letters

Group therapy for ?Alzheimer?s anxiety?

MARJORIE CENTOFANTI?S excellent discussion of 'Alzheimer anxiety' in the elderly population in the June Monitor calls much needed attention to the problem, which has been endemic?at least for geriatric patients in medical and psychiatric clinics for 20 years. It is fortunate that the article began with the description of large group workshops for the general population that were conducted by Gregory Hinrichsen.

Group therapy procedures are also effective with a clinical geriatric population, where sharing such anxiety was remarkably effective in reducing their fears, often with the help of humor. For example, one group member, a 75-year-old man, shared his fears of Alzheimer?s disease with the other members of a geriatric depressed group. He was reminded of a joke: A doctor was giving a lecture on aging. 'There are three ways of knowing when you are getting old. One is that your memory gets bad?uh?I can?t remember the other two.' The other group members, all of whom were cognitively intact, laughed heartily and shared their own fears. The result was not only a reduction of anxiety, but an increase in positive group feeling and cohesion. Therefore, I recommend group procedures for everyone worried about memory loss, including psychologists.

Joseph Richman, PhD
City Island, N.Y.

The earlier, the better when treating children

IN THE JUNE MONITOR ARTICLE 'After the storm, children play out fears,' I was pleased to see the attention drawn to the mental health needs of preschool children and the fact that they are capable of evidencing PTSD symptomatology. Scott Sleek?s article also described that the overwhelming response to whether or not many traumatized children had received professional help was a resounding 'No.'

Unfortunately, many in our society believe that young children are not capable of developing mental health problems and therefore do not need treatment. While the article focused on children who survived natural disasters, research has shown that even infants and toddlers can develop PTSD symptoms in response to abuse, witnessing the murder of a parent, dog bites and other traumatic events.

As an infant and preschool psychologist, I often evaluate and treat traumatized children under 5. One thing that has made my job of accurately assessing PTSD in young children easier is the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3, 1994). Research has shown that the PTSD diagnostic criteria provided by DC:0-3 is more developmentally sensitive and behaviorally anchored for younger children when compared with DSM-IV PTSD criteria (Scheeringa, Zeanah, Drell, & Larrieu, 1995).

Overall, making parents and other professionals more aware of the mental health needs of our younger children can only help to identify and treat problems earlier and even prevent some from developing.

Claire Peebles, PhD
Baltimore

Shedding light on the polygraph

I WAS PLEASED TO SEE IN THE June 1998 Monitor another article educating psychologists about polygraph. In my experience, many psychologists have opinions about polygraph, although only a minute number have ever had any direct, practical experience with forensic polygraph examinations. As a Clinical/Forensic Diplomate and Certified Polygraph Examiner, I have conducted close to 1,000 polygraph examinations over the last 15 years.

Psychologists not familiar with forensic polygraph often seem to ask the same, overgeneralized question: 'Does it work?' That is a bit like asking, 'Does the Rorschach work?' A more realistic approach may be to view forensic polygraph as an investigative tool, not a 'test.'

A forensic polygraph examination should include a review of all available, pertinent case information and documents, a subject?s life history, behavioral observations, a structured, interrogative interview, the subject?s version of the events in question, appropriate test-question formulation and a videotaped, practice, simulation and three polygraph tests, which are then numerically scored by the computer. After a review of the test results and all other information, a polygraph examiner may then shift to an interrogation interview, which may ultimately result in a signed and dated confession by the subject.

Does this happen 100 percent of the time? Of course not! What assessment tool of any kind in any field does? Does the polygraph work? With a senior, well-trained, experienced and sophisticated polygraph examiner utilizing a several-hour, multifaceted polygraph examination, you bet it does!

Stephen Lawrence, PhD
Grand Terrace, Calif.

How do you define ?minority??

I READ 'WHY SOME MINORITY faculty are unhappy' in the June Monitor with something of a smirk. I know why some minority faculty are unhappy; they are invisible. I see articles, reports, books, etc. ?that reportedly focus upon 'minority' issues, but really only mean ethnic issues. Gay and lesbian students and psychologists continue to be invisible minorities. How much simpler it would be if having a sexual and romantic bond with a member of the same sex made your skin turn blue?.Gays and lesbians would be recognized as minorities because we would be people of color, and understanding the discrimination, difficulties and ignorance we face would finally be valued by mainstream psychology.

Many ethnic-minority faculty are hired as 'tokens.' I have no doubts about this. However, gay and lesbian faculty are often not hired at all, unless they are also ethnic minorities. Students wishing to work with experienced faculty to research gay and lesbian issues and learn to work with gay and lesbian clients are generally out of luck. And, god forbid, gay and lesbian students wanting mentoring, training and special attention to issues associated with working with the gay and lesbian community while being a part of it have even less support. All I ask is that we consider applying the definition of the term 'minority,' whether it is based on statistics, shared culture or experiences of discrimination, with a little greater consistency.

Richard Niolon, PhD
Chicago

The exploitation of part-time psychologists

THE ARTICLE 'FLEXIBILITY IS key to a successful career' (June Monitor) suffers from the fallacy that psychologists are islands, not embedded within larger social, economic and political engines. The advice doled out ensures new psychologists remain enthralled and impotent individuals, physically and mentally exhausted from working their multiple, dead-end, low-pay jobs to open their mouths and collectively howl over whether their doctorate was worth the money and the time invested in a world where intellectual capital is worthless, where clerical office temporaries command higher fees than therapists employed by community mental health clinics. Part-time psychologists are exploited. They do not receive pay parity, regular raises, insurance benefits, advancement or tenure for their work. Their experience is little valued over time. They are viewed as less psychologists by their full-time colleagues.

As a collective that allegedly represents the interests of psychologists as a group, APA should be out in the forefront, urging organizations to create and maintain full-time positions that offer liveable salaries and lines of professional advancement.

There is a huge difference between being 'flexible' and being 'delusional' about the reality of employment opportunities for psychologists. Instead of mouthing specious sentiments, go out into the trenches and view for yourself the deplorable domain confronting the average psychologist.

Sharon R. Kahn, PhD
Brooklyn, N.Y.

Misleading headline

PSYCHOLOGISTS SHOULD not be mislead by the headline 'Physicians say ADHD is not overdiagnosed' in the June Monitor. What the AMA?s Council of Scientific Affairs is in effect saying is that it?s okay for doctors to give more Ritalin to children.

As I document in 'Talking Back to Ritalin,' there is no scientific validity to the ADHD diagnoses. It is simply a way of justifying the control of children with drugs. Furthermore, the stimulant drugs are far more harmful than even most physicians realize. Society goes along with the drugs instead of reforming the schools and improving family life in order to meet the real needs of our children.

Meanwhile, in more than 30 years as a psychiatrist, I have never heard my colleagues say that any psychiatric disorder is overdiagnosed or that any psychiatric drug is overprescribed. Within psychiatry, the pressure is always to throw the diagnostic net wider to treat as many people as possible. Only a concerted effort by nonmedical mental health professionals, educators and the public will stop the drowning of American?s children in drugs.

Peter R. Breggin, MD
Bethesda, Md.

On the ?President?s column?

THE BOARD OF SCIENTIFIC Affairs? (BSA) Task Force on Research with Human Participants has been working on a volume that embodies the very message conveyed by APA President Martin E.P. Seligman in his 'President?s column' (June Monitor)?the promotion of active ethics. This nine-member task force voted unanimously to draft a document that is aspirational rather than prescriptive in nature. The volume drafted by the task force is designed to stimulate discussion and increase awareness of the ethical dilemmas inherent in the research process. It aims to educate and sensitize both established as well as aspiring researchers to the subtle and the not-so-subtle ethical issues that arise in the conduct of research with humans. The commissioning of this task force by BSA and the educational volume that it produces is proof positive that APA is already engaged in efforts 'to fulfill its other higher mission?that of raising the level of ethical behavior of its membership.'

Susan Folkman
Bruce D. Sales
Co-Chairs, Task Force on Research with Human Participants

Note: A draft of the above-mentioned document is currently being distributed for public comment. Copies may be obtained by contacting APA?s Science Directorate.

THERE IS A DISTINCT IRONY in Dr. Seligman?s comments in the May Monitor. On page 2, he reports the difference between efficacy studies and effectiveness studies, stating that the former 'have good internal validity, but?generalize poorly to treatment as it is actually done in the real world.' On the other hand, effectiveness studies, like his Consumer?s Reports study, are described as having 'more patient improvement,' and as robustly documenting that 'the longer the therapy, the more improvement on every outcome variable.' (He does not note that one other source of disagreement between the two types of research is the poor scientific quality of many effectiveness studies, including the Consumer Reports study.) Instead, he cites a need for 'a definitive body of effectiveness research' that will ensure that the marketplace 'considers quality as well as cost issues.' The irony is found in Dr. Seligman?s answer to Dr. Goebel?s letter on page 3. Dr. Seligman lists the disorders that 'now can be cured or considerably relieved.' And how have these disorders been studied and treated? Note how many of them are treated with time-limited, fixed duration, manualized treatment. Our best documented successes arise with the type of interventions so many clinicians decry. As unpleasant as it is for many of our members, the reality is that treatment does not have to be lengthy, and the type of intervention does matter. Our profession will serve the public better when we stop trying to dismiss this reality.

Steven D. Moore, PhD
Middletown, Conn.

THE JUNE PROFILE ON Dr. Alan Glaros? work with TMD patients draws valuable attention to this mostly ignored area of psychology and dentistry, but also does a disservice by the misguided emphasis placed on behavior as the 'key to treating jaw disorders.'

Having conducted a qualitative dissertation study on TMD, the opinion that 'an interplay of stress and muscle tension underlies most jaw problems' fails to take into consideration underlying skeletal abnormalities. No mention was made of the importance of ruling out structural pathology before concluding that behavioral or emotional factors are the cause.

The 'key' to proper treatment is conducting thorough assessments to make accurate diagnoses, with medical rule-outs being a crucial first step. In my research, a structural abnormality was not even considered by doctors in 83 percent of patients interviewed.

The results: delays in proper treatment, worsening of symptoms in 75 percent of patients, and inappropriate treatment that created iatrogenically induced problems. Up to 67 percent of patients could not identify any stressors as impacting their symptoms.

Instead, failure to make an accurate diagnosis led to 58 percent of patients? experiencing significant decreases in their psychological well-being.

Bruxism is not just a TMD subcategory but in many cases may be a symptom of another condition requiring more than a mouth guard as treatment. I recommend that Dr. Glaros? efforts 'to divulge the muscular and biochemical underpinnings of TMD' focus on skeletal pathology that may be present and which the best of behavioral treatments cannot possibly correct.

Margarete Ronnett, PsyD
Wheeling, Ill.

Think globally

WE APPRECIATED RAY FOWLER?S encouragement in his May column to 'expand your knowledge of psychology in other cultures' and to attend part of the International Congress of Applied Psychology before APA?s Convention. His further comments are also much appreciated: 'To limit our information to developments in the United States now makes no more sense for psychologists than it does for economists, chemists or political scientists. More than ever, we are all citizens of the world.'

Dr. Fowler?s comments dovetail nicely with ones from Martin Seligman where he states in an interview that APA needs 'to start thinking on a more global perspective?it has to move out from its current insular and provincial roles. Ninety-nine percent of what APA does is about domestic problems' (Psychology International, Spring, 1998).

We are American psychologists living in Europe the past 10 years and consulting on five continents. We want to thank APA?s leadership for pointing us all in the international direction. There is a wide world of need and opportunity for our compassionate, culturally sensitive involvement.

Our only caution is a reminder from our own ongoing process to adjust our professional and cultural backgrounds to fit the needs of those from different countries. We Americans, frankly, have much to offer, but much to learn. Being part of such a respected and well-resourced association opens the doors for many APA members to play a crucial international role.

Kelly O?Donnell, PsyD
Michele O?Donnell, PsyD
Oxfordshire, England

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