What is Geropsychology?

David BeckerBy David Becker

Aging is a fundamental part of being human. Although we all wish to live long and prosper—as the saying goes—and to continue enjoying the good things in life, the realities of aging can be daunting. Our bodies and minds weaken as the years wear on, rendering us more susceptible to medical problems like Alzheimer’s disease and stroke. We also find ourselves coming to terms with mortality as our loved ones and the cultural icons of our youth pass away.

Geropsychologists aim to understand the aging process as it relates to mental health.  Practitioners in this area help older adults negotiate these challenges and improve their mental health and overall well-being.

Even though the aging process has been a subject of contemplation throughout human history, geropsychology itself is fairly new. Belgian scholar Adolphe Quetelet is credited as the first to write about aging from a psychological perspective in his 1835 treatise Sur l’homme et le développement de ses facultés (which translates to English as On Man and the Development of His Faculties; Birren, 1961).  However, geropsychology didn’t really start to flourish until after World War II. This rise was marked by the founding of both the Gerontological Society of America and APA’s Division on Adult Development and Aging in 1945. Only just recently, in 2010, did APA officially recognize geropsychology as a specialty area of practice. The American Board of Professional Psychology (ABPP) also began granting board certification in geropsychology in December 2014.

Some have suggested that the slow emergence of this field may have to do with pseudoscientific myths about aging that persist in the public consciousness, accompanied by the fact that geropsychology brings us face-to-face with uncomfortable realities that we might otherwise prefer to avoid thinking about (Birren & Schroots, 2000).

GeropsychologyThe most significant reason for geropsychology’s recent emergence is undoubtedly the rising population of older adults. According a December 2015 report by the Population Reference Bureau (PRB), there are currently 46 million adults age 65 or older living in the U.S., which is more than a twofold increase from 1960 when there were less than 20 million adults that age. The PRB expects this growth trend to continue in the next 50 years, estimating that this figure will more than double to 98 million in 2060. This increase in the 65+ population means that mental health practitioners will be seeing more and more older clients in the coming years.

Although adults in their 60s and 70s are generally quite healthy thanks to modern medicine, clinical psychologist Patricia Areán (2015) notes that older adults still face a number of unique health issues that require specialized care and that most mental health practitioners lack the knowledge and expertise to adequately address these needs. Clinicians working with older adults are also more likely to encounter a number of unique ethical dilemmas (Bush, Allen, & Molinari, 2017). When treating clients with dementia who have limited decision-making capacities, for instance, it can be challenging to balance the need to respect their autonomy with the need to assure their welfare, especially when outside parties like family members and other healthcare professionals are involved.

The recent emergence of geropsychology, therefore, is a matter of necessity that has also been accompanied many new advances in the last decade. One of the most noteworthy contributions is the Pikes Peak Model for Training in Professional Geropsychology, which has helped define the attitudes, the knowledge, and the skills that are necessary to become a competent geropsychologist (Karel, Molinari, Emery-Tiburcio, & Knight, 2015). APA also recently revised its Guidelines for Psychological Practice with Older Adults in 2014. With this rapid expansion of clinical knowledge, mental health practitioners will be well-prepared to meet the special needs of the growing population of older adults.

 

References 

Areán, P. A. (2015). Treatment of late-life depression, anxiety, trauma, and substance abuse. https://doi.org/10.1037/14524-000

Birren, J. E. (1961). A brief history of the psychology of aging. The Gerontologist, 1, 69–77. https://doi.org/10.1093/geront/1.2.69

Birren, J. E., & Schroots, J. J. F.  (Eds.). (2000). A history of geropsychology in autobiography. https://doi.org/10.1037/10367-000

Bush, S. S., Allen, R. S., & Molinari, V. A. (2017). Ethical practice in geropsychology. https://doi.org/10.1037/0000010-000

Karel, M. J., Molinari, V., Emery-Tiburcio, E. E., & Knight, B. G. (2015). Pikes Peak conference and competency-based training in professional geropsychology. In P. A. Lichtenberg, B. T. Mast, B. D. Carpenter, & J. L. Wetherell (Eds.), APA handbook of clinical geropsychology: Vol. 1. History and status of the field and perspectives on aging (pp. 19–43). https://doi.org/10.1037/14458-003

Jason Ong: On Mindfulness for Insomnia

This is the latest in a series of interviews with APA Books authors. For this author interview, David Becker, a Development Editor at APA Books, talked with Jason Ong, PhD, about his recent book, Mindfulness-Based Therapy for Insomnia.

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.

 

Jason Ong, PhD, Neurology/Sleep Disorders

Jason Ong, PhD, Neurology/Sleep Disorders

Jason C. Ong, PhD, is an associate professor in the department of neurology at the Northwestern University Feinberg School of Medicine. Dr. Ong developed mindfulness-based therapy for insomnia (MBTI) as an innovative group intervention for treating chronic insomnia. MBTI unites the principles and practices of mindfulness therapy with the behavioral strategies of cognitive–behavioral therapy for insomnia (CBT-I). He writes about the theoretical foundations of MBTI and its implementation in his recent publication with APA Books, Mindfulness-Based Therapy for Insomnia. He also recently released a video, Mindfulness for Insomnia, in which he demonstrates how to conduct an MBTI session. Dr. Ong’s work has been published in various academic journals, including JAMA Internal Medicine, SLEEP, Behavior Research and Therapy, and the Journal of Clinical Psychology.

Chronic insomnia is a notoriously difficult disorder to treat. Even when treatments provide some relief, it only seems to be temporary in many cases. Why is insomnia so resistant to treatment?

Chronic insomnia is often perpetuated by cognitive and behavioral changes that develop in response to persistent sleep disturbances. For example, people who experience several nights of poor sleep may try to go to bed earlier or stay in bed longer in the morning as a means of coping with the sleep disturbance. This also sets the stage for worrying about sleep and modifying behaviors based on contingencies (e.g., going to bed earlier in anticipation of needing to “function well” the next day). As a result, more effort is put into making sleep happen, which disrupts the brain’s natural regulation of sleep.

What is mindfulness-based therapy for insomnia (MBTI)? How is it similar to or different from other mindfulness-based therapies?

MBTI is a new treatment for insomnia that uses the practice of mindfulness meditation to help people with insomnia. It is primarily aimed at decreasing the effort to sleep through the principles of mindfulness and allowing the brain to regulate sleep without “getting in the way.” MBTI is similar to other MBTs such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in its use of mindfulness principles and meditation practices. Unlike other MBTs, MBTI includes specific behavioral recommendations that are designed to promote sleep regulation. Therefore, it might be seen as a version of MBSR that is tailored for people with insomnia.

What are some of the most common challenges that instructors and clients encounter in MBTI, and how are they addressed?

For clients, it can be difficult to practice the principles of non-striving and non-attachment to wanting more sleep. Insufficient sleep does have consequences, such as low mood and energy, so it is very challenging to be patient while practicing mindfulness and allow the brain to regulate sleep. Most people are used to being problem solvers and putting forth more effort to accomplish something, but this is one situation where trying harder does not help. For example, doing internet searches for different ways to sleep (e.g., drinking chamomile tea, reading a boring book) and then trying each of these techniques until something works tends to promote anxiety about sleep rather than relaxation.

For instructors, it can be difficult to listen mindfully to the client who is suffering or to refrain from trying to fix things for the client. MBTI instructors are most effective in teaching mindfulness skills when they

embody the principles of mindfulness, so the theme of non-attachment to outcomes can be a challenge for both instructors and clients.

What inspired you to develop MBTI?

On a personal level, I have always had an interest in Eastern philosophy. As a student, one of my favorite hobbies was reading books on Buddhism, especially those by the Dalai Lama. As I moved into my professional career, I really enjoyed working with insomnia patients. I was trained in cognitive–behavioral therapy (CBT) but found that sometimes the traditional CBT approaches were not sufficient. Some people reacted negatively to getting out of bed or spending less time in bed, and it seemed like a power struggle to get these patients to comply with CBT. By bringing my personal interests into my clinical work, I found that mindfulness and self-compassion could provide a different approach to help people work out of the problem of chronic insomnia. I was fortunate enough to have a mentor who supported this idea, and off we went!

In your book, you clarify that MBTI is series of group exercises that should be administered by a licensed instructor. It’s not simply a matter of meditating oneself to sleep. Even so, is there a simple mindfulness exercise and/or a key piece of advice that you can offer readers who suffer from insomnia—something that they can use in their everyday life?

The trainspotting exercise can serve as a good starting point for understanding mindfulness and working with racing thoughts associated with insomnia. The exercise entails imagining oneself standing on a train platform and observing thoughts going by as if they were trains passing through a busy station. Inevitably, the mind will wander and we will “step into a train” by engaging in a thought or analyzing it. Here, we practice self-compassion by acknowledging that we have stepped into a train and without judgment, we step off the train and return to platform to continue trainspotting.

By practicing how to just watch thoughts rather than engage with them or analyze their contents, we learn how to work with a busy mind in a different way. Instead of trying to clear the mind to make sleep happen (which is not likely to work) we can be a trainspotter of the mind, which reduces the struggle to control thoughts and allows sleep to emerge.

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

On Caribbean Psychology

David BeckerBy David Becker

As psychology continues to grow and develop as a field, the importance of considering cultural factors when studying the behaviors and the mental well-being of individuals and communities becomes more and more apparent. To some degree or another, we are all influenced by our cultural heritage. I know for sure that my French Caribbean heritage has had an impact on who I am today.

My mother’s parents emigrated from Martinique to Washington, DC in the 1940s and brought with them elements of French Caribbean culture that have influenced my identity since childhood. However, because my heritage was so prevalent and normalized in my youth, I didn’t begin to fully grasp its uniqueness until I graduated from French immersion school and found myself among non-French-speaking classmates for the first time in the seventh grade. Suddenly I became “exotic,” a curiosity, especially in my high school French classes where I was the only one who spoke with a proper accent, aside from my teacher.

Unlike some, I wasn’t ostracized or treated unfairly because of my cultural roots, but it wasn’t always easy to appreciate my cultural heritage and its origins within the history of the French Caribbean. Some of my early ancestors were people of privilege who killed indigenous Caribs, owned slaves, and committed other acts that have impacted the lives of modern day Caribbean peoples who continue to struggle against the legacies of colonialism, slavery, indentured servitude, and centuries of warfare between rival European powers. Among these ancestors was Guillaume d’Orange, who arrived at Saint-Christophe (now better known as St. Kitts) in 1628. Saint-Christophe was the first Caribbean region settled by the French in 1625, and it was from here that Guillaume made forays to other islands, such as Guadaloupe where he lived for 12 years as an explorer, a warrior, and a planter. Afterwards, he moved to Martinique where he lived until he was killed in the Dutch invasion of Fort-Royal (now Fort-de-France) in 1674. Guillaume d’Orange was one of the pioneers who helped shape the modern French Caribbean, which included the genocide of the indigenous Caribs.

countryside-1200Other ancestors of mine owned sugarcane plantations and slaves, such as Guillaume d’Orange’s more famous descendant, Empress Joséphine, who was born into a plantation family in Martinique. During the transatlantic slave trade, France imported approximately 1,381,000 African slaves to the West Indies, and many of the 217,200 slaves who arrived in Martinique worked on sugar plantations. Although the French revolutionaries abolished slavery in 1794, it was reestablished by Napoleon in 1802 to help fund his campaigns in Europe, and it wasn’t until 1848 that France abolished slavery for good. The freed slaves in Martinique were offered the chance to continue working on the sugarcane plantations for money, which they understandably refused. In response, indentured servants from India started migrating to the French islands and performing this arduous labor. These immigrants brought Indian spices that influenced the local cuisine and resulted in the Colombo spice blend that my family still uses in recipes today. One such recipe is féroce (“ferocious” in English), an avocado dish that is similar to guacamole except that it includes fish and Scotch bonnets—Caribbean peppers so spicy that you dare not touch them with your bare hands. Even sugarcane remains an important part of my family’s cuisine, especially in ti’ ponche (meaning “small punch”), a mixture of Martinican rum, lime, and cane syrup.

During the French Caribbean’s postcolonial period, my ancestors continued to immigrate to Martinique from Europe. As the times changed, so did their reasons for migrating: Many of them were educators. Likewise, other people from across Europe, Africa, India, and elsewhere have come to the Caribbean—whether voluntarily or not—for myriad reasons over the centuries, and communities of indigenous peoples still live on the islands today. And just as my family tree intertwines with the history the French Caribbean and influences living generations, so do other individuals, families, and communities find their own identities tied with one or more Caribbean islands.

Understanding the diverse and unique experiences of Caribbean peoples along with the common themes that bind the islands’ histories together is a key goal of Caribbean psychology. But this is no simple task. In their book, Caribbean Psychology: Indigenous Contributions to a Global Discipline, editors Jaipaul Roopnarine and Derek Chadee (2016) argue that “the psychological stories of Caribbean peoples have been missing from the broader intellectual discourses in the psychological sciences” (p. 4). They acknowledge that this lack of cultural representation is a worldwide problem not isolated to just the Caribbean, and they further argue that “psychological principles that are not inclusive of other cultural groups around the world are inherently limited and fail to utilize the two-way flow and integrations of scientific information from the majority to the developed world” (Roopnarine & Chadee, 2016, p. 4). Yet, viewing contemporary Caribbean peoples through a historical lens is not enough. While understanding the impact of slavery, colonialism, etc. is important, Roopnarine and Chadee (2016) note that psychologists must consider “lived experiences and realities” (p. 7). To fully comprehend contemporary Caribbean individuals and communities, psychological theories and practices must therefore emanate from those individuals and communities. This indigenous knowledge will then feed into the bidirectional flow of scientific information, thus benefiting psychology as a whole.

Why do we need a localized Caribbean psychology? The answer is that Caribbean psychology—along with American psychology, French psychology, Chinese psychology, Turkish psychology, Nigerian psychology, etc.—are all pieces of the same, grand puzzle. Each of these pieces is itself a large and complex puzzle made up of many smaller components. Studying the psychology of African Americans, for instance, is crucial to American psychology as a whole. As we strive to put all of these innumerable pieces together, the hope is that we will come closer and closer to understanding ourselves.

Reference

Roopnarine, J. L., & Chadee, D. (2016). Introduction: Caribbean psychology—More than a regional discipline. In J. L. Roopnarine & D. Chadee (Eds.), Caribbean psychology: Indigenous contributions to a global discipline (pp. 3–11). http://dx.doi.org/10.1037/14753-001

What Is the Dark Triad?

David Beckerby David Becker

It’s not an Iron Maiden album, nor is it an alliance of supervillains bent on world domination. Coined by Paulhus and Williams (2002), the term Dark Triad refers to three strikingly negative personality traits—narcissism, psychopathy, and Machiavellianism. Research shows that individuals who score high in these traits are more likely to commit crimes, cause social distress, and create problems in the workplace. These individuals exhibit several core features, including “disagreeableness, callousness, deceitfulness, egocentrism, lack of honesty-humility, and tendencies toward interpersonal manipulation and exploitation” (Zeigler-Hill & Marcus, 2016, p. 5).

Although many people know the terms narcissism, psychopathy, and Machiavellianism, not everyone fully appreciates their intricacies. Narcissism, for instance, does not simply refer to an inflated ego—or what is known in the literature as narcissistic grandiosity. A person with narcissistic tendencies may in fact have low self-esteem and feel helpless, empty, and ashamed of themselves (a.k.a., narcissistic vulnerability). For this person, narcissism may be an unhealthy adaptation to their negative feelings. Likewise, someone with Machiavellian tendencies might not simply seek dominance at the expense of others. He or she might actually have limited power and be the victim of unfair, discriminatory, and abusive treatment. This person may have developed Machiavellian characteristics as a self-defense mechanism. Darth Vader, for instance, is certainly prone to acts of extreme Machiavellianism, but his desire for ultimate power can be seen as the result of a childhood spent in slavery, and of feeling unfairly treated by the Jedi Council.

the dark side of personality

Psychopathy may be the most complex trait of the Dark Triad. In their book, The Dark Side of Personality: Science and Practice in Social, Personality, and Clinical Psychology (2016), Virgil Zeigler-Hill and David Marcus describe psychopathy as a multidimensional construct made of three loosely connected components: boldness, meanness, and disinhibition, which they correlate with fearless dominance; callousness; and sensation seeking, urgency, and distractibility.

In their exploration of the Dark Triad, Zeigler-Hill and Marcus (2016) acknowledge that it is not necessarily a fixed construct. They point to recent research arguing that sadism shares enough similarities with narcissism, psychopathy, and Machiavellianism for it to be studied as part of what could be called the “Dark Tetrad.” Even traits that are often regarded as positive, like perfectionism and high self-esteem, or traits typically associated more with self-harm than outward harm, such as anxiousness, can have dark features that may warrant their study alongside the more archetypical dark traits within the Dark Triad. With so many new avenues to explore, Zeigler-Hill and Marcus (2016) wonder, “Will the Dark Tetrad expand at some point to be the Dark Pentad? Would the Dark Hexad be far behind?” (p 7).

 

References 

Paulhus, D. L., & Williams, K. M. (2002). The Dark Triad of personality: Narcissism, Machiavellianism, and psychopathy. Journal of Research in Personality, 36, 556–563. http://dx.doi.org/10.1016/S0092-6566(02)00505-6

Zeigler-Hill, V., & Marcus, D. K. (2016). The dark side of personality: Science and practice in social, personality, and clinical psychology. http://dx.doi.org/10.1037/14854-000