Nancy Schlossberg: On Aging Gracefully

This is the latest in a series of interviews with APA Books authors. Here Andrew Gifford, Development Editor at APA Books, interviews Nancy Schlossberg, a well-known authority on aging and life after retirement.  Nancy will be speaking at Politics and Prose bookstore in Washington, DC (5015 Connecticut Ave NW), this Sunday, April 23, at 1:00pm to kick off the release of her new book, Too Young to Be Old: Love, Learn, Work, and Play as You Age. See more about the event here!

Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.

--Photo by Rod Millington

–Photo by Rod Millington

Nancy K. Schlossberg is an expert in the areas of adult transitions, retirement, career development, adults as learners, and intergenerational relationships. Past President of the National Career Development Association, Co-President of a consulting group TransitionWorks, she is a Professor Emerita, Department of Counseling and Personnel Services, College of Education at the University of Maryland.

Dr. Schlossberg has delivered more than 100 keynote addresses, and has been quoted in the cover story in USA Today, the New York Times, Wall Street Journal, Sarasota Herald Tribune, Reader’s Digest, Family Circle, Better Homes and Gardens, U.S. News and World, Consumer Reports.  She has appeared on PBS In the Prime, Derek McGinty’s national talk radio show, CBS This Morning, CBS evening news and is featured in a 90-minute PBS Pledge Special June, 2007, “Retire Smart, Retire Happy.”

AG: In many ways, your latest book feels like part of an unofficial trilogy, starting with the smash hit Retire Smart, Retire Happy which provided a primer on how to adjust to retirement. It was followed by Revitalizing Retirement, which discussed how retirees could reshape their identity and play a vital role in their community.  Too Young to Be Old takes the lessons from the first two books and really emphasizes the idea that retirement is not an ending but a beginning. In it, you discuss relationships, finding your place, embracing adventure, and aging well. Could you tell us a little bit about your own experiences as an author, a psychologist, and a retiree who, herself, is aging very well throughout the process of writing these three books? Do you also see something of a “trilogy” here?

NS: I had not thought of the three books as a trilogy but now that I think about it, each book was an outgrowth of the other. So maybe it is a trilogy. It started with Retire Smart, Retire Happy. I had thought retirement would be a piece of cake. After all, I was an “expert” on transitions and had retired voluntarily. However, retirement for me posed unexpected challenges so I decided to learn how others fared. The result was Retire Smart, Retire Happy. That book became the centerpiece of a PBS special by the same name.

I had many opportunities to continue interviewing and learning about retirement. I realized there was another book which described the paths people follow and the need to strengthen their psychological portfolios. The result was Revitalizing Retirement. This book elaborated on what I had learned in Retire Smart, Retire Happy.

I then became involved in a number of aging projects including writing a transition column for a local magazine. Over time, I realized there was one more—the last—book to focus on aging. This new book broadened my concerns to cover more than retirement. And thus Too Young to be Old was born.

AG: Much of the inspiration for your writing on retirement and aging comes not just from your own experiences, but from the people you’ve worked with in your daily life. Especially after the first book came out, you’ve been engaged by fans and concerned retirees who have come to you with questions about what is often a difficult life transition. What are some of the encounters that have had the most impact on your philosophy and your writing?

NS: Perhaps the most important factor was my own transitions. I found the decade of my eighties filled with transitions—I retired, I became a caregiver, then a widow. I had several surgeries and orthopedic issues. I recovered, began dating and actually went on line, met a retired lawyer, and we now live together. We then moved to a retirement community.

All these transitions make the image of someone in a rocking chair fade.

In addition, many who read my columns reached out saying how they were helped. That made me realize I wanted to keep writing and sharing mine and others experiences.

AG: When Retire Smart, Retire Happy first came out, it coincided with your own decision to retire after nearly three decades teaching counseling psychology at the University of Maryland.  When did you start thinking about ways to retire and age well? Had this been on your mind even in your youth? Or was it your own life transition that spoke to you?

When I was in my late sixties, I went to a retirement party for a much older woman. She was still productive and dynamic. By accident, I left the party walking with two deans. One said, “She should have retired years ago. She is too old to teach and advise.” Right then and there, I knew I would leave before anyone said that about me. And thus began the process of disentangling first from teaching, then advising. My husband and I decided to move to Sarasota where we used to vacation. Since retiring, I have written 4 books and become active in the community. This year will be the first time I have not had a book contract since 1984. So now I will really be retired. I am a bit anxious about it. It is time to reread my own retirement books!

AG: What advice do you give retirees and the soon-to-be-retired about handling this difficult transition?

NS: If someone is struggling to figure out a new path, think about regrets. Is there anything the person wishes he or she had done? If so, is there any way to turn the regret into a plan? That can get someone thinking about a new dream, a new plan.

too young to be oldAG: Too Young to be Old is the first of your titles to really delve into the issue of ageism. America, certainly, is an aging nation. The number of Americans age 55 and older will increase dramatically between now and 2030 – from 60 million today (21 percent of the total US population) to 107.6 million (31 percent of the population) – as the baby boomers reach retirement age.   You’ve written these three books over the course of a decade. What changes have you seen in that time? Is ageism on the rise or the decline? How can individuals embrace aging, and combat ageism?

NS: Ageism is all around us. Even those who are demographically in the old or old-old group exhibit age bias. As the president of AARP wrote, we need to “disrupt aging.” The first step is to be honest about our own ageism, then confront others when they make derogatory comments like, “I live in an old person’s home,” “I just had a senior moment,” “Look at that old lady,” etc.

AG: Do you have some advice on how the children and grandchildren of retirees can help their elders age well and embrace life and happiness after the retirement transition?

NS: Family is very important to most older individuals. So it is important to stay connected. Many of the people I interviewed for Too Young to be Old resented their adult children “bossing” them. Therefore, give the benefit of the doubt to older individuals, give them as much freedom as possible, show respect and help them maintain their dignity.

AG: What is the best thing about aging?

NS: I love the freedom of being 87. I say my age with pride. I never expected to live this long and continue publishing. I like my white hair but must admit the wrinkles surprise and dismay me when I look in the mirror. It is important to remember George Vaillant’s advice–stay young at heart by learning something new, trying something different, and embracing the time you have to spend with family.

A Conversation With Russell A. Barkley, PhD, About Adult ADHD 

 

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Russell A. Barkley, Ph.D., is a Clinical Professor of Psychiatry at the Virginia Treatment Center for Children and Virginia Commonwealth University Medical Center. He holds a Diplomate (board certification) in three specialties: Clinical Psychology, Clinical Child and Adolescent Psychology, and Clinical Neuropsychology.  Dr. Barkley is a clinical scientist, educator, and practitioner whose publications include 22 books, rating scales, and clinical manuals, 7 award-winning DVDs, and more than 260 scientific articles and book chapters related to the nature, assessment, and treatment of ADHD and related disorders.  He is also the founder and Editor of the clinical newsletter, The ADHD Report, now in its 24th year of publication.  Dr. Barkley has presented more than 800 invited addresses internationally and appeared on nationally televised programs such as 60 Minutes, the Today Show, Good Morning America, CBS Sunday Morning, CNN, and many other television and radio programs to disseminate the science about ADHD.  He has received awards from the American Psychological Association, American Academy of Pediatrics, American Board of Professional Psychology, Association for the Advancement of Applied and Preventive Psychology, the Wisconsin Psychological Association, and Children and Adults with ADHD (CHADD) for his career accomplishments, contributions to ADHD research and clinical practice, and for the dissemination of science about ADHD.  His websites are www.russellbarkley.org and ADHDLectures.com. 

shh_headshot-smallBy Susan Herman

Did you know that adults can have ADHD? It’s true—ADHD is not confined to children and teens.

The trademarks of Attention Deficit Hyperactivity Disorder (ADHD) are inattention, combined (for some) with hyperactivity and/or impulsive behaviors. According to the National Institutes of Mental Health, some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors are more severe, occur more often, and interfere with or reduce the quality of how they function socially, at school, or in a job…Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed.

Professor, researcher, and clinician Russell A. Barkley recently published a self-help book with APA LifeTools for family members of adults with ADHD, titled When an Adult You Love Has ADHD: Professional Advice for Parents, Partners, and Siblings. You can find more information about the book and purchase it here.

I recently interviewed Dr. Barkley about his work with adults who have ADHD, and how loved ones in their inner circle can support them.

How recently was adult ADHD recognized? 

A German-language textbook published in 1775 has a remarkably accurate description of what we now call ADHD in adults. But, aside from very periodic mentions in the literature—as “minimal brain dysfunction” in the 1950s, and as “hyperkinetic reaction” or “hyperkinetic disorder” in the 1960s—neither the public nor the research community much recognized it. It wasn’t until the 1970s that a series of longitudinal studies was conducted to find out whether ADHD continued beyond childhood. Interest in this picked up throughout the 1980s and 1990s as it was found that half to two-thirds of kids who were diagnosed with ADHD continued to have symptoms into their twenties. This was the first real evidence base that began to show us how ADHD, like mental retardation, dyslexia, and autism, can continue into adulthood.

What would you say has been your greatest contribution to the field of adult ADHD?

In 1991 I started an adult ADHD research clinic at University of Massachusetts Medical School, and the same year my psychiatrist colleague Joe Biederman started one at Massachusetts General Hospital in Boston. We were collecting data on a variety of domains of impairment and symptoms on these adults to see if it was equivalent to the childhood form of the disorder – it clearly was.  Later, Alan Zametkin and colleagues at the NIMH did the first PET scan study showing brain related deficits in functioning in adults with ADHD.  Other studies on never-before-diagnosed adults were done to learn whether they responded to the same types of drugs that children were being given for ADHD.  Results showed that they did so.

In 2008 I published a monograph where I compared results of my own 20-year longitudinal studies on children with ADHD followed to an average age of 27.  Drs. Kevin Murphy and Mariellen Fischer and I compared them with adults diagnosed with ADHD alongside data I’d been collecting in the

clinic from adults who were not diagnosed as ADHD. This was the first time anyone had compared the two groups directly (children with ADHD grown up vs. adults diagnosed with ADHD). The monograph was massive, but I chose that format over journals because with journal articles you have page limitations and you have to peel off tiny bits of your research and present it over multiple, disparate articles. Instead I presented it all at once, and this allowed adult ADHD to really hit the research map. Others followed up my work with various methods of neuroimaging to show differences in brain activity for adults with ADHD.

Why did you decide to focus on parents, siblings, and partners of people with ADHD in your latest book?

Ever since I wrote a self-help book for adults who have ADHD, called Taking Charge of Adult ADHD (in 2010), I’d been wanting to write one for the family members who support them. At the time there was no science-based trade book available for loved ones of people with ADHD. Also, ADHD is in my family. I had been trying to help various of my own family members, get them treatment and offer a safety net, so I knew there were others out there also feeling frustrated after picking up and dusting off their loved one again and again.

I was ready to write the book when my twin brother died. He had ADHD, and I know that it indirectly contributed to his death. He was driving 40 miles per hour on a country road in the Adirondacks. He never wore a seatbelt, and he had a habit of going too fast and drinking while driving. He ran off the road and was killed. I put the book aside while I was grieving him. Not long after my sister, who had physical disabilities, also died. And about three years after that, my deceased brother’s son, who also had ADHD, hanged himself.  So I just “couldn’t go there” for a while due to all this grieving.

Finally, in 2015 the time was right. Several books on how ADHD affects marriage had appeared by that time. Writing about how to love someone with ADHD was cathartic for me. I feared that re-living events would make me feel worse, but actually I felt better.

Thank you for sharing that personal story. I’m glad you decided to include some of it in the book, too. 

adult-adhdLet’s back up a bit and talk about how ADHD can affect adults who have it. Also, how many adults have ADHD—how common is it in the population?

Four to five percent of adults in the USA have ADHD. The percentage is closer to 3-4% worldwide. It’s higher in Western countries because of longer life expectancy and better access to care. In children the ratio of boys to girls with ADHD is three to one; for adults there’s less of a split; it’s closer to 1.4 to 1 male to female. It’s been great seeing more women come out of the woodwork to talk about ADHD. I recently consulted on articles in Elle, Glamour, and Cosmopolitan magazines about adult ADHD.

ADHD is genetic in about two thirds of all cases; in about one third it is acquired either prenatally or after birth because of head trauma or environmental conditions that affect the brain’s frontal lobe development.

Adults who have ADHD typically achieve a lower level of education than they are capable of, and they have problems in the workplace with boring tasks that require sustained attention. Adults with ADHD tend to do well in non-traditional careers, often those that involve performing, music, athletics, police work, and the military. There are people with ADHD in law and medicine, but fewer than you’ll find in the more physically active careers.

Money management is a challenge for many people who have ADHD, as is driving. Adults with ADHD are 2-3 times more likely to be dead by age 46 from accidental injuries, many of which involve driving. About one third of adults with ADHD exhibit antisocial behavior and may even get involved with crime.

New research areas in adult ADHD include risky sexual behavior, along with marriage and parenting problems. ADHD is really one of the most impairing outpatient disorders there is—I would venture to say it’s even more impairing than depression—because it affects so many diverse areas of life. Clinical care and family counseling for adult ADHD exists and is increasingly available but is far from where it needs to be. As of ten years ago, only about one in ten adults with ADHD was diagnosed. The percentage is better now but there is still much progress to be made.

What do family members and partners need to understand about ADHD to best support their loved one who has it?

It’s important to adopt a biologically-based view of ADHD. ADHD is a neuro-genetic disorder. You can’t attribute your loved one’s behaviors to personality quirks, defective morality, laziness, or poor lifestyle choices or say they deserve whatever they get. You can’t be a good support person if you keep thinking, “My loved one could change if they wanted to, but they don’t want to.” People in the inner circle are their loved one’s best safety net and closest influence, but they can’t step up as stakeholders if they don’t adopt a more compassionate outlook about ADHD.

What kinds of support can family members provide to an adult who has ADHD? 

In my clinical work I walk through six steps with adults who have ADHD and their families. Step One is to get a thorough mental health evaluation to document not only ADHD, but any other disorders that the person might also have. Eighty percent of adults with ADHD have an additional disorder, and about half have two additional disorders. These might be anxiety, depression, a learning disability, bipolar, or something else. Detecting secondary disorders affects the course of ADHD treatment. Psychologists, psychiatrists, and behavioral neurologists can diagnose ADHD.

So the support person might offer to set up various appointments for their loved one and help them follow through getting to the specialist’s office.

Yes.

Step Two is to help the patient “own” their ADHD as a part of their identity. It’s easier to accept a diagnosis intellectually than it is to incorporate it as a part of your own view of yourself. Treatment will be superficial if the person doesn’t accept ADHD as a part of their self-view. When the patient starts to grieve their old self-image, that’s when we know we are getting through. Accepting the new you is also a positive thing because it means you’re giving up the old view of yourself as stupid, lazy, or immoral.

Step Three is to read widely and educate yourself about ADHD. I like to say that “truth is an assembled thing.” You can’t just depend on one source for all your information. Jeff Copper’s podcast, Attention Talk Radio, is a great resource, and I offer many more in the book. Think about it: if you’re diabetic, you have to understand how diet plays into your condition, and hygiene [for blood tests and insulin monitoring], and a host of other things. Because ADHD is a chronic disease I sometimes refer to it as the diabetes of psychiatric conditions.

Step Four is to get on medication. Medication is the best treatment for ADHD. And I’m saying this as a psychologist—there is no longer any “us versus them” going on between psychologists [who typically do not prescribe medication] and psychiatrists when it comes to ADHD treatment. Medication is two to three times more effective than behavioral methods alone for treating ADHD. Most adults with ADHD, 80-90%, need medication as part of the treatment package. Family members can help their loved one remember to take their ADHD medication regularly.

Step Five is behavior modification. Cognitive behavioral therapy (CBT) boosts the benefits of ADHD medication for self-control and executive functioning. Outside of formal therapy, there’s a lot family members can do to encourage their loved one to adopt exercise routines and other healthy habits. Often times people with ADHD need to get additional treatment to cut back or eliminate their use of alcohol, tobacco, and marijuana.

Step Six is accommodation. This means altering the environment so the person with ADHD is more likely to succeed. It might mean dedicating one computer for work only and another one for games and social networking. Family members can help their loved one find and download software that blocks distracting content. At home and on the job, adults with ADHD can advocate for themselves by finding support people to keep them accountable for changes they want to make and goals they want to accomplish.

A new type of accommodation that’s becoming more popular is called ADHD coaching. An ADHD coach makes daily contact via text or other channels to help the person stay organized, cope with frustration, and/or work through social problems. The field of ADHD coaching is still developing and is beginning to police itself. Some people are coming to ADHD coaching from financial planning or life coaching and are not currently held to a specific standard of knowledge or experience within psychology or behavior modification. I expect within five years certification requirements and accreditation for ADHD coaching will be in place.

 

Note: The opinions expressed in this interview are those of the author and should not be taken to represent the official views or policies of the American Psychological Association.

 

Shari Miles-Cohen & Caroline Signore: On Women With Disabilities

This is the latest in a series of interviews with APA Books authors. In this interview, Tyler Aune, Editorial Supervisor at APA Books, spoke with Shari Miles-Cohen PhD, Senior Director of the Women’s Programs Office at the American Psychological Association, and Caroline Signore, MD, MPH, a board-certified obstetrician-gynecologist and a fellow of the American College of Obstetricians and Gynecologists (ACOG).  Their book, Eliminating Inequities for Women with Disabilities: An Agenda for Health and Wellness was recently released by APA Books.   

Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.

 

 

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Shari E. Miles-Cohen, PhD, is Senior Director, Women’s Programs Office (WPO) at the American Psychological Association (APA).  Dr. Miles-Cohen has received funding from the National Science Foundation and the US Department of Health and Human Services, Office of Women Health to explore the educational needs and health care needs of women with disabilities. Prior to joining APA, she served in leadership positions with university-based and independent non-profit organizations working to improve the lives of women and girls, including the African American Women’s Institute, the Society for the Psychological Study of Social Issues, and the Women’s Research and Education Institute. Dr. Miles-Cohen holds a Bachelor of Arts from the University of Colorado at Boulder, and a Master of Science and a Doctor of Philosophy in Personality Psychology from Howard University.

 

Caroline Signore

Caroline Signore, MD, MPH, is a board-certified obstetrician-gynecologist, and a Fellow of the American College of Obstetricians and Gynecologists (ACOG).  Her interest in the reproductive health care needs of women with disabilities arose in 1996, when, shortly after completing her residency training, she sustained a traumatic cervical spinal cord injury. Since then, she has delivered a number of presentations on reproductive health and wellness in women with disabilities, served as a guest reviewer for a handbook on health for women with disabilities in developing countries, and authored chapters for women’s health textbooks. From 2004 to 2009, Dr. Signore served as an Advisory Board member to an American College of Obstetricians and Gynecologists committee to produce resources to assist ACOG members with providing quality reproductive health care to women with disabilities.

What’s great about your book is that you don’t just describe the problem: You also lay out a very detailed agenda for reform, with specific information about what needs to change, and where. And I was really struck by how hopeful the language in that chapter is.  Did you feel hopeful all the way through this project?

Shari: I think we’re both hopeful people by nature, so that helps.  But I also think, if I can name the problem, I can solve the problem.  We may need a lot of people, we may need a lot of money, but there is a solution out there for almost everything.  And for me, the solution is trying to meld the behavioral and physical health structures to better serve women with disabilities.

Caroline: Well, sometimes I didn’t think this book would ever get finished!  But that aside, I agree with Shari, we are hopeful people, and I also believe that if you name the problem you can start to fix it.  We realistically know nothing’s going to change overnight, but there are incremental steps, and this book will serve a guide for people who may be drawn into the field, or who are already here, doing the work that needs to be done.

Shari: I feel like I learned a lot, coming to these issues from a psychologist’s background.  I have a better understanding now of physicians and what they need, and how they think, and what challenges they may have with integrated care.  Because you lose a little bit of autonomy when you start to share, and that can be challenging for people from different disciplines.  And so that was really helpful, because it’s much easier to communicate that path forward when you have a better sense of what the other people who will be part of the team are thinking.

Caroline: I have to say I came into the project not understanding what integrated care is, and Shari has been a patient teacher.  But the more I understood it, the more I thought: This makes so much sense! Why are we so siloed?  Integrated care is especially important for underserved populations, who could really use extra care and guidance.  Particularly in areas like biopsychosocial models of care that aren’t taught in medical school, that physicians may feel poorly equipped to handle on their own.  I’m hopeful that this book can educate physicians about how to provide better care to women with disabilities.

 

Shirley Chisolm, the first black female member of the U.S. congress, said that she faced more obstacles in her life because of her gender than her race. At the risk of oversimplifying a very complex issue, do you think women with disabilities face more discrimination because of their gender, or because of their disability?

Caroline: Without question, in the health care setting, especially in the reproductive health care setting, women with disabilities feel a-gendered. They feel that their caregivers don’t think of them as women.  And that’s very troubling, for them and for me.  Not only are there physical barriers to actually getting to a doctor’s office.  But to not get information, or careful, complete care [in reproductive and sexual health] because of an assumption on the part of the caregiver that’s wrong, is really galling.

Shari: It’s hard for me to separate the gender and the disability, or the gender and the race. A woman with a disability is intact, a gestalt; she is one person.  It’s all in there together, and you can’t really separate them out.  You have to work hard to separate them.  In some ways, physicians and psychologists and others are working against human nature when they a-gender a person coming into the office.

 

So it takes effort to discriminate. I never thought about it that way before.

 Shari: I think it does, yeah.  You have to work at it, right?  I think you have to work hard to see people in that way.

 

Research shows that women with disabilities who live in poverty and particularly in rural areas are at especially high risk for poor outcomes. And these are outcomes that may be difficult to change, given that many of the accommodations you describe in this book will be made to medical facilities that are far away from where they live.  What can we do for these people? 

Caroline: Telehealth is really promising.  Today you can FaceTime with most anybody, almost everybody has a smartphone now.  And even in rural areas, if you can’t physically go to the physician’s office—heck, I’d rather FaceTime with my doctor than actually have to go to his office, it’s just so much easier.  I have high hopes for the incorporation of telemedicine into care in general, and especially care for people who have

difficulty traveling—not just women with disabilities, all people with disabilities, geriatric populations; there’s a lot of care we can give without actually putting two people physically in front of each other.

Shari: Along with technology, infrastructure also has to change.  The smartphone and the monitor are important, but so are the wires and conduits running to rural communities.  So is educating doctors (and psychologists) that it’s a good thing to do, and educating patients that they can still get good care via telehealth.  But all of that’s doable, it just takes education.  We need to educate policymakers here [in Washington], and in the States, using the State Psychological Associations and State Medical Associations to get them engaged in the conversation.

 

Making people aware of the urgent challenges that this population faces, as you’ve done in this book, is obviously enormously beneficial. What are the next steps? 

Shari: We’re seeing women with disabilities across the country who are really engaged in making change.  The book can help give them have a better sense of what the entire map looks like, and how they can be most strategically engaged.  Because one of the things that Caroline and I talk a lot about is, how do you change the ways that physicians and psychologists are educated?  It’s all about teaching hours.  Well, how do you get a school to dedicate teaching hours to the issues women with disabilities face?  One way is that you change the standards: What’s gonna be on the board exam, right?  So how do you get that done?  There are all these steps.  In addition to public education efforts which bring  attention to the issue, raising visibility, there are other complementary activities, such as professional development, research, and policy efforts, which we discuss at some length in the book’s recommendations section, that together can help to bring about change.

Caroline: This is not a completely ignored issue.  But it is underrecognized.  And understudied.  It isn’t just a matter of psychological care or medical care.  It is also a matter of civil rights, and politics, and policy, and that makes it a little more complex.  We must have patience, as each person tries to get the word out.  My hope is that our work will be viewed as a standard textbook for disabilities studies.  I would love to see it in medical schools, nursing schools, psychology classes, graduate education.  The more people know about it, the more we can get done.

 

 

 

 

 

 

 

Anneliese Singh and lore dickey: On Trans-Affirmative Counseling and Psychological Practice

This is the latest in a series of interviews with APA Books authors. For this interview, David Becker, an APA Books Development Editor, talked with Anneliese Singh of the University of Georgia and lore dickey of Northern Arizona University.

Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.

Anneliese Singh

Anneliese A. Singh, PhD, is an Associate Professor at the University of Georgia and co-founder of the Georgia Safe Schools Coalition and Trans Resilience Project. Her work is centered on studying and strengthening the resilience of TGNC people, particularly TGNC youth and people of color.

 

lore dickey

lore m. dickey, PhD, is an Assistant Professor and Doctoral Training Director in the Department of Educational Psychology at Northern Arizona University. His research focuses on understanding the transgender experience, which includes studying sexual identity development and nonsuicidal self-injury.

 

Together, Drs. Singh and dickey cochaired the APA task force that developed the Guidelines for Psychological Practice With Transgender and Gender Nonconforming People. The goal of these guidelines is to enhance psychologists’ cultural competence and help them provide trans-affirmative care, which is characterized by awareness, respect, and support of TGNC people’s identities and life experiences. Their latest book, Affirmative Counseling and Psychological Practice With Transgender and Gender Nonconforming Clients, expands on those guidelines, offering helpful advice and strategies for providing trans-affirmative care to TGNC clients.

 

What is affirmative counseling and psychological practice with transgender and gender nonconforming (TGNC) clients? How does it differ from other common approaches with these populations?

Anneliese: This is a great question that often comes up for mental health practitioners. They may want to do the “right thing” when working with trans people, but are not quite sure how to do that—so lore and I defined affirming transgender counseling and psychological practice in the Introduction to our book as practice that is culturally relevant and responsive to TGNC clients and their multiple social identities, addresses the influence of social inequities on the lives of TGNC clients, enhances TGNC client resilience and coping, advocates to reduce systemic barriers to TGNC mental and physical health, and leverages TGNC client strengths. (Singh & dickey, 2017, p. 4)

We wanted to define it so that the roles of psychologists involve being social change agents who make sure the settings and societies in which they work are trans-affirmative, as well as emphasizing the importance of supporting the development of trans resilience and affirming all the social identities that trans people have (e.g., race/ethnicity, class, disability, spirituality/religion).

What are the most common errors that mental health practitioners make, or misconceptions they might have, when working with TGNC clients?

lore: There are several errors that a mental health provider might make. The first is assuming that a person has a binary gender identity. The second is making the assumption that a person wants medical treatment, especially gender affirmation surgeries. Another mistake is using the wrong name or pronoun. When this happens, the provider should admit the mistake. This signals to the client that the provider realizes they used the wrong name or pronoun, and takes the pressure off of the client as they do not need to correct the provider.

Some TGNC people might be reluctant to enter into therapy for fear of being pathologized or misunderstood. What can a mental health practitioner do to create a safe and welcoming environment for an anxious TGNC client in the first session?

Anneliese: Yes—this is a very common experience trans people have due to the history that the counseling and psychological field has had of pathologizing trans identities. From diagnosis and gatekeeping (e.g., writing referral letters for hormones and requiring excessive control over the transition process) to experiencing discrimination within counseling sessions and the challenges of accessing mental healthcare (e.g., lack of insurance, finding a trans-affirmative provider), many trans people are anxious about what they may experience with a provider. Trans communities are very strong and connected, so there are often also stories of bad experiences with mental health providers that may be known within the community as well. The best thing a mental health practitioner can do is to get out into the community, participate in community events, learn from trans community organizers and activists about what is most needed in their communities and the common issues they face. The key here is to learn much as you can about how to create safe and welcoming environments.

Next, during the first client contact, explain the approach to trans-affirmative counseling you use and any other considerations a client should be aware of that you require (e.g., number of sessions). During my first contact with clients who need a letter of referral for hormones, I emphasize that my counseling approach is to assist them in accessing the care that they want, and one session is usually enough for just a letter; however, they may want to engage in more sessions to support them during their medical and social transition, and that is something we can talk about along the way. I also emphasize that my role is to advocate for them along the way, and that exploring internalized trans-negativity and multiple identities from an empowerment perspective are important aspects of how I work with clients. It is also important for me to tell clients why I am asking certain questions, instead of just gathering typical assessment data. Because the community has experienced so much trauma, this approach is critical to developing an atmosphere of trust and to build rapport. From the first contact, I also share my own

gender pronouns and name that I want people to use when referring to me. I do this with cisgender clients too.

You chose the photos that are featured on the book’s cover because they are TGNC affirming, and you have noted that media portrayals of TGNC people can often be inaccurate or pathologizing. What portrayals did you want to avoid, and why are they problematic? Are there any particularly prevalent tropes or stereotypes that you have noticed?

lore: As with most anything the media uses to tell a story, they prefer the most sensational images—that is what sells papers. The images that don’t tell the sensational stories are ones that show trans people who have ordinary lives. When the only images you see of trans people are those of White people—this is a problem. When trans woman are hypersexualized—this is a problem. When nonbinary individuals are reported to be confused about their identity—this a problem. When the only news you see about trans men are images of a pregnant person—this is a problem. We worked with a renowned photographer to find images that portray “everyday” trans people.

Both of you cochaired the task force that developed APA’s Guidelines for Psychological Practice With Transgender and Gender Nonconforming People. What was that experience like, and how did it influence your book?

Anneliese: Cochairing the APA trans guidelines was an interesting experience! It was important to make sure we added racial/ethnic and gender diversity amongst our 10-person task force, as well as having a variety of disciplines represented within counseling and psychology (e.g., practitioners, researchers). We consulted with a wonderful team of trans community organizers and activists along the way in the development of the text as well. All of these things had an influence on the text, as we wanted it to have a very intersectional and practice-based approach.

In terms of how the text differs from the guidelines, we were restricted in the guidelines development process from highlighting social justice and advocacy as much as we would have liked to do based on our own personal ways of practicing and engaging in research. Therefore, the book is very much informed by research, but it is also informed by the calls to our field that trans community organizers and activists have issued. The role of psychologists as social change agents is much more centralized in the book. We also had a wonderful group of authors—including public health and community perspectives on trans-affirmative counseling.

We hope this book de-mythologizes trans mental healthcare and makes it more accessible for mental health practitioners to get training and see how they can change the world for the better by doing trans-affirmative care.

What still needs to change in the field of psychology in order to fully address the needs of TGNC people?

 lore: This is such an important question. In no particular order: Gender Dysphoria needs to be removed from the DSM and placed in the ICD codes as a medical condition so it is not listed as a mental health diagnosis implying that gender diversity or that gender dysphoria is a disorder. Providers must be sanctioned when they engage in reparative therapy with gender nonconforming clients, and providers must be trained to work with gender diverse people.

References

Singh, A. A., & dickey, l. m. (2017). Introduction. In A. A. Singh & l. m. dickey (Eds.). Affirmative counseling and psychological practice with transgender and gender nonconforming clients (pp. 3–18). http://dx.doi.org/10.1037/14957-001

Roberta Golinkoff and Kathy Hirsh-Pasek: On Becoming Brilliant

This is the latest in a series of interviews with APA Books authors and editors. For this interview, Susan Herman, Development Editor Consultant for APA Books, talked with Roberta Golinkoff of University of Delaware and Kathy Hirsh-Pasek of Temple University and the Brookings Institution.

Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.

golinkoffRoberta Michnick Golinkoff, PhD, obtained her bachelor’s degree at Brooklyn College, her PhD at Cornell University, and was awarded a postdoctoral fellowship at the Learning Research and Development Center of the University of Pittsburgh. She is the Unidel H. Rodney Sharp Professor of Education and professor of psychology and of linguistics and cognitive science at the University of Delaware.

hirsch-pasekKathryn Hirsh-Pasek, PhD, is the Stanley and Debra Lefkowitz Distinguished Faculty Fellow in the Department of Psychology at Temple University and a senior fellow at the Brookings Institution. Her research examines the development of early language and literacy, as well as the role of play in learning. With her long-term collaborator, Roberta Michnick Golinkoff, she is the author of 12 books and hundreds of publications.

“I enjoyed working with this dynamic author team on their APA LifeTools book, Becoming Brilliant: What Science Tells Us About Raising Successful Children.  (The book has been widely discussed in academic circles and national media, and is already an Amazon bestseller.)  One of the reasons I enjoyed it so much is that I felt like the book was actually for me: a mom to two school-age kids! Also, I loved getting emails like this: “We’ll get back to you soon about the edits. We’re away at a conference now and Kathy is filming her flash mob this afternoon.” –Susan Herman

How long have the two of you been collaborating?

KHP: Roberta and I have been working together 37 years. We have lasted longer than most marriages. We would have each been good as solo scientists, but when you have a wonderful working relationship it actually feeds creativity. And I think it also feeds the product.

How did you come from developmental science, primarily working with young children, into looking at school-age children and what’s happening in K-12 education?

KHP: The book isn’t only about K-12. It really is about 0-99. If we want to prepare an educated citizenry of the future, we need to think not only about what’s going on in the schools but also what’s going on outside the schools, in the communities in which children live. If we think of education as only taking place inside the school walls, then we’re missing literally 80 percent of the waking time of children.

This book is really more about redefining education for the 21st century. It poses this central question: what counts as success? When our children grow up, what do we want of them as a society?

What I believe the 21st century answer ought to be is: we want happy, healthy, social, caring, and thinking children today, who are going to grow up to be compassionate, collaborative, critically thinking, creatively innovative, and responsible citizens of tomorrow.

What skills do you need to achieve that? You have to work backwards, reverse engineer it. The business community has been screaming for this for the better part of a decade. We want to reduce inequities and we want [education] to dovetail with the skills you need in the workplace.

Do we want to let [standardized] tests tell society what we can and cannot value? Or do we want to figure out what we value and find ways to see how children learn?

 

I saw an ad for an online learning company that says, “Each child is uniquely brilliant.” Is brilliant a buzzword now? What does it mean to be brilliant?

RG: We’re not about making people exceptional. We want to call attention to the fact that children have a vast range of capabilities, and while we’re mostly teaching content in the schools—and content is great, it’s got to be there—we must broaden what we do.

Because in this new world, it isn’t enough to be brilliant in the classic sense of getting straight A’s. Those people don’t necessarily get the jobs now. What matters for kids is to develop all the skills that will help them be better people.

For me, that’s number one—I want to create menschen. I want to create citizens who are members of their community and who play well together, who will function at a high level in their society. We want to help children get the jobs of the future.

For example, if we’re talking about how manufacturing plants are shutting down and the jobs are moving overseas, we’re not getting it—the nature of the workforce needs to change! The jobs that are going overseas are factory jobs. The jobs that are taking over in America are the high-level jobs.

We need to help our children find the jobs of the future, many of which haven’t been invented yet. We need to educate for the higher-level jobs that we are presently importing people to do because we don’t have enough people who can do them.

In your book, you conceptualize learning as consisting of six skills, the “Six C’s”: Collaboration, Communication, Content, Critical Thinking, Creative Innovation, and Confidence. How do you measure the Six Cs?

KHP: Roberta and I suggest that we can give you a profile of skills, using our Six C Grid [shown below]. What’s cool about the grid is that every one of us can look at ourselves and create a profile for ourselves on the six skills.

 

6 Cs6 Cs

Collaboration is how we learn to communicate. Content builds on communication, our ability to listen, to talk, to have a vocabulary. You’re never going to be a great reader if you don’t have good language skills. And yet we’re starting our tests with reading, not with language. You can do letter-sound correspondence until you’re blue in the face but if you can’t translate sounds into a word that you know, then all of it is moot.

We have too much information—everybody’s talking about big data. But if you can’t sift your way through, then you’re not going to be able to use the content effectively.

Creative innovation teaches you how to use that content that you just critically thought about. So you can use that information to change tomorrow.

Kids need confidence to give it a whirl. We have beaten children into just giving us right answers. The creators of the world—the Edisons, the Steve Jobs—they failed many times before they succeeded.

None of these exists in a vacuum. They build on one another to create a profile of learning.

RG: We’re not arguing that we need a new curriculum for the Six Cs. We’re taking the position that, once you’re aware of these skill sets, you can think about how the assignments you’re creating for your class are building collaboration, confidence, creativity.

Let’s talk about Confidence. One recurring conversation I have with friends who are parents starts with, “Do you let your kid…?” Ride his bike to the park alone? Set up her own YouTube account? That kind of thing. How can parents leverage risk to help their kids build confidence?

RG: The New Albany, Ohio chief of police is now advising parents not to let kids go outside on their own until they’re 16. This is crazy, but not uncommon. This sort of thing happens nowadays for two reasons. One, no one goes on the news and says, “Sally had a good day today. She walked to the library by herself!” The media focuses on the bad stuff and this is the kind of stuff that goes around [on social media].

Two, parents are more fearful. Economic shifts have been profound in recent years and have made people worry that their children will have lesser lifestyles than they did. And this makes them focus more on stuffing that content in the kid, over developing the other skills that kids need.

The way it should work is that little by little, children are given more responsibility for taking care of themselves. Doing errands is the first kind of responsibility, and your kid will want to do it because it’s a way of showing that they’re growing up. Of course, you first have to have a conversation with your kids about how to not go with strangers, and about how to use other adults to help you if someone’s bugging you.

KHP: What do you do when your kid comes home [from the errand]? He has an essay for homework. Do you allow your child to have his own voice, as long as he backs it up? Or does he stick pretty close to the book review he’s supposed to do, “This is what A says, this is what B says…” Push him a little further and say, “what’s your take?”

You encourage him to try that experiment. As long as it’s safe. I remember something my kids wanted to do—they wanted to put water in the sink and add electricity to make a lightning bolt! Other than that one, I was OK with [their experiments].

When your child comes home from soccer and says, I don’t want to do that anymore, are you the kind of person who says, “OK well we’re not going back there anymore!” The lesson, when you stay with it, is confidence.

Everything’s a risk-benefit. Some things you may not want them to take apart, like the television. But you can say “We have this old blender—why not take apart that and see how that works?” Or you can say, “there’s this guy who’s been repairing watches forever. Why not go see what he does?”

How can parents advocate for their schools to teach the Six Cs?

KHP: You can evaluate your child’s classroom based on the Six C grid. The grid becomes almost like a map for us to ask, how are we doing as parents? What do we want from our children? How are we providing opportunities to allow them to get to that goal?

RG: Each chapter in the book has a section called Taking Action where we talk about how to create environments that foster each skill, and we give very concrete suggestions. [We want] to awaken parents’ consciousness to what they need to do to help their children be good, productive people.

And we don’t need to keep it a secret from our kids. We often don’t even talk to our kids about the kinds of things we hope they will get out of school. We can tell them why we want them to do x, y, z. We need to let the kids in on it, have this pervade the culture. It would be so much better than just emphasizing the content, which is giving kids stomachaches when they take these high stakes tests. It’s a culture shift that we’re going for.