants reported that there therapy, followed by specific questions was no influence on the alliance in terms targeting the transition to teletherapy of affective bond and agreement on and its impact on the working alliance. treatment tasks and goals. For example, Follow-up and open-ended questions when asked whether teletherapy has im - were used to facilitate the discussion. All pacted his treatment goals, one patient the interviews were recorded digitally reported, “I would say really the virtual and transcribed verbatim using the soft - versus the in-person maybe didn’t really ware TranscribeMe. Consent for the in - change what we were discussing or terview and recording was sought at the what my issues were.” More generally, beginning of each interview. one therapist stated that “I don’t know that I would say anything about the vir - data analysis tual aspect of our treatment changed the In this study, Interpretive Phenomeno - working alliance. I think it’s just the al - logical Analysis (IPA) was used to ana - liance evolved throughout the therapy lyze the data. It was developed by Smith like it would.” et al. (1995) as a distinctive qualitative approach to explore individuals’ idio - Teletherapy has potential graphic subjective experiences and is There were some therapists who are widely accepted by healthcare disci - proponents of teletherapy due to its plines, including clinical psychology convenience and flexibility in terms (Biggerstaff & Thompson, 2008). The of scheduling that can “dramatically transcripts of each participant’s inter - expand[s] access to mental health serv - views were analyzed by each member of ices.” Additionally, one therapist re - the research team who followed the steps ported that he virtually shared his of reading and re-reading the transcripts, process notes with his patient while in noting significant units, identifying session, which was not something he emerging themes, and grouping the would have done with in-person ther - themes into clusters. Next, consensus continued on page 31

30 apy. This highlighted the benefit of come to [place] and wait in a waiting teletherapy as being a useful therapeu - room” versus “just clicking, ‘Hello,’ on tic tool which “is actually really cool and Zoom or Skype.” Regarding boundaries, probably something [he] should take one therapist reported that her patient more advantage of with future clients.” introduced her to people she knew Patients also reported that they were when she was passing her neighbor - more open to it as it can serve as an al - hood one time. Still, one therapist ended ternative for in-person therapy, even up giving her Google Voice number to though in-person therapy is still pre - her patient, which led them to have “a ferred. For example, one patient stated, more interactive sort outside of session.” “I would say ultimately it made me much more open to teletherapy, even if I Teletherapy caused a felt distance between still would prefer an in-person session.” the therapist and patient, which at times was liberating Negative aspects of teletherapy Interestingly, participants reported that Despite some positivity and potential, the lack of physical presence in telether - participants noted negative aspects of apy made it easier for them to commu - teletherapy which include but are not nicate and express themselves without limited to them finding it less effective, fear of judgment. For example, one pa - difficult to connect emotionally, and an tient found that “the less present the impoverishment of the therapy process. other person is, the easier it is to say Three therapists reported that they felt whatever comes to mind without wor - teletherapy was less effective, with one rying about whether there’s a reaction or stating, “I just felt I wasn’t as effective…I not.” Some therapists also expressed just felt like I couldn’t quite connect with similar views, as one of them pointed [my patient] in the same way that we out, “there’s kind of that distance there, did when we were in person.” Another so it might be a little bit more liberating. therapist reported that her patient thinks He might have let his guard down a doing “telehealth would be an impover - little bit.” ishment of the process,” while she also felt that it “definitely compromised [the Something ineffable is lost with teletherapy process],” with part of the reason being According to some participants, the sub - “it was hard to get to emotional topics” tleties of in-person therapy were lost in when using this form of treatment. a virtual setting, although it was difficult for them to articulate what specifics Teletherapy altered the ritual, process and about the visceral presence of the person frame of therapy were missing in teletherapy. One patient Participants noted how teletherapy stated that “there’s some connection changed the rituals of going to see a that’s hard to explain from being in the therapist were changed; namely, the same room as someone when you’re physical therapy space was altered, the sharing a physical space.” A therapist boundaries loosened, and therapist self- described teletherapy as “doing that stuff disclosure increased. For example, one over the screen is just not the same.” patient believed that “there is a certain ceremony to going in-person to the of - moderately common Themes fice, getting in that space and having Switching to teletherapy caused a that private space” after he transitioned restarting of the working alliance to teletherapy. Similarly, one therapist Some participants reported feeling a compared the difference between “a change in the working alliance after process for him to get on a train and continued on page 32

31 transitioning to teletherapy. For exam - resulted in the “normalizing of one’s ple, one therapist stated that she and her therapist and making them into more of patient “definitely had to restart and re - a person” since they had therapy ses - build” their alliance. This feeling was sions from their home. shared by a patient who found the tran - sition to be difficult because he felt as Privacy/safety concerns in doing teletherapy though he and his therapist were “kind This theme was reported by two patients, of resetting the relationship a little bit.” with one stating that he was living with his parents during the quarantine and Lack of visual cues with teletherapy did not “want them to hear everything Teletherapy may have compromised that I’m saying,” while the other stated participant’s of each other. that he was living with his girlfriend and This was reported by two therapists, that having therapy at home “doesn’t with one saying that she was unable “to even feel like a totally safe space to talk.” get a good read” on her patient in that This theme was supported by a therapist she could not observe her patient’s who stated that her patient would at “non-verbal affect and gestures.” Three times “get interrupted” by her younger patients also reported this theme, with siblings since “she was very much re - one stating that “there’s a lot of cues that sponsible for caring for” them. she [therapist] was able to spot that maybe aren’t as conveyed as effectively” unique Themes with teletherapy. Unique themes included the following (which are listed here due to space re - Covid-19 impacted the treatment strictions): Teletherapy buffered therapist This theme illustrated how COVID-19 feelings after a missed session from the pa - enhanced the bond between some ther - tient ; No difference between in-person ther - apists and their patients as well as af - apy and teletherapy ; Therapist “checked-in” fected the goals of treatment. For more with the patient after switching to example, one therapist stated that “the teletherapy to assure mutual understanding ; stress of COVID sort of brought us and Therapist believed having more initial closer.” Another therapist stated that in-person sessions would have strengthened COVID-19 affected her patient’s treat - the alliance in the alliance in teletherapy ment goal of working on his social and (see Table 1 for all the unique themes performance anxiety at his workplace and supported responses). because he became “more comfortable communicating virtually rather than in- person” after he had to work at home during the quarantine.

Therapist role shifted during teletherapy Interestingly, some patients and thera - pists reported that the role of “therapist” changed during the transition to teletherapy. For example, a therapist stated that he got “into a kind of coach - ing, problem-solving mindset in a vir - tual session,” which he would not have gotten into had he been in the same room as the patient. A patient also described that the use of teletherapy continued on page 33

32 discussion In considering the working alliance ac - In thinking about potential limitations to cording to Bordin’s (1979) formulation, this study, some of the interviews took namely as a combination of shared tasks place months after treatment was com - and goals and the quality of a shared pleted. Furthermore, the researchers bond, the researchers were able to cap - were unable to contact several of the ture the shift from different angles. In - participants, which results in un - terestingly, when participants were matched dyad interviews. The ex - asked outright about changes in the ploratory nature of the present study working alliance, nine participants re - lends itself to implications of further re - ported that teletherapy did not affect the search. While COVID-19 required that working alliance (highly common). How - in-person therapy be transitioned to tele - ever, when asked more specifically health, it allowed for teletherapy to be about the goals, tasks, and bonds, par - considered as a viable alternative option. ticipants reported that Covid-19 affected Now that patients and therapists alike the goals of treatment (moderately com - have become somewhat habituated to mon) that solidarity in Covid-19 en - teletherapy, there is room to expand hanced the bond between therapist and upon therapist training opportunities to patient (moderately common), and that offer therapy virtually. there was an increased focus on tasks as compared with the process of therapy (mod - References erately common). In this way, there is a Biggerstaff, D., & Thompson, A. R. misalignment between the overall sense (2008). Interpretative phenomenolog - of change that was directly reported ver - ical analysis (IPA): A qualitative sus the specific components of the al - methodology of choice in healthcare liance when asked to elaborate. research. Qualitative research in psy - chology , 5(3), 214-224. https://doi. Another interesting finding was that org/10.1080/14780880802314304 some therapists became more relaxed in Bordin, E. S. (1979). The generalizabil - upholding the frame of therapy and ity of the psychoanalytic concept of maintaining boundaries with their pa - the working alliance. Psychotherapy: tients. It is possible that since the virtual Theory, Research & Practice, 16 (3), environment of therapy was taking 252–260. https://doi.org/10.1037/ place in the therapist’s personal space, h0085885 they felt more relaxed and in a less rigid Muran, J. C. (2002). A relational ap - role than they would have felt if they proach to understanding change: were doing therapy in a professional set - Plurality and contextualism in a psy - ting. This may be related to why one chotherapy research program. Psy - therapist reported feeling less disap - chotherapy Research, 12 (2), 113–138. pointed after a no-show in teletherapy, https://doi.org/10.1080/713664276 as she might have felt easier to transition Muran J.C., Safran J.D., Eubanks C.F., to her own space during that freed-up & Gorman B.S. (2018). The effect of hour. Another significant finding was alliance-focused training on a cogni - that there seemed to be something “in - tive-behavioral therapy for personal - effable,” or indescribable, about the vis - ity disorders. Journal of Consulting ceral presence of the other that cannot be and Clinical Psychology , 86, 384–397. reinvented in the virtual setting, which https://doi.org/10.1037/ccp0000284 may be the lack of visual cues or the felt Norwood, C., Moghaddam, N. G., Ma - distance between therapist and patient . continued on page 34

33 lins, S., & Sabin-Farrell, R. (2018). hyperactivity disorder. Telemedicine Working alliance and outcome effec - Journal and E-Health: The official Jour - tiveness in videoconferencing psy - nal of the American Telemedicine Asso - chotherapy: A systematic review and ciation , 21 (6), 451–458. https://doi. noninferiority meta-analysis. Clinical org/10.1089/tmj.2014.0132 psychology & psychotherapy , 25 (6), Wosik, J., Fudim, M., Cameron, B., Gel - 797–808. https://doi.org/10.1002/ lad, Z. F., Cho, A., Phinney, D., Cur - cpp.2315 tis, S., Roman, M., Poon, E. G., Smith, J. A., Harré, R., & Van Langen - Ferranti, J., Katz, J. N., & Tcheng, J. hove, L. (Eds.). (1995). Rethinking (2020). Telehealth transformation: methods in psychology . Sage. COVID-19 and the rise of virtual Tse, Y. J., McCarty, C. A., Stoep, A. V., & care. Journal of the American Medical Myers, K. M. (2015). Teletherapy de - informatics Association: JAMiA, 27 (6), livery of caregiver behavior training 957–962. https://doi.org/10.1093/ for children with attention-deficit jamia/ocaa067

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34 a ReVIeW The Art of Bohart : person-centered therapy and the enhancement of Human potential, by arthur c. bohart , Ph.d. Santa Clara, California

It is rare when a collec - known constructs and re-examines tion of a single author’s them through the prism of true deep lis - papers is neither dis - tening, witnessing and being a compan - jointed or repetitious. ion on the path of self-regulation and So, it was a particular growth. delight to read “The Art of Bohart.” It is also It would be easy to conclude that he was a particularly apropos playing word games here and essen - title. Although he acknowledges a keen tially hashing over his personal view - understanding of the science of thera - point on a familiar theme, but as I got peutic approaches, Bohart argues that it into the chapters and his arguments, I is the artistry that makes the process en - became aware of the depth of his un - gaging and beautiful. Science can pro - derstanding and power of the presenta - vide us with the tools, but only when tion. In exploring wisdom and hope they are used in personal, creative ways, (and I might add intimacy) in his unique do they make a true long-lasting impact. manor, he provides a more nuanced un - derstanding as well as a novel perspec - I have personally heard Dr. Bohart tive on what works in therapy and why. deliver papers several times. I have even had an opportunity to present a point- Over the course of the collection, in the counterpoint dialogue at a few confer - process of describing the essence of ther - ences. Each of his lectures was apy and the artistry involved, Bohart well-crafted, full of useful material and manages to make Rogerian, person-cen - poignant. He can be spellbinding in tered work both rebellious and radical his balance of erudition, composition (portrayals I suspect make him proud). and “down-home” openness. So it is with Repeatedly, through various lenses, he the papers in this book. Each article / depicts the salience of the relationship, chapter is well constructed, reader- of witnessing and being with clients, friendly and contains considerable depth allowing them to activate their personal of insight into what is rightfully called healing and acceptance mechanisms, the “Art of therapy.” rather than being prescriptive and Although every paper offers pearls of interventionist. He makes a powerful understanding about the process of psy - argument by referencing both the evi - chotherapy and the core of what makes dence-based literature and his personal therapy work, two stood out signifi - experience. Indeed, it is a rare collection cantly for me: Chapter 3, further medita - of professional work that is so confes - tions on clients’ wisdom and Chapter 10 , sional. This is particularly effective in Listening as being: an alternative to hope . that he engages in a parallel process, Both chapters take unique perspectives using personal vignettes while eluci - on what might initially seem to be well- continued on page 36

35 dating individual client’s subjective volves a way of being fully with another experience. and as much as possible losing the boundaries between them. So, what is it that the Art of Bohart asks of the reader (and those so fortunate to At times, this book has a certain Cer - have been in the audience for presenta - vantes’ (2000) quality. Bohart sometimes tions of his papers)? He asks that thera - begins his presentations sounding a bit pists forego preset notions of what they like a psychotherapeutic Don Quixote. presume is best for the client, and in - He knows that he is struggling against stead, enter carefully and empathically trends and forces in the field, and yet, he into the client’s world and in doing so, makes a very powerful counter argu - help clients activate their own healing ment to approaches to therapy that are and insight. It is clearly a greater chal - deductive and prescriptive. He doesn’t lenge than a “tab-in-slot” approach. By offer a series of techniques as the essence engaging with clients in this manner, of the best of psychotherapy. He offers our natural egos and desire to problem- instead core principles that begin induc - solve are seen as impediments, rather tively and makes each client the expert than benefits to the actual therapy. on a personal theory of being and of change. Like Senor Quixote, it is in He believes that the client who lives in the process that truth lies, not in the the present has the capacity to make the outcome. best of their awareness and life, and he contrasts it to those who look for “the For therapists who desire to become answer” in the past as a detective might, artists in the field, this is a lovely read or to hope for a specific (potentially) un - and a worthwhile collection. I suspect fulfillable future endeavor. Instead, it is that each re-reading of the chapters will the focus on the present and on being add depth as people grow in the field. that allows for a richer fuller life.

He is not alone in making this assertion. References Many phenomenologists have postu - Binswanger, L. (1963) Being-in-the- lated it similarly (Buber, (1937/1970; World , (J Needleman transl.) Basic Binswanger, 1963; Shapiro, 2016). Viktor Books. Frankl (1959; 2006) argued persuasively Buber, M.(1937/1970) I and thou (W. that even in a concentration/death Kaufman, transl.). Scribner. camp, inmates who found small pieces Cervantes, M.D. S. don Quixote de la of beauty (a bird, a love they carried) Mancha (Rutherford Transl.) (2000) were more likely to survive those hor - Penguin Books. rors. Frankl poignantly avowed that we Cissna, K.N. & Anderson, R. (1994) The have no control over what happens in 1957 Martin Buber- dia - our lives, we only have the power to de - logue as dialogue, Journal of Human - termine how we will perceive those istic Psychology, 34(1), 11-45. events and the attitude we have. Frankl, V. E. (1959) Man’s search for meaning (Kushner, Transl.) Simon It is no surprise that Rogers also had and Schuster such a powerful interaction with Martin Shapiro, J.L. (2016) Pragmatic Existential Buber (Cissna and Anderson, 1994) Counseling and Psychotherapy: intimacy, whose characterization of the I-thou mo - intuition and the search for meaning. ments in relationship “encounter” in - Sage.

36 WaSHInGTon Scene

“The Future’s in the air. can Feel it everywhere” Pat deLeon, Phd former APA President

an exciting Vision for that about 6.5 million use their MHS the Future — Senior benefit. administration: Today the Veterans Ad - In contrast to the VA which is projected ministration (VA) pro - to see a 43% decline in eligible benefici - vides care at 170 aries by 2048, the military health system Medical Centers and beneficiary population will remain es - 1,074 out pat ient sites. sentially constant at about 9.5 million The 2018 VA Projection Model devel - unless there is a significant change in oped estimates there were 19.5 million the size of the active and/or reserve Veterans in 2020 and that by 2048 the components. Currently this appears number will be 13.6 million, a 43% de - unlikely. cline. This year, 2021, there are approxi - mately 18 million Veterans. Nine million The VA has a very large and aging in - of them are enrolled with the VA and frastructure. It has fixed treatment facil - about 6 million actually receive care ities in every continental state and from the VA. shares facilities with the military in Alaska and Hawaii. In addition, there In contrast, the Military Health System are a few joint VA-DOD medical facili - (MHS) provides in- pat ient care at 51 ties in some continental states. For po - hospitals (currently about 16 of these litical reasons the VA infrastructure is hospitals are outside the continental unlikely to shrink. Even now parts of it United States), 424 medical clinics and are not being used at capacity. Perhaps it 248 dental clinics worldwide. There are is time to start considering opening about 1.4 million active-duty military some VA facility care to MHS eligible and 331,000 reserve component person - beneficiaries in areas remote from MHS nel. The MHS also provides health care fixed facilities but near under-utilized to family members of active duty, to re - VA facilities? — Harold Koenig, former tired personnel and their family mem - US Navy Surgeon General bers, surviving family members and others identified as eligible in the De - naSem: The National Academies of fense Enrollment Eligibility Reporting Sciences, Engineering, and Medicine’s system. This care is available (with cer - (NASEM) Forum for Children’s Well- tain limitations and co-payments) now Being conducted a virtual workshop in through the TRICARE health plan. In September, 2020. APA’s Brian Smedley, 2001, TRICARE benefits were extended along with several of his psychology col - to retirees and their dependents over 65 leagues, was an active participant in Re- in a program called Tricare for Life sys - imaging a System of Care to Promote the tem (TFL)—bringing the total popula - Well-Being of Children and families . High - tion eligible for care through the MHS to lights of the workshop: the true impacts about 9.5 million. Estimates now are continued on page 38

37 of COVID-19 on children and families disproportionate cluster of health risks may not be fully known until after the and a lack of resources predominate in pandemic ends, but many agree that a the spaces where people of color live, all new system of care is needed to promote of which are tied to policy decisions. the well-being of children and families in Segregation restricts socioeconomic mo - the pandemic’s aftermath. The key note bility by creating public schools that are speakers focused on addressing the need more under-resourced, have fewer em - to dismantle structural racism through a ployment opportunities, and result in systemic approach. Brian, in particular, small value appreciation on real estate argued for the importance of place as a in minority neighborhoods. African way to frame race and focused on ac - Americans are five times less likely than tionable opportunities to demonstrably White Americans to live near supermar - improve conditions for health equity. kets and more likely to live near fast food and liquor stores. Their spaces Challenges with equity begin early in have fewer parks and green spaces and life; Black babies are still more than are more likely to be exposed to envi - twice as likely to die as White babies. ronmental hazards. There are various For every dollar made in a White house - opportunities in economic systems for hold, Hispanic American households improvement that could contribute to make $0.73 and Black American and Na - reducing wealth disparities. These re - tive American households make $0.59. quire innovative solutions to the current Racial inequities in socio-economic sta - systems that begin with support at the tus (SES) are not reflective of a broken foundation: the home. system. We have a carefully crafted system that is working exactly as it was What can be done? Brian urged a focus designed, successfully implementing so - on prevention, particularly where peo - cial policies, many of which are rooted ple live, work, play, and study. And, in racism. Higher levels of economic, there is a need for multiple strategies psychological, physical, and environ - across sectors, including a significant in - mental stress have major adverse health vestment in early childhood education. consequences. Stressors in early life and A central theme throughout the work - adulthood can be passed on to future shop was that the COVID-19 pandemic generations. For example, research has pulled back the curtain on racial showed that every police shooting of an disparities within our current health sys - unarmed Black male was associated tem. There was a call for a New Para - with worsening health for the entire digm for Improving Maternal and Child Black population in that state. A key step Health at the National Level. Our col - would be to raise the level of awareness league concluded that there is an oppor - about the extent of the problem; how tunity to move forward as a more racism has become embedded within equitable nation with the development of our culture and how negative stereo - a sustained, long-term policy agenda and types develop. the simultaneous use of both place-based and people-based strategies to address Brian called attention to residential seg - structural racism for the greatest change. regation, emphasizing that it set the early career: “With encouragement and stage for many racial inequities in other guidance from my public policy mentor areas beside health. There is a geogra - Russell Lemle, I discovered that my en - phy of opportunity related to where people live. It is abundantly clear that a continued on page 39

38 ergy and passion for improving mental enjoyable memories of practice health policy was valued. I volunteered Visionaries from the past: On June 17, for and was selected as Division 55 (Psy - 1994, APA President “Dr. Bob” Resnick chopharmacology) co-chair of the APA and I attended the graduation ceremony convention committee (thanks to Neal at the Walter Reed Army Medical Cen - Morris) and was subsequently elected to ter. Navy Commander John Sexton and the Division’s Executive Board. Col - Lt. Commander Morgan Sammons be - leagues from these experiences helped came the first graduates of the Depart - me expand my involvement to other op - ment of Defense portunities and provided support. For (PDP) training program, under the aegis example, I applied and was chosen to be of Ron Blanck, future US Army Surgeon the student member for the inaugural General and Chairman of the USU year of the APA Advocacy Coordinating Board of Regents. As Steve Ragusea con - Committee, which led to writing a book stantly emphasizes, they proved to psy - chapter with former University of New chology that our profession could learn Mexico President Bob Frank. My work to prescribe safely, effectively, and in a on the APA convention was recognized cost-effective manner. by a colleague who nominated me for the APA Board of Convention Affairs. From John: “It is wonderful to see the Although I was not elected, this led to steady progression of prescription priv - an offer to join the APA Central Pro - ileges (RxP). While writing that first gramming Group that provides peer re - prescription as an independent provider view for cross-divisional programming on February 10, 1995, I had my doubts and recommends Keynote speakers for about the survivability of psychology the APA Convention.” RxP given the intense opposition to this effort by psychiatry. Psychologists have “I found that after applying to competi - prevailed because we saw the advan - tive training opportunities, I was often in - tages of learning to prescribe, even vited to interviews where I was asked though one might never acquire the cer - about my ‘unusual’ accomplishments. tification. Those undertaking this ardu - Through my APA activities I was also ous process realize the advantages of staying up-to-date on current events in being a clinician with much deeper Psychology, which helped me view my - knowledge. We know we can better spot self as part of our professional commu - the ‘psychological masquerade,’ where nity. As I look back while nearing the end one in seven pat ients who enter coun - of my formal training journey, it is hard seling have an organic basis for their to imagine who I would have become psychological disturbance. Those psy - without these experiences and mentor - chologists learning to prescribe look at ships along the way, for example, from pat ients differently. No matter what the - former APA President Tony Puente. I oretical orientation we had as psycholo - would strongly urge students and early gists, we learned to also look at such career colleagues with a budding interest things as a pat ient’s hair growth, skin in public policy to become actively en - pallor, and breathing rate. Those on gaged in APA and its Divisions, and, of the front lines realize we have become course, in our State Associations.” the ‘full-service mental health provider’ in doing , psy - (Joanna Sells, Uniformed Services Uni - chotherapy, and psychopharmacologic versity (USU) graduate) continued on page 40

39 and health promotion interventions as Rogers H. Wright; Francis Young. In needed. I strongly encourage any psy - Memorium —C.J. Rosencrans, Jr.; S. Don chologist who is sitting on the fence Schultz; Max Siegel.” about acquiring the skill to prescribe to step into RxP training and experience “If the citation could be prepared some - how this exponentially increases one’s what in the fashion of the Broom Closet skill as a clinician.” Society where all the names are listed to - gether on one sheet, I would take it March 27, 1999. “Dear Pat : It was really upon myself to have 14 copies repro - a coincidence being in Hawaii at the duced in color, one for each member (in - same time you were. Once again we en - cluding the deceased for whom I would joyed the Halekulani where true service locate an heir to send it to). The 11 living is still very much alive. Thank you for members have all indicated they will be the APA Presidential Citation for the in attendance, with the presentation Dirty Dozen from Dick Suinn. This is the being made on Thursday, the night be - occasion of its 30 th Anniversary. Interest - fore the APA convenes its convention in ingly, the early meeting to capture the Boston. Ray Fowler has suggested the APA Presidency was held in Honolulu. making of a lapel pin, an idea I under - This is the original list of the very first stand is being implemented. Again, Dirty Dozen, and although it is 14 rather thanks for undertaking this.” —Nick than 12, it might be said that an APA Cummings dozen follows the same number as a dozen bagels in Brooklyn. Here is the “Where the children of tomorrow share list (including 3 deceased): Theodore F. their dreams with you and me” Blau; Nicholas A. Cummings; Raymond (Scorpions) Fowler; Melvin Gravitz; Ernest Lawrence; Marvin Metsky; A. Eugene Aloha, Pat DeLeon, former APA Shapiro; Robert Weitz; Jack G. Wiggins; President – Division 29 – April, 2021

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40 SocIeTY FoR THe adVancemenT oF pSYcHoTHeRapY • apa dIVISIon 29 2021 apa convention progra m Summary

ALL SESSIONS ON SATURDAY, AUGUST 14 TH poster Session (F): I participant/1stauthor/Title Susanna A. Kahnke, MS, University of Kansas development of the feminist Therapy Attitudes Scale Miral Malik, MEd, MA, George Washington University online Supervision during Covid-19: Adjusting in a Time of Crisis Cordaris O. Butler, MS, University of Kansas (KU) Perceived Therapist Cultural Humility/Therapy outcomes for African Americans from White Therapist JungSu Oh, PhD, Eastern Illinois University Analyzing Psychotherapy Transcripts Using an Automated Text Analysis and visualization Technique Carin Lefkowitz, PsyD, Uniformed Services University of the Health Sciences facilitating the implementation of Evidence-Based during the Covid-19 Pandemic Kimberly A. Sikorski, BS, University of Massachusetts Amherst Replicating Patient-Level Moderators of iPT and CBT’s Comparative Efficacy for depression Rachel Hughitt, MS, University of Denver The impact of Cultural Ruptures in Jail Settings Yeji Son, MA, University of Iowa does the Alliance-outcome Relationship differ Across Telepsychology Modalities: A Meta-Analysis Edmund W. Orlowski, BA, University at Albany–State University of New York do discrepant Expectations for Couple Therapy Predict an Unbalanced Working Alliance? Sabina Musliu, MA, University of Denver Anxiety and the Associated Comorbid disorders: Predicting Therapy outcomes Using Cluster Analysis Monica S. Vel, BS, Stanford University identifying Evidence-Based Mental Health interventions That Address the Covid-19 Pandemic Averi N. Gaines, BA, University of Massachusetts Patient-Therapist Expectancy Convergence and outcome in Naturalistic Psychotherapy Averi N. Gaines, BA, University of Massachusetts, Amherst, MA Change in Satisfaction With Social Support as a Common outcome in ipt and Cbt for depression Poster Session, continued on page 42

41 Poster Session, continued from page 41 Nicholas J. Brewster, BA, University of La Verne Public Trust in Mental Healthcare Professionals and Therapy Andrew Dimmick, BS, University of North Texas Early Therapeutic Alliance as a Predictor of Treatment outcomes in Psychotherapy Lindsay A. Phillips, PsyD, Marywood University and Independent Practice, Scranton, PA independent Practitioners’ Experience in initial Months of the Covid-19 Pandemic Jasmine R. Davis, MS, University of Denver Two’s Company, Three’s a Crowd? An Empirical Exploration of Split Alliances in Couples Therapy Minsun Lee, PhD, Seton Hall University Resolution of Bicultural Conflict in Multicultural Counseling: A Task Analysis Danielle Schweitzer, Rowan University Psychologist Use and Attitudes Toward Mobile Applications: A Nationally Representative Sample Andrea E. Castro, University of La Verne The Effect of Ethnicity on Perception of Mental Health Promotion Lauren Zaeske, MS, University of Kansas Guidelines for Therapist Self-disclosure of Language Proficiency in Bilingua Therapy Kelley Quirk, PhD, Colorado State University in-Session Mindfulness of Therapists in Training Jean M. Birbilis, PhD, University of St. Thomas Telehealth, Psychotherapy, and Pandemic Katherine E. Axford, MA, University of Utah Agreement of Therapist Skill Use With Self-Reported Theoretical orientation Debora B. Handojo, MA, Loma Linda University Power dynamics in the dyadic Therapeutic Relationship Peter J. Jankowski, PhD, Danielsen Institute, Boston, MA A Latent Change Model Exploring virtue and Well-Being in Psychodynamic Psychotherapy

Session Id: 508 Symposium: , Virtue, and Flourishing in psychotherapy: Research-practice Integration cochairs: Jesse Owen, PhD, University of Denver Steven J. Sandage, PhD, Boston University participant/1stauthor Jesse Owen, PhD, University of Denver Title: Therapists’ and Trainees’ Perceptions of flourishing in Training and Practice Todd J. Farchione, PhD, Boston University Title: Trajectories of Change in Well-Being during Cognitive-Behavior Therapies for Anxiety disorders Conference Sessions, continued on page 43

42 Conference Sessions, continued from page 42 Sarah Crabtree, PhD, Boston University Title: Mental Health, Well-Being, and Experiences of the Covid-19 Pandemic: A Clinical Mixed Methods Study Michael J. Constantino, PhD, University of Massachusetts Title: Therapist Self-Perceived Competencies as a determinant of General Between-Therapist Effects discussant: Karen W. Tao, PhD, University of Utah

Session Id: 511 Symposium: How do Therapists Influence cultural processes? applied examples and methods for Training chair: Joanna M. Drinane, PhD, University of Utah participant/1stauthor Laurice M. Cabrera, MS, University of Utah Title: intersectional identity Conflicts in Psychotherapy: An Unexplored facet of Cultural Process Wing M. Ng, MS, University of Utah Title: The Effects of Simulation Based Training With feedback on Counselor’s Multicultural Counseling Skill Jeffrey Grimes, MEd, University of Iowa Title: Whose Multicultural orientation Matters More? Effects of Group and Leader MCo discussant: Karen W. Tao, PhD, University of Utah

Session Id: 514 Symposium: Rolling for Recovery: Therapeutic applications of Tabletop Role-playing Games cochairs: Allison Battles, PhD, Minneapolis VA Health Care System, Minneapolis, MN Jared Kilmer, PhD, Minneapolis VA Health Care System, Minneapolis, MN participant/1stauthor Allison Battles, PhD, Minneapolis VA Health Care System, Minneapolis, MN Title: Program Evaluation of a Therapeutically Applied Role Playing Game Group Therapy With veterans Elizabeth Kilmer, PhD, Game to Grow, Kirkland, WA Title: The Game to Grow Method of Therapeutically Applied Role-Playing Games Megan Connell, PhD, Southeast Psych, Charlotte, NC Title: Applied Gaming Groups: Therapeutic Applications and Models of Training

Conference Sessions, continued on page 44

43 Conference Sessions, continued from page 43 Session Id: 517 Symposium: Reducing Health disparities: characterizing Therapists Successful With low-SeS populations chair: Louise A. Douce, PhD, Ohio State University, retired participant/1stauthor Linda F. Campbell, PhD, University of Georgia Title: overcoming Classism and other Barriers to Psychotherapy for People Living in Poverty Iva Greywolf, PhD, Self-Employed Consultant, Roseberg, OR Title: Practicing Psychotherapy outside the Box and Beyond the 50-Minute Hour Susan S. Woodhouse, PhD, Lehigh University Title: Effective Therapist Characteristics With Rural and Low SES Populations Christianne Connelly, MA, University of Georgia Title: Training in Rural and Low-income Communities: A Student Perspective

Session Id: 527 Symposium: developments in measurement-based care: Telehealth, payment models, and practice-oriented Research chair: James F. Boswell, PhD, University at Albany, SUNY participant/1stauthor Bruce L. Bobbitt, PhD, Minnesota Psychological Association, Minneapolis, MN Title: Key issues in value-Based Care and Measurement-Based Care Caroline V. Wright, PhD, APA, Washington DC, DC Title: The Role of Measurement-Based Care in demonstrating Quality to Payers James F. Boswell, PhD, University at Albany, SUNY Title: Empirical and Conceptual developments in Measurement-Based Care implemen - tation Research and Practice Gayle E. Brooks, PhD, Renfrew Center, Coconut Creek, FL Title: Quality Monitoring in Eating disorder Treatment Centers and Sustaining Care during the Pandemic

Session Id: 515 Symposium: decolonial psychotherapy: Healing in context chair : Lillian Comas-Díaz, PhD, Independent Practice, Washington, DC participant/1stauthor Lillian Comas-Díaz, PhD, Independent Practice, Washington, DC Title: decolonial Psychotherapy Hector Y. Adames, PsyD, Chicago School of Professional Psychology Title: A Unified framework of decolonial Psychology Daniel Gaztambide, PsyD, Independent Practice, New York, NY Title: decolonial Psychoanalysis Laura S. Brown, PhD, Independent Practice, Seattle, WA Title: decolonial feminist Therapy

Conference Sessions, continued on page 45

44 Conference Sessions, continued from page 44 Session Id: 516 Symposium: using progress Feedback to enhance outcomes of psychotherapy cochairs: Kim de Jong, PhD, Leiden University, Leiden, Netherlands and Catherine F. Eubanks, PhD, Yeshiva University participant/1stauthor Kim de Jong, PhD, Leiden University, Leiden, Netherlands Title: Using Progress feedback to improve outcomes: A Multilevel Meta-Analysis Wolfgang Lutz, PhD, Trier University, Trier, Germany Title: Prospective Evaluation of a Clinical decision Support System inpsychological Therapy Jaime Delgadillo, PhD, University of Sheffield, Sheffield, United Kingdom Title: Cost-Effectiveness of feedback-informed Psychological Treatment: Evidence from the iAPT-fiT Trial discussant: Catherine F. Eubanks, PhD, Yeshiva University

Session Id: 510 Symposium: using deliberate practice to enhance Graduate Training: a Study and a demonstration chair: Hanna Levenson, PhD, Wright Institute participant/1stauthor Meredith A. Martyr, PhD, University of Minnesota—Twin Cities Title: Qualitative Results of the deliberate Practice Study: What did the Students Say? D. Martin Kivlighan III, PhD, University of Iowa Title: Quantitative Results of the deliberate Practice Graduate School Study Hanna Levenson, PhD, Wright Institute Title: The Goals and Methodology of the dP Graduate School Study With a dP Live demonstration Tony Rousmaniere, PsyD, University of Washington Title: The Goals and Methodology of the dP Graduate School Study With a d P Live demonstration discussant: Hanna Levenson, PhD, Wright Institute

Session Id: 512 Symposium: Treatment Failure in psychotherapy: perspectives on premature Termination chair: George Silberschatz, PhD, Independent Practice, San Francisco, CA participant/1stauthor James McCollum, PhD, San Francisco Psychotherapy Research Group, San Francisco, CA Title: Contextualizing Treatment failure Within the Patient’s Plan for Therapy David Kealy, PhD, University of British Columbia, Vancouver, BC, Canada Title: p reventing Treatment failure: An Evidence-Based of Coaching and Premature Termination Xiaochen Luo, PhD, Santa Clara University Title: A Comparison of Patient’s Coaching Behavior and the Rupture-Repair framework discussant: Shigeru Iwakabe, PhD, Ochanomizu University, Tokyo, Japan Conference Sessions, continued on page 46

45 Conference Sessions, continued from page 45 Session Id: 509 Symposium: defining and Implementing principles of change: a new partnership between clinicians and Researchers cochairs: Louis G. Castonguay, PhD, Penn State University and Michael J. Constantino, PhD, University of Massachusetts Amherst participant/1stauthor Louis G. Castonguay, PhD, Penn State University Title: Revisiting Empirically Based Principles of Change Catherine S. Spayd, PhD, Duncansville Professional Center, Duncansville, PA Title: implementing Principles of Change in the Treatment of Anxiety: A Cognitive Behavioral Perspective Eva D. Papiasvili, PhD, Columbia University in the City of New York Title: implementing Principles of Change in the Treatment of Anxiety: A Psychoanalytic Perspective Igor Weinberg, PhD, McLean Hospital, Harvard University Title: implementing Principles of Change in the Treatment of Anxiety: An integrative Approach Benjamin Johnson, PhD, RICBT Cognitive Behavioral Therapy and Coaching, North Kingstown, RI Title: implementing Principles of Change in Treating depression: A Cognitive Behavioral Perspective Dina Vivian, PhD, Stony Brook University Title: implementing Principles of Change in Treating depression: An integrative Perspective

Session Id: 513 Symposium: What Have We learned From expert Supervisors in action? empirical Studies and a Video Illustration chair: Hanna Levenson, PhD, Wright Institute participant/1stauthor Hanna Levenson, PhD, Wright Institute Title: The APA Expert Psychotherapy Supervision video Series: A description and video illustration Benjamin Feldman, BA, Wright Institute Title: Corrective Experiences in Psychotherapy Supervision: Implications for Learning and Supervising Meital Bendet, MA, Wright Institute Title: What Expert Supervisors do: findings from Use of the Supervisor intervention Scale discussant: Arpana G. Inman, PhD, Ohio State University

46 SOCIETY FOR THE ADVANCEMENT OF PSYCHOTHERAPY THE ONLY APA DIVISION SOLELY DEDICATED TO ADVANCING PSYCHOTHERAPY MEMBERSHIP APPLICATION The Society meets the unique needs of psychologists interested in psychotherapy. By joining the Society for the Advancement of Psychotherapy, you become part of a family of practitioners, scholars, and students who exchange ideas in order to advance psychotherapy. The Society is comprised of psychologists and students who are interested in psychotherapy. Although the Society is a division of the American Psychological Association (APA), APA membership is not required for membership in the Society. JOIN THE SOCIETY AND GET THESE BENEFITS! FREE SUBSCRIPTIONS TO: SOCIETY INITIATIVES Psychotherapy Profit from the Society initiatives such as This quarterly journal features up-to-date the APA Psychotherapy Videotape Series, articles on psychotherapy. Contributors History of Psychotherapy book, and include researchers, practitioners, and Psychotherapy Relationships that Work. educators with diverse approaches. NETWORKING & REFERRAL SOURCES Psychotherapy Bulletin Quarterly newsletter contains the latest news Connect with other psychotherapists so about Society activities, helpful articles on that you may network, make or receive training, research, and practice. Available to referrals, and hear the latest important members only. information that affects the profession.

EARN CE CREDITS OPPORTUNITIES FOR LEADERSHIP Journal Learning Expand your influence and contributions. You can earn Continuing Education (CE) Join us in helping to shape the direction of our credit from the comfort of your home or chosen field. There are many opportunities to office—at your own pace—when it’s convenient serve on a wide range of Society committees for you. Members earn CE credit by reading and task forces. specific articles published in Psychotherapy and completing quizzes. DIVISION 29 LISTSERV As a member, you have access to our DIVISION 29 PROGRAMS Society listserv, where you can exchange We offer exceptional programs at the APA information with other professionals. convention featuring leaders in the field of psychotherapy. Learn from the experts in VISIT OUR WEBSITE personal settings and earn CE credits at www.societyforpsychotherapy.org reduced rates. MEMBERSHIP REQUIREMENTS: Doctorate in psychology • Payment of dues • Interest in advancing psychotherapy

Name ______Degree ______Address ______City ______State ______ZIP ______Phone ______FAX ______Email ______If APA member, please Member Type: q Regular q Fellow q Associate provide membership # q Non-APA Psychologist Affiliate q Student ($29) q Check q Visa q MasterCard Card # ______Exp Date _____/_____ Signature ______Please return the completed application along with payment of $40 by credit card or check to: The Society for the Advancement of Psychotherapy’s Central Office, 6557 E. Riverdale St., Mesa, AZ 85215 You can also join the Division online at: www.societyforpsychotherapy.org

47 \PUBLICATIONS BOARD \EDITORS Chair: Terence Tracey, PhD 2018-2023 Psychotherapy Journal Editor, 2021-2025 413-3588 Ross Drive Jesse J. Owen, PhD Vancouver BC V6S 0K3 Canada University of Denver Phone: 604-802-9893 1999 E Evans [email protected] Denver CO 80210 [email protected] Jesse Goicoechea, Ph.D, 2021-2026 [email protected] Psychotherapy Bulletin Editor, 2020-2022 Joanna M. Drinane, PhD Sarah Knox, PhD, 2019-2024 Department of Educational Psychology [email protected] University of Utah 1721 Campus Center Drive Paul Kwon, PhD, 2019-2024 Salt Lake City, UT 84112 [email protected] Ofc: 801-581-1735 Email: [email protected] Jessica Graham LoPresti 2020-2025 [email protected] Internet Editor, 2020-2022 Kourtney Schroeder, M.S. Michelle Collins Greene, 2020-2025 335 Chandler St. [email protected] Worcester, MA 01602 Ofc: 508-373-7857 Katherine Morales, 2020-2021 E-mail: [email protected] [email protected]

pSYcHoTHeRapY bulleTIn Psychotherapy Bulletin is the official newsletter of the Society for the Advancement of Psychotherapy of the American Psychological Association. Published online four times each year (spring, summer, fall, winter), Psychotherapy Bulletin is designed to: 1) inform the membership of Division 29 about relevant events, awards, and professional opportunities; 2) provide articles and commentary regarding the range of issues that are of interest to psychotherapy theorists, researchers, practitioners, and trainers; 3) establish a forum for students and new members to offer their contributions; and, 4) facilitate opportunities for dialogue and collaboration among the diverse members of our association.

Psychotherapy Bulletin welcomes articles, interviews, commentaries, letters to the editor, book re - views, and SAP-related announcements. Please ensure that articles conform to APA style; graphics, tables, or photos submitted with articles must be of print quality and in high resolution. Complete Submission Guidelines and the online submission portal can be found at http://society forpsy - chotherapy.org/bulletin-about/ (for questions or additional information, please email Lynett.Hen - [email protected] with the subject header line Psychotherapy Bulletin ). Deadlines for submission are as follows: January 15 (#1); April 15 (#2); July 15 (#3); October 15 (#4). Past issues of Psychotherapy Bulletin may be viewed at our website: www.societyforpsycho -therapy.org. Other inquiries regarding Psychotherapy Bulletin (e.g., advertising) or the Society should be directed to Tracey Martin at the the Society’s Central Office ([email protected] or 602-363- 9211).

Society for the advancement of psychotherapy (29) Central Office, 6557 E. Riverdale Street, Mesa, AZ 85215 Ofc: (602) 363-9211 • Fax: (480) 854-8966 • E-mail: [email protected]

www.societyforpsychotherapy.org

48 American Psychological Association 6557 E. Riverdale St. Mesa, AZ 85215

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Want to share your exciting news with your fellow members? Four times throughout the year, the enewsletter is dispersed to members of Division 29 in order to share accomplishments and announcements with fellow professionals. This is a great chance to not only to share your own news, but learn of other opportunities that arise. Email Kourtney Schroeder, the associate website editor, ([email protected] ) to share news and announcements about book releases, published articles, grants received, theses and dissertation defenses, etc.

We’d love to hear from you!