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Contact: Amy Safford, Executive Director, asafford@mepa.org, 207-621-0732

For Immediate Release

Senator King Receives APA Advocacy Champion Award

Portland, Maine (March 25, 2021): At the American Psychological Association’s 2021 Advocacy Summit, Senator King was awarded the APA's Congressional Champion Award. The APA honored Sens. Angus King (I-Maine) and Todd Young (R-Ind.) for their work in introducing the Mental and Behavioral Health Connectivity Act (S.3999) in the 2020 Congress.

This legislation would have permanently expanded Medicare coverage of telehealth services—beyond the COVID-19 public health emergency—to make it possible for Medicare beneficiaries to receive care in their homes and to receive audio-only services for mental and behavioral health care.

“We are delighted and honored that a Maine Senator was chosen for this national award advancing psychology, especially during this historic period when mental health treatment is more vital than ever,” says Maine Psychological Association President Thomas Cooper, PsyD. “Our state association and the APA are advocating for Congress and the Biden Administration to advance tele-behavioral health policies that provide equitable access for all people.

https://vimeo.com/530360407

The Maine Psychological Association (MePA) is a membership organization whose purpose is to advance psychology as a science, as a profession, and as a means of promoting health and human welfare. Founded in 1950, MePA has a long history of effective and principled leadership in Maine. 

List serv post Aug. 8, 2020 by Michelle D Schwab, PhD

In our first worldwide pandemic accompanied by huge mental health issues, we do need to be discussing these issues.  We should be preparing to deal with unique ‘asks’ for at least the next 6-12+ months.  I try to stay very low key about my background but perhaps it's time to come out of the closet in case I can be of service to others.  I worked as a "Medical Director" and also a “Physician QA Reviewer” at UNUM for many years, I did a stint as the Lead Medical Director in the Portland office and, until a few months ago, I did some work on the side as a behavioral health disability consultant, reviewing disability claims for other insurance companies.  I know more than I want to about how insurance companies view claims for FMLA, STD, and LTD.  I have also talked by phone or correspondence with hundreds of health care providers across the country regarding their opinions and the data upon which they are basing said opinion.  I have been deposed numerous times regarding these types of cases.  In short, I am an expert regarding Behavioral Health disability claims and co-morbid claims involving both medical and BH conditions.  This background does pertain to things like requests for accommodations to perform a job remotely.  So, there are my bona fides.  Out of the closet.

I apologize in advance for the likely length of this post: this is a very complex issue and may be a snooze fest for many.  I am not sure if what I offer here will be relevant to any one particular school in Maine, but hopefully it will provide a context for thinking about these matters and your decisions on behalf of your patients.  Additionally, it is useful to learn ‘disability-speak’ because a 22-year-old, newly minted claims adjudicator can understand you better—I am not kidding!  LOL!

• I agree with Tom about the need to be cognizant of intermingling a socioeconomic, politicized health crisis with a data-based request for accommodations or leave of absence. That said, I anticipate a huge influx of disability or FMLA claims as many workers are asked to return to their places of business or perform their duties in new ways.   My impression from the news & my own clinical practice is that a significant # of teachers, maybe even a majority, would PREFER remote work at this time and/or expect to revert to remote teaching within weeks.  If accurate, the anxious patient's concerns will be moot.  But Maine’s viral infection rate is so low that it might be more than a few weeks and many parents will cheer this.  Personally, I am becoming a hoarder of specific items in anticipation of a very difficult late Fall and Winter.  I hope I am wrong in which case you each will receive a free roll of Charmin.  Those who respond to this post will also be eligible for a small bottle of hand sanitizer.[divider line_type="undefined" custom_height="20"]
• Teachers in a union may have a separate set of rules for processing various requests for accommodations; some joined a union, some did not, and some are not eligible due to private schools, and so forth. Individual school districts may vary in how they deal with requests for accommodations.  A union probably has guidelines on what data is needed.  In some places a superintendent or principal may make such decisions.  If such requests are sent to a 3^rd party like an insurance company, the level of information required will probably be higher.  And there can be differences depending on whether an employer is self-insured and uses the disability insurance company to process claims versus fully insured plans where the insurer's money is on the table.   If you know the system by which accommodations or FMLA is managed by your patient’s employer, then what follows may be irrelevant to your question at the present time.[divider line_type="undefined" custom_height="20"]
• Disability insurers handle all sorts of work leaves/changes: FMLA & STD are typically run concurrently, having the impact of limiting total time off. The less financial risk a company has, the less information they request.  Short term disability is lower risk because the time period for benefits is limited.  Many FMLA/STD departments are transactional; claims are paid quickly with the provider completing forms.  LTD claims can present a lifetime financial risk and much more detail will be requested from the provider.  Physicians and psychologists are often surprised to learn that disability determination is a contractual decision, not a medical or clinical one.  This is important when setting expectations with patients: our opinion does not prove disability or the need for accommodations.  Rather, evidence found to support functional restrictions or limitations is compared with the job description — often as it’s performed in the national economy vs at a specific business or school.[divider line_type="undefined" custom_height="20"]
• So, if you do write something or complete a form, be sure to understand to whom you are writing and the potential adverse implications for your patient. The most glaring is when people have to sign an authorization for release of medical information to evaluate the claim (e.g., your records to back up your opinion that they cannot work or a sufficiently thorough treatment summary such that your data can be discerned).  In any behavioral health claim this will include a specific authorization for release of psychotherapy records, and progress notes or test data in particular.  This is not illegal and is done with HIPAA and other confidentiality issues in mind; they have lawyers too.  Of course you can choose to not release your records; but your patient's claim can be denied for failure to provide proof of disability.  In our usual informed consent documentation we explain the limited number of circumstances under which we are legally mandated to not maintain confidentiality.   We don't speculate on the ways in which our patients can waive privilege to pursue something of interest to them such as a disability claim, a lawsuit, etc.  In my opinion, this should be discussed very quickly if a patient raises interest in such matters.  You might think the PCP or some other physician is handling it so you're off the hook.  Maybe that is indeed accurate for some brief STD claims.  Otherwise, expect to be pulled in and plan your boundaries and the impact on your therapeutic relationship.[divider line_type="undefined" custom_height="20"]
• Health care providers of all types are not trained in presenting data to demonstrate functional impairment. Instead we offer impressions that are clinically reasonable.  However, in terms of functional capacity, consider that our views are often based on patient self-report, brief MSE, and our many years of experience.  Most of us don't consider factors such as validity, secondary gain, job site-specific factors, patient preference versus lack of ability, inconsistencies in the FULL record (including the PCP, psychiatrist, Ob/gyn, employer data, surveillance data), etc.   The existence of a diagnosis does not equate to a functional disability.  Clearly many people work with psychiatric diagnoses all across the country every day.  What makes your patient different?  That type of thoughtfulness should serve as a guide as you write.[divider line_type="undefined" custom_height="20"]
• Limitations are what the patient CANNOT do because of a sickness or injury. Restrictions are what the patient SHOULD NOT do because of the probability of exacerbating a serious condition.  A restriction-based claim is harder to ‘prove’.  I will stop writing now as the variables are endless.  The discussion in this thread is about advocating for accommodations, presumably because the clinician has evidence of functional restrictions and/or limitations rather than patient apprehensiveness or discomfort (???).  Maybe asking for accommodations is a friendly process for your patient.  Perhaps a superintendent or principal decides if accommodations are merited or maybe they ask a 3rd party (an insurance company) to decide.  The sheer volume of such requests this year and the need for fairness could result in a handoff to an insurer to make such determinations.  I would expect disability insurance companies to have been preparing for COVID-related claims, including psychiatric claims.  They will not be swayed by public opinion or values.  They will make decisions based on evidence because they simply cannot pay every single claim and stay in business for future claims.  They will know the best public health data currently available (and they know this will change and develop over time).  I do not envy the principal or claims payor who has to make these decisions, but it’s much safer to anticipate their decisions will be based on your data, not just your opinion.[divider line_type="undefined" custom_height="20"]
• Finally, leave any restrictions based on age or underlying medical conditions to your patient's physician. You will lose credibility if you try to go there.  Explicitly defer to their primary care physician or immunologist/etc and stick to the Anxiety Disorder.  Best of all, call the PCP to demonstrate collaboration of care to 3rd parties but also to be sure you are on the same page!  Many patients do not reveal the extent of their anxiety or depression to their physician.  The other common scenario is for a PCP to say a patient is impaired by anxiety/depression/etc but have no clue how to document and defend such a claim.  Work together, deferring to one another on relevant conditions.  Do this with psychiatrists too because they are particularly reliant on patient self report; psychologists are well equipped to observe, describe, and document behavior and observable indicators of many subjective experiences.  Bottom line, insurers look for consistency of patient report across providers and over time.  Good care is coordinated and collaborative in an individual who is posited to be so impaired they cannot work; I don't see why this wouldn't also pertain to requests for accommodative work.

Separate from my missive above, as a clinician I would want to consider the possibility of avoidance behaviors in an anxious patient.  Is it clinically in the best interests of my patient to work from home or is this an opportunity to work intensively around managing their anxiety?  And if I pursued the latter position, encouraging them to return to work, I would document like crazy so that if they become functionally unable to do it, I can demonstrate they tried and failed — that is compelling in a disability file.

Michelle

Michelle D Schwab, PhD
mschwabphd@gmail.com
(207) 294-1771

Recent national events have reignited a national conversation about race relations. The following links are provided for guidance to raise awareness, and tools for coping with racial trauma:

1. Resources for white parents to raise anti-racist children (books,  articles, videos, podcasts)
2.  Institution for the Study and Promotion of Race and Culture (ISPRC) Racism Recovery Plan

The murder of George Floyd in Minneapolis and the shootings of Breonna Taylor, Tony McDade and Ahmaud Arbery, are the most recent offenses in a long history of systemic racism across the country. Long-standing racial inequalities are reflected in violence against unarmed Black men and women, the disproportionate spread of the coronavirus, and the multiple other disparities in income and housing among communities of color.

Now is a time for Maine to come together in its response to what the American Psychological Association (APA) calls the “pandemic of racism.” We need an urgent new focus on underlying causes of long-standing social, economic, and political inequalities. A crucial step toward a more just and unified society is the thoughtful understanding of grievances and refusal to accept divisive language that perpetuates violence.

The people of Maine, as part of a nation built on the goal of a more perfect union, must advocate for a society that does not continue to perpetuate systemic racism and violence. Portland was among cities around the country where protesters demonstrated in response to the murder of George Floyd and others. Over 1,000 people gathered to show support for the condemnation  of violence against minorities.

The concept of xenophobia helps describe the roots of racism in this country. This fear of outsiders or foreigners encourages allegiance and group cohesion and has become intertwined with American racism, white superiority, and nationalism. Unfortunately, xenophobia is also becoming evident with the COVID-19 pandemic and has been intensified by economic uncertainty.

As an organization committed to learning from the collective horror and angst of the recent murders of our fellow Black citizens, the Maine Psychological Association (MePA) encourages civil engagement and social discussion to proactively advance the cause of social and racial justice for all people living in the U.S.

Acting with thoughtful urgency, MePA and the APA are committed to building sustainable and long-lasting policies that address this critical issue to help move our nation forward peacefully. We stand behind all Mainers, and all Americans, to work towards unification and to prioritize the equal rights of all Americans.

Thomas Cooper, PsyD

President, Maine Psychological Association

*The following is a brief summary of my dissertation, titled "A Quantitative Comparison of Adult Children of Alcoholics (ACOAs) and Non-ACOAs on Attachment.”

Children who grow up in an environment where at least one parent is an alcoholic can experience behavioral and emotional problems that continue into adulthood. A critical literature gap concerning the relationship between attachment and adult child of an alcoholic (ACOA) status, as well as personal alcohol abuse and levels of hope, was identified. The purpose of my study was to gain a better understanding of the influence of having alcoholic parents on personal alcohol abuse, attachment, and hope among ACOAs. Informed by attachment theory, my cross-sectional study compared attachment among ACOAs and non-ACOAs and the impact of attachment on personal alcohol abuse and hope.

Attachment theory holds that the quality of attachment to one’s parents, which develops in infancy, affects an individual’s ability to form healthy attachments in adulthood (Lander, Howsare, & Byrne, 2013), which is supported and reflected in the results of this study, as ACOAs reported more avoidant and anxious attachments to their mothers and fathers and anxious attachment with their significant other. Findings were consistent with results reported by previous studies affirming that ACOAs are more likely to develop alcoholism when compared to adults whose parents were not alcoholics (Anda et al., 2002; Bifulco et al., 2006; Haverfield & Theiss, 2014, 2015; World Health Organization [WHO], 2014). As previously noted, no studies have examined the relationship between ACOA status and hope; thus, the results of my study offer a significant contribution, as ACOAs were found to have lower levels of hope when compared to non-ACOAs.

The findings of my study could be used to address the social problem and growing epidemic of alcoholism. Alcoholism is a highly stigmatized disease that affects not only those dependent on alcohol, but also family members, friends, and all those close to such individuals. Although ACOAs have little to no control over the presence and severity of their parents’ dependency and are likely unaware of its residual effects, finding ways to reframe the illness is crucial in the promotion of more positive outcomes. With an enhanced understanding of the experiences of ACOAs, clinicians and other professionals may contribute to more fully developed treatments for ACOAs. The recognition of alcoholism as an uncontrollable disease by not only those closely affected, but also the population as a whole, will allow for less stigma. A decrease in stigma may encourage more ACOAs to speak up and reach out to others, thus improving the likelihood of overcoming the hardships associated with having an alcoholic parent (Haverfield & Theiss, 2015).

Of particular importance, the current findings suggest that children raised by alcoholic parents are likely to carry the problematic effects of their upbringing into adulthood. The current findings suggest that the children of alcoholics may likely be more affected than the alcoholics themselves. By considering children when addressing the effects of alcoholism, even if only from an educational or preventative perspective, the knowledge base can be broadened across the board in order to address the increasing number of individuals negatively affected by alcoholism.

For more information or to read the study in its entirety, please contact me at: 

Carly Rodgers, Ph.D.
Email: carly.rodgers@gmail.com

Sandplay is a hands-on, expressive, play therapy technique developed in the mid 1900’s by Swiss Jungian analyst Dora Kalff.  Sandplay is theoretically rooted in Jungian analytic theory, and integrates the “World Technique” of British psychiatrist Margaret Lowenfield along with Eastern thought and philosophy. 

As the name implies, play is the central feature of Sandplay which facilitates a child’s natural capacity for change and healing. Through the sandplay process children ( and adults alike ) portray, rather than verbalize inaccessible feelings and experiences often difficult to express in words. 

Margaret Lowenfield,  a pioneer in play therapy and a teacher of Dora Kalff,  developed the “World Technique,” as a means of communicating non- verbally with children in treatment.  Lowenfield  understood that children learn through play. She was one of the first therapists to consider the powerful healing impact of children’s “world pictures” made in the sand. 

C. G. Jung believed that each person strives to achieve wholeness by attaining a harmony within consciousness and unconsciousness and that this can be accomplished through dream study. The sand tray is seen as an aspect of our imagination. 

Dora Kalff  further integrated her study of Eastern Philosophy  into the foundations of Sandplay.  Through her studies and close contacts with various prominent Zen Masters and Tibetan teachers ( Dalai Lama) she came to understand that the spirit of Zen is implicit in the sandplay method. The therapist must create a safe space where the path to self -discovery is open. 

The goal of Sandplay is to activate on the deepest psychic level a patients natural internal capacity for healing.  This is accomplished through the process of  viewing, choosing and placing miniatures in the sand. The successive scenes created by the miniatures symbolically act as a bridge between an individual’s inner and outer world. Unconscious conflicts  appear as symbols and are able to be reordered in a healthy way.

The Sandplay Process

In sandplay therapy, patients are invited to “create a world in the sand” utilizing  sand, water and miniature figures that represent all aspects of life and fantasy. The figures are arranged on shelves that are nearby the tray.  The sand tray is of wooden construction and is 28 1/2 inches long by 19 1/2 inches wide and 3 inches deep.  These dimensions are said to contain the natural span of one’s visual field. The sides and bottom of the inside of the tray are painted light blue allowing for the representation of water in the sand.

The therapist sits close by and takes notes of what the child says, does and what figures they choose. The therapist can sketch a diagram and/ or take a photo for later reference.

Sandplay therapists do not interpret or direct the patient in any way but rather safely contain the emerging unconscious material.  Analysis and/ or interpretation is only offered after adequate time has passed for the integration of the sandplay work that was completed.  It is not possible or necessary to understand everything that transpires in a patients sandtray.  Martin Kalff (1993) , sandplay teacher and Buddhist scholar states that verbal or written analysis can not fully represent the symbolic contents of a sand tray. Successful interpretation involves thought but “should also include the functions of intuition, feeling and sensation.” Participating in the patient’s sandplay therapy on a pre-verbal level is paramount to their healing and transformational process. It is also helpful if the therapist is familiar with the cultural and archetypal dimensions of the sand tray contents. 

For further information on the history and or clinical application of Sandplay please refer to the resources listed above. 

ANTOINETTE HARRINGTON, PSYD

Sandplay Therapy Resources

BOOKS

Kalff, Dora M. (2003). Sandplay: A psychotherapeutic approach to the psyche

Tresidder, Jack (2004) The Complete Dictionary of Symbols

Turner, Barbara A. (2005). The Handbook of Sandplay Therapy.

WEBSITES

Sandplay Therapists of America
www.sandplay.org

International Association of Sandplay Therapy
http://www.isst-society.com

The Maine Jung Center
www.mainejungcenter.org

The Jung Institute of New York
http://junginstitute.org

Professional Sandplay Journals

Journal of Sandplay Therapy- USA

The Archives of Sandplay Therapy- JAPAN

The Magazine of Sandplay Therapy- GERMANY

I  was eating my lunch alone in the hospital cafeteria where I was a psychology intern, and was surreptitiously ease-dropping the conversation of two pastoral care counselors at the table next to me.   At one point one said, with pride:  “Today I got my patient from “anger” to “bargaining”. That long-ago overheard statement has stayed with me and influenced my understanding and treatment of grief. Clients experiencing grief often come in with belief that   the Keebler-Ross stages of grief, are like an obstacle course that must be traversed, hopefully as quickly as possible, in order to reach the final goal of “acceptance”.   I view grief part of a life in which we cycle around many of the same issues such as love, loss, triumphs, and disappointment, in hopefully every widening circles of maturity and deeper understanding.  We never leave it behind. We do not “get over” deep grief.  Rather it is incorporated into the deepening of our identity. It is a dynamic process, which I believe was Kubler-Rosses original intent in her writings about the stages of grief.

When I was a young adult, both my parents died within a short time of each other.  My grief was very much informed by the stage of life I was in: that of a young adult pulling away from the family of origin to form my own identity and new family. At the time, I mourned the loss of the opportunity that my parents and I could have an adult relationship that including more adult understanding and reciprocation. I still do mourn that.  Yet my relationship to my parents’ memories is almost as dynamic as it would have been had they lived. As I grow, I understand and appreciate their strengths and struggles in a way I never could have many years ago.   My relationship to their death changes and deepens as I gain experience. In my practice I also encounter the changing nature of grief as clients mature. For example I have seen a man who father died when he was eighteen go into a deep depression over that loss when he was in his mid-thirties.  He entered the military shortly after his father’s death and was well taught to bury vulnerable emotions in order to perform in his profession. His “denial “lasted two decades.  I have seen a widow of a successful man who mourned his death and extolled his virtues for thirty years before she allowed herself to feel her anger about his treating her with a casual disrespect reserved for someone he saw more as a prop than a partner. We are never done with grief.  No one goes to a major family event: a wedding or birth or death of someone close without the stab of grief for those who are not there to share it. Our goal is to help   our clients reach acceptance of their own emotional reactions rather than of the deal itself.

One added thought about forgiveness in the grieving process. I have had many clients who feel the pressure to forgive a parent or other close family member who has treated them terribly when that person dies.   I have heard the statement from people in the helping professions that forgiveness is good for the grieving person because it relieves them of a psychological burden.  My response is “maybe”.   We see a population who have experienced many horrible actions at the hands of people who were changed with caring for them.  Their anger towards the person who has died may be protective for them in avoiding repetitive abuse. I believe that lifting their self-imposed burden of needing to forgive is part of our job.  The pressure to forgive may be viewed as an extension of the pressure not to acknowledge or speak about what was done. Forgiveness may come as a byproduct of deeper understanding, or it   may not.   Our goal is to help clarify the choices our clients make.

Arlene Brewster, PhD.

Dialectic Behavior Therapy is a broad-based cognitive-behavioral model of treatment developed by Marsha Linehan, Ph.D. Although initially designed to treat chronically suicidal and high-risk patients who struggle with patterns of behavior characteristic of Borderline Personality Disorder (BPD), current research shows the effectiveness of the model with other populations such as Post-Traumatic Stress Disorder, Eating Disorders, Substance Dependence, and Depression – all of which involve problems of emotion regulation. Dr. Linehan has often remarked that much of DBT is not new at all. She simply brought together very basic, well-documented behavioral strategies: contingency management, exposure treatment, cognitive modification, and skills training to create a strong behavioral treatment model. She then made it more palatable to both client and therapist by embedding it within Eastern philosophic principles that encourage the development of dialectical thinking and psychological flexibility. According to Linehan, change can only occur in the context of acceptance of what is and “acceptance of what is” is itself change.”

Essential to the practice of and appreciation of DBT is an understanding of the biosocial theory of BPD and, by extension, the general problems of emotion regulation. Disorders that are suited to DBT are essentially defined by problems in regulating emotion due to a combination of biological disposition, environmental context, and the mix between the two during development. There is a continuous and mutual interaction that occurs between a vulnerable individual and a more or less invalidating environment over time that may lead to maladaptive or inadequate emotion modulation strategies and the behavioral and cognitive dysregulation that tends to follow. This theory not only provides a base for effective intervention, it fosters a compassionate attitude toward the intensity of emotion and the difficulty of changing ingrained patterns of behavior.

DBT in its comprehensive form is a very structured approach that involves four components: DBT individual therapy, DBT Skills Training, DBT phone coaching, and DBT therapist consultation team. Although there is some evidence that skills training alone can be helpful, comprehensive DBT requires that all four components are present. The clients who are appropriately referred to DBT programs are those with multiple concurrent problems who often exhibit suicidal and other high-risk behaviors. Phone coaching between sessions is essential – you don’t send the team out on the floor for the championship game without a coach to guide plays. Coaching calls are intended to be brief interactions that help clients identify and use skills to get them through the moment. Team meetings are essentially therapy for the therapist to enable her to stay motivated and provide the best treatment possible. Despite all the structure, DBT is a not a manualized treatment. The therapist is guided by principles at every juncture to work with the client to establish treatment priorities, to build a strong, collaborative relationship, to select specific strategies to solve specific problems, to assign homework, and to clarify and maintain his/her own limits with firmness, compassion and flexibility.

Further information about DBT resources, training, and research can be found at behavioraltech.org

Debora B. Dixon, Ph.D.
20 York Street, Bath, ME 04530
207 443-3692
deborabdixon@gmail.com