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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Wednesday, February 28, 2018

Parental Alienation Advocates Defend Children Against Dangers of Autonomy (They Say)



A Canadian colleague recently sent me an immense document with PowerPoints and summaries of presentations that took place at the conference Children’s Participation in Justice Processes: Finding the Best Ways Forward, sponsored by the Canadian Research Institute for Law and the Family, in Calgary, Alberta, Sept. 15-16, 2017. You can see the PowerPoints of this conference through links at  www.findingthebestwaysforward.com/Materials/index.html.

There were some really excellent presentations  given at the conference, best of all in my opinion one by the well-known lawyer Nicholas Bala, who gave a brilliant discussion of children’s cognitive development and the ways that a stage of cognitive development could affect participation in judicial proceedings. This is really worth reading for anyone who is concerned with laws and judicial decisions as they work for children’s best interests.

However, the conference included some much less admirable presentations as well, notably one that focused on the idea of parental alienation (PA). As many readers will know, PA is the hypothesized situation in which one of two separated or divorced parents “brainwashes” a child and persuades the child to believe that the other parent is bad, abusive, dangerous, etc. The child who is persuaded in this way then rejects and avoids the parent who has been targeted (to use PA) language and strongly prefers to be with the other, alienating (in PA language) parent. PA advocates like Craig Childress and Dorcy Pruter claim that the child who has been alienated (in PA language) has been made mentally ill in ways that will have long-term effects, and needs to be rescued and treated. PA advocates suggest that this can be accomplished by various treatment programs, most of which have infrastructural names involving paths, roads, and bridges, and all of which focus on removing the child by court order from the preferred parent and placing him or her in the custody of the non-preferred parent.
It would be silly to claim that no preferred parent has ever manipulated the child’s attitudes—this can happen even in an intact marriage, and can be encouraged by grandparents, friends, new romantic partners of the preferred parent. However, as is usual in human affairs, multiple factors work together to produce a child’s rejection of a parent, and how often they include “brainwashing” has never been empirically demonstrated. Neither has it been shown that the child’s attitudes, however negative, are indicative of mental illness.

Let’s look more closely at the idea of mental illness as a facet of the child’s rejection of a parent. PA thinking suggests that the child’s thought processes are distorted and that, no matter what the child’s age, some attachment problem has been created. These ideas have not been validated, but in many ways they are the least of the issues here.

The great difficulty with this view is the claim that the hypothesized mental problems will be exacerbated by giving the child any choices—that the child’s stated wishes are narcissistic wishes that must be dropped in order for mental health to be regained. This idea, that adults must exert complete authority, and that children are damaged by autonomous decision-making right up to the age of 18, is common among alternative therapies. Attachment therapists too claim that children they have diagnosed as having attachment disorders must yield all authority to adults, must obey instantly and cheerfully, and should be given no information about what is going to happen to them. To treat a child as an autonomous individual and to allow the child to express beliefs and feelings is seen as a sure way to worsen any existing problems; this is why attachment therapists insist that conventional child psychotherapies will make children “worse”.

At the conference in Calgary,  presentation stood out as representing the PA belief system. They argued against the idea that a child in custody proceedings should be allowed to speak, claiming that this would be detrimental to the child.

The presentation, “The voice of the alienated child”, was the work of Rob Croezen, Melissa Ander, and Alyson Jones. These presenters listed a series of dangers of allowing the child’s voice to be heard:

·         Boundary issues
·         Being caught in the parental conflict
·         Improper empowerment
·         Loss of leadership by adults
·         Loss of hierarchy
·         Loss of stability
·         Loss of security
·         Doing the job of an adult
·         Increased anxiety
·         Feeling of responsibility
·         Parentification
·         Adultified children
·         Role confusion
·         Heightened anxiety (yes, as well as increased)
·         Attachment disruptions
·         Lack of resolution
·         Black and white thinking

Let’s have a closer look at this list. What do we see here that indicates long-term issues of mental health? Keep in mind that this list is not even about the effects of experiencing PA—it’s about being allowed to contribute to the discussion leading to custody decisions.  But are the items on the list unusual? Are they problematic? Are they supported by evidence about what happens either in high-conflict divorces or when children’s voices are heard?

1.    1.  Boundary issues certainly occur in some families and may be associated with certain kinds of parent-child relationships, but surely the argument here, if any, would be that if children have boundary issues their preferences may reflect those issues—not that being allowed to speak will cause boundary issues.

2.    2.  Being caught in the parental conflict is unpleasant for children and can take up energies and resources they need for their own developmental tasks, but children in high-conflict divorce are already caught in this way. Playing a role in decisions about their own lives would appear to allow them to use the situation for their own developmental purposes, of which a move toward autonomy is one.
3.      
“    3. "Improper empowerment” suggests that children who are heard in court will use the experience to take over decisions they are not capable of making. In fact, working to re-establish family rules and decision-making processes is one of the tasks of divorced families, and some children do “take up the slack” from distracted parents and feel empowered in ways that later need to be corrected. This is a general issue of post-divorce adjustment and not a matter either of PA or of child participation.

4.      4. Loss of leadership by adults often occurs during a post-divorce period of several years, as parents struggle to reorganize their own lives and deal with financial and emotional issues; this is true even for the parent who initiated the divorce. Parents do not lose their leadership because a child is heard, but for other reasons.

5.      5, Loss of hierarchy: how I would love to know what is behind this one! It’s so reminiscent of the German “family constellation” therapist Bert Hellinger, who believes that the breaking of age and gender hierarchy causes emotional disturbance in a family. Hellinger wants children who have been molested by an older family member to apologize to the molester because they have been instruments of breaking the hierarchy. I don’t want to exaggerate the possible connection here, but you don’t get a lot of conventional psychologists troubling themselves about hierarchies in this way.

6.     6.  Loss of stability: divorce does this, especially if the child has to move to a new house (cf. custody change with PA claims, by the way) or change schools.

7.    7.  Loss of security: divorce also brings about financial loss, disagreements about child support, and the loss of the sense of a back-up adult if one has a problem. We don’t need to look for the child’s voice in court as causing these things.

8.     8.  Doing the job of an adult: this is only a concern if we assume along PA lines that only adults can speak about their thoughts and feelings. Conventional therapists generally try to teach children to do those things.

9.     9.  Increased anxiety is the lot of any child in a high-conflict divorce and would presumably be reduced by a sense of some autonomous participation.

1   10.  Parentification: This will be a problem if the child feels that he or she must “take care of” a parent who is incompetent, no matter whether the child can speak in court. The solution is more likely to be to give the adult guidance toward competence, not to silence the child.

1 11 .  Adultified children: same as #s 8 and 10.

1 12..  Role confusion: I think the presenters really mean the same thing as they meant in 8, 10, and 11, rather than the term role confusion as used by Erik Erikson in his discussion of adolescent personality development.

1 13.  Heightened anxiety: see #9.

1 14.  Attachment disruption: oh, dear. Our presenters do seem to have forgotten the principle of developmentally appropriate practice. Children over age 3 or 4 do not experience overwhelming distress over separation from a familiar caregiver as younger children do. By age 6 or 7, children all over the world are sent to school, even to boarding school, or are sent out to do farm work or other tasks away from their parents. By the time they are at that age, the powerful emotional attachment of infants and toddlers has changed to an internal working model of social relationships in which caregivers play an important but not exclusive role. Even toddlers adjust in a few months to loss of attachment figures and are able to make new attachments—although if they have been through more than a few separations they may need help in this. These sinister references to attachment, with implications of attachment disorders and severe mental health problems, are characteristic of alternative therapies and unconventional beliefs about child development.

1 15.  Lack of resolution: this is caused by having a voice in custody decisions, is that the claim? Is it not instead a feature of loss by divorce rather than by death?

1 16.  Black-and-white thinking: again we have a problem with developmentally appropriate practice. Young children normally have trouble understanding overlapping categories or multiple factors working together. What is the evidence that continuing to have these characteristics of early thought is more common among children who are allowed to contribute to custody decisions, even if only by having their voices heard? There seems to me to be a problem here in parsing the overlapping categories of children of divorce and children of divorce who either do or do not have their voices heard—a class inclusion problem, in terms of cognitive development.


I think I’ve said enough (or perhaps too much, I don’t know who’s still with me) to show the difficulties inherent in the claims made by those who argue that children’s voices should not be heard in custody proceedings. There is no danger to the children in being heard, and a good deal of danger in being subjected to ill-considered PA thinking and practices.    


Monday, February 19, 2018

Is Attachment Therapy "Controversial"?

A newspaper in Greeley, Colorado has once again incorrectly referred to Attachment Therapy as a “controversial” treatment. AT is not controversial, not are its associated beliefs and adjuvant treatments like Nancy Thomas parenting. They are not controversial because there is no controversy here. No one who has any understanding of child development would enter into any controversy on these ideas and practices, which are clearly wrong, unfounded, and potentially harmful. There is no need to argue the point, as would be done if something were genuinely controversial.

Attachment Therapy is an alternative psychotherapy, the parallel in the psychology world of complementary and alternative medicine (CAM). It can be identified as an alternative treatment because it is implausible, incongruent with what is known about child development, and lacking both an evidence basis and a possible mechanism by which it might work. The same points can be made about the alternative developmental theories and adjuvant treatments associated with AT. Arguments in favor of the AT principles and practices are based on a completely mistaken definition and theory of emotional attachment and use terms related to attachment in obfuscatory ways rather than for clarification.  

There are many other alternative belief systems that are completely wrong, but not controversial, because no knowledgeable person would enter into serious controversy about them. For example, the belief that the earth is flat rather than spherical, as promulgated by the Flat Earth Society (https://www.tfes.org), is wrong, but there is no controversy about it in serious circles. We do not see geographers applying for grants to demonstrate that the earth is a sphere, or writing learned books arguing on philosophical principles that the flat earth view is wrong. Like AT beliefs, the Flat Earth view is a mistaken alternative belief, but not the subject of controversy.

So, why did the Greeley newspaper say AT is controversial? One reason is that lots of other people have said this and it seems like an exciting idea. (And it would be extremely exciting if any evidence were advanced to support AT beliefs, because if they are right, that would mean that almost all established facts and principles about child development have to be abandoned!) Using the word “controversial” also lets the reporter off the hook with both AT proponents and conventional psychologists, by implying that no stand is being taken—although mentioning these ideas at all, when they are so little known in the world of professional psychology, actually is taking a stand. Describing AT as controversial and giving space to differing ideas about attachment and attachment disorders provides the pseudosymmetry, or equal weight for well- and poorly-supported ideas, that passes as “fair treatment” in present-day journalism. Using the “controversial” word  about AT also gives lots of chances to talk about horrible children and the need for adult domination, topics that are bound to attract interest.

Are there controversial ideas and treatments in psychology, as opposed to alternative psychotherapies? Yes, of course. A good example is Eye Movement Desensitization and Reprocessing (EMDR), a treatment claimed to treat anxiety and other emotional discomfort by having the patient imagine the frightening situation while moving the eyes in a pattern. There are lots of controversies here, and lots of people attempting to investigate EMDR empirically. Is EMDR effective in reducing emotional discomfort? If it is effective, what is the mechanism—do the eye movements really make any difference, or is the effective component simply exposure and desensitization as they are used by other treatments without planned eye movements? Because there is genuine controversy here, you will see many articles on these in peer-reviewed professional journals. People who know a lot about the topic disagree on EMDR and seek to test their beliefs by finding new evidence. None of this is true about AT, which is an alternative (CAM) treatment, not a subject of controversy.

If there was ever real controversy among professional psychologists over AT, it died down in 2006 when the joint task force of the American Professional Society on Abuse of Children (APSAC) and the American Psychological Association’s Division 37 rejected out of hand the use of attachment therapy, of adjuvant treatments, of the related views of attachment disorders, and of the alternative theory of child development on which all of these are based. So what keeps reporters and the public talking about these ideas? I would say that it is in part the wholehearted commitment of the public to the idea of attachment as the central theme of human life, coupled with a considerable misunderstanding of what attachment is. “Everybody knows” about attachment so it’s very comfortable for readers and viewers to encounter. Really, however, we need to keep in mind that although attachment (the actual process) is important, it’s not the only thing that’s important in development.

And, there's a difference between controversy and unsupported claims about alternative treatments.


Friday, February 16, 2018

Alternative Therapists Pounce on Florida School Tragedy

Alternative therapists must have been waiting impatiently for an adopted person to commit a tragic school shooting. Now that this has occurred in Florida, various proponents of alternative belief systems have jumped onto the fact , which they claim supports their unsupported equation: adoption=feelings of loss and rage=attachment disorder=violent actions. And, they hope, this horrible situation will give them an entry into the national discussion, fame and fortune.

As I often do, I received an email message from Heather Forbes, former colleague of Bryan Post (a  smooth “plausible fellow”, well-known for his store-bought doctorate), and present ruler of the Beyond Consequences mini-empire. There is a link to the message at https://www.facebook.com/BeyondConsequences/posts/10155982520430256, but let’s look at what she had to say:
“As I watched the news on last night and this morning, all I saw was discussions about gun control, active shooter school policies, mental health, and proper law enforcement protocol. While these are all valid issues to discuss, I believe the most important issue continues to be overlooked. We aren't looking at our students from a social/emotional, heart-centered perspective. This shooter's history was rampant with experiences of rejection. He was adopted and then lost BOTH his adoptive parents. Then he was expelled from school. That is three experiences of severe rejection and loss: 1) the loss of his birth family, 2) the loss of his adoptive family, and 3) the loss of his school family. As humans, we are a social species....we are designed to live in families, especially as children… 
 I can only see that there is no coincidence that this horrifying event took place on Valentine's Day--the day we celebrate love and relationships. “ (Heather then proposed that she be a spokesperson to the nation on these issues and asked her followers to suggest her to various news outlets.)


So, let’s examine Forbes’ thinking under a strong light. What we see is the usual “proof by assertion”.
First, she equates rejection with loss, implying that the sadness and grief of loss are accompanied by equal amounts of the resentment and anger that stem from rejection. While no one can deny that we human beings often feel some anger toward those who have left us, even when they did this unintentionally, the feelings and effects of rejection and loss are not the same, and conflating them confuses the issue. As is the case for most pseudoscientific explanation, the misused terms obfuscate rather than clarifying the discussion.

Second, Heather Forbes states that the loss of the birth family is an experience of severe rejection and loss. There is no evidence that this is the case for children who are adopted early in life, especially those who are adopted before the age of 8 or 9 months when emotional attachment to familiar caregivers may have begun. The idea that adopted children are enraged and full of grief because they have been separated from a birth mother is not based on any observations of children; instead, it is implausibly based on beliefs that mother and child are genetically attached or that attachment occurs prenatally—all these ideas being fostered by alternative groups like the Association for Pre- and Perinatal Psychology and Health (APPPAH). These beliefs are worth their weight in gold to those who offer their guidance to adoptive families and adult adoptees, and who do so by creating unnecessary anxiety about the future for people who are doing very well.

Third, Heather Forbes points to losses in the adoptive family, and I will not try to argue that these may not have contributed to emotional disturbance, although the adoptive status is irrelevant here. Losses in any family act as adverse childhood experiences (ACEs) and may contribute to disturbed emotions and behavior—although they are even more likely to create later physical disorders than mental illness, and are not thought to be a major factor in serious mental illness.

Fourth, Forbes points to the loss of the “school family”, apparently reversing cause and effect. The shooter was expelled from school because of disciplinary problems, so this loss followed rather than caused his disturbed behavior.

Finally, let me note the twisted argument Forbes presents about Valentine’s Day, just as  a further example of the cherry-picking of evidence and illogical conclusions drawn in her statement. According to Forbes, it is “no coincidence” that the shooting happened on Valentine’s Day, so it should be attributed to loss of love as the triggering factor for the shooter. But it was also Ash Wednesday, the beginning of Lent—can Forbes not parlay this fact into a further non-coincidental connection? Was the shooter disturbed by seeing people with ashes on their foreheads, reminding him of life’s ultimate end and therefore his losses? Was the anticipation of giving things up for Lent too much for one who felt he had been robbed of his rights? Sorry, Heather Forbes, but if you use one fact to support your argument, you can’t ignore the other facts, whether they are about attachment or about holidays.

Not surprisingly, our old friend Nancy Thomas has chimed in, recognizing this tragedy as a way to advance her brand. She says, at https://www.facebook.com/ntparenting/posts/1579834535464320 Yes, it is possible this young man may have demonstrated many of the characteristics of RAD when he was younger. The more likely outcome at this point is he may receive a diagnosis of Conduct Disorder. That is usually the go-to dx for adults who have been or should have been diagnosed with RAD when they were children. For those who worry this is where their child is headed we have this. There is always hope as long as they are breathing. Those who have a diagnosis of RAD are not automatically killers.

Well, what a relief Thomas has given us here! Children diagnosed with Reactive Attachment Disorder will not necessarily grow up to be killers. However, she suggests, killing allows us to detect that the killer did as a child have Reactive Attachment Disorder. Presumably this means not Reactive Attachment Disorder as indicated by sadness, lethargy, and disengagement from social interaction, but instead the alternative version in which children are liars and thieves and manipulate or harm others—and, saliently, in which it is predicted that children who show no symptoms are simply too cunning to be caught, but still need an alternative treatment so they will not become either serial killers or prostitutes, depending on gender. (And I’ve always been fascinated by the equation of these two forms of misbehavior.)

One more of these, though I am sure they are multitudinous: http://www.teapartytribune.com/2018/02/15/guns-dont-kill-people/ by a person somewhat disturbingly called Bill the Butcher, who states that guns don’t kill people—psychiatrists kill people. Bill the Butcher states that his granddaughter has Reactive Attachment Disorder and as a result “ripped the ears off a small dog to get its bows for her hair”. This kind of claim is often made by people who are devoted to the alternative view of attachment and of causes of mental illness, but anyone who has jointed and skinned a chicken (a dead one, I mean!) knows that tearing flesh apart with your bare hands is not readily accomplished. I would suggest that this story is a myth related to various alternative therapists’ stories of children who have torn the heads off puppies.  By use of this myth, the child is identified as a powerful, hostile, evil being, and, as Bill the Butcher suggests, incarceration is the only legitimate response. According to B the B, mental health professionals and teachers cause school shootings by attempting to help disturbed children, and responsible people must simply lock the children up.

As most killings are not committed by adopted people (who are only about 2% of the population), it has taken awhile for  alternative therapists to get their chance to claim that mass shootings are related to adoption and to attachment disorders. But their opportunity has finally come and they are taking advantage of it as best as they can. Let’s hope that media outlets do not act in haste to accept, Forbes, Thomas, or B the B as spokespersons for the role of mental health in these tragedies.   


Tuesday, February 13, 2018

T. Berry Brazelton's 100th, and "Touchpoints"

The great pediatrician T. Berry Brazelton’s hundredth birthday will be celebrated April 23, 2018, at a symposium at the Boston Marriott hotel in Newton, MA. A stellar group of speakers will be there and people in the Boston area may want to attend. It is expensive though—so for my part I am going to offer here some reminders about Brazelton’s concept of “touchpoints” as a way for parents to organize their childrearing work.

Brazelton’s various “touchpoints” books, and his work together with Joshua Sparrow and others, focused on times of developmental changes in the lives of babies and young children, and the way those changes can disrupt family life and create parental anxiety (see www.brazeltontouchpoints.org). Guidance about these times of change and disruption can help parents keep calm and work through expectable disruptions.

It’s a big flaw in human thinking that we tend to expect things to stay the same as they are at any moment. If something doesn’t go well, we imagine that there will never be any improvement and are deeply discouraged about the future and life in general. If everything is fine, we dismiss the possibility that anything less desirable could happen, and expect smooth sailing ever after. Learning that life—and parenting—has ups and downs is quite difficult, but this lesson, if learned, helps everyone to weather difficult times. Brazelton’s “touchpoints” approach suggested that if parents can anticipate times of disruption, they will deal with those times more comfortably when they do come.

People other than Brazelton have considered this issue in terms of events in early development. Anna Freud, for example, suggested that there were natural times of what she called “regression”—periods when an infant or child who had been easy to care for became temporarily more difficult, cried a lot, had tantrums, slept or ate poorly, for no apparent reason. It’s interesting that she used the term “regression” for this behavior, because that implies that the child has gone back to acting as he or she did earlier. Actually, though, periods of “difficult” behavior may mean that a child has progressed, not regressed. A 4-month-old is not afraid of strangers and does not fuss when approached by new people, but a 10-month-old, with more advanced cognitive and emotional development, is likely to cry and try to hide, and may be much distressed when introduced into a new environment with new caregivers. Increased maturity of a child can go with greater care difficulties from the parent’s viewpoint, but it can be hard for a parent to see things that way, and when other people express annoyance or concern about developmental steps they do not recognize as progress, parents’ lives are made even harder.

Arnold Gesell and Frances Ilg, who in the 1940s and ‘50s published books for parents and teachers about developmental changes, talked about “interweaving” of negative and positive changes during infancy and the preschool period. The idea again was to anticipate and prepare for events rather than being startled and badly disrupted by them.

Brazelton’s real contribution to the idea of “touchpoints” is that children’s developmental steps—the same ones that may make parents anxious or angry—can be reframed and reinterpreted as evidence of good development. Just as parents look forward to developmental milestones like sitting alone, walking independently, the first word, they can be guided to recognize what Anna Freud called “regressions” as developmental progressions. Because some of these developmental steps are fairly predictable, parents can be encouraged to anticipate them and find them delightful as well as possibly problematic. (I’ve always thought that if I could design a greeting card, I would do one that says, “Congratulations! Your child was afraid of a stranger for the first time today! Her development is going very well!”)

Brazelton’s work looked at a range of changes in areas of development that can provide “touchpoints” for parents. For example, he noted that at about 4 months, babies’ increasing interest in the environment may make them more difficult to feed, as they stop nursing to look at other people in the room or to explore the mother’s face. By about 9 months, their desire to use their newly-developed pincer grip makes them want bits of food to pick up and decreases interest in being spoon-fed. By 12 months, new skills and an increased need for independence indicate developmental progress. Parents can take pleasure in these changes and work to accommodate them by providing changes in diet and encouragement to move forward—or they can fight the changes, making themselves and the babies unhappy. (If the parents accept the belief of some alternative therapists that emotional attachment occurs when an adult feeds the baby, they will definitely run into anxiety and difficulty on this point.)

The Touchpoints books are very much worth a look for parents of infants and toddlers.




Monday, February 12, 2018

A Letter to Florida About Proposed Use of "Alternative Therapies" for Veterans

The Honorable Dana Young
Chair, Health Policy Committee
404 S. Monroe St.
Tallahassee, FL 32399-1100

Dear Ms. Young:

A Florida colleague has told me about Bill 23-00010-18 and I am writing to comment on the proposed provision of “alternative therapies” to veterans.

Let me note first that “alternative therapies” are by definition treatments that are unsupported by an acceptable empirical evidence basis. If they were supported by evidence of safety and effectiveness, these treatments would simply be called “therapies”. Veterans and all citizens deserve help to insure that their investments of time and resources into treatments are protected by evidence of treatment effectiveness. The only people whose best interests are served by provision of “alternative therapies” are the “alternative therapists” themselves.

The proposed use of “equine therapy” for veterans is a a good example of service to “alternative therapists” rather than to veterans. Treatment by horseback riding was originally used as a means of gentle stretching of contracted muscles for children with cerebral palsy and the sequelae of other diseases like polio. Horseback riding was effective for these purposes and was enjoyable and interesting for the children, which helped them tolerate discomfort they might feel. Within the last 20 years or so, however, enthusiasts of horseback riding began to propose that if riding was good for children with cerebral palsy (who may appear to be mentally limited even though they are often not), it should also be good for autistic children or for children whose disturbances were clearly emotional. One “equine therapist” has even claimed that the horse’s gait is “downloaded” to a disturbed child’s brain, thereby normalizing brain functioning, and that horses can tell whether a person is lying to another person; there is no evidence to support these claims, which are in fact rather bizarre.

The proposal that “equine therapy” be used for veterans’ emotional disorders has simply been generalized from the unsupported claims made about the treatment as it has been used for children. If a veteran has contracted thigh muscles as a result of nervous system or other injury, yes, horseback riding may provide helpful stretching. If a veteran is bored and limited in what he or she can do, horseback riding can be fun and rewarding. But these possible benefits for some veterans do not mean that “equine therapy” is effective treatment for PTSD or any other mental disorder, or that it should be supported or even encouraged by the state of Florida..

I hope you will take these points into consideration with respect to 23-00010-18. I would be happy to discuss these issues further if that would be helpful.

Yours sincerely,

Jean Mercer, Ph.D.
Professor Emerita of Psychology, Stockton University, Galloway, NJ