Vol.73 No.2 : Spring–Summer 2021

IN THIS ISSUE From the NCPA President . . 2 From the Executive Director 4 New Members . . . . . 5 CE Update ...... 6 Pharma Marketing . . . . 7 Homeless Youth, Part 3 . . .10 Right Brain Book Review . 12. Rituals and Traditions . . . .14 Parental Alienation, Part 2 .16 Book Corner . . . . .18 . Upcoming CE Events . . .19 . References ...... 21 Classifieds ...... 22 . FROM NCPA Stepping Up to NCPA’s PRESIDENT, NANCY LANEY, Founder Membership PH.D.

n my first newsletter article as NCPA business. During his junior year of Ipresident, I spoke about increasing college his career path changed, and he NCPA’s membership, asking that “EACH ‘Why did you decided that he wanted to become a ONE BRING ONE.” Many of you have college professor and teach business law. reached out to former members and join NCPA?’ While in law school, he was influenced invited them to re-join and passed along by a psychiatrist who taught in the information to potential members. This ‘I thought it was law school. He soon realized that his outreach has paid off. I thank you for thinking and interests aligned more with your efforts and hope we continue to grow what you were psychology than law or business, and he the number as well as the diversity of our simultaneously tackled two thirds of a law organization. Another important thank supposed to do.’ school course load and three fourths of you goes to a person who recently raised an undergraduate psychology course load. his level of membership from Benefactor He also volunteered at McLean Hospital, to Founder. This member has also University of North Carolina Medical a psychiatric hospital in Massachusetts. In inspired others to “Step Up.” School. graduate school, he enjoyed the clinical The NCPA Founder level of He has made many other contributions work much more than writing law-review membership has not been well publicized. to our field and the profession, but I want articles and knew he was on the right According to Merriam-Webster, a to focus on his becoming a psychologist path. After 12 years of being a student, he founder is someone who establishes an and a force in NCPA. I recently asked was eager to work and practice psychology. organization. NCPA defines a Founder Dr. Silverstein about his background He accepted his first position as a as someone who is willing to invest in our as a psychologist, history with NCPA, psychologist at Dorothea Dix Hospital, Association and makes a financial contribution and decision to step up to the Founder thinking he would stay a few years then of more than $650. If you are in a place in level of membership. In highlighting his “move on.” After five years, he added your life or career where you can make this service and commitment to the future teaching and a part-time private therapy commitment, we would welcome you to of psychology in North Carolina, I practice to his professional life. Almost join our first Founders, Susan C. Arnold, encourage each of you to reflect on your 40 years later, he retired from the state Ph.D., Bill Barley, Ph.D., Elliot Silverstein, own answers to these questions. hospital. He mentioned many “kind and J.D., Ph.D., A.B.P.P., and Sandra Wartski, Who or what influenced you to brilliant” mentors and colleagues who PsyD. Let me introduce Dr. Silverstein. become a psychologist? nurtured his interests and encouraged Dr. Silverstein studied accounting him while in school and during his career. OUR FIRST FOUNDER with the aim of joining his family’s …cont’d next page Elliot Silverstein’s educational path as a psychologist was atypical. He earned an accounting degree then went to law The North Carolina Psychological Association school. He then pursued his Ph.D. in The North Carolina Psychologist is published three times per year. Items for the newsletter may be sent to: clinical psychology at the University of NCPA Phone: 919-872-1005 PMB 176 North Carolina at Chapel Hill and later 9660 Falls of Neuse Road, Suite 138 earned board certification in forensic Raleigh, NC 27615 psychology. He became the 736th licensed EDITOR psychologist in North Carolina and has Bill Barley, Ph.D. — The Pisgah Institute, 158 Zillicoa Street, Asheville, NC 28801. 828.254.9494. [email protected]. been a licensed psychologist and NCPA PRODUCTION EDITORS Martha Turner-Quest, Executive Director, NCPA; Karen Gray, Director of Membership & CE, NCPA; Betsy Vardell, Partner, Ruby Studio member for 40 years. In the past 20 years, he has served as a NCPA board member ASSOCIATE EDITORS Mary Gail Frawley-O’Dea, Ph.D., 5203 Sharon Road, Charlotte, NC 28210. 704.554.9900. and most recently as NCPA president Christine Ganis, Psy.D., 749 Burlwood Drive, Southern Pines, NC 28387. 910.725.0307. from 2019 to 2020. He has a private Katrina Kuzyszyn-Jones, Psy.D., 5317 Highgate Drive, Suite 213, Durham, NC 27713. 919.493.1975. Suzanne G. Martin, Psy.D., M.P.H., 409 New Kent Drive, Wilmington, NC 28405. 910.603.8666. therapy practice, lectures in the law school Linda M. Nicolotti, Ph.D., Dept. of Pediatrics, Medical Center Boulevard, Winston-Salem, NC 27157. 336.716.0894. at the University of North Carolina at Belinda Novik, Ph.D., M.S.C.P., M.D., 5801 Cascade Drive, Chapel Hill, NC 27514. 919.383.5023. Beatrice Tauber Prior, Psy.D., 18827 Cloverstone Circle, Cornelius, NC 28031. 704.896.9638. Chapel Hill and teaches students at the Kristen Wynns, Ph.D., 337 Melvin Jackson Drive, Cary, NC 27519. 919.805.0182.

2 THE NORTH CAROLINA PSYCHOLOGIST Stepping Up to NCPA’s Founder Membership continued from page 2

Why did you join NCPA 40 years ago, the Ethics Committee by its chair, Bill and “Step-Up” their membership level or and how has NCPA contributed to your Burlingame, and currently co-chairs become an NCPA Founder? identity, development, and career as a the committee with Erica Wise. He Dr. Silverstein said that at this time psychologist? described the enjoyment he feels from in his life and career he is in a position Dr. Silverstein remarked, “I thought the immediate effect of helping other to increase his financial investment in that was what you were supposed to psychologists through the process of NCPA’s future. But this is not the only do.” By becoming a member of his dealing with ethical dilemmas and reason he decided to step up and raise national and state organizations, he was potential involvement with the psychology his membership level from Benefactor getting information (in print) about the board. He spoke about helping distressed to Founder. He emphasized that NCPA psychology profession. He later joined the colleagues to walk through the details of works in tandem with APA and is the NCPA Public Sector Committee to help their thoughts and actions and take an only organization that “looks out” for psychologists who were working in public alternative point of view. Clarifying their psychologists in its advocacy and practice entities be better compensated. Through situation helps them decide how they efforts in North Carolina. He values that his work with NCPA and employment want to approach the problem. “NCPA pays attention.” He enumerated: at Dorothea Dix he met colleagues who What are some meaningful moments NCPA follows legislation that affects our mentored and joined him in improving for you as an NCPA member? practice; it tracks nuances about insurance psychology’s role in North Carolina. Dr. Silverstein said, “it’s the and reimbursement and develops Because of his many commitments during accumulation of lots of small things over networks “to have a seat at the table and his career, he shared that “I never had the years.” He credited many NCPA not be on the menu”; NCPA offers best- time to serve as the NCPA president until colleagues who helped him to manage practice information for our continuing I retired from the state hospital.” his career. These were the colleagues education; and it consolidates and You have made many contributions he turned to with practice, ethical, and disseminates information quickly, which is with your leadership in NCPA. Which organizational questions. He remarked essential for practice during COVID. leadership role do or did you enjoy the that “NCPA is filled with wonderfully Elliot Silverstein knows that as a most, and why? talented and decent people who work collective body we have made and can Dr. Silverstien reflected that he really toward common goals.” keep making a difference for psychologists did not have a preference. He noted, What would you say to encourage and their future in NC. Q though, that he was asked to serve on others to make the financial contribution

with escalated behavior due to a mental health, intellectual or development disability or substance use disorder who require treatment in a 24-hour residential facility. Facility-Based Crisis is an intensive short Alexander Youth Network is seeking a Licensed term, medically supervised service provided Psychologist (FT or PT) for their brand new, state-of-the- in a physically secure setting. It is available 24 hours art Facility Based Crisis program in Guilford County a day, seven days a week, 365 days a year, with an opening Spring of 2021. The Psychologist provides expected length of stay of five to seven days. clinical psychology services including; assessment Master’s or Doctorate degree in Psychology required of medical necessity, restrictive intervention orders, and fully licensed to practice psychology in NC outpatient services, and psychological assessments plus minimum of two years’ experience in the treatment to clients agency-wide. Services include specialized of children and adolescents with Intellectual/ population skills as well as evidence-based practice Developmental Disabilities. Supervision by a licensed skills. We are looking for passionate, skilled, and psychologist may be provided, if needed. Expertise in dedicated direct care staff to become part of our diverse standardized cognitive, educational, behavioral and team and provide day-to-day opportunities which personality assessment required. support and guide individuals in achieving personal goals for maximum living. Please forward your resume to Sarah Latimer at [email protected]. The Facility-Based Crisis program is a 16-bed inpatient service for children and adolescents that provides To learn more about services or to review our Careers an alternative to hospitalization for youth presenting page, please visit www.alexanderyouth.network.org.

3 THE NORTH CAROLINA PSYCHOLOGIST FROM NCPA Renewal: A Lush and EXECUTIVE DIRECTOR, Fertile Association MARTHA TURNER-QUEST

enewal can be seen as a grand mental health in the public interest, and Rrenaissance or more modestly as in ultimately renewing the Association a restoring or rejuvenating activity. by creating new directions for our own But instrumentally it simply means May I suggest we development. to repeat an action after an interval. It is instructive that the opposite of should not think of NCPA renew is impair, deteriorate, exhaust, or renewal as a grand • We transitioned to web-based discontinue. When we think of NCPA continuing education offerings with at a certain moment each year, renewal renaissance or as dynamic success. of membership dues comes to mind. simply remembering • We kept our membership abreast of Last year, the NCPA Board of Directors the latest COVID-19 information, approved a revision of our dues model to pay our dues. But with an emphasis on our profession’s with fees corresponding to choices of rather let us expand needs in the chaotic and shifting tiers of benefits that suit the needs of environment. each member. Those members who are our vision of how • We defended and advanced the academics, for example, often do not have profession by advocating for state the same needs from their Association we express the needs legislation on psychological issues membership as private practitioners. We and meaning of the crucial to psychology practice and the should think of our necessities as lush, interests of the wider community, not in the sense of what may be deluxe or Association. which included the enactment of the opulent, but of what allows us to thrive PsyPact law on March 1, 2021. and blossom. • We led the effort to reverse the We sometimes forget that while pre-authorization requirement NCPA can set dues levels for all to meet WHAT WE’VE ACCOMPLISHED imposed by Blue Cross Blue Shield its bottom line, that can create an arid IN THE PAST YEAR North Carolina that undermined terrain. For if we do not approach our It is common for leaders to give yearly psychological and neuropsychological revenue goals, or if revenues are annually addresses that illustrate the state of the testing. in decline, then our effort, after making union, nation, territory, or institution. • We instituted the inaugural all necessary austere cuts to overcome In times of crisis, they try to mobilize for Leadership Academy Formation. the inflating costs of operation, has been reform if not war. In moments when they • We started the NCPA Book Club. a failure. However, may I suggest we can pay homage to achievements, they should not think of renewal as a grand claim victories for their associations or NCPF renaissance or as simply remembering to communities. But we cannot declare wins • We partnered with the North pay our dues. But rather let us expand our or moral victories where complacency Carolina Department of Health and vision of how we express the needs and leads to the exhaustion or deterioration Human Services for the creation of meaning of the Association. of the Association even if as individual the Hope4Healers line. Renewal is when participation in our members we are satisfied. It is in light of • We established the Coping with Association is memorable and meaningful. this that I am pleased to report a renewal COVID-19 Mental Health Matters Association professionals and executives of self-directed activity among both new Public Education Recorded Webinar have created an ample discourse about and long-time members of NCPA. These Series. how to get members to engage in striking, are not my victories but your own. “Thy • We successfully sold the Dresser Court unforgettable ways. But the truth is, those will be done.” I am merely a tribune office suites, allowing for virtual/ who direct associations or really facilitate whose job it is to protect and occasionally remote working opportunities for staff. their will cannot view our membership advise and articulate the Association’s • We established the Daniel T. Searcy as a flock or herd with the instinct for interests and activities. Fellowship in honor of the late Dr. exercise; we cannot merely lead members In this past year, these have been Searcy, an NCPA past president, as the to water. NCPA members must take the NCPA’s and NCPF’s accomplishments result of a generous gift given to the initiative to pursue their own prosperity in supporting and protecting the Foundation. and happiness and the Association’s psychological profession, in advancing success. …cont’d next page 4 THE NORTH CAROLINA PSYCHOLOGIST Renewal: A Lush and Fertile Association continued from page 4 New Members In the aftermath of these exhibitions to participate and offer ideas so we can of vibrant power and self-organization, distill them into something alienating MEMBERS it should be easy to remember to pay that serves a central authority. What we Peter Adams, Ph.D. membership dues. They are trending should recognize and record here is the Pamela Bird, Psy.D. upward, approaching what is required reverence for renewal of initiative that Kathleen Brehony, Ph.D. to maintain budgets and profound will grow concurrently as our members Courtney Cantrell, Ph.D. initiatives. I encourage each member to pay their dues on time because their Beth Cerrito, Ph.D. take ownership of NCPA, creating the enthusiastic and innovative activity or Margaret Danforth, Ph.D. new forms of association that foster the desire to become involved by making their Robin Exum-Calhoun, Psy.D. fellowship and change you would like own splash precedes their disbursement. Susan Funk, Psy.D. to see, and taking the lead. We do not This is what renewal and association can Michael Grandis, Ph.D. maintain a bureaucracy to serve the ends be when we are not watching a subtle Susan Hazlett, Ph.D. of a few who cultivate their own garden so deterioration but facilitating lush and Keith Hersh, Ph.D. it can be falsely represented as the desires fertile inspiration. Q Andrea Hussong, Ph.D. of everyone. We do not ask everyone Neal Jones, Psy.D. Martine Jones, Psy.D. Jennifer Kirby, Ph.D. Kristin Krippa, M.A. April Lamanno, Psy.D. Monica Lawson, Ph.D. Ashleigh Leuck, M.A. Jessica Lorenzo, Ph.D. Melanie McCabe, Ph.D. Sarah McCreight, Ph.D. Anne Middaugh, Ph.D. Jenna Montgomery Armstrong, Ph.D. Thomas Raney, Ph.D. Brittany Sherrill, M.S. David Spano, Ph.D. Matthew Varley, Ph.D. Rebecca Webb, Ph.D.

OUT-OF-STATE MEMBERS Angela Enlow, Ph.D.–Idaho David Dove, Ph.D.–Rhode Island

STUDENT MEMBERS Rachel Kantor, M.A.–UNC–Wilmington Rose Holden, B.S.–Webster University Haley Goller, M.A.–Western Carolina University Jan Mooney, M.A.–UNC–Charlotte Melitza Pressley, B.S.–Grand Canyon University

5 THE NORTH CAROLINA PSYCHOLOGIST Update from the Continuing Education Committee

BY CATHERINE A. FORNERIS, PH.D., J.D., COMMITTEE CHAIR

It was the best of times, it was the worst organization’s sustainability. of times, it was the age of wisdom, it • If you are interested in presenting CE was the age of foolishness, it was the for NCPA--NCPF, please email me epoch of belief, it was the epoch of Modernization of ([email protected]), incredulity, it was the season of Light, or Karen Gray (Karen@ncpsychology. it was the season of Darkness, it was how we offer CE org). the spring of hope, it was the winter • If you have any suggestions for CE or of despair, we had everything before allows for increased presenters, please send them our way, us, we had nothing before us, we were participation, too, or add it to your post-CE survey all going direct to Heaven, we were all feedback. going direct the other way – in short, the flexibility about • If you are interested in joining the CE period was so far like the present period, Committee, contact us. We are always that some of its noisiest authorities when we offer looking for new members. insisted on its being received, for good We look forward to seeing you at or for evil, in the superlative degree of it, and great cost future CE events and thank you for your comparison only. ongoing support. Q —Charles Dickens, A Tale of Two effectiveness. Cities, 1859.

ind of sums it up, huh? Yes, now Kthat we have been living with the our highly successful Lunchtime Learning COVID-19 pandemic for over one year, series. It meets for one hour from 12 to 1 and all its sequalae, many of which will PM on the third Thursday of the month, be with us for years to come, I wanted to and it counts as Category A CE. That share some bright spots and an invitation series is scheduled to meet through the to NCPA--NCPF’s continuing-education end of this year. Our other new event is efforts. the Timely Topics symposium, which was We did it folks! Our staff and attended by 178 people, a record for a CE membership pulled together and pivoted offering. —or maybe more aptly, spun like the Virtual offerings are more cost effective Looney Tunes Tasmanian devil—and in terms of both human and monetary

CONTINUING EDUCATION COMMITTEE CONTINUING EDUCATION shifted from in-person CE to all virtual, capital. We do not have to pay the costs of and we did it with very few hiccups. This a venue; staff time to organize it, set up, change, as hard as it was for some of us and manage it; travel for presenters and with respect to technology or the loss of attendees; and so on. As you know, NCPA real time with three-dimensional human continues to struggle financially, so any beings, has also had some benefits. efficiencies are a win–win for all of us. Modernization of how we offer To be sure, we do miss sharing a CE allows for increased participation, meal with each other, getting a hug from flexibility about when we offer it, and a friend and colleague, chatting with great cost effectiveness. Over the past year, new members, and spending time with attendance increased roughly 50% at the our vendors. As safety permits, we will 2020 Spring and Fall Conferences, and consider to what degree we can go back that trend seems to be continuing in 2021, to in-person CE, but full-on, all in-person- the “off year” for CE. (Attendance at CE only CE events are likely a thing of the events is typically higher in the second, past. even-numbered year of the two-year My invitation to you is as follows: mandatory CE period for license renewal.) • Please keep attending NCPA–NCPF- We have been able to offer more and sponsored CE events; your support different CE, too. This year we launched is so important and vital to our

6 THE NORTH CAROLINA PSYCHOLOGIST The Hypnotic Allure of Pharma Marketing

BY BELINDA R. NOVIK, M.S.C.P., M.D., PH.D.

e would all like to believe that it’s easy to trigger denial or defensiveness suffering, anxiety, and depression from Wthere is a magic bullet for what around these common substances that can modern pharmaceuticals. I would also ails us, especially unhappiness. There be useful or harmful. It’s also complicated bet that many have experienced some was a magic bullet for bacterial infections and technical. A lot of money and political benefit, that some feel they couldn’t make in the 1950s, called penicillin. Aspirin lobbying have gone into convincing people it without the drug, that some have been was a magic bullet for fever. Opioids a that pills are what they need and that pills seriously harmed by it, and that most have magic bullet for pain. So why wouldn’t we will cure their suffering. My thesis here experienced significant side effects and want to believe there’s a magic bullet for is that pills will probably not address the would suffer from withdrawal effects if emotional distress? Marketing has had a causes of suffering and that their short- they attempted to stop taking the drug. relatively easy target. Life is often stressful, term allure masks some real disadvantages. If you’ve ever tried to stop a psychotropic and one could be on psychotropics As a medical psychologist with a degree in drug and had withdrawal effects, you for years while still believing they were psychopharmacology, I hope to help make can appreciate how hard stopping can treating an illness that somehow never got sense of psychopharmacology for everyone be. But withdrawal effects are too often cured. else. misunderstood by prescribers and patients It’s hard to talk about drugs and alike as worsening of the symptoms psychopharmacology because the popular MY PURPOSE HERE IS for which the drug was prescribed. It’s ad-driven narrative has been spread across EDUCATIONAL AND important to know that the reduction all media by expert pharmaceutical- EMPOWERING in dosage or discontinuation of a drug company (“Pharma”) marketers. It’s likely I would bet that many of our readers have can cause very significant symptoms and that many of you use psychotropics, and tried to get some relief for their pain and sometimes dangerous …cont’d next page

7 THE NORTH CAROLINA PSYCHOLOGIST The Hypnotic Allure of Pharma Marketing continued from page 7

effects which were not part of a non-drug has invested enormous resources in mineral). However, it, too, has some nasty baseline. How did we get here? lobbying and funding members of side effects and a narrow therapeutic Congress and backing legislation that window. It was used only in those PDUFA benefits it. Though numerous successful rare cases and was carefully medically In 1997, the Federal Food and Drug lawsuits have resulted in enormous fines monitored. Administration eased restrictions for false advertising, the marketing and on direct-to-consumer advertising of the myths continue, and fines are seen prescription drugs. Both consumers and simply as the cost of doing business. prescribers were affected, in obvious Pharma profit margins have continued to directions. The 1990s also brought us grow. Trust your the Prescription Drug User Fee Act (PDUFA) from a well-lobbied Congress. BRILLIANT MARKETING psychology In the ensuing years, the percentage of STRATEGIES funding coming from Pharma to the FDA training and “Treatment-Resistant Depression” has steadily increased from 0% before When the treatment is a pill that has 1992 to 65% of the FDA’s budget. This experience. been shown to be no more effective than changed the FDA from a government- placebo and doesn’t completely clear funded agency at least ostensibly without up depression, doctors might diagnose a commercial agenda to one that in “treatment-resistant depression,” which the past three decades has become The Queens of Deception essentially blames the patient rather than largely dependent for its funding on the Benzodiazepines (Valium, Xanax, Ativan) the drug for the failure. Then, another manufacturers of the product it regulates. all bind to the Gaba receptor, for varying drug may be prescribed as an adjunct Pharmaceutical companies paying “user lengths of time. While bound to receptors, treatment for the continuing depression. fees” to get their drugs reviewed and to they can inhibit anxiety. But when they What a confounding and confusing market means that the incentives are wear off the receptor after even short-term message! certainly there for the FDA reviewers use, anxiety rebounds. Benzodiazepines who are supposed to protect the public to Hyping a Diagnosis to Fit the Drug are fine drugs for one-time surgical protect Pharma’s interest instead. PDUFA Sometimes, drugs are useful. Too often preparation, but they are terrible drugs was approved with the rationale that it they are a substitute for something better for ongoing use because of the inevitable would get “much needed and lifesaving such as human contact and compassion, rebound anxiety. From the inside, it’s drugs” to market faster. The result is that guidance, understanding, perspective, impossible to tell if one’s anxiety is caused emotions are too often being medicalized and emotion-regulation skills. Even useful by circumstances, feelings, or drug effect, and people with emotions medicated. tools can be overused and misused. For and it’s very easy to misinterpret rebound example, the useful drugs for epilepsy anxiety as an intrinsic feeling that THE HYPNOTIC ALLURE have been misused as adjuncts to the requires the next dose to abate it. These I’m impressed with Pharma’s marketing. antidepressants or as treatments for are addictive drugs. If stopped abruptly, Promises of happiness, destigmatiziation Pharma-hyped bipolar disorder. Increased they can cause life-threatening seizures. of mental illness, and correction of rates of its diagnosis have been attributed These drugs are almost never given with chemical imbalance have taken over our to several factors, including “unmasking of adequate information to the patient and good sense. Even the term “evidence bipolar illness” by an SSRI or SNRI which warning about addiction, side effects, or based” has been hijacked for marketing itself has activating side effects. These dangers of drinking alcohol or driving, purposes. Pharma marketing hit its stride side effects are an opportunity to sell even except for the easily disregarded sheet and became the common narrative. more drugs. The patient is diagnosed with handed out by the pharmacist. These Antidepressants are a case in bipolar disorder and given drugs better warnings in very small print are there to point. “SSRIs are like insulin for used for epilepsy: gabapentin (Neurontin), protect the pharmaceutical company from diabetics” (Your serotonin level is low), or lamotrigine (Lamictal), sodium valproate lawsuits resulting from the use of their “it’s a mental illness” (It’s not your fault, (Depakote), or topiramate (Topamax). All product. it’s your faulty brain chemistry). You’ve of these drugs are used to slow down the Even used as directed, addiction, heard these claims over and over again, firing of particular neurons in the brain withdrawal, and increased anxiety are which doesn’t make them true but does to reduce the frequency of seizures. We likely. Anxiety is worrisome, and panic make them common. You know the drugs, still know that manic--depression exists attacks are terrifying, and very effective Prozac, Effexor, Cymbalta, Lexapro, and as a relatively infrequent problem and is psychotherapies exist for their sufferers. their cousins and generic versions. Pharma treated successfully with lithium (a cheap Prescribing can be …cont’d next page

8 THE NORTH CAROLINA PSYCHOLOGIST The Hypnotic Allure of Pharma Marketing continued from page 8

relatively quick, and it can give immediate marketing, upgraded with the language of data, while problems, side effects, relief, but without understanding, “evidence-based” treatment. But they are and even deaths are sometimes education, and skill building, the relief trained in psychopharmacology, though hidden. turns into a long-time habit with long- their training may be significantly biased 4. Remember your own training in term consequences. towards the use of drugs and they may psychology and anchor yourself lack training in effective alternatives such INFORMED CONSENT in it. as psychotherapy, lifestyle interventions, I understand that the days of well-funded 5. Over-prescribing happens psychodynamics, group therapy, and so community mental-health centers and because it is easier and faster on. high-school and college counseling than active listening, than And yet, most psychotropic drugs centers are mostly gone. What are most understanding a fellow human are prescribed in primary care by nurse easily available are pills. But without true being, than empathizing, than practitioners and physicians trained informed consent, people in distress can understanding the cause of in internal medicine, family medicine, end up believing that their brains lack symptoms. You can help by and obstetrics–gynecology, where even the right neurochemicals, that they’re being informed about risks, less education in psychopharmacology going to need pills like a person with side effects, withdrawal effects, occurs, which is to say, hardly any. These diabetes needs insulin, or that “You discontinuation, and duration prescribers get information from “paid have depression and will likely have it of use, and by asking questions. physician influencers” at Pharma-funded your whole life.” This dis-empowerment Transient stress and feelings do dinners, or from the drug rep who might can itself be disabling and casts human not require lifelong medications. bring a lovely lunch to the whole staff suffering into the realm of “mental illness” Chronic stress requires skills and every week, or from their own patients subject to medical intervention. possible changes in environment. who were prescribed a drug by someone Informed consent requires time else for something long ago and have 6. Insist on informed consent. to explain how drugs work and how never been encouraged or supported Know how a drug works and how people can safely start and stop them. about tapering off of it. to start and stop it comfortably. Informed consent requires a partnership Know its side effects. Read the between client and provider to work HOW TO BREAK THE Black Box Warning and heed together not just on drugging symptoms HYPNOTIC SPELL, OR HOPE it. Be aware of the side effects but on achieving life goals, improving FOR THE WELL INFORMED and dangers of the prescribing relationships, and functioning better. 1. Understand that the pervasive cascade in which side effects of Informed consent means admitting that and brilliant marketing slogans one drug are treated with another pills can alter feelings, sexuality, appetite, and campaigns are just that, drug with its own additional side weight, sleep, and driving alertness, marketing slogans and campaigns effects. The prescriber might be and cause a myriad of other side effects. designed to make people feel that able to reduce the dose of the Informed consent requires knowledge that they have a diagnosis and that first drug or taper off of it. changing doses or mixing other drugs or there’s a pill for it. 7. Ask questions and trust your own alcohol with pills can be life threatening. lived experience. Ask your clients Informed consent means mentioning 2. Every time you see or hear an questions about their experience other modes of treatment and therapy that ad that says, “Ask your doctor with drugs and be alert to side might be useful, including psychotherapy, about…” know that it is a effects and combined effects of exercise, dietary changes, and social marketing ploy to get a drug into drugs with other substances. changes. your body. 3. Don’t confuse scientific- This is the informed opinion of a ARE PRESCRIBERS TRAINED IN sounding marketing ploys medical psychologist with extensive PSYCHOPHARMACOLOGY? for science. Today, the words training and professional experience with I’ll bet you weren’t expecting this question. “evidence based” mean that a the use of psychotropic medications. Psychiatrists are educated in academic large pharmaceutical company Please respond by email to The North departments heavily funded by Pharma, in has paid for a study that they Carolina Psychologist with your comments contested theories about biological aspects designed, interpreted, and ghost about this piece. Your name will not be of mental illness. At conferences funded authored, which sounds like used without your permission. We will by Pharma, with friendly drug reps, free science and too often passes for continue a discussion about this topic if samples of drugs, food, and swag, they’re evidence. Know that in such you desire. Q under heavy pressure from the incentives studies, markers for improvement and reinforcers to buy into the alluring are often cherry picked from the

9 THE NORTH CAROLINA PSYCHOLOGIST Rural Youth Homelessness in North Carolina, Part Three Regional Need in Sandhills: Tambra Place

BY CHRISTINE GANIS, PSY.D.

his final part of my report about the at Pinecrest High School, has had a failing to graduate and were unqualified to Thomeless young people in our state special interest in the needs of homeless transition to gainful employment. will describe what our Sandhills region or “unaccompanied youth,” the latter In Chamberlain’s data, the number-one and specifically what one community defined by the McKinney—Vento Act of deleterious factor in youth homelessness in Moore County have been doing to 1987 as those not in the physical custody was “unstable housing” (97.4%), reduce rural homelessness among school- of a parent or guardian. Working with followed by “lack of affordable age children and those aging out of the the state DHHS foster care liaison, Casey housing” (74.4%), “parental abuse” (41%), state Department of Health and Human Saunders, from Families in Transition, and “no health insurance” (28.2%). Services Division of Social Services along with others in the private sector, The task force strongly recommended coverage at age 18. It’s about “Tambra they have tracked hundreds of homeless “cross-agency partnerships” to reach youth Place,” currently a metaphorical “place” and unaccompanied students on Moore in rural communities, as this specific but a real and inspiring community County Schools rolls during that 15-year infrastructure often does not exist. enterprise that has come about in answer period. (Chamberlain, May 2019). However, in rural communities broader to the awful plight of these forgotten Some are placed with foster families, youth-directed organizations such as faith- citizens. and others live with “host families” who based ones, child-welfare systems, and of informally take them in. By 2018, there course schools and sometimes colleges were 83 adolescents (under age 24) living do exist. A 2018 study by a group at the IN MOORE COUNTY, NORTH in Moore County without a parent or University of Chicago called for the CAROLINA guardian. More than half were female, development of a more robust safety net Since 2005, Moore County Schools an overrepresentation often noted in for these young people as they transition social workers have been tracking national data as well (Morris, 2016). More from youth to adulthood (Morton, homeless students in their purview. and more of these young women were Samuels, Dworsky, et al., 2018). Tambra Chamberlain, a social worker …cont’d next page

10 THE NORTH CAROLINA PSYCHOLOGIST Rural Youth Homelessness in North Carolina continued from page 10

TAMBRA PLACE: A WORK IN items in a store staffed by our volunteers of whistling past the graveyard. Some fear PROGRESS and youth, so that they will learn retail the real risk of losing their autonomy if In establishing the idea of Tambra job skills, as well as confidence. We detected, however precarious their grip Place (named to honor and further Ms. made two visits to the highly regarded on it. What is called for is a sensible Chamberlain’s work), we in the task force Methodist Home for Children North Hills ameliorative and, above all, preventive are particularly interested in interrupting Transitional Living facility in Raleigh. It community approach. and remedying the sequence of has served as a model for much of what Thus, we formed our organization homelessness early, whether in bonafide we envision for our youth. We owe many called “Tambra Place.” Ms. Chamberlain homeless or in “unaccompanied” youth at thanks to Ben Sanders, its Vice President recently stepped into the position of risk. Their unstable living environments, for Programs, who has advised us through McKinney—Vento liaison and so remains of course, increase the risk of criminal this point. active in this effort. behavior such as shoplifting food and Three kinds of programs exist in the danger of victimization by older, our small rural county for youth in more street-wise youth, in interpersonal circumstances similar to Tambra Place’s, violence or exploitative relationships. We In 2016 three local but for which our youth are not eligible: have noticed the acute need for financial churches started Private programs exist for youthful literacy among the youth we have helped offenders and those with mental-health so far. We all know of the higher costs helping to supply a or substance-abuse issues (e.g. Methodist of secondary and tertiary intervention, clothing and toiletries Home for Children in Raleigh, and whereas primary prevention and early Youth Villages, with services across intervention not only reduce societal closet, survival foods, North Carolina). Our youth have not yet cost but are more protective of the youth and a “rainy day” offended and do not have frank mental- themselves. health or substance-abuse issues. So, in 2016 three local churches started account for each of the Another local program exists for helping to supply a clothing and toiletries three Moore County females with children, called “Family closet, survival foods, and a “rainy day” Promise.” Our youth fortunately do not account for each of the three Moore high schools. have their own children. County high schools. (Gerard, 2019). Finally, our youth have not been People from these churches and others identified as victims of domestic violence from the community formed an Initial Our society seems to have turned or human trafficking in crisis, for which Operating Committee (IOC) to study a blind eye to the needs of children we have another program in our county how best to develop a transitional living preparing but not quite ready to leave called “Friend to Friend.” facility for those youth aging out of DHHS the nest, and to the sparse resources Societal and family stressors, services including foster care. Committees available for their family members who compounded by lack of access to reliable were formed to define inclusion/exclusion need health care, including mental health health and mental-health services, and criteria, apply for grants, hire staff, and care, so that the children and youth punitive social and treatment policies, are program for youth with high ACES don’t become homeless. Add to that the not helpful to young people trying to grow (Adverse Childhood Experiences) scores complications of COVID-19 with its high up practically on their own. Homelessness and at least some with histories of trauma. youth unemployment, unpredictable work or housing insecurity is often the best that A safety net requires many stitches, so hours, lack of job-related benefits such as happens to children and youth perhaps we have obtained 501(c)3 charitable tax health insurance and sick time, and the a block or two away from where we live. status and are securing liability insurance need for social distancing, extra sanitizing, As psychologists we are duty bound to for our board of directors. We have etc. For the most part, these homeless work toward societal good. If you live in a bought a rural property suitable for two and at-risk young people are trying to rural area, please consider getting involved modest homes and have blueprints for make ends meet and attend school, and with your local schools and other agencies them, one for young women (the higher many have aspirations to attend college or charged with delivering services to this priority due to their higher risk for bad technical school to escape their desperate deserving but often unseen, population outcomes) and the other for young men. plight. Some are trying to provide for the representing our collective futures. We are on social media for community PR needs of younger siblings, too. Some are Tambra Place clearly has a place in Moore and fundraising, and we have a nascent secretive about their plight, out of shame County and elsewhere in rural North bank account, thanks to donations from or in service to what David Elkind referred Carolina. Q the community. We are trying to rent to as “the personal fable”—“Nothing bad a property nearby to sell consignment will ever happen to me”—a teen version REFERENCES AND RESOURCES ON PAGE 21.

11 THE NORTH CAROLINA PSYCHOLOGIST Getting to Know the Right Brain Book Review: Allan Schore’s The Development of the Unconscious Mind BY MARY GAIL FRAWLEY-O’DEA, PH.D.

llan Schore (1994, 2016, 2003a, including psychotherapy. A2003b, 2011, 2015, 2019a [the subject The right brain, according to of this article], 2019b) has been a pioneer Schore, is more developmentally advanced in integration of psychoanalytic theory, than the left from about the 25th of the left brain neurobiology, developmental studies, and gestational week until the left brain has a and dissociation as a right-brain defense. clinical practice. A clinician--scientist, Dr. growth spurt starting in the second year of Likewise, the left brain is the site of Schore is past editor of the Norton Series life. Similar to Bowlby’s conceptualization explicit, verbally encoded experiences and on Interpersonal Neurobiology and is on of the internalized working model of memories, while the right brain contains the clinical faculty of UCLA’s department attachment, Schore claims that “the early implicit, procedural, non-verbally encoded of psychiatry and biobehavioral studies maturing, visuospatial, emotional right experiences and memories. He says, “…I and the David Geffen School of cortex (as opposed to the later developing have suggested that just as the left brain Medicine. (See his website for additional lexical–semantic left cortex), which stores communicates its states to other left biographical information.) His books are and processes self-and-object images,” brains via conscious linguistic behaviors, richly clinical and just as richly steeped in is responsible for the manifestations of so the right nonverbally communicates his own and others’ research. He presents unconscious processes (p.7). Key here is its unconscious states to other right the intricate ideas again and again but Schore’s determination that the quality of brains that are tuned to receive these slightly differently, which I appreciated the mother--child attachment relationship communications” (p. 23). It is the right because of their complexity. Schore is not is formed not so much through cognitive brain’s images of self and other, combined shy about citing himself, but he has the or behavioral influences, but much more with an affective tone and body reactions accomplishments to warrant some self- through non-verbal affect and regulatory that provide “a background state of assertion. I found this book exciting and processes facilitated by the parent’s wellbeing” (Meares, 2012, in Schore, 2019, important and highly recommend it. gaze and facial expression, prosody, and p. 163). tactile engagement. Schore says, “…for Addressing regression, Schore THE DEVELOPMENT OF THE better or worse, the maternal–infant differentiates two types. The first UNCONSCIOUS IN THE RIGHT attachment relationship structuralizes the is a horizontal, topographical, BRAIN developing right brain unconscious via an interhemispheric regression from the Schore topographically locates the implicit intergenerational transmission linguistically organized left brain to unconscious in the right brain, stating, of resilience against or vulnerability the right, imagistically organized brain. “The construct of the unconscious to later psychiatric, personality, and The second, a vertical, structural, has thus shifted from an intangible, developmental disorders” (p. 23). The intrahemisphereic regression, involves immaterial, metapsychological abstraction right-brain unconscious, then, is a a movement from the right cortex to of the mind to a psychoneurobiological relational and affective unconscious, not the limbic system and even to the brain heuristic function of a tangible brain that the Freudian or Kleinian unconscious of stem. We often witness the latter in has material form” (p.2). Its development intrapsychically constructed fantasy and trauma survivors who, when stimulated begins in the prenatal, perinatal, and feelings. by memories, feelings or reactions to postnatal stages, mediated by the right Schore’s model offers a dual system stimuli in some way reminiscent of the brain-to-right brain communication of mind, each with its own affects, trauma, move from consciously regulated, between the mother and the child, memories, self- and other-representations, mature speech and behavior to cognitively, and it is influenced by other, similar and relationship with the body and with affectively, and behaviorally dysregulated communicative modalities throughout life, reality. He places repression as a function presentations consistent …cont’d next page

12 THE NORTH CAROLINA PSYCHOLOGIST Getting to Know the Right Brain Book Review continued from page 12

with limbic-located flight-or-fight what we know about the transgenerational behaviors, or to stony presentations transmission of trauma. characteristic of freeze responses located Schore, like most developmentalists, in the brain stem. In accordance with The right-brain unconscious, focuses on the prenatal and postnatal Schore’s theory, it is not surprising then, is a relational and stages and the first two years of life. that adult patients who are survivors of Trauma specialists studying resilience “adverse childhood experiences” often affective unconscious, indeed point to the vital importance of lurch from states of hyperarousal to not the Freudian or a reliable, good-enough early attachment deadened states of psychic numbing. for building resilience to later adversities. In Schore’s terms, “…Early sundering Kleinian unconscious of If trauma occurs later, however, the of right-brain-to-right-brain attachment intrapsychically constructed individual still can become dysregulated, bonds is critical to the genesis of an begin to rely on dissociation to survive, enduring predisposition to a variety of fantasy and feelings. lose the confident internalized images of early forming severe psychopathologies self and other that were formed earlier, that characteristically access the and develop the physical, cognitive, autoregulating, affect-deadening defense of predisposition for the characterological affective, behavioral, and I would add, pathological dissociation” (p. 34). use of pathological dissociation, and a spiritual disorders common in trauma susceptibility of affect regulation expressed survivors. Schore does not directly address NEW UNDERSTANDINGS in a deficit in coping with socioemotional this phenomenon, but it is implicit in ABOUT BRAIN DEVELOPMENT stressors” (p. 166). his understanding of psychotherapy as According to Schore, early brain a potentially reparative new attachment development results both from genetic PSYCHOTHERAPY AND THE relationship and in his emphasis on the loading and experience. Epigenetic RIGHT BRAIN importance of the non-verbal, right-brain- expression of that encoding is mediated by Finally, Schore presages his companion to-right-brain unconscious communication experiences in the social environment. He book, Right Brain Psychotherapy, by happening in the consulting room. says, “Mother Nature and Mother Nurture describing the role of right-brain-to- The most jarring aspect of Schore’s combine to shape human nature” (p. 155). right-brain communication in the book is his insistence that the mother- He goes on to identify three paradigm psychotherapeutic setting. In much the -child bond is the most important one shifts in our understanding of early same way as good early attachment figures, in brain and emotional development. I development: the therapist engages with the patient suspect this reflects, at least in part, the First, a growing trend in psychiatry, through gaze, the prosody of their voice, reality that much empirical attachment psychology, and neuroscience to and symbolic touching through empathic, research has been conducted with mother- emphasize the primacy of emotions non-verbal connections. Quoting Ogden -child dyads. Ed Tronick’s (2020) “still over cognition in human experience. and colleagues (2005), Schore writes, “… face” experiments did include dads as He says, “…updated models of human the psychotherapy change mechanism well as moms, and the infant’s reaction psychological well-being are now grounded is not in verbal language exchanges, but to either parent suddenly going still in not cognitive, but emotional well-being” in the empathic clinician’s background and unreactive was the same. It would (p. 157). (1) implicit, psychologically attuned, be helpful to see more from Schore Second, increasing attention to the interactive affect regulation and a (2) a and others on the complex attachment centrality of self-regulation in assuring relational context that allows patients to patterns many children today have with emotional well-being. Attachment, he says, safely contact, describe, and regulate his or dads, in two-mom or two-dad homes, promotes self-regulation, which in turn, her inner subjective experience” (p. 167). in multi-generational living situations, facilitates ever more “complex and resilient and with non-familial, but important relationships between the individual and MY REACTIONS TO THE BOOK caregivers. the social environment” (p. 158). As a psychoanalyst and trauma specialist, I have just begun reading his Third, rapid changes in the field of I found this volume reassuring and companion book, Right Brain Psychotherapy, developmental affective neuroscience exciting. It validated the importance and am finding it to be a valuable clinical and the impact of attachment on the of the affectively mediated attachment application of the theory and research developing brain. relationship between the clinician and the presented in The Development of The Later, Schore addresses the impact of patient and was particularly helpful to me Unconscious Mind. I guess I am getting trauma on the developing brain, saying, in understanding why some of what I have attached to Dr. Schore! Q “…relational trauma in early critical been doing for going on 40 years actually periods of brain development imprints a has worked. His discussion of the prenatal permanent reactivity of the right brain, a social environment also comports with REFERENCES ON PAGE 21. 13 THE NORTH CAROLINA PSYCHOLOGIST Rituals and Traditions in These Pandemic Times

BY CHRISTINE GANIS, PSY.D.

was inspired to write this piece by a reflecting on your own experiences as our particular group. Some of them Ibook, Rituals for Our Times: Celebrating, you read about what I discovered, I are performed and participated in Healing, and Changing Our Lives and Our promise. I found this New York Times piece automatically, while others carry deep Relationships, by Evan Imber-Black and particularly useful, and perhaps you will meaning and great emotion. Some of the Janine Roberts. too. family members and friends I spoke with First published in 1998 and in its felt separated from family religious rituals seventh printing, it has great utility for the RITUALS AND TRADITIONS they had performed annually as children, helping professions. While I’d intended Let’s start with definitions. My dictionary such as attending midnight or dawn to write a book review, my family holiday defines tradition in a variety of ways— church services, fasting uncomfortably, obligations and other events consumed ranging from customs and rules to and being subjected to fire-and-brimstone the energy needed to do that inspiration folklore and myth. Perhaps rituals exhortations about sins they hadn’t justice. Unavoidably though, I did think collectively become tradition over the understood. about my family’s and our friends’ holiday course of time, but I will largely use the But of course religious and other traditions and rituals when I was a child, terms interchangeably for now, if the rituals were recalled with great fondness and I asked family members and friends anthropologists don’t mind. and reverence by many, who have created about their memories of them, too. I All cultures create rituals and and observe similar traditions in their own also did a hurried survey of published traditions. They help to celebrate, families now, with tweaks and updates information, and I merged parts of the welcome, honor, and mourn. They are to keep them relevant. (For example by book with my observations. part and parcel of our socialization into using electric musical instruments or more You will be richly rewarded for what it means to be human and into current ritual language). …cont’d next page

14 THE NORTH CAROLINA PSYCHOLOGIST Rituals and Traditions in These Pandemic Times continued from page 14

These rituals are powerful ways to honor Some I asked told me of other rituals in the observance is a bit complicated. deeply held values, heal the past, or I’d never heard of, such as “dry January,” It’s decidedly not like flipping a switch. deepen relationships. a month of abstinence. Others had just Especially not now, when behavior is The Imber-Black and Roberts book passed up writing the family holiday constricted in the interest of public safety. has now been used by a generation of letters. Some communities held “reverse No, plenty of preparation, self-coaching, therapists to craft relevant new rituals parades,” where the floats were stationary and “atta-boys,” “almost theres,” and for nuclear, extended, single-parent, and the spectators passed by in their cars “that’s it, keep going” are involved. It’s and blended families, as well as single for safety. clear that perfectionism is the nemesis of adults and childless couples. Its use is New Year’s resolutions and that training endorsed by respected teaching entities wheels are useful. such as the Family Process Institute and Consider a few other ways the the Ackerman Institute for the Family. It My new holiday ritual: pandemic has changed our everyday life contains guidance on changing gender Since there was no rituals. Children’s educational habits have roles and first-person anecdotes for been upended by the switch to online honoring life’s human ties and milestones, reunion in our family learning. That had a knock-on effect for apropos a myriad of personal events: plans at Thanksgiving, parents of younger children. A parent birthdays; anniversaries; personal changes; often has to stay at home, forfeiting a vacations; reunions; seasonal events; I challenged my own job and income. Many parents can’t holidays; events of merriment, memory, family to participate in work from home. Broadband is not and meaning; divorce; healing; sobriety; universally available. I have heard of and re-imagining and re-creating a happier a challenge popularized families driving their children to parking ending. by Larry Smith in lots with hotspots. This year broadband access became a necessity for students’ THOUGHTS AND EXPERIENCES The New York educations. What about parents and ABOUT RITUALS IN AN Times—to sum up children who have to share one computer? UNUSUAL TIME In many cases professional childcare closed We have been in the throes of a their experiences about or was no longer affordable. Some of us can pandemic, many of our families live some the pandemic in six navigate these problems, but what about distance from us, and we often travel to the family who can’t? Important rituals them or have them go “over the river and simple words—either and traditions are threatened. through the woods” as the old song goes, collectively as a family The rituals we customarily practice to travel to us. Since there was no reunion around saying our last goodbyes have in our family plans at Thanksgiving, I or individually. had to be put away, too, and sometimes challenged my own family to participate enacted by someone else. Funerals for in the challenge popularized by Larry New Year’s resolutions are rituals of our terrible loss of life, as many as 4,500 Smith in The New York Times—to sum up renewal. With every new year, it’s time everyday at this point, have been delayed. their experiences about the pandemic in for new habits, new attitudes, or new Singing was a risk, so we couldn’t sing six words—either collectively as a family or approaches. The most common are together. Instead, we have needed to rely individually. vows to exercise more, get organized, on cards and letters, phone and Facetime Take the trouble to read about the learn a new skill, save more money, and contact, and visiting through closed challenge, even now you will be amply the like. Those of us in the profession windows, with hands pressed against glass. rewarded. It’s guaranteed to bring a smile, of change are not surprised by reports We are developing new rituals, a nod of recognition, or raised eyebrows, that the vast number of New Year’s sometimes kicking and screaming, but we with an “I never thought of that” reaction. resolutions are abandoned in short order. are coping, and the pandemic will be over The way it goes is to sum up your Recall Prochaska and DiClemente’s at some point. Oh, and I almost forgot experience of the pandemic in six simple Transtheoretical Model, the overcoming to share my six-word Covid-19 poem—our words. Some examples are, “the crinkling of inertia using decisional balance, pros new ritual, at least for this year. I have two eye above the mask,” and “my choir and cons, one’s self-talk, and addressing sons and families far away, and a 90-year- still meets on Zoom.” (While my family of stages of change, and the getting of old Mom close by, so I did a couplet. “I humored me about my suggestion, would “motivation” to a critical mass so that the hope you know you’re loved. We know it surprise you to know I was the only one balance shifts in the desired direction. In you love us too. XOXOXO.” And same to to meet the challenge? Did I mention that short, increasing the likelihood that this you, my colleagues, as we approach our new rituals are often met with resistance?) kind of ritual or tradition will be honored next holidays and other milestones. Q

15 THE NORTH CAROLINA PSYCHOLOGIST Parental Alienation, Parent–Child Contact Problems, and Gatekeeping, Part Two

BY JULIANNE LUDLAM, PH.D., NCPA MEMBER arental alienation is a controversial outcomes for children and families and to describe the adverse effects of one Pconcept in mental-health and legal agree that the goal is to determine if parent interfering with the other parent’s fields, despite its continued use in high- rejection of a parent is justified (realistic relationship with a child. conflict family-court disputes. New estrangement) or unjustified (alienation). Parental alienating behaviors (PABs): an research and several alternative terms have In spite of disagreement about the concept alternative (and preferred) term intended now been applied to situations in which of PA, there is general agreement that to aid in the reliable measurement and children resist contact with a parent, and there are different types of PCCPs, with assessment of PA; it refers to a pattern these cases continue to be challenging for multiple contributing factors, and that of negative attitudes or behaviors courts, clinicians, and attorneys. resisting or rejecting a parent may occur communicated by one parent about the This series of articles describes the for either justifiable or unjustifiable other parent to their child, resulting in current research on parental alienation reasons. that child resisting the maligned parent. (PA) and parent--child contact problems. Parent--child contact problems (PCCPs) The first installment, in our Winter- and resist--refuse dynamics: alternative terms Spring issue, described the overlapping suggested in the research to describe cases terms and concepts related to PA, such Another area in which a child resists contact with a as gatekeeping and parental alienating of disagreement parent; these broader terms are preferred behaviors (PABs), as well as some of the in the research, as they shift the focus models used to assess and describe the among professionals from one parent’s negative attitudes or problem. This second article describes behaviors to the many possible reasons some of the major conceptual and and researchers a child might resist a parent in a high- theoretical issues surrounding alienation, is about whether conflict divorce. based on recent reviews of the literature. Gatekeeping: Behaviors and attitudes by family courts are one parent that either facilitate or restrict CURRENT ISSUES currently responding contact between the other parent and the child; gatekeeping is a well-researched The Utility of PA as a Concept adequately to concept thought to occur on a continuum Due to the lack of consensus around and to vary in degree and quality as well as definition, etiology, and prevalence, many concerns about across behavioral domains. researchers have expressed concern about intimate-partner the continuing use of the term or concept PA and Abuse of PA, particularly in court proceedings violence or child Another area of disagreement among (Fidler & Bala, 2020). There are no valid abuse when claims of professionals and researchers is about empirical assessment protocols or tools whether family courts are currently that can reliably measure or establish the parental alienation responding adequately to concerns about presence of alienation or distinguish it have been made. intimate-partner violence or child abuse from other types of parent--child problems, when claims of PA have been made (Fidler such as estrangement or justified rejection & Bala, 2020). Johnston and Sullivan (Fidler & Bala, 2020). (2020, p. 283) argued that the early For this reason, some researchers question posed in such cases—“Is it abuse, have suggested alternative terms, such as Glossary or is it parental alienation?”—was framed parent--child contact problems (PCCPs) This is an acronym- and terminology-dense in simplistic, binary terms. That framing and resist--refuse dynamics (Fidler & Bala, area of research and discussion. Note can lead to the exclusion of physical abuse, 2020). However, others have argued that that the following terms have substantial trauma, poor parenting, and ongoing changing the terms does not resolve the overlap, as they are all essentially attempts parental conflict as contributing factors issue, as PA concepts may still be applied to describe the same problem: children if PA is found to be present. PA and child loosely and without standards (Johnston who appear to be resisting contact with a abuse are not mutually exclusive, and & Sullivan, 2020). Fidler and Bala (2020) parent. unfortunately, “…no bright line exists noted that most professionals involved Parental alienation (PA): a poorly defined between abuse and non-abuse in custody- in these cases are dedicated to the best but frequently used term usually intended disputing cases in family …cont’d next page

16 THE NORTH CAROLINA PSYCHOLOGIST Parental Alienation continued from page 16

courts” (Johnston & Sullivan, 2020, p. • Child factors (age, cognitive capacity, safe relationships with both parents; 273). temperament, vulnerability, special this applies to children who may needs, and resilience); have been abused and those who Single-Factor vs. Multifactor Models • Parental conflict before and after the may have been alienated (p. 585). Theories developed around concepts separation; Deutsch, Drozd, and Ajoku (2020) of PA have moved from a single-factor • Sibling relationships; stated that each case should be evaluated explanatory model to a multifactorial • Favored-parent factors (parenting individually to determine the best predictive model, but beliefs and style and capacity, negative beliefs approach. Both reviews warned that some assumptions based on the single-factor and behaviors, mental health, and children who experience abuse do not model persist. Johnston and Sullivan personality including responsiveness resist an abusive parent and may seek out (2020) explained that the single-factor and willingness to change); contact with that parent. Both also agreed model—that the alienating parent is • Rejected-parent/alienated-parent that there are cases in which a relationship primarily the source of a child’s rejection factors (parenting style and capacity, between a parent and child should not of the other, alienated parent—continues negative reactions, beliefs and be supported, such as when risk of harm to be widely followed despite the actual behaviors, mental health, and continues despite interventions or when complexity of the problem. A single-factor personality including willingness to children who have experienced abuse are model assumes a child is either a victim change); resisting the parent who abused them. of abuse or a victim of PA, precluding the • The adversarial process and litigation; possibility of both. It also assumes that • Third parties (involved professionals CONCLUSIONS SO FAR: any alienation present must be the fault and extended family); and CURRENT ISSUES RELATED TO of the parent who is favored by the child, • Lack of functional co-parenting PARENTAL ALIENATION AND and that the alienated parent is without and poor or conflictual parental GATEKEEPING parenting deficits if no abuse is found communication. The concept of PA is heavily criticized in (Johnston & Sullivan 2020). the research due to problems with clarity, In contrast, the multifactorial model REUNIFICATION IN CASES OF validity, and reliable measurement. Less (initially developed by Kelly and Johnston PCCPS AND ABUSE ambiguous alternatives, such as parent- in 2001) is based on substantial social- Another issue related to PA, PCCPs, -child contact problems or resist--refuse science research and considers an array and gatekeeping is the goal of dynamics, have been suggested. PCCPs of factors that can create a child--parent family reunification or of the child’s are now believed to have multiple alliance with one parent, against the maintenance of contact with both parents, contributing factors, and resisting or other parent (Deutsch, Drozd, & Ajoku, even in situations involving abuse or rejecting a parent can be considered 2020; Fidler & Bala, 2020; Johnston & intimate-partner violence. Several authors either justifiable or unjustifiable. Current Sullivan, 2020). Resistance to contact have noted the substantial research issues involve cases in which both PCCPs with a parent may involve, for example, support for the idea that children benefit and child abuse are present. Despite a history of inadequate parenting by the from good relationships with both parents significant research indicating that a alienated parent, an overanxious and when safety is not an issue, and the child’s rejection of a parent is likely protective favored parent, and/or a child’s law generally follows that presumption complex and multifactorial in origin, discomfort with the custody schedule (Austin, Fieldstone, & Pruett, 2013; Fidler family courts tend to frame such problems (Johnston & Sullivan, 2020). & Bala, 2020). Some researchers suggest as either abuse or alienation. Finally, In the multifactorial model, parental it is in a child’s best interest to repair and although research generally supports alienating behaviors (PABs) are viewed as maintain a relationship with a rejected reunification with resisted or even one factor on the part of a parent that may parent even in cases of abuse, neglect, or formerly abusive parents, there are cases account for a child’s resistance or refusal other grossly poor parenting, and “even in which such relationships should not be of contact with the other. There are many when the child has good reasons to be supported. other potentially explanatory factors to be fearful or feel stressed, uncomfortable, considered. Fidler and Bala (2020) stated hurt or angry with a parent,” as long as that although some cases of parent--child the child is safe (Fidler & Bala, 2020, p. COMING NEXT contact problems may be the fault of one 590; Deutsch, Drozd, & Ajoku, 2020). The third article in this series will parent, both parents often bear some Fidler and Bala (2020) stated: describe interventions for PCCPs and responsibility, and “focusing on a single Developmental research and legal offer recommendations for attorneys and cause is rarely helpful” (p. 576). They policy in child protection, as well evaluators. Q listed eight broad contributing factors to as in custody and access contexts, PCCPs: support children having healthy and REFERENCES ON PAGE 21.

17 THE NORTH CAROLINA PSYCHOLOGIST The Book Corner BY KATRINA KUZYSZYN-JONES, PsyD

We’ve decided to begin a book corner: options for good reading. Some will be psychological in nature and some just for fun. We would love to hear from our members to add to this list. We will either provide lists or reviews of books here, and we welcome suggestions. I’ll get the ball rolling.

KATRINA’S FEMINISM LIST

​​I was an undergraduate at the University of Washington in Seattle during the ‘90s. The grunge scene was in full swing, and it was a time of enlightenment, or so it seemed at the time. UW had one of the first step groups formed by an African American fraternity and sorority in that area (yes, one of each for the campus). Ellen DeGeneres came out on her television show, which we all sat around in the dorm and watched in celebration. And I became a women’s studies minor. Here are a number of books that influenced me then and over time.

The Yellow Wallpaper by Charlotte Perkins Gillman

The Awakening by Kate Chopin

Kabul Beauty School by Deborah Rodriguez and Kristin Ohlson

Eat Pray Love by Elizabeth Gilbert

Tales of a Female Nomad by Rita Golden Gelman

Becoming by Michelle Obama

Educated by Tara Westover

18 THE NORTH CAROLINA PSYCHOLOGIST Save the Dates Photo Credits

FALL CONFERENCE SPRING CONFERENCE Page 6 September 17 and 18, 2021 April 8 and 9, 2022 Photo by Roberto Hund TIMELY TOPICS SYMPOSIUM FALL CONFERENCE Pages 7 & 9 February 19, 2022 September 23 and 24, 2022 Photos by Cottonbro

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This page Photo by Michelle Tiemann

Methodist Home for Children is seeking a licensed Assessment Psychologist to provide clinical oversight at our Western Area Crisis & Assessment Center in Asheville, NC.

This position requires:* • a doctorate degree* • a current license with the NC Psychology Board* • at least two years of full-time, direct experience diagnosing, treating, and evaluating treatment effectiveness for our client population

Benefits available after 90 days of employment. View details and apply at https://bit.ly/MHCCareers

19 THE NORTH CAROLINA PSYCHOLOGIST Professional Liability Insurance The choice is easy - and so is switching!

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Our policy and supporting programs are tailored Complete Career Financial Protection to meet your specific needs and to cover you whenever you perform psychological services. Only The Trust offers the Advocate 800 Program that provides free and confidential consultations with licensed psychologists that have extensive legal, ethical and risk management expertise, not a “claims expert” like with other carriers. When you’re with The Trust, you’re more than a policyholder. You’re part of a community of like-minded peers with a common goal of making the world a better place, one patient at a time. The only insurance provider that’s truly In so many ways, we have you covered - because for psychologists, by psychologists! at The Trust, we’re about more than just insurance.

* Insurance provided by ACE American Insurance Company, Philadelphia, PA and its U.S.-based Chubb underwriting company affiliates. Program administered by Trust Risk Management Services, Inc. The product information above is a summary only. The insurance policy actually issued contains the terms and conditions of the contract. All products may not be available in all states. Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services. For a list of these subsidiaries, please visit new.chubb.com. Chubb Limited, the parent company of Chubb, is listed on the New York Stock Exchange (NYSE: CB) and is a component of the S&P 500 index. www.trustinsurance.com | (800) 477-1200

20 THE NORTH CAROLINA PSYCHOLOGIST References

RURAL YOUTH HOMELESSNESS opportunities: LGBT Youth homelessness Homeless Children and Youth and IN NORTH CAROLINA, PART in rural America. Chapin Hall at the provides answers to the most frequently THREE, PAGE 10 University of Chicago. asked questions on the McKinney-Vento Vitaglione, T. Personal Homeless Assistance Act. Britton, L. & Pilnik, L. (2018). communication, July 14, 2020. Tom@ Blog post from therapist Esther Perel: “Preventing homelessness for system- ncchild.org. “The unprecedented crisis caused by the involved youth.” Juvenile and Family Court Resources novel coronavirus has left us with a set of Journal, 69, 19-33. unfamiliar emotions. Read more to learn Chamberlain, T. Personal Fact Sheet on Homeless Teens/Youth about these new emotions you may be communication, June 22, 2020. Homeless Every Student Succeeds Act experiencing and what to do about them.” [email protected]. (ESSA) Fact Sheet Chamberlain, T. (May 2019). Report Free 5 hour online course provided on unaccompanied youth survey: Results Child Welfare System Forced to Adapt by the National Childhood Traumatic and implications for Region 7, NC BoS During COVID-19 Pandemic Stress Network: “Skills for Psychological CoC. Recovery (SPR) is an evidence-informed North Carolina’s Rural Health Systems Ganis, C. (Summer 2020). Rural youth modular intervention that aims to help Are in Crisis homelessness in North Carolina, part one. survivors gain skills to manage distress North Carolina Psychologist, 72(3, Summer- NC Care360 is North Carolina’s first and cope with post-disaster stress and Fall), 14-15. statewide network that unites healthcare adversity.” Girard, G. (2019, Aug/Sept). A and human services organizations with A traumatic stress inventory that agencies safe place for homeless youth. Sand shared technology for care delivery in a can use for self-evaluation. “The STSI- and Pine Magazine. https://issuu.com/ community-oriented, person-centered OA is an assessment tool that can be sandandpinemag/docs/s_p_as19.issuu approach. It is a public-private partnership used by organizational representatives at https://www.acf.hhs.gov/sites/default/ for all 100 counties for care delivery any level to evaluate the degree to which files/fysb/mckvenapp20120829.pdf established by NC DHHS and the their organization is informed and able https://developingchild.harvard.edu/ Foundation for Health Leadership and to respond to the impact of secondary media-coverage/take-the-ace-quiz-and- Innovation (FHLI). To learn more email traumatic stress in the workplace.” learn-what-it-does-and-doesnt-mean/ [email protected]. https://en.wikipedia.org/wiki/North_ Info from the CDC on coping with Point Source Youth—501©3 Regional Carolina. disaster-related stress for individuals and nonprofit serving marginalized youth https://en.wikipedia.org/wiki/ families with children. through advocacy, research, evaluation, CARES_Act quarterly webinars, and a national https://ncchild.salsalabs.org/stop918/ GETTING TO KNOW THE RIGHT symposium. index.html BRAIN, PAGE 12 https://ncchild.org/child-welfare- National Center for Homeless Education Meares, R. (2012). A Dissociation Model system-adapts/?eType=EmailBlastCon of Borderline Personality Disorder. NY: W.W. State coordinators: a list of state tent&eId=6adb2454-73d2-4a24-a0a9- Norton & Company. coordinators for the McKinney-Vento 567bb8a4fe50 Ogden, P., Pain, C., Minton, K. & Homeless Assistance Act. https://www.newsobserver.com/news/ Fisher, J. (2005). Including the body in coronavirus/article245237590.html These videos give brief introductions mainstream psychotherapy for traumatized https://www.nytimes. to key issues covered in the McKinney- individuals. Psychologist-Psychoanalyst, 25, com/2019/12/04/us/politics/food- Vento Homeless Assistance Act. Most 19-24. stamps.html presentations offer a downloadable Schore, A.N. (1994, 2016). Affect https://www.usich.gov summary of main points and certificate Regulation and the Origins of the Self. NY: https://www.verywellfamily. of completion, upon completing a brief Taylor & Francis. com/personal-fable-meaning-and- quiz on the material presented. The quiz Schore, A.N. (2003a). Affect origins-3287995 and certificate of completion are optional. Dysregulation and Disorders of the Self. NY: Morris, M. W. (2016). Pushout: the Videos available here. W.W. Norton & Company. criminalization of black girls in schools. New Schore, A.N. (2003b). Affect Frequently Asked Questions. This York, NY: The New Press. Dysregulation and the Repair of the Self. NY: document was compiled by the National Morton, M. H., Samuels, G. M., W.W. Norton & Company. Association for the Education of Dworsky, A. & Patel, S. (Oct 2018). Missed Schore, A.N. (2011). …cont’d next page

21 THE NORTH CAROLINA PSYCHOLOGIST References, Resources continued from page 21 Classifieds The Science of the Art of Psychotherapy. NY: RITUALS AND TRADITIONS IN W.W. Norton & Company. THESE PANDEMIC TIMES, PAGE POSITIONS Schore, A.N. (2015). The Neuropsychology 14 of the Unconscious. NY: W.W. Norton & https://www.google.com/search?q= WILSON, NC — WilsonPrivatePractice. Company. most+common+new+year%27s+resolu com NOW HIRING Psychologist Schore, A.N. (2019a). The Development tions&ie=UTF-8&oe=UTF-8&hl=en- •Outpatient therapy of the Unconscious Mind. NY: W.W. Norton us&client=safari •Psychological Testing (optional) & Company. https://www.merriam-webster.com/ •Behavior Plans for Adults with Schore, A.N. (2019b). Right Brain dictionary/ritual MH/IDD (optional) Psychotherapy. NY: W.W. Norton & https://www.merriam-webster.com/ •Choose your schedule and caseload Company. thesaurus/tradition •Children, Teens, and or Adults Tronick, E. & Gold, C.M. (2020). The https://www.nytimes. Power of Discord: Why the Ups and Downs com/2020/11/26/briefing/coronavirus- Contact us directly for inquiry. To apply, of Relationships Are the Secret to Building vaccine-trump-pardon-diego-maradona. please send email of interest & CV/ Intimacy, Resilience, and Trust. NY: Little, html resume: Brown Spark. https://www.nytimes. [email protected] com/2020/12/22/well/family/new- holiday-traditions.html ASHEVILLE, NC — Methodist Home for https://www.amazon.com/Rituals- Children is seeking a licensed Assessment Our-Times-Celebrating-Relationships/ Psychologist to provide clinical oversight dp/0765701561 at our Western Area Crisis & Assessment Center in Asheville, NC.This position requires:* a doctorate degree* a current license with the NC Psychology Board* at least two years of full-time, direct experience diagnosing, treating, and evaluating treatment effectiveness for our client population. Benefits available after 90 days of employment. View details and apply at https://bit.ly/MHCCareers

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22 THE NORTH CAROLINA PSYCHOLOGIST Time to Renew Your Dues! JULY 1, 2021 - JUNE 30, 2022

NCPA dues must be renewed by September 30, 2021. July 1, 2021 - June 30, 2022 Visit our website to login and renew your dues. www.ncpsychology.orgTime to Log in and click on “My Profile” below the nametag. Click on the grey r “Renew”en ebutton.w your dues! In order to set up a payment plan, please call the NCPA office at 919.872.1005.

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