MN Psychologist Online
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In Memoriam: Thomas Paul Carrillo, Ph.D., LP


January 21, 1952 - June 2, 2017

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When You Leave a Clinic: Keep Your Reputation

It has been a pleasure working as a psychologist, in Minnesota, since the early 90s. During that time, I have learned many lessons that were not taught to me in graduate school. Some simply take common sense to figure out, while others are the result of falling down a few times. Here, I present a lesson never taught to me in grad school.

What happened? My first position as a psychologist was at a very large clinic in the Twin Cities. I was so proud to be hired by a place so well known. During my interview, I met the owner, manager, and several therapists. They certainly knew how to recruit. When I showed up for work a few days later, the only people there were the owner, one of the clerical staff, and a couple therapists. There were papers all over the floor, as if the place had been vandalized. I was told that one of their lead therapists, and others, had spent the night in the clinic copying clients’ charts. They had secretly told each of their clients they were opening a new clinic. The owner of my new clinic knew nothing about it. My new clinic eventually went out of business. To me, it was very sad for the owner, and quite greedy, or disheartening, for the therapists to take the business away from the clinic that spent much in time and money to obtain these referrals.

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A Review of Becoming Nicole, by Amy Ellis Nutt

On April 14, 2017, Minnesota Public Radio reported that a group of parents in Virginia, MN had dropped a lawsuit against their school district. They had been trying to prevent students from using bathrooms appropriate to their gender identity. A few weeks earlier, the North Carolina legislature had overturned their own law that had stated that students must use the bathroom appropriate to the sex listed on their birth certificates. Money had prevailed over bigotry, the state having lost a great deal of money from corporations withdrawing business from North Carolina because of that law.  

Nicole’s earlier struggle for equality was heard by Maine Supreme Court in January, 2014. Becoming Nicole takes us to the late 90s when Wyatt, an identical twin who had identified as female from age two, encountered harassment when he used the girls’ restroom. His school, which had been supportive of him until a multiple stall bathroom for fifth graders raised this issue for the first time, failed to support him. Many years later, by the time a lawsuit against the school had been resolved, a boy who had bullied Nicole/Wyatt, wondered whether her identical twin was disappointed about losing a brother. Jonas never was, and once said to Nicole, “I never had a brother. You were always a sister to me.”

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Letter from MPA President Steve Girardeau

A very happy spring to all my fellow Minnesota Psychologists.

A lot has happened since I last checked in with you all.

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Rural and Greater Minnesota Division Update - April 30, 2017

The mission of the Rural and Greater Minnesota Division of the Minnesota Psychological Association is to enhance rural practice through advocacy, representation, and education. Rural psychological practice is highly rewarding as practitioners have a significant impact on their own communities and the state. Psychologists working in small communities are part of the first responders for critical incidents, emergencies, and the emotional well-being of rural residents. Rural psychologists often observe the direct impact of behavioral health services on their communities, while helping to maintain a productive rural workforce. It is this workforce that provides the agricultural and manufacturing resources that support larger cities in the state and nationally.

Recent Rural & Greater Minnesota Division activities include the on-going planning of the Rural Behavioral Health Conference by Coordinator Dr. Kay Slama, and co-chairs Dr. Scott Palmer and Dr. Willie Garrett. The conference is web-based and offers all practitioners rural-specific training. The conference is inexpensive and high value, with national speakers, for up to 7.5 CEs. Past training topics have included integrated behavioral healthcare ethics, substance abuse, GLBT, diversity and cultural minorities, suicide interventions, the Affordable Care Act, school based interventions, and military deployment and reintegration. Rural students and educators also present poster session research. Attendees cross seven time zones and offer diverse perspectives on rural practice. The next Rural Behavioral Health Conference is October 6, 2017.   

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2017 Minnesota Psychological Association's Annual Convention Award Winners

Award:  Susan T. Rydell Outstanding Contribution to Psychology Award
Recipient:  Steven P. Gilbert, Ph.D., ABPP, LP

From left to right: Steven P. Gilbert and Duane Ollendick

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In Memoriam: Sherman E. Nelson, Ph.D.

Born the youngest of six children in Northeast Minneapolis in 1928, Dr. Sherman E. Nelson died in February of this year. Sherm was the therapist’s therapist.  In 1966, I met him while he was treating another graduate student. Over the years, he treated many. He was a professor in the clinical psychology program at the U of M and taught and mentored many until his retirement in 2000.

He was the youngest in his doctoral class in 1952, and went to work at the Minneapolis VA Hospital.  After three years, Sherm became the second local psychologist to go into private practice.  His career was spent at the Minneapolis Clinic of Psychiatry and Neurology, where he headed the psychology department.  His wife, Denise Lillian Nelson, is also a psychologist as is one of his daughters, Liane Nelson.

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Letter from MPA President Steve Girardeau

Greetings fellow Minnesota Psychologists,

It has been an interesting start to the year for MPA in ways that many of you are unaware. 

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Welcoming Minnesota Psychologist Editor Kim Stewart

After four years of dedicated service, Beth Lewis stepped down as editor of the Minnesota Psychologist Online.  We will miss Beth, and are thankful for her commitment to delivering relevant and informative articles for our members over the years. 

We are pleased to introduce our new editor, Kim Stewart.  Kim graduated from the University of St. Thomas in 2016, with a master’s degree in counseling psychology, including a concentration in marriage & family therapy. 

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MPA First Friday Forum: Health Disparities: The Psychological Impact of Breast and Prostate Cancer on African-American Families

On February 3, 2017, the Minnesota Psychological Association and the Metropolitan State University Psychology Department hosted a First Friday Forum titled: “Health Disparities: The Psychological Impact of Breast and Prostate Cancer on African-American Families.”  The presentation was led by Willie Garrett, M.S., LP, Ed.D.  Dr. Garrett is a licensed psychologist with over 35 years of experience working with children, adolescents, adults, and elderly clients both in urban and rural settings.  He is actively involved in MPA, and was the 2016 award recipient for Outstanding Career Achievement in Black Psychology (currently the John M. Taborn Award for Outstanding Contributions as a Mental Health Provider of African Descent).

Dr. Garrett’s presentation was very informative and eye-opening.  He provided various statistics related to breast and prostate cancer, and discussed emotional, psychological, and financial implications African-American families face as a result of this “invisible epidemic” (Garrett, 2017).  There was one statistic that stood out the most.  According to the American Cancer Society, trends in cancer death rates between 1975-2014 show that African-American women have higher death rates than White women.  What made this statistic so powerful was that African-American women actually have lower cancer incidence rates than White women.  

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Frank B. Wilderson, Jr. Honored with John M. Taborn Award

On February 3, 2017, Frank B. Wilderson, Jr., Ph.D., LP, was recognized as the 2017 recipient of the John M. Taborn Award for Outstanding Contributions as a Mental Health Provider of African Descent.  A reception was held in his honor at the Metropolitan State University Founders Hall in St. Paul. 

Dr. Wilderson is a professor emeritus in the Department of Educational Psychology and co-director of the Center for Research on Correctional Education.  He received his B.A. in education from Xavier University in Louisiana and his M.A. and Ph.D. in child development and educational psychology from the University of Michigan.  He is now retired after 39 years at the University of Minnesota where he held multiple positions. He was a faculty member, becoming the first chair of the Department of African-American Studies; he was an Assistant Dean; and he was the first African American among the University’s vice presidents, serving for 14 years in that role. 

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State Beat: Stories from the Hill

Several hundred psychologists traveled to Washington, D.C., to advocate for expanded mental health care coverage during the Practice Leadership Conference. (Note: This included our own Andrew Fink and Matthew Syzdek -- see end of article.)

Every March, psychology’s leaders from all over the United States and Canada convene in Washington, D.C., for the Practice Leadership Conference. On the final day of the conference — after three days of rigorous dialogue, education and advocacy training — delegates from each state go to Capitol Hill to lobby their senators and representatives on behalf of their patients and profession.

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From MPA's President Steve Girardeau, Psy.D., LP: You asked for it, and we will provide it!

A new year has begun and with it my increased responsibilities to MPA.  I say increased, rather than new responsibilities because it is my belief that we have a responsibility to give back to the profession that we have chosen and to be a part of protecting and building psychology’s place in the future of health care.   To that end I have served on the MPA Legislative Committee, the Governing Council, the Executive Committee and now serve you all as president.

In that time, I have come to realize that in many ways MPA has lost its way.  It has moved away from our natural role of a professional association, with responsibilities as a “guild” for the profession.  This became especially clear in our survey of members last year which identified “protection” as the most important responsibility for the association.  We heard that message and have acted.

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Integration of Behavioral Health in Population-Based Approaches to Caring for Patients in Primary Care (Based on the presentation given at the MPA Annual Convention April 2016)

In May 2008, the Minnesota legislature adopted health care reform legislation that allows primary care clinics in Minnesota to become certified as Health Care Homes (HCH).  The HCH program provides “an approach to primary care in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life for individuals with chronic or complex health conditions (Minnesota Department of Health, Health Care Homes).”  The goals for HCH are based on the “Triple Aim” put forth by the Institute for Health Care Improvement.  These aims are 1) improving patients’ experience of care, 2) improving health from a population perspective, all while 3) reducing the cost of health care (Institute for Health Care Improvement).

This shifted the perspective of many primary care clinics, as clinics tended to focus on patients who showed up asking for care.  These aims ask clinics to proactively reach beyond their clinic walls and provide evidence-based care for patients in a systematic manner.  Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”  At the core of population management is defining a group of patients (e.g., those on chronic opioids, patients with elevated PHQ-9 scores, patients with diabetes with blood pressures over a set point, etc.) and using available data to actively follow and review patients to ensure the condition is being optimally managed in relation to available evidence-based guidelines for treatment.

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Tribal Politics and the Liberal Psychologist

The day after the 2016 election, psychologists went to work and met with patients, silently questioning who was sitting across from them.  Is this a Trump voter? A Clinton voter? Third party? Did they even vote? Politics of the therapy room became quite personal on November 9, 2016. And we are a big part of the problem.

The majority of psychologists are liberal (Duarte et al., 2014; Heflick, 2011; Inbar & Lammers, 2012; Konnikova, 2014). Graduate school and CE courses on multicultural issues may have helped us understand ethnicity and microaggressions (kind of); however, most of us never really learned to co-mingle with others of different political persuasions and tax brackets. If you voted for Clinton and do not know someone who voted for Trump, you are living in a bubble. I don’t mean your best friend’s uncle that voted for Trump, but someone that you would go out to coffee with or someone you just had over for dinner.  

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New MN DHS Benefit, Behavioral Health Homes: Resources for MA Beneficiaries with Severe and Complex Conditions

Psychologists and other mental health professionals who serve people with more complex and challenging problems may want to refer them to a new DHS service, Behavioral Health Homes. (BHH).  BHH services can increase support and treatment resources for the person, and can help the mental health professional better respond to the person’s needs. 

The Patient Protection and Affordable Care Act (ACA) created a “health home” benefit to help states better coordinate care for Medicaid enrollees with chronic medical conditions. This program focuses on populations that traditionally face serious barriers to accessing medical care, and end up being underserved by our medical and mental health system.  They also have reduced quality of life and increased mortality, and frequently are high utilizers of expensive urgent care services.

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Behavioral Health Outcomes Measures: Problems, Challenges, Solutions

Psychology’s Ambitions

Human suffering, including mental and behavioral health problems, is elusive to define and measure.  Even with relatively objective markers of diagnosed mental illness, consensus is hard to find. People often have more than one diagnosable condition, and the conditions themselves are increasingly understood as dimensional rather than categorical (APA, 2013).  These   conditions also are often embedded in relational and social contexts.  To complicate things even further, they often occur on a spectrum ranging from absent to severe during the course of a care episode, or a lifetime. All of these factors may have a greater or lesser effect on the person’s functioning at different times and under different circumstances.  It is challenging for both patients and providers to sift through all of the data, all of the layers and all of the noise, in order to identify the most important factors that can guide treatment.

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New Member Spotlight: Amy R. Steiner, Psy.D., LP

1)    What is your background in psychology (e.g., education)?

2002 B.A. in Psychology from Butler University (Indianapolis, IN)

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Culturally-Sensitive Diagnostic Interviewing Protocol for Somali Immigrants and Refugees

Dr. Dasherline Cox Johnson presented her dissertation research on Culturally-Sensitive Diagnostic Interviewing Protocol for Somali Immigrants and Refugees at the Minnesota Psychological Association’s 80th Annual Convention on April 16, 2016 and at the 2nd Annual Mental Health Summit on June 17 in Minneapolis and St. Paul respectively, with the following objectives: 1. Demonstrate cultural-specific understanding of Somali mental health, 2. Recognize relevant issues related to Somali mental health, and 3. Apply cultural competent practice to mental health assessment of Somali clients.

Methodology: The researcher conducted semi-structured, in-depth interviews with eight mental health providers from five local agencies with at least two years of experience working with Somalis. A qualitative method of snowball sampling was conducted to identify research participants. Questions addressed challenges of working with Somalis within the current mental health system and how clinicians handle or resolve them. An inductive content analysis was used to analyze the interviews and to inform the development of a culturally sensitive diagnostic interviewing protocol.

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MPA First Friday Forum: Formulating Diagnostic Impressions and Pitfalls of Self-Report

Catherine A. Carlson, Psy.D., LP

There is undetected psychosis and feigning in mental health settings. Some people lie about symptoms and impairments. Those who feign or malinger (feigning for secondary gain), typically emphasize and endorse psychotic symptoms or cognitive impairments for manipulative reasons. The most common motivation for malingering in non-forensic settings is money. Social Security Disability (SSDI) provides a monthly income. When feigning or malingering, dramatic acting and portrayals of purported symptoms are often part of the ruse. These are far from academy award winning performances given the frequent inconsistencies with bona fide mental illnesses. Some mimic portrayals of mental illness in movies, which are rarely accurate. I find much less drama when examining those with genuine disorders. Other people self-report (malinger) extreme anxiety to get benzodiazepines, a controlled substance that has high potential for abuse. I have rarely seen people feign a non-psychotic Major Depression. For some, the feigning itself is intrinsically reinforcing. Psychological needs related to attention and control are met by deceiving and manipulating others. If this behavior is habitual, and there is no evidence of feigning for secondary gain, a diagnosis of Factitious Disorder needs to be carefully considered. Then there are those with undetected and untreated psychosis, a particularly guarded subgroup, who generally deny psychotic symptoms they have experienced. When they voluntarily seek treatment, chief complaints usually consist of extreme anxiety (including panic attacks), ‘overwhelming stress,’ and/or self-diagnosed Posttraumatic Stress Disorder. They are willing to report anxiety but usually too guarded to disclose the underlying paranoid psychosis (including hallucinations) that is generating the intense anxiety.  They do not seek out treatment for ‘psychosis’ because they have limited to no insight into this condition. They know they are anxious (terrified is probably more accurate) but do not recognize the fears stem from irrational or delusional thought processes. People with non-psychotic depression seek out treatment for depression. Those with guarded psychotic illnesses seek treatment for anxiety not psychosis.

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