Diversity Based Psychology: What Practitioners and Trainers Need to Know

Diversity Based

This document was found in the public domain here.

Dr. Robert Gordon's Comment on DSM

Recently, Dr. Robert Gordon posted a comment on the Pennsylvania Psychological Association's listserv about the upcoming DSM-5 revision.

I have been writing to the DSM 5 committee my suggestions and concerns. However, I do not like the DSM. I use a combination of the ICD and PDM. The DSM is American psychiatry's political motive to put mental health care under their umbrella.

As I commonly state in court, "The DSM is a product of a particular guild and it has no legal or scientific authority. My diagnostic opinion is based on the best available research."

 Yet, in over 100 years, the American Psychological Association has not been able to do better. We argue a lot among ourselves, but we have failed to produce a diagnostic system that is better than the DSM.

The international psychodynamic community produced the excellent Psychodynamic Diagnostic Manual (PDM 2006).

WHY A NEW DIAGNOSTIC MANUAL?

Robert Gordon, PhD ABPP

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is the first psychological diagnostic classification system that considers the whole person in various stages of development. A task force of five major psychoanalytic organizations and leading researchers, under the guidance of Stanley I. Greenspan, Nancy McWilliams, and Robert Wallerstein came together to develop the PDM. The resulting nosology goes from the deep structural foundation of personality to the surface symptoms that include the integration of behavioral, emotional, cognitive, and social functioning.

The PDM improves on the existing diagnostic systems by considering the full range of mental functioning. In addition to culling years of psychoanalytic studies of etiology and pathogenesis, the PDM relies on research in neuroscience, treatment outcome, infant and child development, and personality assessment.

The PDM does not look at symptom patterns described in isolation, as do the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM). Research on brain development and the maturation of mental processes suggests that patterns of behavioral, emotional, cognitive, and social functioning involve many areas working together rather than in isolation. Although it is based on psychodynamic theory and supporting research, the PDM is not doctrinaire in its presentation. It may be used in conjunction with the ICD or DSM. The PDM Task Force made an effort to use language that is accessible to all the schools of psychology. It was developed to be particularly useful in case formulation that could improve the effectiveness of any psychological intervention.

The PDM has received very favorable reviews from mostly the psychoanalytic community (Clemens, 2007; Ekstrom, 2007; Migone, 2006; and Silvio, 2007).  However, even non-psychodynamic psychologists that were introduced to the PDM as part of MMPI-2 and ethics/risk management workshops had a positive reaction to the new diagnostic system.  Ninety percent of 192 psychologists surveyed (65 Psychodynamic, 76 CBT and 51 Family Systems, Humanistic/Existential, Eclectic with no primary preference) rated the PDM as favorable to very favorable (Gordon, 2008).

The entire article is here.

    

Integrating Spirituality and Psychotherapy: Ethical Issues and Principles to Consider

Ethics Psy Spirit


This commentary can be found in the public domain here.

Patient Participation in Medical and Social Decisions in Alzheimer's Disease

By Johannes Hamann, MD; Katharina Bronner; Julia Margull; Rosmarie Mendel, PhD; Janine Diehl-Schmid, MD; Markus Bühner, PhD; Reinhold Klein, MD; Antonius Schneider, MD; Alexander Kurz, MD; Robert Perneczky, MD

From Journal of the American Geriatrics Society

The participation of patients in healthcare-related decisions is an ethical imperative that patient organizations and treatment guidelines promote. The mental health guidelines for most major psychiatric disorders, such as depression or schizophrenia, strongly recommend the inclusion of patients in all healthcare decisions,^{[1, 2]} but Alzheimer's disease (AD) is an exception in this regard; although guidelines emphasize the disclosure of diagnosis and stress patient independence as a major aim, they consider impaired decisional capacity to be a limiting factor for patient participation at the same time.^[3] Although AD is characterized by a cognitive decline that impairs the participation in medical decision-making,^{[4, 5]} decisional capacity for important medical and social decisions might still be intact in patients in the early clinical stages of AD.^[6] Important medical and social decisions that need to be made in these early stages are the introduction of an advance directive, a decision about driving, the initiation of antidementia treatment, and participation in clinical trials. Preventing patients from participating in these decisions not only reduces patient autonomy, but also risks ignoring the patients' will while they are still capable of making decisions, which might result in postponed decisions until decisional capacity has been lost.

The entire study can be found here.  In order to access the study, the reader needs to be registered with Medscape.  Registration is free.

Facebook aims to help prevent suicide

By BROOKE DONALD
The Associated Press

A program launching Tuesday (December 13, 2011) enables users to instantly connect with a crisis counselor through Facebook's "chat" messaging system.

The service is the latest tool from Facebook aimed at improving safety on its site, which has more than 800 million users. Earlier this year, Facebook announced changes to how users report bullying, offensive content and fake profiles.

"One of the big goals here is to get the person in distress into the right help as soon as possible," Fred Wolens, public policy manager at Facebook, told The Associated Press.
Google and Yahoo have long provided the phone number to the National Suicide Prevention Lifeline as the first result when someone searches for "suicide" using their sites. Through email, Facebook also directed users to the hotline or encouraged friends to call law enforcement if they perceived someone was about to do harm.

The new service goes a step further by enabling an instant chat session that experts say can make all the difference with someone seeking help.

"The science shows that people experience reductions in suicidal thinking when there is quick intervention," said Lidia Bernik, associate project director of Lifeline. "We've heard from many people who say they want to talk to someone but don't want to call. Instant message is perfect for that."

How the service works is if a friend spots a suicidal thought on someone's page, he can report it to Facebook by clicking a link next to the comment. Facebook then sends an email to the person who posted the suicidal comment encouraging them to call the hotline or click on a link to begin a confidential chat.

Facebook on its own doesn't troll the site for suicidal expressions, Wolens said. Logistically it would be far too difficult with so many users and so many comments that could be misinterpreted by a computer algorithm.

"The only people who will have a really good idea of what's going on is your friends so we're encouraging them to speak up and giving them an easy and quick way to get help," Wolens said.

The entire story can be found here.

Greek woes drive up suicide rate to highest in Europe

By Helena Smith
The Guardian

Homeless man begs for money

The suicide rate in Greece has reached a pan-European record high, with experts attributing the rise to the country's economic crisis.

Painful austerity measures and a seemingly endless economic drama is exacting a deadly toll on the nation. Statistics released by the Greek ministry of health show a 40% rise in those taking their own lives between January and May this year compared to the same period in 2010.

Before the financial crisis first began to bite three years ago, Greece had the lowest suicide rate in Europe at 2.8 per 100,000 inhabitants. It now has almost double that number, the highest on the continent, despite the stigma in a nation where the Orthodox church refuses funeral rights for those who take their lives. Attempted suicides have also increased.

"It's never just one thing, but almost always debts, joblessness, the fear of being fired are cited when people phone in to say they are contemplating ending their lives," said Eleni Beikari, a psychiatrist at the non-governmental organisation, Klimaka, which runs a 24-hour suicide hotline.

Klimaka received around 10 calls a day before the crisis; it now gets more than 100 in any 24-hour period.

"Most come from women aged between 30 and 50 and men between 40 and 45 despairing over economic problems," said Beikari. "In my experience it's the men, suffering from hurt dignity and lost pride, who are most serious."

The entire story is here.

Responding to Research Wrongdoing: A User-Friendly Guide

We have added a link to our "Ethics Resources, Guides, and Guidelines" page. 

The entire guide can be found here as well.  In 2010, this guide won an award for Innovation from the Health Improvement Institute for Excellence in Human Research Protection.

The Foreword is posted to give an idea of what is in the guide.

Foreword

Every once in awhile a product comes along that is destined to make a difference. This Guide is such a product. Informed by data generated through surveys and interviews involving more than 2,000 scientists, the Guide gives voice to those researchers willing, some with eagerness and others with relief, to share their stories publicly in their own words. There are stories from scientists who want to do the right thing, but are unsure how to go about it or concerned about negative consequences for them or their junior colleagues. There are accounts from researchers who took action, and are keen to share their successful strategies with others. On the flip side, there are those who hesitated and now lament not having guidance that might have altered the course of past events.

In response to these compelling stories, the Guide adopts a problem-solving approach that looks for ways to preempt wrongdoing in research, to create options for scientists faced with suspicions or evidence of irresponsible science, and to assist researchers in working through those options in a manner that reinforces the integrity of the science without risking career or friendships. The Guide pulls no punches. While it is intended to help researchers achieve a successful resolution of what are often very messy matters, it recognizes that this may not always be possible. It is this honest assessment that will appeal to scientists looking for fair-minded and useful guidance, not pious prescriptions that bear no resemblance to the real world.

Perhaps the most encouraging aspect of the research reported in the Guide is that scientists included in the study proclaimed "overwhelming support for the concept of a researcher’s individual responsibility to intervene when suspecting wrongdoing, especially if it rises to the level of a ‘serious nature’ (94%)." Surely, there is no argument that reporting research wrongdoing and preserving the integrity of the research record will depend largely on the willingness of individuals to intervene. Recognition of one’s professional responsibility to act is a necessary step in that direction, but it is not enough. What is also needed is a good compass that points in the right direction, warns of hazardous terrain ahead, locates where support is available, and helps people assess and reason through their choices. Just as the compass greatly improved the safety and efficiency of travel dating back to the 11th century, so too will this Guide greatly help scientists navigate the challenges they encounter when taking the moral high ground.

Mark S. Frankel
Director, Scientific Freedom, Responsibility and Law Program
American Association for the Advancement of Science

Dr. Frankel served as a consultant to the authors of the Guide.

Virtue Ethics and Social Psychology

From a lecture at Ohio State University in November 2003 at the Merson Center.

The paper is available in the public domain here.

Virtue Ethics and Social Psychology

My psychoanalyst’s twisted final session

Once a legend in his field, he was clearly losing his grip. Still, why did he have such a hold on me?

By Simon Yisrael Feuerman

Published by Salon.com

It was with some trepidation that I called Dr. M.

I had read his articles in various psychoanalytic journals and heard his name tossed around at conferences and institutes. He was one of the princes of psychoanalysis and supervision, a member of the old school. He knew people who had been analyzed by Freud and was a colleague of some of the last century’s bad/good boys of psychoanalysis – Hyman Spotnitz, Lou Ormont, Ethel Clevans, Phyllis Meadow.

Nineteen years I had been with a previous analyst and supervisor with whom I had an irreparable break. Nineteen years may sound like a long time for most people, but in the rarefied world of New York psychoanalysis, 19 years is merely a beginning.

Finally, I had made the phone call. And now I was at Dr. M’s Upper West Side office for my interview. I had built a practice that was already sizable, but would I rate for his famous supervision group?

I had arrived about 10 minutes early and expected to read in the waiting room until the appointed hour. By tradition, an analyst will open his door precisely at the right time, neither early nor late.

To my surprise, he came out 10 minutes before our appointment time. Anticipating a silent rebuke I quickly said, “I apologize for coming early.”

“I apologize for seeing you early,” he said. “Come in.”

He had a shock of white hair. He was handsome. Looking at him in that dimly lit hallway in the late spring of 2009, I was taken aback. Why, he must be 90 years old, at least. (He was 89.) His body sent my body a message: I am dying. But at the very same time the vigor in his booming voice said something else entirely. It took hold of me. I was confused: While on the one hand he looked as though he might be nearing the end of his life — the office was dusty, his pants were hiked up too high, subtle but telltale signs of a man losing touch — his voice said, “Beginnings!” New life.

He talked, I talked. I talked, he talked. We had a rhythm. He seemed to be building an enthusiastic lather about having me as his newborn as though he were a man of 30 being given a baby to hold outside the delivery room. There was, you could say, a kind of love in the air.

And it made me somewhat uneasy. In fact, I was quite certain that I had made a mistake. I wanted to run away fast. I did not want to be in this man’s group. Perhaps I feared that I would have to face his death and my own here. I wanted to go to a group that promised me everlasting life. I did not want a dying analyst. I was looking for potency, vitality, virility. I had quite a bit myself, but sought it in others too.

As if magically sensing my turmoil, he stood up. “Enough for today,” he barked. “I would like you to join my group, but say in about nine months. Not before.”

I was astonished. Was he a master, I thought, one of these wonder-worker analysts who can read the mind and even ride like a bronco, two wildly opposing winds of thought in a man? Such things were possible in my world. I had great faith in analysts and their mad magic, their alchemy, their abilities to turn lead into gold and ambivalence and even death into life.

The rest of this interesting story is here.