Tag Archives: News

Let’s Talk About Sex — After 60

timothy-paul-smith-280195

By Christina Pierpaoli Parker, MA (Geropsychology Doctoral Student, University of Alabama)

 

 

Science has started to pay attention to what happens between the sheets after 60, especially as medical advances permit us to live longer and healthier lives. Emerging research shows that older adults get busier than we think, finding that many adults remain sexual well into their 90s. As with other periods of development, sex in later life improves quality of life, mood, and health.

 

The Problem

But sex after 60 still has its consequences. Spikes in sexually transmitted disease (STDs) among older adults illustrate that. Compared to younger folks, older adults know less about STDs, underestimate their risk of infection, and practice safe sex less often. Data from the Centers for Disease Control and Prevention (CDC) reflect this, reporting that adults over 50 represent 15% of new HIV infections. By 2020, upwards of 70% of persons living with HIV will be 50 or older. Other STDs including chlamydia, gonorrhea, primary and secondary syphilis, show similar increases in older groups.

 

What’s going on?

Experts offer two explanations: (1) Treatment advances, such as antiretroviral therapy, have enabled already infected adults to live longer, inflating prevalence; and (2) the number of new infections (incidence) among older adults is increasing.

 

Fine, but why are adults becoming infected at all?

Growth in new infections altogether means recognizing that sex doesn’t retire after 60. Complex interactions of biopsychosocial factors underlie the incidence of STDs among older adults.

 

Biological factors. With normal aging, older adults experience changes in immune function, increasing their vulnerability to sexually transmitted diseases. For example, the number and maturity of their T- cells—white blood cells that help fight infection—decrease, depressing immune responsiveness and aiding transmission.  Systemic reductions in testosterone and estrogen can thin the vaginal and anal mucosae and reduce vaginal lubrication, leaving many older men and women susceptible to tears during sex that can facilitate viral entry.

 

Psychological & behavioral factors. Older adults underestimate their risk for contacting sexually transmitted diseases. A recent study comparing actual and perceived sexual risk found that older adults with the greatest risk of contracting STDs were also the group least aware of their vulnerability. Cohort differences surrounding the 1960s rise of penicillin to treat STDs like syphilis may skew older adults’ identification with risky sexual behavior, explaining low rates of condom use among boomers especially. The widespread availability of erectile dysfunction medications in a climate of shifting divorce and dating patterns in later life— when menopause hits and pregnancy ends— have intersected to create more opportunities for sex and infection.

 

Sociocultural factors. Of course, older adults aren’t entirely to blame. Stereotypes, taboos, and biases about aging and sexuality perpetuate misconceptions surrounding late life sex, trickling down into clinical practice. For example, physician-initiated sexual history taking remains suboptimal among older adults, despite CDC recommendations requiring patients of all ages to receive comprehensive STI/STD education and evaluation. A powerful study revealed that few men (38%) and even fewer women (22%) had discussed sex with a physician since age 50, consistent with findings describing the inverse relationship of age and frequency of sexual health discussions. Other studies simply find that practitioners feel uncomfortable initiating sexual health discussions with older adults.  Prevailing interpretations of these findings conclude that practitioners’ attitudes and beliefs about sex in later life may stem from stereotypes of aging and sexuality, rather than experiences with, or explicit education about, late life sexuality.

 

Where do we begin? A call to action

Sex researchers and educators alike have long pointed to the positive contributions of sex education to healthy sexual attitudes and behavior, but adult-specific models remain breathtakingly scarce. Psychologists must therefore work to develop, implement, and evaluate adult sex education protocols for practitioners and older adults on:

  • Increasing knowledge about sexual health and functioning, as well as their changes, in later life;
  • Growing understanding of the biopsychosocial contributions to sexual risk in older adulthood; and
  • Promoting growth in physician and patient comfort to discuss sexual concerns

 

Recent precedent supports this as a good starting point: internal medicine residents who received three brief 30-minute tutorials on sexual history taking demonstrated improved documentation of older adults’ sexual histories than those who did not.

 

Steps you can take right now

We’ve got a long way to go before the paradigm shifts. Here’s what you can do to nudge it:

  1. Pause to assess, recognize, and reflect on your biases. What attitudes and beliefs do you have about late life sexuality? Where do they come from and how do they serve you? How and why should you challenge them?
  2. Practice the kind of sex you’d encourage your child or loved one to have. Sex that’s safe, consensual, and well lubricated.
  3. Have the knowledge and courage to ask questions. If you’re a health care provider working with older folks, ask about their sexual concerns; research says adults appreciate it. If you’re an older adult, share your sexual concerns with your health care provider—a competent professional will work with you or direct you to someone who can.
  4. Learn more. Explore the references included throughout this piece to get more (scientifically sound) information.
  5. Embrace sexuality as a lifelong, developmental process that improves with age. Isn’t that more fun, anyway?

 

 

 

Biography:

Christina Pierpaoli Parker, MA, is a fourth-year graduate student in the Clinical Geropsychology doctoral program at the University of Alabama under the co-mentorship of Drs. Forrest Scogin and Martha R. Crowther. Her research and clinical work explore the intersection of older adults’ physical and psychological health, focusing on the adjustment to and behavioral management of chronic health conditions (e.g., HIV, metabolic syndrome, osteoarthritis). Current interests include developing psychoeducational interventions for understanding, treating, and improving sexual dysfunction in later life. Christina’s work has been published in the Journals of Aging & Health, Sex & Marital Therapy, and The Clinical Gerontologist and presented at international conferences. She translates her academic research for Eng(aging), her widely acclaimed blog on Psychology Today, which has landed her interviews as aging expert on The Psychology Podcast with Dr. Scott Barry Kaufman and The Aging Literacy Podcast with Dr. Bill Thomas. Her forthcoming book, Trixxx Aren’t Just For Kids, written with Dr. Elizabeth DiNapoli, explores the science and stories of sex in later life.

 

This is Why Social Media is the Secret to Success in Student Engagement

Social media competition. Raised hands trying to catch flying like signs / flat editable vector illustration, clip art

This article is cross-posted on APA’s Psych Learning Curve and GradPsych blogs.
Over the last few years as a School Psychology doctoral student, I have begun to experiment with various social media and technology platforms with hopes to improve efficiency and service delivery. I have found that the attention and information consumption of youth are structured into small but high-volume increments of time. Each social media platform serves its own purpose in the lives of our youth and as educators we must utilize this knowledge to bridge the educational gaps that exist.

This has sparked my interest in how social media can be used effectively in the classroom and it has influenced my career choices for the future. Our ability to receive information is becoming more accessible with advances in technology.  As technology begins to affect different areas of our lives we must take charge and change our approach of receiving and presenting knowledge.

For those of us in the field of school psychology, a portion of our responsibility is to assess and evaluate each student’s ability to learn and acquire knowledge. Just as technology grows and develops, our understanding of how students learn must follow.  When we think of education, most of us picture a teacher lecturing from a PowerPoint or a carefully outlined agenda with minimal student interaction. In the traditional sense, educating students has been viewed as a way of transmitting information from an all-knowing source (the teacher) to students waiting to be enlightened. In most cases this idea still resonates, but the way in which students are engaged has vastly changed over the last ten years.

A vast amount of social media platforms have been created over the past decade; Vine, SnapChat, Instagram, and Periscope to name just a few. With the use of these platforms, more people are using social media as a means of communicating, business, entertainment, and yes, even education. More students are engaged by what they can see or interact with, on an individual or group level. This type of environment promotes a more positive outlook on learning and presents a parallel between how students learn and how they use technology.

Research suggests that when technology and social media are used appropriately student engagement and overall learning are enhanced (Lvala & Gachago, 2012). Due to such findings, researchers and educators have questioned how these findings can promote positive learning environments for students. Is technology friend or foe? The emergence of social media has also increased the rate of information exchange both socially and academically. It has grown more common for individuals to use social platforms to exchange knowledge and create safe spaces for self-expression. With social media becoming a highly used platform, educational uses have been deemed to show positive signs of academic engagement (Lvala & Gachago, 2012).

It is my belief that technology and social media are friends to the classroom. I encourage all readers to investigate the positive impact of social media and digital technology in the classroom. Also, we must understand the difference between educational technology and general digital technology. Social media is a common virtual space that most individuals understand, especially the youth.  If one can properly utilize the key elements of social media, students will become more engaged with course content. If you are a non-believer ask yourself the following questions:

  1. Are you uncomfortable using social media in your academic curriculum? If so, why?
  2. Have you been trained to use technology as an educator?
  3. Do you use social media in your personal life?
  4. Do you believe that social media and digital technology are a distraction? Why or why not?

 

References

Lvala, E., & Gachago, D. (2012). Social media for enhancing student engagement: The use of Facebook and blogs at a University of Technology. SAJHE , 26(1), 152-166.

 

Biography:

Dwayne Bryant is a fourth-year doctoral student at Howard University studying School Psychology. His research interests are social media and digital technology. Most recently he gained experience in providing psychotherapy at a behavioral health clinic in the Washington, DC metropolitan area. This experience provided him with a sense of confidence in his field of study.  Over the last two years he has worked on research projected gear towards the advancement of women in STEM fields. He is currently working as an intern in the APA Public Interest Directorate on the issue of women and STEM. He has a passion for advocacy and fairness for all people. In the future, he plans to open a private practice and a learning and recreation center in his hometown of Oak City, NC.

What High School Psychology Students Told Us About the Future of Healthy Aging

blog-senior-citizens-day

By Maggie Syme, PhD, MPH (Member, APA Committee on Aging & Assistant Professor of Gerontology, Kansas State University)

 

In the past year, high school psychology students embarked upon an essay to describe an “Aging World,” the theme of this year’s Teachers of Psychology in Secondary Schools (TOPSS) annual essay competition for high school psychology students. Ultimately, four students from high schools around the world were named winners, but the broader impact was that a bevy of young people learned about how to age well and how to support this goal for our current aging population. The potential contribution of younger to older generations is enormous, and it has been truly inspiring to see the passion and ingenuity with which these high school students approach an aging world.

It was so inspiring that the APA Committee on Aging, which provided input to this year’s TOPPS competition, interviewed the essay winners. The winners provided insight into their experience and the implications for the psychology of aging.

Three thousand words on aging—this is no easy task. Just ask our winners. Each winning student (see below for names and affiliations) commented on the magnitude of the project, and some reflected on how their peers shied away from the task. Yet, each one appreciated the challenge and found clear benefits to participating.

 

Poorvi Dua, now at University of California – Berkeley, indicated that the size did not intimidate her, but instead the challenge was intriguing.

“The second [my teacher] mentioned it I got really excited, and knew if I put work into this it would be the coolest thing.”

 

Wendi Ji, a senior at Shen Zhen College of International Education, also saw the importance of the topic:

“I usually don’t want to participate in essay contests…but the topic really grabbed my attention.”

 

Grace Rhine, now a freshman at Millersville University, stated that the challenge was part of her motivation for doing the essay:

“I really wanted to prepare myself for the writings in college that I would do…It was really helpful for me.”

 

Similarly, Sophia Song, a senior at Seoul International School, indicated that the contest was a “golden opportunity” and further stated,

“I learned a lot about how to format a research paper, which will help me a lot later on.”

 

The winners were especially thankful for their high school psychology teachers in providing the opportunity. Several mentioned their teachers as an integral source of support in the process, and were appreciative of the formatting guidance, as this was the first APA research paper most had written. When asked about other sources of inspiration and guidance, several mentioned their grandparents or other key figures in their lives who had illustrated the importance of healthy aging.

“I thought often about them [grandparents] in my essay, and I asked them a lot about the concepts I explored to see if it was applicable to them.” Grace also pointed to the influence of her grandparents stating, “I’m really close with all my grandparents, and I thought about how their life will be in the future as they age and want them to have a good life.”

 

Wendi spoke about her grandparents as “fighters,” stating,

“They had to fight off against all the negative images they had seen in the media and stereotyping comments about them. [A family member] used the ‘Because you are old…’ a lot. But the truth is, my grandparents never listen when the sentence starts with those words.”

 

In contrast, Poorvi mentioned that she was highly influenced by her English teacher (and mentor), whose wife developed Alzheimer’s disease during Poorvi’s high school career.

“I saw the process he was going through and the mental toll it took on him. And, just how big it became…That really inspired me to write this essay, to see how we can improve the aging process.”

 

In fact, Poorvi is now studying molecular biology and psychology in college with hopes to go to medical school and do research on neurobiology, the brain, and Alzheimer’s. She reported that she has joined a local club at UC-Berkeley, Action for Alzheimer’s, and will be volunteering in a care center as part of the club activities.

 

The other winners also mentioned an intention to “follow up” on aging in some way. Grace, who is studying to be an art therapist, wants to be able to help people across the lifespan through her work. Sophia aims to take a few aging-related courses in psychology when she goes to college. Wendi also indicated her intent for continuing to study aging.

“After researching the aging topic, I find it very hard to just forget about it and go on studying other subjects, just because aging is such an important issue. I want to dedicate myself to helping elderly citizens fight off the negative mass media images and stereotypes.”

 

When talking about the aging-specific aspects of the essay, each winner felt they grasped key points about healthy aging as a result.

For example, Poorvi was captivated by the life course perspective and the real-life impact of psychological and social concepts on biological aging.

“One thing that really surprised me was how much of your early life can play a role in the process of aging. I knew you should exercise and eat healthy, but these studies actually show a direct correlation between things like stress and the length of telomeres in your DNA.”

 

Grace commented,

“I never really thought about it [aging] before, more than just the biological standpoint. Here, I thought about the different experiences people have in retirement, moving into a nursing home, and the impact on that person.”

 

Sophia also commented on broadening her understanding of aging.

“One thing that stood out to me was subjective happiness. We can help older adults have this through gaining independence, autonomy, and from the simplest things like having transportation.”

 

Wendi focused on the psychological impact on healthy aging, stating,

“The overall take-away message was most of the time people had choices, they had choices to lead a healthy and positive life in their 60s and 70s. But the choices originate from their psychology, their attitude and ways of interpreting life events. If we can help them realize the choices and encourage them to make the ones beneficial to their physical and mental health, the word ‘aging’ may finally be free of associated negative emotions fear and worry.”

 

The winners were asked to consider why people their age (or younger) should be interested in aging. What’s the need, if it is decades away?

“It’s going to happen to all of us, sooner or later,” stated Grace.

 

Similarly, Poorvi asserted,

“Every single day, every single second that you are alive, you are aging. You have to be conscious of the choices you are making now because they will play a role down the line. Very small things you wouldn’t think play a role, the effects are amplified as you go along.”

 

Sophia agreed, stating,

“Aging research is an investment for us as we grow up. It’s crucial to understand where we will be in a few decades.”

 

Wendi emphasized that our actions as younger people make an impact on today’s older adults.

“Young people’s attitude and actions towards elderly citizens impose a significant influence upon the expectations and attitudes of elderly people towards aging.” She further stated that, “as responsible citizens, young people should care and help improve the welfare of this very important group who have contributed so much to our society.”

 

Each winner also specified what people in younger generations could (and should) be doing to get involved with aging issues. All of them suggested methods on a larger scale (e.g., volunteering, getting involved in research), but they also mentioned person-level interventions.

“The easiest way is to get a more personal connection with your grandparents, and ask them about aging in general and how each of these things apply to them,” suggested Sophia.

 

The “gap” between older and younger generations was mentioned by Poorvi, stating,

“There’s very young people, and there’s the very old and it feels marginalized. It is a good idea to get them more involved, and there are studies about this. It is better for people in older care homes if they’re surrounded by young/lively people; it boosts their psychological health.”

 

Grace also emphasized the role of personal, intergenerational connections by stating,

“Getting younger people involved in different community programs can integrate the different generations. I’m really involved in my church, and there is a large older population there. I like to get to know them and spend time with them.”

 

Wendi adds,

“They can start by not stereotyping the elderly as ‘lonely, grumpy, and socially withdrawn,’ and hopefully convince others to do the same.” She also suggested the importance of family support for our older relatives. “Consider spending more family time with elderly members in the family. They have the most wisdom and life experience, not to mention the importance of family support for elderly people.”

 

Overall, the essay impacted each of these students in unique ways. Some gained much-needed college preparation, and gained self-efficacy after tackling that ever-challenging APA formatting. Some solidified a previous interest into a potential career pathway. But each one came away with a more profound understanding of healthy aging and the immediate impacts on society. This is summed up in the following from Poorvi:

“Writing this essay made me realize how important this field of study is…All the research in this field is incredibly important because every study is going to be the scientific background for which more programs and laws are created that are geared toward helping older people. It’s underappreciated, but it’s incredibly important in our society because it is so fundamental.”

 

The four winning essays are available to download and read here: http://www.apa.org/ed/precollege/topss/student-competition.aspx. We encourage you to take a look at how these high schools students have captured the challenges and solutions to aging well in our current world.

 

Of note, TOPSS provides students with a writing contest opportunity annually. See this link for guidelines and previous award winners. They also have an award for high school psychology teachers that have innovative lesson plans in psychology. See http://www.apa.org/about/awards/teaching-excellence.aspx for more information and how to nominate your teacher and/or colleague for this award.

 

2017 Essay Winners

Poorvi Dua (Xavier College Preparatory; Phoenix, AZ)

Grace Rhine (Penn Manor High School; Millersville, PA)

Sophia Song (Seoul International School; Seoul, South Korea)

Wendi Ji (Shen Zhen College of International Education, Guandong, China)

 

Biography:

Maggie Syme, PhD, is an assistant professor in gerontology in the Center on Aging and serves as a faculty member in the School of Family Studies and Human Ecology at Kansas State University. Her background is in counseling psychology and public health, with a doctoral degree from the University of Kansas and MPH from San Diego State University. Her clinical postdoctoral training was concentrated in geropsychology and neuropsychology as well as a research postdoc in cancer health disparities and aging. Prior to coming to K-State, Dr. Syme was a Research Assistant Professor at San Diego State University working on grant-funded research from the Alzheimer’s Association on sexual decision-making among cognitively compromised older adults. Her research interests are centered on sexual health in later life and across the lifespan, sexual decision-making in long-term care residents, and person-centered long-term care.

 


Filed under: Aging Tagged: healthy aging, high school psychology, TOPSS essay contest

Give the Gift of Kindness to Your Elders this Holiday Season

holidays

By Sheri R. Levy, PhD, MaryBeth Apriceno, Ashley Lytle, PhD , and Jamie L. Macdonald 

 

The holiday season has a way of encouraging acts of kindness toward family, friends, and even strangers. As the holiday spirit inspires us to treat others with kindness and respect, let us not overlook older adults who tend not to receive everyday acts of kindness, gratitude, and respect.

Ageism (negative attitudes, stereotypes, and behaviors toward older adults) is a significant social problem that impacts their health and well-being.

As the World Health Organization points out:

“Ageism is everywhere, yet it is the most socially ‘normalized’ of any prejudice, and is not widely challenged – like racism or sexism.”

Older adults face disrespectful, avoidant, and patronizing behavior as well as discrimination and even abuse in the workforce, health care, and housing. Challenging ageist stereotypes and treating older adults with respect and kindness can help confront the detrimental effects of ageism.

 

Some figures that should give us pause:

  • Nearly all depictions of older adults in publicly available Facebook groups (including more than 25,489 members) involved the use of negative ageist stereotypes5.
  • There were 20,857 age discrimination claims in employment in 2016 alone, accounting for 22.8% of all discrimination claims in employment2.
  • Ageism was the most frequently reported type of discrimination by a nationally representative sample of 6,000 American adults ages 50 and over when asked whether they experienced discrimination by doctors or hospitals11.
  • The World Health Organization estimates that 1 in 6 older adults have experienced some form of elder abuse in the past year. This abuse includes neglect as well as physical, emotional, financial, and sexual abuse.

 

What you can do to reduce ageism:

 

1. Get the facts on aging:

2. Explore tips from the World Health Organization and the United Nations 

3. Steer clear of birthday cards that poke fun of older adults, which can lead to the internalization of negative age stereotypes, and further perpetuate myths about aging.

 

Celebrate older adults throughout the year:

 

 

If you would like to learn more about this topic, the following resources might be of interest to you:

 

1Abrams, D., Swift, H.J., and Drury, L. (2016). Old and unemployable? How age-based stereotypes affect willingness to hire job candidates. Journal of Social Issues, 72(1), 105-121. doi 10.1111/josi.12158

2Equal Employment Opportunity Commission (January, 2017). EEOC Releases Fiscal Year 2016 Enforcement and Litigation Data. Retrieved from: https://www.eeoc.gov/eeoc/newsroom/release/1-18-17a.cfm

3Erber, J.T., & Szuchman, L.T. (2015). Great myths of aging. Wiley-Blackwell: Malden, MA

4Levy, B. R. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6): 332-336.

5Levy, B.R., Chung, P.H., Bedford, T., & Navrazhina, K. (2014). Facebook as a site for negative age stereotypes. The Gerontologist, 54(2), 172–176. doi:10.1093/geront/gns194

6Levy, S.R. (2016). Toward reducing ageism: PEACE (Positive Education about Aging and Contact Experiences) Model. The Gerontologist. 10 AUG 2016, doi: 10.1093/geront/gnw116

7Levy, S.R., & Macdonald, J.L. (2016). Progress on Understanding Ageism. Journal of Social Issues, 72(1), 5-25. doi: 10.1111/josi.12153

8Lytle, A., & Levy, S.R. (2017). Reducing Ageism: Education about Aging and Extended Contact with Older Adults. The Gerontologist. Article first published online: 19 NOV 2017, https://doi.org/10.1093/geront/gnx177

9Palmore, E. B., Branch, L., & Harris, D. K. (Eds. 2005). Encyclopedia of ageism. Binghamton, NY, US: Haworth Pastoral Press.

10Pillemer, K,, Burnes, D, Riffin, C., Lachs, M.S., (2016). Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies, The Gerontologist, 56, 194–205. https://doi.org/10.1093/geront/gnw004

11Rogers, S. E., Thrasher, A. D., Miao, Y., Boscardin, W. J., & Smith, A. K. (2015). Discrimination in healthcare settings is associated with disability in older adults: Health and retirement study, 2008–2012. Journal Of General Internal Medicine, 30(10), 1413-1420. doi:10.1007/s11606-015-3233-6

12United Nations (2014). Retrieved from http://www.un.org/en/globalissues/ageing/

13World Health Organization (September, 2015). Ageing and Health. Retrieved from http://www.who.int/mediacentre/factsheets/fs404/en/

14World Health Organization (June, 2017). Elder abuse: Fact sheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs357/en/

 

Biographies:

 

Sheri R. Levy is a Professor in the Department of Psychology at Stony Brook University, USA. She earned her PhD at Columbia University in New York City, USA. Levy studies factors that cause and maintain prejudice, stigmatization, and negative intergroup relations and that can be harnessed to reduce bias, marginalization, and discrimination. Her research focuses on bias based on age, ethnicity, gender, nationality, race, sexual orientation, and social class.  With Jamie L. Macdonald and Todd D. Nelson, Levy co-Edited a special issue of Journal of Social Issues on “Ageism: Health and Employment Contexts” (Levy, Macdonald, & Nelson, 2016). Levy was Editor-in-Chief of Journal of Social Issues from 2010-2013 and is a Fellow of the Society for the Psychological Study of Social Issues (Division 9 of American Psychological Association).

 

MaryBeth Apriceno is a graduate student at Stony Brook University. She received her BA in Forensic Psychology from John Jay College of Criminal Justice. Her research investigates factors that affect ageist attitudes, aging anxiety, and self-stereotyping.

 

Jamie L. Macdonald is a doctoral candidate at Stony Brook University working with Sheri R. Levy. Jamie received her BA and MA in Psychology from Stony Brook University, New York, USA. Her research investigates prejudice, stereotyping, and discrimination with a focus on ageism in different contexts, like the workplace. She was a Co-Editor, with Sheri R. Levy and Todd D. Nelson, on a special issue of Journal of Social Issues on “Ageism: Health and Employment Contexts” (Levy, Macdonald, & Nelson, 2016).

 

Ashley Lytle is an Assistant Professor of Psychology at Stevens Institute of Technology in Hoboken, New Jersey, USA. Lytle earned her PhD at Stony Brook University, New York, USA.  Her research explores how prejudice, discrimination, and stereotyping impact academic, social, and health outcomes among marginalized groups. Much of Lytle’s research has focused on better understanding prejudice toward older adults, sexual minorities, and women, with the ultimate goal of creating simple, yet effective, interventions to reduce prejudice.

 

Image source: iStockPhoto


Filed under: Aging, Health and Wellness Tagged: age discrimination, ageism, discrimination, holiday season, prejudice

Finding Meaning in Life and in Death: A Call to Culturally Competent Action

jake-thacker-113197 (1)

This is the second of three blog posts on grappling with end-of-life issues. Posts will go up for the next two Fridays. Subscribe to our Psychology Benefits Society blog to stay updated.

By Keisha Carden, MA (Doctoral Clinical Geropsychology Student, University of Alabama)

“Technically, I am still alive, but I’ve been dead for a long time. What was the meaning of it all?”

Elaina, seemed to be elsewhere as she shared this, her face void of affect. She was my 68-year-old in-home hospice patient suffering from a myriad of chronic health conditions with little time left to live. While I had used meaning-centered interventions with other clients, none had lived a life quite like this—a life peppered with physical, sexual, and emotional abuse, substantial self-harm, onerous failed attempts at healthy relationships and adaptive coping strategies, and an intimate familiarity with discrimination and prejudice. How could I help her make meaning of the senseless trauma, violence, and hate to which she had been subjected for so long? As a well-intentioned psychology scientist-practitioner, I looked to the evidence.

Like Elaina, many of our dying patients express the need for meaning—in life and in death. In palliative care, our primary goal is to facilitate comfort and maximize quality of life. We often employ interventions that emphasize the importance of meaning-making.

Unfortunately, these interventions seem to be overly individualistic and westernized, overlooking important aspects of intersectionality and cultural variations (e.g., Carden, Murry, Matthews, & Allen, in press). For example, Allen and colleagues (2016) reviewed the existing community-based interventions aimed at reducing the burden of palliative caregiving. Ten of the 17 interventions they identified were investigated among primarily (78% – 100%) non-Hispanic White participants and five studies did not report race. It is therefore conceivable that many palliative interventions fail to effectively assess and address the needs of many cultural groups.

So how do we move forward?

 

Back to the Basics

Meaning-based interventions are rooted in the teaching and writings of Viktor Frankl, founder of logotherapy and holocaust survivor. At their core, they assume:

  1. human beings consist of body, mind, and spirit
  2. life has meaning under all circumstances, even the most miserable
  3. people have a will to meaning
  4. people have freedom under all circumstances to activate the will to find meaning
  5. life has a demanding quality to which people must respond if decisions are to be meaningful
  6. the individual is unique

 

The individual is unique…

Have we lost sight of the individual in our efforts to be prescriptive and standardized in treatment development and delivery? It may be time to go back the basics and infuse our practice with more person-centeredness.

 

Promising beginnings

The scientific community seems to agree and is beginning to investigate innovative and creative solutions. These endeavors include utilizing culturally competent hospice educational materials (Enguidanos, Kogan, Lorenz, & Taylor, 2011), videos aimed at improving disparities in knowledge (Volandes, Ariza, Abbo, & Paasche-Orlow, 2008), employment of patient navigators (Fischer, Sauaia, & Kutner, 2007), and other peer support programs (Hanson et al., 2013).

 

What can you do?

It is time for researchers and providers to tackle this issue together. Research is needed that:

  1. explores factors contributing to differences and disparities in end-of-life and palliative care
  2. evaluates the effectiveness of current end-of-life interventions among diverse groups
  3. considers appropriate and ethical modifications to said interventions to enhance quality end-of-life care for all.

In the meantime, providers must go back to the basics and rely on ethical standards to facilitate quality care to diverse patients and their families.

 

References:

Allen, R. S., Noh, H., Beck, L.N., Smith L. J. (2016). Caring for individuals near the end of life. In L.D. Burgio, J.E. Gaugler, & M.M. Hilgeman (Eds.), The spectrum of family caregiving for adults and elders with chronic illness (pp. 142-172). New York, NY: Oxford University Press.

Enguidanos, S., Kogan, A. C., Lorenz, K., & Taylor, G. (2011). Use of role model stories to overcome barriers to hospice among African Americans. Journal of Palliative Medicine, 14(2), 161-168. doi:10.1089/jpm.2010.0380.

Fischer, S. M., Sauaia, A., & Kutner, J. S. (2007). Patient navigation: A culturally competent strategy to address disparities in palliative care. Journal of Palliative Medicine, 10(5), 1023-1028. doi:10.1089/jpm.2007.0070.

Hanson, L. C., Armstrong, T. D., Green, M. A., Hayes, M., Peacock, S., Elliot-Bynum, S., Goldmon, M. V., Corbie-Smith, G., & Earp, J. A. (2013). Circles of care: Development and initial evaluation of a peer support model for African Americans with advanced cancer. Health Education & Behavior, 40(5), 536-543. doi:10.1177/1090198112461252.

Volandes, A. E., Ariza, M., Abbo, E. D., & Paasche-Orlow, M. (2008). Overcoming educational barriers for advance care planning in Latinos with video images. Journal of Palliative Medicine, 11(5), 700-706.

 

Biography:

Keisha Carden is a fourth year graduate student in Clinical Geropsychology at The University of Alabama working under the mentorship of Dr. Rebecca S. Allen. Her primary clinical and research interests include: family caregiving for older adults (with and without cognitive impairment/Alzheimer’s disease and dementia); resilience; existential/death anxiety; childhood trauma; intergenerational relationships; and outcomes and treatment mechanisms of non-pharmacological interventions that incorporate aspects of positive psychology and meaning-making.

Image source: Photo by Jake Thacker on Unsplash


Filed under: Aging Tagged: end of life, existential, gender, intersectionality, meaning, minority, palliative care, sexuality

“No Duty More Important”: Why We Must Treat Children’s Rights as Fundamental Human Rights

michael-mims-134037

 

By Julia Mancini (Intern, APA Office on Children, Youth and Families)

“There is no trust more sacred than the one the world holds with children. There is no duty more important than ensuring that their rights are respected, that their welfare is protected, that their lives are free from fear and want and that they can grow up in peace.” — Kofi Annan

 

Where exactly do human rights begin? Sunday, December 10th, 2017 is International Human Rights Day. #HumanRightsDay is celebrated in conjunction with the anniversary of the day the United Nations General Assembly adopted the Universal Declaration of Human Rights, which will reach its 70th anniversary this coming year. The Declaration seeks to uplift individuals from all walks of life across the world and protect our kinship and dignity as human beings. However, how far does this kinship and dignity extend?

 

We cannot protect the rights of all people if we do not respect the rights of the youngest and most vulnerable. In November of 1989, the United Nations General Assembly adopted the Convention on the Rights of the Child (CRC). It acknowledges young people as change agents of society and holders of rights1.

 

Some might consider children bystanders in their own lives, directed always by the decisions caregivers and governments make for them. In considering children active agents of society, we respect their dignity and give them a voice to speak on the difficult situations they face so that we might better support them.

 

Adults often have legal, developmental, social, and monetary advantage over children. It is not mistaken that adults support children in ways they are not able to do for themselves. The goal is not to take away caregivers’ rights but to instead retain the balance between the rights of children and the rights of families3.

 

What exactly do those rights include? According to the UN, all children have a right to:

  • a safe physical environment,
  • security,
  • food,
  • shelter,
  • freedom of expression,
  • freedom of association,
  • self-determination,
  • knowledge, and
  • work.

 

On International Human Rights Day, let’s remember that children’s rights are human rights. If we assume the capacity of a child, we often underestimate the contribution they offer to our society and submit their autonomy to a third party or adult with more power. It is important to balance this agency with protection from harm for those who cannot protect themselves2. This pertains especially to the most vulnerable children throughout the world – the ones who often face the most adversity and discrimination, namely disabled, displaced, impoverished, and minority children. It is important that when we speak of the rights of marginalized groups throughout the world, we also give a voice to children within these groups who might be forgotten or exploited.

 

The American Psychological Association has endorsed the principles and spirit of the CRC and thus recognized the importance of the rights of children. This issue is important because, as a society, if we were more aware of what children are entitled to as citizens of the world, there would be opportunity for social justice changes that could have an inter-generational and global impact.

 

It is, of course, essential that adults take a primary role in ensuring their children’s well-being, but it is our international responsibility to ensure that governments and caregivers are doing this in a way that fits the child’s best interests. If we understand and advocate for children’s rights in the present, there will be a better future for not only these individuals, but on an international level as well.

 

Join the conversation on social media:

  • Celebrate children’s rights and International Human Rights Day by telling the world that “children’s right are human rights” on your social media. Use the hashtags #HumanRightsDay and #childdevelopment.
  • Take part in our December 12 Twitter chat on the vital role scientists can play in promoting human rights. It will take place at 2 PM (ET) in partnership with the American Chemical Society and the American Association for the Advancement of Science (AAAS) Science and Human Rights Coalition.

 

References:

1Ruck, M. D., Keating, D. P., Saewyc, E. M., Earls, F. & Ben-Arieh, A. (2014). The United Nations Convention on the Rights of the Child: Its relevance for adolescents. Journal of Research on Adolescence, 26(1) 16-29. doi:10.1111/jora.12172

2Smith, A. B. (2016). Achieving social justice for children : How can children’s rights thinking make a difference? American Journal of Orthopsychiatry, 86(5), 500-507. doi:10.1037/ort0000191

3Huus, K., Dada, S., Bornman, J., Lynegard, F. (2016). The awareness of primary caregivers in South Africa of the human rights of their children with intellectual disabilities. Childcare, Health, and Development, 42(6) 863-870. doi:10.1111/cch.12358

 

Biography:

Julia Mancini is currently a junior Psychology and Criminal Justice double major at George Washington University. Julia has a particular interest in children and families and is excited to be interning with the Children, Youth and Families office this fall. Julia has been involved with behavioral genetic research through The Boston University Twin Project. She also worked as a Clinical Research Intern at Safe Shores, DC’s Children’s Advocacy Center, investigating disparities in PTSD presentations among minority youth. This past summer Julia interned for the Child Protection Unit in the District Attorney’s office in her home state of Massachusetts. She also had the opportunity to work internationally with a non-profit in Cochabamba, Bolivia that provides psychological, legal, and social services to child survivors of sexual violence.

Image source: Photo by Michael Mims on Unsplash


Filed under: Children and Youth, Human Rights and Social Justice Tagged: children's rights, human rights, International Human Rights Day, UN Convention on the Rights of the Child

A Good Death is an Important Part of a Good Life

assisted-dying2

This is the first of three blog posts on grappling with end-of-life issues. Posts will go up for the next three Fridays. Subscribe to our Psychology Benefits Society blog to stay updated.

By Amy Albright (Clinical Geropsychology Doctoral Student, University of Alabama)

We spend a lot of time talking about quality of life, but, increasingly, people around the world are talking about quality of death. Facing the end of life is hard for everyone involved, and many worry about the pain and loss of dignity associated with dying.1 In some areas of the world, individuals may choose legalized medical aid in dying, allowing them to control the time and place of their own death. This assistance allows patients to peacefully and painlessly end their lives through prescribed medication, which is often referred to as “assisted dying” or “death with dignity.” The majority of patients who choose these options are receiving hospice care,2 and many choose to die peacefully at home.3

Within the United States, residents of California, Colorado, Montana, Oregon, Vermont, Washington, and Washington D.C. may seek assisted dying.4 Currently, all U.S. states that allow assisted dying require that the patient is at least 18 years old, has a terminal illness, and has the legal capacity to make medical decisions.5 Psychologists don’t take a stand on this issue one way or the other; instead, they work with individuals to identify their own values and make their own decisions during this difficult time.6 There is a great deal of controversy surrounding  assisted dying, as the idea of ending one’s own life may be uncomfortable within certain cultures and religions.7 This is a choice that must be made at an individual level, and many who explore this option do not choose to hasten their own death. As of 2015, approximately 64% of medications prescribed under Oregon’s Death with Dignity Act were used.3

There is a great deal of variation in assisted dying laws,5 which may be due to how these laws develop. Brittany Maynard, a resident of California, was 29 when she was diagnosed with terminal cancer.8 While she wanted to choose death with dignity, this was not an option in California at the time, and she and her husband moved to Oregon so she could choose a peaceful death on her own terms. Ms. Maynard and her family advocated for California to pass a death with dignity law, and the California End of Life Option Act took effect in June of 2016.9 Due in large part to Ms. Maynard’s efforts, the idea of choosing assisted dying at the end of life is something that many Americans are now aware of. While hastening death is not something that most people will choose, having these tough conversations helps patients and their families become more aware of the services and options available to them at the end of life, allowing them to make the best decision possible.10

Choosing to pursue assisted dying is an incredibly difficult decision for all involved, and judging quality of death is very personal.11 While losing a loved one is never easy, family members of those who seek assisted dying have noted that their relative appeared prepared for death, allowing goodbyes to be said.1 Death is an inevitable part of life, and death with assisted dying  laws allow patients and their families some measure of control over the time and manner of death. Simply having the option to influence quality of death may be enough for some patients, and not all who consider assisted dying laws will choose to hasten death. Ultimately, there are no universal standards about the decision to pursue assisted dying, and this should always remain a matter of personal choice.6

 

References

  1. Smith, K. A., Goy, E. R., Harvath, T. A., & Ganzini, L. (2011). Quality of death and dying in patients who request physician-assisted death. Journal of Palliative Medicine, 14(4), 445-450.
  2. Campbell, C. S., & Black, M. A. (2014). Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. Journal of Pain and Symptom Management, 47(1), 137-153.
  3. Oregon Public Health Division. (2016). Oregon Death with Dignity Act: 2015 Data Summary. Retrieved from http://www.worldrtd.net/sites/default/files/newsfiles/Oregon%20report%202015.pdf.
  4.  Death with Dignity National Center. (2017). Death with Dignity Legislation. Retrieved from https://www.deathwithdignity.org/faqs/#laws.
  5. Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA, 316(1), 79-90.
  6. American Psychological Association. (2017). Resolution on Assisted Dying and Justification. Retrieved from http://www.apa.org/about/policy/assisted-dying-resolution.aspx.
  7. Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers, and the public on assisted dying. Palliative Medicine, 27(1), 13-26.
  8. Maynard, B. (2014, November 2). My right to death with dignity at 29. CNN. Retrieved from http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/index.html.
  9. Coalition for Compassionate Care in California. (2017). End of Life Option Act. Retrieved from http://coalitionccc.org/tools-resources/end-of-life-option-act/.
  10. Balaban, R. B (2000). A physician’s guide to talking about end-of-life care. Journal of General Internal Medicine, 15(3), 195-200.
  11. Meier, E. A., Gallegos, J. V., Thomas, L. P., Depp, C. A., Irwin, S. A., & Jeste, D. V. (2016). Defining a good death (successful dying): Literature review and a call for research and public dialogue. The American Journal of Geriatric Psychiatry, 24(4), 261-271.

 

Biography:

Amy Albright is a doctoral student in the Clinical Geropsychology program at the University of Alabama. Her research focuses on health literacy and the end of life, and she has a particular interest in factors that influence seeking medical assistance in dying. This includes both patient and provider attitudes towards physician-assisted death, as well as health and palliative care literacy.


Filed under: Aging Tagged: aging, assisted dying, death with dignity, end of life, hospice care, palliative care

What Does Our Past Tell Us About Our Future? The Essential Role of Psychologists in Fighting HIV

aidsblogphoto

(L-R) Dr. Rich Wolitski (HHS/OHAIDP); Dr. Fayth Parks (Georgia Southern University) APA Ad Hoc Committee on Psychology & AIDS (COPA) chair and symposium co-chair; Dr. Sherry Wang (Santa Clara University) COPA symposium co-chair; Ms. Cherie Mitchell (APA); Dr. Karen Ingersoll (University of Virginia); Dr. Richard Jenkins (NIH/NIDA); and Dr. Ramani Durvasula (California State University, Los Angeles)

This article is cross-posted from the HIV.gov blog with their permission.

 

By Richard Wolitski, PhD (Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services)

 

Since the early days of the HIV/AIDS epidemic, psychologists have been essential in the response to HIV:

  • They offered mental health support for people living with, or at risk for, HIV—as well as for their families and communities, and those who provide HIV medical care and social services.
  • Psychologists developed programs to educate people about HIV and motivate behavior change to reduce risk.
  • They counseled and supported those who were diagnosed, and also played important roles in working to eliminate the stigma that attaches to HIV/AIDS, sexual minority status, gender identity, substance use, and other characteristics associated with HIV infection.
  • They conducted research that gave us an understanding of cognitive, behavioral, and social determinants of health that create health disparities.

 

They continue to do all of these things, and they play a vital role as the response to HIV/AIDS continues to evolve.

This year, the professional organization for psychologists, the American Psychological Association (APA), celebrated its 125th anniversary. The APA has been deeply involved in the response to HIV/AIDS in the United States:

  • From 1996-2014, the Centers for Disease Control and Prevention (CDC) funded APA’s Behavioral and Social Science Volunteer (BSSV) Program. The program established a national network of more than 300 psychologists, sociologists, anthropologists, and public health experts who provided capacity-building technical assistance to improve the delivery and effectiveness of HIV prevention services to more than 700 organizations.
  • And from 1991-2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded APA’s HIV Office for Psychology Education (HOPE) Program, which trained more than 36,500 psychologists and allied mental health providers about HIV, substance use, and mental health.

 

Today, the organization continues its mission to address the ongoing toll of HIV on the mental and physical health of people living with HIV. You can view information about activities, events, and resources on the APA’s HIV webpage.

 

Dr. Arthur C. Evans, Jr. , PhD, APA’s Chief Executive Officer, expressed his support for APA’s role in this work. He shared with me that he sees psychology’s role in this way:  

Psychology plays a critical role in HIV prevention and treatment by promoting behaviors aimed at helping to improve overall health, mental health and well-being and providing a better understanding of social and cultural factors, such as stigma and culturally appropriate counseling and treatment interventions. We know that access to quality behavioral health services facilitate better outcomes across the HIV care continuum, including viral suppression.

Dr. Arthur C. Evans, Jr., PhD

 

Given the organization’s commitment and long track record of service to the HIV community, I was honored when APA asked me to be a discussant as part of the 125th Anniversary Talk, Past, Present and Future of HIV/AIDS Science and Practice in Psychology. Under the skillful direction of co-chairs Dr. Fayth Parks and Dr. Sherry Wang, the panelists addressed a number of important topics:

  • Eugene Farber, PhD, ABPP, Emory University School of Medicine, The Future of Psychology as a Health Service Discipline: Clinical Lessons from the HIV Epidemic
  • Ramani Durvasula, PhD, California State University, Los Angeles: A History of HIV/AIDS in Women: Shifting Narrative and a Structural Call to Arms
  • Karen Ingersoll, PhD, Professor of Psychiatry and Neurobehavioral Sciences at the Center for Behavioral Health & Technology, University of Virginia: Internet Intervention for HIV+ Substance Users to Improve ART Adherence and Addictive Behaviors
  • Richard Jenkins, PhD, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse: Roles for Psychologists in a World of Changing Epidemics and Policies

Each of the presentations drew attention to the ways that psychologists have contributed to the fight against HIV. A key point made by all the participants is that behavioral approaches to HIV prevention, care, and treatment optimize biomedical approaches—and that the two are inextricably linked.

Dr. Eugene Barber speaking
Dr. Eugene Farber, Emory University

Dr. Gene Farber set the frame for the session by reflecting on the essential role of behavioral health service providers in supporting a humanistic, culturally responsive, and patient-centered care experience for people living with HIV. He stressed that behavioral health services must encompass not only assessment and treatment of behavioral disorders but also interventions to prevent the onset of other health conditions and to optimize biopsychosocial well-being. He also noted that psychologists can make substantial contributions to patient care and evaluation in medical settings.

Dr. Karen Ingersoll took his points a step further to show how psychologists can help individuals even when in-person contact is impossible. She is working on finding better ways to support substance users who are living with HIV—particularly those in rural areas, where HIV and other types of care are not always available and may require time away from work. These individuals are at significantly higher risk for nonadherence to their HIV medications and disengaging from care—so Dr. Ingersoll and her colleagues have developed an interactive online video intervention  that features peer role models offering advice and support to viewers. (Much like our own Positive Spin series, which takes a similar approach to supporting people living with HIV to achieve viral suppression.) This behavioral intervention is currently being tested to see if it can support substance users to take full advantage of biomedical treatment for their HIV disease.

Dr. Ramani Durvasula spoke about the need for holistic approaches to psychological care for women living with HIV. Her presentation focused on “the story of HIV in women,” which includes the multiple challenges women have faced in attempting to:

  • Get information on HIV risk;
  • Obtain an HIV diagnosis, care and treatment; and
  • Participate in HIV clinical trials.

For many women, neither biomedical or behavioral interventions were available.

Dr. Durvasula then discussed the current need for psychologists to be aware of the multiple psychosocial stressors women with HIV face (e.g., economic and caregiving burdens, relational issues, stigma, intersectional discrimination) and how they affect women’s physical health. She also emphasized the need to focus on women’s resiliencies, strengths, and growth rather than just their HIV disease. She ended with the observation that, for the future, psychology training programs should be looking at social justice and advocacy training as key to producing psychologists with the skill sets necessary for the future.

Finally, Dr. Richard Jenkins took the audience through a history of the role of psychologists in the U.S. epidemic, including a look at the ways in which the advent of antiretroviral therapy (ART) and other biomedical approaches have pushed many behavioral interventions to the margins. However, he noted that many of issues that affected people living with HIV in the early days of the epidemic persist and have not been eliminated by effective biomedical treatment, including stigma, access to care, and racial/ethnic disparities. He ended his presentation with a series of questions about how to connect psychologists to opportunities in HIV work, and raise the value of psychology for workforce development related to HIV.

As I listened to these passionate, committed professionals, I thought about the long history of the HIV/AIDS epidemic in the United States. I thought about how our early efforts, which were based on the best information we had at the time, created systems and approaches that have sometimes hampered our efforts to respond to the realities of today’s epidemic.

For example, when the first HIV test became available, we created a standalone system for HIV testing that was supported with siloed funding (meaning the funds could only be used for HIV testing—not any follow-up care or treatment). This was necessary because of the large number of people who needed to be tested and the fact that many people were unwilling to be tested by their usual healthcare providers. They didn’t want their providers to know they were at risk for infection or did not want information about their risk and their HIV test results to be recorded.

So, we set up stand-alone systems for anonymous testing—meaning your name was never attached to your HIV test. You were given a number that matched the one on the vial of blood the worker at the testing site took from you, and you had to have that number to get your results. This approach was intended to alleviate the stigma of testing—but it also meant that we were not able to set up linkages to care and treatment for newly diagnosed people.

The lack of connection with health care was further reinforced—first, by the absence of effective treatment, and, then, for almost three decades, by guidelines indicating that ART was not needed until later in the course of the infection, when damage to the immune system became clear. This history—and the fact that funding streams were established for HIV testing separately from health care—have required substantial changes to facilitate immediate linkage to care, and establishing late in the epidemic coordinated prevention, care, and treatment plans.

Another way that our past response affects our future is in the way that surveillance systems were established. Initially we were focused on AIDS. We did not know what caused it, and we focused on documenting the cases when and where they were identified and when and where the person died. We did not need to gather data to support engagement in HIV care over a lifetime. We were focused on keeping people alive for the next year (or month) and preventing new cases. This changed as we learned what caused HIV, its effects on the body and how to treat it effectively. As changes occurred, we had to start playing catch-up on the surveillance front, and we continue to wrestle with how to collect data in ways that will help us end the epidemic.

We know now that being diagnosed and beginning HIV treatment as soon as possible are essential to the health of people living with HIV. We also know that good physical health and good mental health are closely connected, and that people who feel a sense of well-being are also more likely to feel motivated to care for their bodies. That’s particularly important for people living with HIV.

Our goal is to support every person to engage in care, remain on treatment, and achieve viral suppression—and that goal can only be reached if people feel empowered to take charge of their healthcare. That is where the contributions of my colleagues at APA come in.

Even though biomedical tools are clearly the way we will ultimately win this battle against the HIV epidemic, they will not work if people do not engage in the behaviors that are needed to use them effectively. Psychologists have the training and the skills to help them do just that.


Filed under: AIDS, Health Disparities, Human Rights and Social Justice Tagged: aids, AIDS research, behavioral health, discrimination, HIV, hiv prevention, HIV treatment, mental health, stigma

“Shall We Dance?” How Parents Can Work Together to Teach Kids About Race

Family dancing together

 

This is the fifth in a series of blog posts that the American Psychological Association (APA) will publish regarding racial/ethnic socialization practices, programs, and approaches. APA is putting together a clearinghouse of resources to help parents/caregivers to protect youth of color and themselves from the psychological damage of discrimination and racism. For more information regarding APA’s new initiative and to provide feedback as we continue to engage in this series, please visit: www.apa.org/pi/res

 

By Shawn C. T. Johnson, PhD (Postdoctoral Fellow, University of Pennsylvania)

 

giphy

 

In the world of reality contest shows, are any more fun than those that center around dancing? On shows such as Dancing with the Stars (above), individuals with varying levels of talent pair up with others—sometimes as novice, sometimes advanced—to practice and eventually perform a set routine.  If you have ever watched these shows, you can appreciate the time and effort it takes to get the count right, keep rhythm etc.

 

As a racial-ethnic socialization (RES) scholar, watching these shows has also gotten me to think about another dance that goes on (and is often unnoticed) for many parents: working together to teach their child how to navigate a racialized world. Unlike faulty steps meaning the difference between staying on a show and going home, the stakes for effectively providing your child with affection, protection, and correction, as Dr. Howard Stevenson describes it, are much higher. Yet, while we often consider racial socialization one of the most critical parenting practices, there is not much that exists to help parents think through how their individual and collective skills, what they bring to the dance, can have important consequences for safeguarding their children physically, mentally, and emotionally.

 

So You Think You Can Dance?

 

Individually, it may be important for each parent to consider their styles and comfort around talking to their children about race. For example, one parent’s experiences with racial discrimination may make them more or less committed to preparing their children for potentially similar experiences. For another parent, they may still be carrying forward the messages that they were taught about race as a child, and these messages may inform how they plan to talk about race. Even experiences such as where parents’ grew up can impact how they think about race and the importance of teaching lessons to their children. So it is crucial to ask your co-parenting partner to share thoughts and feelings on race and RES.

 

It Takes Two…

 

giphy (1)

 

In addition to what each parent brings to the dance floor independently, how well parents work together impacts how successfully they can teach their children about race. Have you ever seen two capable dancers stumble through a routine? Oftentimes it has to do with a lack of communication. The most seamless routines are often found when communication is open and frequent. For RES, like dancing, this can mean using verbal or non-verbal means to let your partner know where you are going.

 

Another element of effectively navigating RES may center on discussions of role-taking or leads. Have you discussed who might be the one to teach your child what to do if they get stopped by the police, or is called a racial slur?

 

No Parking on The Dance Floor

 

source

 

Even once parents are able to work together to get into a groove that includes mutual understanding and open communication, it is important to also take a look at what is going on in you and your child’s world. Very skilled dancers may still find it difficult to be successful on a dance floor that is too crowded, and communication may become difficult if the music is too loud. Does the neighborhood or school your child inhabits make having these conversations more critical? How do the current political climate and exposure to social media change the ways in which your maneuver? How do other important people—grandparents, stepparents, and fictive kin— fit in with how we are teaching our children about race?

 

While RES unfortunately does not come with an instructional dance guide, and there may not be just the “right moves”, working together to teach your children about race is achievable. Share experiences and perspectives on race; support one another in co-creating an approach to talking about race; and accommodate one another when disagreements about how to proceed inevitably arise.

 

So tonight, perhaps after watching the latest episode of DWTS, you can pull up APA’s RESilience Parent Tip Tool, and ask your co-parent, “Can we have this dance?”

 

Biography:

 

Shawn C. T. Jones, PhD, is a National Science Foundation SBE Postdoctoral Fellow in the Human Development and Quantitative Methods division at the University of Pennsylvania’s Graduate School of Education. Currently, Shawn works with Dr. Howard Stevenson in the Racial Empowerment Collaborative (REC), which centers on applied research to promote racial literacy and empower families as a means of reducing the deleterious impact of race-related stress. He received his doctorate in Clinical Psychology with a Child and Family emphasis from the University of North Carolina at Chapel Hill and was a Child Clinical Psychology Pre-doctoral intern at UCLA’s Semel Institute for Neuroscience and Human Behavior. During his time at UNC, Shawn was both a Ford Foundation Predoctoral and Dissertation Fellow. Shawn also holds a Master of Health Science in Mental from Johns Hopkins University Bloomberg School of Public Health (2010) and a Bachelor of Science in Psychology from Duke University (2008).

Dr. Jones endeavors to impact the psychosocial wellbeing of Black youth and their families by: a) exploring mechanisms undergirding culturally-relevant protective and promotive factors; b) translating basic research into interventions that harness the unique strengths of the Black experience; and c) disseminating this research to be consumed, critiqued and enhanced by the communities the work intends to serve. Clinically, Dr. Jones is committed to the provision of culturally-informed child, couple and family therapy and assessment. Finally, Dr. Jones is passionate about eliminating racial health disparities, particularly those related to mental health services, which he sees as obtainable through stigma-reduction and mental health literacy interventions.


Filed under: Children and Youth, Culture, Ethnicity and Race Tagged: children's mental health, ethnic identity, parenting, parenting tips, racial and ethnic socialization, racial discrimination, racial identity, racial socialization, resilience

How to Listen When Someone You Know Discloses Sexual Harassment or Assault

listening1

This post is based on a longer article by Dr. Jennifer J. Freyd (Professor of Psychology, University of Oregon)

 

Every day now in the news, we learn of various actions taken by those facing allegations of sexual assault and harassment. One set of actions has to do with their reported sexual harassment and/or assaults. Another set of actions has to do with how they respond when accused. Both types of action are crucially important. A good response can at least do some good (sincere apologies can be healing). But a bad response not only exacerbates the harm of the first injury, it also inflicts new injury, and does so in ways that are usually public and ongoing (well past the media moving on).

 

It is very important to be a good listener when a friend or loved one discloses a difficult or upsetting experience like sexual assault or harassment. We know that respectful, compassionate, attentive, and authentic listening can be healing, while a controlling, blaming, and/or invalidating response can cause harm.

 

1. Do Not “DARVO” and Call It Out When You See It

DARVO stands for “Deny, Attack, and Reverse Victim and Offender.The perpetrator or offender may:

  • Deny the behavior,
  • Attack the individual doing the confronting, and
  • Reverse the roles of Victim and Offender.

DARVO is a particularly pernicious response to disclosure and can cause harm. For more on DARVO see this page.

 

2. Be a Well-Intentioned and Respectful Listener

Many people want to respond well to a disclosure but may not know how. Here are some guidelines to help people and institutions respond well to disclosures of violence and distressing events. These suggestions are drawn from research findings¹

  • Respect the survivor’s autonomy and² strengths
  • Validate the survivor and indicate that the responsibility for the violence is with the perpetrator(s)
  • Stay engaged and focused on the survivor’s needs and validate the survivor’s strengths
  • When it is possible and appropriate, sincerely apologize
  • Do not invalidate, blame or pathologize the survivor
  • Do not take away the survivor’s autonomy 

 

3. Be a Compassionate Listener²

These suggestions are drawn from instructions that address listening skills in the moment.

 

First, it is important to use attentive body language. 

 

  • Do not make inappropriate facial expressions (e.g., smiling when someone is discussing a sad topic, rolling your eyes, raising your eyebrows when hearing how someone coped) and do not move your body too much (e.g., excessive fidgeting, playing with your cell phone).

 

  • Do sit in a posture (e.g., leaning forward or upright) and use gestures that convey engagement (e.g., nodding).

 

  • Do maintain consistent, not constant or darting, eye contact (look directly at the person for brief periods of 3-6 seconds, then look away briefly before reconnecting).

 

Second, it is important to use verbal skills that encourage the speaker to continue.

 

  • Do not change the topic or ask questions that are off-topic. This may seem like a way to decrease your anxiety or make the other person more comfortable, but it often has the opposite effect.

 

  • Do allow silence and convey that you are listening by using encouraging words like “hmmm” and “uh-huh” periodically.

 

  • Do state/name/reflect back the emotion being described.  It might also help you to imagine yourself in the speaker’s place and look at the situation from his/her perspective.

Examples:

“Wow – sounds like it was scary for you.” 

“It seems like you feel really sad about that.”

“I feel like that must’ve made you angry.”

 

  • Do ask questions if you are confused, and try to ask questions that require more than one word.

Instead of:

“Was that scary?” 

“Do you mean it wasn’t that bad?”

 

Ask questions like:

“Could you tell me a little bit more about that?” 

“What was that like for you?” 

“What do you mean when you say ____?”

 

Third, it is important to use words in a way that convey support. 

 

  • Do not reassure the person in a way that might minimize their experience

Examples:

“That happened so long ago, maybe it would help to try move on.”

“It’s not worth the energy to keep thinking about it.”

“Don’t be scared.”

 

  • Do not make judgments or evaluations about their responses or decisions

Examples:

“Couldn’t you do/say ______ instead?”

“I don’t think you should worry about it anymore.”

“I think it’d be better for you to _____.”

“Why don’t you ____?”

 

  • Do validate the person’s emotions in a genuine tone

(Examples: “If that happened to me, I can imagine I’d feel really overwhelmed too.”  “Given that experience, it makes sense you’d feel/say/do ________.”  “I think many people with that experience would have felt similarly.”)

 

  • Do point out the person’s strengths

Examples:

“I’m amazed at how much courage that took.” 

“You’ve done a great job at keeping everything in perspective.” 

“I really admire your strength.” 

“I’m impressed with how you’ve dealt with this.”

 

  • Do focus on their experience rather than your own and only give advice when it is requested.

 

When family and friends listen with respect and compassion they can help survivors on their paths to healing. To receive confidential support following a sexual assault, please contact the RAINN Sexual Assault Hotline at 1-800-656-HOPE (4673).

 

Biography:

 

Jennifer J. Freyd, PhD, is a Professor of Psychology at the University of Oregon. She received her PhD in Psychology from Stanford University. Freyd directs a laboratory investigating the impact of interpersonal and institutional trauma on mental and physical health, behavior, and society. The author or coauthor of 200 articles, Freyd is also the author of the Harvard Press award-winning book Betrayal Trauma: The Logic of Forgetting Childhood Abuse. Her book Blind to Betrayal, co-authored with Pamela J. Birrell, was published in 2013, with seven additional translations. In 2014, Freyd was invited two times to the U.S. White House due to her research on sexual assault and institutional betrayal. Freyd has received numerous awards including being named a John Simon Guggenheim Fellow and an Erskine Fellow at The University of Canterbury in New Zealand, and a Fellow of the American Psychological Association and the American Association for the Advancement of Science. In April 2016, Freyd was awarded the Lifetime Achievement Award from the International Society for the Study of Trauma & Dissociation.  Freyd currently serves as the Editor of The Journal of Trauma & Dissociation. You can follow Dr. Freyd on Twitter at @jjforegon.

 

References:

 

¹For example, Ullman, S. E., & Peter-Hagene, L. (2014). Social reactions to sexual assault disclosure, coping, perceived control, and PTSD symptoms in sexual assault victims. J. Community Psychology, 42: 495-508. doi: 10.1002/jcop.21624. Also these suggestions are drawn from Freyd & Birrell (2013), Blind to Betrayal.

²These instructions were used in a study by: Foynes, M.M., & Freyd, J.J. (2011). The impact of skills training on responses to the disclosure of mistreatment. Psychology of Violence, 1, 66-77. The particular wording of these instructions was designed to match a control condition in our study. (See http://dynamic.uoregon.edu/jjf/disclosure for the specific experimental and control materials).

 


Filed under: Human Rights and Social Justice, Violence Tagged: discrimination, gender discrimination, harassment, sexual assault, sexual harassment, supporting victims, violence against women