Category Archives: Training Issues

An Account of Invisible Disability in Graduate Psychology Training

“But you look so healthy, I’m sure you’ll be fine.”

You would never know that I have a disability from just looking at me. To most people, I appear to be healthy and well-adjusted for my age. Enrolled in a doctoral clinical program, doing well in my coursework, taking on extra curricular activities – from an objective viewpoint, it is easy to assume that I lead a similar life to most people my age in my situation. Yet the very fact that things seem normal is one of the most challenging aspects to an invisible disability. Unless I go out of my way to explain it, you would likely never know that I suffer from severe tinnitus and hyperacusis, or constant ringing in the ears and extreme sensitivity to sound.

“Oh I get tinnitus sometimes, too. You should just ignore it like I do.”

Although increasingly common, issues of tinnitus and hyperacusis are not widely understood, nor is there a clear way of measuring what makes someone’s condition severe (Blasing, Goebel, Flotzinger, Berthold, & Kroner-Herwig, 2010). Unlike hearing impairment, in which the limitations of hearing are objectively measured by a hearing test, the methods for measuring tinnitus are far more subjective. Therefore, people tend to measure tinnitus severity by the amount of stress that people who encounter it experience – tinnitus generally falls into the basic categories of bothersome and non-bothersome. For the bothersome type, there are several remedies with an evidence basis, including various audiological interventions that incorporate psychoeducational counseling (Chan, 2009).

Additionally, Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR) protocols have all been shown to alleviate tinnitus-related distress to varying degrees (Gans, Cole, & Greenberg, 2015; Hesser, Westin, Hayes, & Andersson, 2009). Yet once all of these have been attempted, and the person experiencing the tinnitus and hyperacusis is still not well, current available interventions have little else to offer. Having founded a support group in Palo Alto that is part of a national network and witnessing the pain and despair tinnitus can cause firsthand, I can personally attest to the widespread need for more effective treatments and interventions.

 “Sorry, but I can’t lower the music volume because the other customers want it turned up loud.”

The challenges I face with tinnitus and hyperacusis have impacted every area of my life. While providing me with a sense of mission to contribute to research and advocacy for individuals with my condition and other invisible disabilities, the path to get there has been thoroughly demanding and challenging. Simple things like riding on public transportation, food shopping, and being in noisy restaurants are all potentially painful situations for me. Urban environments are also dangerous, considering the regularity of emergency vehicle sirens, construction, car horns, loud motorcycles, and other frequent noise. At a more personal level, I have even had to tell people that their voice or laugh is too loud, and ask if they can speak more quietly when I am nearby. Frequently, my conditions become exacerbated if I do not have an opportunity to advocate for myself and explain to people the unusual nature of my sound sensitivity so that it may be accommodated.

“If the class gets too loud for you, you can just leave.”

While I am grateful to be engaged in a course of study that I am passionate about, it is a constant challenge to maintain an effective balance between self-care and productivity. Graduate level training in psychology is thoroughly demanding of a person’s physical and emotional resources, particularly considering clinical placements that may require long commutes on top of endless hours of coursework and research requirements. My condition results in frequent exhaustion and difficulty sleeping, with the symptoms often intensified resulting from stress and demands of graduate school. Excessive fatigue is common when someone experiences a disability (Olkin, 1999); by sheer requirement of rest alone, it takes more time to get the same amount of things done. In my case, many aspects of my training are limited and guided by my condition, starting from choosing a school that has parking access and adequate disability resources. Other aspects of the process are restrictive for me too, as clinical training placements involving families with small children and milieu settings with youth are frequently quite loud and therefore not compatible with my illness. Even socializing can be a challenge, as my condition is worsened from time spent in large groups of people in which many conversations are happening. I must rely on my professors, supervisors, and peers to understand and help when I need accommodations for my disability, and even when I must leave a potentially harmful situation for me.

“Oh come on, this can’t be too loud, we’re just having fun.”

Explaining this is frequently difficult. When it’s people’s lifetime experience that being in social situations is a good thing, and they display the best of intentions by wanting me to be there. It can be very hard to articulate how challenged I am by being in the places where people gather such as restaurants, parties, and bars. As such, I am left out of much social activity that I used to partake in and that used to be a resource for me – having a disability requires constant re-adaptation to life, and often in isolation from others.

Diversity factors among graduate students include all the varied forms in which disability manifests. While mobility issues obviously must be accounted for, greater awareness of other types of disabilities, including less visible, chronic disabilities such as endometriosis, Crohn’s disease, irritable bowel syndrome, brain injury, fibromyalgia, and other common conditions such as tinnitus and hyperacusis still require greater awareness among the general public. In this time when diversity is becoming an ever more present dimension of clinical proficiency, it is essential that training programs incorporate greater awareness of the potential impact of disability on people’s lives.

“Well, at least you don’t have a real disability.”

Despite the challenges my disability has put me through, it has been my experience that people truly want to help – even when they aren’t sure how. Yet sadly, often it is the case that when things become too challenging to attend to, it is a culturally consistent reaction to tend to look away. Many of the needs of people who experience limitations due to their disability may be solved by a very simple method – don’t be afraid to ask what it’s like for them, and how you may be able to help. Even just being recognized for dealing with the challenge of an invisible disability can be a huge relief.

About the Author:

Ben Greenberg is a fourth-year doctoral clinical psychology student at the American School of Professional Psychology at Argosy University, San Francisco. A former professional symphony French horn player, he played in the Colorado Symphony Orchestra, Jerusalem Symphony, Hong Kong Philharmonic, and Cairo Opera Orchestra before leaving his career due to debilitating tinnitus and hyperacusis. He is currently a grant recipient of the American Tinnitus Association for his research in the impact of sound sensitivity in tinnitus, and lives in Oakland, CA.

 

References:

Blasing, L., Goebel, G., Flotzinger, U., Berthold, A., & Kroner-Herwig, B. (2010). Hypersensitivity to sound in tinnitus patients: An analysis of a construct based on questionnaire and audiological data. International Journal of Audiology, 49(7), 518-526. doi: 10.3109/14992021003724996

Chan, Y. (2009). Tinnitus: Etiology, classification, characteristics, and treatment. Discovery Medicine, 8(42), 133-136. Retrieved from: http://www.discoverymedicine.com/Yvonne-Chan

Gans, J., Cole, M., & Greenberg, B. (2015). Sustained Benefit of Mindfulness-Based Tinnitus Stress Reduction (MBTSR) in Adults with Chronic Tinnitus: a Pilot Study. Mindfulness. doi: 10.1007/s12671-015-0403-x

Hesser, H., Westin, V., Hayes, S. C., & Andersson, G. (2009). Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behavior Research and Therapy, 47(6), 523-528. doi: 10.1016/j.brat.2009.02.002

Olkin, R. (1999). What psychotherapists should know about disability. New York: Guilford Press.

Thoughts on the EPPP Step 2

By Christine Jehu, Ph.D., APAGS Chair

You may have heard that the Association of State and Provincial Psychology Boards (ASPPB) is currently developing a second examination (EPPP Step 2) for psychology licensure to assess clinical competency. This exam would follow the Examination for Professional Practice in Psychology (EPPP). Continue reading

Charity Lane

Living at the Intersection: Reflections on the Graduate Student Experience

Charity LaneGuest columnist: Charity R. Lane, Regent University, Class of 2016

My identity as a Christian woman not only holds deep meaning for my life but also directs its course, which has been the reason for this adventure called “graduate school.” The challenge I’ve faced consistently is the decision of priority – what is most important to me? As I navigate my journey it’s extremely easy to get caught up in the current of what those around me do. After all, “going with the flow” does not take too much effort or even conscious decision. However, I realized quickly that the demands of grad school could sweep me up in a way that would rush me by the people and needs of the world around me.

Yet, at the same time, those people and needs can be so overwhelming that I lose the ability to faithfully keep in the “stream” of this journey. It’s at the point of this tension that I’m reminded of the question so persistently knocking in my subconscious – “who are you trying to please?” Not just knowing my identity, but resting in it, allows my life to naturally be aligned with who I know myself to be. From this central anchor for my life, I’m able to face the challenges of priority without shame or guilt and without losing focus – even when those priorities look different from those around me. For example, in the midst of my graduate journey, I made the decision to take an extra year in completing my program in order to focus on areas of my life that held particular meaning for myself as a Christian and a woman. I’ve begun to realize that my life as a Christian woman who is also a psychologist will be different from others. Identifying as a Christian pulls me from the current and sets me down in the present while identifying as a woman keeps me focused on the relationships in my life that are of utmost importance. It is from this secure resting place of knowing my identity that I find the most joy and fulfillment.

A significant learning moment for me came when I was just beginning to think about pursuing my doctorate. My dad, a primary point of support as I’ve navigated intersecting identities, encouraged me to never allow my studies to take away from the genuine desire I have to connect with the hearts of those around me. It was quickly apparent to me that I could grow such an academic perspective on the world that I would lose the purity of relationship with a human on a heart level. Henry David Thoreau stated, “It is an interesting question how far men would retain their relative rank if they were divested of their clothes,” which humorously reminds me that “under the degree” I’m still an embodied soul that desires connection. That is why a secure foundation in my identity as a Christian and a woman will allow me to be consistent wherever I am – inside or outside of academia.

This column is part of a monthly series highlighting the experiences of students and professionals with diverse intersecting identities and is sponsored by the APAGS Committee on Sexual Orientation and Gender Diversity and the Committee for the Advancement of Racial and Ethnic Diversity. Are you interested in sharing about your own navigation of intersecting identities in graduate school? We would be happy to hear from you! To learn more, please contact the chair of APAGS-CSOGD (Julia Benjamin) or CARED (James Garcia).

Text

Did you get my text? Processing biases over iMessage

The following dialogue occurred subsequent to last fall’s gradPSYCH blog post, “The Gift of They where an emerging psychologist embraced referring to his client using the plural pronoun of “they.”  

Leighna Harrison is the current Member-at-Large, Diversity Focus. James Garcia is the Chair for the APAGS Committee for the Advancement of Racial and Ethnic Diversity (CARED).  Here is Leighna’s iMessage screenshot:

jamesleighna

Following this conversation, Leighna and James asked APAGS to post their conversation and these reflections:

From Leighna:  James and I text pretty regularly, day and night, across time zones, about anything and everything – school, work, APAGS, current events, reality TV, family, friends, romance, the list goes on. Our relationship is honest, respectful and very open. He is a colleague and a friend. When I first read The Gift of They, I knew that I was missing the point, but I didn’t know what it was. As a woman of color, who thinks a lot about questions of power and privilege, I thought whatever I was missing probably had to do with blind spots I have owing to my privilege as a cisgender individual. I decided to message James for a ‘reality check’ so to speak, in order to figure out what I was missing…

From James: My relationship with Leighna is one where we both feel respected as people with intersecting identities. We are regularly “there” for each other whenever we want to process experiences and situations where we have questions or witness inequities related to different social identities (e.g., race/ethnicity, sexual orientation, economic status, gender diversity among others). Our relationship has evolved into a mutual and solid base, where we feel comfortable to explore issues we may not be familiar with.

Now, back to you, dear reader:

  • What are your thoughts on having honest reflections like these?
  • Do you have a peer or trusted supervisor or mentor with whom you can reflect with?
  • Have you attempted to have these conversations with peers in your graduate program? If so, what was the outcome?

If you find you don’t have peers to have these discussions with, there are student groups you can join. One organization, Grad Students Talk, organizes periodic conference calls to discuss difficult topics in a safe space. If you know of other such student groups, please leave their info in the comments section.

Students, Join Division 31 for FREE!

Did you know that Division 31, the State, Provincial & Territorial Affairs division of APA, provides FREE membership to students?  Along with appreciating anything with the ‘FREE’ moniker, there are several reasons why students, especially those interested in advocating for their profession, might join Division 31:

  1. Receive information about new initiatives affecting our profession (Psypact, ASPPB specialization, laws for Applied Behavioral Analysis, APA-PO, etc.)
  2. Serve on a student taskforce to address these issues  
  3. Be a part of conversations about how your SPTA can help with student debt, securing accredited internships, and more
  4. Network with professionals already in practice through listserves and at conferences
  5. Get a jump start on a career in private practice by gaining exposure to business of practice, licensure laws, reimbursement rates, and other issues

Get more information about  Division 31 and  check out their Student Taskforce blog.