Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?



Sunday, July 20, 2014

Girls Find Science Boring Says Scottish Expert

Say what?

Gijsbert Stoet, a psychologist at the University of Glasgow, told his audience at the British Education Studies Association conference recently that 'effort is wasted trying to bridge gender divides in education when innate differences meant that boys and girls would always be drawn to different subjects and careers', according to an article on the tes connect website. “Do we really care that only 5 per cent of the programmers are women? Well, actually, I don’t care who programs my computers," he is quoted as saying.

Stoet works for the University of Glasgow’s Robert Owen Centre for Educational Change. Anyone else besides me find that ironic?

What about the menz, he wants to know: Apparently to him this is a zero-sum game -- any help given to girls to get them into STEM takes away from help supposedly needed by boys. And of course, if you have a choice between helping boys and helping girls, well. Helping boys is obviously more important, right?

For any of you ladies who think you are living in a post-feminist world, here's evidence that a stone-age mentality is still alive and well among people who have the power to influence your future.

Saturday, July 19, 2014

What a Wonderful World!

U.S. President Theodore Roosevelt (left) and n...
U.S. President Theodore Roosevelt (left) and nature preservationist John Muir, founder of the Sierra Club, on Glacier Point in Yosemite National Park. In the background: Upper and lower Yosemite Falls. (Photo credit: Wikipedia)
It's kind of a depressing world we live in. Every day the news is full of bad news--oil spills, murdered children, plane crashes, political chicanery, terrorism, disappearing species. Or we have direct exposure: You see a stray dog hit and killed in the road, or you are haunted by childhood memories of domestic violence or alcoholism. Someone you know is killed in Afghanistan. Or maybe the thrushes that have nested in your woods every summer since you bought the place back when your kids were little didn't come back this spring. And it is easy to despair. 

"I'm just one person! What can I do?"
This is the question a client asked me the other day. And my answer was, "A lot! You can do a lot!"

Theodore Roosevelt said it best: "Do what you can, with what you have, where you are." People with great resources (money, some sort of public platform from which to reach millions) can do a lot. The rest of us, not so much. But we can always do something, and in relative terms, it counts for much. 

The point as I see it is to be a good steward of your little corner of the world, to leave it just a little bit better than you found it.

Vote. Write a letter to your congressional representative, or your senator. Attend a school-board or city-council meeting. Write a letter to the editor. Demonstrate. Boycott. Raise money for a good cause.

Spay your cat and keep her up. It seems like a small thing, but it does wonders for her health and happiness: Cats allowed to run free are subject to all kinds of bad outcomes, ranging from injuries in fights to infectious diseases to being hit and killed by cars. In her lifetime, you could save as many as 300 birds' lives. That is no small thing! And by not allowing her to reproduce, think how many homeless kitties you've prevented in succeeding generations. 

If you can't afford a dog yourself, volunteer at your local shelter. Your efforts will make the animals' lives healthier and happier while they're there, and every hour you donate increases their odds of survival. Adopt (don't buy) one yourself, if you can. You may not be single-handedly solving the homeless dog population problem yourself, but your action means everything to that one dog. Everything.

Adopt a child. If you can't afford that, get qualified as a foster parent by your local Department of Family and Children Services. Or become a CASA (Court-Appointed Special Advocate) volunteer. Informally, offer a hand to that overwhelmed parent in the supermarket or in your neighborhood. Or pick up the phone and report a child at risk. You could be saving a life.

I used to carry a hot pink key-chain fob that said, "Woman On a Mission." Quite naturally, people would periodically ask me what the mission was. When I was a child protective services caseworker, I told everybody I was out to change the world, one child at a time. When my practice was predominantly women survivors of domestic abuse, it was "changing the world, one woman at a time." I knew I couldn't change the world, but I believed that my work could be world-changing for the one woman or child in my office, at least for the one hour. You're no different: You, too, can change the world for another living being.

Start a blog. They're free here at Blogger.com and via WordPress. Both will walk you through the set-up process, so you don't even have to be very computer-savvy. Perhaps you know more than you give yourself credit for, and you can share your experience, strength and hope with others. All it will take is a little of your time.

Recycle. Pull your weeds the old-fashioned way instead of poisoning them. Don't use pesticides. You'll help save birds, butterflies, and bees, and our soil and streams will be just that tiny bit much cleaner for your effort. If you have property, plant some milkweed.

Speaking of water, use less. If you can afford it, buy shade-grown organic coffee. If you can't, cut your consumption. Don't eat chocolate produced by companies that exploit children, use slave labor, or rape the environment. If you can't afford Rain Forest Alliance-certified chocolate, give it up. Or eat less. Buy locally-produced food-stuffs when you can.

Say something nice to somebody today. Do somebody a favor. Or just smile at them. It may not seem like a big thing to you, but it could be the highlight of their day.

My first ethics text, If Everybody Did, by Jo Ann Stover, asks children to consider their actions in the light of this question: What if everybody did that? When you are taking one tiny step toward improving your world even one tiny little bit, ask yourself that. What if everybody did? 

What a wonderful world it would be!
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Thursday, July 17, 2014

The Circle of Life, or

Red-Shouldered hawk portrait
Red-Shouldered hawk portrait (Photo credit: San Diego Shooter)

Hawks Gotta Eat, Too.

 I was out on the deck one day last Spring, brushing the dog and catching some rays, and watching the nuthatches take possession of the owl box from a squirrel. It was a quiet day, so when I heard the doves suddenly fly up in alarm one yard over, I looked to see what was up. A hawk had apparently caught one of them. He flew up into a tree, paused for a moment to get a better grip and took off, presumably for his own family's nest with dinner for his mate & nestlings.  

It seemed significant to me, somehow. There it was, new life beginning for the nuthatches, a life ending for the dove, and maybe for its babies if it already had any at this point, and life, presumably, continuing for the hawk and his family. 

When one of us dies, it doesn't (usually) contribute to the continuing life of another being--these days, we tend to do that while we're living, with dying for another being the exception rather than the rule. But the other part, the suddenness and the unpredictability, that fits with our experience. 

We are here, until we are not. 

That particular afternoon it could just have easily been the other dove that the hawk caught, or one of the nuthatches. Or the nuthatches could have lost their standoff with the squirrel whose box that has been all winter. Or the dog or I could have been hit by a falling limb. 

We are here. Until we are not.
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Wednesday, July 16, 2014

R-E-S-P-E-C-T!

I read an article a while back about physicians' arrogance and how it results in poor patient care. And as I read, I thought that much of it translated well to the field of psychology.

Psychologists, as a rule, are an arrogant bunch.

I was lucky to be therapized, supervised, taught, and mentored into the profession primarily by psychologists who understood respect. But I had some bad experiences, too, with arrogant supervisors that left me so scarred it took years to recover. And I'm not the only one -- I once had a prospective supervisee burst into tears when I told her I never yelled at students. Apparently she'd been yelled at through most of her grad-school career and was expecting more of the same from her practica.

We as a profession have a tendency to believe that we know it all now that we have that 'terminal' degree, and to fail to take seriously those coming up behind us. We stop being teachable. In our arrogance, we can fail to take our duties to our clients seriously, as well, resulting in everything from poor service to egregious ethical lapses. In that vein, I have seen:
  • A psychologist disrupting a psychometrist's testing sessions to ask questions, obtain items from the testing room, and even to introduce another patient -- because it would have been an inconvenience to wait
  • A psychologist deleting critical safety recommendation from an intern's report
  • A psychologist stating he didn't need to read the new manual for a radically revised test, then disagreeing with the intern about conclusions based on new norms
  • A psychologist using cheap photocopies of test materials and cutting corners in administration  because s/he wasn't getting paid what s/he thought s/he was worth to do the work right
In these cases confidentiality was violated, tests were invalidated, a staff member was assaulted, a client failed a placement, and countless inaccurate conclusions went out in reports. The seriousness of these consequences would be hard to overestimate.


Arrogance can produce abuse or neglect of student interns and staff as well as of patients. I have either experienced myself or witnessed:
  • Staff psychologists and professors sexually harassing students, interns, and nursing staff
  • Staff psychologists attempting to influence interns' communications with site visitors from certifying bodies
  • Senior psychologist telling junior psychologist, who was asking for help with staff management problems on her unit, "Buck up, Bucko!" 
  • Psychologist telling intern, "[Expletive deleted] rolls downhill. And you're downhill."
  • The psychologist leading a supervision group being dismissive of supervisees' input, actively discouraging such participation as "taking over my group"
  • Clinical faculty blowing off supervision appointments and seminar meetings required to meet state licensing standards and then threatening interns who complain
Needless to say, not a lot of learning can occur in such an atmosphere, and that translates into obvious gaps in the care of those students' patients down through the decades over the course of their careers. Over and above the gaps in the learning of facts and skills, such an atmosphere sets an example for students that says that patient appointments are not important to respect, patient and staff input is not valuable, rules and regulations can be bent as long as nobody knows about it, and nobody should ever report anything untoward.

Inadequate supervision of students and staff (when the arrogant psychologist just can't be bothered) translates into patient abuse going unchecked, and in patient neglect. Patients in turn are inadequately supervised or under- or mis-treated, resulting in self-injuries, untreated medical issues, assaults, suicide attempts, elopements, and deaths. I am not just speaking theoretically here, either: These things have actually taken place.

Then there's the arrogant dismissal of patients' needs and lived experiences. We have
  • A psychologist commenting in reference to a severely mentally ill patient s/he deems hopeless, "I can heal the sick but I can't raise the dead!" 
  • A center director considering it taken as read that a person with schizophrenia (most of the center's caseload) is incapable of participating in hir own treatment planning
  • Psychologists failing to advocate appropriately for minor clients or to support self-advocacy in adults
  • Psychologist making fun of a client's parenting style
  • Psychologist blaming dead victim of domestic violence (parent of a child client) for getting into/not leaving the relationship
This sort of attitude trickles down to other staff, students, and even clerical employees, with the bizarre end result that one clinic I worked at was actually cited in an audit for -- wait for it! -- not providing mental health care.  I am not making this up.


The experience of stigma is, by the way, a known health risk. By copping an attitude that we are better than our clients (because we are thinner or healthier or more fit, better-educated or more financially well-off -- any measure seems to be fair game these days), not only are we not being helpful, we're actively making our clients' mental and physical health worse. We're putting tremendous pressure on our students and staff, who are, after all, exposed to our prejudices many more hours each week than are our clients, and we're setting terrible examples for them.
    Obviously parents from different cultures, with differing parenting styles and victims of domestic violence and their children are not getting good therapy from such therapists. But there's a ripple effect. A respectful therapist working with members of such groups is going to be reluctant to be forthcoming in a team treatment setting or in clinical supervision, where the sharing of information is normally considered necessary to good treatment, lest their patient become a target. 

    And then there's
    • Psychologists using patients to house-sit
    • Psychologist using client to help pack up office at retirement
    • Psychologist having intern come in to clean the office on the intern's off days
    • Psychologists using students and patients to buttle parties in their homes, and
    • Faculty using students to babysit.
    A patient is not a servant. Neither is a grad student. And it is the height of arrogance to presume so.

    I think part of the problem is that we live in a cultural climate of general disrespect. We are always attuned to matters of class and rank, to where we stand in the pecking order -- and woe betide anyone on the rungs below. And then of course there are some people who just seem, as individuals, to be particularly arrogant/disrespectful. We've all known at least a few: No one, it seems, is safe from their disdain or their verbal abuse.

    Plus, with some psychologists, there's a tendency to overvalue the doctorate, to demand respect for themselves while believing it somehow frees them from the obligation to show respect for others who might be just as smart, just as knowledgeable, but who for one reason or another, lack the diploma. They seem blissfully unaware that there is often no difference in intelligence or drive between them and the therapist with a masters--or, for that matter, the parapro with the high school diploma. To a degree (if you'll pardon the pun) the difference is often only a matter of privilege: The "I'm-a-doctor-and-don't-you-ever-forget-it" crowd as often as not are people who were born on third base but think they hit a triple.

    And speaking of triples, sometimes you get the triple-whammy -- a psychologist who is (1) not only a product of hir culture but who also is (2) particularly self-important and who (3) takes too much credit for the achievement of a degree which is in itself overvalued*. . . and you have someone who is especially bad for morale, disruptive to the work of the unit/practice/facility/team, and who is potentially downright dangerous to patients.

    Get people like that at the top of the office heap, and they tend to run off the folks who aren't like them and hire more who are, until the whole culture of the institution, be it a huge psychiatric hospital or tiny private practice, will be disrespectful. And when that happens, patients beware!

    I don't know what we can do about it, other than shout out,
    R-E-S-P-E-C-T!
    Find out what it means to me!
    R-E-S-P-E-C-T!

    *Trust me, it's not all that special -- there are thousands of us in the state of Georgia alone.

    Monday, July 15, 2013

    Poor Trayvon



    Well, the George Zimmerman verdict is out, and I suppose every Blogger worth her salt will have to have something to say about it today.

    I'm not a lawyer, so I don't have an opinion about the evidence or the jury, or the conduct of either the prosecution or the defense, or even about the Stand Your Ground law. Well, yeah, I do have something to say about that, but it's not a legal opinion, strictly speaking.

    These kinds of laws spring from a state of mind peculiar to regions that historically were made up of scattered, rural, generally agricultural or herding societies who did have to protect their own land/livestock/homes/families because there was no law close enough around to do it. Pro-actively, the successful men in these societies projected an ├╝ber-male, physically over-bearing persona in order to cause potential criminals to steer off for other parts where presumably they might find easier pickings. It was a matter of honor to be able to protect your boundaries, to be able to project that sort of image, and by extension if somebody messed with you or your stuff, well, then, your honor was at stake until you could even up the score. 

    I can't say anything psychological specifically about George Zimmerman because I have not evaluated him, and I don't have access to anybody else's evaluation of him. Heck, I haven't even watched the non-stop coverage of the trial. But I can say, as a disinterested citizen observer, that George appears to the naked eye to be a bit like the fence-rider of old, ever on the lookout for rustlers who, if you will remember your US history, along with horse thieves back in the day could be hung on sight by whoever caught them in the act. This is, I suspect, partly why it looked so much like it was Trayvon rather than George who was on trial this past week. Indeed, I could not help but notice, some commentators persisted in referring to it as "the Trayvon Martin trial". The mentality is still that pervasive.

    We don't need those kinds of laws any more, but they and the personalities they serve persevere. As does the gun violence that goes with them. 

    If you see yourself as a victim, which, weirdly, an increasing number of white males in this country do, or if you merely fantasize yourself engaging in various make-my-day type heroics, you may find like-minded folk in the gun and prepper communities (there's a lot of overlap between the two). Stand-your-ground laws were written for you. And so you may end up going about your daily business locked and loaded, spoiling for a fight. You don't even have to be part of a neighborhood watch or other, similar, organization. You can self-appoint. Your real-world perceptions are filtered through the movies running through your head, which in turn are heavily influenced by the paranoid poppycock you read on prepper and gun websites and in their magazines and newsletters, to the detriment of your grip on reality. You would be what the American Rifle Association calls an Armed Citizen. They even have a monthly column called "The Armed Citizen" in which they congratulate each other for shooting alleged criminals. 

    But I digress. 

    Anyway, one day you find yourself in a situation which seems to you to call for a violent response. Instead of the dozen other things you could do, or not do, in this situation, you draw your weapon. You're not reluctant. You're not saddened by it. You are justified. This is, after all, the fulfillment of a long-cherished fantasy. You genuinely don't 'get' why anybody else would be horrified at what you've done.

    This would happen even if there were no stand-your-ground laws, but at least then there might be some justice for your victim afterwards.

    But I am not a lawyer, so no, my only real opinion is from my point of view as a mother, and that is that justice was not done here. It seems to me that part of the whole point of the USA is that a person -- most especially a child -- should be able to walk the streets of his or her community in peace and safety. And anyone who violates that is in violation of some law. Be it written or ethical or moral, he is in violation. He has violated the peace of the community, and the safety of all of its citizens. He has violated the faith and trust that we have in our neighbors.  

    I don't see how Trayvon's parents can have any peace at all until we as a nation stand up and say this. 

    Sunday, June 23, 2013

    On Humility, and the Limits of Formal Education, or More on Arrogance



    I know everybody's watched it, but have any of you read the series A Song of Ice and Fire? I'm on Book Four, A Feast for Crows. When I'm not working, I think, I live more in Westeros than I do in America. It's that intriguing, enchanting, absorbing. And the other night, I came across this passage, in the Prologue: 

    "The night before an acolyte says his vows, he must stand a vigil in the vault. No lantern is permitted him, no torch, no lamp, no taper . . . only a candle of obsidian. He must spend the night in darkness, unless he can light that candle. Some will try. The foolish and the stubborn, those who have made a study of these so-called higher mysteries. Often they cut their fingers, for the ridges on the candles are said to be as sharp as razors. Then, with bloody hands, they must wait upon the dawn, brooding on their failure. Wiser men simply go to sleep, or spend their night in prayer, but every year there are always a few who must try."  

    ". . . what's the use of a candle that casts no light?"

    "It is a lesson," Armen said, "the last lesson we must learn before we don our
    maestcr's chains. The glass candle is meant to represent truth and learning,
    rare and beautiful and fragile things. It is made in the shape of a candle to
    remind us that a maester must cast light wherever he serves, and it is sharp to
    remind us that knowledge can be dangerous. Wise men may grow arrogant in their wisdom, but a maester must alwavs remain humble. The glass candle reminds us of that as well. Even after he has said his vow and donned his chain and gone forth to serve, a maester will think back on the darkness of his vigil and remember how nothing that he did could make the candle burn. . . for even with knowledge, some things are not possible."
    That stopped me in my tracks. I read it again. And then once more. And I wished that (or something like it, since we have neither dragons nor dragon glass in 21st-century America) had been our last lesson, perhaps the night before our hooding ceremony, since we don't don chains like the maesters of Westeros.

    How I wish they'd taught us how to simply sit with the dark. 

    I have been a therapist for 33 years, and in that time I have seen many who have grown arrogant--in their knowledge, if not their wisdom. I have seen a few use their knowledge in dangerous ways. And I have seen not a few who think that because they have the terminal degree, they must know everything. I have known psychologists trained in the scientist/practitioner tradition who abandoned all pretense at critical thinking the evening of the day they defended their dissertations. I have known psychologists who thought they had nothing else to learn and shut their minds to new ideas and new data. And I've met very few who didn't hold themselves above the less-educated. The whole profession has come to think of itself as wholly superior to masters-level practitioners, and spends a lot of time dissing them and expending energy defending turf from them that might be put to better use elsewhere. But that is another rant for another day.

    Worse, and there is another rant coming on this one in a future post, psychology has come to believe that they have the power to change people. Therapy has become and "intervention" to be "delivered" as if to a  retail consumer and its success is to be measured in "behavioral outcomes".

    Our clients believe this, too, and will say to us, "What do we do about it?" or, "I am ready to be fixed, now." And when we can't, they ask us, "What is the use of a candle that casts no light?" So we are seduced into trying, only to bloody our fingers once more.

    As the next passage in the Prologue to A Feast for Crows makes plain, the obsidian candle can give off light -- but that's not under our control.
     "I know what I saw. The light was queer and bright, much brighter than any
    beeswax or tallow- candle. It cast strange shadows and the flame never
    flickered, not even when a draft blew through the open door behind me."

    Armen crossed his arms. "Obsidian does not burn."

    "Dragonglass.'' Pate said. "The smallfolk call it dragonglass." Somehow that seemed important.

    "They do," mused Alleras, the Sphinx, "and if there are dragons in the world
    again . . ."

    "Dragons and darker things,'' said Leo.
    The dragonglass candle is in this sense a metaphor for healing, and gives another bit to the lesson Armen describes. Illness, unhappiness, neurosis--whatever you may wish to call it--is contained within us, and so is healing. There are things we may say or do, or not say or do in a session, things that grew out of our learning (not all of which is formal, by the way) that enter into a person in the same way that a maester's antidote enters the body to combat a poison, and we may contribute to a person's healing in that way. But in the same way that the antidote and the poison do battle inside the victim's body, with the body itself as one of the combatants, so, too, is psychological healing an inside job. We have very little power compared to what resides in you.

    And powers far greater than either of us may determine whether that candle burns.
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    Monday, June 17, 2013

    From the In Box

    The most recent edition of Professional Psychology: Research and Practice landed in my In Box this week, and in it was an interesting study on a multifamily group program for vets with PTSD at the Oklahoma City Veterans Affairs Medical Center (VAMC). 

    It has long been known that while good family support helps people recover from PTSD, the PTSD itself can alienate the sufferer from family members, depriving them of support. Bad family relationships actually interfere with treatment. With this in mind, the Oklahoma City VAMC set out to adapt a multi-family group approach to the specific needs of veterans. They call it REACH, for Reaching out to Educate and Assist Caring, Healthy families. 

    They've collected data from about 95% of their participants, over a period of a little over four years, and they believe that it works. But it's the first such study specifically with veterans diagnosed with PTSD, and it's a small study so these results are very preliminary.

    This was a longitudinal study with no control group, meaning there were no vets wait-listed for it or in some other form of treatment (comparison groups of both types would have been ideal). And the data on improvement was reported by the study participants themselves, to the therapists who both provided the treatment and conducted the research. As with any study of this nature, it may appear to work better than it apparently does, for a couple of reasons:
    1. People can get better over time, either because 'time heals all wounds,' or due to other things occurring in their lives during the course of the study. The authors performed a statistical test for this, but still, a control group would have helped to tease out how much improvement is due to the program itself, and how much due just to life going on. And since some study participants were receiving other treatments at the same time, there's no telling exactly what improvements are due exclusively to REACH.
    2. It is well known that when people invest a lot of time and energy in something, there's a psychological bias towards finding it worthwhile. This is true for researchers and participants, and is bound, in this kind of study, to influence the reporting and interpreting of results.
    One thing that makes the results stronger in this case than in some studies to come out of the VA system in recent years is that the researchers didn't "cherry-pick" their participants, which is to say that nearly everybody who wanted in, got in. Cherry-picking is frequently a problem with treatment efficacy studies, as anyone with co-existing conditions, or who is taking medications, is ruled out, and definitions of the diagnoses that get you into the study are very narrowly defined. This results in the study population not looking much like a typical clinical population. For the purposes of this study, persons with active addictions or who were suicidal or homicidal were screened out, but these are criteria that are almost universally applied in clinical practice as well, so does not much affect the applicability of the results. 

    Even better, their definition of "family" was open and welcoming: A veteran could bring her or his adult significant other of nearly any description -- a lover, a spouse, a parent, a sibling, an adult child, or even a friend. 

    Veterans ranged in age from 22 to 85, which would include the Korean War if not World War II, and that both adds to and detracts from the strength of the study. Different "cohorts" (age groups) serving in different wars could have widely varying backgrounds and combat experiences and therefore respond very differently to a treatment. Also, older vets, by definition, have a more chronic form of PTSD. An average age, as in this study, of 55.8 years means that this is something that may not work as well for very young folk just back from Afghanistan or Iraq with their differing upbringings, combat experiences, and acute onset of PTSD as it does for VietNam-era or Persian Gulf veterans.

    Unfortunately, the study population wound up being almost all white (non-Hispanic) straight males, so we don't know, pending further study, whether this program would be equally helpful to people of color, women, LGBTQQI folk -- never mind veterans or family members who fall into all three categories at once! 

    Of course, there's no reason to believe that it wouldn't work for a wider range of folk, since groups in general have been studied for over half a century now and the results are consistent. It works for nearly everybody, for nearly every problem. It's just that with this study, the authors could not claim with any certainty that this particular protocol would work for other than adult, straight, white males of a certain age.

    From the description, REACH appears to be a nicely-structured program, with a generous time allowance for assessment and engagement with the program, and a nice consolidation/follow-up phase to help families maintain and elaborate on their gains. At the same time, it does not appear to be so structured as to be a cook-book-y, overly technical approach. And folks liked it! Some of them reported that the meetings were the high point of their weeks. Participants knew more about PTSD when it ended than they had when it began, and some of their symptoms improved. They learned coping skills, and their relationships improved. 

    The authors note that in a study of this sort, while you can say you're pretty sure the program helps, it's hard to say exactly what components of the program are most -- or least -- effective. That makes it a bit of a crapshoot whether you can replicate the results elsewhere. What if, for example, one of the only four psychologists running the study is just especially talented, and no matter what she did, her people would get better? On the other hand, if the standard curative factors of all effective groups were in operation here, you could do REACH or any other variation of multifamily group and get the same results anywhere. This is why we like to see multi-center studies, or studies replicated elsewhere producing similar results. However, when you are running only 4-6 vets and their families through at a time, and the whole process takes nine months, as this one does, we'd be waiting a minimum of four more years for the next study -- and that's not counting the time to organize and fund a study, write it up, and get it into print! So I think you will see a lot of psychologists running with this one, and soon. 

    Although VA is mandated to provide some form of family education, the REACH program specifically does not appear to be available at our local (Atlanta) VAMC yet. However, the study's authors will make the materials needed to conduct the group available to any psychologist who wishes to lead one. If a half-a-dozen or so of you are interested, I think we could have one up and running by the end of summer. Just let me know!
    Fischer, E. P., Sherman, M. D., Han, X., & Owen, R. R. (2013). Outcomes of
        participation in the REACH multifamily group program for veterans with PTSD and
        their families. Professional Psychology: Research and Practice (44), 127-134.
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