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Phases of Corporate Development

R. Mallory Starr, Ph.D.

INTRODUCTION

Business researchers, corporate development observers and social science consultants have come to an important conclusion: historical forces can have a major impact on and shape the future growth and development of organizations, including professional associations. In their haste to grow and further develop, many organizations overlook critical developmental questions, such as where has our organization been, where is it now, and where is it going? The clues for corporate organization including a professional association itself and its evolving stages of development often lie in the organization’s history.

This article will focus on phases of corporate development within an organization and specify that in order to survive and thrive, an organization must pass through several states of development. Before going into specific developmental phases though some background information is specified. The concept of corporate development can be applied to business organizations and non-profits as well as families, and even down to the detailed level of parts of organizations, such as divisions or departments. Families and corporate organizations have many features in common such as status, roles of members, goals, decision-making, financial concerns, plans, productivity, success and failure. Also, there are other considerations as part of the developmental framework — the age of an organization, the size of an organization and the growth rate of the industry.

Much of the research background for this article was done by Larry E. Greiner (Harvard Business Review, 50, No. 4, pp. 37-46, 1972). As a result of his research he found and articulated five major phases of corporate growth and development that have been seen in business organizations and can be applied to other types of organizations such as professional associations, specific organizations, and even families. In theory, each developmental phase is characterized by a dominant management style that can best position an organization for further growth. In addition, each phase comes with a major management problem or crisis that must be overcome to achieve further growth. Each phase can also be seen as an effect of the previous phase and a cause of the next phase.

IMPLICATIONS

What is the purpose of presenting information on corporate or organization development? One purpose is to give an idea of corporate development and what may and can occur in an organization as it moves though development phases. Organizations of all types have phases which are stages of change and of demands for adaptation — new learnings, new tasks and new ways of functioning are required. Every organization and part of an organization goes through phases and one job of top management is to be aware of such issues and be able to act and provide leadership in influencing needed change. With such knowledge comes the best decisions. Knowledge generated from experience with phases can be helpful in informing leadership and management that change is constant, and that the time comes when their current styles may be ineffective and a new style is needed. Also, solutions to one problem during one stage of change may lead to more problems and further adjustments may become necessary. Important also is that an organization’s history is not to be buried and that in that history can come important insights.

PHASES OF CORPORATE DEVELOPMENT

The first phase of development is Creativity which is characteristic of the birth stage of an organization. Features of this phase can also be seen when an organization or part of an organization reorganizes, starts new major initiatives, or recovers from major downturns. In this Creativity phase the management style and energies of the leadership are focused on reacting to the demands of the marketplace, and leadership and major management activity are focused on product creation and marketing, as well as reacting to perceived demands from the market. This is management by reaction rather than management by plans. Communication is informal, actions are reactive. However, as the organization grows in terms of size and complexity of actions required, plus increased demands on the organization, a leadership crisis develops. What then is needed is skilled professional management and the introduction of management techniques into the creative mix which can pull the organization together. DCPA currently appears to be moving into a phase in which there has been growth, and plans are needed, rather than a reaction to the marketplace.

The second phase of corporate development is that of Direction in which professional management techniques are developed and put in place, such as policies, management information systems (MIS), accounting systems, and reporting. Formal position descriptions and the roles of members are defined, organizational charts are developed, and formal meetings and communications systems are installed. The organization becomes more complex, diverse, and formal, and centralized decision making may become less effective. Conflict between major leaders and managers may increase, and formal planning — strategic planning --- becomes important. The strategic plans and goal-focused activity become more important while the ability to keep a focus on and be reactive to marketplace demands is retained. DCPA is showing signs of being in this phase.

The third phase of development is called Delegation, and DCPA is showing a few signs of heading into this phase. In this phase, greater responsibility for management and activities is delegated from top level management and leadership to others in the organization. Decisions are made at many levels as responsibility and authority are pushed downward. Top managers or executives constrain themselves to managing by exception, and base their actions on periodic reports from the front lines where the activities and actions are implemented. Top leaders or executives may focus on development of alliances with other organizations which can further the growth and development of the organization. The delegation phase is useful for expansion into new areas of functioning as well as retaining capability to respond rapidly to marketplace demands. Top managers, executives or leaders sense that those to whom they delegate want more autonomy; they want to “run their own show” without reporting to and obeying those above them.  Because of the increased size and scope of activities, the organization becomes too big to be under the control of a few executives. This leads to the next phase, called Coordination.

Coordination involves formal organization-wide planning, procedures, programs for control and review, and formulas for allocation of resources. A problem in this phase can be the development of too much “red tape”, which can cripple an organization in terms of speed of decisions and actions. This leads to the next phase, known as Collaboration, which allows for less centralized and less formal procedures and systems. It allows for spontaneity and actions through task teams and the installation of participative management in which managers and executives move from controlling and evaluating, to being resources, consultants, and advocates for their teams or groups. Formal and informal interpersonal skill development programs increase greatly, the use of metrics becomes decentralized, experiments in new practices are encouraged, team performance becomes more the mode, and conflict management systems are implemented.

CONCLUSION

Having described phases of corporate development, it is important to emphasize once again that each phase is both “an effect of the previous phase and a cause for the next phase,” in that what determines much of the future of an organization is its history, rather than current “outside forces.” With this awareness, rather than blaming outside forces, leaders have more freedom to evaluate their organization’s phase of development more accurately and to implement goals more effectively. Moreover, it is important for leaders to choose solutions from options that can optimize evolution to a new phase. The ideal is to select those action options backed by insights into what has worked in model organizations and in consideration of who implements and what do they implement.

Also, as mentioned before regarding corporate development, each new organizational problem and each problem solution may breed a new crisis characteristic of each phase. This may require learning new skills to further lead to new insights and associated strength crucial for success in the next phases. For this reason, identifying and optimizing the relationship between an organizations’ leaders can help systems evolve as the ability to respond by leaders of organizations – that is to effectively respond to crisis that may occur during each developmental phase.

Also, as organizations grow and evolve and as DCPA moves toward a more interconnected world, it is “the relationship between people and systems” that is becoming a more crucial force in corporate development, rather than the traditional approach of focusing on people/systems themselves in isolation.

Carl,T. Extracts from ‘Evolution & Revolution as Organizations Grow’, Larry E. Greiner. (1972) Harvard Business Review.

Taylor,C. Extract from Allen, K,E., & Cherrey, C. (2000). Systemic Leadership –Enriching the Meaning of Our Work.  

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Parental Alienation: Origins, Controversies and a New Paradigm

Douglas L. Romberg, Ph. D.

ABSTRACT

​An in depth study of severe parental alienation portrays families who manifest high levels of aggression, emotional reactivity, dysregulated states, and at times, bizarre behavior. Tracing the field from its origins and unpacking some of the controversies reveals a field in internal conflict and, overall, not able to report reliable success regarding treatment outcomes. A new paradigm is offered for diagnosis and treatment. Utilizing research in the field of complex trauma, it is suggested that incorporating specific approaches from trauma assessment and treatment for treating parental alienation will enhance researchers' and clinicians' chances of success.

  Parental alienation cases have long baffled and frustrated family law attorneys, judges, and many mental health professionals. Conflicting and polarizing arguments among principal researchers in the field have contributed to this confusion. Although the parental alienation field has received increasing attention in the past 15 years, there has been continuous conflict between the family theorists who study all the reasons why children reject parents and those researchers who look specifically at parental alienation. As an alternative to the existing approaches, this author proposes a new paradigm for conceptualizing alienated families: that is, through the lens of trauma, specifically complex trauma. This approach can provide diagnostic clarity and valid treatment direction in a field where poor outcomes are characteristic and where disagreements in the approaches to treating parental alienation have persisted.

To understand the field as it is currently constructed, however, it is necessary to look at how the field began and how it developed.  When Richard Gardner began writing extensively on the topic of parental alienation in the early 1980s,​ he was quickly taken to task on a number of fronts. Kelley & Johnston and their colleagues, as family theorists and clinicians, eschewed Gardner’s focus on an alienating parent, a targeted parent and a receptive child(ren). Their preference was to assume all family members have influence. This led many clinicians to weight the contributions of each family member equally or almost so.

They felt that Gardner's use of a medical syndrome was inappropriate to explain the behavior of family social systems. Further, they believed his research was weak since not every child who had an alienating parent became alienated (a common finding in social science research).  They also took strong exception to some of his treatment suggestions, many of which have now been accepted into the mainstream of many treatment approaches.  Although Gardner had compelling rebuttals for each of these attacks and demonstrated their faulty logic, family theorists were not swayed.

In opposition to Gardner, Kelley & Johnston posited an entirely different model.  Their model posited 5 different relationships between the child and parents. The two most extreme, estrangement and alienation, were considered to be pathological. Their major thesis was that their model was "objective" and "neutral", and therefore preferable to the work of Richard Gardner. Unfortunately, the authors provided little evidence, none of it compelling, and their model was neither objective nor neutral. Moreover, to present their model as a direct alternative to Gardner was a design of false equivalence. While there are differences in emphasis and in the specific order of the steps to include in an assessment of parental alienation, Gardner, and certainly current parental alienation researchers (e.g., Baker, 2007; Warshak, 2010; Sauber, 2006; Darnall, 1998) were mindful of other family constellations and considered them. In reviewing the entire field, there is far more that unites these two major schools than divides them. Unfortunately, the significant similarities between the two approaches were minimized, while the differences were amplified. This has served to maintain a strained divide in the field that exists to the present (for a detailed review of the field, see Fiddler & Bala (2010)).

To sharpen one's conception of what parental alienation is, it is helpful to review what parental alienation  is not. For example, many attorneys have told this author that these are "he said, she said" cases. Others say that these are cases of adults behaving badly. One attorney opined that every custody case involves parental alienation and, therefore, no additional scrutiny of the case or expertise on the part of the professionals involved is necessary.  These conceptualizations are overly simplistic and misleading. Importantly, they prevent the child and the family from getting the help they need.

What needs emphasis is that an alienating parent is very often the key to understanding these chaotic and, at times, bizarre cases. While a targeted parent may get angry and retaliate periodically, this is fundamentally different from the quest of the alienating parent. Whether father or mother, the alienating parent has a singular mission: to destroy the bond between the children and the targeted parent.

Contemporary researchers and clinicians understand that destroying a child's relationship with one parent destroys fundamental aspects of and capabilities in the child. Significant emotional damage results that likely will be life-long (Ben-Ami & Baker, 2012; Baker, 2012). In severe cases, alienating behaviors begin when children are quite young and occur on a daily, or almost daily, basis. These externally induced symptoms persist for years, become internalized and change the child’s view of the targeted parent, the alienating parent, and of themselves in profound ways.

Perhaps the biggest obstacle to professionals’ understanding of the concept of parental alienation and its consequences is that the actions of the people involved in these families are literally beyond the realm of the experience and/or the emotional tolerance of most professionals, even those in the mental health field. In severe cases, many alienating parents are charming, adept at influencing outcomes and shaping the perceptions of others related to the case. Conversely, the targeted parent, having been branded the outsider in the family and already viewed as somehow menacing, dangerous, or otherwise not qualified to be seen as a good parent, presents as highly stressed, defensive, and controlling (Baker, Fine & LaCheen-Baker (2016) report similar observations). As a result, the alienated children’s denigration of the targeted parent and even the most implausible attacks on the targeted parent seem credible.

As therapists struggle to manage the extreme levels of aggression in these cases, many default to their early training of being supportive and empathic, particularly to the alienating parent and the children. Perhaps ironically, the methodology that is effective with less disturbed people worsens the symptoms in alienating parents and alienated children, and often leads to the end of treatment. It is this author’s observation that alienating parents need to be managed within clear boundaries and with clear consequences. Simply reflecting their distorted beliefs and powerful emotional states reinforces the symptoms and increases their strength. A similar process occurs with children. However, what children initially understand to be fibs, misrepresentations and lies becomes calcified into their thinking as they grow. It has been estimated that by the age of 10, the lies harden into what is seen as the truth (Schutz, 2006).

There are a number of other issues that have been often underweighted or ignored by the clinical and legal communities. ​ Many attorneys and therapists reduce parental alienation to variations in everyday problems in living in order to manage the high levels of tension in themselves and these cases. In addition, they assert that the natural resilience of children will provide immunity from the alienation process1. This is simply not supported by the data obtained by contemporary parental alienation researchers and clinicians (Baker, 2007).  Specifically, it is now understood that once an alienating parent has successfully inculcated the children with false, toxic, and damaging beliefs about the targeted parent, the children grow up with distorted beliefs and dysregulated states which are hardened into their personalities. These global deficiencies can then be passed on to the next generation, as is commonly seen in families where alcoholism and/or physical abuse is present.

Incidence and prevalence data (Clawar & Rivlin, 1991; Johnston & Campbell, 1988; Bernet, 2008) suggests that parental alienation is much more common than was previously thought.  More current research points to a high level of emotional pathology in alienating parents (Summer & Summer, 2010; Donner, 2006).  

Baker, Fine & LaCheen-Baker (2016, p. 37) found that “… in moderate and severe cases of alienation, there is usually pathological enmeshment between the children and the favored parent.” These authors point out that without specific expertise in parental alienation, professionals involved in the case are likely to confuse enmeshment with a close, loving and healthy relationship.

Given the above findings it is not surprising that therapists and legal professionals have been at a loss to constructively interact with a child who despises a parent for vague and overdetermined reasons. Similarly, the alienating parent’s robust animus and wish to remove the targeted parent from the family has foiled the efforts of therapists across the theoretical spectrum.

​ Although each theoretical school which has tackled parental alienation has garnered a bit of success in terms of outcomes, none has shown itself to have a reliable and valid treatment. Lackluster outcomes are more the rule than are consistent successes. Given the current state of the field, this author proposes a new way of conceptualizing parental alienation.

Although overlooked, there are established diagnostic criteria that are frequently highly correlated with the symptoms experienced by children in severe parental alienation cases. Consider the following frequently reported experiences: recurrent and intrusive distressing memories of the targeted parent; physiological reactions to internal or external cues that symbolize and represent the targeted parent; persistent avoidance of the targeted parent and/or thoughts, feelings, and behaviors associated with the targeted parent; persistent and exaggerated negative beliefs or expectations about the targeted parent; and marked alterations in physiological reactions towards the targeted parent (e.g., irritable behavior, physical outbursts, shutting down emotionally).

Many other examples can be cited, but the basic point will be obvious to all trauma therapists and those familiar with the origins of trauma and the DSM-5. Conceptualizing alienated families through the lens of trauma, and specifically complex trauma, provides diagnostic clarity and valid treatment direction (Herman, 2015; Levine, 2008; Courtois & Ford, 2016; Grand, 2013).

So many therapies have failed families involved in parental alienation because the therapists start with and concentrate on the families' narratives. As trauma therapists have shown, the neocortices of traumatized family members are typically off-line during stressful periods and while in therapy.

The more traditional approaches, however well-intentioned, tend not to have much success in these cases and can even accelerate symptoms (see Warshak, 2010; Baker-Fine & LaCheen-Baker, 2016). As those who work with complex trauma know, these families have to first be helped to significantly lower the speed of their responding and become less reactive so that they are not just dominated by fight-flight-freeze responses. Importantly, parental alienation cases are not the result of one or two situations wherein one parent behaves badly, and the other parent retaliates. These conflicts have been ground into the children’s psyches over years and are very much intertwined with their basic understanding of human emotions, including their own.  These cases demand the specific skills of a therapist who is flexible, not easily intimidated, and who can effectively modulate emotions at the extremes.

Some treatment providers give brief attention to trauma as one possible contributing factor in parental alienation cases. However, most therapy approaches default to the researchers’/clinicians’ favored treatment modalities: family systems, cognitive/cognitive-behavioral, problem solving, psychodynamic psychotherapy, psychoanalysis, and so on. All of these approaches overlook or minimize the neurobiology of trauma, which can now be understood, not just as one more factor in the mix, but as a primary component of parental alienation.  After reviewing the parental alienation literature since the early 1980s, and analyzing clinical cases over the past 14 years, it is this author’s proposal that complex trauma is the most accurate diagnostic system through which one can view severe parental alienation. Employing the theory and interventions typically used in cases of complex trauma as a precondition to the usual approaches listed above, as well as incorporating these techniques into ongoing treatment with children and their parents in parental alienation cases should greatly enhance their chances of success.  

Complex trauma theory can begin to untie the Gordian Knot of such intense family dysfunction. It clarifies how, in severe cases, the targeted parent serves as a constant trigger for the alienating parent’s own unresolved issues regarding their own history of trauma and, possibly, parental alienation. This provides a persuasive and compassionate explanation for the destructive and, at times, pathological behavior of the alienating parent. Through the lens of trauma theory, the high levels of aggression, misrepresentation, and deceit commonly at work in the alienating parent can be seen as attempts, however misguided, at managing their own unresolved emotional distress and dysregulated states. Repetitive acts of retribution for perceived slights, which are often misrepresented or even simply fabricated, can now be placed into a paradigm that provides clear guidance for diagnosis and treatment.

Employing trauma theory, children who say little or nothing and were previously diagnosed as overly passive, vacant and/or non-compliant may more precisely be understood as suffering from symptoms such as dissociation.  Children who were seen as expressing behaviors of a conduct disorder may be more accurately seen as manifesting the irritable behavior and angry outbursts, as well as the reckless and/or self-destructive behavior associated with complex trauma.  Instead of attempting to normalize one parent's unequivocal hatred of the other for little or no objective reason, this genuine distress can be seen for what it actually is. Trauma theory may illuminate the previously perplexing finding that children who were abused by a parent frequently seek out a relationship with that parent, whereas alienated children, not abused by the targeted parent, refuse to have any contact for the long term (see Fiddler & Bala, 2010).  Robust reliance on avoidance allows the child/adult child to split off from the trauma and obtain momentary relief.  However, it is well known that this type of strategy damages the child, reduces their autonomy and negatively affects emotional regulation, attachment and self-esteem (Brand, 2016).

In addition to the significant benefit of deemphasizing narrative, and thus avoiding hours of contentious exchanges between the alienating parent and the targeted parent, as well as between the children and the targeted parent, trauma work offers a variety of approaches, increasing the chances of a good match between therapists and family members.

The technique of Somatic Experiencing (SE) is a common approach used in trauma work. SE has the benefit of subtly communicating to the patient, child or parent, that keeping solely focused on the hated parent/spouse isn't their best strategy and is likely making them feel worse. The attention of the patient shifts from ruminating about getting spouses or children to immediately change their behavior to the importance of the individual's own internal experience and then providing strategies to protect themselves from disturbing emotions and images.

A second technique, EMDR, is a straightforward and sufficiently novel approach to be interesting, particularly to children. The underlying principle here is bilateral stimulation, which can be harnessed in a number of ways. The EMDR Light Bar, which alternates between left and right blinking lights, sometimes with sound, is probably the best known EDMR device. Pulsating "tappers" which alternate vibrations between the hands, are also frequently employed. If devices aren't available, having the patient tap their knees, alternating left and right, serves the same purpose. As these techniques are mastered by the parents and children, difficult emotional material can be judiciously introduced, and the therapist will modulate the emotional tension by "pendulating" between more intense states and less intense ones.

There is a growing list of alternative approaches to trauma. Brainspotting is just one more example, which stems from the work of David Grand (2013). An extensive review of all the new trauma treatments is beyond the scope of this paper. The salient point is that instead of enduring therapy/play therapy sessions that are frustrating for the therapist and burdensome for the patients, therapists may now correctly understand the family's presenting symptoms and utilize techniques that have been well researched and demonstrated to be effective.

Viewing parental alienation cases as intertwined with complex trauma, of course, suggests utilizing a therapist with expertise in trauma work as the first option for treatment. Unfortunately, getting alienating parents to constructively engage in any therapy has proved to be a daunting task.  In addition, well-qualified complex trauma experts may not always be available. In such instances, treatment of these traumatized families might be found in the mindfulness movement, which has been used successfully in myriad aspects of current culture (e.g., schools, large and small business environments, leadership forums, sports, and community organizations). There are pluses and minuses to the mindfulness movement that are not within the scope of this paper to discuss, but some aspects of mindfulness, including mindfulness meditation, may be particularly well suited for the population that involves alienated families and the people who provide services to them.

One benefit is that mindfulness can simply be employed as a technique, one that is not necessarily connected to a particular religion, spiritual path, or set of beliefs. There is no need to get into a tangle over what this technique represents. It is just a technique, and as a technique, it has been amply shown to be effective. Therefore, a new first step in the treatment of family members in parental alienation cases, which could be represented legally and therapeutically as not being technically part of the therapy, could be to use mindfulness techniques to help participants become calmer, less reactive and more clear-minded. As an added benefit, it might help forestall the inevitable arguments about how much these family members hate and blame each other, and possibly some of the ways the children try to protect themselves by protecting the alienating parent. These issues will be addressed, but from a new, less reactive platform, one where therapy can constructively begin.

In sum, the study of parental alienation is a relatively new research area, which has been beset by a number of ills, both inside and outside the field. Few treatment models dealing with severe parental alienation have demonstrated reliable success. These cases are burdened by extraordinary levels of aggression, emotional reactivity, polarized thinking and deceit.

Over the past 35 years, approaches to dealing with severe parental alienation have been presented in the lay literature and in scholarly research. It is the observation of this author from reviewing the extensive literature, as well as from clinical practice, that the extent to which these highly charged environments can be productively harnessed seems to be the primary determining factor regarding outcome. Complex trauma treatment protocols, in addition to the techniques of mindfulness, could prove to be highly effective first and second lines of defense. Once these skills have been mastered, the interventions that follow will be more likely to have a positive effect on the highly aggressive and toxic world of parental alienation.

Notes

1. In this author's review of the literature there is only one study (Johnston & Goldman, 2010) that suggests that alienated children will return to the targeted parent on their own. However, as the authors' suggest, methodological flaws limit the generalizability of the findings. Moreover, faulty logic on conclusions drawn, limit the study even further than the authors suggest.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Baker, A. (2007). Adult children of parental alienation syndrome (1st ed.). New York, NY: Norton.

Baker, A., & Fine, P.R. (2008). Beyond the High Road: Responding to 17 Parental Alienation Strategies without Compromising Your Morals or Harming Your Child. Unpublished manuscript.

Baker, A., & Fine, P.R. (2013). Educating divorcing parents: Taking them beyond the high road. In A, Baker & S.R. Sauber (Eds.), Working with alienated children and families: A clinical guidebook (pp. 90-107). New York: Routledge.

Baker, A., Fine, P.R., & LaCheen-Baker, A. (2016). Restoring Family Connections: Helping Targeted Parents and Adult Alienated Children Work Through Conflict, Improve Communication, and Enhance Connections. Unpublished manuscript.

Bernet, W. (2008). Parental Alienation Disorder and DSM-V. The American Journal Of Family Therapy, 36(5), 349-366.

Brand, B. (2016, November 18). I Don't Trust You But You are My Last Hope: Assessing and Treating Complex Trauma. Lecture presented at District of Columbia Psychological Association, The Chicago School of Professional Psychology, Washington, DC.

Clawar, S. S., & Rivlin, B. V. (1991). Children held hostage: Dealing with programmed and brainwashed children. Washington, DC: American Bar Association Section of Family Law.

Courtois, C., & Ford, J. (2016). Treatment of complex trauma. New York, NY: Guilford.

Fidler, B., & Bala, N. (2010). Children Resisting Postseparation Contact With A Parent: Concepts, Controversies, And Conundrums. Family Court Review, 48(1), 10-47.

Gardner, R. (2001). Should courts order PAS children to visit/reside with the alienated parent? A follow-up study. American Journal of Forensic Psychology, 19(3), 61-106.

Gardner, R. (2000). The parental alienation syndrome (1st ed.). Cresskill, NJ: Creative Therapeutics.

Gardner, R., Sauber, S., & Lorandos, D. (2006). The International Handbook of Parental Alienation Syndrome: Conceptual, Clinical and Legal Considerations (American Series in Behavioral Science and Law) (1st ed.). Charles C. Thomas.

Grand, D. (2013). Brainspotting (1st ed.). Boulder, CO: Sounds True.

Herman, J. (2015). Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. New York, NY: Basic Books.

Johnston, J. R., & Campbell, L. E. (1988). Impasses of divorce: The dynamics and resolution of family conflict. New York: The Free Press.

Kelly, J., & Johnston, J. (2005). The alienated child: A reformulation of parental alienation syndrome. Family Court Review, 39(3), 249-266.

Levine, P. (2008). Healing trauma (1st ed.). Boulder, CO: Sounds True.

Shapiro, F., & Forrest, M. (2004). EMDR (1st ed.). New York, NY: BasicBooks.

Warshak, R. (2010). Divorce poison (1st ed.). New York, NY: Harper.

Douglas L Romberg, PhD, is a licensed clinical psychologist who has practiced in the Washington, DC, area for 35 years. His clinical foci have been in individual, couple, family, and group psychotherapy. He has specialized in the fields of gender identity and gender orientation; integrative medicine and chronic illness; parental alienation; and Buddhist psychology.

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Report on the Motion Regarding the Overview Group’s Recommendations for Reorganization

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DCPA and DIV 19 Military Psychology

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"What would Gandhi Do" in this age of anxiety and political turmoil, asked DCPA Board member David Freeman at a March meeting? And so we went to Srimati Karuna, the director of the Gandhi Memorial Center here in the Washington area.

Some of us conjured forms of peaceful resistance - including perhaps going limp as we are dragged off by the police. 

How did this great man lead the forces of India to move out of the darkness of colonialism? How did he influence Martin Luther King, Jr.? Who truly was this skinny little guy in a lion clothing?

 As psychotherapists, we endeavor to encourage personal growth in our clients and in ourselves. At our September DCPA workshop hosted by the Gandhi Memorial Center, Srimati Karuna told us of the personal transformation toward which Gandhi worked so constantly and humbly through spiritual practice and experimentation in order to becoming more centered, loving, patient, and fearless. At the same time he did social experiments by helping people of all traditions appreciate each other and work together with respect and reverence.

The ashram he founded was a tangible part of day-to-day living where individuals from many backgrounds coexisted and endeavored to become better human beings. Gandhi's personal and social experiments in developing and strengthening people in mind, body and spirit were remarkable and inspiring -- extremely relevant to our time and our own struggles.  

The following quotes may help us remember Gandhi's journey and its significance: 

“We ignore him at our own risk (MLK)."

 "Generations to come will scarcely believe that such a one in flesh and blood walked upon this earth.” - Albert Einstein (Theoretical physicist and Nobel Prize Recipient)

”In his own way he had discovered the art of living and had made of his life an artistic whole. Every gesture had meaning and grace, without a false touch. There were no rough edges or sharp corners about him, no trace of vulgarity. Having found an inner peace, he radiated it to others and marched through life's tortuous ways with firm and undaunted step.” - Jewarhalal Nehru (First Prime Minister of India).

 "The greatness of Gandhi is more in his holy living than in his heroic struggles, in his insistence on the creative power of the soul and its life-giving quality at a time when the destructive force seems to be in the ascendant.” - Sarvepalli Radhakrishnan (Philosopher, First Vice President of India and Second President of India).

 "One point which everybody felt — educated, uneducated, people of all levels who came in touch with him — was his (Gandhi's) abounding love. Everybody felt that he is my own and we mean to him something, that any little thing of ours is precious to him. Every human being was precious to him and there was a big horizon of love in which he kept people; that was the number one quality.” - Sucheta Kripalani (Freedom Fighter and India’s first woman Chief Minister)

 "His (Gandhi's) basic thinking was that the individual is a part of the little bit of that universal divine, a divinity within man, and it is that basic concept of the divinity within man which has to be developed, which has to be brightened, so that he becomes a part of the universal divine. And if you do, if you establish a connection with that universal divine, then your part becomes unlimited.” - Sushila Nayyar (Physician to Gandhi and younger sister to Gandhi’s personal secretary).

 “The law of love governs the world. Life persists in the face of death. The universe continues in spite of destruction, incessantly going on. Truth triumphs over untruth. Love conquers hate.”- Mohandas Karamchand Gandhi,Young India, October 23, 1924.

 “Hope for the future I have never lost and never will.” -Mahatma Gandhi

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APA Practice Organization Information Alert

On June 21st, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule on Medicare’s Quality Payment Program (QPP) for 2018. The proposed rule outlines prospective changes to two key payment programs: The Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models. Created under the Medicare Access and CHIP Reauthorization Act (MACRA), the 2015 law that repealed the Sustainable Growth Rate cut, the QPP is designed to have Medicare payments reflect value rather than volume as the country’s largest federal healthcare program continues to move away from a traditional fee-for-service (FFS) model. Because Advanced APMs are typically physician-based organizations, psychologists and other practitioners are more likely to fall under MIPS.

Of all the changes proposed by CMS, the one that will be of greatest interest to psychologists involves the expansion of the low volume threshold (LVT) in MIPS. The LVT, which the APA Practice Organization lobbied CMS to expand back in 2016, currently exempts eligible clinicians (ECs) with 100 or fewer Medicare patients or $30,000 or less in Medicare charges. CMS is now proposing to exempt ECs who treat 200 or fewer Medicare patients or bill Medicare for $90,000 or less in allowed charges. Psychologists are not yet included in MIPS but are expected to be added to the program in 2019. If CMS adopts the LVT it is now proposing, then relatively few psychologists in Medicare will need to report under MIPS even after being added in 2019.

While being excluded from MIPS may be a relief to many psychologists it is important to remember that the QPP under MACRA replaces the annual updates for Medicare payments. ECs who do not report under MIPS or through Advanced APMs will find their payment rates largely unchanged from year to year. Not reporting under MIPS will allow psychologists to avoid possible penalties, but it also means they will not have the chance to earn bonus payments.

MIPS combines key facets of three former programs in Medicare: The Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), which compares quality of care to cost, and the Electronic Health Record (EHR) incentives, often referred to as “meaningful use.” Psychologists have been eligible to participate in PQRS since its inception in 2007 but were not subject to the VM or meaningful use.

MIPS impacts Medicare payments by assessing ECs on four categories and then assigning a composite score. The composite score will be compared to a threshold score. Those falling below the threshold score will incur a payment penalty while those scoring above the threshold will receive a bonus. MIPS is designed to be budget neutral and many clinicians will see no adjustment, positive or negative, to their payments. The composite score for 2018 will be based on quality measures (60%), advancing care information (25%), and clinical practice improvement activities (15%). The fourth category, cost data, will be obtained by CMS from claims but will not be included in the MIPS composite score.

In the proposed rule the agency suggests ECs exempt under the LVT should be given the option of reporting under MIPS and being subject to the MIPS payment adjustments at some time in the future. CMS contemplates making this option available to ECs who fail to meet just one of the two determining factors (i.e., # of patients or amount in charges). APAPO has urged CMS to make MIPS reporting optional for those who are exempt but still wish to demonstrate that they provide quality services to earn bonuses for successful performance.

CMS will continue to allow those who are not ECs under MIPS to voluntarily report measures with the assurance that there will be no payment adjustment based on voluntary reporting. For 2018, there is a Mental / Behavioral Health set of 26 measures and those who voluntarily report MIPS measures will received feedback from CMS on their performance. Healthmonix, the registry vendor that created and maintained the APAPO PQRSPRO registry for 2014 – 2016, is now offering the APAPO MIPSPRO registry for psychologists who wish to voluntarily report MIPS measures. The registry can be accessed online at: https://apapo.mipspro.com/.

The proposed rule can be viewed at https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-13010.pdf. Comments are due to CMS by August 21, 2017.

For more information, contact APA Practice Organization Government Relations Office at Pracgovt@apa.org or (202) 336-5889.  Visit APA Practice Organization on-line at APAPracticeCentral.org/Advocacy.

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RAINN or Shine: Lace Up for RAINN 5K followed by a Discussion on Sexual Assault

Adriana Penafiel; Kiana Cummings; Sarah DiGregorio; Frances Cooke; Samuel Swisher; Stephen Bowles, Ph.D., ABPP

Washington DC, May 20th 2017 – It was a nice spring day at the Congressional Cemetery in Southeast, DC when 138 men and women of all ages came out to run and walk in RAINN’s (Rape Abuse Incest National Network) fourth annual Lace Up for RAINN 5K. Overall attendance for the event this year included over 530 people from across the country participating virtually. A virtual race, unlike the traditional kind, utilizes tracking technology to allow participation from any venue, whether from a treadmill or a track. When asked about the event, coordinator Jim Breslin responded, “It was an all-around great day...everyone was excited and happy to cross the finish line. We also received messages from our virtual racers sharing how happy they were to make a difference in their own community! We could not have asked for a better day.”  

The event began in May 2014 when runners, walkers, and cyclists from across the country were asked to participate in RAINN’s first virtual-5K. In 2016, RAINN placed an additional in-person race, which is chip-timed and USA Track and Field certified, in DC just down the road from RAINN’s headquarters. Runners, cyclists, and walkers from all over America have come together for the past three years to support survivors of sexual assault in one inspiring event that will continue to occur annually both in DC and throughout the country.

Among those in attendance was a group of 11 members from the DC Psychological Association who came out in support of sexual assault prevention and recovery. DCPA members raised $660 for survivors while exercising for a good cause. Dr. Victoria Sylos-Labini organized the DCPA team for the event and stated:

“On a larger scale, attending the event was inspiring, especially when hearing the stories of actual survivors before the race and hearing about the great impact our fundraising has for the cause. I believe it was really important for the RAINN community to see that DCPA was in support of their cause and could be used as a resource to find therapists and other supportive services. It is my hope to make this an annual event for DCPA. It is also my hope that more DCPA members will come out in support of these causes in the future, whether in person or with a simple donation.”

The DCPA will continue its mission to give back to the community by sponsoring and fundraising the Out of the Darkness Suicide Prevention walk that will be held on October 28th. Additionally the DCPA will look to partner with universities in the DC area to look at mindful ways of managing stress.

While participating in events such as Lace Up for RAINN 5K shows support for all survivors, knowing how to work with survivors one on one is also imperative.  Dr. Sarah Godoy is a clinical psychologist practicing in the Washington, DC area who works with a myriad of clients, including sexual assault survivors. She is currently a staff psychologist at the Catholic University Counseling Center and is a Certified Clinical Trauma Professional (CCTP) through the International Association of Trauma Professionals. We corresponded with Dr. Godoy for statistics and tips about sexual assault and sexual assault survivors. Detailed below are excerpts from the interview with Dr. Godoy:

Statistics on Campus Sexual Assault

“RAINN's nationwide estimates are that about 11% of college students (this includes both undergrad and grad) experience rape or sexual assault (https://www.rainn.org/statistics/campus-sexual-violence). When we just look at undergrads, they estimate that about 23% of women and about 5% of men experience rape or sexual assault. The rates for trans/genderqueer/gender-nonconforming undergrads are very high, around 21%.”

Resources for DC psychologists

“Groups can do wonders for decreasing a survivor's sense of shame and isolation, and the connections and empowerment that develop through group work can play a major role in a survivor's recovery. For survivors who are students at a university, I recommend asking if the counseling center offers a support group for survivors…For broader community resources, the DC Rape Crisis Center is a great place to start. Beyond therapy, I also encourage my survivor clients to tend to their well-being through physical activity. Though not directly focused on trauma recovery, activities like running or yoga can help survivors feel strong, grounded, and calm, which are great for promoting a sense of empowerment.”

Common Risk Factors

“It is hard (and unwise!) to ignore the role that alcohol plays in many sexual assaults, and I consider it a major risk factor, both for perpetrating and being the victim of sexual assault. I have to emphasize that when professionals talk about the role of alcohol, this is not at all intended to blame survivors of sexual violence for drinking. The reality is that alcohol plays a role in incapacitation, and it can blur boundaries in a way that can ultimately become very unsafe.”

Encouraging Disclosure

“When it comes to disclosure, I like to explore with my clients what it would mean for them to tell various people in their lives about the assault. I think it's important for survivors to understand the practical and emotional consequences of sharing their story…I also know that grappling with the stress of an investigation or the potential of their story going public can be too much for many survivors. I tend to encourage my clients to at least share their story with a close friend or family member, but only when they feel strong enough to do so. I make sure that my clients know that they are under no pressure to report or disclose and that I will support them in whatever decision feel’s right for them at that time.”

Kinds of Therapy

“I use a lot of mindfulness to teach grounding skills that help clients manage their anxiety and increase their sense of safety. By engaging with the present moment and increasing their awareness of what they are feeling in a particular moment, they are able to regulate their emotions and feel more in control…I usually integrate aspects of narrative exposure therapy so that the client can develop a cohesive account of their experiences that considers the larger context of their life history and where they hope to be in the future. We incorporate self-compassion and a focus on resilience as we construct those narratives, and I think it helps clients see that while they have endured an incredibly painful event, or perhaps even survived an extended trauma, it does not have to define who they are and who they will become.”

The DCPA and RAINN can benefit sexual assault survivors and help them move forward through further support, sexual assault education, and therapy. We look forward to encouraging participation in more events sponsored by RAINN and other mental health organizations that will support the DC community.

There are currently no more future events planned through RAINN; however, they have independent volunteer fundraisers across the country that host events to raise money for important sexual violence services, such as the National Sexual Assault Hotline (800.656.HOPE). People interested in helping fundraise for RAINN can find more information at donate.rainn.org.

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Interjurisdictional Compact – Is it right for DC?

by David White, Executive Director, DCPA

Have you ever thought about expanding your practice to another state but wanted to check out the market first? What if you just wanted to continue to see your client but your client is temporarily out of state? Well, there is a solution on the horizon. The Association of State and Provincial Psychology Boards (ASPPB), created the Psychological Interjurisdictional Compact (PSYPACT), which is an interstate compact that facilitates the practice of psychology using telecommunication technology and/or temporary face-to-face psychological practice. This compact is a cooperative agreement enacted into law by state legislatures.

This is how it works: if you are licensed in a state that is part of PSYPACT and you want to practice in a state that is also part of the compact, then you will receive an E-Passport certificate that allows you to provide telepsychology. In addition, if you want to practice face-to-face in that state, you will receive an Interjurisdictional Practice Certificate (IPC) that in essence will be your temporary license to practice in that state.  PSYPACT allows you to practice 30 days outside your primary jurisdiction, and they define a day as one interaction. For example, on one day you can have one interaction or 10+ interactions, but no matter the number, the first interaction will constitute a day.  

The benefits of this are numerous. It allows the psychologists to practice across state lines without having to become licensed in additional states, plus it offers a higher degree of consumer protection. It also permits the psychologists to provide services to populations currently underserved or geographically isolated. However, the greatest benefit is it facilitates continuity of care for your clients when they reallocate and/or travel.  

Is this something you would like to have access to? PSYPACT must be adopted by seven states before it is operational and at this point there are three states that have passed legislation and three other states that have pending legislation.

The DCPA Board is discussing the possibility of presenting this concept to the DC Council for discussion and adoption. If you think this would be a good idea, let us know. We want to serve you!

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Ethics

This article will focus upon the ethics committee and will be divided into 2 parts. Part 1 will focus upon purpose, objectives, and functions of the ethics committee. This section is designed to inform members about the functioning of the committee and the services it provides to the membership and to the general community. Part 2 is an opinion piece, focusing upon an expanded conceptualization of ethics to include social justice and cultural competence.

  Part 1

                      Procedures for individual ethical consultation

Purpose, Objective, and Function of Ethics Committee:

The basic purpose of the DCPA Ethics Committee is to support and uphold ethical sensitivity and practice among members of the District of Columbia Psychological Association.

We serve primarily as an educative and consultative body to our membership, the DCPA Board and, as appropriate, to the public. We are not an investigative or punitive body.

To achieve our goal of providing education, consultation, and support, the committee intends to provide seminars, consultation groups, and individual consultation. A description of the operational procedures of the individual consultation will be provided below.

Information about the workshops, professional training and seminars will be provided on an ongoing basis as events are scheduled.

Operating procedures and policies of the Ethics Committee:

1-The Ethics Committee will provide individual ethics consultation to the DCPA members, non-member psychologists and the public within the limits of its competency.

The committee members and their areas of interest and expertise are as follows: Doug Favero (Ethics Chair): LGBTQ issues, group therapy, grieving and loss, and supervision. Jean Gearon: Trauma, research, and integration of mind/body approaches to treatment. Stephen Lally: forensic psychology and assessment issues. Marilyn Schwartz: adult ADHD couples therapy and life transition. Suzan Stafford: PTSD couples therapy, and disaster responses. Jeanette Witter: trauma, women’s issues, and LGBTQ.

2- The Ethics Committee will provide ethics consultation to DCPA members, non-member psychologists, and the public within the limits of its competency.

3- The Chair of the Ethics Committee in collaboration with the committee will determine a rotation of committee members responding to requests for ethical

consultation.

4-  Requests for ethics consultation will be responded to by a member of the Ethics Committee within a 48 hour period of time.

5- The Ethics Committee will observe the strictest confidentiality in providing ethics consultation to DCPA members, non-member psychologists and the public.

6- To provide uniformity and consistency of response in cases that seem unclear, extremely complicated, or beyond the expertise of the committee member on call, the caller will consult with the chair and/or the other members of the committee whose expertise is better suited to address the concern in question.

7- Persons making complaints to the Ethics Committee about ethical concerns or ethical infractions of DCPA members or non-member psychologists will be referred to the DC Psychologist Licensing Board or the Ethics Committee of the American Psychological Association.

8- Persons presenting to the Ethics Committee questions or concerns of a legal nature will be referred to appropriate sources of legal information or consultation.

9- The Ethics Committee will periodically inform the Board of any patterns or trends in ethical concerns or issues that maybe of interest to the DCPA membership at large.

Part 2

As both the Past President of DCPA and a former Chair of the Ethics Committee, and also as a practicing psychologist, it is my belief that ethics is much more than the set of principles, procedures and codes that govern our conduct.

It is a moral compass that guides the principles and practice of our field and the soul of our foundation.

For these reasons, committees, seminars, and programs of social justice, diversity, and cultural competency have emerged to enhance the association’s effort to meet the challenging zeitgeist of the current political reality we are immersed in.  

Miss Samira Paul, who served as Chair of the Diversity and Cultural Competency Committee (2015-2017) has been an outstanding champion of justice and compassion. Her tireless efforts, moral character, and wisdom have provided a voice to promote social justice and compassion and mindfulness. Her leadership of DCCC will be missed. Her efforts and examples however will live on. And it is my hope that they are carried on and become part of the association’s character.

As an association I strongly believe that we have an obligation to the field and practice of psychology and to the wellbeing of the general community, and to all those who benefit from our activities and services. To achieve these goals, the association should be an active participant in promoting an ethical, compassionate, and just vision, grounded in our principles and commitments.

We welcome all who share this vision and want to join us.

Stephen Stein, PhD

Past President, 2014-2016

Former Chair, Ethics Committee, 2010-2013

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From New APA Council Rep

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Message from Executive Director David White

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ECP Social Held in June

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Workshop on TMS Therapy

Transcranial Magnetic Stimulation Therapy (TMS Therapy) is a safe and effective treatment for individuals diagnosed with Major Depressive Disorder (MDD) who have not experienced satisfactory improvement from antidepressant medication. TMS Therapy can be used in conjunction with medication or as a stand-alone treatment.

TMS Therapy works by delivering magnetic pulses to specific areas of the brain involved in mood regulation--areas known to be underactive in those diagnosed with MDD. The magnetic pulses stimulate brain cells, thereby improving the brain’s ability to regulate mood.

Come and learn more about TMS on September 29, 2017 at 1pm when DCPA presents this interesting, informative workshop.  Learn clinical application, biological effects, predictors of response, and other issues of this approach.

This 3 CE credit workshop will be presented at The Chicago School of Professional Psychology, 901 15th St NW, Washington DC 20005.