Joseph R. Scardapane, Ph.D
The Psychological Evaluation, Research and Counseling (PERC) Clinic was started in the mid- 1960s by Dr. Julia Vane. At a time when most of the psychology world was still using psychoanalytic techniques, Dr. Vane brought in behavioral techniques such as home token economies that relied on the work of B.F. Skinner. The concept of reinforcement was applied to psychotherapy in many ways, including verbal praise, stickers and tokens for children, and increased social interaction and pleasant events for adults. While this might seem logical today, it was revolutionary in the 1960s. The focus of the therapy was still on the therapeutic relationship, but the context was very different.
Since that time, the PERC Clinic has evolved into a clinic that serves two doctoral programs – one in school psychology and the other in clinical psychology. The clinic provides direct clinical experience in a number of ways, the most important being the provision of cutting-edge services to the community, including psychodiagnostic assessment, psychotherapy and applied behavior analysis, where appropriate. We also have the technology to go along with these new techniques. The clinics and institutes within the PERC Clinic are supervised by Hofstra faculty and administrators who specialize in each area. This joining of expertise and student enthusiasm makes the education and service components of the clinic a very rich experience for all.
The PERC Clinic focuses on psychodiagnostic assessments for children, adolescents and adults. The assessment consists of a biographical data review. This occurs through the use of interviews and detailed background questionnaires. Patients are provided with a comprehensive assessment, which includes tests of intelligence, academic achievement, memory, visual, motor development, emotional and behavioral functioning, and personality traits. An interpretive conference is convened shortly after the assessment. The individual adult or parents/adult guardians attend these conferences to review fi ndings and discuss recommendations. A full psychological report, including test results, diagnostic interpretations and recommendations, is mailed to the individual or parents/ adult guardians. When requested, and with written informed consent, a copy of the report is sent to agencies, schools or other professionals. If psychiatric or medical care, remedial reading or speech-language-hearing services are needed, a referral is made. An effort is made to work in conjunction with other professionals to facilitate rapid remediation of problems.
The clinic engages in the collection and analysis of data with a view toward refi ning its own services and expanding knowledge in the fi eld of psychology and mental health. Publications in journals and presentations at national and international conferences often result from this work. The PERC Clinic accepts referrals from physicians, educators, clergy, attorneys, psychologists and other professionals.
The following paragraphs describe each of the specialty clinics that now make up the PERC Clinic.
Institute for the Study and Treatment of Anger and Aggression
Director: Dr. Howard Kassinove
The Institute for the Study and Treatment of Anger and Aggression involves the evaluation, management and investigation of anger disorders. Three types of anger in adults and adolescents have been identifi ed: adjustment disorder with anger, general anger disorder and situational anger disorder.
With adjustment disorder, people become angry in reaction to a specifi c and limited set of circumstances, such as divorce or loss of a job. Although they may have been previously welladjusted, their anger may now appear in multiple situations and include general irritability, sarcasm, complaining and “being on edge.”
With general anger disorder, people become angry in reaction to a wide variety of probPsychological Evaluation, Research and Counseling Cliniclems, including disappointments, frustrations, perceived insults or perceived social neglect. Their anger may be frequent and intense and may endure for long periods of time. The anger may be associated with aggressive behavior or may exist as an internal, personal experience that leads to yelling, arguing or sarcasm.
With situational anger disorder, people become angry or aggressive in reaction to a limited set of circumstances. Their anger may show itself only while driving or only when interacting with a spouse or a child. In other situations, such as work, they remain relatively calm. It is common that people with this disorder deny that they have a real anger problem.
The evaluation consists of a structured clinical interview and psychological tests to assess the frequency, intensity and duration of specifi c anger episodes. The strength of an anger trait is also assessed.
In the management of anger, there are four steps. First, a collaborative plan is developed to gain agreement on the goals and methods to be used. Second, techniques are taught to help change response to anger-provoking situations.
Third, a perspective that centers on reality and forgiveness is promoted. Relapse prevention skills are also developed.
This program for the treatment of anger and aggression provides clients with the opportunity to drastically change their lives with regard to the negative consequences of these behaviors. The impact of this change can be both life enhancing and punishment diminishing.
It is common for the probation department to refer clients for the treatment of anger disorders. This system of referrals from this department allows the clinic to work with individuals whose behavior has resulted in involvement with the legal system.
Institute for Family Forensic Psychology
Director: Dr. Paul Meller
Divorce, separation, or any other family transition can create a great deal of stress for a child. During this time, children are confronted with many changes at one time. These changes include understanding family roles, redefi ning relationships with parents, changes in schedules, and the possibility of changing schools and establishing new friendships. Confl ict between parents is one of the most destabilizing factors in a family reorganization.
The Institute for Family Forensic Psychology provides services to help parents responsively manage their confl ict. Evaluations of the strengths and needs of the parents and children and therapeutic programs for children and families going through divorce or other family transitions are provided.
The two major components of this institute are evaluations and family therapeutic services. Family therapeutic services include Peace4Kids and therapeutic visitation. Evaluations include helping parents and the courts make appropriate decisions regarding time spent with each child and responsibility for fi nancial and housing arrangements. When parents cannot agree on basic issues about the children, they often go to court. At this time, a judge may order a forensic evaluation, which is sometimes called a custody and visitation evaluation. The primary purpose of this evaluation is to assess the family unit and provide the court with objective information to help the family make decisions. All assessments follow the guidelines of the Association of Family and Conciliation Courts and the New York State Matrimonial Commission. Additionally, the guidelines of the American Psychological Association are followed closely so that doctoral students learn to write these assessments in an appropriate and useful manner. All assessments are supervised by an experienced forensic evaluator and licensed psychologist.
Peace4Kids is one of the family therapeutic services offered through the institute. It is a psycho-educational program designed to help children from kindergarten through fourth grade. The goal is to help these children cope more effectively with divorce. Children meet in a group setting for six one-hour sessions. Through age-appropriate activities, children learn to effectively adjust to family changes. The topics of the sessions include defi ning a family, problem solving, understanding legal issues, responding to changes, and asking for help. The language used for these topics depends upon the developmental level of the children in each group.
Therapeutic visitation is designed to help mend parent/child relationships that may have been affected by parental confl ict. The expertise of the supervisors and the education provided to doctoral students allow the services of the Institute for Family Forensic Psychology to be highly professional and meaningful. This institute is yet another example of the diverse training available to our doctoral candidates.
Diagnostic and Research Institute for Autism Spectrum Disorders
Director: Dr. Kimberly Gilbert
Autism is a neuro-biological developmental disability that generally appears before the age of 3. Individuals with Autism Spectrum Disorders typically have diffi culty with communication and social interaction, and display repetitive/stereotyped behaviors. Research clearly indicates the importance of early identifi cation and implementation of behavior and language interventions. Knowing that early and accurate diagnosis provides the most effi cacious treatment for this population, the institute employs the most current diagnostic measures and research-based practices.
The institute offers a full range of services to address the needs of the family as a system. Clinical services include comprehensive assessments and behavior/language interventions such as prelinguistic milieu intervention, social skills groups, and sibling and family support groups.
Interventions and therapy for individuals with Autism Spectrum Disorders include functional behavioral assessments; behavior intervention plans; milieu communication therapy for young talkers; social skills groups for children, adolescents and adults; home curriculum development; and psychotherapy. Family therapy, parent support groups and sibling workshops are offered to support the entire family.
Ongoing research is conducted at the institute in order to help develop and enhance treatment methods and contribute to the current body of scientifi c literature.
Acceptance and Commitment Therapy (ACT) Clinic
Director: Dr. Joseph R. Scardapane
The Acceptance and Commitment Therapy (ACT) Clinic serves individuals who are 18 years of age and older. Rather than focus on specifi c disorders, the ACT Clinic focuses on behavior, emotions and thoughts that act as barriers to living meaningful lives. This therapy encourages people to accept what is out of their personal control while committing to do whatever is in their personal control, to improve the quality of their lives. ACT teaches psychological skills to deal effectively with painful thoughts and feelings. These psychological skills are taught in such a way that these painful thoughts and feelings have much less impact on the individual. ACT also helps people clarify what is truly important and meaningful to them. The therapist helps clients use that knowledge to guide, inspire and motivate them to change their lives for the better. The aim of ACT is to help people create rich, full and meaningful lives while effectively handling the pain and stress that life inevitably brings.
The approaches used in ACT include mindfulness meditation, which helps increase awareness and decrease experiential avoidance. Developing willingness to experience all that life brings is associated with letting go of those things we cannot control. Cognitive diffusion is a technique that separates thoughts from the thinker, and helps the client experience thoughts as mere words and sounds. In addition, values as chosen life directions are explored and decided upon by the client. These values lead to committed action. Committed action is defi ned as behavior needed to act in line with the client’s values. It is common that these behaviors were associated with diffi cult emotions or thoughts in the past and are therefore avoided. ACT helps clients understand why they may be willing to suffer from feelings and thoughts they previously avoided.
For example, if a client develops a value that family relationships are important to the meaning of their lives, they are likely to engage in behavior that enhances that value. However, if a client is fearful of crossing bridges, and his/ her son lives in an area that involves crossing a bridge, the client is stuck in the dilemma involved in approaching or avoiding emotions. When faced with the choice of staying home or crossing the bridge to visit a son and his family, the anxiety associated with the latter behavior is put in the context of the values in his/her life. Willingness to suffer the anxiety is an important aspect of decreasing emotional avoidance and increasing behavior associated with living a rich life. These are the basic paradigms associated with ACT.
Phobia and Trauma Clinic
Director: Dr. Mitchell Schare
The Phobia and Trauma Clinic offers treatment for patients whose fears inhibit their quality of life as well as for clients with posttraumatic stress disorder, a condition caused by a devastating or tragic experience. These people tend to avoid certain life activities because of their fears and phobias. Although some people actually participate in these activities, they experience extreme dread. Others miss out on activities such as family celebrations, vacations and professional obligations. The clinic treats clients with a fear of traveling on airplanes and trains, public speaking, heights and animals, among other common phobias.
The clinic uses a treatment called “exposure therapy.” This treatment involves therapy under safe, controlled clinic conditions. Patients are immersed in situations they have long avoided or asked to confront traumas they have experienced in their lives. On a case-bycase basis, therapists may simulate environments that trigger a phobic response so patients can learn to better manage their fears.
The therapeutic techniques used in this clinic include the following:
- Imaginal exposure: Therapist-guided mental imagery associated with phobic responses in the patient.
- Virtual reality exposure: Computergenerated environments that create sights, sounds and physical cues associated with the patient’s fear.
- In-vivo exposure: Confronting fear cues in the real world (for example, a patient with public speaking anxiety giving a speech in front of fi ve people).
These treatments for phobia and trauma combine well-researched approaches and cutting-edge technology to help these patients live lives that are less restricted by fear and anxiety
Child and Parent Psychotherapy Services (CAPPS) Clinic
Director: Dr. Phyllis Ohr
The Child and Parent Psychotherapy Services Clinic serves all child/ adolescent and parent clients who apply for psychological services at the Saltzman Community Services Center. The clinic provides cognitive-behavior therapy, play therapy, behavioral parent consultation, and mindfulness-based programs to enhance awareness and values. The focus tends to be on the parent-child dyad or triad. Therefore, the child is never seen in isolation but rather as part of a larger context in the home and at school. One of the most important components of the CAPPS Clinic is Parent-Child Interaction Therapy, which is detailed below.
Parent-Child Interaction Therapy (PCIT)
Parent-Child Interaction Therapy (PCIT) is a positive and intensive program for children aged 2 to 7 years and their parents, specially designed to enrich the quality of their relationship, spring 2010 HOFSTRAhorizons 9 reduce parenting stress, and improve overall child behavior.
Individual psychotherapy sessions and conjoint parent-child sessions offer behavior therapy, cognitive-behavior therapy and play therapy. The treatments are effective for individuals with aggressive behaviors, anger, defi ance/oppositional behaviors, impulsivity, mood swings, obsessive/ compulsive behaviors, panic, phobia, general anxiety, sadness, school and test anxiety, separation diffi culties, shyness and inhibitions, worries and fears, among other diffi culties.
PCIT is appropriate for families with child relationship problems, highly stressed parents, and children with adjustment problems, aggressive behaviors, attention diffi culties, separation anxiety and social diffi culties. Techniques used include behavior therapy, behavioral parent consultation, cognitive-behavior therapy, mindfulness and acceptance commitment therapies, video-based parent training programs, and parent training programs for child management.
The parent training programs for child management and video-based parent training involve the opportunity to use technology to accomplish therapeutic goals. At the beginning of treatment, therapists interact with the child in a manner that typically brings out a problematic behavior such as tantruming. At this point, therapists interact with the child to meet his or her current need without reinforcing the problematic behavior. This approach allows parents to view new behavior to improve the interaction between themselves and their child. They are able to view and hear this new type of interaction through the use of a one-way mirror and blue-tooth technology.
The second phase of this approach allows the parent to try out the new behaviors modeled by the therapist. Initially, a therapist is in the room helping to guide the parent’s behavior. Subsequently, the parent interacts with the child while being viewed by the therapist (who gives the parent verbal feedback via blue-tooth). The advantage of this approach is that the behavior recommended to the parent can actually be shaped, modeled and established. It is a much more powerful approach than traditional verbal therapy, which involves little emphasis on actual behavior. Our doctoral students learn an approach that is not only effi cacious but cost-effective for parents and the institutions they may serve.