Author Archives: Susan

LSBEP Sends Blistering Critique to Psych Boards in US & Canada. ASPPB Rescinds Decision to Make EPPP-2 Mandatory

On August 17, President of the Association of State and Provincial Psychology Boards (ASPPB), Sharon Lightfoot, PhD, announced that the ASPPB Board of Directors voted to rescind their 2017 decision, a decision which would have essentially mandated a second exam for those seeking a license in psychology.

“Based on your input this summer and our own priority-setting,” wrote Lightfoot, “the ASPPB Board of Directors on Sunday August 12, passed a motion to rescind our decision of August 2017 and announced to you in October that made the Enhanced EPPP (including both knowledge and skills portions) as the single licensure exam offered by the ASPPB.”

“We will continue toward launch of the Enhanced EPPP in 2020,” Lightfoot said, “and make it available to states and provinces interested in serving as early adopters. We are lifting the requirement for use of the Enhanced EPPP and are lifting the deadline for implementation.”

Lightfoot’s announcement came after a blistering critique of ASPPB’s methods, sent July 20 on behalf of the Louisiana State Board of Examiners of Psychologists (LSBEP) and signed by Executive Director Jaime Monic. The letter listed numerous criticisms and was addressed to the ASPPB Board of Directors, ASPPB members, and copied to the administrators at state psychology boards across the US and Canada.

“LSBEP does not believe that data exists demonstrating that psychologists are not already held to high standards of competence,” wrote Monic. “The data that exists in terms of complaints and disciplinary actions toward psychologists also does not support the theory that competency problems abound in the field of psychology. In fact, ASPPB’s own data regarding complaint patterns notes that ‘Incompetence’ is not even among the top 10 reasons psychologists were disciplined in 2016 (the most recent year of date reported). Moreover, reported disciplinary action (for any reason) has steadily decreased since 2013.”

“Nationwide, ASPPB reported that only 12 licenses were revoked in both 2015 and 2016,” Monic said. “These numbers are exceedingly low and do not suggests that public safety is in question. Therefore, LSBEP is not convinced that another exam is justified by the current data. Prior to instituting additional barriers to the process of licensure by the LSBEP, clear rationale must be presented for their necessity.”

The letter also noted that there is a strong anti-regulatory climate in the country and that Board members are concerned that additional barriers to practice would draw the attention of Louisiana legislators. They also criticized the idea put forth by the ASPPB that additional testing for psychologists would bring the professional psychology in line with medical training, saying that these two professions are inherently different.

Monic, on behalf of the Board, also pointed out concerns with validity and test construction. “Psychology has long held itself as the profession with the most expertise surrounding test design and construction. We are uniquely qualified to create and implement assessments. We are trained that tests are not used prior to establishing validity and reliability. Changing statutes and rules preemptively before we know that the test is necessary and valid is not prudent and would prevent us from choosing another, perhaps better, exam from another vendor.”

The authors also criticized ASPPB’s role and reminded them that they are not a regulating body and have no jurisdiction in Louisiana, and that the decision is “…an overstep.”

“We are concerned that ASPPB has lost sight of their original mission, which from this board’s understanding was limited to facilitating communication between various member jurisdictions,” Monic and the LSBEP pointed out, and that mandatory decisions on EPPP-2 do not fit this role but rather the role of a vendor providing a product.

The expansion of the current licensing exam, called the EPPP2, has been a source of controversy in Louisiana and for some other state boards.

In 2016, ASPPB CEO, Dr. Stephen DeMers, told the state boards that the ASPPB Board of Directors approved the development and implementation of a second examination to assess competency-based skills. Through 2016 and 2017 the new “skills” test was promoted as a voluntary addition to the Examination for Professional Practice in Psychology (EPPP).

Through 2016 and 2017 objections to the EPPP-2 mounted, mostly from student and early career psychologist organizations. In Louisiana, Dr. Amy Henke, then a Director on the Executive Council of the Louisiana Psychological Association (LPA) and Co-Chair of the LPA Early Career Psychologists Committee, put forth a Resolution to oppose the EPPP-2 for Louisiana. The Resolution passed unanimously.

However, then, in a surprise move, the ASPPB Board voted to make the new test mandatory. In late 2017 Dr. DeMers announced that the EPPP-2 was no longer going to be voluntary and that the price would increase from $600 to $1200 for the two sections.

Issues of need and statistical validity have been concerns for Dr. Henke, the state psychology board, and the state psychological association. She took up the banner for the young doctoral graduates, who will bear the financial and emotional burdens of the proposed new test. Other LPA members began looking closely at the scientific need for the new test and also the methodology.

“There is no evidence that the public is facing some sort of previously unheard of crisis in terms of safety from currently practicing psychologists,” said Henke, who currently serves on the LSBEP.

This past April Dr. DeMers met with LSBEP members and representatives of LPA and others about the objections. After the meeting, Dr. Kim VanGeffen, LPA Past-President and current Chair of the Professional Affairs Committee for LPA, said, “Dr. DeMers acknowledged that, currently, there is not really any research on the validity of the EPPP-2.

“The EPPP2 committee believes that this exam has face validity and content validity,” VanGeffen said. “They are satisfied that these types of validity are acceptable for the EPPP2. There do not seem to be any plans to obtain predictive validity nor does the EPPP2 committee believe that establishing this type of validity is necessary,” she said.

Dr. Marc Zimmermann, past LSBEP board member and Chair of the LPA Medical Psychology Committee, also attended DeMers’ meeting. “I think the idea of measuring a professional’s skills before turning him/her lose on the public is a good idea. I do not think this attempt hits the mark,” Zimmermann said. “When the Board does oral examinations we come closer to this by allowing the
person to provide reasoning for their projected behaviors.”

“He [Dr. DeMers] stated that there is no predictive validity,” said Zimmermann. “He also threw in that none of the national tests had predictive validity. He reported that content validity was the accepted standard because a test with predictive validity could not be constructed.”

“He said several times that they were just a vendor, but they have put themselves in the position of being the only vendor,” said Dr. Zimmermann, and it impressed him that, “… DeMers had the
temerity to try to sell us something that does not meet the standard that psychological tests being published are expected to have.”

In Dr. Lightfoot’s announcement, she wrote, “our goal is to provide the best possible resource to you to evaluate your candidates. All jurisdictions will continue to receive detailed information about the nature, content, validity, and utility of the Enhanced EPPP as that information becomes available during 2020 and beyond.” The ASPPB is a private, nonprofit, 501(c) tax-exempt corporation located in Tyrone, Georgia. The company states its mission is to “Facilitate communication among member jurisdictions about licensure, certification, and mobility of professional psychologists.”

ASPPB’s main income producing product is the national exam for psychologists, which brings in about $5,000,000 in gross sales each year. They have a few other products, such as the Psychology Interjurisdictional Compact (PSYPACT), a service to coordinate psychologists working across state lines. In 2016 they listed assets of $8,954,240.

The “members” are about 65 representatives from regulatory boards from across the United States and Canada. The boards pay dues to be a member of ASPPB.

While many members are government officials, ASPPB does not follow open meetings laws. Deliberations and decisions are private. “If you are not a member or staff of an ASPPB Member Psychology Regulatory Board or an individual member, you are not eligible to access this section of our website,” they write. Their conferences are also members only.

The company it also owns the intellectual property rights to the EPPP and the data generated by the testing program, which they appear to have acquired in or around 2013 from PES.
ASPPB officials said that the change was “mutually beneficial because ASPPB can now provide a simplified agreement that is more specific to the needs of psychology licensure boards. In addition, the renewal of contracts is expected to be more efficient…” And, “Finally, as voting members of ASPPB, each jurisdiction exercises more oversight of this important examination service by contracting directly with ASPPB for examination services.”

Over the last two years, Henke and others have also pointed to multiple hurdles that candidatesalready must clear, including two years of supervision, a written exam, oral exam, background check, and jurisprudence exam. Additionally, the law allows the board to require additional physical and psychological assessments whenever needed, Henke has pointed out.
However, Dr. Emil Rodolfa, involved with test development at ASPPB, has said he questions if these standards are enough, saying that supervisors have “… difficulty providing accurate evaluations of their supervisees to others who may have to evaluate the supervisee’s competency.”

Dr. Henke has said, “I am particularly concerned about ASPPB Rescinds Decision Continued regulatory boards encroaching ownership of training standards. The goal of a regulatory board, in my personal opinion, is to provide the least restrictive amount of guidelines possible in order to protect the safety of the public.”

Dr. Rodolfa disagrees and said, “Licensing boards have a mandate to ensure that the professionals they license are competent. Competence is comprised of the integrated use of knowledge, skills, attitudes and values.”

[Editors Note: The Times has reported on this topic over a number of years. See reports in past issues, Vol 7, No. 6, No. 5, No. 8, and No. 9, and Vol. 8, No. 12, and Vol. 9, No. 5, available on our website.]

Mission Impossible –Fallout

by Alvin G. Burstein

There are two levels on which to enjoy this film. The first is its predictable employment of the features that characterize the whole series of movie adaptations of its television predecessor: the pounding musical theme, the amazing face masks, the fanciful technology, metal crunching car and motorcycle races, bloody hand-to-hand combat, acrophobic dangling, and the familiar mantra, “Your mission, should you choose to accept it….”.

The edge of some of the physical violence is carefully modulated with a dollop of camp. After a fight, the shirt is hardly rumpled, and the suit can merit entrance into a fancy soiree. The risks being run can be enjoyed even more safely than a real roller coaster ride.

The plot, too, is familiar. The Mission Impossible Force must deal with a conspiracy that threatens the civilized word. The degree of threat is such that IMF itself can violate rules, but must not be caught in the act. If it is, “The Secretary will deny all knowledge of….”.

All this is gratifying to IMF buffs. But this episode has another, subtler element. That is the tension between personal obligations and love for the individual and heroic struggles in the service of society as a whole.

In this film the threat to society is posed by a conspiracy peopled by a group called “The Apostles.” The group believes that social perfection can ensue only from the total destruction of society as we know it. A Leninist point of view, but arguably also a jab at religious zealotry. The Apostles have stolen nuclear material and plan world-wide nuclear and epidemic chaos.

In a hint of the personal/institutional tension that the film will explore, it opens with a scene of Ethan Hunt’s—he is the leader of the IMF team—marriage ceremony. The officiant’s invocation devolves into a recitation of the risks the marriage will involve for Julia, his bride, and Hunt begins franticly to protest. He is having a nightmare, and wakes from his restless sleep to receive a package that will begin the IMF war with the Apostles. IMF/Ethan Hunt buffs will recall the backstory of the couple’s painful decision to divorce, for Julia to “walk away,” leaving Ethan unfettered in his role as the IMF leader.

IMF’s pursuit of the Apostles will bring Hunt into the usual encounters with femmes fatales, and Julia will reappear in a way that I won’t spoil by describing. In addition, the issue of individual caring vs. what would aptly be titled “missions” repeatedly arises as the plot unfolds. In an echo of the basis for his divorce, Hunt muffs an opportunity to recover the
stolen nuclear material in order to save the life of one of his colleagues. The decision earns him predictable operational criticism. Hunt, and his IMF team, are contrasted with the Apostle’s by the former’s valuing of individuals at the cost of risking mission failures, and the latter’s unflinching pursuit of their “greater” good.

Many viewers probably won’t care much about that conflict, and will be happy with the film’s pyrotechnics. But it is a complicated and interesting element of the story—and it makes sense of the film’s title.

Getting Involved Can Reduce the Stress Caused by Today’s Politics

by Susan Andrews, PhD

One psychologist, Dr. Tammy Savoie, has taken those words to heart. Dr. Savoie decided to run for office because of the same stress that 63 percent of Americans reported last December in an APA poll. The stress – simply put – is concern about the division of neighbors and families over partisan bickering and an ineffective Congress, concern about the future of our country.

“Americans Are Freaking Out” was the headline conclusion of the 2017 Stress in America poll conducted for the APA by Harris. As I reported last year, nearly two-thirds of the people who responded to the Harris poll said that this is the lowest point in US history – and it is keeping a lot of them up at night. The poll, which was the 11th annual Stress in America survey done by the APA, was conducted online between August 2 and August 31 and included 3,440 respondents, aged 18 and over.

Those who are being kept up at night reported that they are worried about health care, the economy and an overall feeling of division and conflict between them and their neighbors. More Democrats (73 percent) than Republicans (56 percent) agreed that this was their top concern. Nonetheless, the sentiment was this is the lowest point in our nation’s history spanned generations, which includes World War II, Vietnam, and 9/11.

As we approach the mid-term elections, that stress has been building for many of us. Actually, many of us have complained for years about the qualifications of the politicians who are supposed to represent us. We complain but most of us will tell you that in truth they have not gotten involved, even with the local School Board elections. Sure, the most frequent answer: “Sorry, I am just too busy to volunteer.”

And, forget putting your hat into the Ring. That really would take too much time. This year is different, and as one who never volunteered before but complained a lot, I have been volunteering for Dr. Tammy Savoie’s campaign for two reasons:

1. She is a Clinical Psychologist, trained at Emory U., served for 23 years in the Air Force and retired in 2016 as a Lieutenant Colonel. Dr. Savoie was born and raised in the New Orleans area. As a Clinical Psychologist in the Air Force, she is naturally concerned about our veterans. As a Clinical Psychologist, Dr. Savoie understands the importance of a good education, proper child care, and good health care. Further, most people who choose a career as a Clinical Psychologist care about people and want to help them. More psychologists need to get involved actively in politics. We need people trained in critical thinking and objectivity; and Dare I Say It, more women.

2. I have been so stressed with concern about the future of our country that when I saw a woman with recognized credentials, not a professional politician, that I decided to put my time and energy where my mouth was. And, it has worked. Win, Lose, or Draw, I feel better knowing that I got involved. I hope we can have many more qualified candidates, like Dr. Tammy Savoie, in the future. I hope you Get Involved!

A Simple Favor

by Alvin G. Burstein

The film’s opening credits are backed with a shifting array of images and pop songs, a neat foretaste of the complicated tale to follow. The story opens on an ongoing charmingly amateurish vlog (video-log). Stephanie Smothers is regaling her audience of mothers with a mélange of homemaking advice. We quickly learn that the vlog is designed, not only to help her viewers, but to enable her to keep her and her child afloat financially after the death of her husband in an auto accident.

As we follow Stephanie picking up her child at school, we come to see her as a Type A fixit problem-solver and perennial volunteer. At the school, she encounters Emily Nelson, the mother of a classmate of Stephanie’s son. Blonde Emily, in a knock-out white vested pants suit, golden pocket watch chain, and spike heels is a striking contrast to the slightly frumpy brunette Stephanie, but they strike up a friendship.

A pattern ensues of after school visits to Emily’s palatial home, where the children play, and the women drink martinis mixed by the hostess. Stephanie is swept into an idolizing and sexually tinged relationship with her new friend.

One day, she gets an urgent call. Emily must leave town to deal with an emergency. Her husband has gone to visit his dying mother. Can Stephanie pick Emily’s son up at school and child-sit him until his mother gets back? A simple favor.

But Emily does not come back that night. Or the next nights. When Stephanie, panicked, manages to contact the husband, he returns, but has no knowledge of where or why his wife might be. They call the police.

The unfolding mystery has a quick-silver quality. Just as a solution appears, it skitters off in a new, surprising direction. I will refrain from spoiling the pleasure of experiencing those twists and turns, and content myself with comments on the film’s style and approach. When Emily is making the first martini, after shaking the gin and vermouth (just a touch), she pours the drink into long stemmed crystal glasses and twists a bit of lemon rind over them. We see the mist of zest evanesce. That image captures the lightness, delicacy, of this movie. The film cocks an eye at the contrast between high and low culture. It smiles at sisterhood and motherhood. It verges on slapstick humor, paradoxically heightening the fun by artfully scant allusions to human misery.

After the tale twists and turns its way to its climax, the audience is presented with an epigraph outlining what has become of those whose lives we have been following. It is an apt, updated version of the Looney Tunes’ “That’s All Folks.”

Gov. Edwards Joined Pres. Trump and Other Governors to Discuss Criminal Justice Reform

On August 9, Gov. Edwards joined President Trump, other state governors, and White House cabinet members in a roundtable discussion about the positive impact that criminal justice reform is having across the nation.

Gov. Edwards explained to the President that the package of bipartisan criminal justice reform legislation that Edwards signed into law in 2017 was working.

“In Louisiana, we’re proud of the work we’ve done,” said the Governor. “It’s been sentencing reform, prison reform, and a real focus on reentry and for the first time in 20 years, I can tell you Louisiana does not have the highest incarceration rate in the nation today.”

“We are reinvesting the savings into our reentry program and also into the victim services. And so we are excited about what we’re doing and looking forward to sharing that with you,” according to the press release.

A report in the Advocate by Elizabeth Crips noted that Trump and others at the meeting spoke about the need to enhance job and skills training programs in prisons, and to focus on how to prepare people to be productive citizens when they get out. “Our first duty is to our citizens, including those who have taken the wrong path but are seeking redemption and a new beginning,” Trump said. “That’s people that have been in prison, and they come out and they’re having a hard time.”

According to Gov. Edwards’ press release, he was the only democratic governor attending. Also attending were Gov. Matt Bevin (R-Kentucky), Gov. Phil Bryant (R-Mississippi), Gov. Nathan Deal (R-Georgia), Gov. Doug Burgum (R-N. Dakota), Atty. General Ken Paxton (R-Texas), Atty. General Pam Bondi (R-Florida), Labor Secretary Alexander Acosta, Energy Secretary Rick Perry, Jared Kushner and other White House staffers.

Gov. Matt Bevin of Kentucky, commented, “The most powerful thing about this… I look at guys like John Bel Edwards in Louisiana, represents a different party than I do in Kentucky in terms of our political affiliation. This is something that we are very much of like-mind on. I think this transcends anything political.”

Energy Sec. Rick Perry said, “I want to share with these governors around here; every one of them is courageous…”

Just after the meeting, Gov. Edwards gave President Trump a letter detailing Louisiana’s efforts, said the release.

The Governor wrote, “For nearly twenty years, Louisiana was known as the nation’s incarceration capital. Our imprisonment rate was nearly double the national average. We were spending roughly $700 million annually on corrections, more than any other line item except education and healthcare, but our communities were not safer for it….”

And, “With the technical support from The Pew Charitable Trusts, we convened a bipartisan task force and spent a year scrutinizing our correctional policies and practices. In June of 2017, I signed into law the most expansive criminal justice reform package in Louisiana’s history…Republicans, Democrats and Independents, as well as the business and religious community, came together to pass these historic reforms.”

The Governor invited the President to tour the State Penitentiary at Angola and see efforts to reform the state’s criminal justice system.

“I believe you will gain a great deal of insight by visiting Louisiana State Penitentiary and I look forward to welcoming you to Louisiana on behalf of the people I serve,” Edwards wrote in the letter given to Trump. “The reentry programming services at LSP (Louisiana State Penitentiary) are key examples of how we plan to utilize the savings from our reforms to better prepare those being released from our prison system. In fact, the first year savings is dedicated specifically to the five parishes that generate nearly 50% of Louisiana’s prison admissions…

Also according to the report by Crisp, Governor Edwards joined other Democratic governors in Colorado recently and discussed divisive politics and ways to unite people. “Folks are just anxious,” the Aspen Daily News quoted Edwards as saying Friday at the Aspen Institute event. “We ought not to vilify anyone. I don’t talk about Trump backers as crazy or racist.”

The justice reform efforts have not been without controversy. Critics point to the two individuals who are now accused of murder and others who have been rearrested. District attorneys are some of the most vocal skeptics, according to various sources.

Some estimate that as many as 22 percent are now back in the justice system, according to the Advocate. The Department of Corrections disputes that figure as inflated. “I’m not sure where the DAs are getting their information from,” said the head of Corrections, James LeBlanc. “Our numbers are not anywhere close to what they are saying.”

Dr. Susan Tucker, clinical psychologist and the Assistant Warden at the Bossier Parish Medium Security Facility, has explained the significance of comprehensive psychological programs in the corrections and justice system.

Tucker developed the Steve Hoyle Intensive Substance Abuse Program which has earned national recognition for excellence. In 2016 the Louisiana Legislature commended Tucker and her team in a House Concurrent Resolution pointing to multi-million dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed by Tucker.

Dr. Raman Singh, previous Medical Director at Corrections, pointed out the reasons for over-incarceration in Louisiana. Based on a 2016 Louisiana Legislative Auditor’s review Singh said the top reasons were mandatory sentences and habitual offender laws, high rates of local incarceration without treatment programs, and “not addressing issues driving criminal behavior such as substance and mental illness.”

Jails and prisons have a disproportionately high number of persons with mental health issues and people with a serious mental illness. He noted that of the mentally ill in society, greater than 40 percent have been arrested and the majority of these are brought in for minor offenses. Those with mental illness spend two to five times longer in jail.

There is a complex interplay of multiple societal factors stemming from problems in education, stressed family structures, socio-economic challenges and lack of job opportunities. The unemployment rate in the mentally ill adults in Louisiana is 88.3 percent.

And while 16 percent of the DOC prison population has been diagnosed with a serious mental illness, 82 percent are diagnosed with a substance use disorder.

Stabilized funding for higher education. State Budget Finally Stable Says Governor Edwards

This week Gov. Edwards authored a guest column in The Advocate detailing the progress Louisiana has made since overcoming the state’s fiscal challenges.

“… Louisiana is projected to have a $300 million surplus for the fiscal year 2018,” the Governor said. “This surplus is available to us because Louisiana businesses are doing
better, more Louisianans are finding work, and the improving economy has allowed corporate tax receipts to outpace expectations. Since I’ve been governor, the unemployment rate has fallen from a high of 6.2 percent to its current rate of 5 percent. But our good news doesn’t stop there.”

Gov. Edwards said that Louisiana now has long-term budget stability.

“For the first time in years, we have a stable budget structure that does not rely on one-time money or gimmicks, and we have put an end to the annual cuts to higher education that have threatened our children’s future. Republicans, Democrats, and Independents did all of that, and we still reduced the tax burden on the people of Louisiana by nearly $600 million.”

“Within weeks the national credit rating agencies removed Louisiana from the negative watch list. Our universities began the fall semester with nearly every campus’ enrollment at record levels because for the second year in a row, we stabilized funding for higher education and fully funded TOPS and Go Grants.”

“Bipartisanship has served our state well in other areas as well. Louisiana has taken the courageous step of implementing historic bipartisan criminal justice reforms. The reforms have been in place for just over a year, and the early results show that they are working. The state is no longer the incarceration capital of the world, a title we held for decades. In addition, the reforms have saved Louisiana $12.2 million, money that we are reinvesting into public safety and efforts to reduce recidivism. Our reforms were focused on nonviolent, non-sex offenders and were based off efforts in other Southern, conservative states, and we are proud to continue working with the White House and other states hoping to follow Louisiana’s lead.”

In a September 25 press release, the Governor announced that Louisiana was second in the nation for personal income growth in 2nd Quarter of 2018, behind only Texas, based on Bureau of Economic Analysis. Personal income in Louisiana grew at a rate of 5.9 percent, outpacing the national average of 4.2 percent, said the statement.

“Last week, we announced that the state ended the last fiscal year with a surplus. Today, the Bureau of Economic Analysis confirmed our assumptions – Louisiana’s businesses are doing better and people are bringing home more in their paychecks. This is excellent news, and just another sign that Louisiana is moving in the right direction. Our economy is growing, more people are working, and we have a stable budget structure for the first time in many years. While this is all positive news, we still have more work to do, but there is no denying that the momentum we have in Louisiana is real.”

The good news comes as a feature of the nationally based economic boom but also after painful legislative battles for the Governor.

After a total of seven special sessions since 2016, and three special sessions this year, Governor Edwards and legislators finally wrestled the budget into some type of order this past spring,
by the passage of an extra .45 percent sales tax, in down to the wire negotiations that ended last week. The move sidestepped drastic cuts to public health and higher education and provides several years of stability.

The new sales tax, a partial renewal of an expiring one percent sales tax, gave the lawmakers some respite from the yearly battles with the budget. The .45 brings the state sales tax to 4.45.

In the special sessions lawmakers were attempting to deal with the state’s budget crisis when more than $1 billion in taxes would expire on June 30, 2018. The two earlier special sessions floundered after the House repeatedly rejected increased taxes.

The House passed a budget that made dramatic cuts to TOPs, universities and state agencies. That budget was vetoed by the Governor.

Gov. Edwards Resists Attorney General Landry’s Decision on PreExisting Health Coverage Issues

In September the Governor issued a statement, “Attorney General’s Lawsuit threatens health coverage for 849,000 Louisianans with pre-existing conditions.”

The Governor commented that Attorney General Jeff Landry’s unilateral decision to enter the state of Louisiana into a lawsuit that eliminates health care protections for people with pre-existing conditions would deny people coverage.

On September 10, the attorney general appeared on CNN to discuss his effort. During the interview, said the statement, Landry made clear that prior to joining the lawsuit, he did not have a plan in place to ensure insurance companies do not deny coverage for the 849,000 people in Louisiana who could lose health care because they have a pre-existing condition.

“In Louisiana, 849,000 people have a preexisting condition that could lead to an insurance company denying them healthcare if Attorney General Jeff Landry is successful in his latest lawsuit,” said the Governor.

“It’s deeply disturbing that he has committed the state to this effort without consulting anyone and even worse, without having a plan in place to ensure these individuals do not lose their health care. Entering into this lawsuit should not be an impulse decision. It requires thoughtful consideration of the repercussions to the people of Louisiana. After seeing the attorney general’s interview on CNN this morning, it’s clear he did not think this through. Everyone acknowledges the Affordable Care Act (ACA) has flaws, and we should be working together to fix what’s broken. Protecting coverage for people with pre-existing conditions is one area where there is broad, bipartisan support. If successful, this lawsuit would cause chaos within the health care system, and the people of Louisiana would be left to pick up the pieces.”

The attorney general appeared on CNN to discuss the lawsuit. Pressed by a reporter about his plans for the 849,000 people in Louisiana who would lose health care if the court strikes down the pre-existing condition provision, he had no answer, indicating the attorney general had not spoken to anyone for a “Plan B” prior to filing the lawsuit. The interview is available here.

The press release also offered background, including the following:

According to a Kaiser Family Foundation study, approximately 849,000 in Louisiana have a pre-existing condition that could allow an insurance company to deny them health coverage.

A poll conducted by the UNO Survey Research Center in 2014 found that 76 percent of the people of Louisiana supported “requiring health insurance companies to cover anyone, even if they have a pre-existing medical condition.”

NOLA.com|Times Picayune: “The crux of Paxton’s and Landry’s argument is that Congress has repealed the “individual mandate” that required people to carry health insurance or pay a tax penalty, which means that the whole law should be declared unconstitutional. Paxton and Landry argue that the mandate for health insurance companies to cover people with pre-existing conditions cannot work if the individual mandate to carry health insurance will no longer be in place in 2019.

“…But even if he doesn’t succeed at getting Obamacare thrown out, Paxton has asked the court to still strike down the requirement for insurance companies to cover pre-existing medical conditions in the 20 states participating in the lawsuit, including Louisiana.

“…The Texas Attorney General’s office argued both in written briefs and court Wednesday that states — not the federal government — should get to decide whether health insurance companies are
forced to cover people with pre-existing medical conditions.” [NOLA.com|Times Picayune, 9/7/2018]

Stress Solutions

by Susan Andrews, PhD

“The greatest weapon we have against stress is our ability to choose one thought over another.” William James

This reminds me of a saying I once saw on a T-shirt: “Meditation: It IS what you think.” Of course, William James is taking for granted that most people are capable of controlling their minds well enough to actually choose to think about one thing and NOT to think about something else. Obviously, if everyone could do that, the world would be a much more relaxed and stress-free zone. The trouble seems to be coming from 2 possibilities: (1) many people do not realize that stress can be managed by controlling what they are thinking about and (2) too many people in the world today lack the ability to control what they are thinking.

Stress is absolutely a function of what we think. It is our thoughts about what is happening in the moment that actually trigger stress. And, as James points out, humans can choose to think about something that would normally cause them stress whereas nonhumans do not have that choice. For example, mice can be exposed to chronic stress in a laboratory a number of ways, such as by keeping them in a small space for 21 days. Mice, thus treated, show behavioral and brain cell changes in the amygdala associated with anxiety and depression1.

Research indicates that “reappraising” our situation – i.e., changing the way we think – can actually improve our body’s physiological and cognitive reactions to a stressful event. A team of Harvard and UC San Francisco researchers1 tested this theory by simply instructing participants in a reappraisal condition to think about their physiological arousal during a stressful task as “functional and adaptive.” There were two control conditions: attention reorientation and no instructions.

The participants instructed to “reappraise” their physiological arousal by thinking of the arousal as being more adaptive or functional showed measurably better cardiovascular stress responses (in terms of increased cardio efficiency and lower vascular resistance) and decreased attentional bias. Thus, changing our thoughts and thereby our perception can significantly improve the effects of stress on our body.

The suggestion to reappraise how we are looking at a stressful situation so that we think of it as somehow benefiting us or helping us do something better may be a much easier way to help people learn to control what they are thinking. Often when clients are instructed to try to control what they are thinking and NOT to think of the “X” that is upsetting them, they respond by saying they cannot control what they are thinking. Thus, using the suggestion of “reappraising” or reframing how they think about something may be much more successful at getting a stressed client to think differently – and feel less stressed.

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1 T Lau, B Bigio, D Zelli, B S McEwen, C Nasca. Stress-induced structural plasticity of medial amygdala stellate neurons and rapid prevention by a candidate antidepressant. Molecular Psychiatry, 2016.
2Jamieson, J. Nock, M. and Mendes, W. Brief Report: Mind Over Matter: Reappraising Arousal Improves Cardiovascular and Cognitive Responses to Stress. 2012. Journal of Experimental Psychology: General 2012, 141, 3, 417-422.

Three Identical Strangers: A Review

by Alvin G. Burstein

This is a powerhouse film, deeply stirring emotionally, and raising profound questions about morality and the nature of truth.

Three Identical Strangers is an indie film by Neon/CNN, produced by Tim Wardle. It won raves at this summer’s Sundance Film Festival, and is now beginning general release. I will do my best to outline how it achieves its impact while avoiding spoilers that would dilute its impact.

It begins with one of the three identical twins that are its focus addressing the camera, documentary style. He describes to the viewer his arrival for his freshman year on campus. Puzzled by the warmth and familiarity with which he is greeted, he shortly learns he is being taken for another student who had attended the year before, but had not returned. A buddy of that predecessor realizes that the newcomer must be an identical twin, and immediately barrels the twins into a meeting. The publicity around the surprising encounter leads a third identical triplet to emerge.

What ensues is an account of how it happened that, at six months of age, these male triplets had been placed by a Jewish adoption agency with three different sets of parents and of their lives subsequent to the reunion.

It emerges that they were subjects of a research project conducted by the noted child psychoanalyst, Peter Neubauer, who wanted to study the effects of varying parenting on similar children, and who had arranged with the agency to facilitate his study of identical twins—and triplets—with different families.

Either by design or intentionally, the three adoptive families differ, with a focus on fathers that is clear, though not explicit. That of the triplet that opens the film, Bobby, is middle class. The father, described as very warm, runs a small retail store. Eddy, his brother, is placed in a different setting. His father is a teacher, described as stern and demanding. The third triplet, David, has a new family headed by prosperous but very busy physician.

The film documents the boys’ lives subsequent to the astonishing and joyful reunion with an artful mix of narration, photos, home movies and re-enactment. The three become media celebrities, diving into a 60’s farrago of highlife and hijinks.

The documentation includes contemporary interviews with some of those originally involved—surviving members of the families, Neubauer’s former research assistants and Neubauer himself—burnishing the authority of the re-enactments. But some of the reconstructions, for example a celebratory toasting by the adoption agency staff, seem doubtful.

As the film goes on, the mood darkens and the emotional reaction of the three brothers to what they have learned becomes more complicated. In addition, the very striking physical similarity of the three brothers develops a subtle psychological counterpoint.

A crucial part of the film’s depth lies in questions about nature vs. nurture. Another issue is that of authenticity and the nature of truth. The film raises questions about Neubauer’s motives for not publishing this study. The film makes no allusion to the 1960’s furor about the Tuskegee study of the course of untreated syphilis and the Willowbrook study of infant hepatitis. Those studies were castigated for failing to involve consent from the subjects. Those familiar with the psychoanalyst’s work know that he sought to contextualize the view that maternal failures—remember the 1950’s shibboleth about refrigerator mothers and autism—with an exploration of paternal contributions. Arguably an important question. But had he obtained informed consent?

And I will end with a combination paradox and teaser. Bobby’s father, about whom the triplets clustered as young adults, had a Yiddish nickname, “Bubeleh”. It means “Little Grandmother.”

State to Reinvest Justice Reform Savings to Reduce Recidivism

Gov. Edwards and the Louisiana Department of Public Safety and Corrections (DPS&C) released the first report outlining savings from criminal justice reform measures passed by the legislature in 2017. The savings, according to the report, have exceeded Pew Charitable Trusts’ projections. Savings for fiscal year 2018 totaled $12.2 million, doubling Pew’s original projections of $6.1 million.

“In 2017, Republicans, Democrats and Independents came together to rethink our criminal justice system,” said Gov. Edwards. “We knew what we were doing just wasn’t working and it was costing us more money. By following the lead of other southern, conservative states, we passed a package of 10 bills that will improve public safety and reduce recidivism.”

“This is great news for the state of Louisiana,” said James M. Le Blanc, Secretary, Louisiana Department of Public Safety and Corrections. “Our goal and our mission with criminal justice reform is to reinvest money we would usually pay for incarceration into programs aimed at better preparing our returning citizens and individuals on probation and parole, and to help victims of crime.”

The Justice Reinvestment bills are anticipated to save the state more than $262 million over the next decade, and 70 percent of the savings will be reinvested into programs to reduce recidivism and support victims.

The Department currently intends to use first-year reinvestment funding in support of the following priorities: Increasing programming for state inmates housed at local jails; Enhancing and expanding Regional Reentry Centers; Increasing Probation and Parole staffing and Day Reporting Centers; Launching a Transitional Housing pilot program; Opening a new Reception Center to conduct assessments for new inmates; and Expanding Specialty Courts.

Grants to Community-Based Services: With the goal of ensuring this funding is spent in the most effective and transparent way possible, DPS&C has created a Community Incentive Grant Program and has issued a Request for Proposals (RFP).

The RFP is intended to elicit proposals from qualified community organizations that are interested in enhancing or expanding coordination of reentry services and community supports to increase prison alternatives and reduce recidivism. Funding will be awarded in the fall of 2018.

Grants to Support Victims’ Services: Louisiana Commission on Law Enforcement (LCLE) currently intends to use first-year reinvestment funding in support of the following priorities:

Supplementing the Crime Victims’ Reparations Fund; Establishing a new Family Justice Center in East Baton Rouge Parish; Improving
electronic notifications for victims by developing an electronic system that will interface with all 64 parish clerks of court; and Providing funding to the Louisiana Bureau of Investigations for a dedicated forensics server for their Cybercrimes Unit.

Prior to the passage of the Justice Reinvestment Initiative (JRI) legislation, Louisiana was leading the nation in imprisonment, with a rate nearly double the national average.

Dr. Susan Tucker, psychologist with the DPS&C has been working on programs to reduce incarceration rates. In 2016 legislators pointed to multimillion dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed and delivered by Tucker and her team at the Bossier Sherriff’s Office, Medium Correctional Facility, located between Benton and Plain Dealing, Louisiana. Dr. Tucker has been working on reducing the rates through her comprehensive, innovative, and evidenced-based programs, to improve lives, families and community safety.

“I am very proud of our program and that we accomplish two goals which save taxpayer money but also provide rehabilitation to the substance abuse incarcerated offenders as well as their families,” Dr. Tucker told the Times.

Governor Appoints Dr. Gormanous to Psychology Board

In a July 10 press release the Governor announced that he appointed Greg Gormanous, PhD, of Alexandria, to the Louisiana State Board of Examiners of Psychologists (LSBEP).

Dr. Gormanous will fill the position opened by Dr. Phillip Griffin, who has completed his term. Vice Chair Dr. Jesse Lambert was elected to theChair at last month’s meeting and Dr. Koren Boggs will serve as Vice Chair.

Dr. Gormanous previously served on the board twice, the first time in 1981 to 1984, and then from 1986 to 1989. He is Professor Emeritus of Psychology, LSU Alexandria, and earned his PhD from the University of Southern Mississippi in General Psychology in 1976. He has been a member of Association of State & Provincial Psychology Boards (ASPPB), the Federation of Associations of Regulatory Boards, the American Psychological Association, the Society for Industrial & Organizational Psychology (APA Div. 14), the Society of Consulting Psychology Louisiana is Heading in Right Economic Direction Says Governor Edwards in July (APA Div. 13), and the Association for Psychological Science. He is also a veteran of the United States Army.

Dr. Gormanous was the sole candidate to selfnominate for the current position and was nominated by the Louisiana Psychological Association.

Dr. Gormanous noted several goals of his service. “My view for regulating psychology in Louisiana is helping the board become more effective and efficient in protecting consumers of psychological services, while simultaneously ensuring due process, irrespective of particular staff, board members, issues and personalities.”

He wants, “To proactively enhance effectiveness, collegiality and transparency with administrative, legislative, media, professional, psychological & public stakeholders in order for the LSBEP to ensure statutorily that consumers have access to qualified providers of psychological services and to ensure enforcement of ethical standards of practice to which providers are required to adhere, with appropriate over sight of the Board’s function by the state of Louisiana.

When applying to serve, he listed six specific issues:

“1. Revising the “complaint” rules, procedures and practices by focusing on two equally important objectives: protecting consumers of psychological services AND ensuring due process for all.

“2. Achieving more effective outcomes for the expenditure of legal fees – presumably underway now.

“3. Staying a pace with changes in education and training. For example, other jurisdictions will be moving toward eligibility for candidates to sit for the EPPP 1 after doctoral course work is completed.

“4. Adjusting to implementation of the competency model (EPPP 1 Knowledge and EPPP 2 Skills) by other jurisdictions and considering what is best for consumers in LA.

“5. Revisiting Generic versus Specialty Credentialing. Does the board stay with its “opportunity for registering…within a limited list of recognized specialties…” or does it implement the health service psychologist (HSP) & general applied psychologist (GAP) categories recognized by APA and ASPPB?

“6. Exploring any ramifications of implementation of the ASPPB’s PEP for LA.”

In a 2010 Times feature article (“Close-Up,” Vol. 2. No. 1.) Dr. Gormanous said that his heart was in teaching.

“Teaching is my drug of choice,” he said “I was one of those people who, in the Ericksonian sense, was late in forming my identity. I wanted to be a college professor. It was English, then math, and then I stumbled across psychology. I realized it was the field where I could discover myself, and discover my need to teach. I love to teach and help develop people, and we have students who want to learn and develop, and so it’s been a perfect fit.”

At that time, Dr. Gormanous has remained involved in his community through efforts with the Alexandria Zoo, Business Incubator, the Rapides Parish Primary Health Care Center, the Syra-Meric Club, and the Alexandria Mardi Gras Association, where he started a new parade – Classic Cars & College Cheerleaders. He also started the Krewe of Kolbi Bow-Wow with the Animal Shelter and the Alexandria Zoo. This is a dog Krewe that advocates for pet adoptions. He has been active with the Chamber of Commerce, Rotary Club of Alexandria, and the Convention and Visitors Bureau.

While his heart might be in teaching, his soul is in the blues. A special project, “Psychology of the Blues,” where he applied psychological principles to songs and singers, and how they have been molded into who they’ve become, has captured his imagination for many years.

“Psychology of the Blues” involves four musicians as he explained–Otis
Redding, Steve Cropper, Grady Gaines, and the great B.B. King.

“I’ve had the privilege of knowing, and sort of informally and unofficially traveling with B.B. King since 1983,” he said. In 1983 Dr. Gormanous attended an event memorializing the slain civil rights leader Medgar Evers. “Charles Evers and B.B. King
wanted to keep the spirit of Medgar alive,” he said.

“BB King and his band played free so that music could be the language to bring people together to overcome racism.” He realized then that music was a vehicle to change the world and it inspired him to be involved.

Louisiana Psychological Assn to Host Evolutionary Psychology Legend, Professor Robert Trivers

Times Magazine listed him as one of the 100 Greatest Thinkers of the 20th Century. Richard Dawkins calls him “A uniquely brilliant scientist.” Science named him “One of the most influential evolutionary theorists alive today.”

Stephen Pinker, Professor of Psychology at Harvard and author of How the Mind Works, said, “I consider
Trivers one of the great thinkers in the history of Western thought. It would not be too much of an exaggeration to say that he has provided a scientific explanation for the human condition: the intricately complicated and endlessly fascinating relationships that bind us to one another.”

He is Professor Robert Trivers, the man who pulled back the curtain on key concepts of evolved preferences, and produced a major redirection in social and evolutionary psychology. He will speak at the Louisiana Psychological Association workshop on November 9, in New Orleans.

In a series of brilliant papers beginning in the 1970s, he laid out the evolutionary logic and foundational theory for major areas of human social interaction. His combining of psychology and evolutionary biology opened the door to a better understanding of the deep connections of love, cooperation, competition and the unconscious conflicts that accompany them.

In 1971, with, “The evolution of reciprocal altruism,” Dr. Trivers put the heart back into the psyche: Being moral, good, and fair, had in fact, evolved right alongside our purely selfish traits.

The model is where “friendship, dislike, moralistic aggression, gratitude, trust, suspicion, trustworthiness, aspects of guilt, and some forms of dishonesty and hypocrisy” could be explained as important adaptations to regulate the reciprocalaltruistic system, sensitive to developmental variables and selected to their specific social environment.

Trivers’ theories inspired a staggering amount of research and discussion with bestsellers like E.O. Wilson’s Sociobiology and Richard Dawkins’ The Selfish Gene, and later books like The Adapted Mind, The Red Queen, Born to Rebel, The Origin of Virtue, The Moral Animal, and Evolution of Desire.

As the explosion of research continued, Trivers wrote that some of the ideas had “…almost biblical proportions.” He said, “… you could see how a kind of social heaven and social hell could evolve right here on earth. The social hell was perpetual isolation, perpetual inability to link up with others in a positive way, never being cheated by others to be sure, but at the cost of eternal loneliness. The social heaven was not heavenly in some naïve way, dancing around the mulberry bush together without regard for selfish possibilities. Instead, cooperation required perpetual vigilance to enjoy its fruits, …’”

Together, Trivers’ work helped explain evolved tendencies in romantic relationships between females and males (“Parental Investment and Sexual Selection”) relationships between parents and children, and between siblings (“Parent-offspring conflict”), and how friends deal with friends, acquaintances and strangers (“The evolution of reciprocal altruism”).

In the 1990s, Trivers took another leap and explained an evolutionary logic of self-deception. (“The crash of Flight 90: Doomed by self-deception?” co-authored with Black Panther leader, Huey P. Newton; and “The elements of a scientific theory of self-deception”).

Dr. Trivers has stated that he “… was eager to contribute to building social theory based on natural selection, because a scientific system of social theory must, by logic be based on natural selection, and getting the foundations correct would have important implications for understanding our own psyches and social systems.”

Today, while psychology includes vast amounts of fascinating data and interesting partial theories, it still lacks a foundational, meta-theory, say evolutionary psychologists William Von Hipple and David Buss. In their survey, the two found that almost 90% of social psychologists accept Darwin’s ideas in general, but only about 50% believe that evolved characteristics apply to the human mind and social tendencies.

Trivers himself wrote that he expected his work would be welcomed––he viewed himself to be “on the side of the angels,” he said. Instead, it was labeled “regressive.”

In the past, evolutionary theory may have seemed harsh, and even to be a theory that gives permission for inequality, something psychologists work against. Von Hipple and Buss point to the mistaken idea of “genetic determinism”––the belief that genetic behavior is fixed, and also to the confusion between evolved preferences and actual behaviors in modern humans, as contributing to discomfort with embracing evolution as a metatheory.

Today, a stronger understanding that the expression of these predispositions is plastic, fluid, varying and context-dependent, has worked its way into psychologists’ thinking, along with the acknowledgement that the discipline cannot ignore important science only because it may at times be uncomfortable.

“But Trivers’ ideas are, if such a thing is possible,” said Pinker in an interview with the Edge, an intellectual think tank, “even more important than the countless experiments and field studies they kicked off. They belong in the category of ideas that are obvious once they are explained, yet eluded great minds for ages; simple enough to be stated in a few words, yet with implications we are only beginning to work out,” Pinker said. This may be the case. Trivers Google Scholar citations, now over 44,500, are continuing to increase. Citations for his 10 major papers are much higher now than they were for the first 30 years after publication.

The Louisiana Psychological Association will host the evolutionary theorist at their winter workshop, to be held Friday, November 9, at the Hotel Monteleone in New Orleans.

The one-day event, “Evolutionary Psychology & Ethics,” will address the scientific foundations of self-interest, reciprocal-altruism, cooperation and deception in human relationships, and the evolutionary logic that predicts this complex psychological terrain.

Dr. Trivers will speak on “Ethics and Social Theory: The Evolution of Reciprocal Altruism,” and then on “The Logic of Deceit and Self-Deception.

“I will define natural selection, the basis social traits, then concentrate on altruism and quickly move to reciprocal,” he said, and explain gross and subtle cheating, sense of justice and other traits.

In “The Logic of Deceit and Self-Deception,” he will start with the co-evolutionary struggle between deceiver and deceived, the intrinsic bias in favor of the deceiver, and the invention of self-deception to facilitate deception.

Also presenting and participating as discussants will be Dr. Jack Palmer, from University of Louisiana Monroe, author of Evolutionary Psychology: The Ultimate Origins of Human Behavior.

Dr. Matthew Rossano, from Southeastern Louisiana University, author of Supernatural Selection: How Religion Evolved, will also present.

Dr. Michael Chafetz, known for his extensive work in malingering research, and Dr. Denise Newman, chair of the Louisiana Psychological Association Psychotherapy Interest Area and a psychoanalytic psychologist, and others.

Brilliant and controversial, Robert Trivers has attracted attention for his immensely original thinking and also for his unconventional activities. He currently lives in Jamaica, which he loves, and where he studies body symmetry in elite runners, and where he recently completed an autobiographical memoir––Wild Life: Adventures of an Evolutionary Biologist.

Registration opens August 10 at louisianapsychologicalassociation.org

Munchausen Syndrome by proxy Act 193 Taps into Complex Issues in Effort to Limit Diagnostic Errors

In the 2018 regular session, House Bill No. 145 placed limitations on who may diagnose the disorder known as “Munchausen Syndrome by proxy,” which is known in the DSM-5 as factitious disorder imposed on another or FDIA. The bill, by Representative Kenny Cox, was signed by the Governor and became Act 193.

Formally known as Munchausen syndrome by proxy (MSP), this condition is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. In some cases, illnesses may be actually produced by the caretaker.

Act 193 directs that no physician or other health care provider shall diagnose the condition of factitious disorder imposed on another (formerly “Munchausen syndrome by proxy”) unless he or she meets certain criteria, such as being licensed, qualified by his or her license and training to diagnose, able to provide a certain level of quality in the evaluation, and other stipulations. The new law indicates that the evaluator must review relevant records, history, current clinical conditions, and obtain records from external sources searches schools, childcare providers, and family.

While these quality controls and expectations are standard for psychological evaluation, Representative Cox’s measure suggests that problems have been encountered in the past in this complex area where teasing out the accuracy of claims and symptoms could require a deeper understanding of illness-deception.

The measure was signed by the governor recently and became law as Act 193. However, the real complexities of the matter may still cause issues for those practitioners who are not highly trained to understand nuances and pitfalls regarding illnessdeception.

Dr. Michael Chafetz, a nationally recognized expert when it comes to malingering in forensic and medical
assessments, points to the complexities in understanding these issues.

“Every practitioner who makes a diagnosis has two potential positive outcomes and two potential errors,” said Chafetz. “If the diagnosis is made and is correct, it is a good thing because the patient has the pathology identified and can get appropriate treatment. If the diagnosis is correctly rejected (because no evidence for the pathology could be adduced), it is a good thing because the patient is spared the wrong treatment for pathology that does not exist.”

“The flip side of the positive outcomes involves the errors that are potentially made,” he said. “If the practitioner makes a diagnosis of a condition that the patient does not have, that is a false-positive error. Everyone involved with the case is now acting on false new information about the patient.

“On the other hand, if the practitioner rejects the diagnosis for a condition that the patient does have, that is a false-negative error,” he explained. “This error can be problematic, as no one involved with the case will get on board with the appropriate interventions.”

In decision-making, there is often a trade-off between false-positive and falsenegative errors, and the importance of not making one or the other depends on the relative merits of the outcomes, he explained. “For example, in cancer screening and bomb detection, a false negative error can be more costly than a false-positive error. TSA certainly does not want to miss a bomb, and the radiologist certainly does not want to miss a possible cancer. These false-positive errors may cause some discomfort, but they sure beat the alternatives!”

In Factitious Disorder Imposed on Another, both kinds of errors have realworld consequences. “If the practitioner makes a false-negative error, missing the parental deceptions, the parent does not get diagnosed, which increases the potential for a child to suffer abuse,” Dr. Chafetz said.

“If the practitioner makes a false-positive misdiagnosis of the parent, that parent may face drastic consequences with the possibility of termination of their parental rights.”

He noted that Factitious disorder (FD), like malingering (M), involves deceptive behaviors. In fact, both FD and M are similar in that they both involve deception of others. Malingering involves deception in a medico-legal setting, whereas FD typically occurs in a medical or psychological setting.

The “by-proxy” or “imposed on another” conditions for both disorders are meant to convey that an individual, usually a caretaker, is creating the deception by use of a person under their care.

Dr. Melissa Dufrene and Chafetz have studied these exact issues, in Chafetz, M.D., & Dufrene, M. (2014). Malingering-by-proxy: Need for child protection and guidance for reporting. Child Abuse & Neglect, 38, 17551765.

Both of the by-proxy or imposed conditions can lead to child abuse, he explained. In their guidance article, Chafetz and Dufrene developed guidelines for reporting.

Dr. Chafetz has also discussed these conditions in a physicianeducation article, Chafetz, M.D. (2018). Factitious Disorder Imposed on Another and Malingering by Proxy: Controversies, Recognition, Responsibilities, and Management. American Physician Institute, CMEtoGo, Volume 7, Issue 2.

It is important to recognize that both conditions, M and FD, involve deception of others. Typically, psychological treatments do not take into account the deception, he said.

While Act 193 may help somewhat to make sure qualified professionals are called upon for these complex issues, there could still be a lot of confusion for those that do not have the tools and methods to evaluate these serious issues.