Our Students Need Support: Gaps in Graduate Student Mental Health Options
Alexandra B. Klein, M.A. (1), Ana Rabasco, M.A. (2), Ellen H. Steele, M.A. (3), Nora Barnes-Horowitz, B.A. (4), & Ivy Tran, M.A. (5)
Case Western Reserve University (1); Fordham University(2); Mississippi State University (3); University of California, Los Angeles (4); Hofstra University (5)
As many as 70% of graduate students in clinical psychology will experience stressors that impact their functioning, including those related to academic pressures, financial stress, anxiety, and poor work/life balance (El-Ghoroury et al., 2012). Recent literature has highlighted the importance of self-care strategies in helping graduate students effectively cope with both present and future stress. In particular, professional support systems and awareness of one’s needs and reactions to stressors have emerged as two important aspects of self-care among a sample (N = 358) of clinical psychology graduate students (Zahniser et al., 2017). However, student perspectives on self-care initiatives in their programs suggest that a systematic effort to educate about, encourage, and model self-care strategies is lacking (Zahniser et al., 2017). Further, one study found that 38 to 75% of clinical psychology graduate students are likely to seek treatment for a range of issues including psychopathology and career-related stressors (Holzman et al., 1996).
Taken together, this small body of research suggests that graduate students in clinical psychology have a need for mental health treatment and that systematic, top-down initiatives focused on implementing clear pathways for students to obtain support and engage in self-care are lacking. Further complicating this issue is the fact that graduate student stipends may not cover the relatively high cost of psychotherapy, though this assumption is anecdotal and requires empirical testing. Additionally, providers in the community may serve as supervisors and lecturers within clinical psychology programs, limiting the number of providers with whom students can initiate care. Therefore, the SSCP Student Committee conducted a survey to better understand the resources currently available to assist graduate students in SSCP with accessing mental health treatment. Findings from this survey and initiatives being implemented to address this issue are discussed below.
A total of 73 students completed the anonymous survey, which was administered via the SSCP student listserv. The results suggest that over half of students (52.1%; n = 38) do not have a clear way within their graduate program to obtain information about mental health treatment that may be available to them. The majority (54.8%, n = 40) reported that if they were to seek care, they would look for resources on their own rather than through their advisor, DCT, program, or university. Of the programs where a DCT does keep a list of available resources, the majority of students reported that the lists were either not up to date (21.3%; n = 13) or they were unsure if the resource list was up to date (65.6%, n = 40).
Further, while the majority of students reported that the resource lists included clinicians providing empirically supported treatments (56.4%, n = 31), over a third reported that the treatment options are not affordable (35.2%, n = 19). Taken together, findings from this survey reflect a clear need for clinical psychology programs to develop resource lists of affordable, empirically supported treatment options for their graduate students, or when such resources are not available in the local community, options that are accessible via telehealth. Additionally, students need a clear avenue for obtaining these resources and seeking treatment.
In an effort to assist graduate students and programs with obtaining and advertising mental health resources, the SSCP Student Committee will be engaging in three ongoing initiatives. First, the committee plans to publish findings from this brief survey in a peer reviewed publication in order to bring awareness to this issue and encourage future research. Secondly, we will develop a high-level list of resources to help students navigate finding mental health resources that will be effective for them. Finally, we plan to form partnerships with other professional organizations in order to: 1) assist DCTs with compiling resources, and 2) engage providers in offering services to graduate students at a reduced rate. As graduate students are the future of scientific research and practice in clinical psychology, opportunities for treatment and care will prove a valuable initiative for the future.
El-Ghoroury, N. H., Galper, D. I., Sawaqdeh, A., & Bufka, L. F. (2012). Stress, coping, and barriers to wellness among psychology graduate students. Training and Education in Professional Psychology, 6(2), 122.
Holzman, L. A., Searight, H. R., & Hughes, H. M. (1996). Clinical psychology graduate students and personal psychotherapy: Results of an exploratory survey. Professional Psychology: Research and Practice, 27(1), 98.
Zahniser, E., Rupert, P. A., & Dorociak, K. E. (2017). Self-care in clinical psychology graduate training. Training and Education in Professional Psychology, 11(4), 283.
Telehealth in Clinical Psychology:Challenges and Future Directions
Henry A. Willis, M.A.
University of North Carolina at Chapel Hill
I am a doctoral candidate from the University of North Carolina at Chapel Hill, and a current psychology intern at Montefiore Medical Center/Albert Einstein College of Medicine. My dissertation, defended just a few months before the start of the COVID-19 pandemic, explored culturally adapting mobile-health (mHealth) and telehealth technologies for use among African American youth and young adults. At the time of my defense, the widespread use of telehealth and mHealth in clinical psychology seemed like a far-off reality. Yet, in light of the COVID-19 pandemic, the field was forced to immediately adapt to telehealth, and mental health professionals experienced a sudden, mass migration to delivering services online. Despite my own foundation and passion for telehealth, I still found that utilizing technology to deliver psychological services to be a jarring experience. Though some aspects of delivering psychological services via telehealth seemed straightforward, both my research and personal experiences have exposed the challenges that face clinicians and student therapists, especially when we treat those from vulnerable populations (i.e., people of color, those from low-income backgrounds, etc.). In this perspective, I discuss challenges that may arise when utilizing telehealth as a student clinician, considerations for using telehealth with vulnerable populations, and potential future directions for telehealth and mHealth.
1. Possible Challenges of Utilizing Telehealth as a Student
Delivering psychotherapy via telehealth has its many advantages (i.e., reaching clients that may have transportation challenges, who may live in rural areas, etc.) but as a student, I’ve found that I was often faced with many practical challenges that impeded early attempts to deliver services effectively. The first challenge is access to working devices and effective internet. Faculty members and supervisors may assume that students have access to a camera-enabled mobile device and high-speed internet due to our status as graduate students, but delivering psychotherapy via telehealth often requires additional resources. For instance, even if one has the necessary “hardware” (i.e., a computer with a working camera and microphone), there can sometimes be difficulties with devices being able to effectively handle the various programs required for telehealth (i.e., Zoom, Microsoft Teams, etc.). Initially, I often found that my home internet was not “fast enough” to handle telehealth sessions, and this is often a challenge for students who do not live alone and may have others utilizing the same internet/WiFi. This can be distressing to student therapists as it leads to constant disconnections or visual/audio difficulties that impacts our ability to deliver services effectively. Moreover, student therapists may not have the resources to create an environment that is conducive to delivering treatment. For instance, students who are parents, live with family members or roommates, and/or who have limited space within their homes are at a particular disadvantage.
Lack of access to reliable hardware and internet may disproportionately impact graduate students who are from low-income backgrounds and/or already feeling financially strained by their graduate student stipend. As students, in order to grapple with these challenges, it is important that training programs provide additional resources that allow us to effectively conduct telehealth sessions (i.e., funding for mobile-devices/computers, reimbursement for high-speed internet services, etc.). Even if student clinicians have the necessary equipment to conduct psychotherapy via telehealth, our clients may need additional support to engage in telehealth effectively. Often times, I found myself in the dual role of being both a clinician and an IT specialist. For students beginning telehealth, it is important to realize that some session time may be spent helping clients connect to telehealth platforms and/or troubleshoot technological issues. This is stressful for both the student clinician and the client, as either may have varying knowledge of technology and software platforms. Again, this is a situation in which it is important that institutions and training programs provide ample resources, trainings, and support for graduate students to help them feel competent when navigating potential technological issues/difficulties.
In the “virtual” therapy room, a host of other issues may arise. First, given that sessions occur outside of the clinic, there is an increased chance that session content is overheard, either by others in the client’s home, or by others in the clinician’s home. Some solutions exist, such as the use of headphones, but do not entirely ameliorate the difficulty in ensuring confidentiality when therapy takes place virtually. Moreover, during sessions, I often found it harder to navigate leading and facilitating group therapy sessions as it’s easier for clients to talk over each other over Zoom. I also had to become more comfortable “talking over” or interjecting more forcefully during sessions with more talkative clients. In video sessions, it may also be more difficult to pick up on non-verbal cues that we might notice during in-person sessions, such as eye contact, fidgeting, etc.
Additionally, environments outside of the traditional clinical setting are expectedly more chaotic. As a student therapist, I had to become adjusted to being more comfortable with unexpected intrusions, such as loud noises from cars or neighbors, unexpected visitors, and even package deliveries. Our clients are also navigating similar intrusions and unexpected distractions while in virtual psychotherapy. These experiences may impact rapport with our clients and our own perceived effectiveness as clinicians. For example, technical difficulties (i.e., becoming disconnected or frozen) or intrusions may interrupt a client during a particularly emotional or difficult exchange. This inevitably will frustrate both the clinician and the client, and may impact how the client perceives treatment or the clinician. While navigating this, I’ve found that first, cultivating a heightened sense of empathy and self-compassion for myself has helped to deal with the stress of these challenges. Moreover, discussing these potential intrusions/distractions with clients at the beginning of telehealth sessions helps to reduce the distress that occurs when these intrusions inevitably occur. The transition to telehealth and these new challenges also highlighted an increased need for supervisors to begin to take into account how to help students navigate the many issues raised above, and the unique challenges that arise when delivering mental health services via telehealth.
Finally, the biggest challenge I faced when transitioning to telehealth is an increased difficulty to “be present” while in sessions. As I highlighted earlier, a host of intrusions that would not normally occur in a clinical setting increases the risk that both the therapist and client become distracted. Even just being on a computer or mobile device increases the chance that one is distracted by incoming emails, messages, or calls. For those students beginning telehealth, some “best practices” include: closing/silencing mail and message applications, putting your device on “do not disturb”, and communicating any potential interruptions that may occur on your end to the client (i.e., the potential that the session is interrupted by a pet, children, or other factor). Clients should also be made aware and agree to follow these “best practices” to the extent possible. In the end, being transparent with clients about the many challenges we face when engaging in telehealth, being flexible, and applying empathy to both ourselves and our clients, can reduce anxiety related to delivering psychotherapy via telehealth.
2. Telehealth with Vulnerable Populations
Despite my passion for telehealth and mHealth, my research and clinical experiences have highlighted how telehealth is not a silver bullet in terms of resolving disparities in access to or utilization of mental health services. Simply put, existing disparities, especially in marginalized communities, will impact how people engage in tele-mental health treatments. For example, finding safe, private, and secure locations to have therapy is already challenging given the impact COVID-19 has had on several facets of life (adults working full-time from home, children attending school virtually from home, etc.). Unsurprisingly, finding these spaces is even more challenging for those from low-income backgrounds and/or those who may be in urban areas/small households. For clinicians, this means we have to be open to being flexible on where psychotherapy takes place. In my most recent experiences, it’s not uncommon for clients to attend sessions from a car, a park bench, a closet, or even a bathroom. It is also important to realize that those from low-income backgrounds may lack access to working devices, high-speed internet, and/or may not feel comfortable navigating the various software platforms we use for therapy. It’s important for clinicians and supervisors to assess these factors with clients and also be able to help the client find resources in the community that may help them resolve these barriers.
When engaging in telehealth with vulnerable and often underserved populations, it is also important to realize that traditional systemic barriers to treatment do not magically go away because of telehealth. In fact, these obstacles may just impact telehealth in more complex ways. For example, access to childcare is often a barrier to treatment engagement among marginalized groups. Though telehealth means that now families can engage in treatment from home, lack of access to childcare during telehealth sessions can impact parents’ ability to engage in therapy, especially when there is only one caregiver in the home with multiple children. Similarly, existing disparities in equitable access to resources and other determinants of health outcomes (i.e., food, housing, employment, adequate insurance, etc.) have been exacerbated by the COVID-19 pandemic, and disproportionately affect vulnerable populations such as people of color, those from low-income and/or rural backgrounds, individuals with disabilities, and more. These stressors impact the psychological well-being of clients from these backgrounds, and are undoubtedly more stressful or debilitating during this crisis. Healthcare systems and training programs should take on the responsibility of making effective telehealth services more accessible during (and after) this pandemic for these populations.
Finally, it is also necessary to acknowledge the ongoing racial violence against African Americans and the ensuing protests occurring across the country. This, in combination with individuals quarantining and spending more time at home and online, means that there is an increased risk for African Americans and those from other racial-ethnic minority groups to be exposed to the traumatic effects of viewing videos of such violence and unrest online or in the media. My prior research highlighted how exposure to traumatic videos online that portray African American men being shot by police are linked to higher levels of posttraumatic stress and depressive symptoms for African American and Latinx youth (Tynes, Willis, Stewart, & Hamilton, 2019). This increased exposure to online traumatic videos, in combination with stress related to the pandemic, highlights the increased need for culturally-relevant tele-mental health services. Unfortunately, these at-risk communities may also have reduced access to traditional sources of support that contribute to resilience due to the pandemic and quarantine, such as community and family events, religious activities, and social support. Clinicians should address this during telehealth sessions by providing safe, affirming spaces for client’s to process and develop coping strategies to navigate these race-related stressors, while also helping the client find ways to access culturally-relevant support and affirming spaces that exist online. Because of this, culturally-informed clinical training becomes even more vital, as clinicians and supervisors should be prepared to have these race-related discussions during the course of treatment.
3. Future Directions for Telehealth and mHealth
As we continue to utilize telehealth and face the challenges that accompany this delivery method, there is a sense among many that this may become the “new normal” in mental healthcare. As we move forward, despite the many advantages of telehealth, there are many ways these interventions can be improved. Primarily, I believe that the field should strive to integrate telehealth services with mHealth (i.e., the use of smartphone/mobile technology to deliver telehealth) technologies, which could bolster treatment accessibility and engagement, especially among underserved populations. For instance, mHealth applications have the ability to help clients manage appointments and remain engaged in therapy (i.e., mobile devices can deliver text-based appointment reminders/notifications). It may increase homework compliance and accessibility by providing on-demand access to digital resources such as worksheets and psychoeducational readings and videos. mHealth technologies can also help clinicians track clients’ symptoms and response to treatment, as well as improve communication between clients and therapists by providing opportunities to text via secure application messaging in-between sessions. In the end, although telehealth and mHealth aren’t silver bullets for resolving existing barriers to treatment, over time, they have the potential to help clinicians increase access to effective mental health treatments, especially to those from underserved communities.
4. Conclusion: Special Considerations for
Clinical Students of Color
The COVID-19 pandemic, in addition to the concurrent racial violence and injustices, have presented many challenges for students of color. I’ve heard varying experiences from peers about, and have personally struggled with, how to best navigate clinical training during these times. As a Black clinical psychology student, this is even more distressing in that so often, the world around me and the events that are happening have immediate and devastating effects on myself, my family, friends, and community. During this period, I have found it most helpful to engage in self-care, while seeking out safe spaces with advisors and fellow students who identify with my experiences. Most importantly, navigating this time with awareness and acceptance that things are difficult has increased my own self-compassion.
Academia often forces us into a bubble that can sometimes feel separate from the world going on around us. This isolating effect is also compounded by the pandemic and the need to quarantine in an effort to keep those that we care about safe. As we continue to move forward in our clinical training, I hope students of color can continue to find safe ways to cultivate resilience and thrive during this difficult time. As institutions and training programs begin to provide support to graduate students that help them navigate the many changes to our education/training that COVID-19 has prompted (i.e., the switch to telehealth and virtual classes, etc.), I hope that special considerations and culturally-informed support for clinical students of color is also made a priority.
Tynes, B. M., Willis, H. A., Stewart, A. M., & Hamilton, M. W. (2019). Race-Related Traumatic Events Online and Mental Health Among Adolescents of Color. Journal of Adolescent Health, 65(3), 371–377. https://doi.org/10.1016/j.jadohealth.2019.03.006
About the Author
Henry Willis is a doctoral candidate in the Clinical Psychology program at the University of North Carolina at Chapel Hill. His current interests include exploring the relationship between online and offline racial discrimination and mental health outcomes, understanding sociocultural protective factors (i.e., racial identity) and how they impact psychopathology (i.e., obsessive-compulsive disorder) within African Americans, creating cultural adaptations of evidence-based treatments, and utilizing mobile-health technology to increase access to mental health treatments for underserved populations. He is currently completing his predoctoral clinical internship at the Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, New York.
It Won’t Cost You Much, Just Your Voice! On Rediscovering A Human Voice in Academia
Craig Rodriguez-Seijas, Ph.D.
University of Michigan
Am I Qualified to Write This? Absolutely Not! Here It Is.
When I was asked to write this early career perspective, I was honored to contribute my viewpoint to the SSCP membership. And then … excitement quickly blossomed into glowing anxiety, sparkling self-consciousness, and preemptive embarrassment. Naturally, I put off writing this until the day before it was due (Happy International Coming Out Day Everyone!). What’s working without imminent-deadline-angst anyway? To write this is to stand in front of a crowd of academics extemporizing. Unlike any conference or symposium I’d ever attended, there are no notes at my disposal. No citations or references to hide behind. No previous scholarship in which to ground my words. Instead, here I am given free reign to say whatever I want to say. To use my voice in a way that feels much more vulnerable to me. What could I say that would be helpful? What can I say that won’t land me in some abstract trouble that we, as junior scientists, often worry about? And that’s how I settled on writing a piece about my own personal journey to finding a stronger voice within academia. Forgive the needlessly verbose introduction, but I rarely get to write independent of the strict confines and rules of academic scholarship. I’m capitalizing on this opportunity for a more “colorful” approach, as my advisor would have called it.
Initial Soft Whispers
A brief history is worthwhile to provide context of some ways in which I learned to self-silence. It’s the quintessential story of academic coming-of-age. Boy grows up on a tropical island in the Caribbean. Boy typically excels at the top of his class. Boy eventually decided to go to medical school because boy perceived it to be the career boy should aspire to. After two years, boy abandons medical training to restart his undergraduate degree in psychology. And as I trace my professional journey, I realize that this would be the point in my life where I began using my own voice. At this point, I began the process of trying to say and do things consistent with how I actually felt. The decision to leave medical school for a career in psychology was met with several comments of “you’re going the wrong way” and “nobody leaves medicine for psychology”. However, my resolve to switch fields was mostly driven by the close group of friends, my mother included, who spoke truth to my inner experiences. Never in my life did I want to pursue medicine, but I thought that I should since I had the grades to do so, and it was expected of me by my teachers and mentors at that time. Growing up in the proverbial closet means learning, early on, to do, say, and eventually study the things that one perceives will buy approval, affirmation, and acceptance.
I felt liberated studying psychology and everything related to it. Readers might be shocked to learn this, but I quickly became one of the more vocal students in my classes.
Well Hello Again Self-Silence!
Fast forward four years, and I was moving from the warmth of the Caribbean to Long Island, USA, for graduate school at Stony Brook University. As I began graduate training away from friends and family, my voice was held hostage by a much louder internal voice -- one which every graduate student knows all too well -- that second guessed everything I do, did, or contemplated doing. Parts of that voice are common to the graduate experience I believe: we’re in a situation where we are still learning, building expertise, and so never know if we actually know enough to have a truly informed opinion. Other examples seemed more unique to my personal circumstances. As an immigrant, I felt somewhat an outsider. Typical social references used among peers and faculty flew over my head. Knowing that I had initially been waitlisted before eventual acceptance to my graduate program consistently echoed that I was not as smart as my peers. The feeling that I had to ensure that I was maximally productive, more so than some peers, was ever present; I needed to justify my worth to overcome the extra “work” that would befall any institution hiring an immigrant as myself. Leaving the relative safety of Stony Brook, navigating new dimensions of sexual orientation concealment within the professional sphere arose. Should I remove my earrings during the internship interview process, lest some subconscious bias or concern about a perceivably gay therapist’s effect on potential patients land me in a suboptimal internship placment (or none at all)? It wasn’t much consolation to hear from female friends that they had similar struggles in deciding if to wear their wedding rings during internship interviews.
I have had the privilege of being mentored by a host of compassionate and understanding scholars throughout my professional career, starting with my advisor. Fortunately, I was always provided the space to process and discuss perceived injustices within academia. For example, I extensively discussed that decision to proceed on internship interviews without earrings (though I still insisted on at least wearing a pink shirt or tie) with him. I resolved that I needed to engage in some concealment to get myself in the door. Thereafter, I could wreak havoc … I mean … be my authentic self! I believe that much of academia is spent, especially for the most vulnerable, covering one’s mouth and telling oneself that eventually, in a safer place, in the not too distant future, one can do more. One day I will be more vocal. In the future, I will change the way things were, so that those coming after might have an easier time. And I personally believe that these internal dialogues keep junior voices silenced within academia (at least within clinical psychology which is my sole familiarity).
Even now, as I reread what I’ve written thus far, I worry that others will interpret my words as some sort of virtue signalling or hyperbolic description of academia. I worry that readers will view this as some search for sympathy and need for admiration from others. A “woe is me” sort of trope. Perhaps this tidbit most effectively illustrates that voice of self-doubt and expectation of rejection about which I speak.
Now I Can Hardly Shut Up!
This past year has really been a decade! Personally, I have found myself speaking up more than ever before. I realize that, or perhaps I’d like to believe that, I have (re)discovered my voice. I have found myself more willing to invite the extensive distress and anxiety that comes with speaking up into my life (such as a week of sleepless nights worrying about how others might interpret my responses on a professional listserv and if this could result in some long standing negative effects on my professional career). I believe that a major catalyst for this has been my exit from the relative protection I possessed as a graduate student who was fortunate to work with mentors who consistently protected my time, energy, and wellbeing. Academics who studied, and lived with attention to, issues related to stigma and its impact on health. Most importantly, mentors who did the speaking up on many occasions. Having seen these models in my formative professional years really normalized dissent for me.
I wanted this piece to do two things. My major reason for writing this was to voice some small portion of my own continuing struggle to come to terms with the desire to speak openly in academic circles and the desire to exist in relative obscurity. I wanted to voice the normalcy of any and all of *waves hands wildly* this, especially for vulnerable students, early career researchers, and those who fit into one of the many underrepresented bins within academia. Secondarily, as I’ve reflected on the factors that impacted my own eagerness to be more vocal, I figured that they could be helpful for everyone who has felt the desire to speak up, but ultimately been unable to for various reasons. To this second point I turn now: The factors that have given me my own professional voice.
1. Relative Professional Safety
I have been one of the lucky few to be hired at the faculty level. Personally, and I will go out on a limb here saying similarly for many/most/all graduate students, I feel that it is now safer for me to be a voice of even more dissent. One of the primary reasons for silencing has been the whisper that we all hear about where some senior faculty member(s) invariably sabotages the prospects of junior folks due to dislike or disagreement with some seemingly innocuous question or comment that was made by the student/postdoc/ECR. Tenure is still up for grabs, but I feel like there is sufficient relative career safety to justify being more outspoken at this point in my life. I am in the most tremendous awe of the courage of even more junior folks who speak openly, with seemingly so much more to lose than I. Affirm them! When you see it, send a back-channel email. Enter the conversation to support them. Let them know how much you appreciate their willingness to invite discord into their professional-emotional lives. They will appreciate it.
I began graduate school in 2013. After seven or so years of hanging back I truly feel tired of staying silent. Even before the relative safety of a faculty position, I’d begun speaking out more. I’d be lying if I didn’t mention that the sociopolitical climate, one which feels like a continued affront to populations with whom I share several individual attributes, simply means that I’ve been left with a shorter rope. I feel less able to let things just slide by without comment. I might not be able to do as much to enact change in any individual way on a wider global level, but speaking up can help shift the narrative in the more circumscribed academic society in which I exist. However, tiredness has translated to increased action largely because of the other factors I point to above and below.
I have privilege. My relative privilege extends to academia. First and foremost, as a cisgender, non-disabled man I am lauded for speaking out. I’ve been socialized to admire the outspoken male academics within my circles. The adjective “outspoken” invariably conveys only the most positive connotation when describing men yet often takes a more derogatory tone when referring to women. I’m less likely to be disregarded as “emotional” if I voice any concerns. Another example: though I am of mixed descent, my ethnic ambiguity means I can often pass for white or white of Hispanic descent. I believe that I, then, have a responsibility to utilize said privilege in ways that can be beneficial. Having seen numerous women and BIPOC academics be vocal, I’ve gained much contact courage from them, and have felt like I have little excuse to stay silent much longer. That I’ve admired the mentors who spoke up regularly, thereby allowing me to remain silent, I’ve decided that I want to be one of those persons, and again I have a wealth of privilege on my side which permits me to actively do this. I think it imperative to point out that silence does not equate cowardice; speaking up does not equate bravery.
4. Social-Professional Support
Several factors related to social support fundamentally increased over the last three years, directly impacting my willingness to speak more frankly and openly. First, beginning my internship at Brown University found me within a 25-person cohort of very vocal, social-justice oriented colleagues. Ask them at Brown ... we routinely caused (good) trouble! Second, becoming more involved in academic twitter helped me realise that most of the people whom I admired, and by whom I was most intimidated, are largely an interesting band of dad-joke-posting, sourdough-baking folks. Seeing this more human side within academia meant I saw senior academics as less intimidating. Third, when I have ventured to speak out I have largely been met with back-channel support and encouragement, resulting in my own increased resolve to remain vocal (see point 3 above, especially when the support has come from graduate students or those with more to lose than I had for speaking out).
In Conclusion: Proceed with Caution
What is this piece not meant to do? Guilt anyone who has chosen/been forced to stay silent or ignore any inner compulsions to speak up within academia. Further, in no way do I suggest that the onus for change remains at the individual level. Instead, all those folks in academia who hold powerful positions have collectively dropped the ball in creating an appropriately inclusive environment for junior research scientists. I simply present my individual decision-making process. Psychological science leaders hold the lion’s share of the responsibility for change.
What would I like anyone to take home from this? Deciding to be more vocal in any atmosphere is going to be a personal decision. I wanted to outline the processes that go into my own choice of whether or not I can handle the stress that comes with speaking frankly and openly within some academic circles. We’re trying to survive historic injustices that show little sign of abatement, academia, a global pandemic, and so much more. I’ll end with a sentiment that I’ve often used in therapy with young sexual minority clients when discussing the decision to be “out”: There is no blanket rule when it comes to speaking out in academia. Staying silent can be necessary self-preservation. Hopefully you can find some professional environment(s) where you can be your authentically-voiced self.
Craig Rodriguez-Seijas, Ph.D. is an Assistant Professor in the Clinical Science area within the Department of Psychology at the University of Michigan. He currently directs the Stigma, Psychopathology, & Assessment (SPLAT) Lab which focuses on understanding dimensional models of psychopathology and, in particular, factors related to the expression, assessment, conceptualization, and treatment of psychopathology among populations that contend with stigma, discrimination, and denigration.
Client Attitudes Towards Telemental Health and What We Can Do to Address Them
Hannah Brockstein, B.S.
Alvord, Baker & Associates, LLC
The COVID-19 global pandemic has increased the need for telemental health services worldwide as offices are closed due to state and local guidelines. Clients are feeling isolated and lonely while quarantined to their homes, they are lacking in social interaction and support, and are feeling anxious about the uncertainties that have come along with a global pandemic. We know based on previous research that telemental health is effective across ages for a variety of disorders including anxiety (Berryhill et al., 2019), depression (Osenbach et al., 2013), PTSD (Frueh et al., 2007), and ADHD (Myers et al., 2015). There has been minimal research conducted on how clients perceive these services. As employees and clinicians of a private psychology practice, we sought a better understanding of the attitudes of clients and potential clients towards telemental health services before and during COVID-19 in order to help clients feel more comfortable with this technology.
We devised a survey asking a variety of questions related to the demographic information of the respondents, their comfort and experience with technology and video conferencing, their experience with mental health services, and their greatest concerns and potential benefits of telemental health services. This survey was then disseminated during the month of June using social media, word of mouth from the clinicians in our practice, listservs, and neighborhood groups. In total, we had 185 survey respondents. Unfortunately, our participants were not very diverse. Due to limitations of COVID-19, the survey could only be distributed through online platforms and word of mouth. Of the 185 participants, 76.2% identified as female, 88.6% were White, 90.8% had a Bachelor’s degree or higher levels or education, and 77.8% live in suburban areas. The average age of participants was 42.6 years ± 15.4. We only collected data from consented adults ages 18 or older.
What did participants say?
What is appealing about telemental health?
The majority of responses focused on the convenience of telemental health including reduced travel, optimal hours, ability to continue therapy when sick or unable to leave home, and the opportunity to continue therapy from a remote location.
What are your biggest concerns about telemental health?
The two most common concerns that participants had were less in person interaction and worries about their ability to build a relationship with their therapist. Some other concerns included worries about their ability to communicate virtually, the confidentiality of virtual platforms, worries about dealing with change and unfamiliar modes of therapy, and feeling socially uncomfortable with virtual communication. Most of our participants were not concerned about access or ability to use the technology needed as the vast majority had some video conferencing experience and were relatively comfortable with using technology. Additionally, our participants were highly educated and reside in suburban areas and as a result have greater access to the technology needed (high speed Internet and computer access). In populations with limited financial resources and/or in rural areas, this could be a concern that needs to be addressed with clients.
How has COVID-19 influenced attitudes towards telemental health?
Would you be interested in therapy via (video) telemental health if you wanted/needed therapy?
Overall, 87.5% of people surveyed were interested. Two-thirds of respondents stated that COVID-19 had made them more open to using telemental health.
Please explain how/why COVID-19 influenced or changed your perspective on the use of (video) telemental health?
The overall themes of these comments show that people have begun to see the place for telemental health and how it can be advantageous to access necessary services. People who were previously reluctant have now tried it themselves and agreed that it is very useful for when they are unable to make their appointment or see their clinician in person. Many who had experienced telemental health in the past noted that they still prefer their in-person sessions to virtual sessions.
It is promising that the conditions of COVID-19 have made clients more open to telemental health services. With increasing willingness to try virtual sessions, we have the ability to reach more individuals, especially in communities that have less access to mental health services. It is also important to understand how important access to and comfort with technology are to the willingness to try telemental health. These factors may be important prerequisites for positive attitudes towards telemental health, so it is important for clinicians to advocate for better access for their clients. We can also take this information about client concerns and work to better address them with our own clients.
With input from licensed clinical psychologists at Alvord, Baker, & Associates, LLC, I have eight tips to share about what we can do to address these concerns with clients.
1. Be careful with your assumptions regarding technology comfort.
It is easy to assume, especially now, that clients are experienced and comfortable using technology. However, there are still many people who are not ready to jump into virtual sessions because they do not feel comfortable with the platforms or devices that they need. Offer to practice with your client. You can walk through the steps together (over the phone or in person after COVID-19) until they feel ready to get online themselves.
2. Make sure you have informed consent for telehealth use.
In our practice, we have a specific telehealth agreement form that states the risks of telemental health as well as outlines an emergency plan if you are disconnected or need immediate care.
3. Have a conversation about how telemental health may or may not be different.
Have an open discussion about doing virtual sessions and what might feel different to your client. You can also discuss what might feel the same in order to ease your client’s transition to a virtual platform.
4. Invite clients to bring up their concerns.
Make sure to allow your client to voice their own concerns about transitioning to telemental health. If you can directly address their worries, it may be easier to gain their willingness to try it.
5. Share some of the benefits.
Speak with your client about some of the positive aspects of telemental health. You can use some of the benefits discussed above or come up with some of your own that you have seen with your own clients. Help them see it in a positive light!
6. Ensure privacy.
It is important to discuss confidentiality with clients as well as the parents of a client if they are a child. For example, our clinicians discussed clients having their session in the car with others present or parents who want to eavesdrop on their child’s session now that it is happening in their home. You can address these concerns before they become an issue.
7. Have a backup plan!
We all know that technology sometimes fails, and have probably experienced our fair share of it during this pandemic. Talk to your client about what you will do if something goes wrong. You can make sure you have a phone number to reach each other at if one of you loses internet service or the platform that you use stops working. Having a plan in advance with a client can help ease worries that clients may have about their virtual sessions and can help you think on the spot when something goes wrong!
8. Spend time on the relationship.
One of the main concerns that many of our survey participants had was building or keeping a relationship with their therapist. If you are working with a child, it may be hard to do this so our clinicians suggested having the child screen, draw on the virtual whiteboard, or show you things in their room that they like. There are many virtual games and activities you can find online, or you can get creative and make them yourself!
Never in history has there been such a great need for telemental health. It is positive that most of our participants were willing to try this format for therapy sessions. We believe with the right precautions and collaboration amongst clinicians, telemental health can be an effective way to deliver therapy services to clients in need.
Berryhill, M.B., Halli-Tierney, A., Culmer, N., Williams, N., Betancourt, A., King, M., & Ruggles, H. (2019). Videoconferncing psychological therapy and anxiety: a systematic review. Family Practice, 36(1), 53-63. https://doi.org/10.1093/fampra/cmy072
Frueh, B.C., Monnier, J., Yim, E., Grabaugh, A.L., Hamner, M.B., & Knapp, R.G. (2007). A randomized trial of telepsychiatry for post-traumatic stress disorder. Journal of Telemedicine and Telecare. 13(3), 142-147. http://dx.doi.org.proxygw.wrlc.org/10.1258/135763307780677604
Myers, K., Vander Stoep, A., Zhou, C., McCarty, C.A., & Katon, W. (2015). Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 54(4), 263-274. http://dx.doi.org.proxygw.wrlc.org/10.1016/j.jaac.2015.01.009
Osenbach, J.E., O’Brien, K.M., Mishkind, M., & Smolenski, D.J. (2013). Synchronous telehealth technologies in psychotherapy for depression: a meta-analysis. Depression and Anxiety, 30(11), 1058-1067. https://doi-org.proxygw.wrlc.org/10.1002/da.22165
Hannah is a clinical research coordinator at Alvord, Baker & Associates, LLC, a large group private practice located in Rockville, MD. She graduated from the University of Maryland, College Park in 2019 with a double degree in psychology and family science. Hannah is applying to clinical psychology doctoral programs and is interested in studying the development, implementation, and outcomes of accessible, evidence-based interventions for children and adolescents with ADHD and anxiety disorders.
Stony Brook University
I will start this Presidential column by saying that this has not been the year I thought it was going to be. Indeed, I never could have predicted what would happen during my SSCP Presidency and how science could be affected. I wrote this column in early September, as I was reflecting on a very difficult six months. And even in the weeks between when I prepared this column and its publication just now, events happened, the timing of which I could not have predicted.
One of those was the passing of Scott Lilienfeld.
Though I could not have predicted when we would lose Scott, it was not unexpected. Sadly, when I stepped into the role of President in January, I knew that it was coming. What I didn’t know was coming last January was that Scott would resign and sever his relationship with SSCP later in June. That was completely unexpected. I never would have predicted it, nor the content and intensity of the listserv debate that he initiated. Regardless of your take on that debate, I suspect that most of us would agree that the debate changed SSCP in some ways. I also believe that we can find another point of agreement. Whatever your feelings about Scott, I think we can all agree that Scott made extensive, significant contributions to clinical psychological science, and challenged the field to think critically in novel ways. This is why Scott received the SSCP Visionary Award (formerly the Scott Lilienfeld Visionary Award). Though the award no longer bears his name (on his request), that he was the inaugural recipient of it will always be a part of SSCP history. In addition, as you may know from the listserv, the SSCP Board is discussing, in consultation with stakeholders, the best way to honor Scott in the context of his resignation and request.
So, now I will continue on with what I wrote in early September, reflecting on other unexpected events of the year and their effect on science. I’ll start by telling you a non-scientific story that sets the stage for how I have been thinking about what’s happened, and SSCP’s role going forward. Back in September 2019, when I was President-Elect, Tom Olino (our prior APS Convention organizer) told me that I would need to give a Presidential address at APS. Somehow, I hadn’t realized that. I actually like giving talks, but I didn’t know what I wanted to talk about and the idea of a Presidential address felt somewhat daunting. So I said to Tom, “Ugh, do I have to? I really don’t want to... Would I be totally out of line if I didn’t do this?” Tom was quite surprised by this, knowing me, and he was very kind in response (and basically said “yes, you have to”), but I continued to fret (privately) about my talk. Well, then came the COVID pandemic, the cancellation of APS, and, of course, the cancellation of my talk. Fortunately, I’m enough of a scientist to know that I didn’t cause the pandemic with my wish to not give a talk, but it certainly is one of those “be careful what you wish for” situations! Anyway, not to let passive avoidance take over, I wrote my Presidential address and delivered it as an SSCP VCL. And, of course, now I really wish that I had been able to give the talk at APS.
I’ve had a number of moments this past year when I wished for things, in addition to those related to my Presidential address. I wished the pandemic had never happened. I wished George Floyd (and all the others) had never been murdered. I wished that we could just go back to the time before all of this. But, of course, we can’t. And I quickly came to see that we shouldn’t, even if we could, because these events must be used to teach us about science. The COVID pandemic, and how it has been handled, reinforces the importance of science, the importance of using science to make informed decisions, and the importance of promoting science to everyone. The blatant racist police brutality in the US has drawn our attention to, among other things, the structural and systemic racism that exists, including in science and academia. Although it’s easy to wish this wasn’t true, we would be abandoning our roles as scientists if we did so.
A key aspect of science is questioning. When I was growing up, I was told not to question things, and particularly not to ask people too many questions. But I had a lot of questions, and, although it was hard for me to ask them (you can only imagine the first time I did therapy!), I wanted to, and I knew I had to. My training reinforced this. So now, I bring this questioning to my own science and to the endeavor of science itself in light of calls to look at structural and systemic racism. If we, as scientists, don’t question our own science – including, how it developed, what we value and why, our assumptions, the theories and methods and samples we use – then we’re not being good scientists.
My Presidential address was all about questioning. Although not focused on issues related to racism, it was focused on other aspects of diversity in relationship science, including sexual and gender orientation, and diversity in relationship types. In the talk, I questioned key assumptions on which the field had been operating, with the hopes of encouraging new ways of thinking about and approaching relationships. Relationship science also needs to pay greater attention to diversity with regard to race/ethnicity as well, though I am heartened by the work that does exist. Indeed, there is a growing body of literature on relationship functioning and interventions with underserved couples (e.g., Doss et al., 2020; Parker & Campbell, 2017; Salivar, Roddy, Nowlan, & Doss, 2018; Wischkaemper et a., 2020), particularly African American couples (e.g., Barton et al., 2018; Fincham, Ajayi, & Beach, 2011; Lavner, Barton, Bryant, & Beach, 2018; McNeil, Fincham, & Beach, 2014; Mikle & Dorie, 2019), as well as approaches to understanding and working clinically with diverse couples and families (e.g., Halford & Van De Vijver, 2020; Rastogi & Thomas, 2009).
One thing that stands out for me are data showing that associations between satisfaction in romantic relationships and mental and physical health are consistent across a range of racial/ethnic groups in the US (McShall & Johnson, 2015a; 2015b). Although, we must be very cautious in generalizing from romantic relationships to other relationships, if we look at the literature on interpersonal factors more generally, meta-analytic data support the association between social support broadly defined and health (e.g., Holt-Lunstad, Smith, & Layton, 2010). Broadening further, and pertinent to us, meta-analytic data also support the association between perceived workplace racial discrimination and (poorer) health (e.g., del Carmen Triana, Jayasinghe, & Pieper, 2015). The point I want to make here is that data generally support the notion that the quality of the relationships we have with people, and the extent to which we feel supported and not discriminated against (including in our workplace), is related to our well-being, and this appears to be true across racial/ethnic groups.
My reflections on what has happened in our world since March 2020 and on the state of relationship science (broadly speaking) reinforced two key things that I believe we, as individuals, as an
organization, and as a field, need to do. One is to examine ourselves and our science because, as I noted earlier, questioning is a foundation of science. The other is to build supportive relationships with others, because science tells us how critical relationships are to healthy functioning, across diverse individuals. Importantly, both of these are central to developing cultural humility and to creating an inclusive environment. At the core of doing so is self-examination and awareness, the examination and awareness of structures in our life that we have taken for granted, and being other-oriented in a way that conveys understanding, value, and respect, and allows for the building of collaborative relationships (e.g., Duan, 2020; Hook, Davis, Owen, & DeBleare, 2017).
In the context of this, let me reflect on my SSCP Presidency thus far. In my February 2020 column, I outlined three goals that I intended to pursue.
The first was for SSCP to uphold our focus on science. There are some who believe that I have not done so. SSCP has continued this year to promote science in all the ways it has always done. But there is one way in which we have deviated from what SSCP has always done. And this has been by opening the door to the explicit promotion of a more inclusive science, and to the questioning of ourselves and our science in ways that we typically have not done before as an organization. Furthermore, in doing so, the organization has supported the building of relationships that are more inclusive as well. The SSCP board believes this is an important step for the organization.
Among our organizational achievements in these regards are:
Including resources on racism and anti- racism on our website
Providing reflection questions that may assist SSCP members in developing strategies to become anti-racist
Creating a blog, hosted by our Diversity Committee, that will provide a forum for discussing issues relevant to clinical psychological science
Launching an initiative to utilize our Virtual Clinical Lunch (VCL) mechanism as a shared and centralized venue to compile talks by BIPOC scholars and/or about diversity related issues
Creating an additional set of awards dedicated specifically for BIPOC scholars and/or about diversity related issues. As you know, we recently launched a successful fundraising campaign with the aim of consistently funding a fourth Varda Shoham Clinical Science Training Initiative award focusing on Diversity and Inclusion. We will be creating additional awards, within our existing award mechanisms, going forward.
As another aspect of my Presidential goal to uphold science, I encouraged all of us to do so at the individual level as well as the organization level. In particular, here is a quote from my February column:
“There are things I think we all need to do as individuals as well to continue to promote a scientific approach. One is to think about how we conduct and disseminate science. I have been thinking about something that was discussed at the CAAPS (Coalition for the Advancement and Application of Psychological Science) meeting at ABCT this past November, which was also clearly articulated by Bethany Teachman in a November posting to the SSCP listserv. It’s not surprising, but it highlights one of the ways in which we are failing. Specifically, if we want to truly make an impact and reduce the burden of mental illness, we need to better engage with the people and communities we want to serve and understand their needs in context. Sounds obvious, but we are not successfully doing this. I encourage all of you to think about how you, personally, can conduct research, engage in prevention and intervention efforts, and generally promote science in a way that connects with and reaches those we most need to reach.”
At the time I wrote this, I had no idea we’d be where we are in the US with regard to the anti-racism movement. Indeed, I myself did not fully recognize how negligent we had been as a field despite my personally being actively engaged in diversity, equity, and inclusion efforts since graduate school. As I reflect back on my own words, they resonate even more strongly for me now. In addition, although I framed this as an individual endeavor, this is now, clearly, a necessary organizational and field level endeavor.
The second goal that I intended to pursue this year was to promote collaborative relationships with others to reach shared goals. SSCP was able to accomplish this goal in a very specific way that I had intended. We created an alliance between our External Boards and Awards Committee (EBA) and the Academy of Psychological Clinical Science’s Collaboration and Partnerships Committee (CPC) to work together to increase clinical science representation in the major organizations and leadership roles in psychology. The joint mission of these committees will be to publicize and help elect clinical scientists to leadership positions (and the EBA will retain its other functions as well). Our thanks go to the Chair of EBA, Eugene Botanov, and the Executive Committee of the Academy, led by President Cindy Yee-Bradbury, for facilitating this.
We were also able to accomplish this goal in a way that I could not have predicted when my term began. Specifically, I assisted in initiating and maintaining a collaboration among the leaders of SSCP, the Academy, CAAPS, CUDCP (Council of University Directors of Clinical Psychology), and CCTC (Council of Chairs of Training Councils) to stay informed and, where sensible, to work jointly on anti-racism efforts in the field. At a time where so many organizations are engaging in self- assessment, organizing committees and task-forces to make anti-racism action plans, and calling on BIPOC colleagues to assist, it is important that our leading organizations share resources, work together, distribute workload, and engage in novel activities – and support one another in doing so. I thank Bethany Teachman, Mitch Prinstein, Mandy Jensen-Doss, Cindy Yee-Bradbury, Jason Washburn, and Debi Bell for their engagement in this collaborative and supportive process.
This leads to the third goal that I intended to pursue, which was to encourage service so that our shared goals can be reached. Service is needed now more than ever with the field’s emphasis on anti-racism. This emphasis involves many new and expanded service activities – activities that should be done by everyone. Not just BIPOC individuals, and not just organization leaders, but all of us. And with that, I am thrilled to say that we have a number of new SSCP Board members joining us as we continue to support and promote clinical science, and as we work to support greater inclusivity in our field. Please welcome:
President-Elect: Marisol Perez, Associate Professor, Department of Psychology, Arizona State University
Member-at-Large: Sarah Hope Lincoln, Assistant Professor, Department of Psychological Sciences, Case Western Reserve University
Division 12 Representative: Shari Steinman, Assistant Professor, Department of Psychology, West Virginia University
Student Representative: Rachel Walsh, Graduate Student, Department of Psychology, Temple University
President-Elect: Marisol Perez, Associate Professor, Department of Psychology, Arizona State University
Member-at-Large: Sarah Hope Lincoln, Assistant Professor, Department of Psychological Sciences, Case Western Reserve University
Division 12 Representative: Shari Steinman, Assistant Professor, Department of Psychology, West Virginia University
Student Representative: Rachel Walsh, Graduate Student, Department of Psychology, Temple University
I also want to take this opportunity to thank our out-going Board members:
Ana Rabasco (Student Representative)
Bob Klepac (Division 12 Representative)
Katie Baucom (Member-at-Large)
Carolyn Becker (Past-President)
Their dedication to SSCP was tremendous and unfailing, and their contributions were significant. Indeed, the entire SSCP Board this past year worked extremely hard and was the epitome of collaborative, committed teamwork. The organization has benefitted greatly from, and I thank them deeply for, their service. I particularly want to thank our out-going Past- President, Carolyn, for her strong leadership and wise guidance.
I look forward to continuing my Presidential initiatives in the remaining months of my Presidency, and I thank you all for your support. Although not the year I thought it was going to be, it was an honor to serve as President of SSCP.
Barton, A.W., Beach, S.R.H., Wells, A.C., Ingels, J. B., Corso, P. S., Sperr, M. C., Anderson, T. N., & Brody, G. H. (2018). The Protecting Strong African American Families Program: A Randomized Controlled Trial with Rural African American Couples. Prevention Science, 19, 904–913. https://doi.org/10.1007/s11121-018-0895-4
del Carmen Triana, M., Jayasinghe, M., & Pieper, J. R. (2015). Perceived workplace racial discrimination and its correlates: A meta-analysis. Journal of Organizational Behavior, 36, 491-513.
Doss, B. D., Knopp, K., Roddy, M. K., Rothman, K., Hatch, S. G., & Rhoades, G. K. (2020). Online programs improve relationship functioning for distressed low-income couples: Results from a nationwide randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(4), 283–294. https://doi.org/10.1037/ccp0000479
Duan, C. (2020). Serving the underserved: Delivering culturally appropriate psychotherapy to racial and ethnic minorities. In J. Zimmerman, J. E. Barnett, & L. F. Campbell (Eds.), Bringing Psychotherapy to the Underserved (pp. 69-07). NY: Oxford.
Fincham, F. D., Ajayi, C., & Beach, S. R. H. (2011). Spirituality and marital satisfaction in African American couples. Psychology of Religion and Spirituality, 3(4), 259–268. https://doi.org/10.1037/a0023909
Georgia Salivar, E. J., Roddy, M. K., Nowlan, K. M., & Doss, B. D. (2018). Effectiveness of the online OurRelationship program for underserved couples. Couple and Family Psychology: Research and Practice, 7(3-4), 212–226. https://doi.org/10.1037/cfp0000110
Halford, W. K. & Van De Vijver. F. (2020). Cross-Cultural Family Research and Practice. Academic Press.
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7, e1000316. http://dx.doi.org/10.1371/journal.pmed.1000316
Hook, J. N., Davis, D., Owen, J., & DeBleare, C. (2017). Cultural Humility: Engaging Diverse Identities in Therapy. Washington DC: APA.
Lavner, J. A., Barton, A. W., Bryant, C. M., & Beach, S. R. H. (2018). Racial discrimination and relationship functioning among African American couples. Journal of Family Psychology, 32(5), 686–691. https://doi.org/10.1037/fam0000415
McNeil, S. N., Fincham, F. D., & Beach, S. R. H. (2014). Does spousal support moderate the association between perceived racial discrimination and depressive symptoms among African American couples? Family Process, 53(1), 109–119. https://doi.org/10.1111/famp.12054
McShall, J. R. & Johnson, M. D. (2015). The Association Between Relationship Distress and Psychopathology Is Consistent Across Racial and Ethnic Groups. Journal of Abnormal Psychology, 124, 226–231.
McShall, J. R. & Johnson, M. D. (2015). The Association Between Relationship Quality and Physical
Health Across Racial and Ethnic Groups. Journal of Cross-Cultural Psychology, 46, 789–804.
Mikle, K. S &. Gilbert, D. J. (2019). A systematic review of culturally relevant marriage and couple relationship education programs for African-American couples. Journal of Ethnic & Cultural Diversity in Social Work: Innovation in Theory, Research & Practice, 28, 50-75.
Parker, M. L., & Campbell, K. (2017). Infidelity and attachment: The moderating role of race/ethnicity. Contemporary Family Therapy: An International Journal, 39(3), 172–183. https://doi.org/10.1007/s10591-017-9415-0
Rastogi, M., & Volker, K. T. (2018). Multicultural Couple Therapy. Thousand Oaks, CA: Sage.
Wischkaemper, K. C., Fleming, C. J. E., Lenger, K. A., Roberson, P. N. E., Gray, T. D., Cordova, J. V., & Gordon, K. C. (2020). Attitudes toward relationship treatment among underserved couples. Couple and Family Psychology: Research and Practice, 9(3), 156–166.
Note. This article will be featured in our Clinical Science newsletter: Fall 2020.
“Rona”, as I colloquially call the virus when in conversation with friends and loved ones, has caused a complete upheaval of my life professionally and practically. In this column, I will discuss some of the implications from COVID-19 as a graduate student of color and personally. I will then provide some recommendations for students and for faculty members on how best to support their students from marginalized populations, including a positive initiative I have seen take place within my own organization.
COVID-19: The Good, the Bad, and the Semi-Ugly
Before all of the associated changes from COVID-19, I can admit that I was trying to accomplish too much this semester and was risking burning out. There is literature to suggest that ethnic minority students in graduate programs face stressors including racial discrimination, racial prejudice, feelings of isolation, and different cultural expectations that negatively impact their academic experience (Dyrbye et al., 2007). As a result, ethnic minority students had higher rates of burnout and depressive symptoms, and a reduced quality of life. Not only was I on a trajectory towards burnout by virtue of being one of the few minorities in my program, I was also actively (unintentionally) pushing myself to that point.
COVID-19 slowed me down dramatically. Professionally, almost all of my obligations were abruptly put on hold. I ended up cancelling my Spring Break plans and entered into immediate self-isolation. However, I did not realize how much I had been pushing myself until about a week into my Spring Break (my University extended Spring Break an extra week) when I realized I had barely opened my laptop and was checking my email at the rate of once every few days (I typically check my email multiple times in one day). I felt free, but I also felt an inkling of guilt at not being productive. To compound these feelings, New Jersey quickly emerged as the second epicenter of COVID-19 in the U.S. While I am currently living in Alabama for school, I am from New Jersey and many of my family members still live there. My parents and my grandmother are all either older or have some health complications that would make them vulnerable to the virus. My mother is also a certified nurse midwife, making her an essential worker. On top of my guilt at being unproductive, I was developing growing anxiety for my family. I made the decision not to fly home in early March for fear that I might catch something on the plane and give it to my parents (imagine the irony). It was a hard notion to contend with for many of the early weeks of the pandemic.
Moreover, my larger struggle was in challenging the rhetoric of the “Strong Black Woman”. The Strong Black Woman race-gender schema holds that Black women must be strong, self-reliant, resistant to negative mental health outcomes regardless of the circumstance, and willing to take care of others even at her own personal expense (Abrams, Maxwell, Pope, & Belgrave, 2014; Black & Peacock, 2010; Nelson, Cardermil, & Adeoye, 2016; Watson & Hunter, 2015). For the Strong Black Woman, breaks are not even thought of. This is a not a role I actively sought, but it is absolutely one that I have fallen into. For this reason, after my second week of doing nothing, the feelings of peace quickly shifted to blame, guilt, and some self-chiding. The grace that I had given myself during the weeks prior had dissolved into negative self-talk suggesting that I should be doing more and that my productivity should have doubled (or even tripled) with the increased time at home. I was unduly hard on myself. I had to have some candid conversations with loved ones, engage in journaling, and find others who seemed to understand my struggle (see the citation for the New York Times piece: “Stop Trying To Be Productive”) in order to let myself off the hook and find a happy medium between self-care and productivity during COVID-19.
I am not at all an expert on the marginalized student experience during COVID, but I want to share a couple of things that I have found helpful personally that could help you if you are a student from a marginalized population, or if you are seeking to help your students from marginalized populations.
Recommendations for Students from Marginalized Populations During This Time
Limitations of My Experience
While I acknowledge that COVID-19 has presented additional hurdles for all graduate students regardless of race, ethnicity, or cultural background, I would be remiss if I did not highlight a special group that could be disproportionately disadvantaged at this time: students of Asian descent and/or international students from Asian countries. There is a portion of the rhetoric surrounding COVID-19 that is placing blame on Asian countries for the creation and spread of COVID-19. Some of the implications from this have been hate crimes and mistreatment of selected groups of people/students. I cannot fathom what students of Asian descent/from Asian countries might be going through at the moment, and I will not try to speculate about or dictate their narratives for them.
Abrams, J. A., Maxwell, M., Pope, M., & Belgrave, F. Z. (2014). Carrying the world with the grace of a lady and the grit of a warrior: Deepening our understanding of the “strong black woman” schema. Psychology of Women Quarterly, 38, 503–518.
Black, A. R., & Peacock, N. (2011). Pleasing the masses: Messages for daily life management in African American women’s popular media sources. American Journal of Public Health, 101, 144–150.
Dyrbye, L. N., Thomas, M. R., Eacker, A., Harper, W., Massie, F. S., Power, D. V.,…Shanafelt, T. D. (2007). Race, ethnicity, and medical student well-being in the United States. Archives of Internal Medicine, 167, 2103-2109.
Lorenz, T. (2020). Stop trying to be productive. Retrieved from https://www.nytimes.com/2020/04/01/style/productivity-coronavirus.html
Nelson, T., Cardermil, E. V., & Adeoye, C. T. (2016). Black women’s perceptions of the “Strong Black Woman” role. Psychology of Women Quarterly, 40, 551–563.
Watson, N. N., & Hunter, C. D. (2015). Anxiety and depression among African American women: The costs of strength and negative attitudes toward psychological help-seeking. Cultural Diversity and Ethnic Minority Psychology, 21, 604–612.
Thomas Ollendick, Ph.D.
Distinguished Professor in Clinical Psychology
Director of the Child Study Center
Virginia Polytechnic Institute and State University
Thomas H. Ollendick, Ph.D., is University Distinguished Professor in Clinical Psychology and Director of the Child Study Cent- er at Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA. He is the author or co-author of 350+ research publications, 100+ book chapters, and 38 books. His recent books include the Oxford Handbook of Clinical Child and Adolescent Psychology, Innovations in CBT Treatment for Childhood Anxiety, OCD, and PTSD (Cambridge), and Emotion Regulation and Psychopathology in Children and Adolescents (Oxford).
He is the past editor of the Journal of Clinical Child and Adolescent Psychology and Behavior Therapy, as well as founding and current Co-Editor of Clinical Child and Family Psychology Review. He is Past-President of the Association for the Advancement of Behavior Therapy (1995), the Society of Clinical Psychology (1999), the Society of Clinical Child and Adolescent Psychology (2007), and the Society for the Science of Clinical Psychology (2010). The recipient of several NIMH grant awards, his clinical and research interests range from the study of diverse forms of child psychopathology to the assessment, treatment, and prevention of these child disorders from a social learning/social cognitive theory perspective. He has served as the mentor and dissertation advisor for 44 doctoral students – all since joining Virginia Tech in 1980.
Dr. Ollendick received an Honorary Doctorate from Stockholm University in 2011 and holds Honorary Adjunct Professor Positons at Roehampton University in London, Griffith University in Brisbane, Australia, and Sydney Institute of Technology in Sydney, Australia. He was awarded the Distinguished Research Contributions to the Field of Clinical Child Psychology in 2007 (APA), the Career/Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies in 2013, the Lifetime Achievement Award for Scientific Contributions from the Society of Clinical Psychology (APA) in 2017, the Aaron T. Beck Lifetime Career Award from the Academy of Cognitive Therapy (2019), and, most recent- ly, the Lifetime Achievement Award from the Spanish Society for Child and Adolescent Clinical Psychology (2019).
Tommy Ho-Yee Ng, M.Phil.
Tommy Ho-Yee Ng, M.Phil. is a sixth year Ph.D. student in Clinical Psychology with a Specialization in Neuroscience at Temple University under the supervision of Dr. Lauren Alloy. Tommy earned a B.A. in Psychology from the University of California, Berkeley and a M.Phil. in Psychiatry from the University of Hong Kong (HKU). He is completing his clinical internship at NewYork-Presbyterian Hospital / Weill Cornell Medicine.
Tommy’s research is committed to improving our understanding of bipolar disorder and unipolar depression. His work is funded by grants from the American Psychological Foundation, the Council of Graduate Departments of Psychology, the American Psychological Association of Graduate Students, the National Institute of Mental Health, and the Sir Edward Youde Memorial Fund. Tommy is the recipient of a number of awards, such as the Early Graduate Student Researcher Award from the American Psychological Association, the President’s Award from the Society Research in Psychopathology, and the Outstanding Student Researcher Award from SSCP.
1. What are your research interests? Bipolar disorder and unipolar depression are two of the most debilitating conditions in the world, according to the World Health Organization. Many patients do not respond to conventional treatments and remain symptomatic after years of treatment. Despite the great public health significance, major unanswered questions exist regarding their underlying mechanisms. Yet, understanding their pathophysiology is crucial for translating foundational knowledge to theoretically coherent interventions designed to prevent or treat these impairing conditions. My area of research is exciting to me because of its potential to lead to targeted prevention and treatment programs for those with or at risk for mood disorders and relieve their burden.
2. Why is this area of research exciting to you? Bipolar disorder and unipolar depression are two of the most debilitating conditions in the world, according to the World Health Organization. Many patients do not respond to conventional treatments and remain symptomatic after years of treatment. Despite the great public health significance, major unanswered questions exist regarding their underlying mechanisms. Yet, understanding their pathophysiology is crucial for translating foundational knowledge to theoretically coherent interventions designed to prevent or treat these impairing conditions. My area of research is exciting to me because of its potential to lead to targeted prevention and treatment programs for those with or at risk for mood disorders and relieve their burden.
3. Who are/have been your mentor(s) or scientific influences? I am fortunate to have received mentorship from a group of inspiring scientists who also happen to be incredible human beings. This includes Dr. Sheri Johnson who helped me to discover my love of research; Dr. Ka Fai Chung who provided me with the freedom and encouragement to rigorously pursue important research questions; Dr. David Smith who has been extraordinarily generous with his time and instrumental in my learning of neuroimaging methods; and Dr. Lauren Alloy who has been unbelievably supportive and deeply invested in my growth in every way.
4. What advice would you give to other students pursuing their graduate degree? Do what you genuinely want to do, not what you think you should do. One of the most wonderful things about our profession is its wide range of career options. Find out what career path is the most suited and exciting to you as quickly as possible during graduate school and plan your time accordingly