More psychologists needed on integrated-care teams
Thanks to Dr. Kettlewell for focusing on the positive impact of psychologists in primary care settings (July/August issue, "Integrated care at work.")
As part of the leadership team for a recent summit on care management, I was both surprised and disappointed to see few psychologists among our more than 100 participants. Although social workers and nurses predominate in the care management field, the Monitor's article makes it clear that other practitioners also have work to do to improve medical outcomes and efficiencies.
For example, we know that many individuals with primary medical diagnoses and/or chronic conditions may develop psychological symptoms as well. Elders, too, can be susceptible to depression and substance abuse. These co-occurring conditions might be identified, but are not necessarily treated in the course of a basic physical examination or functional assessment. In such cases, I am often asked to provide additional information and referrals through my consulting practice. I encourage APA to continue to highlight the value that psychologists can add to care management and medical treatment teams, and to support legislation and reimbursement structures that make psychological services an accessible and affordable part of integrated care.
Laura E. Pasquale, PhD
La Jolla, California
Protecting our planet
Kudos for the June Monitor article "Climate change communication heats up." The article is useful in equipping more of us with conceptual and practical tools for helping to lighten the carbon footprint. Yet a subtle influence that may underlie selective resistance to addressing problem-solving approaches to climate change is religious ideology.
For example, in the Journal of Theoretical & Philosophical Psychology, a well-referenced article by Jost et al. (February, 2014, pp. 56–81), "Belief in a Just God (and a Just Society): A System Justification Perspective on Religious Ideology," asserts that "religious ideology appears to serve the palliative function of making people happier or more satisfied with the way things are" (p. 56). Yet rather than ideological complacency, the existence of climate change at the environmental level challenges the notion of status quo.
As Winerman cites in the Monitor article, "The pain of paying more for gas at the pump, turning down the thermostat, or deciding to forgo airplane trips is real and immediate. And yet those actions can feel minuscule compared with what needs to be done to limit global warming. Meanwhile, the most serious consequences of climate change seem remote — far away and far in the future."
Nevertheless, discussion with parents regarding the improved status of future life if climate change is brought under control seems a promising incentive. That is, appeals to healthier, safer lives for children, grandchildren, great-grandchildren and beyond offer a trans-generational perspective for effective communication.
William F. Vitulli, PhD
Mobile, Alabama
Misguided article on parental alienation
The "Contested custody" article in the July/August Monitor presents an extremely biased view of the problem of parental alienation in disputed custody cases. The article quotes Joan Meier, an attorney, who dismisses parental alienation as "a small problem" and states that only a "tiny" percentage of children end up "seriously" alienated from one parent in divorce cases. The article also implies that the concept of parental alienation is a ploy used by abusive fathers' attorneys to gain custody of their children. These positions do not represent the views of most forensic psychologists who perform custody evaluations, nor do they accurately reflect the findings of the many empirical studies of parental alienation.
The other two "experts" who were cited in the article hold similarly extreme views about the utility of the concept of parental alienation. The views expressed by the three "experts" cited in the article do not reflect the views of most psychologists who perform custody evaluations. For example, a survey of 84 forensic psychologists who perform custody evaluations found that 58 percent of respondents rated the usefulness of the concept of parental alienation in the evaluation of allegations of sexual abuse in custody disputes as 4 or 5 on a scale from 1 (useless) to 5 (very useful). Only 11 percent rated it as useless (1). This study, by Bow, Quinnell, Zaroff, and Assemany (2002), was published in a peer-reviewed APA journal, Professional Psychology: Research and Practice.
Steve Herman, PhD
University of Hawaii at Hilo
The "Contested custody" article was a one-sided and questionably framed argument about child abuse and parental alienation, actually two distinct phenomena associated with high conflict divorce. As an evaluator with over 30 years experience, I have observed judges weigh evidence — including parent testimony — carefully in countless court appearances.
In abuse cases, there are often data available to establish patterns of abuse: social services reports, observation of the parent-child relationships, child interviews and third-party corroboration. Alienated children don't display the ambivalence of abused children; they often express exaggerated and global accusations without supportive data and wholly reject the parent and their extended families.
Protocols exist to aid evaluators in determining realistic estrangement vs. alienation: a far more likely scenario than alienation vs. abuse. In over 1,300 cases, I have never seen a judge remove a child from a caring mother and "have them handed over to abusive fathers." Litigating parents are a separate population from divorcing parents. As such, there are a variety of significant issues that arise and rarely is it abuse and/or alienation. And no one I know serves in dual roles. A professional is never likely to be a therapist and an evaluator. But an evaluator can, after litigation is over, serve as a parenting coordinator. I only do so if both parents make that request and with the caveat that I will not return to the evaluator role if their case is re-litigated.
Bill J. Fyfe, EdD
Denver
While the title is correct, the content of the Monitor's "Contested custody" article cannot be further from what I, as an attorney, see in the courts.
The article appears, at best, uninformed of reality of the subject matter. There is much research that supports the existence of alienating behavior when parents are divorcing. Although my vantage point is that of an attorney, I can assuredly state that alienation tactics are much more common than one would ever expect. Not surprisingly, the flip-side — false allegations — are usually coupled in the same cases. The debates over research in this area have been highlighted in articles by Jennifer McIntosh, PhD, and Richard Warshak, PhD. Perhaps an article documenting actual research, as opposed to unsupported statements, would be appropriate in the near future.
Michael D. Gerhardt
Chicago
