female sexual dysfunction… a silent condition

Transcription

$5.00
Vol 25 No 4
The Monthly Newsletter of the San Diego Psychological Association
FEMALE SEXUAL DYSFUNCTION…
A SILENT CONDITION
IN THiS iSSUE
Female Sexual
Cover
Dysfunction... A Silent
Condition
Texting Patients p8
Intuition p13
From Battle Front p14
Falling to Heaven p17
Quail at Two O’ Clock p18
Book Review p20
to Back Home
What’s Happening with p20
the Public Education & Media
Committee?
IN EVERY iSSUE
From the Editor
p3
President’s Corner
p4
Calendar of Events
p21
Group Therapy Directory
p22
Classifieds
p22
San Diego
Psychological
Association
2010
Fall Conference
Ootober 8-9
August/september 2010
S
By Lori A. Futterman, RN, Ph.D
exual functioning is an integral part
of health involving the psychological,
physiological
and
socio-cultural
aspects of an individual. In an era
sometimes called “The Graying of America,”
aging women from the baby boomer generation
no longer speak about life expectancy – now
they talk about health expectancy, meaning they
want to live longer with a minimum of health
issues while enjoying sex throughout their life.
Our culture has shifted from considering sex as
mainly a means of procreation to seeing it as a
form of recreation. Sex is openly discussed by
many, and is seen in a positive light unless one is
suffering from a sexual dysfunction. People tend
to suffer with sexual problems silently.
Male sexual dysfunctions began earning media focus in a predominant way
in the late 80’s with the introduction of Viagra-like agents. This began the era
of sexual pharmacology. A number of “Viagra failures” made it clear that a
pill alone would not create an adequate sexual relationship. The complexity
of sexual functioning was recognized and gave birth to the field of sexual
medicine.
To understand sexual functioning, we turn to the sexual response cycle. The
linear version was described by Masters and Johnson (1970) and modified by
Singer Kaplan (1974). This model states that the desire phase leads to the arousal
phase which leads to the orgasm phase resulting in the resolution phase. Some
of the limitations of this model are that desire may be initially absent, desire
and arousal may overlap, arousal and orgasm may be on a continuum, and
orgasm may not lead to satisfaction. Basson (2001) came up with an alternate
sexual response model – the intimacy-based model. This model states that the
neutral woman, when faced with intimacy, will be propelled by biological and
psychological factors that govern arousal. If she experiences arousal, if she
Continued on page 5
San Diego Psychological Association
2010 Fall Conference
Practice Opportunities:
Tools You Can Use
 Ofer Zur, Ph.D. will be back after his popular
Spring conference presentation; the details of
his presentation are still being worked out, so
stay tuned to the Friday On-Line News, and look
in the mail soon for your Fall Conference
brochure for details of all the presentations.
 A wide variety of courses for you to choose
from will be offered.
 All courses are designed to be immediately
applicable to your clinical work.
 As always, there will be time to socialize and
network with our colleagues!
Friday & Saturday
October 8 – 9, 2010
Register at
http://www.sdpsych.org/calendar.cfm
Registration is available for one or both days
San Diego, CA
4699 Murphy Canyon Road, Suite 105
San Diego, CA 92123
Phone: (858) 277 – 1463
Fax: (858) 277 - 1402
2
www.sdpsych.org
FRom tHe EditoR
San Diego
Psychologist
Stephen Scherer, Ed.D., Editor
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opinions of the SDPA Board of Directors.
Stephen Scherer, Ed.D. PSY21337
3636 4th Avenue, Suite 302, San Diego, CA 92103
Office: 619-542-1426 / Cell: 858-922-5319
Email: [email protected]
4699 Murphy Canyon Road, Suite 105, San Diego, CA
92123
858.277.1463 • Fax 858.277.1402
Website: www.sdpsych.org
august/september 2010
W
Stephen Scherer, Ed.D.
[email protected]
elcome to the San Diego Psychologist’s August/September
issue. As the editor for the San Diego Psychologist, I find myself
pleasantly surprised by the contributions received from our
members. Several of the articles submitted are of such a caliber that they
might be published in academic journals with few if any modifications. It
is difficult to say whether these submissions are more or less impressive
than submissions with a more personal touch, containing descriptions and
anecdotes that we as clinicians can so easily identify with.
Our first article is by Dr. Lori Futterman, who provides us with a framework
for the analysis of female sexual behavior, which is demonstrated to
comprise a complex and significant behavioral repertoire. Dr. Futterman
presents a surprising array of variables that are likely contributors to female
sexual dysfunction (FSD), variables the origins of which may be “organic,
psychological, sociocultural and interpersonal.” Methods for assessment
and treatment of FSD are presented as well.
A thought provoking article on the role of intuition is presented by Dr.
Jason Camu. He offers up the possibility of dissecting our intuitive and
emotional experiences of a clinical case for increased personal awareness.
The result may lead to more accurate and honest intuitive assessments and
the possibility that you can learn to “trust your intuition” in the clinical
setting.
Matthew Lebovitz provided us with a very personal and powerful
composition on the topic of PTSD, a behavioral phenomenon that clinicians
are observing on a dishearteningly frequent basis as overseas fighting
continues. Not for the feint of heart, the work that Mr. Lebovitz describes
engenders a sense of pride in the strength of our clinical community in
addressing such a difficult problem.
Two contributions from Dr. David DiCicco provide us with a window into
the more personal side of psychology in San Diego. His first contribution is
a biography of SDPA member Dr. Jeanne Peterson, including her personal
history and information on her recently published book, Falling to Heaven.
Dr. DiCicco then provides us with a bit of an adventure, as he documents
his experience of bird watching in San Diego with several members of the
SDPA.
Finally, Dr. Jonathan Gale provides a brief review of Men in Therapy: New
Approaches for Effective Treatment, by SDPA member Dr. David Wexler.
A failure to note the difficult times in which we live might seem disingenuous,
but it might also be worthwhile to maintain focus on the bright spots of
our professions and our personal lives with an occasional nod in the other
direction. I hope that this issue of the San Diego Psychologist reflects our
attempts to focus on our strengths while at the same time acknowledging
some of our challenges.
www.sdpsych.org
3
PRESIDENT’S CORNER:
Mary Harb Sheets, Ph.D.
[email protected]
858.484.8332
T
his time of year finds us at an interesting and
challenging juncture. We are acutely aware of
approaching endings and, at the same time,
look forward to the promise of new beginnings. The
recent past is not so far behind that it has escaped us
leaving our memories of that time dim. Yet we are
also in the midst of meeting today’s opportunities and
demands. And, while we are engaged in the present,
we are also cognizant of our future on the horizon.
Albert Einstein saw the value in capturing something
from each of these seemingly disparate time periods
to enhance our overall quality of life. The wisdom in
his encouragement to “Learn from yesterday, live for
today, hope for tomorrow” is relevant and useful as
we consider our life as an organization today.
Learn. For SDPA, some of the most important
lessons of yesterday have been about “sight.” We
have learned the necessity of maintaining adequate
oversight of activities involving our Association’s
business and programs. We have been reminded of
the consequences of losing sight of what we are about.
We have recognized the value of using hindsight and
foresight to anticipate how decisions made today will
impact tomorrow.
Live. Today’s SDPA is “involved.” We are thoroughly
engaged in a variety of programs and activities
which support our profession and the greater San
Diego community. You can be involved through
attending programs for professional growth such as
the upcoming MMPI-2-RF course with Yossef S. BenPorath, Ph.D. on September 2nd and our annual Fall
Conference on October 8th and 9th. Our Mentoring
Program which helps new members find ways to
be involved in our SDPA community invites your
involvement. Committee meetings are opportunities
4
to be involved with colleagues and friends, offering
both professional and personal benefits. Ongoing
committee community service contributions such as
with Psychology 2000, Disaster Response, and our
Speaker’s Service are opportunities to be involved
with SDPA colleagues while supporting our fellow
San Diegans.
Hope. “Preparation” is what will allow us to look to
our future with hope. We are in the midst of preparing
to vote for candidates to fill open positions on our
2011 Board of Directors. Ballots will be mailed in late
September. Every vote counts so please be part of
this important process which will significantly impact
the direction our Association takes in future years.
Preparations are also underway for launching our
2011 Membership Renewal Campaign. As part of our
Board of Directors’ role to prepare and position SDPA
for the upcoming year, our September Board meeting
will be an extended one and will focus on “Proactive
Futuring,” a term coined by Russ Ackoff, to describe
a realistic and practical process of defining and taking
responsibility for our future.
Einstein presents us with an approach to maintaining
continuity as our Association grows and meets the
challenges that face us from within and outside
SDPA. He provides a path to help us avoid the
destructiveness of fragmentation and leads us in
the direction of integration to help ensure the future
integrity of SDPA. As we come into this pivotal time
of year, we are working to thoughtfully incorporate
our vision of yesterday with the experiences of today
and our plans and hopes for tomorrow. While the
“destination” for 2011 is not yet entirely clear, we are
committed to enjoying the journey and invite all of
you to come along.
www.sdpsych.org
Continued from cover FEMALE SEXUAL DYSFUNCTION… A SILENT CONDITION
remains focused and the arousal is enjoyable, she may
be driven by the desire of intimacy to complete and
repeat the sexual encounter.
Over the last several years there has been a growing
collection of clinical research and treatment.
Researchers face the challenge of meeting the highest
level of evidence-based medicine while demonstrating
the complexity of sexual life. Not typically discussed
in scientific literature is the vital part that love plays
in interpersonal and sexual intimacy (Levine, 2007;
McCabe, Tanner, & Heiman, 2010). “Mechanistically
treating sexual problems without considering or
discussing the quality of caring and love between
partners is not likely to resolve the sexual problem,
particularly over the longer term.” (McCabe, et al.,
2010).
THE IMPORTANCE OF A SEXUAL ASSESSMENT
Why is it important to take a sex history? Adequate
assessment leads to adequate treatment. Female Sexual
Dysfunction (FSD) is a condition experienced by
women who largely suffer in silence. It is common for
someone to present for treatment with complaints that
are medical or psychological in nature but underlying
these disturbances may be a sexual difficulty. An
adequate sex life is associated with well-being and
happiness.
Clinicians may be hesitant to ask questions related to
sexual health. In reality, their training may be limited
in sexual medicine. Time constraints, cultural barriers
and their own biases may be other influences that
cause clinicians to pause and not inquire.
There are five steps to an initial inquiry regarding
sexual health:
1. General questions: Are you experiencing any
changes in sexual functioning?
2. Specific questions: Are there changes in desire?
Arousal? Orgasmic functioning?
3. Is there an increase or decrease in sexual response,
satisfaction, or frequency of activity? You may
ask the patient to rate the level of distress on a
10-point Likert scale with 10 being the most
distress that someone may experience. If a patient
reports 5 or more on this distress scale, they may
need to be evaluated by an expert in the field of
sexual medicine.
4. Educate and inform.
5. Refer to a specialist for a comprehensive sexual
evaluation, if indicated.
In conducting a comprehensive
sexual evaluation of the presenting
symptom, one needs to clarify the
sexual problem by considering the
following:
• Are the symptoms acquired
or lifelong; generalized or Lori A. Futterman,
RN, Ph.D
situational?
• What phases of the sexual
response cycle are involved?
• Does the problem bother the patient or her
partner?
• What is the context of the symptom in terms of
past and present relationships and/or are they
currently active?
• What is the partner’s response?
• Is the problem psychological, organic, or a
combination?
Other considerations in a comprehensive assessment
are the following:
• A general clinical history and physical examination
which identify psychological, medical and sexual
disorders.
• A more specific evaluation of mood and cognitive
disorders, trauma, substance abuse, stressors,
interpersonal relationships, medications and
medical conditions would be essential.
• It is important to obtain lab values such as
an ovarian hormone profile to determine the
influences of estrogen and testosterone on sexual
functioning.
The clinician may ask the following questions to
determine the factors involved in the dysfunction
(McCabe, et al., 2010):
• Is it a result of predisposing factors such as sexual
trauma or disturbing family relationships; or
• Is it a result of precipitating factors such as
infidelity, problems related to childbirth, fertility
difficulties, ovarian decline, or other age-related
changes; or
• Is it a result of maintenance factors such as
anticipation of sexual failure, poor communication,
or inadequate education?
Another question to consider: Is the FSD related to
mood, hormones or both? Consideration of an existing
mood disorder, e.g., Anxiety/Depression/Bipolar
Disorders, is important in doing an evaluation. There
are many times that menstrual cycle-related disorders,
www.sdpsych.org
5
e.g., PMS, PMDD, Perimenopause, Menopause, or
disorders during pregnancy, e.g., Affective Disorder or
Postpartum Affective Disorder, may trigger the onset
of a sexual problem (Futterman & Jones, 2000; Clayton,
2001; Burt & Stein, 2002). Another consideration is that
any hormonal disorder may occur simultaneously
with a sexual disorder.
WHAT ROLE DOES MOOD PLAY IN SEXUAL
FUNCTIONING?
When looking at mood and sexual functioning there
needs to be a distinction made between a mood state
and a mood disorder. In addition, menstrual cyclerelated disorders such as PMS, PMDD, Perimenopause,
Menopause or disorders during pregnancy may
trigger the onset of a sexual disorder (Futterman &
Jones, 2000; Clayton, 2001). In addition, any mood
disorder may occur simultaneously with a sexual
disorder. In either case, inhibition or activation of the
psychoneuroendocrine system will affect the sexual
response cycle. The result will be a change in desire,
arousal or orgasmic functioning.
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by falling in water:
you only drown in
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This comorbidity is also seen in woman with a
Depressive Disorder (Ekselius, von Knorring, 2001;
Kuffel & Heiman, 2006; Kanaly & Berman, 2008).
The relationship between sexual dysfunction and
depression is complicated by the use of antidepressant
therapy as part of a treatment regime (Ferguson,
2001). These psychotropic medications carry sexual
liability with them (Clayton, 2002; Kanaly & Berman,
2008; Derogotis, 2009). Selective Serotonin Reuptake
Inhibitors (SSRIs) are the most common medications
associated with FSD. The overall incidence of FSD
was 59% when all antidepressants were considered.
Seventy percent of female patients on antidepressants
experience loss or delay of orgasm with reduced
sexual desire and arousal (Clayton, 2002; Kanaly
& Berman, 2008; Derogotis, 2009). However, if
depression is untreated there is a 50% reduction
in sexual desire and arousal and a 15-23% delay in
orgasmic functioning. Longer periods of untreated
depression may predispose women to increased rates
858.581.3534
State-anxiety has been shown to be arousing for most
women except if they suffer from a sexual dysfunction
or mood disorder. There is a high comorbidity of
Anxiety Disorders and Sexual Disorders (Palace &
Gorszalka, 1990; van Minnen & Kampman, 2000;
Aksaray, Yelken, Kaptanoglu, Oflu, & Ozaltin,
2001; Figueira, Possicente, Marques, & Hayes, 2001;
Bonierbale, Lançon, & Tignol, 2003; Bradford &
Meston, 2006; Corretti & Baldi, 2007; McCabe, et al.,
2010).
Applied Interventions & Methodologies, Inc.
Director: Dr. Sandy Shaw (PSY 18351)
Specializing in
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Phone: (858) 657-9117 Fax: (858) 657-0251
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www.sdpsych.org
of FSD (Kennedy, Dickens, Eisfeld, & Bagby, 1999;
Ekselius & von Knorring, 2001). There is no empirical
evidence on untreated anxiety and FSD. It’s possible
that any form of mental disorder would negatively
impact sexual functioning.
TREATMENT FOR FSD IS MULTIDEMENSIONAL:
EAST MEETS WEST
Non-medical approaches often address root causes
and can assist in prevention of FSD. Individual and
couples psychotherapy combined with biomedical
interventions from western and eastern schools
of medicine produce the optimum outcomes. Use
of hormonal stabilization which includes ovarian
hormones, thyroid or both may augment therapy.
Eastern approaches that have been useful are
acupuncture, homeopathic medicine and herbal
therapies. Some of the psychotherapeutic techniques
used include Mindfulness training; Meditation; Clinical
Hypnosis; Cognitive-Behavioral Therapy (CBT); and
Eye Movement Desensitization and Reprocessing
(EMDR), as well as psychodynamic approaches.
The clinician will need to contemplate ways to balance
the psychoneuroendocrine system using western
and eastern therapies. The aim of all treatments is
the stabilization and elimination of the presenting
symptoms.
PSYCHOLOGICAL TREATMENTS
Psychological treatments are specific to each of the
sexual disorders (Lieblum, 2007). A differentiation
between spontaneous vs. responsive desire is
important. A lack of responsive desire may be a
stronger indication of FSD than spontaneous desire
(Basson, 2001; Leiblum & Nathan, 2001). In assessing
a desire disorder, some questions to consider are:
• What factors are impeding the sexual interest?
• What is disturbing their ability to be intimate?
This may be approached from a psychodynamic,
cognitive, or behavioral perspective or a combination
of modalities. Empirical data on Cognitive-Behavioral
techniques have shown a significant improvement in
quality of sexual and marital life, sexual satisfaction,
and a decline in desire disorders (Trudel, et al., 2001).
Cognitive strategies aimed at changing negative to
positive beliefs related to sexual encounters have used
the technique of imaging scenes which incorporate
higher levels of sexual interest. In addition, a
traditional behavioral strategy that has been used
with couples is called sensate focus, which relies on
relaxation techniques to overcome the stress related
to intimacy. The concept of discouraging genital
touching or intercourse while affectionately engaging
in bodily caressing is an in vivo desensitization
exercise. Clinicians have also utilized Eye Movement
Desensitization and Reprocessing (EMDR) or other
systematic desensitization techniques to assist patients
in overcoming performance anxiety and inhibitions.
Treatment for arousal disorders can incorporate sexual
skill training or fantasy training. To assist patients in
developing a sense of confidence, the clinician may
encourage the use of positive imaging of sexually
arousing scenes, either with or without masturbation.
Fantasy and masturbation exercises can be in
combination with manual devices such as vibrators
or the EROS device to enhance genital arousal.
These exercises can be done in masturbation where
the fantasy incorporates the existing partner; once
familiarity with arousal is experienced, interactive
sex may become easier. “Sexual scripting” involves
an overt script between the partners and the ideal or
imagined script of each individual partner. Assisting
the couple to create flexible or unconventional scripts
can enhance sexual arousal and positively affect sexual
interactions.
Arousal and orgasm are considered to be part of a
continuum. A heightened state of arousal can lead to
orgasm. It is important to determine if this is a primary
orgasmic problem, in which case the woman has never
reached orgasm, or a secondary orgasmic problem,
in which case she has a history of being orgasmic
and is suddenly unable to reach orgasm. Another
consideration is situational: whether she has been able
to achieve orgasm through masturbation and/or with
a partner. Many women with orgasmic dysfunctions
may not know ways to increase arousal and sustain
the arousal long enough to reach orgasmic levels.
Building on the skill of sexual fantasy development
during masturbation while incorporating the partner
into the fantasies can be a prelude to interactive sexual
encounters (Heiman & Meston, 1997; Heiman, 2002;
Kilmann, et al., 1986; Segraves & Althof, 1998). The
goal is to assist in achieving successful encounters that
will lead to orgasmic functioning.
Contributing factors that can result in orgasmic
dysfunction are organic, psychological, sociocultural
and interpersonal (Lieblum, 2001). Physical/
gynecological and in some cases neurological
examinations are essential to rule out an organic
component. A psychological evaluation includes an
assessment of the influence of religion, education,
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7
age, relationship status, life style factors, and
history of sexual and/or physical trauma on sexual
functioning. Orgasmic dysfunctions may be viewed
as a developmental arrest within the individual.
The unconscious obstacle to letting go and
becoming vulnerable to another person may become
overwhelming and result in anxiety and fear. The focus
is to assist the individual in reaching psychological
differentiation and an enhanced sense of self esteem.
Orgasmic dysfunctions may also be viewed as a
learned response to sexual experiences that have
been traumatic. This may result in interference with
the ability to relax and enjoy the sexual interaction,
thereby inhibiting the orgasmic responses. In addition,
if the partnership is fraught with discord, issues with
vulnerability may arise.
Common painful sexual disorders are dyspareunia
and vaginismus. It is thought that dyspareunia and
vaginismus are not primary sexual disorders but
are secondary responses to recurrent experiences
of genital pain and should be considered as pain
disorders (Reissing, et al., 2004). The diagnosis of
these two classifications is based on complaints of
painful sexual penetration and on location of the
pain. Increased multidisciplinary attention is given to
various diagnostic labels such as vulvodynia, vulvar
vestibulitis, vestibulodynia, and focal vulvitis, in
addition to the labels of dyspareunia and vaginismus
(Lieblum, 2007).
One approach to treating these disorders is to shift
the focus from sex to pain and fear. The goal is to
decrease the avoidance and traumatic pain response
which results in increased pelvic floor and bodily
tension, in order to attain a relaxed response to vaginal
penetration. A combination of physical therapy,
medical/pharmacological interventions, education and
psychological interventions are used. Psychological
interventions that increase relaxation such as cognitivebehavioral therapy, clinical hypnosis, eye-movement
desensitization and reprocessing (EMDR), meditation
and biofeedback have been used.
In summary, sexual functioning and dysfunction
need to be addressed from a psychoneuro¬endocrine
model. As psychologists, we are in the perfect position
to view ourselves as primary care clinicians. We can
take time to understand the complexities surrounding
sexual functioning and intimacy. A comprehensive
assessment which takes into account the predisposing,
precipitating, maintaining and contextual factors and
identifies the difficulty as acquired or lifelong can
shed light on the multidimensional aspects involved
in sexual dysfunction. Given that no
single intervention will be sufficient
in treating these conditions, we can
utilize multiple treatment options
and facilitate the levels of care
needed.
(References are posted on SDPA’S
website)
TextinG Patients: WHat to Do?
T
By Marlene M. Maheu, Myron L. Pulier, MD, & Joseph McMenamin, MD, JD.
he use of text messages or “texting” in
professional communication is rarely covered
in medical or graduate school courses. Chances
are that the only discussion of such a medium occurs
when a professor scolds students for texting in class.
Pioneering professionals therefore lack guidance for
navigating the murky waters of new interactions that
can arise during text messaging.
The importance of this new wave of communication
and the risks it brings should not be taken casually
by psychotherapists. As with any other conversation
8
a counselor may have with a client, safeguards must
be in place to properly record and document the texts
produced during a patient’s treatment.
Text messaging is the communication of choice for
Generation Y, those born between the late seventies
and the late nineties, many of whom regard phone
conversations and email as obsolete and old-fashioned
modes of communication (Yan, 2006). In fact, the
popularity of texting amongst all cell phone users has
increased dramatically in just a few years from an
average of 9.8 billion text messages sent per month in
www.sdpsych.org
2005 to 152.7 billion monthly in 2009 (CTIA, 2010).
Teenagers (Generation Z) are even texting each other
while sitting in the same room. In contrast, many
older therapists avoid giving patients their cell phone
number because of concern over security issues, the
lack of research on how texting affects the therapeutic
relationship and treatment and not wanting patients
to access them casually after office hours.
Despite therapists’ reluctance to text with patients,
some of their tasks will soon be conducted via this
medium because of a steady consumer push for the
markedly increased convenience that, in psychological
terms, is almost equivalent to increased accessibility.
Many young people have no land line and subscribe
only to a mobile phone service. They are available to
text with anyone, anywhere, at anytime from a smart
phone kept in their hip pockets.
What is a cautious professional to do?
Is it reasonable to ask a patient to hang up their cell
phones, find a landline and call back? Whether we
like it or not, we may not have much choice. As this
young generation leaves for college, attains the proper
education and training, and then goes on to start their
own therapeutic practices, we can only assume that
professionals will be inclined to embrace more direct
and instantaneous communication such as texting (that
is, if a newer and more widely adopted technology
does not replace or modify texting as we know it in
the next few years).
Therapists of today will either follow suit or not, as they
struggle to maintain a foothold in an ever-changing
and increasingly technological marketplace where
coaches, counselors, social workers, psychologists as
well as psychiatrists vie for market share.
We may have our interdisciplinary “turf wars,”
refusing to work in multi-disciplinary settings,
failing to adequately refer to each other and seeking
to undercut each other’s offerings. Meanwhile,
consumers seem unconcerned about the zealouslyguarded borders between our professional disciplines.
Most consumers can’t tell the difference between
counseling and therapy, nor do many of them
they know the difference between psychologists,
psychiatrists, coaches or counselors. Eventually, much
like any other group vending services to consumers,
those disciplines that can best respond to consumer
demand will survive. Adoption of technology may be
essential to avoid extinction.
As with any emerging mode of communication, the
drawbacks of texting and of relying on the mobile
devices used to send text messages are only beginning
to come to light. Therapists have yet to sit down and
establish a uniform set of guidelines that will influence
how their colleagues use texting in professional
settings. Just as with other electronic communications,
therapists must exercise caution and utilize informed
consent with their patients if they are seriously
considering texting. There are important risks about
which patients ethically must be informed.
There is always the potential that a relationship with
a patient can take a turn for the worse if a short and
simple text message is misunderstood, especially
if the therapist is unable to read their patient’s
emotional cues as they are reading and writing their
text messages. Then there aare the risks to a patient’s
confidentiality should the therapist’s mobile phone be
lost or stolen. Most mobile phones are lost in highlytrafficked public places, with 40% going missing in
taxi-cabs and another 20% in restaurants, bars, and
nightclubs (Gross, 2009).
Hidden Dangers: How to Avoid
The number of lost mobile devices is staggering. This
it is not at all an uncommon problem. Over a sixmonth period from late 2004 into early 2005, Chicago
taxi drivers reported finding more than 85,000 lost
cell phones, 21,000 PDAs and pocket PCs, and 4500
electronic notebooks left behind in their cabs. Statistics
from taxi drivers in other metropolitan areas such as
London, Munich, Oslo, Paris, Stockholm, and Sydney
are similar (Biba, 2005).
The Therapist’s Cell Phone
The following vignette illustrates some dangers of
relying too much on a “smart phone” for interaction
with patients:
Dr. Kim, a psychologist with a busy Manhattan practice
was delighted with the applications his computer engineer
friend set up on his new iPhone, including one that
directed all his work emails to the hand held device.
Soon Dr. Kim found himself relying on the smart phone
for everything, from confirming his appointments with
patients to sending PDF files to colleagues. The address
book in his phone made it easy to connect with everyone.
One day, after a particularly stressful couple’s therapy
session that had lasted longer than anticipated, Dr. Kim
ducked into a Lower East Side diner for a quick lunch. He
set his iPhone next to his plate so that he could read an
important email he had been expecting from a colleague.
Running late, in his haste to cross town for his next
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9
appointment, he tossed some cash on the table and hurried
off, forgetting his iPhone.
What happened next sent Dr. Kim into a tailspin for the
next few months. After an hour, he realized his error, but
by the time he returned to the diner the iPhone was gone
and he and his colleagues had begun receiving unsolicited
email in their work and home accounts. Soon, telephone
solicitors were phoning their offices and homes at all times
of day.
Almost worst of all, professionals he had known for years
called asking if he were OK and complaining they were
receiving profane text messages from his iPhone. Truly
worst of all, after talking to his patients, Dr. Kim realized
that similar abusive messaging was coming to them as
well.
Dr. Kim hastily purchased a new iPhone and replaced his
old iPhone number with a new one so that the missing
machine could no longer function in his name. Dr. Kim
also set up a new email account and told his administrator
to cancel the old one.
Only after he consulted his attorney did he realize the full
ramifications of his error.
HIPAA mandates notifying patients when their Patient
Identifiable Information is compromised. Accordingly
Dr. Kim was instructed by his attorney to write a formal
letter to his patients informing them of the incident
and explaining the loss of his cell phone along with all
their stored text messages, telephone numbers and email
addresses. He apologized and directed them to his new
phone number. He advised them that to stop further
unwanted email and telephone advertisements and
potential other obnoxious messages they would have to
change their telephone numbers and email addresses and
give their friends, relatives, business associates , online
groups and others the new contact information.
The full cost of losing a cell phone is difficult to measure,
as it not only entails loss of purchased hardware and
software, but also adversely affects a professional’s
reputation and stature. In 2009 the average total cost
of a lost laptop was $49,246, according to a study of
twenty-nine organizations conducted by the Ponemon
Institute. About 80% of this cost was attributed to data
breaches (Ponemon, 2009).
While mobile phones lack the storage capacity and
productive capabilities of laptops, they are similar
in that they allow access to saved data and wireless
communications. This is especially true of smart
phones, which enable users to connect to the same
e-mail accounts and applications that they use on their
10
computers. A therapist that loses a smart phone may
find him or herself paying costs comparable to those
of a lost laptop, once the value of replacing equipment,
legal expenses, lost productivity and professional
embarrassment is calculated.
Aside from the direct out-of-pocket costs and time
spent to remedy such losses, amendments to HIPPA
regulations can make data breaches even more
expensive. Effective February 18, 2009, the Department
of Health and Human Services increased the maximum
civil penalty for illegally accessing individually
identifiable health records from $25,000 to $1.5 million
(Dolan, 2010). Therapists could face the threat of such
fines if they fail to install encryption software on their
mobile devices.
Losses of mobile devices are common, but how much
of a threat do they really pose to the average therapist
or mental health professional? The statistics suggest
that the possibility of unauthorized access to patient
records is indeed a major problem. According to a 2008
survey conducted by Credant Technologies, a data
security company based in Dallas, over one-third of
physicians and healthcare professionals store patient
records on smart phones, USB drives and laptops.
Most of those interviewed admitted that they did not
take the necessary precautions to secure data on their
mobile devices. Even after HIPAA regulations were
amended in early 2009 to further protect patients, gaps
remained in securing data. As late as November 2009,
only 39% of healthcare organizations had encrypted
their mobile devices (Dolan, 2010). Individual
practioners on the whole can be expected to be less
aware of this problem than are professional healthcare
administrators.
The Patient’s Cell Phone
In addition to the potential loss, damage or theft
that may occur to a therapist’s mobile device, similar
misfortune may befall a patient’s mobile phone. Aside
from this, operational problems with wireless devices
may inhibit communication. Dropped calls, static,
delays in wireless signals and background noise
during a cell phone call or in the middle of texting add
to the disadvantage of this mode of communication.
Such incidents are tolerable in casual conversations
between friends but can be consequential during
patient-therapist communications.
Dr. Sue Ellen was having some renovations done on her
home, in which she ran a small private practice. She had
her office voice mail redirected to her cell phone, as she was
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now away for long intervals. During a trip back from the
grocery store, Dr. Ellen received a disturbing call on her
cell from a distraught woman she had never met before.
“Hi, Dr. Ellen. I’m Beth and my husband’s insurance
company said to call you. I need to see somebody as soon
as possible.”
”OK, Beth, I don’t . . .”
“You see, my dad’s really old and he refuses to shower.
We don’t have money for a nurse. The other day I got
so fed up that I had to just throw him in the shower he
smelled so bad, and he fell down and I turned the water on
anyway, I don’t know why. It was hot.”
”Beth, please, you’re breaking up . . . .”
”He’s bruised a little and can’t walk too good. I mean
he’s OK and doesn’t need to go the emergency room or
anything, but I think I might do something again. Please,
I need help . . . .”
The call drops. Dr. Ellen stares at her phone. She has caller
ID so she clearly sees the name and number of the caller.
She tries calling back several times. No one answers. Then
she receives a text message: ”sory 4 b ng dramatc re dad i
m ok now no worries.”
This series of events puts Dr. Ellen in a predicament.
She received a call from a woman that she has never
met who clearly is in trouble. The call dropped and
she wasn’t able to extract further details, but has
reason to believe that elder abuse is occurring. The
caller’s failure to answer a return call and, worse, the
text message certainly provided no assurance that the
incident was resolved and that the caller’s father was
out of danger. The text message is a concrete record
that must be acted upon.
What would you do?
Psychologists must be prepared for such incidents.
Similarly, current and potential patients should
be made aware of the pitfalls and shortcomings of
communication with such limited interaction. For
these reasons, among many others, psychotherapists
must seek the consent of their patients before engaging
in any communication via texting. Boundaries and
expectations need to be established with patients
during the informed consent process, prior to
treatment.
Informed Consent Process
How to make contact and when messages will be
retrieved and returned are issues to be included in the
informed consent discussion and documented in the
written informed consent agreement. The informed
consent process might also explain that text messages
will be documented and archived just like any other
communication. This precaution serves not only to
provide the psychotherapist with a record of the
patient’s behavior but also safeguards him or her from
potential litigious pitfalls. Why?
Consider the following scenario:
Dr. Jensen has scheduled giving some lectures during a
two-week period. When she plans to return, one of her
patients, Maryanne, will just be leaving on her own
business trip, resulting in an even longer gap in treatment.
Out of concern for her patient Dr. Jensen agrees to give
Maryanne her cell phone number and reminds Maryanne
of their consent agreement. Maryanne expresses her
understanding of the doctor-patient boundaries.
Several days pass before Dr. Jensen receives text messages
from Maryanne. Translated into conventional English the
text reads: “I’ve been offered another job but I’m nervous
about telling my boss because I’m afraid he might get mad
at me. What should I do?”
Dr. Jensen was concerned that something like this would
happen; Maryanne has had issues with confrontation
in the past that have adversely affected her career and
relationships. Although she has made progress in her
therapy she still struggles with addressing authority
figures, including her manager.
Dr. Jensen calls Maryanne and tells her that she does not
accept text messages, but would like to meet with her in
person to discuss her current situation. They schedule
an appointment for the Monday following Maryanne’s
return from her trip. Most importantly, Dr. Jensen retypes
the text message onto her secure hard drive and makes a
note of how she responded to the situation.
If Dr. Jensen had used an iPhone application to print
out the text message, what assurances does she have
that:
• her own smart phone won’t be stolen and that the
patient’s information, including phone number,
won’t be compromised by a hacker
• a subpoena issued by an unfriendly attorney
could be used to obtain information that will
compromise the patient
• the application developer isn’t secretly
accumulating such information about users of
that application.
If a therapist chooses to engage clients or patients with
text messages despite the dangers described above,
specific precautions are warranted and discussed
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during the informed consent process. The following
steps are safeguards therapists can implement to
record text messages securely so that they can be
printed or saved for clinical records:
• Use a service such as Mobile Spy (http://www.
mobile-spy.com/) to record text messages from
Windows Mobile and Symbian OS Smartphones.
• Text messages can be forwarded to the therapist’s
email address via applications such as txtForward
(http://txtforward.com/), which may be used on
Blackberries and Windows Mobile devices.
• Some “smart” phones, like iPhones or Androids,
allow the owner to buy applications that can take
“screen shots” (pictures) of their text messages.
The screen shot can then easily be sent to an email
address as an attachment and saved for future
archival purposes.
Final Practicalities
When using the methods listed above or any other
means to record confidential patient communications,
keep in mind issues of security and privacy. The most
important task is to ensure that the patient knows that
their text messages are being recorded. Otherwise,
feelings of betrayal and distrust may arise if they
discover an archive of their messages at a later date.
Therapists may want to reference their professional
and state organizations for further information
on securing patient text messages. Standards are
constantly being updated and as of the publication of
this article, the American Psychological Association
(APA) does not single out texting specifically in any
of their guidelines.
The APA does, however, suggest a conservative and
all-encompassing approach to patient records in
their “Revised Record Keeping Guidelines.” Under
the heading “Content of Records,” there are three
subsections entitled “General File Information,”
“Documentation of Substantive Contact,” and “Other
Information,” which suggest general standards of
practice. Among the content to be included with
patient records are “extraneous case information
and correspondence, and materials provided directly
by the client such as journals, logs, or drawings”
(Connell, et al., 2010). Depending on how one defines
“correspondence,” a case can be made that the term
can be interpreted to include any text messages
between therapist and patient.
Beyond professional guidelines, it is also worth
considering that some texting services send
12
information over unencrypted lines to non-secure
servers. One can inquire of the companies offering
these communication services whether they provide
alternative secure methods to transmit and archive
patient communications, and if so, what the cost is
and what steps need to be taken to use such services.
Also, be ready to be subpoenaed if your patient ends
up in court and an attorney wants to see your textbased interactions with that patient. When in doubt
over whether you are adequately protecting your
patients and your practice, refer to the most recent
HIPAA regulations and amendments to ensure that
your patients’ rights to privacy and confidentiality are
not compromised.
As for information stored on a smart phone, anything
that can compromise patient privacy should be
encrypted for storage. Additionally, the device should
be set to lock itself after a period of inactivity so that a
password is required to get in, preventing pranksters
from misusing the phone if it is lost or stolen. If this
cannot be done with one’s device, it may be unwise to
that particular information on the device.
A therapist should be able to reach patients in an
emergency, such as when the day’s appointments
must suddenly be canceled. The schedule and the
patients’ telephone numbers can be kept in the oldfashioned way: in a pocket day planner or a printout.
This provides backup in case of equipment failure or if
one cannot go online to access one’s electronic address
book.
Such an address book should be secure and not
available to anyone who might come across (or
purchase) one’s missing handheld device. Such
devices (PDAs, smartphones, etc.), when they are
discarded or recycled, should be reliably cleansed of
any patient information and stored records of texting
communications. This may require expert assistance,
as simply doing a “delete” may not suffice.
Without the owner’s knowledge, texted messages may
be stored elsewhere than on the owner’s cell phone or
other hand-held device. For example, the Google Voice
service can automatically copy messages to a GMail
account, where security may be less than desirable.
In practical terms, many of the risks involved with
texting between mental health professionals and
patients will not actually be avoided by the parties
involved. While the wise therapist will strive to take
all reasonable precautions and to try not to let lapses
occur, texting is currently inherently not at all as secure
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as alternative communication modes.
Advances in technology, equipment, the practices of
communication carrier providers and demands of the
marketplace will undoubtedly improve in the next
few years. Until then, many professionals will resist
the siren call (and patient requests) of texting, despite
its being perhaps the most accessible communication
medium to date.
(References are posted on SDPA’S website)
Intuition: OuR GReatest peRsonal Gift
oR pRofessional weaKness?
By Jason N. Camu, Ph.D.
[email protected]
In a field seen perhaps more for mystery and art than
science, as psychologists we sometimes struggle to
explain our methods and procedures. This is especially
true when our own emotional experience is used as a
less than scientific tool in the moment.
Our patients want to believe and trust that we can help
and that we know how to help. Sometimes the notion
that you are a very “intuitive” person is reassuring
to a particular type of patient—maybe the person
who needs to believe in something bigger and more
impressive than the tested hypothesis. For others it
means the doctor is not bound by reason and the rules
of the social sciences, but rather is flakey and magical.
After all, other professions like medicine and law make
it clear; because it is in fact clear. I wanted an x-ray for
my broken elbow, not the physician’s intuitive sense
that it was shattered.
“Intuition” may conjure images of a well-timed
intervention that freed a patient from his or her internal
prison. Conversely it may sound imprecise, affected,
and unskilled. Like any of our tools, if intuition is to
be judged as useful, discussion of what it actually is
may be beneficial.
What then does “intuitive” mean?
I posit the
following regarding intuition as it applies to clinical
work. Many psychologists are remarkably sensitive
people with wonderful gifts in terms of reflective
capacity, observation, and detail. This natural or
innate predisposition of strong affect is then sifted
and structured through education and professional
training. Consequently, in addition to all of our
scientifically derived skills as psychologists we also
aim to use our own feelings and reactions to further
understand people—for example, the confusion
that occurs at a staff meeting regarding a psychotic
patient (parallel-process), or the schoolgirl crush that
is privately experienced by a female intern for the
handsome and just charming enough young sociopath.
These are examples of countertransference in some
form or another. When we fail to acknowledge and
explain the experience of countertransference or
projective identification, the feelings may be priming
the inevitable build up of something that becomes
intuitive.
Thus the collision between projected material that is
felt (identified with) and our own life experience that
also results in an intuitive action by the psychologist,
is unique because it escapes understanding or
articulation, e.g., “I don’t know it just felt intuitive.”
Intuition in clinical practice may be defined as the
following:
The accumulation of powerful emotional data gathered
via profound sensitivity and attention to both verbal
and non-verbal cues and all of the senses known
and unknown, that simultaneously elicits feelings in
the recipient that are not articulated or understood
in the moment, yet may be translated to action or
intervention.
The inability to clearly articulate the source of the
intuition should spark interest for those of us in the
business of introspection and insight. Action without
understanding could be risky. Conversely, it could be
just what a patient needed, or doctor ordered for that
matter.
Dissection of these keen moments of emotional
experience—whether you acted on your intuition or
not—may yield incredibly meaningful information
about your patient, and maybe more importantly
about you. A colleague of mine described a feeling
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13
that one of his psychotic patients was in fact safe
to have to his home for dinner. Arguably, this
patient’s treatment needs included socialization and
interpersonal skills. But what of his history I asked.
He could be impatient and verbally aggressive and
had poor frustration tolerance, including a formal
thought disorder. So what was it that my colleague
felt that made him so certain this man would be safe
with his family? And my colleague by all measures
of performance, including treatment outcome, is an
excellent psychologist and not foolish. Maybe this
was a terrible lapse of judgment, a boundary violation,
and a dangerous empathic fantasy to help. I knew I
would never do it. Rather than judge and blame, I
wondered.
So I had to wonder about the mechanism, or pathway
of internal experiences that led my colleague to
this place. Perhaps it was an emotional bond with
this person. This patient cared enough about the
psychologist that the dynamic experience between the
two was internalized (a newer object relationship), and
caring developed. Caring for the therapist resulted in a
moral standard against hurting the therapist or anyone
the therapist cares for; and maybe my colleague felt
this change. But this would be a clinical explanation
after the fact, derived mostly from object relations and
psychodynamic theories. My colleague had already
acted and invited this patient home from a residential
treatment facility. I knew this was well outside of my
comfort zone. And years later this patient has thrived
from this real-life trusting relationship with the
psychologist and en vivo experience with boundaries
and rules.
of your intuitive gifts can be difficult. As psychologists
we know that like the people we treat, we are susceptible
to our own self-serving biases and the use of defenses.
For example, if a patient decompensated following
the use of intuition, would it be noted? Would the
patient be held responsible for simply defending
against the truth. Said differently, the intervention was
accurate and useful but it was the patient’s resistance
that thwarted the intuitive wisdom—remember it
is a patient’s job to use defenses against things that
are painful. Maybe operating intuitively was off the
mark. Another question that surfaces is, would the
misaligned intuitive intervention even be noticed by
the clinician? Social psychology tells us that Biased
Scanning is used to confirm our biases. Consequently
we only notice, acknowledge, and count/log those
events that are consistent with what we believe to be
true. The evidence that suggests that we might be
wrong is never even noticed.
I have found that one of the best ways to keep myself
accurate and honest is through the use of supervision,
especially peers that will offer honest observations
rather than personal judgments. It is the group that will
come to see your patterns, strengths and weaknesses
even when you don’t. Peers also pose the recurrent
question either directly or indirectly, “why do you
think this was, or would be helpful for this patient?”
This challenge can reorganize the scientist in all of us,
allowing for critical reason-based thinking as well as
the integration of what I believe is one of our greatest
gifts, sensitivity. To correspond regarding this or other
articles, please contact me, Dr. Jason Camu via email
at: [email protected].
Accuracy and efficacy of intuition—does it work? A
word that often precedes intuition is trust: “trust your
intuition.” But assessing the accuracy of, or usefulness
FRom Battle FRont to BacK at Home:
PeRspectiVes on tHe RetuRninG SoldieR’s
Combat ExpeRiences
M
By Matthew Lebovitz, M.A
onths ago I wrote about mental health
care for United States Marine Corps
recruits during boot camp. I hope that the
article illuminated one of the many ways in which
psychology is practiced in the military. What I have
14
found in working nearly two years amidst this culture,
however, is that change is one of but a few constants;
just as active duty servicemen and women frequently
deploy and return, so may those who work in one
place get relocated to another. As a civilian, I was not
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immune to these patterns, and since my last article I
have been transplanted from the Marine Corps Recruit
Depot (MCRD) to Balboa Hospital to work in a new
capacity.
The Setup
With countless service members returning from
deployments to Iraq and Afghanistan, one could
imagine how great the psychological tolls have been,
and how great is the need for efficacious assessment
and treatment. Most well-known among the negative
consequences of combat is Post-Traumatic Stress
Disorder (also referred to as Combat Operational
Stress). To meet criteria for this disorder, one must
first have had exposure to an extremely traumatic
event and secondly have had a reaction of intense fear,
helplessness, or horror (though service members give
many responses to this item, and it is subject to change
in DSM-V). Subsequently, the individual will express a
series of symptoms falling into DSM-IV-TR “clusters”
of re-experiencing (e.g., nightmares, flashbacks,
intense recollections), avoidance (e.g., avoiding
reminders of the event, emotional numbing, sense
of detachment from others), and hyperarousal (e.g.,
difficulty sleeping, hypervigilance, anger outbursts).
From a basic anatomical perspective, we understand
that the trauma affects three key structures of the
brain: the amygdala, hippocampus, and prefrontal
cortex, important in regulating emotions, processing
memories, and controlling impulses, respectively.
Service members, often lacking insight and training
in diagnostics, routinely are either not aware of their
problem or do not “connect the dots,” so to speak, and
when distressed by the above symptoms turn to alcohol
and drug use which, while providing a transient
escape, often pave the way for a path of destruction.
Not so seldom does substance use become abuse or
dependence and the service member finds himself in
interpersonal, occupational, and/or legal trouble, and
may end up in a rehabilitation program.
At the Naval Medical Center a new assessment and
treatment program for returning service members is
getting its feet off the ground. The goal of the program
is to unite the work of the new research department,
Naval Center for Combat Operational Stress Control
(NCOSC) with multiple clinics in the assessment,
case management, and treatment of returning service
members. This is being executed through conducting
a standardized battery of self-report measures and
an in-depth clinical interview, case conferences,
psychoeducation groups, and assignment of patients
to providers who practice the most appropriate
evidence-based therapies for each individual in need.
As a clinician-in-training, one of my main responsibilities
has been to conduct the initial assessments with the
service members, present and discuss their cases
at weekly conferences, and network with various
clinics in the performance of case management
responsibilities. The assessments, guided by in-depth
structured interviews that allow for additional inquiry,
have yielded intense and disturbing accounts of the
war experience and subsequent psychological fallout.
The Stories
To review each story would be fitting for a book rather
than a brief article, therefore I will highlight a number
of cases with the hope of providing a snapshot of
the invisible wounds of PTSD. To begin with an
incredible account, let’s take the wounded Marine
in his mid-twenties who I saw less than two months
after his trauma. Rolling himself into the office in a
wheelchair, this nice-looking veteran propped himself
onto the couch, repeatedly massaging the stumps that
were his thighs. “The worst part about it,” he told me,
matter-of-factly, “is that my feet are killing me, and I
can’t do anything about it.” The striking aspect of this
was that he had no feet. He had no lower legs. As he
described the phantom pain, he rubbed what remained
of his lower limbs to provide himself some semblance
of relief. As we proceeded through the interview and
arrived at the PTSD module, I inquired further about
the incident. “Well, we were walking down a narrow
pathway, looking for IEDs. Two grunts had gone ahead
of me, so I figured it was clear. Then I stepped on it.”
He proceeded to describe being launched through the
air, with everything silent around him, and landing in
a daze yet knowing that “at least one leg was gone.”
This brave soldier did not endorse any PTSD or any
other anxiety-related symptoms, stating that he had
experienced a single panic attack a few weeks prior but
claimed that one session with his therapist provided
him with tools that had allowed him to avert anything
further. Later, in case conference, we discussed the
phenomenon of polytrauma, or the experience of both
a physical and psychological trauma. Often times
in the immediate aftermath of such occurrences, the
response to the physical component is the focus of
the patient’s energies, and only later do significant
psychological sequelae emerge.
Among the unique features of the war in Iraq and
combating the insurgency is the inability to know
who is a combatant and who is a comrade. Whereas
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15
in previous wars a soldier could be reasonably certain
who was an enemy, this is now hardly the case. Time
and time again I have been told that “one minute
someone will wave hello, and the next minute they’ll
pull out an ‘AK’ (47) and open fire.” With stress fatigue,
i.e., the accumulation of high levels of stress over a
period of time being predictive of one’s developing
PTSD symptoms, one could only imagine the
emotional overload experienced by these young men
who understand that at any moment the seemingly
friendly Iraqi could turn around to literally shoot you
in the back. In the words of a co-worker and friend,
“every day we pretty much expected to die.”
This uncertainty about who was a friend or foe is
hardly restricted to the stereotypical young adult
male insurgent. One Army Specialist described to
me how, as a good will gesture, elderly women and
young children would often bring candy or other
goods to American soldiers, and a warm relationship
between the two parties would ensue. However, the
insurgents, aware of such dynamics, and looking for
every possible opportunity to kill Americans, offer
relatively large sums of money to the families of those
willing to carry out the deed. One afternoon, as he
approached a checkpoint from several hundred yards
away, this corpsman watched a young boy approach
a pair of Marines, “and it was just a big explosion.
When we got there, there wasn’t anything left.”
There is no easy part of such a war, but if one
experience is most devastating for a service member, it
may be the death of a child. Unimaginable to envision
and overwhelming to hear, children and young
adolescents are trying to kill American soldiers, and
they aren’t doing it with sticks and small stones. On
multiple occasions, service members have related that
they were forced to engage a child, resulting in that
child’s demise. A young Marine sergeant detailed
an encounter he could not stop re-living: “When we
go out on patrol, we pull out of the FOB (forwardoperating base) onto a busy road. We fire warning
shots in each direction so the traffic will stop and let
us through. So we were out on patrol as usual, in the
armored vehicle. We came across some kids, and one
threw a brick at my gunner, hit him in the face, and
shattered his jaw and cut him up real bad. We fired
a warning shot and the kid ran away. A little later
another kid, a 7 year old, was reaching back to throw
a rock at us. The rock looked like a grenade, and we’d
had kids throwing grenades at us before, so we have
no choice but to engage. I normally fire a warning
shot above their head with my shotgun. I have two
16
kinds of ammo—buck shot and bird shot. I always
use the buck for the warning shot, because the bird
shot scatters all over, but I this time had reached into
the wrong pocket and accidentally loaded bird shot.”
He looked down and shook his head. “I aimed above
his head, and I fired. The buck would have gone over
his head, but, yeah. I keep seeing it over and over
again.”
The Sequelae
The action-packed accounts are painfully captivating,
but equally painful to behold can be the manifestations
of the traumatized and rewired brain that occur
in their wake. Research has demonstrated that
individuals with PTSD have an overactive amygdala
and diminished inhibitory function of their prefrontal
cortex, which is associated with increased impulsivity
and extreme reactions triggered by seemingly
innocuous events. A perfect example is Eddie, who
had stopped at a 7-11 to purchase food. He noticed
a Middle-Eastern-looking man at the store, and his
anxiety peaked. Though Eddie attempted to avoid
confrontation, the unsuspecting man walked too close
for comfort, and Eddie grabbed him by his lapels and
shoved him against the glass refrigerator door. It
wasn’t until he had already acted that Eddie realized
what he had done, and apologized profusely to the
stunned victim. Ryan talked about how nervous he
becomes when cars drive close to him, and shared that
once after being cut off while driving he got out of his
car at a stoplight, and began screaming at the other
driver. Bobby, who avoids going to public places alone,
was with a fellow service member at the supermarket
when, in the adjacent aisle, an item fell from the shelf
and made a loud noise. “Immediately we both hit the
deck,” he said, incredulously. Mike veered away from
a soda can on the street curb that reminded him of
an IED that blew up his vehicle in Iraq. Fernando
was shopping when someone brushed up against
his side, and before he could think he put the fellow
into an arm-bar, a martial arts technique for breaking
an assailant’s arm. Chris keeps a loaded gun under
the mattress, and thrashes about so much that his
wife cannot sleep in the same bed. Tyrone is racked
with guilt, not so much for what he did, but rather
that he is in San Diego when there is much work to
be done in Iraq and Afghanistan. Derek’s marriage
is disintegrating in large part because he no longer
responds emotionally as he did before being deployed,
case and point being when his daughter was nearly hit
by a car and he reacted nonchalantly while his wife
panicked. And Brock, a funny and friendly young
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man, told me “really all I want is to meet a good girl—I
just don’t think anyone will put up with me and all of
my issues.”
The stories go on and on, and the psychological changes
in the men and women who have faced the horrors are
undeniable. Whether a service member drove through
Iraqi cities in 2003 immediately after the “Shock
and Awe” bombing campaign, tended to wounded
soldiers fighting off drugged-out insurgents, drove
over multiple IEDs, was ambushed by insurgents, lost
a best friend to the enemy, was a first responder to
the scene of suicide bombings, or worked as a trauma
nurse for thousands of maimed and dying Iraqis
and Americans, the intense experiences leave their
mark. These brave individuals are walking among
us, yet most of us can never know the invisible and
irremovable signs that they bear. After all, even the
most cutting-edge treatments aim to help the suffering
integrate, not eradicate these memories in the hope
of a return to adaptive functioning. Some deny that
anything is different. Some speak openly. Others speak
about possibility that they may have been affected.
Yet if our experiences, positive or negative, subtle or
extreme, shape our thoughts, our feelings, and our
worldviews, it is hard to argue that facing such lifethreatening and horrific events on a routine basis does
not leave an imprint. We owe it to ourselves and to
the incredible men and women whose sacrifice has left
them with such scars to learn about, understand, and
make efforts to help inasmuch as we can.
FallinG to HeaVen
By David A. DiCicco, Ph.D
W
hen Jeanne
Peterson first
walked into
my office, I couldn’t
help but think that this
attractive woman was a
person of strong character. Nothing I experienced over
the next hour altered that original opinion. Jeanne, a
north county psychologist and SDPA member, had
written a novel, and we were meeting to discs it and
her life.
Born in Bakersfield to “hippie” parents, Jeanne may
have been one of the few people from that city to
attend to ultra liberal Wesleyan College in Middleton,
Connecticut. She loved her time there, and after college
she began working with prisoners in Bakersfield,
helping them stay connected with their families
while incarcerated. She then worked at a Residential
Treatment Center for adolescents before attending
CSPP in San Diego. She graduated in 1993.
Jeanne has done work at the Linda Vista Health
Center and HIV Mental Health Services Center. Now
she works in five hospitals with people with severe
medical conditions like ALS or multiple amputations.
Interestingly she pointed out that catastrophic illness
leaves people psychologically undefended and ready
to make change! She feels honored to witness her
patients’ courage, adaptability, and resiliency.
In addition to her hospital work Jeanne has a private
practice in Hillcrest. Fluent in Spanish, she conducts
sessions in both languages. When I asked how she
learned to speak another language so well, she told
me her family moved to Mexico for a year, when she
was eight. Her two sons aged 6 and 8 are currently
studying in Spanish immersion programs.
Curious how a Southern California woman ends up
writing a book about Tibet, I asked Jeanne how this
all happened. Jeanne had been exploring different
belief systems from an early age. She was interested in
Buddhism and the Quakers, and this led to her idea for
a book. Her work with torture
victims from Southeast Asia
was an additional motivating
thread for the book, Falling to
Heaven, which took ten years
to write. A synopsis of the book
from Amazon is below:
“A stirring glimpse into the
culture of Tibet... A moving
account of religion and love...
A powerful debut by a talented
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17
new writer. In 1954 Emma and Gerald Kittredge
leave their secure Quaker community and travel to
the small Tibetan town of Shigatse where they soon
find companionship with their neighbors, Dorje
and Rinchen, and their sons Dawa and Chumpa.
But the arrival of Maoist soldiers into their quiet
life shatters everything. Gerald is captured by the
soldiers, leaving a pregnant Emma at the mercy of
her Tibetan neighbors; relying on them for survival
and spiritual support. Dorje and Rinchen cope with
their sons; one who chooses a path of violence, despite
his monastic life, and the other who must grow up
amid political struggle. Told in three distinct voices
rich in their respective spiritual traditions, Falling
to Heaven is ultimately a novel about faith: losing it
and rediscovering it in places you’d never expect. In
a startlingly poignant voice, debut writer Peterson
explores the duality of religion as both the Quakers
and Buddhists reconcile their spiritual tenets. And
through it all, the reader witnesses an overwhelming
beauty—in the lush Himalayas of Tibet, considered
the ceiling of the world, in a place believed to be the
closest to heaven.”
It was natural at some point that I ask Jeanne if she
had been to Tibet. Not surprisingly the answer was,
“Yes.” Some years ago she visited Tibet and Nepal.
She found Yak Butter Tea “disgusting,” but loved
visiting the many monasteries that dotted the Tibetan
landscape. She enjoyed talking to locals and quickly
realized how much westerners could learn from the
Tibetans. She expected to find anger and rage against
the Chinese, but Jeanne told me that that was not the
case. She said the Dalai Lama summoned it up best,
when he said, “The Chinese have already occupied my
country. Why let them occupy my mind too?”
Western Nepal/David DiCicco photo
Jeanne found the spirituality of Nepal and Tibet
intoxicating, as she did sights, sounds, and smells of
these vibrant places. She will go back.
When I asked her about the process of publishing,
Jeanne told me that many agents turned down the
book before she found one who would represent
her. She now has publishers in the United States and
England, and preliminary reviews of Falling to Heaven
have been good. She hopes eventually to sell the book
to film makers. She is now working on the second
draft of her second book.
As I listened to Jeanne Peterson, I thought what
energy this person had! Mother of two and busy
professional, I wondered how she found time to write
such a complex book that required hundreds of hours
of research. I also thought of what people are capable,
when they have a direction and goal. I found myself
looking at Jeanne with a sense of awe and respect. As
Robert Reed use to say at the end of his TV program,
there really are 8 million stories in the Naked City, and
indeed, I had just heard one of them.
Quail at Two O’clocK
By David A. DiCicco, Ph.D
“I
18
SDPA Birders
n my next life I want to come back as a bird,
so I can watch the tourists and identify where
they come from!” were the words of group
leader Bruce Sachs. He and Arnie Sheets were leading
a group through Mission Trails Park and later along a
seaside trail in Ocean Beach to view native San Diego
birds. Arlene Young had bid on their tip package,
which included lunch prepared by Janet Farrell, at the
www.sdpsych.org
SDPA Gala earlier in the year. My wife Vicki and I
were guests of Arlene.
At eight A.M. Mission Trails Park was cool and
quiet. We stood near the old dam and Bruce and
Arnie showed us how to maneuver our binoculars
effectively to identify nearby birds. Suddenly the little
creatures were everywhere. Bruce picked up a sound
and identified a bird. Using his high powered scope,
Arnie kept finding camouflaged birds in the middle of
trees. Soon we were all finding woodpeckers, orioles,
and other kinds of birds. It was fun!
Later we hiked along a trail and saw hawk’s nest. It
was warmer now but not uncomfortable. I learned
that San Diego is one of the top bird watching spots
in the country. People travel from afar to spot birds.
Though I had hiked in Mission Trail Park many times,
I hadn’t noticed the many walkers with scopes and
bird books. Now they seemed to be omnipresent.
of birds, an extraordinarily high number for such a
small area. Arnie was just as passionate, and their
enthusiasm was contagious. After a fine lunch of
chicken and egg salad sandwiches on pita bread along
with fruit and potato salad, we loaded up our cars and
headed for Ocean Beach to view sea birds.
The canal adjacent to Robb Field was teeming with
bird life. Other birders were there too, along with
bikers, skateboarders, and the softball and rugby teams
playing on Robb Field. We spent an hour or more
there enjoying the sun and animal life before heading
back to North County. Both Vicki and I enjoyed the
day’s activity, our fellow birders, and particularly our
expert leaders, Arnie and Bruce.
After several hours
of
identifying
birds we stopped
for lunch. Arnie
and Bruce were
excited, as the
morning had been
rich in sightings.
Bruce saw more
Arnie and local birder than 40 kinds
Ocean Birds
CONTINUING EDUCATION HOURS (CE’S)
FOR SDPA MEMBERS
Two articles in this newsletter, “Texting Patients: What to Do?” and “Female Sexual Dysfunction…A Silent
Condition,” are each worth one continuing education hour for SDPA members. After reading one or both of the
articles, do the following to receive continuing education credit:
1. Go to www.sdpsych.org
2. On the right column, scroll down to Member Log On. Log in.
3. Click on “Continuing Education” on the right navigation bar.
4. Scroll down to the “Online Distance Learning” section.
5. Locate the test you want to take and click the corresponding “Take Test” button.
6. Take the online test. Click “Submit Answers” when ready.
7. If you are informed, after submitting your answers, that one or more of them are wrong, re-consider your
responses and then click “Submit Answers” again when you are ready.
8. To ensure proper credit is received, verify that your information is correct on the page that appears, then click
SUBMIT FORM. This will submit your test results to the SDPA Office.
9. You will receive a Certificate of Completion via email within 2 to 3 business days.
www.sdpsych.org
19
BooK ReView: Men in THeRapy:
New AppRoacHes foR EffectiVe TReatment,
by DaVid WexleR, PH.D.
By Jonathan Gale, Ph.D.
S
an Diego psychologist, David Wexler, has
written a ‘must read’ if you plan to work with
men in your psychotherapy practice. Reading
this book has felt like being in therapy, as David
shows (in addition to telling) the reader about men in
therapy. His natural writing style moves you along
through quite a comprehensive and well-organized
framework for understanding and treating men.
As men in psychotherapeutic treatment are becoming
increasingly identified and studied as a unique
subgroup of the population, it is important that
practitioners learn about and understand how men
are raised and socialized, how they view themselves,
and their intrapsychic struggles as a partial result of
their gender-based socialization. David’s book walks
the reader through several aspects of what it is to be
a man, and how men can present in your office. He
offers valuable information from the current literature
in addition to vignettes and examples that help bring
the concepts into the room.
and other female mental health practitioners treat
men in their practices. This book covers all the bases,
and basically any clinician who reads it will come
away with enhanced understanding of treating men
in therapy.
One of the main tenets in the book, in Wexler’s words, is:
“we are trying to help [men] become better men, not to
be more like women.” As David elucidates throughout
his text, men bring unique issues to the table, and it
is crucial to treat them with an understanding of the
impact of being male and simultaneously with a focus
on them as individuals.
Thank you David for your contribution to the literature.
I look forward to the next one!
Jonathan Gale, Ph.D., Clinical and Consulting
Psychologist
Dr. Gale works in private practice in La Jolla where he
treats adolescents and adults, individually and in couples,
and specializes in men’s issues and life transitions.
Men in Therapy is not just for male psychologists to
read. As Wexler points out, many female psychologists
WHat’s HappeninG witH tHe Public
Education and Media Committee?
by Katherine Moore, Ph.D.
T
he Public Education and Media Committee’s
objective is to provide education for the San
Diego Community and expertise to the media.
The committee is responsible for connecting a licensed
psychologist to an entity looking for a presenter. We
receive speaker requests from clinics, hospitals, schools,
retirement homes, and business groups. Psychologist’s
who offer to serve as speakers are volunteering
their time and expertise to serve as speakers, panel
members, or discussion leaders at meetings or other
functions for local organizations. With an abundance
20
of experience among the members of the SDPA, we
are able to provide licensed psychologists who can
speak on numerous topics.
We also receive requests from newspapers, online
news sites, and radio/television stations. Due to time
sensitivity, this type of request requires the committee
to quickly connect a licensed psychologist with the
media outlet. We have created a Topic database which
consists of the members’ name, area(s) of expertise,
and contact information.
This database assist’s
the committee with quickly connecting a licensed
www.sdpsycH.oRG
psychologist with the media requests. The media
request typically references a current news event and
the responding psychologist is usually interviewed
within a twenty-four hour period after receiving the
request.
We are also responsible for nominating media projects
as recipients of the SDPA’s Annual Media Award.
Throughout the year we review television, radio,
newspaper, and online news sites searching for a
media project that has made a significant contribution
to the coverage of psychology, psychologists, and/or
important mental health issues.
The benefit the speaker service brings to the SDPA
and its members is exposure of the organization
and the licensed psychologist within the San Diego
community.
If you are interested in joining the committee or would
like your name added to the Topic database, contact
Katherine Moore, Ph.D.,
e-mail address: [email protected]
CALENDAR OF EVENTS
Wednesday, August 11, 2010
Psychotherapy Relationships That Work:
Tailoring the Relationship to the Individual Patient
Co-Sponsored by Practical Recovery
Presented by: John C. Norcross, Ph.D., ABPP
Time: 9:00 am — 1:00 pm
Place: To be announced
CE: 4 hours Approval # pending
Cost: Morning Course ONLY:
Members $55 Non-Members $85
Student Members: $20 Student Non-Members $25
Leaving It at the Office: Psychotherapist Self-Care
Co-Sponsored by Practical Recovery
Presented by: John C. Norcross, Ph.D., ABPP
Time: 2:00 pm — 4:00 pm
Place: To be announced
CE: 2 hours Approval # pending
Cost: Afternoon Course ONLY:
Members $31 Non-Members $50
Student Members: $10 Student Non-Members $15
Discount available if you would like to attend BOTH the
morning and afternoon sessions Members $79 Non-Members
$125 Student Members: $30 Student Non-Member $40 Register
online at www.sdpsych.org/calendar.cfm
CONTINUING EDUCATION POLICY: CE Credit and
Certificates will not be issued to those who arrive later than
10 minutes or leave early from any course scheduled time.
This policy is highly enforced to ensure compliance with APA
Guidelines.
Thursday, September 2, 2010
An Introduction to the MMPI-2-RF™ (Restructured
Form)
Presented by: Yossef S. Ben-Porath , Ph.D.
Time: 8:00 am—4:30 pm
Place: The San Diego Psychological Association
Cost: Members $ 79 Non-members $115
Student Members $30 Student Non-members $40
CE:
6 Hours Approval # 10.0900.00
Register online at www.sdpsych.org/calendar.cfm
Friday, September 10th, 2010
SDPA Legislative Roundtable with Assemblymember
Anderson
Assemblymen Anderson’s El Cajon District Office
Time: 9:00am –10:00 am
For more information or to RSVP contact:
Bruce Sachs, Ph.D. at [email protected]
Welcome New SDPA MembeRs!
New Full Member
Marjan Davoudi, Psy.D.
Don E. Miller, Ph.D.
Allie Pashley, Ph.D.
Beth Kalal, Ph.D.
Sheri Kirshenbaum, Ph.D.
Matthew Weisskopf, Ph.D.
Joseph Yedid, Ph.D.
New Early Career Professionals
(3 - 4 Years Post Awarding of PhD or PsyD)
Terra Schmookler, Ph.D.
Megan Wilson, Psy.D.
New Early Career Professionals
New Student Members
Ramsey Khouri, M.A.
Rubi Lozano, MA
Grace Ning, MA
Meredith Rix, BA
Rachel Robison-De Fever, M.A.
(1 - 2 Years Post Awarding of PhD or PsyD)
Asal Azizi, Psy.D.
Katherine Ellis-Hernandez, Ph.D.
New Affiliate Members
(Individual)
Linda Hammond, Ph.D.
www.sdpsycH.oRG
21
GROUP THERAPY DIRECTORY
MIXED GROUPS
ADHD ADULT SUPPORT GROUP: Informational/
educational meetings for adults with Attention Deficit
Hyperactivity Disorder (ADHD/ADD). Mondays 6:30
to 8:00 p.m. Call 619.276.6912 or check website www.
learningdevelopmentservices.com for upcoming topics
and to reserve a spot. Mark Katz, Ph.D. (PSY4866),
Learning Development Services, 3754 Clairemont Drive,
San Diego, CA 92117.
ADULT DEPRESSION & ANXIETY GROUP will focus
on skills building to change maladaptive behaviors
and thoughts, and improve emotional regulation,
communication and interpersonal skills.
Increased
awareness can prevent relapse of depression and anxiety.
Insurance accepted. Contact Dr. Polina Bryson 858-6952237 x 2
ADULT GROUP PSYCHOTHERAPY: Ongoing,
mixed weekly process group. Cognitive behavioral/
psychodynamic. UTC/La Jolla area. Thomas Wegman,
Ph.D. (PSY 4228). 858.455.5252. 9255 Towne Centre Dr.,
Suite 875, SD 92121.
CHRONIC PAIN SUPPORT GROUP:
Understand how to work with your physical pain with
the support of others who understand you. Consistent
weekly attendance required. $45/session.
Dawn Dilley, Ph.D. PSY21452 PH: 619.255.7001 or
[email protected]
COGNITIVE THERAPY GROUPS: 12-weeks treatment
groups for Panic, Depression, Social Anxiety & OCD.
Education, skills- building, and positive group support.
$40-50/per 90 min group session. La Jolla/UTC James
Shenk, Ph.D. (PSY11550)
DIVORCE SUPPORT GROUP: Forming in Carmel
Valley/Rancho Santa Fe area. Co-ed, cognitive-behavioral,
positive psychology, supportive atmosphere. Group will
meet weekly after 5:00 pm. Cost is $55 per session.
For more information, please contact Dr. Diana WeissWisdom @ (858) 259-0146 or [email protected] (PSY12476)
MEN’S GROUPS
“YOUNG-ISH” MEN’S GROUP: This group is open
to generally high-functioning adult men from 20-40
ish years old who are interested in an ongoing therapy
group. An ideal adjunct to individual therapy, group
topics address interpersonal concerns with a focus on
men’s issues (work-life balance, stress management,
relationships, fatherhood, divorce, anger, depression, etc).
The group meets every other Wednesday for 90 minutes,
and perspective members are encouraged to commit to
attending for at least six consecutive months. For more
information, contact Danny Singley, Ph.D. (PSY 20995) at
858.344.4698 or [email protected]
MEN’S GROUP: Men’s support and psychotherapy group
for adult males who have had childhood or adolescent
experiences of abuse, currently in individual therapy, nonoffending as adults and motivated for a group experience.
Group meets bi-weekly and requires several screening
interviews. For more information Call Paul Sussman,
Ph.D. at 619.542.1335 or visit paulsussmanphd.com.
22
WOMEN’S GROUPS
WOMEN’S SUPPORT GROUP: addresses: Balance
between self and others • Managing stress, family and
career • Parenting • Relationships • Body image •
Healthy living • Personal growth. Contact Dr. Aleksandra
Drecun, Licensed Psychologist (PSY 21778) at dr.drecun@
a4ct.com or www.a4ct.com
CHOOSING SINGLE MOTHERHOOD GROUP: For
women who have chosen, are in the process, or who are
considering becoming single mothers on their own. Group
meets every other Tuesday evening in Del Mar. Contact
Karen Hall, Ph.D. at 760-443-5425 www.karenhallphd@
aol.com or [email protected].
(PSY16803)
OTHER
APPLIED DBT CLINICIANS: Applied DBT Clinicians
Dialectical Behavioral Skills Training Groups are now
forming! Applied DBT Clinicians is a Team of three
therapists, who have completed the Intensive DBT
Training that was conducted by Dr. Marsha Linehan.
We adhere to Dr. Marsha Linehan’s protocol. Our Team
provides individual, group, and 24 hour phone coaching,
for people with multiple emotional and behavioral
problems, including self-injurious behaviors and eating
disorders, in the San Diego County area. (PSY 22788) For
information about new groups, including Family and
Friends Groups, call: 619.569.0777
BEREAVEMENT THERAPY FOR CHILDREN: Rochelle
Perper, Ph.D PSY 23090 is pleased to offer bereavement
therapy for children, adolescents, and adults at the
Center for Cognitive Therapy. Dr. Perper has experience
working with complicated grief and violent loss. For
more information, visit www.therapychanges.com or call
619.275.2286.
PSYCHOLOGY CENTER OF LA JOLLA: offers group
therapy for children, adolescents, young adults, and
parents. Issues addressed include ADHD, anxiety,
depression, bipolar disorder, grief, ODD, and support for
siblings. To learn more, please call (858) 336-7036 or visit
www.psychologycenter.com.
PSYCHOTHERAPY FOR GRADUATE STUDENTS:
Reasonable rates for students who need to meet their
program’s psychotherapy requirements. Extensive
experience as therapist and supervisor with graduate
students. Editor of Humanistic Psychotherapies. Offices in
Carlsbad & San Marcos. Call David J. Cain, Ph.D., A.B.P.P
(PSY6654). Free phone consultation at: 760.510.9520.
ANNOUNCEMENTS
Dialectical Behavior Therapy Center of
San Diego
DBTCSD is the only clinic in San Diego providing full
DBT for adults, couples, and adolescents with multiple
extreme emotional and behavioral problems, including
self-injury and BPD. Individual DBT, skills groups, and
24 hr phone coaching, are delivered by a team of experts
who received years of training from Linehan, the creator
of DBT. We also provide other CBT for other emotion
dysregulation and impulse-control disorders, including
complex PTSD. www.dbtsandiego.com, 619-602-0726
Catherine E. Lewis, Psy.D., Clinical Psychologist
PSY 22954: is pleased to announce the opening of her
practice in Point Loma. Dr. Lewis provides individual and
couples therapy, specializing in the treatment of anxiety,
depression, relationship issues, and life transitions. Please
visit her website at www.drcathylewis.com.
Attend a free lecture on sex related
topics on the 3rd Wednesday of every month at Sex
Medicine, Education & Therapy (STEM) meeting at
Alvarado Hospital at 7:30pm. Go to www.sdsm.info and
look under Education save the date for details. Mary M
Clark, Ph.D. (MFC17748)
CSPP Clinical Supervision CE Courses in San
Diego taught by Dr. Paul Sussman: Basics 09/17/10, 9am4pm, 6hrs CE credit $135; Ethics 09/17/10, 4:30-6:30pm,
2hrs CE credit $60; Advanced 09/18/10 9am-5pm, 7hrs CE
credit $155 – Register online www.ce-psychology.com or
call 800-457-1273. (PSY13876)
OPPORTUNITIES
BILINGUAL THERAPIST: Harmonium, Inc. is
immediately hiring a part-time Spanish speaking bilingual
therapist.
Duties include providing psychological
assessments, therapy, and community presentations in
Spanish, organizing and implementing youth support
groups and classes, working with diverse community
groups to provide clinical assessments for Hispanic
based programs, reviewing records, maintaining
written and statistical documentation of clinical activity
and participating in weekly individual and group
supervisions, and staff meeting. Must have MA in clinical
psychology and have taken all assessment courses. This
position is up to 20 hours per week, based on fee split for
reimbursement. Supervision provided for pre/post-doc
hours. Send resume to [email protected]
CLINICAL PSYCHOLOGISTS: The Dialectical Behavior
Therapy Center of San Diego is seeking to hire clinical
psychologists who have received prior training in
DBT or ACT. At a minimum, solid training in CBT and
behavioral interventions is required. Additional staff
therapists are needed to provide DBT for adults and
adolescents. License-eligible applicants will be given
serious consideration. For more information or to submit
an application, go to: www.dbtsandiego.com
NON-THERAPY SERVICES
CAREER CONSULTATION AND COACHING: Let me
help your clients, friends, or family navigate career-related
issues such as career identification, career transition,
job search, difficult job situations. Comprehensive
approach, including assessments as indicated. Contact
Jacqueline Butler Ph.D. (CA PSY 19513) [email protected]
619.644.5750.
www.sdpsycH.oRG
FLICENSED PSYCHOLOGIST(S): Part-time to fulltime opportunity to engage in individual, couples,
group psychotherapy and administer and score
neuropsychological
and
psychological
testing.
Opportunity to supervise psychological assistants. Will
consider part-time or one full-time psychologist. Please
send curriculum vitae and 2 references to either 619-5439900 (fax) or [email protected].
LICENSED PSYCHOLOGIST(S): HELP (Home-based
Effective Living Professionals) is recruiting licensed
psychologists as independent contractors interested in
providing clinical services to persons in their homes or
care facilities throughout San Diego County. Psychological
Assessment and Chronic Pain Management, Bilingual
and Medicare a plus. Full or part time, flexible hours, 80%
reimubursement paid. Contact HELP at 858-481-8827,
or www.helptherapist.com for application information.
Annette Conway, Psy.D. (PSY 19997)
LICENSED PSYCHOLOGIST/LCSW: for outpatient
community clinic in central San Diego. Flexible part-time
to full-time with excellent salary, benefits, and retirement
match. Immediate availability. High quality mental
health team. Bilingual (Spanish) preferred. Experience
with children is necessary. Please fax vita to Kendra
Weissbein, Ph.D. at 858.279.0377.
PROFESSOR: CSPP-San Diego is currently in need of
someone qualified to teach our graduate level course in
Cognitive and Affective Bases of Behavior. Please send CV
to: Adele Rabin, Ph.D., Director, Clinical Psychology PhD
Program, [email protected]. Or, for more information,
contact Dr. Rabin at 858.635.4801.
PSYCHOLOGISTS: HELP (Home-based Effective Living
Professionals) is recruiting licensed psychologists and
social workers as independent contractors interested in
providing clinical services to persons in their homes or
care facilities throughout San Diego County. Medicare
and bilingual providers are a plus. Full or part time,
flexible hours, 80% reimbursement paid. Contact HELP
at 858.481.8827 or at www.helprofessionals.com for
application information. Annette Conway, Psy.D. (PSY
19997).
SPANISH SPEAKING THERAPIST: Harmonium
needs Spanish speaking therapist immediately. Provide
bilingual clinical assessments, therapy, and presentations.
Must have completed assessment courses and Masters in
Clinical Psychology. 10-20 hours/week with fee split for
reimbursement. Supervision provided for pre/post-doc.
Send resume to Dr. Wutzke, [email protected]
VARIOUS POSITIONS:
Heritage Clinic has the
following job openings in San Diego and Escondido
offices: Licensed Clinicians, Mental Health Rehabilitation
Specialists, and Case Managers. If interested, please
visit www.heritageclinic.org/jobopening.html for more
information.
LOOKING FOR
PSYCHOLOGICAL ASSISTANTSHIP: 4th-year clinical
Psy.D. student; master’s degree; completed personal
development hours. I am in the ABD stage of my program,
dissertation topic being private practice.
Therapy
qualifications include: a) psychodynamic advanced
training (brief and long-term); b) crisis intervention and
brief CBT; c) adolescents, transition to adulthood, and
adults; d) inpatient, outpatient, academic setting, and inhome; e) therapy groups, psycho-education groups, and
focus groups. Testing qualifications include: psychological
and psycho-educational evaluation (administration,
report writing, objective, and projective). For more
detailed information, please contact me at: 858.610.6451;
[email protected].
OFFICE SPACE AVAILABLE
CARLSBAD: Beautiful office with windows overlooking
a park like serene setting. Great location with ample
parking. Call lights in waiting room, staff kitchen, &
exit door for clients & staff adds to confidentiality and
privacy. Available 1 to 4 days per week. Warm & caring
collegial atmosphere. Please call Dr. Vesna Radojevic at
760.438.6890 .
DEL MAR: Part-Time office space available in Del Mar
Medical Clinic, near Ocean/I-5. Fully furnished, private
entrance, waiting room, phone, excellent sound proofing,
air conditioning, near bus. Includes utilities, janitorial
services, parking. Contact Tom Hollander, Ph.D. at
858.755.5826.
DEL MAR: (across from Lagoon) Office space for rent by
half day or day.
Waiting rm, collegial atmosphere, fully furnished (brand
new) Flexible schd. Includes utilities, janitorial and
parking. Please call (619) 971-2229
DEL MAR/CARMEL VALLEY: Part-time office available
in beautiful Hacienda building. Fully furnished, brand
new suite, open-air courtyard with lush garden and
outdoor cafe. Office space includes waiting room,
kitchen, copier, fax, wireless setup. Karen Hall, Ph.D.:
760-443-5425.
ESCONDIDO: Beautifully furnished and spacious office,
in a suite with other psychotherapists, available parttime. Close to I15. Parking. Large waiting room. Kitchen
and workroom facilities, including copier/fax. Janitorial
included. Contact Dr. Jeannie Buchanan, 760.310.1632.
ESCONDIDO: 3 Offices Subleasing to FFS provider. 10’
x 12’, kitchen, restrooms, lobby with receptionist to greet
only. Handicap accessible, furnished. 8:30am – 5:00pm.
1 year lease $500/month/office, utilities 75/25. 200 E.
Washington Ave. #100, Escondido, CA 92025. Monica
Morel: 760-737-8642 x250, [email protected]
HILLCREST/NORTH PARK: An attractive office in a park
like setting. A fulltime furnished private office (including
antique s-roll top desk). $480/mo. Rent includes: Light
janitorial services (1 mo.), utilities, off street parking and
access to a group area. 3699 Park Blvd. Stan Lederman,
Ph.D. (PSY5756) 619.296.0087
KEARNY MESA: Beautiful office, full or part time,
conveniently located north/central county. Private office
of mental health professionals, within the Children’s
Hospital Medical Office Building in Kearny Mesa. Many
on campus amenities. Furnished or unfurnished. Please
call Steven Sparta, Ph.D., 858) 966-6750.
LA JOLLA/GOLDEN TRIANGLE: Lovely, furnished
office with full wall of windows in La Jolla/Golden
Triangle Area. Centrally located between 805 and 5
freeways. Full or part time. Close to Starbucks and other
eateries. Positive and friendly environment. Call Sallie
Hildebrandt (Psy 10119), 858.453.1800.
LA JOLLA: Want to be in La Jolla on Fridays and/
or Mondays but can’t afford the prices? Come share a
beautiful, cozy, inside office across from UCSD and the
VA - in a suite with two others for only $150. per month,
per day. Call or email Wendi Maurer at 619.491.3459
[email protected]. Referrals available often.
LA JOLLA/UTC: Part-time/full-time office available July
2010. Convenient location, recently renovated office
within suite of 5. Large windows, top floor, separate
client exit, all utilities, fax/copy, wi-fi, microwave/frig, free
parking. $600 -- $1,100/mo. Contact: Gregory Dickson,
Ph.D. 858-587-1180.
LA MESA: Quality professional offices available on
hourly, part-day, full-day basis. Comfortable waiting
room with signal lights. Fully-furnished workroom/
kitchen. Building is handicap-accessible and adjacent
trolley/bus. We can help you build your practice. Contact
Jacqueline Butler Ph.D. 619.644.5750. drjacqbulter@
gmail.com.
LA MESA: New small office available FT/PT with other
psychologists. Copier, fax, kitchen, and phone included;
referrals possible. Established professionals; great
“starter” office; $500/mo FT, negotiate rent PT. Thomas
Keller, Ph.D. or Linda Schrenk, Ph.D. 619-698-9525
LA MESA/LAKE MURRAY: Suite of offices available for
part-time and/or full/time psychologist, MFT, or LCSW.
Office space includes a reception room, kitchen, and office
room with copier, fax, wireless capability. Call Dr. Sharon
Colgan (619) 466-0656 for further information.
MISSON VALLEY: 14’x17’ furnished windowed office
space available all day Monday, Wednesday, Saturday and
Sunday. Rent 1, 2, 3 or all 4 days. Utilities and janitorial
services included. Centralized location. Month-to-month.
3511 Camino del Rio South #302. Call Patti 858-792-6060.
MISSION VALLEY: Centrally located offices with a
view for rent on Thursday afternoons and Fridays. Class
A building includes free parking, copier and fax. Close
to bus transportation. Contact Rosalie Easton at 619-2949177.
MISSION VALLEY: Office, per diem or part time, very
reasonable rates, negotiable, centrally located, newly
carpeted & painted, nicely appointed.
Call Murray Rudenberg, Ph.D. 619-995-3854.
POWAY: Small office for full time sublease in nice space
with other therapist’s in Poway. $350/month. All utilities
included. Please call Michelle Lalouche-Kadden, Ph.D.
858.485.8185.
POWAY/ RANCHO BERNARDO: Large furnished
office with window in medical office building with other
therapist and shared office amenities. Available Mondays
($175 per month) or Monday and Tuesday and another
partial day ($300/month). Available immediately. Call
John Lee Evans, Ph.D. at 858-673-9600.
RANCHO BERNARDO: Sublet opportunity at landmark
Rancho Bernardo Courtyard (16935 West Bernardo Drive,
San Diego, 92127 right off Rancho Bernardo Road).
Mondays and/or Fridays are available. Please visit www.
RBCourtyard for site photos. Office boasts double entry,
French doors to the courtyard on the first floor as well
as grand West lobby access. Call Dr. Steven Goldstein
760.715.0815.
VISTA: Beautiful, large windowed office 1-3 days/week.
Professionally appointed, furnished. Class A building,
elevator. Off the 78 Freeway. South Melrose Drive.
Many office amenities. Referral rich. 1 psychologist, 1
psychiatrist already. Reasonably priced. Contact Robin
Bronstein, Ph.D., 760.643.4043, email [email protected]
LA JOLLA: Office space available in La Jolla Village: I
am interested in sharing my office, either a 50% share or
sublet one or two days a week. The office is attractive
and well established, easy to access, and works well for
therapy and consultation. Jean Campbell 858.456.2206
Write to Us
We welcome letters. The editor reserves the right to determine the suitability of letters for publication
and to edit them for accuracy and length. We regret that not all letters can be published, nor can they
be returned. Letters should run no more than 200 words in length, refer to material published/related
to the newsletter, and include the writer’s full name and credentials. Email your letter to the editor at
[email protected]
www.sdpsycH.oRG
23
Location of SDPA’s office:
4699 Murphy Canyon Road, Suite 105
Clairemont Mesa Blvd.
Balboa Avenue
San Diego, CA 92123
Murphy Canyon Road
4699
N
PRSRT STD
U.S. POSTAGE
858.277.1463 Phone
PAID
SAN DIEGO, CA
PERMIT No. 981
858.277.1402 Fax
I-15
*no access from Balboa Avenue
Aero Drive
SDPA Staff
Office Administrator
Keny Leepier
BOARD OF DIRECTORS
President
President-Elect
Past President
Secretary
Treasurer
Members at Large
CPA Representatives
CPA Alternate Representatives
Student Representative
Mary Harb-Sheets, Ph.D.
Joel Lazar, Ph.D.
Lori Futterman, RN, Ph.D.
Lindsey Alper, Ph.D.
Victor Frazao, Ph.D.
Mei-I Chang, Psy.D.
Felise Levine, Ph.D.
Bapsi Slali, Ph.D.
Anabel Bejarano, Ph.D.
Annette Conway, Psy.D.
Steve Tess, Ph.D.
Kelsey Schraufnagel, M.A.
ASSOCIATION SERVICES
Colleague Assistance
Legal Counsel
Newsletter
Psychologist Referral and Information Service (PIRS)
Psychology 2000
TBD
David Leatherberry, J.D.
Stephen Scherer, Ed.D.
Vanja Gale, Psy.D.,
Adriana Molina, Ph.D.
Ain Roost, Ph.D.
SDPA REPRESENTATIVES
Board of Psychology
Adult System of Care
Children’s System of Care
Mental Health Board
Mental Health Board
Mental Heath Coalition
Older Adult Systems of Care
TERM Advisory Board
U.B.H. Credentialing Committee
U.B.H. Peer Review Committee
Hugh Pates, Ph.D.
Lori Futterman, RN., Ph.D.
Karen Zappone, Ph.D.
Katherine DiFrancesca, Ph.D.
Gloria G. Harris, Ph.D.
Mary Ann Brummer, Ph.D.
Ken Dellefield, Ph.D.
Martha Ingham, Ph.D.
Hugh Pates, Ph.D.
Steve Tess, Ph.D.
StandinG Committees
Community Mental Health
Mary McGuinn Clark, Ph.D.
Steve Tess, Ph.D.
Continuing Education Victor Frazao, Ph.D
Ethics and Standards
Temple Zander, Ph.D.
Government Affairs
Bruce Sachs, Ph.D.
Membership (Recruit & Retention) Bapsi Slali, Ph.D.
(Mentoring Program) Mei-I Chang, Psy.D.
FoRmal Committees
Cultural Diversity
Disaster Response
Early Career Professional Forensic
Men’s Issues
Neuropsychology
Psychologist Retirement, Incapacitation or Death (PRID)
Public Education & Media
Science Fair
Student Affairs
Supervision
Women’s
Ernest Llynn Lotecka, Ph.D.
Roberta Flynn, Psy.D.
Aleksandra Marinovic, Psy.D.
Vanessa Weinbach, Ph.D.
Shaul Saddick, Ph.D
Preston Sims, Ph.D.
Danny Singley, Ph.D.
Michael Kabat, Ph.D.
Antonia Meltzoff, Ph.D.
Katherine Moore, Ph.D.
Richard Schere, Ph.D.
Dane Ripelino, Ph.D.
Jessie Macaulay, M.A.
Angela Hanchett, B.A.
Patty Petterson, Ph.D.
Margaret Lee Higgins, Ph.D.
Special InteRest Committees
Aging
Arts
Lesbian, Gay, Bisexual & Transgender
Past Presidents Sports Psychology
Hugh Pates, Ph.D.
Toni Ann Cafaro, Psy.D.
Diane Pendragon, Ph.D.
Paul Sussman, Ph.D.
Chris Osterloh, Ph.D.
Sharon Colgan, Ph.D.
TasK FoRce GRoups
Children & Youth Mindfulness
Barbara Cureton, Ph.D.
Angela Kilman, Ph.D.
Steve Hickman, Ph.D.
Jessica Evers-Killebrew, M.A.

female sexual dysfunction… a silent condition

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