Archive | November, 2011

Skittle-Free Methods for Getting Kids to Cooperate with Testing

29 Nov

I gave the Woodcock-Johnson III Tests of Achievement to an 8-year-old yesterday. While the Woodcock Johnson (WJ-III) is widely loved by graduate students for its excellent name, it is not widely loved for the length of its administration. My clinic’s policy is to administer half of the subtests in the extended battery in addition to the standard 12-subtest battery, which can easily extend testing time to 2.5 hours or beyond – especially if you’re working with a small wiggly person who needs a lot of breaks.

My 8-year-old, like most of the children I have tortured with given the WJ-III, was not at all enthused about testing, and the situation was looking bleak: my sticker supply had been exhausted, I had no change for a bag of Skittles from the vending machine, and my kid’s parents had left the building, removing any chance of negotiating for post-assessment incentives from mom and dad.

It’s amazing what you can do with a blank piece of paper, though, and I managed to scrounge up a reinforcement strategy that kept my kiddo engaged for a full 2.5 hours. She was a self-professed horse lover, and we agreed that for every subtest she completed, I would draw a small portion of a horse – an ear, an eye, a leg – so that at the end of testing, she would have a complete picture to take home. I let her choose which part I drew after each test, where spots should go, what the horse’s legs should be doing, etc. It worked like a charm, and it got me thinking about other simple methods I might use to motivate children to cooperate during assessments… methods that did not encourage cavities or require frequent trips to the sticker aisle at Hobby Lobby. If you’ve been looking for quick, cheap reinforcers to use during testing with elementary-age kids, here are some ideas:

  • This is one that has worked well for another therapist in my program: Draw a path on a piece of paper, and draw lines across the path to divide it into sections representing subtests. Tell the child it’s a game board, and give her a small object or coin she can use as a game piece. Allow her to advance the game piece forward after completing each subtest.
  • Draw a series of circles on a piece of paper (one circle per subtest) and tell the child you’ll draw in a smiley face for each subtest he completes. Tell him that once every face is smiling, the two of you will do something fun together. Agree on what that activity will be. In the past I’ve used a game of red light/green light as a testing reinforcer, but the fun activity you choose could be anything: playing a quick board game, drawing a goofy picture together, playing trash can basketball with a wad of paper, and so on.
  • Draw a large slice of pizza with no toppings on it. Tell the child that whenever you notice that she is doing an exceptionally good job of sitting still and following directions, you’ll draw a pepperoni on the pizza. Tell her that if the pizza is covered with pepperoni by the end of the testing session, you’ll do a fun activity together (see above).
  • If you know how to do any sort of origami or paper folding – paper cranes, “fortune-tellers,” sailboats – tell the child you’re going to make him a surprise out of folded paper. Explain that you’ll make one fold for every subtest he completes. If you finish your creation before testing is done, tell him that now you’ll show him how to make the folds, and teach one fold per subtest.

A note of caution: if you use subtests as units of achievement, a child may get in the habit of asking how long each subtest will take (“Is it almost over?”). You can avoid this entirely by framing achievement as “doing a good job of sitting still and following directions” and reinforcing accordingly, as in the pizza example above. I like the structure of subtest-based achievement, and I’ve found that I can usually get kids to stop asking how long subtests will take by explaining that these questions make the subtests last longer. “Oh, man, it’s a shame you’re asking me that, because whenever you do, it takes us even longer to get done with the section.”

I’d be interested to hear from others who do assessments with children. What reinforcement strategies work for you?

Internship Blues

29 Nov

In the grand scheme of the universe, there are many things that I should probably be more worried about than the APPIC internship application process, including but not limited to climate change, international strife, global food shortages, the terrifying implications of the Singularity should it ever come to pass, what Diet Coke is doing to my body, etc. But like most 4th or 5th-year doctoral students in counseling/clinical psych programs, lately I’ve been directing the full power of my anxiety toward the question of whether or not I’ll get an internship.

For those reading who aren’t familiar with the internship process, APPIC stands for the Association of Psychology Postdoctoral and Internship Centers. Doctoral students in clinical or counseling psychology programs who have finished their coursework and comps are required to complete a 1-year predoctoral internship approved by the American Psychological Association in order to receive their doctorates. All approved internship sites are registered with APPIC, which facilitates the application and match process. Eligible students labor feverishly over applications and submit them to internship sites of interest (usually around 15 sites) during October, November, and early December. APPIC encourages sites to inform candidates whether or not they qualify for interviews by December 15, but every site operates on a slightly different timeline. Some students may hear back about interviews before Thanksgiving (causing dark fears to bloom in the minds of their cohort members, who will spend the next two weeks wondering why no one wants to interview them and asking themselves, Did I actually hit the send button on my applications? What if I didn’t hit the send button on my applications?). Other sites may not notify candidates about their interview status until after December 15, a date that will by that point have cemented itself in students’ minds as the Absolute Deadline for Hope and what if I hit the send button on some of my applications but not all of my applications? Interviews take place in December and January, and students rank the sites at which they interviewed in order of preference. Sites also create ranked lists of candidates, and students are informed on Match Day in late February whether or not they’ve been matched with a site. Those who aren’t matched go through a sort of clearinghouse process called Phase 2, which I don’t know much about because it makes me unhappy to think about it. There is no guarantee you’ll be matched during Phase 2.

There is currently a shortage of APA-accredited internships. Last year, almost a fourth of applicants were not matched with a site, and not matching has major implications for students. It means another year between you and your degree, another year between you and your career, and potentially nasty financial consequences (many programs, mine included, do not guarantee funding for students who stay beyond their fourth year). I guess that it’s little wonder that the message boards and listservs frequented by internship applicants exude all the cheer and calm of a fire evacuation. Dr. Greg Keilin, the psychologist and training director who sacrificially agreed to coordinate the Match and its listservs, sent out a message on the APPIC Intern Network last night that had a certain tone of parental exasperation:

“Everyone,

Before everyone on this list has a heart attack because one person has reported hearing back from a site, let me state categorically that it is VERY EARLY FOR ANYONE TO BE HEARING BACK ON THEIR APPLICATIONS OR GETTING OFFERS FOR INTERVIEWS!  Some application deadlines haven’t even passed yet, much less have sites had the opportunity to review materials and contact applicants to set up interviews.

So, if you haven’t received any notification yet, all that means is that you are one of 4,000 other applicants who also have not yet received any communication from sites and who feel like they are the only one in North America who hasn’t heard anything… If you want to make yourself really anxious for no good reason, you can:  (a) wonder how each site notifies applicants (alphabetically?  by date the application was received?  by astrological sign?, etc.) and how you will fit in that process, (b) start worrying two weeks before the “interview notification date” in the Directory about why you haven’t heard anything and then assume it must be bad news, and (c) assume that if a classmate hears from a site before you do, it means you’re toast.  All of these are tried and true methods of generating gobs of anxiety while waiting to hear from sites.

Seriously, go by the dates in the Directory, and assume you’ll hear at 11:59pm on those dates and not a moment earlier.  Will some notify you days earlier?  Yes, but some won’t.  One year, I sent out my notifications the evening of my interview notification date, and I was surprised how many applicants told me that they had assumed they weren’t getting an interview because they hadn’t heard anything from me.

In the relatively infrequent event that you don’t hear from a site by the end of that ‘interview notification date,’ you should call or e-mail the site the next morning to inquire about your status.”

Unfortunately, graduate students are very talented in the area of making themselves really anxious for no good reason. I’ve found that the best way to address my anxiety is to develop excellent backup plans in the event that I don’t get an internship. Current frontrunners include starting an adorable pie shop like Keri Russel in Waitress or becoming a “dog enrichment coordinator” at a doggie daycare, which is apparently a real job.

I might change up the uniform a little.

I applied to 15 internship sites in North Carolina, Texas, Georgia, and Virginia. My husband Ted and I would like to move back in a southeasterly direction to be closer to family and college friends, and for some reason, Ted requested that we move somewhere where he could enjoy continued employment. I’ve gotten an invitation for one interview in Texas (instant elation!) and a regretful email from a site in North Carolina (instant desolation). Guess I’ll twiddle my thumbs, contemplate how my astrological sign might affect the manner in which I’m notified about interviews, and hope for the best.

Feminist Win of the Week: Response to “Put Me in Charge”

22 Nov

A friend in my program recently got me hooked on Persephone Magazine (http://persephonemagazine.com/), and I’ve been consistently impressed with the blog’s fresh take on feminist issues, politics, entertainment, and everything in between. Yesterday, contributor Malyksha wrote a fantastic response to an incredibly small-minded, arrogant, misguided piece of writing (to put it mildly) that has been circulating the internet lately. Check out her post here: http://persephonemagazine.com/2011/11/put-me-in-charge/

 

Psych Q&A: ADHD vs. Asperger’s, Hormonal Imbalances, Why Living Location Matters, and Bad Therapy

21 Nov

A friend teaching an abnormal psych course at a local community college asked me and a couple of my cohort members to serve as an “expert panel” for her class. I told her I’d be happy to help as long as the word “expert” stayed firmly between a pair of quotation marks. Her students ask great questions. Here are a few of them, with my two cents in response:

“On paper, ADHD and Asperger’s seem very different.  However, can a misdiagnosis happen to these patients?”

Kids with ADHD often miss the social cues their peers are able to catch, which can result in poor understanding of appropriate social behavior. They tend to have a hard time forming age-appropriate friendships, and eye contact is often poor. For these reasons (and possibly because Asperger’s is something of an “in vogue” diagnosis at the moment), we have quite a few parents who come into my departmental clinic for a child Asperger’s eval and leave with an ADHD diagnosis. In structured diagnostic observations, it’s usually not difficult to differentiate between the two. Kids with ADHD are more interested in reciprocal social interaction than kids on the spectrum, are more expressive, gesture normally, use normal intonation, and don’t have a clearly defined special interest. Autism spectrum disorders and ADHD are frequently comorbid, however.

“It seems like lots of disorders involve mood swings.  Are patients ever treated for hormonal imbalances?”

Psychologists who have had  exposure to integrated care models and cross-disciplinary research (and these days, most psychologists have) are very likely to consider the possibility of medical causes, although they can’t administer medical treatments themselves. When conducting intakes with clients in my departmental clinic, I usually ask about personal/family history of both medical and mental health conditions and any current medication or substance use. If a client has no relevant medical problems or family medical history, and did not begin using a new type of hormonal birth control or treatment around the time mood issues began, I usually abandon hope that a simple hormonal issue is implicated, especially if there’s a family history of mood disorders. (To be honest,  I’m always secretly hoping that clients struggling with fatigue or apathy will turn out to have hypothyroidism, because it’s so beautifully easy to treat. Unfortunately, hypothyroidism is much less common than mood disorders, and this rarely happens.)

 “Does where you live matter for developing mental illness?  Like in the city vs. suburbs, or East Coast vs. West Coast?”

That’s a tough question to answer. Cities often provide better access to care than more rural areas, so mental illness may be more quickly diagnosed and treated there. Poverty is more likely to be seen in inner cities or rural areas than suburbs, and since poverty is associated with increased risk of mental illness, you might see better mental health in suburbs if only because the people who live there tend to have a higher socioeconomic status. Supportive social networks serve as a protective factor, so living in isolation might put a person at higher risk for mental health problems than living near or among other people. Seasonal affective disorder (which isn’t a disorder in itself, but a depression modifier) is more common in less sunny states (like Washington state… might explain why no one in the Twilight movies ever seemed that cheerful). If you can find a relatively sunny place to live near people you like, a job with a middle-class salary, and good access to mental health care, your risk for mental health problems will be lower, although you’ll still be stuck with your genes.

“Does therapy ever make a person worse?  How often?  Why?”

Therapy can sometimes make things worse. I have no idea how often this happens, or how you’d track it. Sometimes it comes down to therapist variables – a therapist may behave unethically (it’s rare, but therapists do occasionally take advantage of clients), leading questions or comments might be directed toward a suggestible client, or a client may be so put off by a therapist’s personality, technique, or ignorance to cultural variables that he doesn’t seek psychological services he needs in the future. Sometimes it comes down to errors in treatment: some interventions are helpful for some disorders but contraindicated for others (ex: behavioral activation in the form of intense exercise can produce great results for a person with anxiety or depression, but it’s a bad choice for a client with an eating disorder). Psychology has a long history of unhelpful and dangerous treatments, including but not limited to rebirthing, “boot camp”/”scared straight” interventions for conduct disorder, recovered memory techniques, conversion therapy, and so on. Researchers can do a pretty good job of identifying treatments that don’t work, but it takes a lot of time and money to do this. As a client, you always have the right to ask your psychologist what techniques he/she plans to use and whether there’s research support for them. If a technique isn’t research-supported, it doesn’t necessarily mean it will be harmful, but it has yet to be proven that it works. On the whole, research indicates that therapy is an effective treatment for psychological disorders, and people with mental health conditions will generally benefit from it. You’re more likely to get worse by not going to therapy than you are by going.

A Confession

21 Nov

I like grad school. Kind of a lot.

I probably shouldn’t tell you this. It’s common knowledge that graduate students bond with each other by complaining about grad school. A random sample of any graduate gabfest will invariably include references to a) sleep deprivation due to grad school, b) the morale crushing behavior of [insert professor/supervisor here], c) wistful visions of life after grad school, d) fears that grad school may never end, or e) all of the above. I participate in discussions like this in an enthusiastically indignant/wistful manner – my social life would be hobbled if I didn’t, and I never have trouble scrounging up something to complain about – but in all honesty, on a happiness scale of 1 to 10, I’m in the neighborhood of 9.5, and that’s only because I feel the need to reserve .5 in case something fabulously awesome happens. I enjoy being in a counseling psych Ph.D. program. I like what I’m learning, I like the people in my department, I like my clients. I kind of…and seriously, let’s keep this on the DL… don’t feel ready for grad school to end.

It hasn’t always been like this. My first two years in my program were fairly traditional, meaning that I spent a lot of time attempting to be perfect at everything, moping, daydreaming about dropping out of grad school, researching careers I could have if I dropped out of grad school, looking up median salaries for “professional cupcake baker” and feeling disappointed, etc.

During my third year, everything seemed to click into place, and suddenly grad school no longer felt like a bed of sizzling coals I had to race through to get to the life I wanted. I was, I realized, living the life I wanted. It was not a life that contained every dream I’d ever had, but it was a life that included all the most important things I could have asked for at 25: great relationships, client work I cared about, a constant stream of opportunities to learn interesting things,  enough money to pay the bills and have some left over to play with, and room to work toward all the other dreams that were still unrealized. (Well, maybe all of them except the ones featuring me nonchalantly saving the universe using beams of magic I shoot out of my hands. If anyone knows what the first steps are for working toward those dreams, please contact me.)

Third year was also the year that I got the hang of “strategic caring.” My weeks were stuffed with individual client sessions, couples’ counseling, group counseling, assessments, consultation work, clinical supervision, thesis research, funded research unrelated to my thesis research, coursework, outreach presentations, scholarly reading, and ambitious caffeine consumption, plus all the stuff that comes along with everyday living: maintaining relationships, laundry, grocery trips, pet care, home maintenance, cleaning, cooking, money management, some semblance of hobbies, the works. It was not possible to care about everything. In retrospect, it was probably never possible to care about everything, but prior to this revelatory time, I had convinced myself that it was. I would beat myself up ferociously whenever inevitable screw-ups happened, tell myself through gritted teeth that I just needed to care more and work harder, and carefully steer myself into misery. I’m not saying that I enjoy screwing up now, but I’ve sorted out which things are worth caring a lot about (relationships, clients, broad movement toward long-term goals) and which things aren’t (grades, getting my oil changed exactly when I’m supposed to, producing flawless research drafts, eating well-balanced breakfasts). I’ve learned to allocate care accordingly.

I’m halfway through my fourth year now, and hopefully I’ll be moving on to an internship next summer. (“Hopefully” being the operative word, what with the current shortage of APA-accredited internship programs… more semi-panicky musings on that later.) As excited as I am by the prospect of starting the next chapter of my life, I’m sad that I have to end my graduate experience so soon after I discovered it was possible to enjoy it. Sometimes I wish I could go back in time and tell my newly-minted graduate self to lighten up, but I’m pretty sure that if I did, my past self would become convinced that she was experiencing psychotic symptoms and leave the program immediately.

None of this is meant to downplay the struggles people face in grad school. I know intimately how much it can suck, how overwhelming and pointless and thankless it can feel sometimes. And I’m also aware that many of the things that contribute heavily to my current level of happiness – a husband who is both emotionally and financially supportive, good health, sane and caring family and friends, few sociocultural barriers – have nothing to do with grad school at all and are not a given. But I do want to put it out there that I don’t think grad school has to be a hoop we jump through on the way to our real lives. If you’re currently in a grad program and think of life as something that starts after grad school, it might be time to re-evaluate your values, figure out which of your needs aren’t being met, and make tweaks where tweaking is possible. Five to seven years is a long time to put off living.

Does anyone else out there secretly (or openly) enjoy grad school? What did it take to get you to that point?

%d bloggers like this: