Columnists
Cultural competence and Groundhog Day
By Alan Bodnar Ph.D.
If you ever need a demonstration of the importance of cultural competence, just imagine yourself in psychotherapy in a country that doesn’t celebrate Groundhog Day. You are spending your first winter in a tropical country in Asia and, in the waning days of January, your thoughts turn to friends and family back home. You think of your snowbound grandmother and how important it is for her to get to Savannah for the country’s biggest Saint Patrick’s Day parade on March 17. With an early spring, she will have just enough time to crank up her Model A Ford and make [More]
Saving our lives one step at a time
By Alan Bodnar Ph.D.
Just one month into the new year, some of our resolutions for self-improvement may have already started to split along the fault lines of old comfortable habits and resistance to change. It happens every year and, according to one source I consulted, it began with the Babylonians who were the very first to make new years’ resolutions. They probably weren’t much better at it than we are. But that’s okay because, for most of us, the price of failure isn’t terribly high. There are some, however, for whom the ability to change is a matter of life and death every [More]
More than a few good interns
By Alan Bodnar Ph.D.
By the time this column appears in January, the interview phase of the annual internship sweepstakes will be in full swing. But as I write in December, I have just finished reviewing my share of the mountain of applications that come every year to our hospital’s training program. Reading applications for internships always makes me think that I have been transported to Lake Wobegon, Garrison Keillor’s fictional Midwestern city where “all the women are strong, all the men are good looking and all the children are above average.” I don’t know about strength or looks and those qualities aren’t relevant [More]
Ebenezer Scrooge and the Season of Second Chances
By Alan Bodnar Ph.D.
What I love most about the dark cold days of December is the opportunity they give us to notice and enjoy glimpses of contrasting light and warmth. Outdoors the cold makes everything sharp and clear and paradoxically we are more aware of the sun glinting off crystalline expanses of blinding white snow. Indoors we light fires, celebrate holidays and remind ourselves that anything is possible. True or not, this is something we need to believe because we see too much distress and suffering and know too well the importance of second chances. This is the season of second chances and [More]
Living by stories
By Alan Bodnar Ph.D.
When I decided to spend part of a recent Sunday afternoon at a reading by Robert Coles in a bookstore in a nearby town, I knew I was in for a pleasant drive through the fall countryside and an hour or so of interesting observations by a man whose ideas on life and literature have inspired me throughout my professional career. Interesting observations and a pleasant drive would have been more than enough to make my day but the highlight of the afternoon was something for which I am still searching for the words to describe. It had to do [More]
Prescription authority comes with risks, uncertainties
By Edward Stern J.D.
Forces are in the health care system changing its landscape. The greatest changes seem to revolve around the payments of insurance, including who will provide particular services. One of the services that has become part of the discussion is which professionals will be permitted to have prescription-writing privileges for controlled substances. Traditionally, Doctors of Medicine (MDs) and Doctors of Osteopathic Medicine (DOs) could write prescriptions for medications. Dentists (DDS and DMD) also can prescribe. In some areas, Advanced Practice Registered Nurses (APRN), known in some places as Psychiatric Mental Health Nurse Practitioners (PMHNP), with a master’s degree in psychiatric/mental health [More]
Ambushed by insight
By Alan Bodnar Ph.D.
Metaphors abound in everyday speech but psychologists use them mindfully, most often to clarify something that we think is important for our audience to remember. We like to think we are the masters of our metaphors but, once expressed, they have a way of doubling back and sneaking up on us with an unexpected lesson. Setting ourselves up to be ambushed by insight, my wife and I recently boarded a westbound train in a Boston suburb and traveled to Seattle and back home again. Having done something like this before, we had an idea of what to expect and no [More]
Bridges
By Alan Bodnar Ph.D.
When our hospital closed in April, we lost our internship and, with it, a long list of practices, rituals and ceremonies that had come to mark the seasons of a year dedicated to learning the skills of our craft as clinical psychologists. Every year as the New England winter gave way to spring, we talked about “termination” – that most peculiar of all words meant to give scientific respectability or at least provide safe emotional distance from the simply human act of saying goodbye. That discussion prepared our interns to leave their patients, stopping or interrupting their treatment, while processing [More]
The risks of restraint and seclusion
By Edward Stern J.D.
Last month, New England Psychologist looked at the use of restraint and seclusion. In this installment, the column examines some of the risks of these methods to both patients and mental health care workers. Restraint and seclusion have their own risks because restraint can involve physical struggling, pressure on the chest or other interruptions in breathing. JCAHO reviewed 20 restraint-related deaths and found that in 40 percent, the cause of death was asphyxiation, while strangulation, cardiac arrest or fire caused the remainder. Reported deaths (Hartford Courant) in cases where restraint or seclusion was a factor were caused by asphyxia, cardiac [More]
Use of restraint, seclusion is controversial, Part 1
By Edward Stern J.D.
The first of a two-part column. When the justice and mental health systems believe that someone is a risk to himself/herself or a threat to others, the courts may intervene and involuntarily commit that person. To the public, an involuntary commitment might be the end of the inquiry regarding the treatment and care of those in mental health treatment. This month’s column focuses on the use of seclusion and restraint for patients being treated within the mental health system. These issues are important, especially settings where the program is understaffed. First, it’s important to discuss the variety of people who [More]