These edited reports were originally posted to the Current Topics, Therapy Online, and Cyberpsychology list-servs, August 2008.  

2008 Convention Highlights:
Grand Theft Childhood | Opening | Malcolm Gladwell | College Success, Love, Hate, More | My Life With Asperger's
My Space, You Tube, Psychotherapy, Relationships... | Aaron T. Beck - 2008 | The Mind and Brain of Voters


 

"Asynchronously Live" from Boston

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*DISCLAIMER*
I was very careful to take accurate notes during these presentations (including several pithy verbatim quotes), using handouts and/or photos of graphics to verify my notes. I apologize for any remaining errors or typos, and will be happy to immediately correct any mis-quotes, misattributions or mis-spellings brought to my attention. I welcome presenters' submission of additional online references which are relevant to (or mentioned in) these reports. Thanks, and... Enjoy! I hope you find this slice of psychology interesting and informative.

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APA CONVENTION REPORT #1

August 14, 2008





Asynchronously Live from Boston!
14 August 2008

Hi, and greetings from Boston!

Asynchronously Live from the APA Convention -- APA's 116th -- reported on in virtual real-time, hopefully providing those who cannot be at the convention here & now, with a sense of the live interactions and presentions.

Here are some nearly-live reports from just a few of today's APA events, hopefully providing a flavor of this huge gathering of psychologists, some of the "themes" which APA has been developing (and I've been following), and a taste of the energy and excitement people are buzzing about still, in the restaurants and hotels of Boston.

Here we go, with a few of the quot;main events" for the organization (like the opening ceremony, late in the day) and a few of my own choices which of course reflect but a fraction of "what's out there" in the world of psychology, particularly for students and new psychologists, in this rapidly changing landscape for healthcare/mental healthcare. More on this later, from APA leadership, the mayor, and a Kennedy...

My goal is to "share psychology" and provide at least a sense of this year's annual convention experience, using imagery, transcripts, and my own take on some of the "hot topics", so as to give a feel for the event as it is still happening, being reported on by the media, etc. As always, this year brings with it social unrest, internal debates among psychologists about the role and future of psychology, many new students participating (a large group of Fulbright Scholars attending and presenting this year too), and many exhibitors - largely book publishers and practice-oriented test developers, drug companies, relaxation device makers, etc. Lots of handouts too: brain sponges a perennial favorite along with pens, brochures, and this year, cookies everywhere!

I hope some or all of this will allow you to share some of the excitement of "being here" and experiencing both the diversity of psychologists as well as the pleasure of hearing from the experts about new and important trends and research tracks, along with education, training and practice issues.

Without further adieu, here's a sampler from today, 14 August 2008, Boston Massachusetts, in the new, very imposing (and distant from downtown hotels!) Boston Convention and Exhibition Center (BCEC).


 
1140 - Discussion: Humanizing an Inhumane World - Grand Theft Childhood: Videogame and Media Violence

Chaired by Dr. James Bray, with Drs. Lawrence Kutner and Cheryl Olson, participants.

James Bray, a former APA President, began by introducing Dr. Kutner, who is well-known to media psychologists and known to many as the author of those wonderful NY Times columns called Parent and Child, which inspired me and which I used as "handouts" to give parents, before the Internet began its rule. Dr. Bray noted the fortuitous coincidence of Grand Theft Auto the video game being released at the same time as Dr. Kutner's book, which refers to this very game, and related phenomena. Bray called this "an important book" which sheds some light on a multi-billion dollar industry which has its share of both defenders and detractors. With that, he gave the podium to Dr. Lawrence Kutner, leaving him with THE question to consider, so it seems, "Are video games good or bad for kids?"

Lawrence Kutner: The answer is 'yes'. Obviously it's not so simple or one dimensional. [There are some who think "letting out violence" through games is healthy, "cathartic", cleansing; others think it teaches disinhibition, anti-social modeling, &/or dissociation.]

The media, said Dr. Kutner, have historically embraced, collectively, what turned out to be alarmist spin, reminiscent of the days of Congressional testimony in 1949, where our country's legislators were upset about several comic books of the day - now classics - which they were convinced would lead to all sorts of terrible consequences by "glamourizing" violence and influencing teens. Long before that, in fact there was big concern about "the terrible influence of the new media: the paperback novel". Dr. Kutner concluded that, aside from looking at individual events and people, there is a cultural context too, in which "the media" always seems to panic, historically, when new media types are introduced.

Next, Dr. Olson was introduced, as co-author of the Grand Theft Childhood book (with Dr. Kutner) and as a distinguished Harvard professor with some very interesting findings coming out which are relevant to "media psychology". Dr. Olson clarified first that her doctorate is in public health. She is working as a researcher, along with Dr. Kutner, in a medical setting (Mass. General).

She offered a "condensed book version" which gave a sense of where some of the research has focused, and is headed, in an environment where there is a push for public policy. Studies have already been done which look at the relationship between violent games and "cop killing". As more refined studies are done, however, it seems that the media are often innaccurate in the reporting. One of the early findings was that contrary to what people may have thought, the killers in the Columbine High School assault were really "not into video games".

Like Dr. Kutner, Dr. Olson too is interested in learning more about the power of context. She explained that she "wanted to explore what patterns of behavior could be observed" in speaking with parents, teachers, and others. What she found is that "there's no information out there on what is 'normal'." And looking still at context, parents were asked what they were most concerned about, in terms of influence on their children. It was not "video games" as some monolithic entity. In fact, people (adults and teens) do look at specific games and evaluate the context for, and type of, violence. "There's a difference between killing aliens and zombies", in a fantasy context, versus graphically decapitating people.

Next question: "What about different kinds of violence in the context of different kids?"
[Yours truly picked up on this later, asking about different types of personalities and tendencies to dissociate/disinhibit from game-life into real-life, etc. Another question.]

Dr. Olson described her study of video games and young teens (age 13 and 14), which involved an extensive survey of over 1250 7th and 8th grade students from both high and low socioeconomic status environments in Philadelphia and South Carolina. A similar survey was completed by approximately 500 of the teens' parents. Drs. Kutner and Olson had also run some focus groups with approximately 50 boys and 25 parents. It was not until after the survey results, however, that they realized how many girls were frequent players of GTA as well (i.e., "played a lot over the past six months"). [Thank you, Dr. Kutner, for further clarifying this!]

The study yielded a great deal of data and the researchers, Dr. Olson explained, are still combing through it in myriad ways. "In our 32nd summary", she said with a smile, it was found that 2/3 of boys had an "M" score of equal/greater than 1*. The #1 attraction in video games for the boys, was Grand Theft Auto, followed by sports-based videogames.

For girls, #1 was The Sims, and #2 was Grand Theft Auto. (Some of the boys berated Sims as being yucky, people-oriented stuff, with kissing... And then there's the debate about the boys exposure to the GTA "main message".) Dr. Olson shared that it was a shame that the earlier focus groups were only on the boys, because she now thinks, as girls were also interested in Grand Theft Auto, it would be fascinating to look at whether girls and boys play the games differently [or have different experiences or goals!].

One interesting finding was that the more "M" games* -- those rated with "mature" content -- which the girls played, the more likely to find reports of social problems, especially bullying. Boys who played a lot were less likely to be bullied.

Other questions arose as patterns and surprises emerged. Could some of the game-playing frenzy be "self-medicating for depression?" Very complex, obviously.

Next, the larger issue of motivation became a focus. [See last year's presentations by Zimbardo, Beck, Farley and others, about group and system pressures leading to evil, hate, and horror.]

Motivation is very complex: Why are games played, for example, and why are specific ones chosen? It can be a group experience, an individual may be looking to deal with stress, "get your anger out", etc. Dr. Olson has heard reports by teens of how, if they were really stressed and angry, they'd get the cheat codes for a game and just blow everything up. At the same time, some reported they learned that actions have consequences which attend bad behavior. In sum, it's all still a "sandbox-type environment". We're still learning, and there's so much to learn in a rapidly changing social and world context.

Next Dr. Kutner spoke, beginning where Dr. Olson had left off, describing several other findings - and questions - which have emerged from the study, and particularly from the focus group feedback. For example, boys were asked, "Are there any games you shouldn't play?" The boys said SIMS. The researcher asked why, was it not violent enough? But the answer was actually "They do things with people" (as opposed to fantasy), like kissing. There was a big disagreement in one focus group. How old should one be before playing such games? One said 8, one said 100. If you could invent a game, what would it include? "Cool costumes", "I'd rule the world", "No homework"...

Now as to the big media response, it was fortuitous that Grand Theft Auto 4 was released at precisely the same time as the book, with the game becoming the most popular game EVER. But, in keeping with history apparently, the level of debate about violent media's impact on behavior still remains superficial, at least in the popular press. It's a "hot topic" nonetheless.

What often happens is "distorted coverage" gets picked up by the "blogosphere" (a word Kutner said would have just stymied his editor at the NY Times years back), and travels from one person to the next, akin to the old game of 'telephone' with a new distortion or omission/substitution with each new relay, until the report gets back and "it's not at all anything I would recognize".

Dr. Kutner shared that he too is fascinated by some of the focus group feedback. One student wrote back (about a book which was named), "I'd buy this book if I could read". Both he and Dr. Olson also got some inappropriate personal attacks and/or overtures. [Such is the nature of adolescence and response to authority?]

Journalists sometimes have reasonable expectations about ways in which video games can exert a "good" or "positive" influence. What is most expected? Better hand-eye coordination, for example. But it can also offer young minds a chance to set up a society via a game. "Video games are a medium and they can be very useful".

With that, James Bray took the podium again (I'm not being literal!) and shared his own observations of a 16-year old son as he actively relates to others using new media. Now he invited audience questions.

QU: What about the context, the peer context? [Peer pressure, etc.]

A: (Kutner) - Teens were not only drawn to games which portrayed "good versus evil". In fact they were found to be attracted to the complexity of characters. [Avatars for alter-egos??] For boys, the playing seems to be a marker of social competence.
A:(Olson) - Moral choices are engaging too. You can become a good guy or bad guy.

Also one learns problem-solving skills. [This is a hallmark of intelligence for Sternberg, as he would speak about later today.]

Q: Didn't the Columbine shooters model from Doom?
A: Yes but... this game has been shown to relate to motor skills and shooting [but not to induce imitative behavior]
[My Q on disinhibitition/desensitization; A: Interesting point, ripe for research.]

James Bray commented that from his perspective within a medical school, obesity is presenting as a big problem. That may be one outcome which is not good from video games. Exercising only the thumbs while eating snacks doesn't bode well.

Dr. Olson commented that in fact TV "seems to be a greater contributor" to the public health environment, as it is a passive activity and one which is constantly presenting ads for junk food.

Dr. Kutner concluded as did Dr. Olson, that the dynamics are complex. We're living in a time when violence is up again, after years of a downturn beginning in the 90's. There continue to be new research directions (e.g., Savage) but still, in general the overall body of evidence is not conclusive. The best 3 predictors still seem to be violence at home, violence in the community, and being dropped on one's head.

Something to think about.






 
CONVERSATION HOUR:
Humanizing an Inhumane World - College Success, Love, Hate, More


Frank Farley presenting award to Robert Sternberg [Photo by Fenichel]


This was a relaxed and interesting, hopeful hour with Dr. Robert Sternberg, now dean of Tufts University College of Arts & Science, after a distinguished career at Yale, and a lifetime of thinking and writing about "intelligence". He was introduced by Dr. Frank Farley as "the most prolific living psychologist", having written over 1200 articles and 100 books. They tried to do the math - rather impressive!

Sternberg summarized his past "triarchic" theory of intelligence, as Farley jested that Sternberg always found 3 factors to explain everything, like love, hate, & IQ.

Sternberg's current interest, having come from being the student told that he had no potential to being a scholar, to now being dean of a college, is: college success. Obviously, he is not enamored of any single test to predict success, be it IQ or SAT/ACT. (They predicted his failure!)

While still at Yale Sternberg launched a project (Rainbow Project) to "improve our prediction of people who would really make a positive contribution to the world". He knew that SAT success was too narrow an indicator of capability or potential, and that world leaders like Ghandi, for example, may never have been seen for their potential based only on a test score. So he set out to further explore attributes which related to large-context success. [Be sure to catch keynote speaker

1. Negation of intimacy (These victims are like vermin, insects, dregs of our society, it's ok to hate them.)
2. Passion. (Someone smashes into your new car; you arrive home a day early to find your spouse in a compromised situation.)
3. Commitment. (They do bad things to us; we have to act against our enemies, enemies of G-d, etc.)

Q: Any feelings about the work of Zimbardo, regarding hate and evil?
A:"Where we agree is: context really matters. [There is] an interaction between the person and the context. Not everyone becomes a terrorist."

Last Q: [Me, inquiring how he grades the non-SAT portions of the applications he gets]
A: "We use a rubric." There is more than one rater (with good inter-rater reliability) and the things they look at include the extent to which the essays are novel, responsive, organized, logical, and balanced.

And onto a fun event, not one I'll devote time to except to say it was fun, and positive. Danny Wedding, Frank Farley, Judith Kurianski (the syndicated talk-show host), former CEO of APA Ray Fowler, and Debbie Joffe Ellis (widow of Albert Ellis, whose sing-alongs were legend) took turns sharing both psychology-related humor and some slightly more serious thoughts about the power of laughter in abating stress, etc. Ms. Ellis shared some of Albert Ellis' early essays - including raging tirades directed at teachers and professors who wanted 'parrots' rather than scholars in his estimation. Other highlights included some sight humor by Ray Fowler (who donned a parrot hat!) but basically it was an hour of fun, jokes about psychology legends and everyday life, etc. Dr. Kurianski shared some of the things she hears from callers and added some of the things she heard herself, growing up. All good fun. With some old friends and colleagues, and many people just dropping in to see what this was, the annual Division 46 (media) event called "APA Comedy Jam".

OK, lastly for today, a main event to be sure:

 
 

OPENING CEREMONY AND KEYNOTE SPEECH

Keynote Address: Malcolm Gladwell

where one can find photos there, by his parents, documenting how *he* was functioning 40 years ago, by himself, in the sandbox: "A lost,miserable boy." He wished he had a video clip. "I was worse than many people I see now. [But] think of me and Temple Grandin. You just never know."

He ended by revealing how he'd had a revelation about neurological functioning when he learned of a new treatment at Beth Israel/Harvard, called Transcranial Magnetic Stimulation (TMS) and he in fact "captured" two of the team to attend his presentation, there in the room. He was very excited about what happened to him after treatment he volunteered for, as a "guinea pig". Lo and behold, he said, "like 'Flowers for Algernon', now with the change I can go into a room with 50 people and engage 49. It's completely upside down!" Before he'd be the one in 50 who could not engage the other 49. "It's like magic that you can supplement with therapy", he said.

Harkening back to Sternberg's notions of analytical, practical, creative intellectual ability, clearly this was someone before us who was brilliant in several spheres. As Sternberg and Gladwell both addressed - the phenomenon of *success* seems both constitutional and contextual. Here's a "lost miserable boy" considered a freak who has succeeded both economically and in terms of self-knowledge and (increasingly) self-acceptance.

I bought his book ("Look Me in the Eye") later, and chatted briefly with him. He autographed it, too: "For Dr Mike, a fan of Aspergians like us. JER. Woof!"


Noam Chomsky -

Unfortunately, though I rearranged my hectic day to be able to hear Noam Chomsky, while getting to at least one other mainstream psych and/or cyberpsychology nugget, Chomsky had an emergency - his wife was gravely ill and he could not leave her. He did participate via phone, with some difficulty, and fielded several questions about what we need to do to "humanize" the world. Basically he railed against the hypocrisy of saying as a society we're against things like terrorism when we put war criminals in charge of counter-terrorism. (This was a reference to an Ambassador).

The connections broke, and though we heard him well, he struggled to respond to questions, and stayed on the theme of needing to restore our integrity on the world stage, as a nation. Hmm, I wonder what he would have said and done were he present. Alas no, so I headed out soon to attend a two hour CE session on ethics and professional considerations in our new age of communication technology. It's entitled "My Space, You Tube, Psychotherapy and Professional Relationships - Crisis or Opportunity?"



ASYNCHRONOUSLY LIVE FROM APA -
Boston, 15 Aug 2008

Greetings from Boston. Here's a quick report on a symposium which I attended today on a subject near and dear to my heart, a "current topic" in psychology, and also relevant to "online therapy" and "cyberpsychology". Like Sternberg, I have my triarch!" ;-)
 
Symposium: My Space, You Tube, Psychotherapy and Professional Relationships -
Crisis or Opportunity?

This was a well-attended continuing education symposium presented by a panel of ethics experts, including Dr. Jeffrey Barnett, who has been editor of a scholarly journal series about ethics in practice today, Stephen Behnke, Ph.D., JD, director of the APA ethics office, David Powers of Loyola, who studies training models in the Internet age, and Keren Lehavot, a graduate student who won an award for her work in ethics, where she explored academic & personal use of social networking sites.

There were several recent studies and statistics shared; here are some of the key findings and the 'main idea', straight from the event today. Dr. Barnett noted that he learns a great deal by observing his teenage daughter and is fortunate to be able to consult with her as an expert.

[As I've described elsewhere recently, I was quite impressed with how a teen responded so poignantly when I asked about comfort with multi-tasking and using multiple devices, etc.: "We don't know anything else. What do you expect? You had television and the telephone. We grew up with cell phones, computers, and Internet." Cameras now, too.]

One thing his daughter underscored for Dr. Barnett was that whatever one wants - or reveals - "it's out there on the Internet. And everybody can see it."

Some statistics:

• MySpace is the 6th largest "country" in the world" with more monthly visitors than any other site, and with the most rapid growth of any Internet site in history. (Rosen, 2007)
• 73% of US adults are now online, 55% with broadband connections. [Our saturation and bandwidth/speed lags as a nation behind much of the world still, fwiw!]
• 82% of college students own their own computer.
• 72% "check their email at least once a day". [The speaker quipped: C'mon! Only once a day? We know better! :-) ]

• "If I'm on an admissions committee, should I google applicants, or take a look at YouTube?" [This evoked quite a bit of discussion and some audience questions/comments.]
  
  
• "What about clients searching for us online?" Again, "we need to be careful about what we put out there." [One comment in the audience was about the value of intentionally putting out info, rather then fearing it - my response was/is that calling-card type sites are just that, and if the goal is truly to attract attention, Google can help with that.]

• 7% of student therapists surveyed said they'd been informed by a client that they (clients) had gotten info about their therapist online.
• 27% of the therapists did some online "fact-checking" of clients' statements, visiting MySpace pages for example - to see, as one example, if clients were being truthful with them.
• 8 of 10 Americans use the net to verify or find health information. (This was one of the first and most robust findings about Internet use.)

• Faculty are generally unaware of what's e-happening, especially beyond email.
• So far the focus of discussion and guideline development has been on confidentiality and email.
• Social networking technology makes the public/private distinction less clear.
• Development of faculty guidelines and social networking use may be helpful for faculty and students.
• These guidelines should be mindful of the power differential between students and faculty/supervisors, as well as of professional presentation.

The last speaker was Stephen Behnke, APA ethics director.

Dr. Behnke began by saying he was impressed by the richness of the *cultures* which are seen among online groups. He also noted that we'd barely mentioned the ethical area of research in this Internet age, and clearly this is an area of importance as well.

Time was drawing to an end, so following Dr. Behnke's recap of key issues, the panel did a brief Q&A. The questions involved dating web sites, the dynamic of anonymity, the diagnostic potential for working therapeutically at the computer with child/teen clients, gambling disorders and narcissism.

In conclusion Dr. Barnett reiterated that "this is really new stuff. It IS the cutting edge. Some of the ideas being discussed today might influence future ethical principles", discussions, etc. I smiled, knowing it's already underway, particulary in education and increasingly reflected in practice and research. I was pleased to see mainstream APA discussions as well as student and faculty research and training getting up to speed in reflecting the 21st Century.

--

This is going out to the very quiet "Online Therapy" list as well as general psychology list, as this clearly has implications for the evolution of online mental health services, certainly in the U.S.

Regards from "BeanTown", Boston Massachusetts.

Michael




16 August 2008 Asynchronously "Live from APA" Onsite reports on select samplings of the 116th APA Convention, this year in Boston.

It is Saturday, and a nice sunny day after a few afternoon and evening storms the past few days.

Here now, one more time (for now) a sampling of psychology from a few of the shining lights. In part blind luck, I did manage to be in a few places at the same time (without splitting!) as one event ended early and I was able to catch part of the "plan B" event which I really wanted to catch too. Lastly there was a lot of buzz among the media psychology pros I spoke with, excitement about the appearance today of Drew Westen. Who is he? An expert on "the mind of voters" and how the spin machines manipulate messages (or not) in an effective way. But first: the legendary Aaron T. Beck.
 

Aaron T. Beck 2008
Continuing Discussion with Dr. Frank Farley


Aaron T. Beck (Photo by Fenichel)

In what has now become a very popular and memorable tradition, Dr. Beck -- famed for his numerous "Beck Scales" and "father of cognitive therapy" -- drew a huge crowd of admirers, including many psychology students. A psychiatrist by training, Beck was introduced as "the man who slew Freud". He immediately responded that in fact he had long *embraced* Freud, until he (Beck) "managed to take a risk" and defy some of the Freudian tenets, for which he "paid a price". But he was a believer. And now his own focus on belief itself has truly eclipsed Freud, as the introduction playfully suggested, because Beck's methods enjoy empirical validation.

Dr. Farley began by stating the obvious, that Aaron T. Beck really needed no introduction. So he proceeded right to the presentation, also in the interest of time. (Beck had to leave a few minutes early.)

Beck began by commenting that "I always enjoyed having a dialogue with Albert Ellis" at these gatherings. [You can get a sense of these historic discussions in the collection on my site, including the discussions in

• Negative symptoms
• Poor quality of life
• No goal seeking
• Giving up

In some controlled studies a "key factor" - in statistical terms one which soaked up much of the variance - was "negative attitude, probably stemming from actual failures, where the quality of life deteriorated."

So now, Beck was thinking, we have a "psychological hook" for a trigger of negative symptoms: "defeatism". But at the same time, "You can't talk a schizophrenic out of an attitude. You have to go at it indirectly".

What do they want? "They would like to work, have money, have relationships..."

Asked "what about hallucinations", can't these be especially distressing? Beck replied that the effect of them may not be as bad, in relative terms.

"One patient said he could no longer read, he was unable", due to his lethargy, &/or defeated attitude. That was his main complaint. He was given a paragraph to read, and he found he could do it. When this happened, "you would see a shift in attitude" and he became more active. "The more active, the more the attitude change, with change in behavior and in symptoms."

Beck is now doing a random/control study with a treatment and non-treatment group, testing this paradigm. Thus far he is seeing improvement, people beginning to get out and go to the library or gym, or possibly being able to attend a job training program or some type of work. Treatment with former college students has shown success as they return to college. Also he is seeing some of the more listless patients moving from group homes into independent living situations. "The whole quality of life is improved. It's the most exciting thing so far."

The floor was opened to the audience who queued at an open microphone.

Here I'll just summarize:

Question on working with schizophrenics who function in the mildly MR range, who exhibit aggressive acts and behaviors, using CBT.

Answer: Emotional control is really a big facet. We have to train them in anger management. This can be done in a session, for example recreating the situation where they're frustrated, or easily angered, and simulate a situation. You may try to first convince the person that anger is unproductive. Teach them to use self-talk: 'It doesn't pay to express these feelings because I'm only going to get in trouble'. Learn to take a walk." Etc.

Beck used this to segue into an example of a case where there was serious dysfunction due to PTSD, a soldier back from war:

Patient: I'm irritable, I yell at my wife, I'm having terrible nightmares, flashbacks... I'm going to end up a deadbeat, or I probably will kill myself.

Dr: What led to this? Tell me what happened.

Patient: I can't do that sir; if I do I will cry.

Dr.: It's ok.

Patient. I can't even drive. If I see garbage cans it reminds me of roadside IED's. And I can't talk to people.

Dr.: Tell me about the flashbacks.

Patient: I came across 3 soldiers in Iraq, huddled around their comrade's body, just staring "catatonic"-like. He had a big gash in his head, brains exposed... The 3 soldiers began to talk with me about their lost friend and somehow started to feel better, talking about him.

Dr. B: You should feel *good*. You helped!

Pt: But I should have done more! I should have...

Dr.: Nobody could have re-assembled his brains, nobody.

The soldier began to cry.
Dr: You did something good.
More crying...

"He kept in therapy and his nightmares diminished, along with his flashbacks. It was all the guilt."

Q: from audience - I am a student in public health, and wonder about CBT applications in a preventive context.

Beck: Primary prevention is ideal. One of my colleagues - Seligman - is working in schools with children at high risk for depression. Ken Dodge did a study on children prone to act out in school [and ] developed a psychoeducational program which did have an impact on acting out.

Very few psychologists and counselors have actually had training in CBT. We're doing training now with the VA, with the idea the counselors will be more helpful. This is secondary prevention. We need to be sure there is proper training. For 6 months they get stringent supervision [which includes use of taped session transcripts]. Right now, Philadelphia has a great Medicaid program.

Q: I work in a trauma center for terrorism victims. How do you deal with parents feeling guilty for the loss of a child?

A: It's not something I've specifically thought about... it's difficult. I once spoke to such a group of parents whose children were killed. It goes like this: 'If only... If only...' A boy took a shortcut on his way to school. Crossed the railroad tracks and was hit by a train. 'If only I'd gotten him up earlier'. Should've, would've, could've. The only thing I can think of is to go through what they think they would have done differently to get them to realize that they simply had no control over the situation and were not responsible.

Q: Is there a relationship between Seligman's work and CBT?

A: Actually we meet once a month and have these discussions. From a positive CBT perspective, we have to teach them what they have control over and what they don't, the positive part. That they *do* have control over some things. [Sounds like Ellis, too!]

Beck gave an example I'd heard before, but now (to me at least) it sounded more like DBT (with empathy!), with the "dialectic" component encouraging less extreme reactions. There was a distinguished patient of Beck's with a deep depression after having been passed over for a Nobel prize. Beck drew a circle on a blackboard and asked how important it was getting that prize, in his life. "Eighty percent", the patient said. "Do you have children?" Beck asked. "Fifteen percent". "Do you have much to do with your children?" No, not really much opportunity...
"And how was growing up for you?", Beck asked the patient.

Pt: I didn't have much contact, actually.
Beck: And how did that make you feel?
Pt: Terrible.
Beck: Is it possible that your children feel like that too?
The patient began to light up and declared that yes, he was going to spend more time with *his* son than his father spent with him.

Beck: OK, so how important in your life is your son?
Pt: 60%
Beck: And do you enjoy time with friends? Pt: Yes, I like to play tennis. OK, 40%
Beck: That's 100%. What happened to your wife?
And so it went until in the end things were more proportioned for a positive and realistic outlook.

"This is positive psychology in a CBT way", Beck said, getting at root causes directly through experience.

Q: How can we deal with fixed delusions?
A: First a disclaimer: It doesn't work with everybody. People with fixed delusions are not going to take kindly to being told their delusions are just delusions. (What Beck has done in such a situation is to avoid being patronizing but help establish a framework which is conducive, and positive.) The therapist says, I'm sorry, I really don't understand what you're saying, as I don't have the same experience. The patient liked this, as he's not being told he's crazy and dismissed. The therapist continues: "You know, the more you empower yourself the less intrusions will bother you. " The clever patient asks, "Are you saying they're not real?" and Beck replies, "it doesn't matter if they're real or not". The therapy is the same. And the patient becomes steadily more active, and the symptoms lessen.

Beck recalled how one patient had become absorbed by the meaning of some letters he saw on a bus going by: G, O something, T something. It must be a cryptic message from G-d. Go to something! But where? It turns out the letters were GOTS - Greater Ontario Transit System.

Q: There are big debates on outcome studies, efficacy, etc. They say a relationship is a necessary but insufficient component of therapy. What do you think?
A: People with moderate depression can benefit from mostly supportive relation-based treatments, like Rogerian methods. "You can get some cognitive change with an empathic therapist. There's some kind of transformation. Acceptance works. With more severe disorders, however, acceptance doesn't carry it. Technique becomes critical. With mild to moderate depression there are 'common factors'. Empirical evidence is that techniques matter."

Also, you can compare supportive vs. cognitive restructuring treatment. It may come out similarly. However, with supportive counseling only we see regression in a year, but with cognitive therapy they keep improving. It seems they develop the tools to deal with problems.

Q: How has your life experience colored your perception of the current political landscape?
A: Beck said he's only good at this after having a chance to speak to the players individually, and finding out what their "automatic thoughts and beliefs" are.

Q: I'm a grad student interested in the use of therapy animals, which have in fact been found effective in treating anhedonia, increasing ADL and socialization, etc. Ever thought about this?
A: I have not, but I will!

Q: Where can one get training - besides the Beck Institute?
A: There is a network, and he can provide specifics on request. His daughter Judy is now doing the workshops at the Institute.

Q: Can you speak to the role of empathy in successful CBT?
A: "I think it's really critical. You can set an agenda, teach the tools of the trade, but with the more difficult patient you really need to be able to imagine yourself in the patient's shoes. 'What would I do?' 'How would I react if I failed?'" Incidentally, Beck added (to some laughter), "some of the best therapists may not be terrific researchers".

Q: Any brief therapy model for CBT?
A: Some patients get better in 1 or 2 sessions, others need a year.

Beck briefly mentioned some of the genetic work being done which may help future targeting of symptom treatment. It seems as if a "hyper-reactive amygdala" is somehow related to negativity. There are a few ongoing studies testing this.

Beck was asked about his experience with paraphilias, which was limited, although he had some experience with incest and has seen promising results working with the parents - for example focusing on the underlying belief of the father, e.g., "It's best for her, it prepares her for real life and and who better to do this than a father who cares for her?"

Q:Have you done any more work with Borderline patients?
A: DBT seems to have done quite well in the treatment of BPD. More has been done than with CBT. "It takes a long time to get the get the type of result you want". There's also "schema therapy, a CBT variant" which can also be long-term. "The psychologist has to be flexible, kindly but stern... and teach the patient self-control without being demeaning." In some ways, it is easier to work with schizophrenics, delusions and all, than borderline personality disorders.

Dr. Beck needed to end the session a bit early, so I dashed off to catch the end of a nearby symposium on non-traditional modalities of treatment, including bibliotherapy, cinematherapy etc. I missed the first part -- about online counseling (which I was told used some of my own material)-- but caught the tail end of a look at cimematherapy and a review of bibliotherapy research. Lucky me! I was able to attend two symposia at the same time without a need to "split"! But I did miss the first 2/3 of the 2nd symposium: on use of media as therapy supplements.



Alternative Treatment Methods and Modalities

The bit which I caught of the symposium on alternative modalities as therapeutic supplements was on bibliotherapy, and the various impressions which people typically have of what this entails: "Self-help prescription" [British NHS] and "Reading your way to mental health" [Wall Street Journal] are two examples of why devotees are enthusiastic about therapeutic potential. In fact, in the UK their National Health Service embraces self-help as a cost-effective treatment option, one which might be in the form of a "prescription" for a book which is held on reserve in the local library. Stuart Fischoff presented an overview of Cinematherapy - covering for the presenter who was absent, and then Lawrence Balter spoke about his area of interest, bibliotherapy.

The question, in this age of evidence and efficacy, is: does bibliotherapy help? Unfortunately there is no strong evidence to support a definitive response. One (2008) study which Dr. Balter cited had in its conclusion a call for more research, but also noted that such methods "might well hold some promise as a useful adjunct for the busy practitioner." Dr. Balter has published numerous children's books with the idea of providing a tool which is age and situation appropriate. There have in been some studies which demonstrate, in particular, a positive effect in terms of ameliorating a specific type of problem behavior via how-to books for parents. The results were that although more effective than wait-list status, even more of a positive effect was obtained with a group therapy condition.

In terms of the future, when thinking about providing supplemental (non-f2f) treatment tools as bibliotherapy or self-help tools/prescriptions, think about this:

1. "Know your populations". People are caught in all different types of situations, and the studies aren't specific enough.
2. Is a person self-administering bibliotherapy or working with a psychologist or someone else?

There is still a lack of evidence to support use of some interventions in particular situations. It is important to ask, therefore: Can it hurt? A "cautionary note" was sounded also about the risk of missing the need for "necessary and adequate help" and also of "negative attributions" where the unsuccessful self-helper will become increasingly self-blaming for failure to get better. On the other hand.... the issue of "functional credibility" sometimes takes on a large role, and "self-help is not going away any time soon.... It's aspirational, it's anecdotal, but it's not sufficiently empirical."

A last comment or two was made on the power of film, which shares a status with Reading in this regard: "Film is the new literature, the literature of the 21st century. People don't discuss book chapters, they talk about movie scenes." [And YouTube clips! -mf]

Research shows that "laughing helps, crying helps... there are physiological factors" and the power of humor and sharing feelings is well known. The "3 E's" of movie therapy are "entertainment, education, and empowerment". Films provide canvases where they talk about the same issues as your patients are deal with. They can parallel or illuminate a process. "Projection, Identification, and Discussion". Some examples were shared of powerful movie scenes having strong impact on a viewer, for example being shaken and determined not to return home. The speed and power of feelings being evoked via film can be powerful, and "a sort of immersion experience".

A few thoughts were tossed about: "TV as a Rorschach", the cultural infatuation with "Family Guy", the news coverage of a travelling garden troll, and more.

Suggestions for further reading included Dr. Danny Wedding's "Movies and Mental Illness" for a different perspective: the media's depiction of psychology/mental health. A site worth visiting (said the speaker) : Cinematherapy.com

My last big event of today (and this year's convention, in terms of symposia), was a presentation by the legendary Drew Westen, who is a bright, witty political analyst (among other things) who presented on "the mind and brain of the voter", and analyzed the ways in which parties and candidates are using word association and other strategies to send overt and 'subliminal' messages.

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DISCLAIMERS: 1) I do my best to take verbatim notes and rely on additional handouts and individual speakers to help ensure facts & numbers are reported accurately. If I have erred in any quote or presentation of data/findings etc., I would be happy to correct the report upon being informed, and I welcome additional references/comments by individual presenters. 2) Drew Westen, whose presentation follows, very quickly and clearly stated that while politics and public opinion were the focus, in no way was it intended to be partisan or suggest any endorsement of one or another party or candidate. Similarly, I endeavor here to report on the presentation and refrain from partisan/political endorsement or position.

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Asynchronously Live from APA 2008
16 Aug 2008



Invited Plenary Address # 3346
Drew Westen: Inside the Mind and Brain of the Voter: The Presidential Campaign of 2008.

I was lucky enough to converse with some media psychologists during the conference, and over the 2 days I heard several references to an exciting-sounding presentation on an important topic: Presidential elections, and beyond that, the ways in which issues and positions get engraved in our social lexicon via "spin" and focused messages... this was the topic: How hearts and minds are manipulated by the media and political spin doctors, and how the general public reacts.

Dr. Westen - who has a new book out entitled "The Political Brain" - began by saying that his presentation would be non-partisan. While the audience may have reflected its own (diverse) response to various film clips and anecdotes, there were certainly examples of many blunders by both major political parties, and within parties among candidates. If nothing else, what was presented was fascinating for the look at how psychology gets put to work deliberately and otherwise in putting out messages to an electorate. What makes people vote for a given candidate? Beyond that, how easy is it to manipulate public opinion through clever advertising with hot buzz words and word associations? How is it that words (e.g., "liberal") once beloved, are now radioactive? How can one present a position on things like abortion or economic circumstances, immigration or education, without invoking frightening images, and (within the political context) providing a candidate with an effective sound byte to ingrain into the public's consciousness? Think: "right to life" vs. "women's rights", "surge" vs. "war", "victory", "flip-flop", "liberal" vs. "progressive", "conservative" vs. "evangelical", etc.

It was clear why the large room was packed and people had been buzzing: Dr. Westen was engaging, spoke quickly and with wit, and gave anecdotal examples as well as video clips, which included his "worst of breed" nominations for getting out the right message for the moment.

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Drew Westen, introduced by panel chair Sharon Brennan, began by having the audience take part in an "experiment" where we were to memorize 3 pairs of words, and then say the name of a car (as a test &/or "distractor item") and then the name of a laundry detergent. Almost everyone chose "Tide", after being "primed" by exposure to several words such as "moon" and "ocean". His point was made. We hear the same buzz words and associations, or "networks" of word associations all the time, in ads for detergent and ads for our Presidents. What are the psychological principles at play here, and how are some campaigns exploiting the power of the media in successful ways while some get nowhere with their efforts at generating voter enthusiasm? This report, along with Drew Westen's presentation, is non-partisan, and he made that point. And in fact, his illustrations of the good, bad, and ugly presentations of candidates poked equal fun (on their own, usually) at people of all persuasions, politically.

Following his word association demonstration, he showed a video of a news anchor making a slip so that he mouthed a sexual slang word rather than a similarly sounding word. Examining the clip we could see that he was following a type of internal linguistic script and where his processing went awry because of similar sound sequences having upset his pattern of speaking. (You had to be there. This article is intent on being not only non-partisan, but also G-rated!)

One of the strengths of the GOP (Republican Party) has been their "brand recognition" as the party of democracy, small government, etc... but as news followers clearly see, the "brand" is no longer selling on name alone, and people are inclined to vote for personal priorities being represented, and for ideals - including "this person has values I believe in" and "I feel I can trust this person to lead us in the right direction". The good news for Republicans who are confronting a tarnished brand now, is that Democrats don't have a viable "brand" either. So you know the level of discussion now: it's about the future, core values, and leadership.

There are constraints on Democrats, such as how to approach guns, even on the heels of recent gun massacres. The numbers are in: 75% of Americans believe in the right to hunt, and the right to protect one's family. Stated like that, that's an impressive core belief. Worded differently, however, we find that 100% of parents questioned said they want their children to come home safely from school. Clearly there is room here for some reflection on implications. But the right notes have to be sounded, and people doze off with discussions of 12 point plans and complex plans which only vaguely relate to core issues. Al Gore did not help his efforts to reign in gun access by saying 'I believe in registering new handguns but not old ones'. "Is there a principle?"

Republicans "always lead with their principles". Democrats lead with policy: "Here's what I believe in" versus "Here's my 12-point plan".

Other bad ideas include talking about S-CHIP rather than "children's health". One needs to better explain "universal health care" in trying to promote it. The first problem is the phrase, which like "liberal" has been turned into a catch phrase for communism or socialism, "socialized medicine" devoid of choice, etc. Westen would not use the words "universal health care", since our network of associations almost invariably connect this to "socialized medicine" and "bad". What would happen if there was a push for "a family doctor for every family"? Unfortunately for Democrats, they often "work on the plan but not the language". The Republicans have become masters at their version of "instant messaging". [However they have not exploited the Internet as well as Democrats, and their Presidential standard bearer for change does not know how to use a computer. Many pundits are wondering the extent to which the Internet factor will exert a role.]

Another example of how hot-button words get connected to a network of associations and responses: abortion. "If you say 'reproductive health", they say "baby killer". That outweighs it. But you could win by 20 points if you speak instead about a woman's "right to choose".

Americans (85%) are religious. One might acknowledge and use this in several ways, as we can observe in the daily news. This could be framed differently as well: One side might focus on "the woman's right to choose versus God's right to choose", and the other might reply "I just don't like the idea of the government telling a couple when they should start a family". Choosing one's "network" of associations can change one's effectiveness. "The difference between winning and losing depends on what networks you choose to activate".

One needs to be aware that there is cultural and historical context as well. While many people embrace a "woman's right to choose" as a core human right, it was a central theme of the "women's movement", very powerful, but in a different time. Words and networks change over time.

Too much detail turns people off, notwithstanding the inevitable calls for "details", often from the media. Gore was seen as doing fabulous in a debate, but even after listening to it 100 times, it's not easy to recall the points. Listening to Bush, who was seen as (technically) a much poorer performer, it is clear that he came across as a person who knew what he wanted, whereas Gore was talking about actuaries and assuming people knew what they are. "Simplicity... tell people you mean it."

Competence is not a big factor in persuading people to vote for them. What is? Passion. The best predictors of garnering votes are:

1. Feelings towards the principles of the parties (You can't just think "liberal" and "conservative" these days as shorthand for "what I believe in" since the GOP managed to poison the word "liberal".)
2. Feelings toward the candidate.
3. Feelings towards attributes - leadership, trustworthiness, etc.
4. Feeling towards policies of the candidate - something particularly important for the single-issue voter.
5. Facts about the candidates policies. [Interestingly, this factor alone has very little predictive power.]

1. I want someone who shares my values.
2. I want someone I can trust.

• What story are you telling about yourself?
• What story are you telling about the opponent?
• What stories are your opponents telling about themselves?
• What stories are your opponents telling about you?

INDEX OF 2001 APA Convention Articles:
Behavioral Telehealth | E-biz of Mental Health | 2001: A Cyberspace Odyssey

INDEX OF 2002 APA Convention Articles:
CyberSex & Cyber-Infidelity | Beck & Ellis 2002 | Behavior Therapy | CyberPsychology | E-Ethics

2003 Convention Highlights: Full Text | Beck 2003 | Quality of Online Health Info | Sternberg's Vision

2005 Convention Highlights:   Opening Session | Pioneers of Behavior Therapy
Distinguished Elders of Psychotherapy | Legends Discuss Psychology | Online Clinical Work | Town Hall Meeting

2006 Convention Highlights:
Opening | Online Psychotherapy & Research | Psychological Vital Signs | Advances in Cognitive Therapy
Brok on Chaplin | Conversation with Aaron T. Beck - 2006 | Dr.Phil | 21st Century Ethics | Media: Town Hall '06

2007 Convention Highlights:
Humanizing an Inhumane World | Opening Session | Albert Bandura | Linehan, on Suicide
Psychology's Future | Conversation with Aaron T. Beck - 2007 | Evil, Hate, & Horror

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