[Current Topics in Psychology]

A.P.A. Convention Highlights

American Psychological Association
118th Annual Convention - San Diego
August 12-15, 2010


These edited reports were originally posted to the Current Topics, Therapy Online, and Cyberpsychology list-servs, August 2010.  

2010 Convention Highlights:
Online Support Groups & Applications | Evidence & Ethical Practice | Opening Ceremony | Sir Michael Rutter: Resilience
Group Memory | Psychology in the Digital Age | Steven Hayes: What Psychotherapists Have that the World Needs Now


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"Asynchronously Live" from San Diego



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*DISCLAIMER*
I was very careful to take accurate notes during these presentations (including several pithy verbatim quotes), using handouts and/or photos of graphics to verify my notes. I apologize for any remaining errors or typos, and will be happy to immediately correct any mis-quotes, misattributions or mis-spellings brought to my attention. I welcome presenters' submission of additional online references which are relevant to (or mentioned in) these reports. Thanks, and... Enjoy! I hope you find this slice of psychology interesting and informative.

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APA CONVENTION REPORT #1

August 11, 2010




[San Diego]

Asynchronously Live from San Diego!
12-15 August 2010

Following is my first report, "asynchronously live" from the 2010 APA Convention, as the events are still happening and what I'm about to describe took place only minutes ago.

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Hi, and greetings from San Diego!

Asynchronously live from the APA's 118th Annual Convention...

This year, like the past few, APA has a much-condensed program, so it's a shorter duration in terms of days, and many time slots have a number of excellent presentations all competing, same time, different places. As usual, the sessions I attend and report on are representative of my own areas of interest, primarily clinical psychology, cognition, psychotherapy, online/computer-facilitated mental health tools and resources, and some of the keynote/plenary sessions on the big trends and issues of general psychology. My goal "here" is to share some of this with those who are interested in psychology, both broad and some of the areas which at least fascinate a few of us, and for those who cannot be here to witness first-hand. My usual disclaimer: I do my best to be accurate, asking follow-up questions, taking extensive notes, and using photos or reproductions of elaborate charts and graphs to tease out and present in summary form, as these asynchronously live reports are edited and revised as needed afterwards, and turned into more polished articles, this year both for my own site and (in summary form) elsewhere.

FWIW: San Diego is sunny and pleasant, around 72 degrees plus or minus (depending on wind and proximity to the water). Some are dressed for Siberia while most locals are in short sleeves and hotel doormen wear shorts. Ah, California. For those of who have seen a summer of extreme heat, this is beautiful weather, and locals are enjoying it too.

Now onto the events, the first of which has just ended moments go (with the Official APA opening ceremony still to come at day's end, Pacific Time). Hope you enjoy.


APA 2010 panel - online mental health

Symposium # 1118:
Online Psychological and Mental Health Interventions
L-R: Drs. Acacia Parks, John Grohol(Chair), Helen Christensen, Azy Barak

Following a brief introduction by Dr. John Grohol (PsychCentral.com), and apologies that one scheduled presenter was unable to be present, the panelists each described their own experience with online interventions, not only in terms of practice issues and technology within our society, but with some very impressive empirical findings to underscore just how positive results can be from using a rigorously researched program and design/implementation of a platform upon which users might access a program or research study or self-help resource.

What was most striking to this psychologist is how much overlap there now seems to be between several formulations of "therapeutic" approaches, ranging from self-guided use of specific online tools or programs, to mediated online group experiences, to teaching "happiness" skills in an educative manner, derived from Seligman's work with "positive psychology".

The first speaker was Azy Barak, Ph.D., from University of Haifa, perhaps the most prolific author/researcher alive in the area of online applications and mental health activities, ranging from treatment and prevention programs to meta-analyses of the ever-increasing body of research relevant to online mental health activities.

Dr. Barak presented his recent research exploring salient factors in positive outcomes among support group members:

The Moderating Effect of Participants' Involvement in Online Support Groups

Azy Barak, APA 2010 - San Diego
      Azy Barak

Reviewing several studies and the wide variety of forms and applications of online support groups, Dr. Barak noted that in terms of effectiveness, in general "research shows that participants usually report of satisfaction and relief" following participation in online support groups. Such groups now exist widely all over the Internet, and are offered in response to a number of areas of distress, including but not limited to emotional, physical, social, medical and educational. Online support sites typically utilize "open forum" technology, but also take the form of chat rooms and e-mail lists. They may be unmoderated or have moderators, either professional or paraprofessional.

While there are differences depending upon the nature of individuals' particular area of distress or dysfunction, among the dynamics seen as exerting a powerful impact there are two major psychological mechanisms:

  1. The psychological effects of expressive writing (op. cit, the work of J Pennebaker); and
  2. Group process - following the classic dynamics described by Yalom.

In addition to the universal dynamics such as the development of group cohesion, online group processes which are clearly observable include universality, ventilation, mutual support and encouragement, advice giving and receiving, & learning.

In general the body of research shows that participants usually report satisfaction and relief, although debates continue (just as in psychotherapy outcome research into "traditional" f2f therapies) about "actual improvement" as validated by empirical indices of symptom reduction and lowered distress. [The old "effectiveness vs. efficacy" distinction!] While there is general agreement that participants in online support groups tend to experience an improved sense of empowerment and well-being, research also finds "personal differences" in experience of personal gain. Enter Azy Barak and colleagues.

Dr. Barak's series of studies have been oriented towards identifying exactly the nature of some of those differences, asking: "What are the reasons for the differences in research findings?" Not only are there differences between study findings, but also within groups within single studies.

Dr. Barak went on to describe a series of 4 studies, each using a different methodology and targeting a different population. The general hypothesis was that "level of participants' actual participation and engagement is related to their personal gains".

[MF - And we still need to learn *why* the most active netizens feel better. From holding court? having empathic feedback? Acting out? Rehearsing positive behaviors? Having social modeling? Having tons of objective support? Or is so much of the variance in results attributable to "personality" differences not so readily connected to our experience with Skinner boxes and BoBo dolls?]

Study #1: Adolescents in Severe Emotional Stress

The first study examined the level of online support group participation among adolescents experiencing severe emotional distress. This group was offered as a free, anonymous and open support group, in the form of a moderated forum. Twenty participants were surveyed after participating for at least 3 months. Each participant's level of participation was assessed by counting both messages and responses. In addition, three expert judges rated "level of distress" present in a sample of participants' messages.

Among the findings: "People who posted more messages in the first month felt better in the 2nd and 3rd months."

Study #2: Adolescents Experiencing Problematic Relationships With Their Parents

In the 2nd study - of adolescents with relationship problems with their parents - the support was provided using a moderated, closed, anonymous and free forum format. Forty-one participants were selected from a pool of 500, and agreed to participate in this research, which lasted for 10 weeks between pre-test and post-test, with Subjects completing self-reports before and after. Their number of messages and responses were also counted. As in the first study, the most significant findings were in relation to level of participation, as those with the most messages sent and received reported the biggest change in sense of "self image" (the strongest correlation to total messages posted) and also the sense of "social belonging" (the strongest correlation to total responses received). Both at a very strong significance level, (p<.001) - thank you Dr. Barak for sharing the data charts so I'm sure I'm seeing and reporting accurately!

Study #3: Adolescents Experiencing Social Isolation

Like the 2nd study, 44 participants were selected from the initial pool of 500, this group reporting high levels of social isolation: significant social problems such as shyness or painful loneliness. This too utilized a closed, anonymous, moderated forum format. Participants filled out a pre-test and post-test questionnaire, and as the other group, messages and responses were counted. Here the results were not significant in terms of changed "relationships with peers" (as self-reported), but there was a strong correlation between both sending and receiving messages and "self-image", "social belonging", and "social support".

[Hoping to see that one explained! Maybe that's a reflection on defining one's goals - and the experience was positive and self-efficacy building, even if it didn't change a sense of overall peer relationship improvement through group participation.]

Study #4: Comparison among Helped, Un-helped, and Neutral Participants in Various Online Support Groups

The fourth study involved 60 participants who were active with one of 46 online support groups for at least 3 months. Three groups of 20 each were identified, representing group members who explicitly stated they had been helped by their group, those who explicitly stated they were not helped by the group, and 20 who did not state anything about being helped or not by the group. In exploring the difference between these 3 groups, number of messages and responses were counted, as well as number of words and emoticons.

The findings were that members generally reported the experience had either "helped" or been neutral, with those who found it helpful being those who posted and received many more messages, and wrote more words, than others. [I wonder about whether the extent they were acknowledged/supported is a large factor, as opposed to (or in addition too) benefiting from the chance to express oneself in words.]

Dr. Barak underscored how level of participation needs to continue being closely studied, as it seems to relate to outcome, at least in these studies. In conclusion he asserted that across populations and methodologies, "results clearly show that involvement, engagement, and activity level - as reflected by active writing and interacting - are related to personal gain achieved through participation in online support groups." He noted that some research suggests even "lurkers" might benefit from their listening in, but in general he advises that moderators encourage active participation. Finally, he thinks that future research into online support group outcomes should also include participants' activity level as a moderator.

Q&A

Dr. Barak now took some questions:

Question #1 was about the role of motivation in continued participation, and Dr. Barak agreed this was an important dynamic, and related to the notion of "therapeutic alliance".

Question: Any impact of the severity level of presenting problems on outcome?
Answer: Didn't find any [in these studies]

Q: The moderators/group leaders who you called "paraprofessionals". What was their training?
A: All had at least masters' degrees in psychology or related subject, plus special training.

Q: Was there an effect relating to the group leader's training?
A: Not as relevant an impact as the whole experience.

Q: And what might be one of the key factors arising from the experience?
A: Motivation


Q: Are you saying participation level is the most important thing?
A: I guess that participation is not the ONLY factor which influences outcome, but this is what we focused on.

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The second speaker today was Helen Christensen, Ph.D., from Australia, whose impressive work with the Mood Gym and automated online CBT-based programs dates back to 2001.

Dr. Christensen's presentation flowed nicely from Dr. Barak's describing several shared aspects of research into online health treatments and client utilization (e.g., motivation/reinforcement as well as outcomes). She has been exploring quite a broad array of factors in online help-seeking factors, as reflected in the title of her presentation:

The Role of the Internet in Encouragement of Help Seeking, and Prevention
Helen Christensen, Centre for Mental Health Researcher UNU Canberra, Australia

Helen Christensen at APA - San Diego

Dr. Christensen began by expressing her great joy to be back in San Diego, which she's dreamed of since a brief visit 22 years ago. And then, into the heart of what she's learned since the launching 9 years ago of the Internet based Mood Gym:

To begin with, as some context, Dr. Christensen noted that today approximately 40% of depression sufferers and 74% of those with anxiety problems "do NOT receive evidenced-based help". ["Evidence based" is now a very hot term being used everywhere in the health/mental health fields, but sometimes "evidence" is not so easy to interpret or apply. You can see a discussion about this exact topic
here .] The "gist" of evidence important to share includes research findings that suggest automated e health applications can be effective in the treatment of depression and anxiety, as well as in prevention.

It seems clear that a need is there, for some type of treatment option for a great many people, but "clinical services cannot meet the demand". At the same time it is clear that "prevention is critical". These and other factors argue strongly for systemic approaches.

The Mood Gym, Dr. Christensen continued, has both understood and added to the research base that suggests that CBT (cognitive behavioral therapy) approaches can be shown as effective (i.e., "evidence based") across settings, and also be effective as part of an online ehealth system. The Mood Gym (with which I have no affiliation!) looks very sophisticated in terms of the actual user experience. The audience was given a virtual tour highlighting how the site offers a secure, confidential environment where users can monitor their own progress over time, all the while also offering a "portal for researchers". More than a dozen research projects have been done or are now underway @ the Mood Gym.

So what does the evidence suggest might be advantages of a CBT-based online program which is either self-directed or supported? On a practical level there are the large benefits of access, cost, volume etc., for providers. But what about benefits for users?

Dr. Christensen referred to a graph of positive effects for what she dubbed "personal psychotherapy online - admittedly, somewhat paradoxical" and not what some may envision as typical psychotherapy.

Several studies have found value in online treatments for the most common and most commonly underserved difficulties where relief might be sought online. On depression trials one study found an effect size of .08-1.1, A study on anxiety (Spence, 2006) found some value in psycho-educational approaches to panic disorder. With social phobia treatment, there has been a strong effect size as well. In sum, depression interventions had the strongest response to intervention, but there were positive effects attributable to online interventions for generalized anxiety, panic disorder, and also social anxiety disorder.

Which gets to the question one might be asking, about whether the Mood Gym is completely self-guided or therapist guided. (It is many things, actually.) A key question in research has been, "Do you need guided therapy or will self-help yield the same results?" If the self-guided, CBT-based treatments are shown to be as effective/efficacious as f2f therapy sessions, then it follows that this is quite cost-effective. So they did a study on cost-effectiveness, and did a comparison which found that the cost may be the same, in term of unit price overall. But, with automated systems what happens is there is a high startup cost, and the cost per-person is very low. Once you are at a point of serving 3000 people, it comes out to something like 5 cents per person! (She made the analogy to making a movie DVD - huge initial cost in the production, marketing, etc, and then the actual DVD's sold in the thousands or millions cost just a few cents to make.)

Dr. Christensen presented a map of the world, color-coded with users of the Mood Gym training program, illustrating 300,000 users from 203 countries worldwide: almost all of the world except a small part of West Africa. In addition to registered users, the site has about 37,000 visitors each month. Now, back to research.

A study was done in Australia, with 30 schools across the country, including in Aboriginal areas. (56% female, 17% living on a farm or rural area, mean age =14.33, 30% previously diagnosed as depressed, 34% having sought help from doctor/counselor). Following implementation of the program, there was at 6 months follow-up a significant result: reduction in depression, for boys. Girls seemed about the same. With anxiety, there was a positive impact on both boys and girls. [Could it be that "depression" did not respond to automated intervention because females, distinct from males, tend to cope through seeking social support rather than activity or escape?]

Barriers to Prevention Program Participation

Aside from treatment, it was hoped that program participation among basically healthy children might have a preventive value. They now know that for these children, those that were healthy at pre-test remained healthy - 6 months later.

So how do you prove the preventive value? To do this you need healthy subjects to follow over time, as well as those with difficulties who can be tracked for improvement. Compare with a control group and it might be a powerful study.

There turned out to be several barriers.

First: Engagement. "How do you get young people who are well to participate in a prevention program?" Younger people tend to dislike doctors, feel just fine, and are unlikely to see themselves "at risk". They may also feel stigmatized. Or be too dysfunctional to participate or simply not engaged. Perhaps there is an alternative? Do these teens need evidence? Basically it is felt that "giving information is not enough". At the same there is much evidence to support the power of social networking and "info-tainment" (e.g., YouTube) among many young people and it must be acknowledged how very powerful - and engaging - the Internet can be." The presence of incentives can be quite engaging too.

Barrier #2: Acceptance. "Some people feel 'prevention doesn't help'". There has been resistance among professionals in unexpected ways, too, such as attacks based on the feeling that self-help programs based on CBT will be "bad for real CBT". Still others conclude it is suspect or "unproven", etc.

Barrier #3: Adherence. The dropout rate has actually been "not as bad" as expected, given that up to 70% of patients drop out of face to face therapy. One finding which dovetails on Dr. Barak's closing comments on the value of moderation, is that "open" (membership) online sites have higher dropout rates.

Barrier #4: Safety - People believe that it is "not safe on the Internet"

The Beacon Project

Dr. Christensen introduced us to the
Beacon Project. Their site offers a user-friendly web interface, replete with smileys, and has been targeted at helping stress, PTSD, and Social Anxiety Disorder. One of the underlying assumptions of the developers is that it is possible to not only create a useful quality site but to create algorithmic rating tools - which can be automated - to quickly assess the value of a given web resource. This can be very useful if presenting a large compendium of web resources, and help to "identify and yield high quality websites."

Finally, Dr. Christensen repeated her belief that automated approaches might provide an effective tool to help people "immunize" against developing disorders.

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Next up is Acacia Parks, Ph.D., who was a student of Martin Seligman at University of Pennsylvania and who continues to research the development of "happiness" and work within the framework of "positive psychology", including at the UP Positive Psychology Center.

Acacia Parks - APA 2010

Dr. Parks began by explaining that much of the research being done [on facilitating happiness through positive psychology approaches] relates to people with "sub-clinical depressive symptoms", a large population given that this symptom constellation is "just as common as major depressive disorder" (MDD). This sub-clinical group also may be at risk for MDD.

Dr. Parks is currently conducting a study which is based on the understanding that there is a significant population online looking to improve their "mood", but presenting at a sub-clinical level. Unlike Dr. Christensen, her view is that CBT is not the direction where online intervention systems need to be headed. She mentioned two large studies of CBT, one at U of P and one at KPCHR (Kaiser-Permanente), both finding apparent effects, but of small magnitude (using the Beck Inventory). The components of the intervention were described as time-intensive and costly formats.

Here is "why I think cognitive behavioral approaches may not be best for a great number of people online", Dr. Parks continued.

First, there is the question of how to entice or motivate people to actively participate. No interest, unlikely utilization. The U of P study found that when offered a group intervention with an optional web supplement, "almost nobody used the online supplement".

Secondly, regarding CBT, "we just don't know" and it doesn't seem right therefore to just proceed with "psychology as usual - what's the problem and how can we fix it?" In contrast, Dr. Parks asserted that a positive psychotherapy (PP) approach yields the benefit of a positive emotional experience and fosters resilience. It can counter depressive problems without the need to label a disorder. And to counter anyone's worries about the potential for ignoring serious risk, we were reminded that these are sub-clinical populations, not actively suicidal.

Why the PP approach is ideal for this population:

Effectiveness:
Seligman, Rashid, and Parks (2006) found preliminary evidence of effectiveness for the PP approach. "It works [using] techniques for increasing happiness, not treating depression."

Motivation:
Additionally, there is the factor of motivation [which echoed Drs. Barak and Christensen in their description of "engagement"] (op cit Haidt 2002, 2004) Dr. Parks' observation is that "It improves with learning through positive psychotherapy."

Stigma:
"People may be more willing to pursue happiness than seeking to fix a problem."

Implementation of a PP program, finally, is said to be relatively easy.

Next Seligman's (2002) notions of the "3 Routes to Happiness" were presented: Pleasure, Engagement, and Meaning. (Here engagement refers to absorption in an activity, like a hobby. Meaning refers to "connection to something larger than oneself".) Pleasure also has 3 aspects, emotions about past, present and future (Seligman, 2002). The "Flow Concept" was also briefly mentioned.

[Seligman/PP fans can find additional reports from past APA conventions where Seligman and others review the studies and philosophy.]

There has been a recent study, with participants recruited through Seligman's website (
authentichappiness.org) , and undergoing a 6-week program consisting of completing 6 different exercises "targeting very different aspects of happiness", and done online, using a "buffet" of homework assignments. [Doesn't this sound just a tiny bit like a CBT approach? Yet a key philosophical difference seems to be the cognitive framing of learning happiness vs. treating an illness/problem.] The program involves "maintenance" of learned positive thinking tools, as well.

In what Dr. Parks presented as an Outline of Positive Psychotherapy, she presented the six exercises which involve targeting pleasure, engagement, and meaning:

Dr. Parks described some very dense data analyses of a study where 661 self-help seekers were recruited through authentichappiness.org . Although well designed and with a strong number of Subject/participants, and built-in mechanisms to follow Subjects over time (1 year) findings are limited thus far in terms of definitive results, although promising. Dr. Parks noted how there have been additional considerations being generated through recognition of the initial study's limitations. For example, what might be lacking in terms of engagement is that the current online format is not interactive, it lacks a sense of community or group, and the distance may mean "less accountability". Finally, like Dr. Barak, Dr. Parks has some questions which emerge from the literature thus far, and beg for further research. She would like to look at individual factors, such as the exercises and explore which seem to be most effective. She's also like to get some baseline data on symptoms, happiness beliefs, and look more closely at person-activity fit.* [* I just love the latter term, as my own dissertation, 25 years ago, was titled "person-therapy fit" and led to a lifetime of interest in the same question: what works best for whom, in what situations, as the mantra of psychotherapy outcome research goes.]

Future directions include studying aspects of people's beliefs about "the nature of happiness" and "person activity fit".

In conclusion, great potential is seen for online application of what Dr. Parks dubs "positive psychotherapy", although she uses this term pointedly and was quick to point out that in fact this therapeutic endeavor is seen as teaching happiness rather than un-teaching mild depression through traditional open-ended (or CBT system) psychotherapies.

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John Grohol spoke briefly and shared some observations about the present landscape as had been discussed. Finally, he engaged the panel in some final questions and a Q & A with the audience.

John Grohol at APA Convention 2010 - San Diego

Dr. Grohol is well known, among his many accomplishments, as the founder of PsychCentral.com, co-founder of ISMHO.org, and observer/promoter of online mental health applications and activities for the past 15 years. He began with a few salient statistics illustrating the extent to which people turn to the Internet

35% of US adults now use social media for health and medical purposes ; Fully 40% of US adults online search for health information, each month. (Fox 2009, Pew Internet and American Life Project)

Presenting a timeline, Dr. Grohol traced Internet history from the 1990s into the 2000's, with more interactivity being taken advantage of with the rise of Facebook and MySpace, for example. In 2001, Mood Gym was launched (and today has 300,000 users). In the 2010's, it remains to be seen "what will catch users attention next" [op cit Jan Bergrstrom, the absent panelist, and colleagues, with research demonstrating the benefits of guided Internet CBT] And then there are exciting developments such as the evolution of the Beacon database, offering portals now into 90 programs. (Some are restricted, for example in the UK, where some treatments require prescriptions).

Dr. Grohol concluded by opening up a Q&A session, beginning with a question of his own about "adherence" (similar to "engagement"). Dr. Christensen mentioned how her study had used an iPhone as an incentive, with the added benefit that it required participation and the iPhone-submitted feedback was automatically tallied.

Dr. Barak was asked about the value and power of support groups in general and responded that "it's a question of expectations" and that "more guidance" appears helpful, along with feedback, such as many now are accustomed to with FB apps.

Dr. Grohol asked, should we then "be reaching out more to where people are", e.g., looking towards FB applications rather than focusing on driving people to our own sites? Dr. Parks agreed with reaching out to where the users are, and repeated that using a tool like an iPhone can be enticing - "get a free iPhone but answer 3 questions a day".

Question (from audience): Where do clinicians fit into this world? Are these things supplements? Are these interventions only for the 80% who would never seek intervention f2f?

And we end with such questions to ponder, along with reflections on the promising results being seen thus far.

Next up: A discussion quite relevant to online and also offline clinical practice, with a panel of esteemed experts in ethics and practice:


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Ethics and Evidence-Based Practice

Discussion #1280: Is it Unethical to Conduct Nonevidence-Based Practice?

This event was skillfully moderated by Dr. Mitchell Prinstein, directing important questions for today's practitioners towards a panel of experts including Drs. Katherine Nordal (APA's Practice Directorate head), Scott Lilienfeld, Bruce Chorpita, and Gerald Koocher (editor, Ethics and Behavior).

This is quite a dense and passionately debated topic, "evidence-based treatment", with ethical and "best" practice requiring this, but with tension arising from the options that have arisen, such as rigid, "manualized treatments" or the prospect of no treatment at all where there's not a body of documented solid "evidence". Hugely important topics, which cannot all be covered here, but hopefully this will provide a flavor of the issues and concerns as discussed by those present today.

Dr. Koocher and others referenced the extant model of APA policy regarding evidence based practice, seeing a "3 legged stool" that not everyone fully subscribes to but which basically calls for awareness of 1) Best research based evidence 2) clinical expertise 3) Patient context

Dr. Koocher was blunt: he'd like to throw out blind allegiance to a 3-legged stool, noting as a point of fact that a bench does very well on 2 legs, just as a well-cemented one-leg chair can be solid. With a tripod model, each of the individual legs bear scrutiny.

Some important points include how in the real world "clients have preferences" so that while evidence may show a combination of medication and therapy to be most effective, a parent may not want the medication part. Therapists too may have preferences which can include ingrained but untenable allegiance to particular "schools" (for example trying to treat enuresis psychoanalytically, as opposed to providing a bell and pad, at risk of being called guilty of "symptom substitution")

Dr. Chorpita asked how the 3 legged stool works if a proposed treatment is "not on the list". [I later asked where one might even find such a list - it is not easy!]

What if a seemingly effective treatment is "in front of us" but it's not proven? Dr. Lilienfeld recalled Paul Meehl's observation of therapy being a "hybrid between practice and art" and agreed with Dr. Chorpita's point about the importance sometimes of "local evidence".

Dr. Nordal agreed with Dr. Koocher's earlier comments: "The best prescribed care in the world can go nowhere", as with a patient simply being non-compliant, and thus it is important to note "clients' preferences combined with our understanding of what's best for that particular patient". [Some discussion of appropriate treatment for enuresis ensued, given context and facts, such as age, etc.]

Dr. Koocher re-iterated a mantra shared by many over the years: "The critical thing to evoke change is the therapeutic relationship". This is not merely a fact borne from research, but a consideration in such cases where a client has a strong preference. The importance of a truthful, meaningful informed consent process was underscored.

Dr. Lilienfeld agreed and reminded us: quot;We have a role as a clinician also as a persuader". [E.g., encouraging a proven treatment, fully informing of risks, etc.] Dr. Nordal added, "A client may not have a preference for something but it may be because they're uninformed.".

And thus informed consent is doubly important at the beginning of a therapeutic relationship, both to be educative as to what evidence exists, as well as honest about the risks and expectations should the client decide to begin a professional relationship which is founded on honesty and best practice tenets.

Dr. Koocher repeated a point about "the value of human judgment" and recalled struggles over the pressures to develop treatment manuals, ultimately suggesting at times that one "read our manual and adapt your techniques to a specific client, as you know how to do. We treat real peole in the real world and they all look very different."

Dr. Prinstein (moderator) asked: "What do we say to a clinician for 20-30 years, who says 'I know the debate but I know my community and what I'm doing is definitely helpful'?" Dr. Koocher responded that "the 1/2 life of a doctorate is 7-8 years", i.e., "half of what you learned is obsolete". This person may need to ask if they're practicing appropriately, as in being aware of best practice through continuing education.

In addition (bearing on the isolated or entrenched clinician), Dr. Nordal commented that "one of the most dangerous things is clinicians who don't have contact with colleagues. CE is one way to do this. Isolation - and maybe big egos - can get some psychologists in trouble."

Dr. Koocher added that it's not just psychologists who make mental health treatment decisions, and it is the case that "most psychiatrists under 40 have not had psychotherapy training". So if someone walks in, say for ODD, most likely they leave with a prescription, and without any discussion of parent training. The question then becomes, how does one disseminate the "evidence"? Not only to psychologists but to allied professionals and general public, in addition to CE? [Continuing Education]

Following the presentation I spoke briefly with Drs. Koocher and Nordal, and then an APA practice leader to whom I was directed, in my search for the aforementioned, iconic "list" or even a database of what is considered "evidence based best-practice", across diagnoses, contexts, etc. Nothing online was named, but one recommendation was the APA (print) publication, "Treatments that Work". (Is it on Kindle?)

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Last stop for today is Opening Ceremony 2010, Carol Goodheart, APA President presiding over this 118th Convention.

En route to the ballroom I stopped in the Exhibit Hall (briefly - with so much writing to do!) - and will say that one highlight this year is a case displaying Albert Bandura's original Bobo doll. (If anyone really wants to see it, I'll share a photo.)

Also the APA is giving out what looks like small coffee mugs - and they playfully tried to trick me! But they are actually squeezable mini-mug stress reducers/ADD channelers.

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Opening Ceremony

Opening Ceremony 2010 was a very slick and hi-tech extravaganza with huge triple-screen videos of APA's 2009 accomplishments, recognition of several groups, a chat with Norm Anderson (who shared how he gave up basketball to study psychology, though his initials forever remain NBA), and an award for outstanding lifetime Contributions to Psychology for Shelley Taylor, Ph.D

Next up, on this lovely set reminiscent of a tv talk show rather than a fixed-podium lecture, a very special guest joined Dr. Goodheart: Former First Lady Rosalynn Carter. She was asked about her own longtime commitment to supporting caregivers, and then more broadly, mental health.

Rosalyn Carter at APA 2010
Rosalyn Carter receives APA award

In her thoughtful, Southern accent reminiscent of husband Jimmy Carter (who she referenced several times in recalling her activities as her husband was campaigning), she spoke of her early experiences seeing poor healthcare and fighting to improve it, and her later huge efforts to reform healthcare/insurance and "pass Parity" legislation for mental health care (which is now, years later, a reality).

Mrs. Carter's early concerns focused around "burnout" of caregivers in a small community, and exploring what they go through, including at "the most emotional meeting I've ever seen - people in the audience were crying". It was evident that "nobody had ever labeled or identified the stress of caregivers. And that's how it started".

The former first lady shared several memories and anecdotes, such as her memory of being in the midst of crusading for caregivers and mental health, and running into Jimmy Carter while he busy campaigning (for governor). As he extended his hand to hers - he was on a long line shaking every hand that came towards him - he was surprised to see himself looking at Rosalyn. She asked him like anyone else might question a candidate on the stump, so "what are you going to do about mental health?" "I'm going to create the best program our country has ever seen and put you in charge of it", he replied.

Mrs. Carter was asked about the role of stigma - which is a big issue - and she really didn't have an answer in terms of a solution, venturing only that she's hopeful "parity" might help.

Rosalyn Carter has recently written a new book entitled "Do What's Right For Mental Illness". This has been an enduring passion of hers for decades and she is still advancing the cause.

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Lastly, we were treated to this year's ...

Keynote Address:

Daniel Gilbert
Daniel Gilbert, Ph.D.

The keynote was delivered by author & Harvard professor Daniel Gilbert, Ph.D., widely known for his book, "Stumbling Upon Happiness". His contribution includes looking at "how people predict their emotional reaction to forthcoming events".

Dr. Gilbert was a dynamo on the stage, and presented a vivid and humorous slide show along with his stories about popular misconceptions about happiness, among the general public and as distorted by his mother's traditional views of what is needed for happiness.

He began by debunking the popular notion of "What is happiness", beginning with the historical context that throughout most of time life was "nasty, short & brutish" and the goal of life was to get out of bed and live. And there are predispositions: "Right out of the box, I wanted fat and salt!" People think happiness comes when you get what you want. We've had agricultural, industrial, and technological revolutions. Now we have everything. Right? So why are we not happy?

For starts,"Genes are selfish. They don't care if you're happy, they just care that you pass them along."

And then there's culture. The same thing. It doesn't care about DNA, it just wants to be passed along.

Up on the screen: a drawing of Mother (his), and the introduction that Mom means much more than advice that "you need to wear clean underwear so if you're in the ER they'll think you come from a good home."

So what are the causes of happiness - according to his mom (~traditional popular opinion) versus according to research?

#1 Marriage and Happiness. Does marriage make you happy? Or does happiness lead to marriage? ("Who wants to marry Eeyore if you can have Piglet? Happy people are better marriage material.")

#2 Money. Can money buy happiness? "No? Have you spoken to someone under a bridge in a cardbard box? Anyone who says money doesn't buy happiness... Say 'ok, give me yours'". Seriously, $40-70,000 is about "all you need to buy happiness. A lot of money doesn't buy a lot of happiness. People with lots of money just have better toys, they have better nutrition, healthcare, control over their lives... If money doesn't make you happy you're not spending it on the right things."

[ Happiness.... Want to track your happiness? "How about an iPhone app? trackyour happiness.org "]

What impacts happiness? Work, commuting, TV, talking, sex, rest, social interaction. Is just "resting and relaxing" (the goal of many) happiness-inducing? No, because then the mind doesn't rest, it wonders. We are happiest in the present moment.

One last mother's theory for now - and that has to do with the happiness that is borne from children. Well, yes and no, according to much research. No surprise - it differs by gender. And the happiness spike, following the new addition, may be mitigated at the least.

"Economists tell you we pay for what we value. Psychologists know we value what you've paid for. Children cost a lot". And a new baby may be wonderful, "but you don't have sex, socialize, or travel to Europe any more." He said that when he cites these findings, "younger women throw things at me" while older women tell him how wise he is. Children are clearly a joy and blessing, but "children can crowd out joy".

Note - Dr. Gilbert wanted to be clear: "I never said children are the source of all unhappiness! Maybe we don't raise them right! And... As my mother would say, 'what's happiness?'"

Conclusion: 1. Mothers can be mistaken 2. Call your mother anyway.

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Well, that is it for today, Day One of APA 2010.

Big day tomorrow, into the night, but will report as I can.

Regards from San Diego.
Be happy. :-)

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Asynchronously Live from the APA 2010 Convention - San Diego, 13 August

Hi all. It's a lovely, slightly warmer day today in SD and my day began with a presentation/discussion by Sir Michael Rutter, moderated by past-APA president Richard Suinn, Ph.D.

The topic:

From Individual Differences to Resilience: From Traits to Processes
Sir Michael Rutter



Sir Michael Rutter

The introduction to Sir Michael Rutter was extensive and effusive: While Sir Michael Rutter is to some synonymous with "resilience", long before the recent attention to this subject, he was already considered to be "the father of modern child psychiatry", with more than 40 books to his name, and numerous awards and honors, not least of which was Knighthood.

[At the end he was asked by Dr. Suinn to describe his experience of being knighted, and naturally obliged, with good nature and great humility.]

Sir Michael Rutter described the development of his interest, from his family origins to his work studying stress and coping mechanisms (op cit Gamezy & Rutter, 1983) to his growing interest in longitudinal studies suggesting there may be some "protective factors". As a medical practitioner he was aware of the ongoing tension between genetic factors versus environment, and throughout this presentation referred to their interaction [GxE], and how there is a process, distinct from static traits, which can inoculate.

"My book on 'Maternal Deprivation Reassessed' in 1972 concluded that children differed greatly in their responses to deprivation and suggested that genetically influenced variations in environmental susceptibility might be important."

During 1979-1980, while at the Stanford Center for Advanced Study in Behavioral Sciences, Sir Rutter became engaged by the early research looking at stress, coping, and development. (op cit. Garmezy & Rutter, 1983). It became apparent to him that single variables or events might not tell the whole story, as in some cases we see good adaptation in adults who had to overcome early negative experiences.* Neither genetic nor environmental variables alone seemed to be plausible explanations. Sir Michael Rutter continued in his quest to better understand (and potentially harness) the power and nature of "protective factors". He was influenced by animal research into stress responses as well as in genetic and other human factors. One specific variable which may interact with genetics and environment to be preventive or foster resiliency, may be prior exposure to risk.



Prior Exposure to Risk as a Preventive Factor

"During the 1979/80 year at the Stanford Center for Advanced Study in Behavioral Sciences, I took part in a group dedicated to understanding 'Stress, Coping, and Development' (See Garmezy & Rutter, 1983). For me, that was a formative year in numerous ways but one aspect, through talking with 'Gig' Levine, was to renew my appreciation for animal models.... [Levine's rodent studies in the 1950's] were influential through the demonstration that animals subjected to physical stressors showed an increased resistance to subsequent stress.

I also became aware of parallel human studies by Glen Elder (1979) showing that adolescents who coped successfully with the stressors of the great economic depression emerged strengthened."


[*Two points for possible discussion: First, the notion which captured Sir Michael Rutter - how under fortuitous circumstances, one overcomes prior disadvantages - is consistent with Harry Stax Sullivan's notions (e.g., in The Interpersonal Theory of Psychiatry) about "fortuitous circumstances" being able to counteract one bad period stage later on. Secondly, Sir Michael Rutter, whose name is synonomous to many with the study of "resiliency" made the point that there is no basis at all for applying formulaic resiliency training programs and expecting them to have positive results.]

We are clear now in understanding that there is a gene/environment interaction which acts along with other factors to work preventively, or contribute to what is now being widely discussed and despite his trepidation, "taught" - "resilience".


Resilience = Relative resistance to environmental risk experiences, OR the overcoming of stress or adversity, OR a relatively good outcome despite risk experiences. - Sir Michael Rutter


"Resilience is NOT", said Sir Michael Rutter, "just social competence or positive mental health".

There are various coping mechanisms which may inoculate against damage, which Sir Michael Rutter refers to as "the steeling effects" of coping strategies. One example might be parachute jumping, where "parachute jumping leads to physiological adaptation" and a normal sort of steeling against fear or physiological survival responses. Generally, "if you want to be resistant to infection the worst possible thing you could do is avoid ALL exposure". One needs to develop some resistance/coping mechanisms. Add to this psychological defenses in addition to physical, and notions such as Bandura's sense of self-efficacy come to mind.

Sir/Dr. Rutter posed and answered some "provocative questions" such as "Is resilience just a fancy way of re-inventing concepts of risk and protection? No, because risk and protection start with a focus on variables and move to outcomes with an implicit assumption that the impact of risk and protective factors will be broadly similar in everyone, and that outcomes will depend on the mix and balance between risk and protective influences."

Do resilience concepts reject traditional study of risk and protective factors? No, because " 1) there is an abundance of evidence that much of the variance in psychopathological outcomes can be accounted for by the summative effects of risk and protective factors; 2) Resilience is an interactive concept that can only be studied if there is a thorough measurement of risk and protective factors."

One last point he made, for now: "Schools trying to teach resilience like the ABC's are bound to fail."
Real-life education about coping techniques is more likely to work. Schools, take note!
 
Suparna Rajaram
Suparna Rajaram, Ph.D.

Invited Address #2184 - Social Influences on Memory
The Perils of Learning and Remembering with Others

This presentation on "social memory" was quite interesting, but very dense in research presentation, charts, graphs, etc., so I'll try to hone that into a more easy-to-digest report next. The key "takeaway" for me was that what I learned as "state dependent learning" is indeed a factor in the research findings, but more than the environment, the presenter's research focused on how groups organize, check, and supplement individual memory, in either normative or collaborative groups. While the results tend to highlight how individual learning, rehearsal, and repeated recall are the most robust determinants of memory, and group learning can actually inhibit recall, except by the group. And there can be group distortions also. So the question may be asked, "Are two heads better than one?". Maybe. But there were some silver linings to suggest some value in some types of group learning, particularly keeping in mind the power of organizing the retrieval activity effectively, which for me is akin to teaching effective executive functioning skills. Schools might do well to take in some of the research here, just as Sir Michael said with regard to "resilience education".

To be continued. I just have a few moments free (now gone as I rush back to Ballroom 6A) - as Phil Zimbardo was unable to present what was scheduled right now, as he is recovering (according to F. Farley) from major surgery, successfully so that he has not had to do battle with Lucifer. ;-)

Regards from San Diego and APA 2010, asynchronously live from the Convention.

Michael


Asynchronously Live from APA - San Diego
Day 3 - Saturday

Today I found some really interesting topics and great presenters. First I attended a perennial fun event, APA's Deft Comedy Jam, which followed the tradition of opening with some sing-along to Albert Ellis songs. [oop, I think I did not post a report about a tribute to him earlier, hosted by wife Debbie Joffe-Ellis - I'll add that.]

This get-together featured the anthropologist who worked to develop Chemistry.com (the dating site), along with several psychologists and host Frank Farley, Ph.D. This basically was a fun and funny time for poking fun at psychology and human foibles generally, with an open-mic joke-telling segment at the end. Plus some stand up comedy and a great skit with Drs. Ellis and Farley, in a Nichols & May like therapist/patient dialogue. And now, from the lighter side to a more serious side: ethics in the digital age.

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Next up: former APA ethics chair Dr. Jeffrey Barnett gave a presentation entitled:
 
Ru red e 4 ths? The Practice of Psychology in the Digital Age

Jeffrey Barnett, Ph.D.

Invited Address #3300: Jeffrey Barnett, Ph.D.

Dr. Barnett had presented on this general topic in 2008 - and an article about that is on my site
here. Some of the threads this year were familiar, such as the cautionary words about boundaries - especially in the sense of "friending" issues regarding patients & therapists -- and generally being mindful of what is out there online, and knowing the limitations and demands of confidentiality and privacy. Issues of trust, issues of appropriate behavior by therapists, and the value of having a specific policy were more front and center now, and this is one of the things which I will expand upon to provide you with some of the resources he spoke of, such as sample informed consent letters regarding social networking policy. One physician, for example, sent out letters to all his patients pro-actively stating his policy regarding FB "friending" requests. One psychologist, Dr. Keely Kolmes, has devised an informed consent which was put onscreen and was said to be findable on the APA website. [On Dr. Kolmes' website you can find her informed consent statement regarding FB, twitter, etc. - an Adobe .pdf file .] Aside from some new tools for these new times, Dr. Barnett also updated some of the demographics on Internet and social network usage.

Dr. Barnett again referenced what he has learned from his own daughters (such as the value of an unlimited texting plan) and the importance of adhering to best practice, but he made a point of also acknowledging that nothing is set in stone such that one should be rigid, and that sometimes borders are crossed with good results.

Dr. Barnett began by noting that in speaking about the practice of psychology "in a digital world", this covers a lot of ground, from the basic and the "smart" phone through use of Skype based therapy happening on Naval vessels. Surgeons in Bethesda, for example, can provide live support to medical workers on ships.

When it gets to therapies online, which he described as "a subset of telehealth" more broadly (while acknowledging several other terms), there come into play a variety of ethical issues. There is a prime concern with guaranteeing confidentiality, and in this regard use of encryption is important. There are additional issues of jurisdiction, as in this digital age the notion of boundaries have changed, and the digital world is an international one.

Clinical issues-

Dr. Barnett summarized the well-known challenges to effective online work, one of the biggest being the absence of visual and verbal cues. Confirmation of the other's identity is another. The entire environment is "rapidly evolving". As of May 2010 (Time 5-31-2010, p.15) there are now 4.6 Billion cell phone subscribers worldwide. [I would add that it is not only our love of connectedness and gadgets, but when it comes to "worldwide", in some contries Internet service cost, or the cost of electricity for a computer, lead citizenry to choose cell phones/SMS rather than sit-on-a-desk computers or laptops.]

Facebook -

Some extreme behaviors are being seen, such as the boy reported upon by the Washington Post (2009) of one American boy who sent 6473 messages in one month. Aside from the time devoted to this, there often is heavy cost. Parents of teens now are learning, from this and other examples, it may be cost-effective to choose an unlimited-texting phone plan.

A few statistics: Facebook (2009) reported 3 Billion minutes are spent on Facebook each day... Or, if time is not so precise a measure, 18 million users update their page each day. There are 500 million active users (up from 400 in 2009) and it seem clear that many people enjoy mediated communication. FB is also available in over 60 languages, and based on population is equivalent to the world's 6th largest nation.

Dr. Barnett asked for a show of hands to see how many people are Twitter users. Despite the presence of a wide age range, including college students, only one hand went up. There was general agreement with the limited value of getting interrupted by such pithy announcements as "I'm bored" or "It's sunny".

A few cartoons illustrated the likely future if we end up as a tweeting society, like texting "Yes! Yes I will" at one's wedding.

Generational Differences -

While some online interests may be widely shared (e.g., Facebook) in some cases there are clear generational preferences and/or differences. Prensky (2001) spoke about there being a clear difference between "digital natives" (born into the technology and knowing nothing else) and "digital immigrants", newly shifting from habitual technologies to newer ones. Digital natives don't print things out, as they simply keep what they need in their device. "If you're a digital immigrant and your client is a digital native, will you have a communication problem?" [The classic Prensky article is available as a .pdf/Acrobat file
here.]

Where might this end? Dr. Barnett showed another cartoon - this time of a baby in a maternity ward crib, texting: "OMG, I just got born!"

Next Dr. Barnett played a clip of the May 2010
SNL appearance of the beloved Betty White, now 89 years old, addressing the audience who petitioned the powers that be through the power of Facebook - which she'd never heard of, though she acknowledged that when she was young she did use Phonebook. (But not all day.) She thanked the audience profusely and explained that she never before knew anything about Facebook. But now that it's been explained, she understands: it's a tremendous waste of time.

Social Networking and Social Networking -

Here Dr. Barnett reiterated the overview he presented in 2008 (as described elsewhere on this site), focusing on the particular thorny issues of how to handle "be my friend" requests (when ethical codes forbid f2f/RL dual relationships) and how it is both an ethics and practice trap to go trawling the Internet to find out if a client is accurately portraying his/her life - although we know the client may well be checking on us. And if they find pictures of us on Spring Break '96? Nothing disappears from "online" and we can have our privacy disappear through friends' links on Facebook, or being tagged or identified in a group photo, anywhere online, forever. So caution and a plan (i.e., informed consent, discussion before treatment) are prudent.

Informed consent is of course proactive - and helpful in terms of setting up ground rules and turning to the building of a trusting relationship. Written policies have gone out from physicians and appeared on web sites of psychologists. One such model disclaimer letter (developed by Dr. Keely Kolmes) is available on her site at http://drkolmes.com

Facebook and Threats to Privacy -

Most of us familiar with FB over time are aware of the privacy policies seemingly becoming less and less protective as each round of protests by users heats up. But by default, 2nd-generation links (friends of friends) and other avenues end up sharing "private" information with others beyond what we think we have set (i.e., friends/family only, nobody, whatever). The level of fine-tuning ability has gone down while the FB Privacy statement is, as one person said, "like Swiss Cheese". Actually, just before this presentation, at the APA Deft Comedy Jam, a presentation about media included the fact that the FB Privacy Policy has more words in it than the US Constitution. (I'll leave it to you to decide which is more clear and/or protective.)

The NY Times published a list of privacy concerns recently. (Dr. Barnett again said his background links and resources are listed on the APA site. I might add to the list
this recent NY Times article which appeared [18 Aug 2010] several days after the convention, sounding concern about FB's continuing assault on personal privacy with its new location tracking application, Places. And then there was also Google's founder saying this month (August 2010) that the only way to escape your online profile is to change your OFFline identity! Food for thought?

Searching for one of the resources Dr. Barnett mentioned, a compendium of Privacy Issues, I came across this excellent
resource page - a veritable clearinghouse on Privacy Issues - assembled by the NY Times. Perhaps the mentioned list is there, but already the concerns and list of articles has grown, seemingly each and every day.

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For now, it's time to get to the next event of the day (for me), and finally a brief stroll around the Exhibit hall.

Next up is a legend in psychology, the magnitude of his accomplishment and skill I'd not really fully appreciated until the introduction and listening to him. This is someone who exudes a passion about helping individuals and also the human condition within society, as several in the audience attested, one having made some wrist bands to give out in acknowledgement. Dr. Steven C.Hayes.
 
Be forewarned: there are bits of literal transcript here that may seem disjointed. But that's how he presented, powerful sound-bytes and time-shifting back to formative events, personal and societal, and then circling back to a conceptual point or another point in time. Then silence. And more passion and poetry. It was a riveting, hypnotic, brilliant presentation. For me, only slightly familiar with either the details or fame of ACT, this was eye-opening as to why Dr. Hayes is held within such high regard by peers. Being mindful himself, of time and place, Hayes explicitly said he was not going to try to explain ACT, although some of the profound explorations he shared included some results of using this specific approach. (Remember, we live in evidence-based times!) But even without the results of studies, just following his ideas about human nature, and the sea of language we are swimming in, objectified by words of others, and by ourselves...

I can see why this extraordinary man is so inspirational and admired. This afternoon he shared a mixture of personal anecdote and human experience, not promoting any specific technique or brand, or hammering home any one specific take-away message, except maybe what the title of the presentation hints. The world really needs people who can rise above what Hayes referred to as the sea of language - the distortions, the hype, the blame, the objecifying, and doing it to both others and self. That was my reaction. Here's the presentation.


Steven Hayes
Invited Address#3343
Steven C. Hayes: What Psychotherapists Have That the World Needs Now


This was an extraordinary experience. Introduced by the American Psychological Association's CEO (and Hayes'college roommate!) Dr. Norm Anderson, Steven Hayes was described as one of the world's most infuential psychologists, known for his widely regarded ACT (Acceptance & Commitment Therapy), and also for the philosophical/linguistic underpinnings and his placing an emphasis on "mindfulness".

Speaking in a gentle, Southern-tinted voice, Hayes immediately captivated the audience with a slide referring to the 1950's, black & white television, and his witnessing his mother's reaction to the TV when seeing something relating to the Holocaust on the tube. (She spit at it and turned it off.)

1956. A little boy watching his mother.

He didn't understand at the time. But he knew something powerful had happened, between what was shown on the television and the reaction of his mother. Thirty five years later he gave the name of his mother's assumed name (to escape sure death), to his own daughter.

All the while, we watch horrors - images of the World Trade Center burning,etc. While we all remember that disaster, "what if it were suitcase bombs in the city?". Perhaps 10 years from now it will be online, how to do this effectively.

OBJECTIFICATION

Objectification is all around us. [Up on a big screen: Graph of hatred pre and post 9/11. One sees it never returned to the earlier level post 2001.]

1961. A black man in a bowling alley. Being made fun of, in degrading terms

Are we better now?

Now is a new era of "objectifying" people, groups, ideas... Immersion in a new Television era of hate-talk and polarization evoked by a continuum from Fox "News" to MSNBC, and the echo chamber's intensity. "Lack of compassion. Objectification". Everything is black and white. Speaking of which, Hayes noted that he has a Latino wife and African American daughter, himself. He continues...

It is now 1972, and they are in a Southern club, with a swimming pool. A man stops to comment to Dr. Hayes, "Your baby... is a little... brown..." He knew then they'd be leaving.

"The ubiquity of objectification. It's everywhere!" He displayed a photo of a very obese person (later noting that this is one class of people who get very little sympathy or relief from blatant ridicule). Next, the image of George W. Bush appears, and evokes expression of both distaste and laughter from the large audience. Everyone reacts. Have we objectified?

Hayes continues. It's not enough to say that others are doing this, being cruel, and objectifying. "We do the same to ourselves. And if we're not lying to ourselves, we know that it's true."

1978. Sitting on a bench on the campus of North Carolina- Greensboro

There is a way to change psychotherapy. A way to change our thinking. If that is true, we need to know about what the human language and condition is.

Some aspects of language are described well through relational frame theory. Seen from this perspective,

Language is:

Dr. Hayes now introduced a slide with 2 different sized circles. "Even a cockroach", he said, "can learn to choose the bigger of 2 circles."

Three year old humans are busy learning concepts such as symbolism and quantity. Ask a 3 year old if they'd like a big nickel or small dime, they'll know it's money that buys candy and the bigger one (they think) is the best choice. By age 5 they choose the dime.

"Such processes are necessary for problem solving". One needs to learn symbolic categories.

Of course, "problem-solving is also a curse", for example being good at remembering and wondering about painful things... "I can torture myself with how I should have more, or how this is, what I should have been... If we can choose the dime we can torture ourselves."

A SEA OF LANGUAGE

"We are swimming in a sea of language". In a poetic and brilliant burst of prose (which I could not catch all of though I tried!) Dr. Hayes tied in our use of language to what's being done by Fox and MSNBC (in polarized, objectifying opining), adding to our "feeding like pigs in a trough on the insanity generated by our own culture", driven by iPads, instant messages and tweets, et cetera. In general, "the more sick and twisted and perverted something is, the quicker you can find it on the Internet. There's a YouTube video." We have YouTube on one side, the NY Times on the table on the other side, and info-tainment TV droning before us, masquerading as news.

"The more you watch the more objectifying of women you develop. The more objectifying of all sorts of other things, too."

Objectification. Judgment. Lack of Acceptance. "Guess what? If you can apply it to others you can apply it to yourself. And if it's not you, then it's the person sitting on either side of you."

1984. Watching my African-American daughter come into a room. And seeing the reaction.

Carrying the Burden of History

"We've put science and technology on steroids. We need to create modern minds for the modern world. Mental health professionals need to solve it because the politicians sure ain't gonna do it!"

Putnam 2007. "I like being."

"You can't just do this social policy thing and expect we're going to see modern minds for this modern world."

MINDFULNESS

Mindfulness - work on this "is exploding". Why? "Hippies grew up and the crazies drive the bus."

1982 - The Panic Attack from Hell

"Pain in the chest. Left arm numb with radiating pain. Clearly it is a heart attack. And I know it's a panic attack." He had a shift of attention. He survived. He has always been interested in noticing shifts of attention. In order to see you need to know: "There's more to you than your history. We have a spiritual side. We can say that."

The science is increasingly saying one thing while media tells us another. It is important to use and understand words "to change your frame".

"Psychological flexibility: We want people to be open, active, and centered. The Buddhists are right."

Dr. Hayes paused to tell us that he doesn't want to get into technical talk about his particular "brand name" therapy (ACT). He wants to talk about flexibility and its role. And he will give some examples of how to put this into action.

Dr. Hayes emphasized the importance of "self acceptance" and cited research on variables which promote flexibility or predict it. He spoke of shame, and a study of applying his principles to international students from Japan, resulting in a positive impact, and seeing still more potential.

Here, finally, are a few more bits, from his concluding remarks, tying his life observations to his theory and relating it back to how therapists can be truly helpful.

"So what do therapists have that the world needs? A focus on what you value. Don't erase the past, carry it forward!" We need to address and channel our painful past burdens, not hide it away. Indeed, he said, "Inhale it!" He continued again to poetically argue with great passion, for a new paradigm to truly understand the past and present within people's lives. Actively.

There was an audience Q&A -

Response to a question: "We move in spirals, not in leaps. And we stand on the shoulders of others. For the first time, Western science is reflecting on acceptance and mindfulness." [While ridiculously polarized media circuses of hate and polarization and objectification are rampant.]

Q: Any thoughts on the objectifying of mental health professionals?
A: Don't professionals flip it? Like, 'You're a borderline'. I don't believe you can solve it by saying, "you said it wrong". Or, like "moron". It was a word. [He elaborated on how words have power and are objectified too.]

Dr. Hayes concluded by saying that his vision for "a modern mind for a modern world is that we can catch those notions, in flight." He mentioned the history of research into nonsense syllables and using funny songs as therapy, and noted how the power of words is so pervasive and so connected to our thinking.

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Off now to some "social networking" events - offline. :-)

The only thing I'd not gotten to flesh out here [asynchronously live, same day, onsite] are the Deft Comedy Hour, informal observations on sitein the Exhibit Hall, social events, etc. As always, I'm trying not to bore you given several complex presentations this year (the memory lecture, for example, was nonstop graphs and studies so truly I need to look again at notes and graphs and then will tidy that up too.) Also, I mentioned but didn't elaborate on the presentation of Debbie Jaffe-Ellis (widow of the great Albert Ellis, or as he would call himself, Saint Albert). Dr. Jaffe-Ellis told touching anecdotes about Ellis' devotion to students until literally his last moments (insisting on holding a class in hospital), his hidden passion for people (and music) which wasn't generally recognized due to his brusque style and crusty language, and his courageous attitude towards life - and death. His new autobiography is just out, combining his own memory with thoughts from his wife, published by Promethian Press.

Much of the tribute to Ellis delivered here was also made at his APA "wake" the year he died. A
report on that event is available on my site, for the interested.

Apologies if I've made lots of typos or omissions as my eyes grow bleary...
Please let me know of any big bloopers!

Meanwhile I hope you've found something interesting, and I'll add more detail and references next phase of editing down from this raw, often literal reportage.

It ends tomorrow (Sunday) and I've made plans to check out some VR-related software at the exhibit hall. Any great links or revelations will surely be shared!

For now, take care, enjoy, and Regards from APA 2010 - in San Diego this year, first time and hopefully not the last. I've come to appreciate this city, in the brief time I've had free, and would love to return. But enough about me! :

Ciao for now.
Michael
http://www.fenichel.com/Current.shtml

---------

Disclaimer: I try to ensure accurate reports of study results, names, dates, etc., and use a combination of verbatim notes, presenter materials, Power Point data summaries, and direct follow-ups with presenters. If I have inadvertently misstated or mis-typed any information (names, dates, numbers, etc.) I would be grateful for any corrections and will be sure to update/correct any articles I present pertaining to these presentations.

--

Michael Fenichel, Ph.D.
http:/www.psychservices.com



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INDEX OF 2001 APA Convention Articles:
Behavioral Telehealth | E-biz of Mental Health | 2001: A Cyberspace Odyssey

INDEX OF 2002 APA Convention Articles:
CyberSex & Cyber-Infidelity | Beck & Ellis 2002 | Behavior Therapy | CyberPsychology | E-Ethics

2003 Convention Highlights: Full Text | Beck 2003 | Quality of Online Health Info | Sternberg's Vision

2005 Convention Highlights:   Opening Session | Pioneers of Behavior Therapy
Distinguished Elders of Psychotherapy | Legends Discuss Psychology | Online Clinical Work | Town Hall Meeting

2006 Convention Highlights:
Opening | Online Psychotherapy & Research | Psychological Vital Signs | Advances in Cognitive Therapy
Brok on Chaplin | Conversation with Aaron T. Beck - 2006 | Dr.Phil | 21st Century Ethics | Media: Town Hall '06

2007 Convention Highlights:
Humanizing an Inhumane World | Opening Session | Albert Bandura | Linehan, on Suicide
Psychology's Future | Conversation with Aaron T. Beck - 2007 | Evil, Hate, & Horror

2008 Convention Highlights:
Grand Theft Childhood | Opening | Malcolm Gladwell | College Success, Love, Hate, More | My Life With Asperger's
My Space, You Tube, Psychotherapy, Relationships... | Aaron T. Beck - 2008 | The Mind and Brain of Voters

2009 Convention Highlights:
Internet: Pathway for Networking, Connecting, and Addiction | Opening | Virtual Psychology & Therapy | Q&A with Zimbardo
Seligman: Positive Education | Future of Internet Media | Sex, Love, & Psychology | How Dogs Think

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