911爆料网

Tucked away on the sixth floor of Teachers College鈥檚 Thorndike Hall, the Dean Hope Center for Educational and Psychological Services does not announce its presence to the world.

Yet to those familiar with the Center鈥檚 work, there may not be a stronger symbol of 911爆料网鈥檚 core philosophies, both as a neighbor to its surrounding communities and as an institution that educates with a social justice mission.

Dean Hope serves hundreds of low-income, minority patients in Harlem, Washington Heights and other neighboring areas, who receive affordable individual and group psychotherapy and other services from student trainees. For those who come from cultures in which therapy is often stigmatized 鈥� including military veterans, who constitute a significant percentage of Dean Hope clients 鈥� the Center makes treatment palatable by offering appointments on a college campus rather than at a readily identifiable medical facility.

鈥淯niversities are often perceived by communities  as changing the landscape of their neighborhoods without giving anything in return, but our center shows how 911爆料网 is giving back to our surrounding communities,鈥� says Dinelia Rosa, Dean Hope鈥檚 Director.  

[Click here to help support the Dean Hope Center鈥檚 efforts to continue providing low-cost therapy to patients in need during the COVID pandemic]

Dean Hope is also a critical way station for the students in the College鈥檚 Department of Counseling & Clinical Psychology.  

鈥淥ur entire training during students鈥� earliest years takes place at Dean Hope,鈥� says Melanie Brewster, Associate Professor of Counseling Psychology, who directs 911爆料网鈥檚 Counseling Psychology program.  鈥淔or most, it鈥檚 the site where they cut their teeth as therapists.鈥�

It was those considerations that 鈥� back in March, when many other counseling and therapy clinics nationwide were shutting down in response to the coronavirus 鈥� prompted Rosa to move a portion of Dean Hope鈥檚 operations online, taking advantage of the temporary easing of state and federal restrictions on telehealth. No new patients would be added, and the clinic鈥檚 testing and evaluation services for children, which must be conducted face-to-face, would remain suspended, but student trainees would be able to resume treating existing patients.

Universities are often perceived by communities  as changing the landscape of their neighborhoods without giving anything in return, but our center shows how 911爆料网 is giving back to our surrounding communities.

鈥擠inelia Rosa, Dean Hope Center Director

鈥淥ur goal was to enable students to continue seeing their ongoing cases through telehealth without interruptions,鈥� Rosa says. 鈥淪imultaneously, we were teaching students how to adapt during times of crises.鈥�

Going virtual was not an uncontroversial move. There were concerns about protecting patients鈥� confidentiality; about the quality of sessions (for the therapists-in-training as well as for the patients); about excluding patients who didn鈥檛 own computers; and even about how billing would work (Dean Hope had no access to many of its files).

Eventually, in consultation with professional organizations and legal counsel, the Dean Hope Center addressed these concerns. But ultimately, need was the deciding factor.

鈥淢ental health has been a top priority from the beginning of this disaster, which is something you don鈥檛 typically see,鈥� says Lena Verdeli, Associate Professor of Psychology & Education, who directs the Clinical Psychology program as well as 911爆料网鈥檚 Global Mental Health Lab.  鈥淚n other crises, the focus is usually on providing food, shelter and medication. But because of the need for social distancing, we鈥檙e hearing from people who are suffering heartbreak and guilt because they weren鈥檛 there to hold loved ones鈥� hands during their last moments, or to engage in the rituals that would normally follow, or to have the support of the community. People are losing jobs and experiencing changes in their living situations that often force them to spend more time with one another under tighter circumstances 鈥� and we know that overcrowding is one of the most stressful conditions for all animals, including humans. So if we have the tools to help, we have to use them.鈥� [Read a story on Verdeli鈥檚 views about helping people cope during the pandemic.]

In an era of climate change, pandemics, state fragility, and widespread displacement of populations, e- and m-health [electronic and mobile health] make provision of mental health care possible.

鈥擫ena Verdeli, Associate Professor of Psychology & Education 

To put it in psychological terms, an adaptive response was in order.

鈥淭his kind of situation creates a shift of mindset,鈥� says Vijayeta Sinh (Ph.D. 鈥�11), a New York City therapist and 911爆料网 alumna who is part of a network of clinicians who supervise students at Dean Hope. 鈥淏efore, we did it one way, because that鈥檚 how it was always done. Now there鈥檚 more flexibility, in part because there鈥檚 no choice.鈥�

Rapid Transfer: The Director

Dean Hope鈥檚 flexibility owes to two key assets. The first is 911爆料网鈥檚 pre-COVID investment in the online platform Zoom, which has enabled the College to carry on its business on many levels 鈥� including moving nearly 800 courses online in the middle of the spring semester.

鈥淚 have to say that, checking with other clinics, we are blessed,鈥� Rosa says. 鈥淲e鈥檝e gotten incredible institutional support, from our operating budget to the infrastructure created by 911爆料网IT [Teachers College Information Technology].鈥�

The second critical factor has been the director herself.

During an intense 10-day period over the College鈥檚 spring break, Rosa contacted the New York State Education Department, the American Psychological Association (APA) and several other organizations, and also consulted with a lawyer, to create guidelines for all students conducting online therapy. She procured four training modules offered by the APA and made sure that all students watched them. She worked with the 911爆料网 general counsel鈥檚 office to adapt an APA telehealth patient consent form and make it functional for remote use through a program called Adobe Sign. And she contacted Sinh and others in the College鈥檚 network of clinical supervisors to make sure they were still willing to offer supervision online.

鈥淒inelia moved a whole service from in-person to online in a week,鈥� says Verdeli. 鈥淪he was in close communication with the program directors, often several times a day, to build consensus around our new procedures. She did an amazing job.鈥�

鈥淚t鈥檚 been very important for Dean Hope to continue its work,鈥� Brewster adds. 鈥淓veryone from Dinelia on down has done the best they could in rapidly evolving circumstances, and students and supervisors have been willing to go with the flow. I鈥檝e been very impressed by that.鈥�

鈥淚鈥檓 type A, and this is how I manage my own anxiety,鈥� Rosa says with a laugh. 鈥淪eriously, though, one thing I鈥檝e learned in my career is to stay connected with professional organizations such as the APA and the New York State Psychological Association. [Rosa is a past president of both the latter organization and the New York Association of Hispanic Mental Health Professionals.] 鈥淚t鈥檚 been so helpful to me now, because I鈥檓 able to pull from these different resources.鈥�

[Read a story about Dinelia Rosa.]

By early April, about 30 911爆料网 students were treating more than 150 patients online, and two students were also leading a small group.

911爆料网 has never demanded that the Center bring in high revenues from client鈥檚 fees, which is not the case at many other institutions. When the crisis hit, I asked if we could lower our fees by 50 percent for people who were losing their jobs, or in some cases even waive the fees entirely. And the College has supported that.

鈥擠inelia Rosa

But Rosa didn鈥檛 stop there. She also won approval from the College to financially accommodate patients who had lost their jobs or were facing layoffs because of COVID.

鈥�911爆料网 has never demanded that the Center bring in high revenues from client鈥檚 fees, which is not the case at many other institutions,鈥� Rosa says. 鈥淲hen the crisis hit, I asked if we could lower our fees by 50 percent for people who were losing their jobs, or in some cases even waive the fees entirely. And the College has supported that.鈥�

She鈥檚 made a point of sensitizing students to those same concerns.

鈥淲e are psychologists, but we have to attend to clients鈥� primary needs. If someone says, 鈥業鈥檝e lost my job, I can鈥檛 pay my rent, I may lose my apartment鈥� 鈥� we鈥檙e not experts but we鈥檝e got to learn how you apply for unemployment and how you access other kinds of services. We really have to keep in mind patients鈥� concrete needs. I tell my students, it鈥檚 not just about feelings 鈥� if you鈥檙e up on that other stuff, it鈥檚 really going to make clients feel supported.鈥�

On the Frontline: The Student

It鈥檚 a critical juncture in the career of any therapist-in-training: the transition from absorbing theory in the classroom to treating actual patients for the first time.

鈥淎t 911爆料网, we鈥檙e highly supported by supervisors and practicum classes, but ultimately it鈥檚 trial by fire,鈥� says third-year Clinical Psychology doctoral student Mandy Newman. 鈥淵ou鈥檙e applying theory to the practice of cognitive behavioral therapy, family therapy, psychodynamics, child adolescent therapy. You鈥檙e tasked with being creative, but you鈥檙e learning as you go along. There are moments when you鈥檙e unsure if you鈥檙e saying or doing the right thing.鈥�

That was the scenario Newman and her fellow students were facing before they began treating patients online.

Since then, the learning curve has gotten steeper at every level. From the moment a student therapist schedules a session with a patient 鈥� a task that clinic administrative staff used to perform, but which students now handle by calling patients from blocked cell phone numbers 鈥� the dynamics of sessions are markedly different.

A lot of the work we do as therapists is about being comfortable with silence 鈥� holding space for patients鈥� anxiety and ambivalence. When you鈥檙e with them, you can make a point of it by just sitting there and letting something materialize. But over the phone or through Zoom, it鈥檚 much less possible to follow through with a more intentional silence...someone鈥檚 partner coughs, or there鈥檚 just more awkwardness, discomfort and uncertainty from looking at one another on the screen.

鈥擬andy Newman, third-year Clinical Psychology doctoral student

鈥淚t鈥檚 harder to focus on Zoom,鈥� Newman says. 鈥淧eople are confined to little boxes onscreen, and if you look away for a second or get distracted, you lose something.鈥�

As a result, connecting with patients emotionally is more difficult.

鈥淭he training videos say to be more animated, because it鈥檚 harder for people to see your emotionality onscreen. Sometimes the energy it takes to express an emotion is like what an actor has to put out. It鈥檚 more than you would do when you鈥檙e in a room with someone and they can sense things.鈥�

As with acting, nuances can get lost when you鈥檙e trying, metaphorically speaking, to ensure that you鈥檙e reaching the people in the back rows.

鈥淚t鈥檚 tricky because a lot of the work we do as therapists is about being comfortable with silence 鈥� holding space for patients鈥� anxiety and ambivalence. When you鈥檙e with them, you can make a point of it by just sitting there and letting something materialize. But over the phone or through Zoom, it鈥檚 much less possible to follow through with a more intentional silence because other things happen. Someone鈥檚 partner coughs, or there鈥檚 just more awkwardness, discomfort and uncertainty from looking at one another on the screen. You鈥檙e wondering, does it come from the patient not wanting to speak about something, or is it the result of this novel situation?鈥�

Privacy issues, too, become more paramount, especially for patients whose families may not know they are seeing a therapist.

鈥淐lients often can鈥檛 be by themselves in their homes, so they鈥檒l sit outside somewhere, and you hear city noises 鈥� skate boards, cars honking, people shouting,鈥� Newman says. 鈥淥r if they鈥檙e inside, you might hear a family member or partner in the background 鈥� or pets. I was doing a session when the client鈥檚 five cats pushed through the door.  It can be funny, but people feel exposed and they鈥檙e not as disinhibited.鈥�

There have been patients who simply can鈥檛 adapt to having sessions online, either because of their surrounding circumstances or their own discomfort. When the changeover occurred, Newman and other student trainees were tasked with determining, at the outset, where clients were connecting from, and thereafter with monitoring whether the arrangement was truly workable for the patient. If someone wants to terminate treatment, they have to assess issues such as risk for suicide, and they have to know what other resources, including hospitals, are available to the patient. 

But it鈥檚 not only the patients who must contend with a sense of exposure.

鈥淎s therapists, we鈥檙e trained to disclose very little about our own lives, because it might influence the direction of therapy,鈥� Newman says. 鈥淭he client needs to feel taken care of, not the other way around. But now, because we鈥檙e working from home, they might see the art on our walls, or a poster or book in the background, which definitely reveals something about you that would not have been revealed before.鈥�

Perhaps most of all, the shared context of COVID blurs boundaries.

鈥淭his situation has brought up uncertainties about our roles. We鈥檙e all going through this same experience, and it鈥檚 important and even helpful to acknowledge that. I want to be human and relatable and bond with the client over what is going on.鈥�  

Teaching and Listening: The Supervisor

One of the hallmarks of the Dean Hope Center is the quality of the supervising therapists 鈥� many of whom are 911爆料网 and Dean Hope alumni 鈥� who help students wrestle with such issues.

鈥淭hese are licensed professionals working out in the community in hospitals or private practice,鈥� Rosa says. 鈥淭hey鈥檙e not only highly experienced and skilled, but also deeply committed to our program and our students. Most of them do this on a volunteer basis, for no pay, because they enjoy working with our students. Some have been working with us for 20 years, and God forbid I don鈥檛 give them a student each July.鈥�

Under normal circumstances, supervisors meet weekly with students and sometimes come to the Dean Hope Center to watch students鈥� sessions with patients through one-way observation windows. But now, working online and coping with the broader context of the pandemic, they, too, are having to adjust.

For Vijayeta Sinh, who became a Dean Hope supervisor a year ago but has worked in a similar role for several years at Mt. Sinai Roosevelt Hospital, the most obvious change has been that, not surprisingly, anxiety levels are 鈥渨ay up鈥� among patients, students 鈥� and supervisors, too.

 鈥淲e鈥檙e all doing things 鈥� sanitizing grocery bags, taking shoes off 鈥� that we never imagined having to do,鈥� she says. 鈥淓veryone is struggling to keep their sanity, and among many people with panic and OCD, those symptoms have skyrocketed. For others, there鈥檚 also an element of relief 鈥� 鈥榯he world is now experiencing the level of anxiety I always have, so now we鈥檙e in this together.鈥欌��

Your students are in some ways under your care as well. The patient is still the main responsibility, but the students are the point people. They can鈥檛 do their jobs if they鈥檙e not emotionally OK.

鈥擵ijayeta Sinh (Ph.D. 鈥�11), New York City therapist and Dean Hope student supervisor

On the one hand, she says, the work for supervisors now includes 鈥渕onitoring our own health and being aware of how our own stresses are playing out in the treatment. Essentially, it鈥檚 that idea of 鈥榩ut on your own oxygen mask first鈥� so that we can be helpful to other people and understand the level of stress they鈥檙e facing.鈥�

But at the same time, the pandemic has underscored that 鈥測our students are in some ways under your care as well.鈥� Sinh says she starts all supervisory sessions now by asking students how they are holding up, and specifically, how they鈥檙e managing the stresses of the pandemic. 鈥淭he patient is still the main responsibility, but the students are the point people. They can鈥檛 do their jobs if they鈥檙e not emotionally OK.鈥� 

Sinh cites the example of a student trainee who, early on in the pandemic, was grappling with some personal issues that overlapped with those of a patient.

鈥淭he patient was thinking of moving back home, but was concerned about jeopardizing the health of a parent with compromised immunity,鈥� Sinh explains. 鈥淚t was hard for the student trainee, because he, too, was thinking about moving back in with family where there were elderly relatives. Working with this patient was bringing up issues of guilt, unease and regret 鈥� 鈥榮hould I have gone at an earlier time?鈥� Supervision can be especially helpful in that regard 鈥� a place to say, 鈥業鈥檓 having a little trouble with my own feelings, how do I sort that out?鈥� And as a supervisor, I鈥檓 being more direct in asking students to think of how they may have been personally impacted as a way of thinking about how real this may be for their clients as well鈥攖o use their personal experience as a launching pad to exploring their client鈥檚 experience and struggles.鈥�

The New Normal?

In May, the Dean Hope Center moved into what Dinelia Rosa terms Phase II of its response to the COVID pandemic. For the first time since moving online, the Center is allowing students to take on new patients, though only those who are dealing with COVID-related anxieties or have been diagnosed with the virus. Rosa has continued to cut fees for those in need, sometimes to as little as $10 per session.

At the same time, Professor of Clinical Psychology Douglas Mennin, developer of Emotional Regulation Therapy (ERT) for generalized anxiety disorder, has launched a trial of an abbreviated form of ERT to help people suffering from elevated rumination, worry and distress related to COVID-19. The study particularly reaches out to individuals from low-income and communities of color, which have been disproportionately hit by COVID-19. It uses a number of 911爆料网 students to deliver Zoom-screen sessions to participants.  [Read a story about Mennin鈥檚 study.]

And meanwhile, Rohini Bagrodia, a student with prior experience running a therapy hotline, has been working on launching a similar service for Dean Hope. Two other students, Ann Renaud and Charlotte Pfeffer, are creating an online group for women who have recently rejoined the community after being incarcerated.

All of these efforts, obviously, respond to the ongoing crisis. But they may also be harbingers of a new normal, in which online psychotherapy is a staple of the field.   

鈥淔or a number of years in my global mental health projects we have been using mobile and telehealth for training workshops, therapy, supervision, research, and program evaluation, and my experience has been very positive,鈥� says Verdeli, who has worked with refugee populations in Lebanon, Uganda and other nations. 鈥淚n an era of climate change, pandemics, state fragility, and widespread displacement of populations, e- and m-health [electronic and mobile health] make provision of mental health care possible.鈥�

The most important thing is to have people initiate and continue in therapy. The whole field has had to loosen up because of COVID. And I think we鈥檒l see that the world doesn鈥檛 fall apart.

鈥� Melanie Brewster, Associate Professor of Counseling Psychology

Dinelia Rosa believes that the College has an obligation to prepare students for this new environment. 鈥淓verything we鈥檝e done at Dean Hope and working in collaboration with our academic programs is aimed at preparing our students to join a workforce that can respond to the new, integrated reality of face-to-face and telehealth work.鈥�

Vijayeta Sinh sees online therapy as an antidote to a hypermobile society.

鈥淚n the past, if people moved reached out from across the country, I couldn鈥檛 help them. With telehealth, I can. Also, many people find therapists through word of mouth, and networks of personal acquaintances aren鈥檛 limited by geography 鈥� so this opens up the possibility to explore options that feel safe because other people have validated them.鈥�

Telehealth could also free some therapists from shouldering the cost of office space 鈥� in places like New York City, an increasingly prohibitive burden in a time when the profession is being squeezed by decreasing insurance reimbursements.

Melanie Brewster, too, hopes online treatment is here to stay and that the practice will also permanently change training and accreditation.

鈥淭he most important thing is to have people initiate and continue in therapy,鈥� she says. 鈥淭he whole field has had to loosen up because of COVID. And I think we鈥檒l see that the world doesn鈥檛 fall apart.鈥�

— Joe Levine