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Articles: 

New psychological research highlights 

factors fueling gun violence epidemic

By Ronald F. Levant, Ed.D., Ryon C. McDermott, Ph.D.,

Nicole L. Johnson, Ph.D., and Nick Borgogna, Ph.D.

Considerations for telesupervision in mental health clinical training

By Jonathan G. Perle, Ph.D.

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New psychological research highlights 

factors fueling gun violence epidemic

By Ronald F. Levant, Ed.D., Ryon C. McDermott, Ph.D.,

Nicole L. Johnson, Ph.D., and Nick Borgogna, Ph.D.

     The United States stands out among the leading democracies in the world in having an intractable problem with gun violence. Last year, there were 656 mass shootings, almost two a day, according to the Gun Violence Archive. As the shooting at the Kansas City Super Bowl celebration proved, no place is safe anymore. Not schools, malls, places of worship, grocery stores, or our streets. 

     Boys and men commit more than 90 percent of gun violence crimes, yet most boys and men are not violent. An unpacking of this incongruence requires an analysis of the role of masculinity. A recent study found that males who either did not live up to their standards for being masculine or whose masculinity was threatened were more likely to be violent, and this was found across several social science disciplines: psychology, sociology, anthropology, and criminology. Further, accounts of actual shooters were found to be associated with this sense of threatened masculinity. 

     In addition, the gun maker Remington settled a lawsuit with parents and survivors of the Sandy Hook massacre for $73 Million based on the marketing campaign titled “Your Man Card Reissued,” directed toward boys and men who felt that their masculinity was threatened. Finally, this study suggested that comfort and familiarity with guns may also play a role in fostering gun violence, an influence termed “acquired capability.”  

     Other research examined the relationship between gun ownership and preferences for engaging in stereotypical masculine behaviors by both men and women, finding that individuals were likely to own firearms if they were White, conservative, and (regardless of their gender) preferred to behave in stereotypically masculine ways. The investigators then randomly assigned men and women to three conditions where they received fake feedback on a personality test of three types: 1. Their personality was not very masculine (masculinity threat); 2. They were very masculine (masculinity boost); and 3. They were of average masculinity. All participants were then asked to

indicate their willingness to purchase a firearm. They found that men

(not women) who were exposed to the masculinity threat condition were

uniquely compelled to buy a gun of any type. Masculinity threats

did not influence women, and there was no effect of boosting anyone's

masculinity.

     A somewhat surprising factor is the connection between school

shootings and violence against women. A recent study found that 70%

of school shooters perpetrated acts of violence against women, including

intimate partner violence and sexual assault. School shooters endorsed such

traditional masculine norms as toughness, anti-femininity, and pursuit of

status. Still, many also felt that they had failed to live up to these norms or that their masculinity was threatened. Finally, school shooters tended to normalize violence by, for example, ignoring everyday acts of violence, again flagging an “acquired capability” element.

    For the approximately 20 million boys in the US between the ages of 10-18, exposure to dominant masculine gender norms and related pressures pervades many aspects of life. It can be limiting and harmful, including potentiating gun violence. What can be done? We can use these results to reduce boys’ expectations that they must conform to traditional masculine norms, including the acceptance of violence as a fact of life. Such resources are available to help boys, such as The Masculinity Workbook for Teens, by Christopher S. Reigeluth.

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Ronald F. Levant, Ed.D., is noted for his leading role in creating the field of the psychology of men and masculinities. He is a former president of the American Psychological Association. He may be reached by email at levant @uakron.edu.

    Ryon C. McDermott, Ph. D., is the past president of the Society for the Psychological Study of Men and Masculinities, a division of the American Psychological Association.

    Nicole L. Johnson, Ph.D., is an Associate Professor of Counseling Psychology at Lehigh University, the coordinator of The Resistance Lab, and a licensed psychologist.

    Nicholas C. Borgogna Ph.D., is an assistant professor of psychological science at Texas Tech University and licensed clinical psychologist. He specializes in clinical intervention science.

Considerations for telesupervision

in clinical training

By Jonathan G. Perle, Ph.D.

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     Clinical supervision of master and doctoral-level mental healthcare trainees has long been cited as a meaningful component of a student’s education, fostering competency in the multiple areas of clinical practice.

    Such competency is not only an ethical mandate for safe and evidence-informed care but also a licensure requirement. Processes allow a supervisor to identify a trainee's strengths and areas of improvement, promote self-reflection of the trainee’s abilities and practices, and assist in the trainee’s professional development. Although historically predominantly completed face-to-face (F2F), the rapid expansion of coronavirus 2019 (COVID-19) prompted an unexpected and rapid shift to distant training methods. As a result, telesupervision exploded in popularity, becoming a norm for trainee education. 

    Telesupervision provides individual or group distant supervision of face-to-face (F2F) or telehealth-based clinical services through telecommunication technologies (e.g., video, telephone, email, electronic health record). Research has highlighted that telesupervision often yields comparable rates of supervision satisfaction for both telesupervisors and trainees compared to F2F methods. More importantly, if proper adjustments are made, use has been demonstrated not to positively affect either the working alliance or supervision quality. 

    Although a viable option to encourage an ethical supervisory practice that aligns with the American Psychological Association’s guidelines (i.e., APA Guidelines for Clinical Supervision in Health Service Psychology, 2014), prospective telesupervisors should not only ensure competence with the new modalities but consider both the benefits and challenges associated with the use of telesupervision when compared to the more traditional F2F methods. 

    Although additional study is required to understand the many differences between F2F practices, telesupervision has been suggested as having multiple benefits compared to traditional methods. Perhaps the most crucial benefit is the ability to provide increased access to timely and evidence-informed feedback through the increased availability of specialized supervisors who may otherwise be unavailable to the trainee (e.g., not in the area, state, or country). The ability to connect telesupervisors and trainees also allows for reduced financial and time-related costs associated with travel, allows for greater scheduling flexibility (e.g., supervisor is unavailable when trainee is on-site), and fosters increased diversity of supervisory experiences through access to different providers. 

    Additionally, some have suggested reduced hierarchical effects that may occur in traditional F2F practices, leading trainees to be more comfortable and forthcoming with their thoughts and feelings when the supervisor is not in the same room. 

    Finally, if a trainee utilizes telehealth, it allows them to practice using the new technologies in a controlled and safe environment with guided expert feedback to optimize future telehealth services.

    Despite the numerous identified benefits, several challenges have also

been documented that warrant consideration for any prospective

telesupervisor. Common challenges can be broadly grouped into three

categories: technological challenges, supervisory process challenges,

and research-related challenges. 

     Regarding technology, internet connectivity issues can create lag or

disconnects for either party. Compounding this are the possible

program-related “down times” and updates leading to problems for 

computer programs such as electronic health records.

“Dead zones” can also create technological challenges, especially

for those using the internet or telephone in more remote locations (e.g., rural areas), limiting appropriate and continuous interactions. General compatibility issues can further prompt problems for those attempting to share materials across different operating systems and program versions. 

    Supplementing technology considerations, the supervision processes themselves require additional planning. For example, at the onset of the supervisory relationship, the telesupervisor should evaluate the trainee’s comfort and familiarity with the technology to ensure proper “fit.” As technology fosters a greater propensity toward distraction, the telesupervisor should establish methods of addressing a non-participatory trainee (especially in a group telesupervision format) as a preventive measure. To plan for technological issues, a “Plan B” (e.g., using the telephone) should be created for situations in which the primary telesupervision method (e.g., video) becomes unviable. 

    As patient care can be unpredictable, the telesupervisor and trainee should collaborate to create a safety plan for what the trainee should do if a crisis arises and the telesupervisor is unavailable. Similarly, the telesupervisor should clarify appropriate and inappropriate means of communication for routine challenges and emergencies (e.g., some telesupervisors may approve of text messaging, while others do not; only video or telephone should be used in emergencies). To ensure the telesupervisor has adequate records to review and receive such records via a HIPAA-compliant method, the telesupervisor should explain what materials should be sent and how (i.e., encrypted file-sharing methods). 

    Lastly, the telesupervisor should indicate appropriate and inappropriate settings for the telesupervision. This last point not only helps ensure a private and confidential workspace but also encourages professionalism due to a higher probability of what some have referred to as the disinhibition effect, leading to more relaxed communication styles and standards during the telesupervision (e.g., higher chances of inappropriate disclosure, higher chance of engaging in non-supervisory activities during the telesupervision). 

    Finally, the current state of the telesupervision literature can be viewed as a challenge to providing evidence-informed telesupervision. More specifically, although available works have broadly showcased positive outcomes for telesupervisory practices, large-scale evaluations clarifying optimal telesupervisor characteristics and potential differences between modalities (e.g., video vs telephone vs email) are still required. 

    Supervisors must evolve to meet the growing demand as technology continues to become more and more integrated into healthcare education. As such, prospective telesupervisors should seek competency in general supervision models and methods of adapting F2F supervision strategies for the new technological medium. Simply put, being an excellent F2F supervisor knowledgeable of clinical matters and good at technology does not necessarily prepare one for the many novel “what ifs” that can arise in a telesupervisory relationship.

National Psychologist CE Quiz

Jonathan G. Perle, Ph.D., ABPP, is a licensed clinical child and adolescent psychologist, associate professor of clinical psychology, and Director of Telepsychology at West Virginia University School of Medicine. He has significant experience providing clinical assessment and intervention services within diverse clinical settings and roles, and he has developed a specialization in the practice and teaching of telehealth modalities. His research interests include childhood ADHD, childhood disruptive behavior, and telehealth.

His email address is jonathan.perle@hsc.wvu.edu.

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