[Current Topics in Psychology]

Questions and Answers for Psychology Students




Aggression & Violence | Anxiety | Body Piercing | Clinical Psychology | Humor | Interesting Topics
Learning Disability | Online Addictions | Online Therapy | Psychoanalytic Theory | Teen Years

I get many requests from high school and college students using the the Internet, for information about "interesting topics" in psychology. One thing I can be sure of, as a clinical psychologist, is that the person best qualified to say what is "interesting" or "cool" to you, is you! And if you choose something which is real interesting to you, it will probably be even more interesting when you share what you've learned with your teacher or classmates. This website is my attempt to share what I myself find "interesting" or useful, to me, to students like yourself, to fellow mental health professionals, and to the general public worldwide (thank you, Internet!).

It is nice to know that my website gets some visitors and is helpful, and might even help create interest in the topic of "psychology": the science of understanding our fellow human beings. I've gotten some nice comments as well as several requests for suitable topics for papers, or for speeches. I've also received requests for topics other than the ones I have highlighted on my webpages, and for my opinion on such difficult questions such as "What is an interesting topic?" or "What would a teenager find interesting?".

I've decided to post some of the inquiries I've gotten, along with my responses, in the hope that this might answer some questions--perhaps your own--about psychology, or about "good" research topics for students. This page is also for inquiring adult minds! There are some very interesting topics and issues raised here, and the complexity level varies widely.

Perhaps too I can bring you a smile if you are an educator or mental health professional who enjoys, as I do, the enthusiasm and perspective of today's on-line students. I hope this Q&A is helpful.



Ask Dr. Mike!

Frequently Asked Questions:


Adolescence

Q:   Hello My Name is Tina and I am working on my Bachalor's in Psychology. At the present time I am in Psychology of Adolescents, I am required to put togather a portfolio on all the topics in my text. I need to locate some stories or clippings on real life instences of a adolescent(s). Some of the topics I need to go into slight depth are; Sexuality, Peer relations, Physical development, Theories of Adolescence, Stress and Mental Disturbance.
I want to identify and put in my own words how these clippings or reports relate to the chapter's in my text. I want to create a portfolio that is brief yet to the point, and something that I can use in futhering my career in dealing and helping Adolescents get through the stages they must face. So if there is anything you know of that would help me in my quest ....

A: Tina-
Psychology of Adolescents is a specialty of mine, and a few of my
web pages are basically your assignment, either in my interviews with adolescents (e.g., "What is Cool?"), links to sites by adolescents (e.g., by the sister of an anorexic, on my "Adolescent Mental Health" page), and tons of sites about adolescent disorders, for and by teens. Also my articles on the hallmarks of adolescence, like "Peer Pressure" and "Self Esteem". A large corporate foundation [Pepsi-cola] has distributed some of these things to high schools around this country and McGraw-Hill has asked to use them in textbooks in Europe, so I guess people find them useful. I don't know what of this you've seen, but I'd start on my adolescent mental health page, http://www.fenichel.com/adolhealth.shtml. I think this has articles or resources on everything you mention in your letter. Then, follow the link back to my main site, Current topics in psychology if you need more (http://www.fenichel.com/Current.shtml). In particular, on the self-esteem page (http://www.fenichel.com/selfest.shtml) there are 2 links, "Courageous Kids" and "Success Stories by Teens" which will have personal stories by teens, something you say you want ("real life instances"). You will definitely find some personal stories on sexuality (e.g., the value of abstinence and impact of motherhood) at the CFOC site, and between the "teen advice" sites and my own page on peer pressure you should come up with something on peer relationships. For physical development, try the Ask Dr. Marla page (a link on my adolescent health/mental health page), as there's lots of stuff there on normal development and issues around everything from puberty to acne, etc. As for stress, there are lots of links around my sites to "anxiety" mega-sites, and also a new collection of resources on violence, the most profound effect of "stress" - at http://www.fenichel.com/violence.shtml .

I don't off-hand know of anything on "theories of adolescence" [online], though I do have a link from my main site to theories of personality. But adolescence isn't something too theoretical, actually, as there are pretty universal stresses and phenomena, such as increased importance of peer approval, wish to be popular, damaged self-esteem due to failure, rejection, etc..... There may be some sites I've not seen on adolescence "theories", however, but I don't know of them offhand.

I hope some of this helps. There's a lot here for you to whittle down into a "brief yet to the point" portfolio. You seem to be very organized and motivated to do well, and you're also a really good writer! So good luck in your pursuits.

[Note: Like all these Q&A postings, permission to reprint here was obtained beforehand.]
[See also
Body Piercing, below.]

Humor

I have gotten several requests for references on psychology and humor, or the use of humor in promoting healing. Hope this is useful:

John K wrote:

> Got anything on the value of humour in mental health care?

Hmmm, actually I do, somewhere! And you're about the 3rd person to ask about humor recently....

By coincidence (or synchronicity), I just put down my pile of today's (snail) mail next to the computer, and what do I see? An invitation to a forum by Harvard Medical School on "Mind/Body Training in Optimism, Humor, and Cognitive Restructuring". Sounds interesting. It's in Dublin, Ireland, Sept 12-15, 1999. Continuing with today's mail, there are several letters about "humor in therapy" in the May 1999 APA Monitor, including references to an entire focus on the healing power of humor back in the March issue....

Here you go, titled "More psychologists are finding that discrete uses of humor promote healing in their patients." [This article no longer online, circa 2010, although humor can be easily researched and continues to be both an important topic - and asset. See below for a more recent study on the role of humor, as reported in the November 2007 APA Monitor:]

http://www.apa.org/monitor/nov07/thejoke.aspx.

And now, miracle of miracles, I have actually located the response I'd prepared for someone elso on the topic of humor and psychology. The letter follows, complete with some humor at the end, and several links relevant to the topic....humor seems to be a growing topic--and necessity, in today's stressful world.

---------------------


Mona writes-

> Hi Doctor Mike,

Hi.

> Help me Obi Wan Kanobi, you're my only hope...
>
> I am a Master of Social Work Student, 2nd year, doing my internship at
> a VA hospital Spinal Cord Injury Clinic. I need to propose a "group"
> (6 to 8 weeks/once per week) and I want to do one that involves humor as
> a coping tool to deal with changes in body image, and to help combat the
>thoughts that lead to depression.

If you're looking for "words from the Master", all I can think to share with you is that I have long been working with all types of disability, and appreciate on a personal level the value of humor. (Not only for clients, but for therapists, who tend to burn out if they really put themselves into their work.) I think humor and perspective need to be balanced sensitively when introducing humor, but if you're as empathic as you are funny, you'll be fine. I would imagine in a VA setting you have some real bitterness in the spinal cord units, as well as depression. I think the ha-ha type of humor works better with depression (where truly a little laughter can be therapeutic), while I think with deeply angry people, they need to first gain some perspective and be receptive to an "outsider" trying to get them to lighten up, like some young social work student. Then again, maybe you'll regularly be the life of the party, and very therapeutic just because of your personality.

OK, but you want the evidence that you're doing something valuable, right?

> I, by nature, am a funny person and can pull it off, but I need to back up my
> proposal with research. Beck used humor, but so far I don't know of any other theorists.

Right. Freud said a great deal about humor, actually. :-)
Scientific research I don't have off the top of my head, and it looks like you've done a good job of surfing the net for "humor"-related topics. (tnx for your comments.) But I have in fact visited several sites, psychology-related mostly, dealing with humor.

> If you know of any other groups that focused on humor (remember it is the best
> medicine) or research in that area, I would be one happy camper to hear about it.

Hmm, let's check a few bookmarks, here. Guess I should put something up on "Current Topics in Psychology" (my main site), as humor does seem to get a lot of attention these days. I mean, check out our country's leadership and tell me there's no need for a sense of humor. But I digress... [That was written around the time of our impeachment trial.]

Here we go. Here's something from a Bipolar Disorder association, with lots of stuff like "30 ways to handle stress" and "Are you Normal?"
That's at:


http://www.pendulum.org/information/information.html

Hmm, it's not as hefty as I'd remembered in the humor department, but there's some humor components and lots to think about at the "Creativity Web", though this is not yet "research":

http://members.optusnet.com.au/~charles57/Creative/

But it might inspire some of your clients. What else? OK, OK, I've got you the golden grail, to make you a happy camper (I hope)-

Check this out, the motherlode: American Association for Therapeutic Humor... Features like: "Lighten up, seriously", convention news, some comedy, and some articles which appear to be serious, and probably lead to other relevant links as well. It's at:

http://aath.org/

I see our session's up for today.... good luck with your group and your internship....(Keep smiling) And may the Force be with you.

Obi Wannabe Cannoli (aka Dr. Mike)

PS, If you liked the Managed Care humor, you might enjoy this corrolary, a humorous (and accurate) look at employment practices in government agencies...
Ciao.
---

>A local business was looking for office help. They put a sign in the
>window, stating the following: "HELP WANTED. Must be able to type,
>must be good with a computer and must be bilingual. We are an Equal
>Opportunity Employer."
>A short time afterwards, a dog trotted up to the window, saw the sign
>and went inside. He looked at the receptionist and wagged his tail,
then walked over to the sign, looked at it and whined.
> Getting the idea, the receptionist got the office manager. The office
>manager looked at the dog and was surprised, to say the least. However,
>the dog looked determined, so he lead him into the office. Inside, the
>dog jumped up on the chair and stared at the manager.
>The manager said "I can't hire you. The sign says you have to be able to
>type." The dog jumped down, went to the typewriter and proceeded to type
>out a perfect letter. He took out the page and trotted over to the
>manager and gave it to him, then jumped back on the chair.
>The manager was stunned, but then told the dog "the sign says you have
>to be good with a computer." The dog jumped down again and went to the
>computer. The dog proceeded to enter and execute a perfect program, that
>worked flawlessly the first time.
>
>By this time the manager was totally dumb-founded! He looked at the dog
>and said "I realize that you are a very intelligent dog and have some
>interesting abilities. However, I still can't give you the job."
>The dog jumped down and went to a copy of the sign and put his paw on
>the sentences that told about being an Equal Opportunity Employer. The
>manager said "yes, but the sign also says that you have to be
>bilingual."
>
>The dog looked at the manager calmly and said, "Meow!"

Some say laughter is the best medicine. It certainly is one of the best stress-busters! Thanks to all who have written lately about humor and psychology. (No offense meant to either dogs or cats!)



Aggression & Violence | Clinical Psychology | Humor | Interesting Topics | Learning Disability
Online Addictions | Online Therapy[Updated] | Psychoanalytic Theory[New] | Teen Years | TOP


Body Piercing

Q:(From Megan B.)

Sunday, April 26, 1998

Dear Dr. Mike:

I am a 16 year old high school student ... in Ohio. I am working on a research paper based on revolution in today's society which I could use your help in. My topic is "Body Piercing: Art Form verses Self Mutilation".

A:

Hi Megan--

I love hearing from high school students doing interesting papers, and using the Internet for finding current research or asking questions directly, like yourself.... Let's see what I can do. Revolution in today's society? Hmmm. Sounds like you're talking about cultural/societal revolution in American society, or youth society....

Art Form verses Self Mutilation

Now that is a very powerful and complicated question! Some might say that body piercing is symbolic of many things, from self-expression to self-mutilation, a very positive and necessary thing for teens, versus an expression of today's society being self-mutilating. Since you (or your teacher) wants this to be in terms of "psychology", I'd suggest discussing this either in terms of adolescence (self-expression, peer pressure, popularity, etc.) or self-mutilation. I think the first option is far easier, and much more pleasant, personally. :)

I work with teens, who are very into body-piercing (and Leonardo). For some of my discussions with and about "what's cool" and about "peer pressure", check out:


Peer Pressure http://www.fenichel.com/peerpress.shtml
(A collection of links to great pages about peer pressure.)

What is Cool? http://www.fenichel.com/Cool.shtml
(What teens are saying is cool, and what's not.)

Adolescence http://www.fenichel.com/adolhealth.shtml
(A collection of websites about teen health and mental health.)

And you will find articles and sites by teens along the way, with probably some discussion on body-piercing. I'm sure if you searched around you could find articles [elsewhere] about the self-mutilation aspects of body piercing, but I'm sure that on the Internet you'd come up with some things you really wouldn't want to look at or report about for school!

You might try some of the teen forums on AOL, though, and there's a few very good teen forums posted on my
TeenTime page, http://www.fenichel.com/teentime.shtml

Q: My teacher suggested I might speak to someone in your field about this topic. I was wondering if you would be willing to tell me a little bit about why people mutilate themselves and how they do it in relation to body piercing. It would be greatly appreciated.

A: If you'd like my personal opinion, I believe that body piercing, like tatoos, reflects a desire to be "special". A lot of people feel one's body is our temple, not to be desecrated by inks or holes, but then again almost all societies have young girls learning to wear jewelry and be socially acceptable to other females, while also paying attention to the response of males. So peer pressure plays a big role if "everybody's got pierced ears" (1978) or "everybody's got pierced tongues" (1998). And underneath the social pressure, and the desire to be "special" or "cool", is sometimes the desire to do what you want to do, the heck with parents. (Some people get Goethic, some people get metallic, some people get tattoos and body piercing.)

Many mental health professionals believe that if one feels good enough about oneself, physically , mentally, spiritually, socially...whatever...one should not need to go to excessive lengths to change the body one is born with, and often the extent to which one really dislikes oneself gets translated into an attitude of "I've got nothing to lose" and sometimes people do not know when to stop, and fashion statements really do become self-harmful. Same with anorexia, exactly. Body image. That's the general topic, if you were to do a search. I'd go for "body image", "self-concept", and "peer pressure" as the main motivation for teens to get seriously into body piercing.

Q: Why do you think people would want to pierce body parts, and how do they view it?

A: I think I answered that! :)
People want to feel (more) special, or "cool". Or they have a poor self-image, as is. Of course there's less-drastic ways to accomplish the same thing: A new haircut, new clothes, new friends.....

Q: Is it relaxing for some of them, stress relieving?

A: Depends on the stress. I listened the other day to the story of a girl terribly embarrassed by having a tongue ring come out while she was chewing on something and had to go to the girls' room right away with her friend, while she screwed it back in. Is that "cool"? Is that "relaxing"?

Q: I'd be interested to hear a professional's opinion.

A:You heard it. Hope any of this helped you....good luck on your paper and your search for understanding your topic!

>-megan
> "That's it then! Cancel the kitchen scraps for the lepers and orphans, no
> more merciful beheadings, and call off Christmas!"

---------------------


Deliberate Self Harm (DSH)/Self-Injurious Behavior (SIB)

The issues around self-harmful behavior on the part of teens continue to be of concern to both friends and concerned parents. Here's a few questions now about instances of clearly intentional self-injury.

March 29, 2003

Q: Dear Dr. Mike,

I'm researching DSH, specfically cutting in adolescent girls. Any resources or information that you have to offer is greatly appreciated.
-Maureen L

A: Hi Maureen,

I don't have anything specific to suggest off the top of my head, other than to include in your research such key words as "self-injurious behavior" along with DSH, as SIB is commonly used in many settings.

In terms of the research/literature you'll find much written about impulsive, sometimes self-injurious behavior in the areas of Borderline Personality Disorder and in more specific diagnostic categories such as anorexia, or broader categories such as "suicide" and "self-abuse". And of course, "adolescence" or "adolescent" attached to one of these other key words in a search will narrow it down.

I'd begin your research in the areas I mentioned, and using some of the resources on my site, not only "adolescence" but also "violence", eating disorders, & borderline personality disorder. You can play with some various search engines I'd recommend (google and others) on my search tools page at
http://www.fenichel.com/search/.

I found just over 1500 references in about 10 seconds. Here's a sample, including a good journal article and an overview from AACAP's Facts for Families collection:

Focus Adolescent Services: Self-Injury ... Other forms of self-injurious behavior include ... Disclaimer: Information contained in Focus Adolescent Services or on any linked sites is not intended as medical ...
www.focusas.com/SelfInjury.html

Self-Injury in Adolescents - AACAP Facts For Families # 73
... A child and adolescent psychiatrist can also diagnose and treat the serious psychiatric disorders that may accompany self-injurious behavior. ...
www.aacap.org/publications/factsfam/73.htm

Understanding Self-Injurious Behavior ... Self-injurious behavior can be reduced and eventually extinguished once the adolescent is ready to embrace alternative behaviors designed to promote healthier ...
www.prponline.net/School/SAJ/Articles/ understanding_self_injurious_behavior.htm

Journal of the American Academy of Child and Adolescent ...
... Contagion of deliberate self-harm among adolescent inpatients. ... in the present article, we use the term DSH to refer all self-injurious behavior, both with and ...
www.findarticles.com/cf_dls/m2250/ n2_v37/20576443/p1/article.jhtml pages

Self Injurious Behavior: Breakthroughs in Drug Treatment for ...
... Journal of Child and Adolescent Psychopharmacology, 11, 229-238. King, BH (1993). ... Opioids and the maintenance of self-injurious behavior. ...
merrill.ku.edu/IntheKnow/sciencearticles/ selfinjuriousbehavior.part2.html

[PDF]Self-Injurious Behavior File Format: PDF/Adobe Acrobat - View as HTML ... in drug treatment No drug to date has been created specifically for self-injurious behavior (SIB ... Journal of Child and Adolescent Psychopharmacology, 11, 229-238 ...
merrill.ku.edu/PDFfiles/selfinjurious%20behavior.pdf

KidsPeace - Healing Magazine ... The adolescent would begin to flood with affect, quickly escalate to suicidal ideation, and intervene with self-injurious behavior ...
www.kidspeace.org/healingmagazine/issue6/pg3.asp

[PDF]11/01 csc self-injurious beh
File Format: PDF/Adobe Acrobat
... Conclusion Self-injurious behavior can be reduced and eventually extinguished once the adolescent is ready to embrace alternative behaviors designed to promote ...
www.aboutourkids.org/letter/novdec01.pdf

GGRC - Medical Care Information ... Schroeder R, et al (2001), Self-injurious behavior: gene-brain-behavior relationships. ... Journal of the American Academy of Child and Adolescent Psychiatry 38:12 ...
www.ddhealthinfo.org/ggrc/doc2.asp?ParentID=5298

[PDF]SELF-INJURIOUS BEHAVIOR
File Format: PDF/Adobe Acrobat - View as HTML ... my pain!" All of the following are motivators for self-injurious behavior: * Limited or ... however, that it is not the typical, well-adjusted adolescent or adult ...
www.onlineparadigm.com/archives/137-FOO_AD.MH.pdf

Self-Injurious Behavior
Self-Injurious Behavior [up]. Self-Injurious Behavior / in adolescence ... Self-Injurious Behavior / in adolescence. Deliberate self-harm in young people, ...
omni.ac.uk/browse/mesh/detail/C0085271L0087229.html

Understanding Self-Injurious Behavior
... Both males and females engage in self-injurious behavior. Self-harm often begins in early adolescence, peaks between the ages of 18 and 24, and decreases as ...
www.prponline.net/School/SAJ/Articles/ understanding_self_injurious_behavior.htm

File Format: PDF/Adobe Acrobat
www.aboutourkids.org/letter/novdec01.pdf

[PDF]SELF-INJURIOUS BEHAVIOR
File Format: PDF/Adobe Acrobat - View as HTML ... my pain!" All of the following are motivators for self-injurious behavior: * Limited or ... Being tough and rebellious are hallmarks of adolescence, when youths ...
www.onlineparadigm.com/archives/137-FOO_AD.MH.pdf

Skin-picking and self-injurous behavior
... Skin-picking as a form of self-injurious behavior. Amy Gedeon. ... Usually gradual and long-term; Mean age of onset reported to be adolescence to early adulthood; ...
www.childadvocate.net/ Skin-picking_and_Self-injurious_Behavior.htm

Journal of the American Academy of Child and Adolescent ...
... for the first acts of self-mutilation in adolescence are heterogeneous, self ... of female habitual self-mutilators considered their self-injurious behavior to be ...
www.findarticles.com/cf_dls/m2250/ n2_v37/20576443/p1/article.jhtml

PARADIGM Magazine- Fall 2000
... All of the following are motivators for self-injurious behavior: Limited or primitive ... Being tough and rebellious are hallmarks of adolescence, when youths ...
www.addictionrecov.org/paradigm/ P_PR_F00/cont_jacobs.htm

Well, there's a start for you! (I used the search phrase: adolescent "self injurious behavior")

Good luck!

Q:
>You've offered
> some sound advice and resources and they are greatly appreciated. Maybe
> someone who is as knowledgeable as you are could add information on this
> fascinating yet frightening topic somewhere in your website.

Done! :-)

Dear Dr. Mike,

I definitely do believe that this is (and if it isn't, certainly should be) a current topic in psych. I have an adolescent step daughter who was engaging in cutting, and had been for about 5 years before anyone knew :(, and 4 of the girls she was hanging with at the time. This brings me to another question, can self injurious behavior be contagious among adolescent girls?


A: Social behavior, modelling, and peer pressure are "contagious".
And adolescence brings some huge impulsivity and risk-taking.


Q: I also work in middle school and am seeing and hearing about girls cutting and taking pills. This is of major concern to me and should be to other parents, teachers and school psychologists. Being able to identify symptoms, or something would be helpful.

A:

I totally agree, and I spend a lot of time in middle schools saying and seeing the same thing.

> Being able to identify
> symptoms, or something would be helpful.

I was involved with the APA/MTV project called "Warning Signs", mostly about suicide and homicide (e.g., the Columbine Syndrome), but a lot of it is generalizeable to violence towards self, if not suicide. Similarly, the best people to pick up on warning signs are peers, but in the case of SIB which is conducted in a group there might be a reluctance to consider it "unusual" rather than trendy. Anyway, you're right, prevention and awareness is always a good approach.

> Please feel free to use my name, it's an important subject.

okee doke. Will do, next chance I get to update the page. And again, good luck in your own research.


Aggression and Violence

The topic of violence continues to be one of very great interest recently, after the tragedy at Columbine High School in Littleton and given the events and aftermath of 9/11. My site is getting more hits on my "Children and Violence" page than any other single page I've ever put online, including my main Psychology page. People are clearly concerned about violence, and I am happy to provide what appears to be a useful resource for students and mental health professionals.

I have been very active in presenting teen forums and discussion groups, in schools, churches and hospitals in New York City, as well as in training other mental health professionals in the use of the APA/MTV video and other resources describing the warning signs, causes, and effects of violence among our youth and society. I have put together a resource page on
Children and Violence at www.fenichel.com/violence.shtml .

Now here is an e-mail message I received which asks a few questions which students looking here for topics to explore might also find interesting. From Michelle (with her permission).

Subject: Help!!!!

Q:

I am a fourth year Biology student taking a class in personality psychology. I have to write a paper on aggression-heredity vs environment. Would you know of any good sources? Any help would be greatly appreciated.
Michelle-University of Sask.

A:

Hi Michelle... now don't panic, and don't get violent! :-)

I'm not sure you'll love this answer, but it's really pretty simple: Virtually *all* aggression is "environment", or more accurately, "learned behavior".

While there may be genetic markers for aggressiveness, or predispostion to assertiveness vs. passivity, in humans at least, I think the suggestion that heredity is responsible for violent temperment is so politically incorrect as to be dangerous. (It could make some racial or ethnic groups get upset, for example, as with similar discussions of "intelligence".)

So I'd say the short answer is that most aggressive behavior is a function of social learning, experience, and situations, findings shown time and again in the fields of social psychology and clinical psychology. You can find some of the classic social psychology experiments online, including the work of Stanley Milgram, who showed how crowding produces aggression, and Zimbardo's classic "prisoner" study where college students simulated jailers and prisoners and wound up actually becoming sadistic in their behavior towards "inmates" when they adopted the roles of guards [great website, with slide show, at
http://www.prisonexp.org/ ]

I've been doing forums in cooperation with the American Psychological Association and MTV, and I can tell you that one of the big themes in the research and presentations is captured in the phrase, "Violence is a learned behavior". Since Littleton's Columbine High School tragedy --and do you think those white, upper middle class students had hereditary tendencies towards violence... or were reacting to anger at being teased and treated as outcasts?-- psychologists have been trying to work with schools and parents to sensitize them to the "Warning Signs" and causes of violence. I have loads of information about this, and links to the APA's materials on this, on a site I put together, http://www.fenichel.com/violence.shtml. You might also want to check some of the other research on the APA homepage. Also, on my main web site, main screen, I've got a whole collection of articles and resources, under either "Aggression and Violence" or Violence. (Everything from the influence of television to "bullying" and other social factors.) That page is at http://www.fenichel.com/Current.shtml .

Now, being involved with biology rather than psychology, I know you may really want to look at what biological factors there may actually be (e.g., violence due to brain injury, or demographics of violence due to mental illness, or whatever, as well as any information about "heredity"). I've got a major resource for you, which could keep you busy a long time researching this site. It's the Social Psychology page at Wesleyan University, http://www.socialpsychology.org/

As soon as you go to this page, you'll see a search screen there. Leave it set to search only their own site (the default setting it will be on), and type in the word "aggression". You'll get a list of tons of journals specific to resarch and discussion about aggression.

Aggression is something that you might have a problem with only because there's too *much* written about it, rather than too little. I'm sure you'll find things on "nature vs. nurture", or "heredity versus environment", and even a search engine search will get you millions of articles. (Some good search tools are at
http://www.fenichel.com/search.shtml )

However, even if biologists might think there's a major role for heredity, the overwhelming findings of social science research suggest, as I said, that "violence is a learned behavior", which offers hope for our violent society if only we start looking at that learning process. Oh yes, one last thing. If you'd like to sift through some of the presentations at the century's last psychology convention, there are some reports on current research about violence, and the way it's learned through the media, neighborhood violence, pro wrestling, and so forth. That's pretty interesting reading too, at
http://www.fenichel.com/APAlive.shtml , but it might be boring or not what you're interested in unless the topics of "Internet Addiction" and societal violence are interesting to you in terms of their *psychology* (as opposed to biology).

So, what did you expect from a *psychologist*? :-)

Hope some of this does the trick for you. Good luck!

---

Note: In the years since that question was asked and answered, I've attended and reported on some presentations by some of the most accomplished psychologists in history addressing some of the large questions about the nature of behavior, and why some good people end up doing bad things, or why there is so much hatred in the world, as reflected in daily life, politics and the media. One presentation made at the APA Convention in 2007 saw two legends of psychology - Phil Zimbardo, social psychologist, and Aaron T. Beck, "father of cognitive psychology" - address the topic of
Evil, Hate, and Horror. This is highly recommended as an excellent starting point for pithy, advanced-level discussions about aggression & violence, thinking & behavior, and the nature of human beings. From a psychological point of view.



Aggression & Violence | Body Piercing | Clinical Psychology | Humor | Interesting Topics
Online Addictions | Online Therapy[Updated] | Psychoanalytic Theory | Teen Years | TOP



Learning Disability


Q: I am a senior in high school and I am doing a report on learning disorders and dyslexia. I found your psychology site and it helped out a lot. I was wondering if you would mind sending me some more information or telling me about other great sites on the web! Thank You,
--Anna

A: Sure, I'll see what I can do. Learning disability happens to be a specialty of mine, and so dyslexia is something I work with too. I'm real glad if my site "helped out a lot" or was interesting to a high school senior....

I will say this: for Dyslexia, in specific, the
International Dyslexia Association is the most respected source for information, research, and treatment of dyslexia. The paper on Learning Disability is something you might find interesting. It's very general, but beautifully describes just how frustrated students can feel, in elementary through high school, when they "feel smart but read stupid", if you know what I mean. (Non-stop Embarrassment!!) ...Learning Disability, if you haven't heard or read this, really is only found in people with at least Average intelligence, and often in very bright people, but one thing or another "just doesn't click", like the wiring in the brain has a short circuit somewhere where reading gets processed, but everything else is fine.

I don't know where you are, but most states have Associations for Learning Disability, and many states have Orton Society Chapters (some are on my web pages). There is also a site called "Poor Richard's" [now LD Resources-4/97] which is about Dyslexia and Learning Disability, with several links to LD organizations, and a couple of interesting personal essays by
Richard Wanderman (about his first date, overcoming LD, etc,). But for the most part, on the Internet, I'd recommend beginning with the links on my own page, Orton Society [now the International Dyslexia Association], and the American Psychological Association (which has papers on Learning Disability and dyslexia), in particular. The Facts for Families pages aren't too detailed but do give info on how many people in the general population have learning disability, etc.


Hope some of this helps! Thanks for visiting, hope I've been of some help, and that you get an interesting paper for yourself, in addition to a good grade for school. Best of luck.



 
Q: I am doing a research paper on agoraphobia. I was wondering if knew of any interesting sources. If you could respond by 3:30 today (4-1-97) I would greatly appreciate it.
Sincerely,
Megan Riley


A: Hi Megan-

Agoraphobia is pretty good to research or find out about for general interest, on the Internet. My own choices are right on my web page, CURRENT TOPICS IN PSYCHOLOGY:

www.fenichel.com/Current.shtml

On the main page is a very good site by the National Institute of Mental Health, called Anxiety Disorders, which is basically on on-line brochure explaining in basic terms some of the more common anxiety disorders, including "Generalized Anxiety Disorder", a technical term very close to agoraphobia.

I also just put up a page on
"School Phobia", which is written by a colleague of mine and it is the only thing like it that I've seen on the Internet, a 2-page discussion of this very specific, rare and interesting form of anxiety disorder. The reason this is related, is because some psychologists (including myself) have seen instances of "school phobia" where a child is just so anxious about "everything", that they may qualify as agoraphobic (unless they're extremely anxious in their own home and "safety zone"). Then again, there are adult agoraphobics who may have a unique kind of "traumatic stress disorder" which blossoms into "agoraphobia", as opposed to an ongoing "generalized anxiety disorder" which overwhelms 99% of ability to function in a non-hospital setting. Agoraphobia is a very interesting topic, and much has been written about it.

The School Phobia page, if you're interested is at:
http://www.fenichel.com/schoolphobia.html



*** TIP ON USING MY WEB PAGE ***

ALL of the topics covered here -- and more -- are listed among other resources on my Current Topics in Psychology page. If you are looking at this Q&A page while exploring the Current Topics in Psychology site, please to explore the many pages and links, and you can always return to the main index page by selecting "CURRENT TOPICS IN PSYCHOLOGY" on the smaller "Quick Reference Guide" screen on your left. Click on any of those topics there, and you're off to another web site and in totally new directions as you follow the links to some mega-resources of the Internet.

So, please bookmark this page (make it a "favorite") and also the
Current Topics in Psychology main page, so you can always refer back to any of the other sites or references "on my bookshelf" which I think are valuable to students and parents and professionals.


OK, you've got me writing another paper of my own here, and I'm online long distance! So, do some research of your own now, and feel free to quote me if you'd like... I wish you well with your research paper.

----

Online Addictions

Date: Thu, 24 Dec 1998
From: Stephy

Dear Dr. Fenichel:

I found your article on "Internet addiction" very enlightening, since most of the research I've encountered has more or less defined and categorized the "Internet addict"" (like it can be easily diagnosed).

Right. And thanks for the compliment, on what's not much more than my off-the-cuff reaction to the more serious research and the web sites specifically about "Internet addiction". You're right. Lots of addictions and compulsions tend to combine if given the opportunity, and the computer offers endless opportunities from the comfort of one's own home. Lots has been written about various "addictions", from cigarettes to love to gambling and narcotics. Shopping clearly is another (as might be, say, jogging, soap operas, you-name-it). Just ask Amazon.com and Wall Street if there's a belief that people will become "addicted" to online shopping! Auctions, however, may be a pretty small sub-group addiction, or a "niche" or a hobby-addiction combined with love-of-shopping. (It's still pretty hard to try on a new dress online, isn't it, btw?)

I am trying to find more information on people who not only frequent the Internet, but also online auctions. These "online auction addicts" seem to mix "Internet addiction" with compulsive shopping. I guess it could also be described as a certain type of gambling since the shoppers are bidding on the products without any knowledge of whether they'll "win" or not.

Absolutely, good point. There's some of the same thrill as a gambling payoff and excitement about whether you will "win"...

I am presently writing a short article on "online auction addicts" (if you can even put a name on it) and I need your expertise. I would greatly appreciate your answer to the following questions (for possible use as quotes in my article)...

My questions:

*** Do you think there is such a thing as "online auction addiction"? If someone came to you with this problem, how would you treat it?

I am sure that such a formal diagnosis does *not* exist, though I could imagine some family members and/or friends using the term, to describe the person who fits the description. There are psychiatric disorders of addiction, including "not otherwise specified", which might conceivably allow for Managed Care treatment, but while I've come across drug addicts, love addicts, and "Internet addicts", I've not personally encountered, nor even heard of any "online auction addicts". In fact, I've not ever been asked to treat any *offline* auction addicts, despite being in New York with its many auction houses. I've known many people who might be "shopping addicted", but that hasn't been as central to diagnosis and treatment as the larger clinical picture, which might range from bipolar affective disorder (formerly manic-depressive illness), to compulsive behavior as part of a depression or personality disorder, etc. So that's the formal answer.

*** If this is a "problem," can it be solved? Would a person with this problem have to completely avoid online auctions, like an alcoholic has to stay away from alcohol? Or is that even a fair comparison?

Well, again, you're asking me to speculate on a treatment plan without having an individual person in front of me, nor any research or guidelines on your identified "problem". A problem could indeed occur if someone bids "only $40,000" for a used Rolls Royce because "it's a bargain", when they can't afford to pay their mortgage or buy food for the kids or the cat. If a wealthy retiree spends hours each day acquiring Russian art via Internet auction, is that a "problem"?

Can "it" be solved? First (sorry to repeat myself), as a scientist, I need a definition of terms, as to what "it" is, which is "the problem". Unplug the computer, problem is fixed. Run out of money and get sued by the auctioneer for non-payment, "the problem" gets resolved differently. You ask if complete abstinence "like an alcoholic" is the only solution. Notwithstanding my concerns about what "solution" should be without fully identifying "the problem", if it is truly a manifestation of an "addictive personality" gone amuck specifically with regard to online auctions, your analogy may be a good one, bringing in the role of "enablers", the need for supports and a lifelong pledge of abstinence, if the AA "12-step" model is to be employed. Then again, just as there are differences between an "alcoholic" and someone with an alcohol problem, the same may be true for the person who binge-auctions but can go without, versus the person whose entire life is oriented around the next drink.

*** Would you classify being addicted to online auctions as a type of "Internet addiction"?

(See above re "classification"). I think, to a large extent, addiction is addiction, though the physiology differs (for example "needing a fix" to avert the Joneses may be different than anxiety and stress when ripped away from the computer). If a "shopping" or "auction addict" (as I suspect you would use the terms) is pursuing this relentlessly, and *only* online, then I'd say that the *reinforcement*, *control*, and *feedback* aspects of having the computer instantly respond to impulses and keystrokes would be driving the addictive component still further. Kimberly Young, ("Pathological Internet Use" researcher) spoke at the 1997 APA Convention about families torn apart and (before AOL stopped charging per-minute) homes lost for non-payment of mortgages, due to the addictive power of the computer. I allude to the drug-like reinforcement, I think, in my article. I think the specific forms of "Internet addiction" typically combine several factors, ranging from "addictive" predisposition, to compulsive or depressive tendencies, or worse, and that the computer has for some people replaced social interactions, a family pet, or one's own quiet sense of self, with all it's immediacy, stimulation, and ease-of-relationship.

*** If so, do you think this is a minor problem, or a problem that is going to expand as the Internet grows?

So far I only know of one person who has identified this "problem": you. However, I do think you're on to something, and there certainly is room for expansion. In fact, Madison Avenue, AOL, Wall Street, and Amazon.com are all banking on it, just as they count on "television addiction" to sell products now.

***Or do you think that mental health professionals too easily classify people whom enjoy being online as "online junkies"?

Again, this is one humongous generalization! I think the majority of mental health professionals are either not on line at all, or limited to email and/or a bit of web surfing. I think that movies such as "You've Got Mail" will actually make a big impact on further absorbing Internet experiences into the fabric of everyday American life. I do *not* think mental health professionals (other than the few you find with sites about it online) are at all pre-disposed to formally diagnose "online junkies", though certainly almost everyone can name a friend, patient, or family member who has displaced television or whatever with time spent online. And we all know how some may go overboard. But I believe most well-trained and experienced psychologists and psychiatrists, anyway, will (as I did above) look at the overall functional lives of individuals in the context of relationships and behavior, and not be quick to "blame the Internet" in and of itself.

I would greatly appreciate your insight on the subject. Thank you for your time and consideration. Sincerely, Stephanie P.

You got it! Interesting questions and topic. Thank you for giving permission to reprint your mail.

Note: Shortly after this exchange, in January 1999, I observed my first "E-Bay Addict"! Only small things are purchased, and inexpensive (so far), but lots of time and energy is being spent online!

For an early article on Compulsive Shopping/"Shopoholism", Click Here.

Fast forward to 2012 and there is a new online resource page specific to "shopping addiction" with an overview on How to Manage Shopaholism which you may find interesting, in terms of both the 'addictive' and 'OCD'ish' aspects. [Tnx, Cindy!]

New for the 21st Century: There is growing concern about Facebook Addiction! Is it everywhere? Is it a "disorder"?




Aggression & Violence | Anxiety | Body Piercing | Clinical Psychology | Humor | Interesting Topics
Learning Disability | Online Addictions | Online Therapy | Psychoanalytic Theory | Teen Years




Clinical Psychology

Date: Tuesday, October 27, 1998 5:17 PM
Subject: Information on Clinical Psychology

Dear Dr. Mike I am currently a student rat the university of North Carolina at Wilmington and I am doing a research paper on clinical psychology and was wonder if you could answer some questions for me about the filed of clinical psychology. I just need some basic info as to how you got into the career that you are currently in and what is required of a clinical psychologist. If it was not too much trouble could you please just send me some basic info on your field and some personal info as to why you chose this career . Any help you can give me will be greatly appreciated.

Sincerely,
Cameron

----

Hi Cameron,

OK, here's a quick perspective. I'm not sure if I'm helping with you here with a term paper or graduate school decision here, but here's a brief overview.

Clinical psychology has evolved as a specialty within psychology, which is very broad and basically covers the science of behavior and human mental experience. Psychology spans a broad number of areas, ranging from child development (thinking, language, etc.) through experimental and industrial psychology, and the study of human relationships, to name a few major aspects. Clinical psychology has become identified with the study, in clinical settings (laboratories and therapy sessions) of the individual human being, in all it's psychological manifestations-- intelligence, thinking (cognition and perception), socializing, and communicating, and a few other biggies in the area of clinical psychology.

In most states, "clinical psychologists" are licensed, at the doctoral level (Ph.D., Psy.D., Ed.D.) only after years of graduate training, and a one or two year internship in applied (i.e., clinical) settings, typically in hospitals, outpatient clinics, and other mental health facilities. There are relatively few clinical psychologists, among all the varieties of people you'll find who are working as "psychologists". Some have licenses or certificates which are for work in "exempt" settings like schools and government agencies, where they work only under supervision rather than independently.

In the old days (pre-1990's), clinical psychologists, some of whom also studied psychoanalysis (along with some psychiatrists), often enjoyed thriving practices with individuals and groups. Patients were covered for much of the cost by insurance companies, and research showed that providing mental health services was a cost-effective way to keep employees healthy, productive and happy. Lately, however, much has changed since health care has become "managed" by insurance companies, rather than left up to the doctors and therapists. But that's another story, about "managed care", which negatively affects health care by *all* our licensed mental health care professionals, not just clinical psychologists.

What else...you want personal info on what got *me* interested in clinical psychology and how I got into it?

OK, (are you writing my biography?)... Actually, you're helping me in return for my taking the time with this letter to you. I get asked "why" I got into psychology often, so unless you object, I'd like to post my response to you on my "Questions and Answers" page... You ask some important questions, so I'm trying to give you a thoughtful response.

Believe it or not, without getting *too* personal, I think I was interested practically since I was born (if not before), in psychology. I just didn't know what it was. Everything about people fascinates me. The way we talk, and walk, and express our feelings, and our ideas, to name a few things which are worthy of real reflection, for me at least. In junior high and high school, right after they invented the telephone, (that's a joke!), many of my teen friends would call me up, and say "I need my shrink!". They must've known something I didn't know. I guess I like to listen to people's stories. And people like to be heard. In high school I worried about normal high school stuff, dating, hanging out, being a rock star, things like that.

I went to college not really knowing what I'd be doing in 10 years, only where I'd be living for 4. But I sampled all kinds of courses my first year at a good liberal arts college, studying music and philosophy and psychology, mostly. And then I had PSYCH 101, and my life changed. In a humongous lecture hall, as we sat back in our seats the first of 3 professors taking turns teaching this class walked in front of the stage and to the lecturn. He calmly said "CS" and shot off a gun into the air. We all jumped. A minute later he did it again, and again we jumped. Finally he paused a moment and calmly said again "CS". We all cringed but this time he didn't fire the gun. He explained that we'd just been the subject of Pavlovian conditioning. The next professor did a crazy "turkey dance" onstage, and spoke about "species-specific responses". He'd been communicating a mating ritual, so it seems. The third professor talked about about mental processes, mental illness, and the history of psychological testing and psychotherapy. I was hooked.

It's not easy getting into Ph.D. clinical psychology programs, but I was determined to do it, after 2 years of getting a masters degree in "personality, psychopathology and psychotherapy", which was pretty useless, career-wise. I worked first as a volunteer, and then in a community for schizophrenics, where I was called a "social worker" and I ran a newspaper which was reported by, typed, and distributed by "de-institutionalized mental patients". I taught them how to work in corporate settings, and I produced music and photography in my spare time. (Hah! I dimly remember spare time.) And then finally, I was ready. I applied to a dozen or so programs and was lucky enough to have been accepted to several. In graduate school I focused on my continuing interests in psychotherapy, language, thinking, and interpersonal relationships. And my friends still refer to me as "my shrink". :-)

Beyond that, it's really irrelevant to your questions about my initial interest and how I got into it. I followed my heart and my instincts. I'd advise the same for you, be it clinical psychology, social work, art, or music or medicine...whatever. Do what you feel you're good at, or try out various things until one clicks. Sometimes it comes early, sometimes it takes a while. I had great experiences in psychology which didn't come until graduate school and internship. And I learn more all the time.

One other quick suggestion: There are many aspects of clinical psychology reflected across my web pages, but one in particular may be useful to your pursuit. The American Psychological Association has a great page about careers in psychology, and if your motivation lies in making a personal decision about clinical psychology versus another type of psychology (rather than psychologist versus NBA star, preacher or lawyer)...check out the APA website. It's grown very dense and sometimes the pages disappear, but here's a good start, at the APA site beginning with their description of the many divisions and programs within the field of psychology:
     Divisions of APA

Good luck! I hope this answered your query and is useful.

--

[New]UPDATE (2012)

I continue to read queries (in emails and online posts) about study in psychology, online and off. Here is my current short-version:

Clinical psychology is a fairly well known entity in the US, but can be completely different relative to other specialty areas in Europe and elsewhere. Within the U.S., clinical psychology Ph.D. programs are among the most difficult programs in terms of acceptance rates, usually with small programs and an emphasis on clinical and/or research skill-building on an individual level. Great for therapy, research or teaching, but a long road. Academic programs also include important topics such as social psychology (which looks at everything from social media to social trends, and how groups and systems shape behavior), industrial/organizational psychology, child/educational school psychology and more. I hear a great interest lately in 'cyberpsychology', and this seems to be on the way towards being a focus area but as yet is not widely offered as a specialty area of study. And there is statistics, tests & measurement, community psychology, developmental psychology, experimental psychology, cognitive science and brain specialization, and more.

My latest advice continues to be: familiarize yourself with "what's out there", and put some thought into what will be required in terms of time and cost, and what will be necessary to actually find employment where you want to live, doing something which you will find satisfying, maybe even fascinating and personally/professionally rewarding. I generally suggest, after narrowing one's interests and goals to match the landscape of what's available, supplement the guides by speaking with faculty and students from specific programs. To begin with, one can get a list of schools with APA-accredited programs (especially important for clinical psychology) and on the graduate level peruse the APA Guide to
Graduate Study in Psychology. There are also, of course, lots of 'insiders guides' to campus life and so on.

While there is great interest lately in online education, some programs (and experiences) are still most powerful f2f - with classroom instruction, lab work, and practicum experience (with f2f supervision) all part of the training. There are some risks too, as many people are finding out, of doing online degree work only to learn that one's state of residence does not accept a given school's accreditation. Know these things in advance!

Finally, there is a new online resource worth mentioning. The guide was suggested to me as an 'online psychology degrees guide' - and there are many to be found already which offer pages promoting sometimes marginal online programs, and full of ads. This site is different. Here you can find real psychology degree programs within colleges and universities (mostly on RL campuses). I quickly found several psychology programs I'm familiar with, as their easy-to-navigate web guide delivered useful information presented in a cohesive, well-organized way. Things like accreditation and program descriptions make this a useful tool for surveying psychology programs. Moreover, it's a clean, ad and pop-up free page as I've just seen it (3/2012). I've heard about it several times now recently [Tnx, Makalyn!] - As more people seem to be considering study in psychology, this may indeed be a useful and timely tool:
   Psychology Degrees Guide [ www.onlinepsychologydegreesguide.info ]



Online Therapy [Updated]

In the Y2K I was interviewed by a graduate student of counseling psychology and asked to address 3 questions regarding online counseling, each involving some rather complicated concepts or scenarios. My response, in turn, is also a bit complex, and assumes that the reader has some familiarity with ethical, legal, and practice issues. This particular grad student wrote back that " after reading your email I felt like I have just taken an 'Ethical Issues in Online Counseling' class from you". Great! :-) Now given that reaction, I'm sharing this here for the benefit of other practitioners and advanced psychology students training in online or offline counseling or psychotherapy. (I'd be happy to identify the grad student by name, if she gives permission.)

The questions I addressed follow. Anyone doing research on the topic of Online Therapy might look to some of the source materials presented on my
Online Therapy page at http://www.fenichel.com/OnlineTherapy.shtml

QUESTIONS:

1. As a practitioner, what do you regard as the biggest challenge in internet counseling?

2. How would you deal with a client who expresses intent to suicide in his or her email? What are the steps an on-line counselor could do to resolve this issue?

3. As a licensed Psychologist in New York State, what is your take on the regulation that only licensed Psychologist of California could provide internet psychological services to residents of California?


Hope you had a nice Thanksgiving. (Thanks for the nice comments on my site, btw, and hope you've rummaged through some of the basic source material I compiled on my main site, or at http://www.fenichel.com/TownHall.shtml )

Actually, I just finished a new article which I've been working on for a while now, and hope to publish within the next few weeks, specifically on the topic of "technical difficulties" with online work. (It's not quite ready to share, but focuses on issues of personality and behavior styles, technology, legal/ethical issues, phonemic versus textual processing, visual cues, and cognitive styles.) But I'll stick to answering your questions for now!

1. As a practitioner, what do you regard as the biggest challenge in internet counseling?

That's not so simple to answer, for a multitude of reasons, including that most of my work is still primarily f2f, as is most "counseling" or "therapy" nationwide and worldwide. I'll try to respond wearing my "practitioner hat" rather than my supervisor/researcher hat, with which I am doing a great deal of examination (with colleagues) regarding online work.

In general, most practitioners (but not all) regard the greatest limitation of pure online work to be the lack of visual cues, in particular. Research, moreover, suggests that e-mail lends itself to distortions of meaning, and is often so poor at expressing *nuance* (despite emoticons or parenthesized grins and so forth) that supportiveness may be interpreted as sarcasm, or humor/sarcasm as hostility, etc. I mention a (Harvard) study about email vs. phone vs. f2f negotiation outcomes in an article I wrote about the APA's Town Hall Meeting about "
The Digital Crossroads", at http://www.fenichel.com/TownHall.shtml.

In essence, I see the biggest single challenge as the ability to become "in sync", therapist and client. Your predecessor at Columbia-TC, Carl Rogers, did some of the earliest basic research (with Truax) on the main ingredients of effective counseling, and came up with "warmth, empathy, and genuiness", often collectively termed "the nonspecific factors" of psychotherapy. Some argue that the use of e-mail is liberating, allowing for spontaneity and disinhibition, as the counselor doesn't see the client physically, and is less likely to be perceived as critical. (Not every f2f counselor, apparently, practices "unconditional positive regard"!) It is said that email communication also fosters "time compression" where people get right to the heart of the matter (without shame or self-consciousness) as it feels like writing a diary, and feels "safe". (Others, however, might argue, as I point out in my article, that this might also create or mask a "false identity", or maintain "as if" dissociative tendencies, or even positively reinforce "internet addiction" or social isolation. Even as it is sometimes noted that such online access may provide the *only* incentive to seek help from some who are geographically or socially isolated.)

So, all these big issues aside--and ignoring the fact that for some licensed professionals a big obstacle is also fear of doing something illegal or unethical--from a *practitioner* point of view, the biggest challenge is in establishing and maintaining a connection through the "threads" of dialogue, whether e-mail or chat-based, and building a relationship which feels genuine to both parties, and where the client also feels supported and hopeful based on what the counselor imparts. This requires to some extent, enough computer savvy on the part of both counselor and client so that the "communication" channel being employed is transparent, and not an obstacle. The human factor. It must feel natural, and not intimidating. In a best case scenario, having the written text can be an additional bonus, but in other circumstances it can be used like ammunition.

2. How would you deal with a client who expresses intent to suicide in his or her email? What are the steps an on-line counselor could do to resolve this issue?

This is a very hot and important issue. It is an ongoing topic of discussion in the peer supervision Case Conference Group co-facilitated by myself and Dr. John Suler. Many clinicians, including those of us who helped develop practice guidelines which relate to this concern, feel that it is imperative to have solid contingency plans established before undertaking treatment. (I am partial to having a good intake interview with new clients, and feel this is important in deciding whether online work would be appropriate.) Ideas that have been expressed include requiring the client to provide the name of a primary care physician (which many felt was too restrictive) and most of my colleagues feel strongly that there need to be emergency phone numbers exchanged before undertaking treatment with anyone. Tarasoff Law requires mandated mental health professionals to honor a "duty to warn" where possible harm to others appears imminent, and that is very difficult as well..... Sometimes it simply appears prudent not to take on high-risk cases online. (Others feel crisis work is perfect for the Internet. Still others vehemently defend the need for total anonymity.)

The short answer is, with a potentially suicidal client, I'd want to make sure all sorts of contingencies are in place, local to that client, as well as in regard to my own responsibility. I personally would not willingly take on an actively suicidal patient online. In fact, the most problematic aspect of doing online work in general is probably the issue of how to do an assessment without meeting face to face prior to "treatment". Of course, some people simply do "coaching" or help with self-help or advice...

3. As a licensed Psychologist in New York State, what is your take on the regulation that only licensed Psychologist of California could provide internet psychological services to residents of California?

Have you followed the very intense discussion about precisely this issue, on the
ISMHO list-serv? Without going too far afield, the issue here is basically the right (or duty) of California to protect it's citizens from unqualified professionals. That's why lawyers, physicians, architects, and electricians (along with psychologists) are regulated. What is unique about the California situation is that the web page of the State Licensing Board for Psychology (but no other profession!) carries a statement to the effect that the provision of psychological services is limited in California to those licensed to provide those services in California. And, they explicitly state that therapists located elsewhere who appear via the Internet in California, must be licensed to practice there.

Well, the arguments go like this: If I'm in my office in New York, and someone from L.A. writes to me as a supposed expert in some area, and I offer to provide "psychological services" to this person, I might well believe that I am still in my office, at my own computer, in my own State, and so I am practicing here. California's interpretation says no, their resident is receiving the service there, which is being, in essence, imported into that State even though I've not gotten a license to provide the service there. (As Dr. Bob Hsiung likes to use as an analogy, municipalities do have the right to ban alcohol or whatever else from coming into their borders. In this case they're banning outside psychologist contraband, however.)

Some point out this is protecting their residents from harm by professionals their State is unlikely to prosecute (although States can "reach out" across borders on behalf of citizens). Legalists say, "Yes, only if the resident is harmed where he or she lives can they seek remedies from their own State government, while they're free to sue anywhere." Some professionals say, "C'mon, this is just a guild protection law which protects local professionals from competition, and doesn't protect the citizens, who remain free to leave the state and see professionals elsewhere of their own free will". So where exactly does the counseling take place? And what if you don't call it "counseling" or "psychological services", but offer "personal coaching" or advice, or consultation? Keep in mind, also, that "counseling" is not a protected professional title everywhere-- and that corporations and HMO's might be content to provide services by the least-qualified provider, and can simply elect not to use psychologists, or to set policies that they can only work within the state of their license.

My take is: I don't personally want to be the test case. I hear that often. (Actually, last week Yahoo! became that test, being sued by France, successfully, for providing Internet access to materials prohibited by French law. Their reaction, like some of the stalwart online therapists is, "let's see if they really have the power to enforce it".)

I am in favor of licensing to ensure qualifications of health professionals and other professionals. I argue for "license reciprocity" or "portability", appreciating that different states might have different requirements under law (e.g., in reporting abuse or threats of homicide), but believing that most states have similar professional standards and that often consumers are hurt rather than helped. (E.g., when they find professionals unwilling to help them out of fear another state will come after them, or a client will seek damages should something go wrong and it's learned the counselor is unlicensed in their state.) It's a quagmire. But one point of view is: Why not just practice as one always does, but within one's own State? Or get a few licenses if need be? (Simply add Internet communication to the telephone and office as possibilities!) Florida's nurses have an interesting licensing concept, which Dave Nickelson of APA calls the "driver's license" model, whereby it is assumed that when one is competent to drive in New York, they can also drive in California, or Florida, while passing through. They allow for temporary practice, similarly, for visitors in their state, recognizing that helping people may be similar across boundaries.

Perhaps more important than a professional's "right" to access populations in other states, it can be argued, is the consumer's right to know that the person they're trusting with their life is qualified, and accountable. (That's the consumer point of view!) I'd add that it might also be important to know that the counselor is well-trained and experienced in using the Internet as a tool.... Just as it is important to know that the consumer gives "informed consent" which verifies their comfort level with the technology, risks, and potential benefits. To quote the clothing store ad (Sy Syms), "Our best customer is an informed consumer". Which was the premise of APA's Dot.Com Sense brochure (a guide to consumers which unfortunately ceased being available online in Spring 2004).

-------------------

Questions - on "Suitability" for Online Treatment
(4-2001)


Dear Dr. Fenichel,

I am a student...researching a paper for Psych. Counseling theories. I decided to do this paper on Online therapy and have found your site after much research of one of your articles. I had previously e-mailed two therapists but had not received a reply. One of the questions on your site answered one of my questions. The other questions I would like answered are:


What types of therapy do you find suitable for the practice of Online Therapy?

What types of behaviors or problems of patients are best treated on the Internet? ie. Anorexia, Buliima. Obsessive Compulslve Disorder, Depression

thank you for your time - any response will be greatly appreciated

--Lillie D.V.

Answer-

Dear Lilli,

I'm glad you've read what *I* have to say (though I'm not sure which of my articles or pages you've actually read).

Sounds like a great study, but we're really only in the beginning stages of knowing what kind of therapies (online) work best for what sorts of "problems", and using what sort of communication (i.e., chat vs. e-mail vs. message board or f2f).....

I've just co-written a paper about assessing "suitability for treatment" at all, about the beginning stages of therapy. It focuses on considerations for specific skills and preferences in communication style which need to be taken into account before deciding to "do online therapy". It's online at the ISMHO site, listed under the case study group. It's really aimed at practicing therapists, so it's pretty clinical, and advanced level, sometimes technical, in the language. At:
http://ismho.org/casestudy/ccsgas.htm

But you have specific questions about specific situations, so here goes, proceed with your interview.

> What types of therapy do you find suitable for the practice of Online
> Therapy?

Hmm. See above article! :-) And.... if you want me to respond specifically about "types of therapy" rather than types of presenting problems (which is what we've been focusing on in ISMHO's Clinical Case Study Group)...

The first thing we came to agree on within our CSG (case study group) is that we cannot "translate" face to face therapies directly into online practice which is "the same". (I wrote an article about that at
http://www.fenichel.com/technical.shtml .)

In the offline world, we talk about types of therapy as "interpersonal", "Cognitive-behavioral", "psychoanalytic", "group", "Marriage-Family Therapy", etc. Online, however, there are not only theoretical orientations and technical skills of the therapist to reckon with, as in office practice, but there's also the client/patient's ability and willingness (or need) to use e-mail rather than talking face to face (f2f), or using chat, or using the telephone combined with office visits. So much is possible now if we focus on the technology, rather than the therapist's training, the client's need, the type of therapy modality (individual vs. group, e-mail vs. chat, "live" vs "asynchronous"). But it's also important for a therapist to have some understanding of the human mind, and basic principles of one or another school of psychotherapy, plus the ability to fully use the technology themself if we're talking about online work.

> What types of behaviors or problems of patients are best treated on the
> Internet? ie. Anorexia, Buliima. Obsessive Compulslve Disorder, Depression

That has yet to be determined (and in fact is still being debated and studied in terms of being treated in a private office, f2f!)

In terms of anorexia/bulimia, as you can see on my own site (e.g.,
Adolescent Mental Health, or Current Topics in Psychology, http://www.psychservices.com/Current.shtml), one of the most powerful aspects of help for eating disorders which can be found on line, is *information*, and support groups, and self-help references.

I suppose that there are some people who have found each other, and the other resources, and gotten medical, family, spiritual, whatever, help as a result of learning more about these disorders, and there may well be recovery groups (and certainly are individuals supporting eachother via email and chat).

OCD is interesting to think about. On one hand, the cognitive/behavioral aspects might be addressed through text, whether chat or e-mail, list or message board, yet on the other hand often the best treatment has been shown to be a combination of medication and psychotherapy. I am sure that some online counseling of people with OCD is happening, and would guess that many times the "patient" is in fact under medical/psychiatric care but using the e-mail counselor as an emotional support and/or problem-solver. Medication is not usually prescribed online, btw...

Depression. That is as widespread a word, feeling, diagnosis, as is "problems". I don't think, actually, that depression means the same thing to everyone. Almost everyone has good and bad days, and stressful periods, etc. Often people seek therapy for re-assurance, or support, or to help identify self-defeating behaviors or beliefs, or a general feeling of things not being good or fun or right... Sometimes, as with OCD, there's really a physiological component where medication is important, or helpful, but other times depression is a normal response to helplessness in situations, or in reaction to objectively stressful or "depressing" circumstances. So it is the case, imho, that as has been said from the dark ages on, "sometimes it helps to talk about it". Sometimes to a friend, sometimes to a therapist, sometimes to a safe but anonymous cyberbuddy in a support group or chat room or message board.

OK, I think I about covered it. At least all I can say, because it's all I know from my vantage point, but certainly somewhere, someone is doing just about anything, online.



Psychoanalytic Theory

Q: I am a senior psychology major at Mississippi State University. I am working on a small presentation regarding transference and countertransference. Because of my course work and education I'm familiar with the terms, but am having a hard time finding literature that will help with my presentation. I'm simply looking for a textbook definition and a few examples other than the examples I've learned in class. Do you know where I might can find a little information.
Thanks
Allison McMahon (Dec.2000)

A: Hi Allison,

You've asked a question I can certainly answer.... One of my favorite topics.

Now, one of my colleagues [a psychology professor] tells me to "stop spoon-feeding the students", who need to learn to do a little research on their own. So, I'm going to ask you to do a little work, too! This is an example (almost) of countertransference.... :-)

OK, if you've discussed these terms, you know that transference/countertransference is the heart of psychoanalytic theory and practice. It was everything to Freud, who interpreted resistance to psychoanalysis and how transference allowed the examination of a neurosis. These terms are from Freud, and any of his works, especially early works, would be very much involved in discussing transference. (Historically, it was mostly his followers and present-day psychoanalytic therapists who emphasize the role of *counter-transference* as heavily as that of transference.)

Textbook definitions you want?

TRANSFERENCE is the process whereby a patient relates to his or her analyst in a manner which parallels or replicates how they typically relate to another significant person in their life. Behavior, language, defensive style, fantasy and dreams can all be interpreted as manifestations of transference.

Examples: A female patient is easily irritated by therapist's suggestions or snaps sarcastically, even when therapist has said nothing except "hello". A male patient considers his analyst god-like. A patient "falls in love" with his/her analyst. Op cit: tons of movie references, and stereotypes.

COUNTERTRANSFERENCE is the analyst's side of the equation, and presumes that since even psychoanalysts are human, they have reactions to their patients' stories and behavior towards them. In psychoanalytic practice, the analyst closely examines his or her own feelings in response to the words of the patient, to separate out their own personal reaction from objective observations of the patient's distorted (transference) behavior.

Examples: If a patient is perceived as being flirtatious or hostile, is it a "personal" reaction (meaning the analyst's own subjective response) or because some other feeling is being brought out as a natural reaction to how the patient is acting out a transference neurosis?

Counter-transference is probably defined in text books along the lines of "the feeling engendered in a psychoanalyst by how a given patient is communicating to him or her during a therapy session". The well-analyzed therapist, it is important to note, has been trained to understand their own "hot buttons" and "blind spots" through his/her own psychoanalysis, and so is presumably well-equipped to understand (and interpret) when a patient is reacting to them in a distorted way, borne out of "transference neurosis".

A good example of countertransference is when a therapist is told about something a patient thinks or does which makes the therapist very uncomfortable. Why the discomfort? That's the purpose of analysts learning about themselves before trying to be totally neutral and encourage the patient to relax and "free associate" on the couch.

Some of the best textbook definitions, if you need a library (i.e., hardcopy reference) come in a book you'll probably find easily in a college library or Psych Department, called The Psychoanalytic Theory of Neurosis.

If you want to read more about transference and countertransference, begin by reading Freud, or about him. Here's where you can do a little research of your own now. (And of course I appreciate how you ended up writing to me as part of doing research.) Look on my
main psychology page for some of the links on Freud (in the main screen) and some of the links on the left side Psychology Reference Guide, especially the one for "Personality Theories". I'm sure there's an easy-reading discussion of Freud's theories there. If it's a (paper) text *book* definition you need, that's truly very easy... any book about the history of psychoanalysis or Freud.

Good luck!

[Note: Because of seeing the term searched for on my site, I added a mini-definition of another Freudian term,
repression in 2001.]

Interesting Topics


Q: I want to write about an interesting topic. Could you recommend one?


A: Well, the things that interest me are all over my web pages! What is interesting to you? Psychology is the study, as I see it, of "what makes people tick" -- how people think, feel, and behave. If you enjoy learning about how different people are, or how similar, there's an endless number of "interesting" topics you could choose for a psychology assignment. I've tried to list some of the topics which are interesting to me and other psychologists, as well as some very important information for people who may have disabilities themselves. Or friends or family who do. I'd suggest checking out several of the topics which sound interesting to you, from the description, and if there's nothing that leads to something "good", try some of the other sites listed in the reference section on the left side of the screen. You could spend days looking around some of them. Some are very technical, others are like looking through an encyclopedia. Hope you can find a topic somewhere here! Good luck.

-------

Q: I have to give a speech to my psychology class. I am a Senior. I was going to do it over ESP, but I could not find very much information over it. I do not know why it interests me I just think it is neat. I am doing my paper over Autism and I would like to do my speech over something "crazy." I really thank you for your help.
--Misty

A: ESP is a great topic for Halloween time! Actually, there's a whole lot of stuff on ESP, but not under "psychology". If you search the Internet (using Yahoo or Webcrawler, or whatever your internet service offers), you will find information on
"parapsychology", which is the study of the unexplained, supernatural, and especially ESP. "Parapsychology", "ESP" and "telekinesis" may all be topics you could explore on the internet. Not very directly related to psychology study though, except that it involves the mind. "Neat", as you say...sure is interesting.

-------

Q: What about something "crazy"?


A: If you like the idea of the "crazy"... you might try, in the field of PSYCHOLOGY such topics as "schizophrenia", where people may hear voices telling them to do "crazy" things (like some of the more terrible things people sometimes do), or maybe they imagine people studying them and trying to harm them, which is "paranoia" or "paranoid schizophrenia". (This is different than being a teenager; for lots of teens it is very "normal" to not feel normal, or to think other people are saying things, or whatever...) On my page there are a few schizophrenia links, including the Schizophrenia Homepage, which is at
http://www.schizophrenia.com and also www.Schizophrenic.com

But maybe that topic is "already taken", as you say many of the topics are.

There is also a page or two which deals with the topic of
agoraphobia--fear of everything outside your house, or even just of everything, period. Maybe that's not so "crazy" to you, but there's a lot of people like that, who write about it on the internet. Another thing which you might either find very interesting, or very scary, or very boring, is the topic of eating disorders (including anorexia and bulimia), which more than anyone else affects girls, mostly around your age, sometimes younger, often older. What is "crazy" is that these people are often as skinny as a rail and they think--really believe--they are overweight and need to starve themselves until they're just bones. They may become like agoraphobics, too, get very strange and afraid of reality.

The last thing I can think of, which is very unusual, very interesting, and probably not "already taken", is the topic of "multiple personality" [now re-named
Dissociative Identity Disorder]. This is what people sometimes mistakenly call "schizophrenia" (which is different) or "split personality". These people are like Jekyll and Hyde, if you know who they are, different sides of the same person, completely different personalities. They don't remember each other, and it's like having your body taken over by 5 or 6 people who share your mind, and then you wake up as yourself and realize you've just spent several days acting like different people, dressing differently, going places you'd never go to "in your right mind", and you'd have amnesia about what the other personalities in you did. Sortof interesting, no? That's "multiple personality disorder", which is different than amnesia. Multiple personality is actually a difficult topic, because often it is the result of horrible, traumatic experiences (war, torture, abuse, etc.) which are so terrible that the mind does these things in order to protect the person from a "total breakdown". Amnesia, on the other hand, is often the result of traumatic brain injury, where your whole mind gets rearranged sometimes, because part of it is damaged in an accident or by disease or trauma.

There's a "traumatic brain injury" link on my page, which describes the effects of brain damage, which is seen in quite a number of children and teenagers. (There's also a section on "educational implications", which describes some of the ways TBI affects students in school.)

Hope this helps, in time for your speech. And good luck on your autism paper....... Good thing you're getting good with the computer and "surfing the Internet" now. I'm sure it will help you for the rest of your life. Best of luck in your psych. studies!

Dr.Michael Fenichel
New York, New York


A personal note: In the aftermath of the attack on America, and the devastation here where I live and work in New York City, I have put together an extensive set of resources on Children and Trauma which has wide applicability to many types of trauma. :-(

It has been because of the tragic events affecting me, clients, colleagues, and the children & teens I see every day, that I've not had the time to put into updating this page more frequently. But I'm doing my best to keep it current and am sure you can find just about anything you need between the links above and those on my main psychology page.


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