Rory Fleming Richardson, Ph.D., ABMP, TEP

Clincial Medical Psychologist & Neuropsychologist

 

Telepsychology Consultation Services

If you are interested in scheduling a consultation, please contact me at [email protected] for details.


World at Risk of a Pandemic


The Sociometric Science of Disease:

The Ultimate Who Shall Survive in Sociometric Epidemiology

Rory Fleming Richardson, Ph.D., ABMP, TEP


In 1934, Jacob L. Moreno, M.D. published his ground-breaking book Who Shall Survive?: Foundations of Sociometry, Group Psychotherapy, and Sociodrama. Dr. Moreno was a contemporary of Freud, Adler and Jung pioneering the study of social dynamics and the therapeutic power of “live and therapy in action.” Today, we have a challenge that few are prepared for. We are an extremely mobile civilization with interaction with others and environments that others contact. If one person touches the handle to enter a store, how many other people touch that handle? If you count the number of people one person is within two feet of in a 24 hour period, how many would that be? One of the saving graces of most infections is that there is a short incubation period. This means that within a short period a person would know that they are ill and be able to limit exposing others. For those who design biological weapons, long, asymptomatic incubation periods are best to insure the spread of an infection. The longer the time that the incubation period is, the more individuals can spread it and the less prepared communities and countries are in limiting the spread. If we use the science of sociometry with the science of epidemiology, we start to understand the scope and the obstacles to prevention of epidemic and pandemic concerns. I find it interesting that Dr. Moreno entitled his book Who Shall Survive? in 1934 when the application in today’s world is so profound.


Let us examine how sociometric epidemiology works. A person goes to a major airport to catch a flight on a business trip. Besides those within the breathing distance of that person, there are key places of infection. In sociometry, a sociometric star is one who is chosen most by others. If we expand this to things where pathogens can be exchanged, we start to see the risk. The infected person enters the airport, goes to the ticket counter, has a coffee, sits in the waiting area, and goes to the restroom. The sociometric stars would be the hands on the doors in the airport, the money given to the coffee shop, the counter where he/she picked up the coffee, the creme and sugar counter, the chair in the waiting room, and the handle on the restroom (both in and out). How many individuals would touch the same areas without washing their hands before they touch their face? If the infected person is asymptomatic, there are hundreds infected even before you count the individuals in close proximity or on the plane. Depending on the pathogen and the incubation period, it becomes very easy to understand the potential of a pandemic and the tendency of the public to underestimate risk.


Depending on the pathogen and transmission, there are other sociometric stars. As anyone who has knowledge of air exchange systems knows, specific filtering is needed for various pathogens. Unfortunately, not all commercial entities invest and maintain the best equipment. If we were to diagram pathogen droplet flow and concentrations, there are locations which are at higher risk. Also, money changing comes another location for sociometric stars. The cash registers may become petri dishes. There are some high contamination towns that are likely to suspend use of paper money and coinage. It would be an error in thinking to believe that in a world where nanotechnological medicine and pathogens (Cui, 2014) exist accidental or intentional use of both may not result in mutations which do not operate on the level of a standard infection. Making assumptions about the viability of a pathogen without monitoring a significantly extended time period could easily result in placing additional individuals at risk. In addition, standard laboratory testing may inadvertently show false negatives. Although this is quickly brought to like, potential carriers of an infection can be release back into circulation.


In itself, the natural evolution and mutation of pathogens represent a diverse profile which is more than challenging for healthcare providers. When combined with current technology, development of pathogens useful in biochemical warfare poses a profound challenge. Although there are some providers who have training in treating biochemically infected patients, most have very little training or orientation. During the last two decades, efforts were taken to train at least one individual in each hospital in the use of hazmat protocols.


The history of biological weapons can be traced back to 1155 Tortona, Italy when Emperor Barbarossa poisoned well water with human bodies. During the first and second World Wars, the use of biological weapons grew. In 1969, the United Nations’ disarmament forum discussed the concerns about biochemical warfare. One of the problems with weaponized biological pathogens is that, unlike troops, they are not aware of or recognize country borders. On April 10, 1972, Biological Weapons Convention (BWC) created a legally binding treaty that outlaws biological arms (Frischnecht, 2003). As of August of 2019, 183 countries have agreed to the BWC. Through the various conventions, the one caveat to the agreement is that biological agents can be collect (stockpiled) for "prophylactic, protective or other peaceful purposes." Over the same period of time, the development and blending of various other sciences occurred. We developed a better understanding of nanotechnology, ways of utilizing nanotechnology in medicine, and engineer ethnically targeted pathogens based on DNA. Most individuals thing of this level of technological development as science fiction, but the knowledge base of these technologies is significant and growing.


Regardless of agreements and protective protocols, accidents can occur resulting in threats to human and animal life. One of the unfortunate reality is that it is easier to develop a pathogen that to develop a cure. Regardless of the intent or development of a pathogen, it can result in a pandemic.


More complicated pathogens can impact type of contagion (i.e., airborne, tactile, droplets, fluid exchange, etc.), its life span, and other factors making prevention and control a nightmare. These variables alter the sociometric epidemiologic dynamics. It is essential that the sociometry of the individuals, the pathogens, and the environment be fully considered in the prevention and control of disease.


The next element of sociometric epidemiology is examining the sociodynamic factors which support or negate containment. In olden times when the best modes of transportation were on foot, in carts, or on ships, spread of a contagion was limited because of the amount of time which it took people to get outside a catchment area. Also, communication was limited by the same constraints. If a pathogen showed symptoms within a week, the contagion could be isolated. This is what resulted in “plague ships” which were held off coast rather than being allowed to land. Today, people from Southeast Asia can be in the USA within 32 hours via air travel. Depending on the speed of response, many contagions can be limited.


What are the sociodynamic factors which impact this? It is an issue of controlling the information. If a government does not want to instill a panic, information may be controlled minimizing the risk so that countermeasures can be put in place to limit those who could move outside the catchment area. The trade-off is that this delays appropriate response by healthcare professions. Another factor is the impact on economics. If a contagion is identified, it will impact the movement of consumers and products to the point of halting commerce. Rather than a motivation which may be based on common good, the motivation is more likely because of greed, profiteering, or fear of unwanted consequences. The trade-off is that the very consumers who would purchase items are likely to become infected and, in the long term, be removed from the equation. Epidemiologically speaking, the best action would be to isolate the individuals who are connected to the sociometric stars. Sanitizing sociometric star locations while not isolating the individuals connected to those areas is just likely to reinfect the areas and spread the disease.


It is very easy to see how the expanded, sociometric approach to epidemiology can introduce more complex factors which are at play in the spread of disease. As we move towards faster mobility and the incubation period for infections are counted in days and weeks rather than hours, our ability to enhance our understanding of these factors becomes even more important.


If one is dealing with a highly contagious, mutating pathogen, it is better to look at the pathogen itself as the infected carrier. By doing this, the matrix of risk is inclusive of the places, things and people that the pathogen contacts. If one only looks at active cases (human), it is like the turtle trying to catch up with a hare. The result is an ever increasing pandemic. Preventative epidemiology using this sociometric matrix of the pathogen will shut down daily functions quickly and have far reaching economic impact, but it is the one sane action to minimize loss of human life. In the long run, normal life and societal function will return sooner.


REFERENCES

Cui, Z. (2014). Interdisciplinary Research of Virology and Nanobiology. Austin Virol and Retrovirology. 2014;1(1): 2.

Frischknecht F. (2003). The history of biological warfare. Human experimentation, modern nightmares and lone madmen in the twentieth century. EMBO reports, 4 Spec No(Suppl 1), S47–S52. https://doi.org/10.1038/sj.embor.embor849

Moreno, J. L. (1953). Who shall survive?: Foundations of sociometry, group psychotherapy and sociodrama. Beacon, N.Y: Beacon House.

AUTHOR:

Dr. Rory Fleming Richardson is a Board-Certified Medical Psychologist and a Board-Certified Trainer/Educator/Practitioner of Psychodrama, Group Psychotherapy and Sociometry. He is a Licensed Psychologist in Oregon and Missouri, USA, and is HCPC Registered as a Clinical, Counseling and Health Psychologist in the United Kingdom. In addition to various post-doctoral training programs, he holds a Ph.D. in Biopsychology and Clinical Psychology. In 1973 through 1975, he completed a training program at the Moreno Institute under J.L. Moreno, M.D. and Zerka Moreno during which time he completed his training in Psychodrama, Group Psychotherapy and Sociometry. 

To arrange for a consultation or appointment, send information to either:

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Fee for consultation services is $250 per hour (via phone, video-conference or face-to-face)


The Complicated History of Medical Psychology Over 170 Years

Rory Fleming Richardson, Ph.D., ABMP, TEP


For 5000 years, humans have contemplated the mind and the body repeatedly discovering the interconnections and inter-impact each has on the other. The most completed extended history of Medical Psychology was documented by Gregory Zilboorg, M.D. in 1941 in his book, A History of Medical Psychology (Zilboorg G, 1941). Since then, the path that the field has traveled has added new dynamics and struggles. As the lines have been drawn separating out the domains of mind, body and spirit, the definition of “turf” has emerged again and again. Periodically, the lines between the domains have disappeared because of the intimate connection between all three. During these periods, experts from each domain have sought to unite these into a biopsychosocialspiritual approach. Unfortunately, these attempts have frequently met with opposition from some professionals afraid that their position or expertise will be threatened.


RECENT HISTORY OF MEDICAL PSYCHOLOGY

Medical psychology is not new. In1845, Baron Ernst Von Feuchtersleben, M.D. published The Principles of Medical Psychology (Von Feuchtersleben, 1847). Baron Ernst Von Feuchtersleben, M.D. has been called the “forgotten psychiatrist” because his contribution was essentially ignored in the later explosion of Sigmund Freud’s work on psychoanalysis. Dr. Von Feuchtersleben work on the integration of psychological and medical sciences was profound, but the sexually oriented works of Freud garnered significantly more notoriety. His work provided an integrated approach to the interconnectedness of medicine and psychology outlining detailed discussion (Burns, 1945).

If we look at the use of the term “medical psychology,” we have to look to the first edition of the British Journal of Medical Psychology which was published in 1921.

During the 1950s, the Council on Medical Education and Hospitals of the American Medical Association revised the essential standards for medical school to include human behavior as an basic science. That same year, the first school of Medical Psychology in the United States was established at University of Oregon Medical School (later renamed Oregon Health Sciences University) in Portland, Oregon with the focus to train psychologists in this specialty (Straus, 1959). David W. E. Baird, M.D., George Saslow, M.D., Ph.D., and Joseph D. Matarazzo, Ph.D. were the key figures whose work is responsible for the development of the Medical Psychology department at the University of Oregon Medical School. While working as an instructor at Washington University School of Medicine in St. Louis in 1951 and 1952, Dr. Matarazzo enrolled as a student in the medical school and completed 29 credit hours (Matarazzo, 1994).


In 1957, David W.E. Baird, M.D., Dean of the Medical School in Portland, established the first full-time school of psychiatry and the department of psychiatry’s division of medical psychology. He appointed Dr. George Saslow as the head of the psychiatry department and Dr. Matarazzo as professor and chairperson of the Department of Medical Psychology. Over the years, Dr. Matarazzo and other attempted to resolve the conflicts between psychiatry and medical psychology, but from his own account, this was not achieved. In the 1990s, the Medical Psychology program was focused at preparing psychologists for careers in health-biopsychology research. The program provided more clinical neuropsychological examinations which it became known for in Oregon (Matarazzo, 1994).


In 1981, the American Psychological Association established a task force which focused on the role of the psychologist in concluded that physical interventions were within the scope of psychologist. Hawaiian Senator Daniel Inouye suggested psychologists developing prescriptive privilege. In 1989, Congress funded a pilot project to train psychologists in prescribing in the Department of Defense. In 1992, Samuel Feldman, Ph.D. established the training program, Prescribing Psychologists Register, which provided mid-career training workshops to psychologists who wished to develop skills toward prescription privilege. The workshops collectively totaled 450 classroom hours and required completion of a written examination at the end of each weekend workshop. The workshops were designed to provide the course standards which were developed by the American Psychological Association over the next ten years. Strong political opposition and propoganda was present from the psychiatric community during these years attempting to demean these trainings which were provided by psychiatrists, physicians, pharmacologists, and experienced psychologists. As these psychologists completed the training, physician supervised perceptorships and the first written national examination at UCLA, other training options developed. It was because of the efforts of Dr. Feldman and others that prescription privilege laws were passed in New Mexico.


As the American Psychological Association standards developed, more training options developed which consisted of Masters programs in psychopharmacology(basic science, anatomy and physiology, biochemistry, neurosciences, neuroanatomy, neurophysiology, neurochemistry, physical assessment, laboratory and radiological assessment, medical terminology and documentation, clinical medicine and pathophysiology, pathophysiology with particular emphasis on cardiac, renal, hepatic, neurologic, gastrointestinal, hematologic, dermatologic, and endocrine systems, clinical medicine, with particular emphasis on signs, symptoms, and treatment of disease states with behavioral, cognitive, and emotional manifestations or co-morbidities, differential diagnosis, clinical correlations—the illustration of the content of this domain through case study, substance-related and co-occurring disorders chronic pain management, clinical and research pharmacology and psychopharmacology, pharmacology clinical pharmacology pharmacogenetics, psychopharmacology, developmental psychopharmacology, issues of diversity in pharmacological practice, clinical pharmacotherapeutics, combined, psychotherapy/pharmacotherapy interactions, computer-based aids to practice, pharmacoepidemiology, research methodology and design of psychopharmacological research, interpretation and evaluation of research, FDA drug development and other regulatory processes, professional, ethical, and legal issues, application of existing law, standards, and guidelines to pharmacological practice, relationships with pharmaceutical industry, conflict of interest, evaluation of pharmaceutical marketing practices, critical consumer, physical exam and mental status, review of systems, medical history interview and documentation assessment: indications and interpretation, differential diagnosis, integrated treatment planning, consultation and collaboration, treatment management). As is true with any group attempting to prove their worth, the level of in depth study and improvement of expertise increased. The awareness that medical psychology was more than just prescriptive privilege further fueled the develop of the feel. With the establishment of the American Academy of Medical Psychology and the National Alliance of Professional Practicing Psychologists, the field evolved. The expansion of research, study and consultations further contributed to the overall healthcare field and integrated healthcare.


Today, those of us who are dedicated to providing the best care possible to patients continue to work with other providers struggling against misconceptions and misunderstanding. There are many of us that never expected to obtain prescription privilege, but rather, to provide the best consultations and interdisciplinary care possible to a population struggling to survive and thrive. Clinical psychologists who complete the extensive post-doctoral training to become medical psychologists provide a resource. This is especially true with physician-patient time being limited, limited training in nutritional sciences provided in medical schools, and the ever increasing impact of toxins in our environment. Even the use of psychiatrists and psychiatric nurse practitioners has been reduced to prescribing medications with fifteen minute sessions every month to two months. Medical psychologists see the patients more frequently, can monitor responses to medications, examine details of each case in reference to nutrition and symptoms of deficiencies, and provide a needed expertise to the healthcare treatment team. At this time, the emphasis in training clinical psychologists lacks the level of preparation in biopsychological and biomedical sciences. Those who take on the challenge of becoming medical psychologists can bridge this gap.


REFERENCE

Burns C. L. (1954). A forgotten psychiatrist: Baron Ernst von Feuchtersleben, 1833. Proceedings of the Royal Society of Medicine, 47(3), 190–194

.

Evans, G. D., & Murphy, M. J. (1997). The practicality of predoctoral prescription training for psychologists: A survey of directors of clinical training. Professional Psychology: Research and Practice, 28(2), 113-117. http://dx.doi.org/10.1037/0735-7028.28.2.113


Matarazzo JD. (1994). Psychology in a Medical School: a Personal Account of a Department's 35-year History. Journal of Clinical Psychology, January 1994, Vol. 50, No. 1.

McGrath R. (2010). Prescriptive Authority for Psychologists. Annu. Rev. Clin. Psychol. 2010.6:21-47. Downloaded from arjournals.annualreviews.org


Sechrest L & Coan JC. (2002) Preparing Psychologists to Prescribe. Journal of Clinical Psychology. Vol. 58(6), 649–658.

Von Feuchtersleben E. (1847). The principles of medical psychology, being the outlines of a course of lectures. Sydenham Society.


Zilboorg, G. (2008). A history of medical psychology. New York: W.W. Norton

A Seasoned Look at Getting Older in America

Rory Fleming Richardson, Ph.D., ABMP, TEP

Have you ever seen an older individual with a kindly smile whose face also reflects sadness, pain and loneliness? It is hard for some to understand the inner reality of someone who is looking at less days ahead of them than the number of days they have lived. As individuals start to reach the last ten to twenty years of their lives, the perspective on the future can change. If one has children, they grow up and have their own lives. They become busy with their own families and making a living. If one has savings, it is easier to distract one’s self from the absence of family and friends. Year by year more and more of one’s mentors and friends die. If funds are low, an older individual wonders if there will be enough to survive. It becomes more difficult to not just pass time until one dies. This becomes even more significant as health fails. How many individuals living in nursing homes feel like they are just being warehoused until they die? It is hard not feeling abandoned and more of a 

burden than having any value on this earth. Despite a lifetime of experiences, knowledge and insight, they face everything they were being lost in time.

It is not unusual for older individuals to get to the point that living alone is no longer possible. Unfortunately, the reaction of their children and family members is to move them out of their homes into a retirement or care facility. To the younger generation, this makes sense. Unfortunately, this ignores the needs and feelings of the older person. Consider that you are elderly. You purchased your home, worked to make it yours over decades, and have decades of memories in those surroundings. Your loving children then place you in a strange environment without your tokens of memories from the past and without your independence. I heard of a man who had multiple problems with vision and hearing. Given the opportunity to move him into a retirement home in a coastal city, they moved him out of his home. This is the home where he knew by memory how to get around, that matched the memories which he can no longer clearly sense with his own eyes and ears. By moving him into the new “golden bird cage,” he was lost with the only positive being having strangers (caregivers) come to check on him. In return, his children took over his home and his decision-making. I use to joke about the need to be careful because “your children are the ones who are likely to decide what nursing home to put you in.” Unfortunately, those children do not always understand the impact of their decisions on their elderly parents. They also tend to be unaware of the loss that they are putting on themselves, of not having more time with their parents. Many times this loss is not recognized until after their parents have passed away.

Imagine being a master carpenter who remodeled his own home over the years to make it just what he wanted. Now, imagine having that home taken from him and being placed in a strange environment. I have seen individuals who believed in the “American Dream” working throughout their lives only to have their homes, which they thought they owned, being taxed to the point that they have it taken from them. Is the American Dream a lie? What do each of us have to look forward to as we get older? Are we to be discarded like a pair of worn out shoes? As we get older, we give up the dreams of fame or wealth (if we had them in the first place). We simply want to be valued and needed. We are in the position of giving to those we love things we have saved over a lifetime. To us, these things have special meaning and are tied to memories/stories. The thought of them ending up on the shelf at Goodwill, or in the trash, literally tears out a piece of our soul. The things that we were saving up to do start to fade away, as we realize that there is very little likelihood that we will ever be able to use them. We realize that there are so many things that we would have done differently if given a chance. We don’t always have an heir apparent to carry on our work and our dreams.

The reality is that there is nothing that will take the sting out of growing old. The sensitivities of family and friends help. The valuing of one’s lifetime of experiences and knowledge helps profoundly. As an older person, I appreciate the struggles that all ages experience. It is my hope that in our rush to survive in this world we consider the needs of those who struggled to get us where we are today.

Biopsychosocialspiritual Treatment: More than Just Lip Service

Over the years, it has be extremely frustrating to see treatment options being ignored because of blind spots, dogma indoctrination, and simple lack of knowledge. It is well documented that individuals suffering from some psychiatric conditions tend to have nutritional deficiencies or other physiological factors which lend to the presence of the condition, but many psychologists, psychiatrists and physicians will fail to effectively address these issues. Even though the medications prescribed are dependent on the presence of a balanced base body chemistry to work, the focus tends to be solely on the use of medications and psychotherapy.

These are frustrations:

• lack of understanding and appreciation for the internal experience of the patient suffering from a psychiatric condition,

• lack of knowledge and appreciation for the importance of biological factors impacting psychiatric and medical health,

• the tendency of professionals to read only the literature in their respective fields,

• an almost dogmatic resistence to any viewpoint other than their own, or the university they graduated from, or outside the norm of their geographic area,

• the lack of attention to the importance of the body eliminating toxins, the need for health of the lymphatic system, methods of improving toxic elimination, and the overall toxic load and the impact on health,

• the limited requirements for training of counselors and therapists compared to the previous decades where two years of focused training in psychotherapy was required,

• the lack of training in various religious and belief systems provided to healthcare professionals.

The spiritual aspect of treatment is also considered by some to be a forbidden zone for anyone except clergy. One of the primary interpersonal relationships in an individual’s life is often the relationship between the person and their Creator. Many individuals may have had an experience which created a “gripe with God” which impacts their lives. Thankfully, the contributions of the recovery community for addictions has reintroduced this relationship.

Regardless of the institutional standards, each professional is morally and ethically required to enhance there knowledge and competency. This puts the onus on each individual provider to accept this challenge.

Medical Support Staff: Benefit or Destruction of a Professional Practice

Preface:

I am writing this as an attempt to help correct problems which can undermine treatment efforts and the overall function of healthcare clinics. I hope it is helpful.

Everyone has gone to the physician’s or healthcare provider’s office. The first contact with the office is frequently via the phone. From this contact, the patient starts to develop a perception of the level of care. The patient is looking for compassion, sensitivity, understanding of the severity of the problem, a desire to be helpful, and genuine kindness. This level of professionalism is essential if the patient is to feel that their care is in good hands. This combination of traits should be the same all the way through the professional care that they receive from the physician or other provider. It is estimated that 30% of the chances that a patient gets well is depended on if that patient has a good relationship with his/her physician. It is easy to see how poor a patient-physician relationship can impact care.

Recently, I had the opportunity to be reminded of this when my wife was referred to a small clinic who happened to how a CT scanner. The staff at that clinic met all of the criteria noted above. This is in contrast to the terse, insensitive attitude demonstrated by all of the support and medical staff (except for a few) at the clinic where my wife is normally seen. The one receptionist/scheduler of her physician is one of the few excellent professional. When I attempted to get a post-hospital follow-up appointment which needed to be within 3 to 5 days, a different scheduler answered the phone and told her that it is set for 7 days, despite my life having any appoint on what could be considered the 5 day of my hospital discharge. This scheduler was terce, insensitive and inflexible giving off an attitude of indifference. If it were not for the fact that finding a physician willing to follow up on a medication combination which she has been on by necessity for decades, we would be changing clinics. What is not surprising is that the hospital entity which owns the clinic has, over the past years closed one of their hospital with the their near functioning hospital being in the another State. Also, when we went to their clinic with the CT scanner, more than half the office appeared closed down.

So what can be done to correct this? If the problem is a personality issue or a psychodynamic orient, one could try referring them to an Employee Assistance Specialist to see if therapy might help. If not, replacement of that employee is needed. Retraining may also be of value. The reality is that if the behaviors do not change, replacement is essential. It is very possible that the obvious demise of this one hospital entity in this one area of the country may be the result of these details being ignore.

Each of Us Has a Unique Path

My Memories: One Psychologist’s Professional Journey

Rory Fleming Richardson, Ph.D., ABMP, TEP

During my childhood years, I had the experiences of having a brother who was injured by medical malpractice (missed Rh factor conflict) which resulted in him being mentally impaired and blind. When I was starting college, I married a young woman with bipolarity. The real life experiences of this and seeing the impact of various conditions on family members and the individuals who suffered from neurological and/or psychiatric conditions was profound.

I remember when I was in fifth grade I was so terrified of doing pooring in the next, I had my parents by the books for the next grade. I then processed to construct a twenty-five food PERT chart of butcher paper breaking the entire summer vacation into hourly segments to finish all the books and studies by the start of the next year. This way, I would have completed all the studying for the courses to come. At that time, it was seen as unusual. In retrospect, it was extremely Obsessive Compulsive. I did my first Sociogram when I was in seventh grade to create a "study buddy system."

I remember starting to correspond with Bernard Gunther in the 1960s. I had attended a Sensitivity Group at Portland State University during that time and read his book. Over the years, he become my friend, Master’s Degree advisor, and eventually, God father of my oldest son. He started out as a resident massage specialist at Esalen, becoming an expert in Psychosynthesis, and a student and writer on Eastern methods. Working with a chiropractor, he developed and taught Psycho-Physical-Synthesis, one of the early forms of psychological body work.

I have been privileged to have studied under and worked with several key figures in psychology over the years since 1969. Over the next few posts, I will try to share some of these individuals. Here are two individuals who I have valued as teachers: Bob Bartholow and Dr. Hans Ansbacher. At the Timberline Lodge conference, I was introduced to Hans and Rowena Ansbacher, as well as key figures in the Adlerian movement.

In 1970, I was taken under the wings of three dedicated professionals: Drs. Aloys & Georgia Daack, and Sister Dominic Bancroft, M.Ed., SP. I miss them all. They were dedicated to both Adlerian Psychotherapy and Montessori Education. Dr. Aloys Daack was a D.O. They introduced me to Maurice and Eva Bullard and the world of Adlerian Psychology.

I remember my first introduction to Adlerian psychology at Timberline Lodge ASAP conference where Dr. Mosak presented Life Style Analysis. A few years later, I attended the Alfred Adler Institute of Minnesota where I completed the two additional trainings.

I started my Master's years and ended them with two 15 day retreats in La Jolla with these pioneers in non-directive group process. Facilitators of these programs were Drs. Carl Rogers, Bill Coulson and Bruce Menter.

In 1973-1974, I had private tutorials with James Wade, M.Ed. in psychological testing as a part of my MA. Little did I know that Mr. Wade who provided psychological testing to key school districts throughout Portland and was the founder of the Suicide Prevention Program, he was a Clinical Instructor at Oregon Health Sciences University.

How soon we forget. I had the opportunity to study with and participation in a demonstration with Dr. Kurt Adler, the son of Alfred Adler, M.D. I encourage you to listen to the wisdom of a master therapist.

I remember attending a five day workshop led by Charlotte Selver and Charles Brooks at Esalen in 1974. It was an excellent experience and I recommend experiencing this method to all. Toward the end of the one week workshop, I started to become ill and ended up having acupunture treatments and gallons of rose-hip tea. I felt great after the accupunture session for one day, but then was “sick as a dog.”

In 1974, I had the opportunity to meet and learn from Dr. Harold Greenwald, who had just published his newest book, Direct Decision Therapy (an innovative style of rational emotive therapy). Over the years, I have used this method as it is presented and in psychodramatic form. He ended up being one of my references for certification as a psychodramatist.

One of the things that is interesting is that when I was in training in psychotherapy, they used reel to reel video tape to record sessions. While studying at the Moreno Institute in Beacon, New York, J.L. died. His wife, Zerka, took the lead and many of the top psychodramatists around the world helped provide the support and assisted in doing the trainings. During the first year of my training at the Moreno Institute, many world renowned psychologist/psychodramatists came to see Dr. Moreno and assist Zerka with conducting the trainings because of Dr. Moreno’s illness. These included Drs. Anne Ancelin Schutzenberger, John Nolte, Elaine Goldman, Larry Sacks, and others. Since in psychodrama sessions, it is not unusual for cussing to occur, one of the most enjoyable tasks that I and other students had was to teach one of the other students who was from Sweden cuss words. Some words just don’t have the same impact with an “oo” sound instead of the “u” sound. Other trainees and psychodramatists-in-training included Ann Hale, Mary Ann Sheridan, John Brindell, Elizabeth White and many others.

Prospective/Preventative Medicine: A Look Back. In the early-1970's, I was involved with the Commonhealth Club in Santa Rosa. Here is a nice summary of an excellent early attempt.

https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/jfp-archived-issues/1978-volume_6-7/JFP_1978-03_v6_i3_patient-education-and-multiphasic-screen.pdf

I was just trying to find and get back in touch with Ken Bubb who I worked with at the Commonhealth Club. Unfortunately, like many of my friends, he passed away in 2016. I will always value those years.

In 1974, I heard of an innovative doctoral program in Clinical Psychology in Santa Barbara (The Fielding Graduate School). After enrolling, I had the pleasure of learning from two of it's founders, Drs. Frederic Hudson, and Hallock Hoffman.

When I was in the Fielding Institute doctoral program back in 1975, my Core Adviser was Clinton Phillips, Ph.D., who was one of the lead figures in the development of Marriage & Family Counseling field.

During the 1980's when I was working in addiction and eating disorders, I had the opportunity to get to know Father Martin and visit Harve de Grace. I blame him, in part, for some of my bad jokes.

In July of 1993 as part of my doctoral studies, I had the opportunity to attend the World Congress on Neural Networks (July 11-15, 1993, Oregon Convention Center, Portland, Oregon). Two of the presentations were by Dr. Walter Freeman from UC Berkley and Dr. Vilayanur Ramachandran, two profound excellent neuroscientists. I remember Dr. Freeman and I having a mutual recognition of each other, but we could not place where we know eachother from. Given my multiple adventures/learning experiences in California, I still can not remember. Many years later, I remember enjoying Dr. Vilayanur Ramachandran presentation on Mirror Neurons. One of the individuals I would have like to have met and talked with was Dr. Donald Hebb. I have used his work extensively which directly relates to the impact of psychotherapy.

During my doctoral program in the early 1990s, I had the privilege to take several trainings with Drs. Ralph Reitan and Deborah Wolfson. These were held at Georgetown University and were the most informative, well designed trainings I have ever attended. Over the years, I have found the Reitan Neuropsychological Battery to be the most useful method of neuropsychological assessment. I was able to augment it with other tools to refine assessments. Given the nature of the types of function based tests, test and retest could reveal improvement or decline in patient performance. When I combined this with material that I gained from the presentations by Edith Kaplan, Ph.D. regarding process-based assessment, the techniques were even more revealing. 

When I attended the Union Institute and University Graduate Professional Psychology Program, the university was in the process of applying for APA approval. This put the onus on each faculty member and the learners to make sure that their graduate training went above and beyond the standards. I was fortunate to have Dr. Larry Ryan, Dean of the program, as my Core Advisor. My second Core Advisor was Noel Markwell, Ph.D., Society for the Study of Peace, Conflict, and Violence: Peace Psychology Division of the American Psychological Association. They inspired me to do a program that most individuals could only dream of doing. I was also privileged to have Mary Ann Marazzi, Ph.D., Professor at Wayne State and principle researcher in the use of Naltroxine for treatment of Anorexia Nervosa and Bulimia Nervosa. After I had completed my Ph.D. in Clinical Psychology and Biopsychology, I had the opportunity to co-teach a seminar on neuropsychology with Dr. Ryan in Washington, D.C.

Because I was doing a dual-major (Clinical Psychology and Biopsychology), I had two psychologists who supervised my work, Bruce Bundy, Ph.D. and Marvin Greenbaum, Ph.D., ABPP, and a psychiatrist, Lawrence Sacks, M.D. Dr. Sacks was an excellent (but tough) supervisor with a profound understanding of psychopharmacology and psychiatry.

After attending two short workshops presented by Daniel Amen, M.D., I decided to attend an extensive training in Long Beach on SPECT imaging and psychiatric disorders. While there, I had the opportunity to not only learn to read SPECT imaging and tie in my already existing knowledge of neurobiological aspects of psychiatric conditions, but had the opportunity to meet and talk to Terence McGuire, M.D., a psychiatrist who had been NASA’s psychiatric consultant for manned space activities for 36 years and Chief of Neuropsychiatry at the USAF School of Aerospace Medicine. Dr. McGuire took the time to review and support my work. I continue to integrate this knowledge in the treatment of patients.

My training in advanced psychopharmacology through Prescribing Psychologists Register provided me with an excellent foundation. Over the years in training, presenters included John Preston, Ph.D., psychiatrists, and various biomedical scientists. I had the opportunity to get to know Sam Feldman, Ph.D., the founder of PPR and a good friend.

Because I was one of the first psychologists who was Board Certified in Advanced Psychopharmacology, I became a target of a few medical professionals who opposed the concept of psychologists gaining prescription privileges. One of the professionals who came to my defense was Joseph Matarazzo, Ph.D., past president of the American Psychological Association (APA), chair of the first medical psychology department in the United States, and has been credited with much of the early work in health psychology. Ever since I had started studying psychological assessment, I had been reading the master textbooks that Dr. Matarazzo had written. I very much enjoyed meeting him and talking with him. His support and efforts I will forever be grateful.

One of the problems I had since first grade was what is known as scotopic sensitivity. Back then (1959), this visual distortion was unknown. In the 1970s, Helen Irlen, a school psychologist in Long Beach, California discovered this light sensitivity which impacts reading, depth perception and almost all academic tasks. I took a training in Irlen Syndrome (scotopic sensitivity) to become an Irlen Screener from Susan Hughes, an Irlen Diagnostician. I was so impressed by this, I then made arrangement to complete the training with Helen Irlen in Long Beach to become a diagnostician. Her significant work and insight into learning disorders and appropriate accommodations continue to influence my work. I could see that having Irlen Syndrome could profoundly impact not only performance in everyday life, but also the performance on psychological/neuropsychological testing. Since then, I have written several articles on Irlen Syndrome including one which was published in the Journal of Neurology and Psychology.

When I think of my life experiences prior to and in between these, I see that from my very childhood I was being honed to take on the challenges of being in the field I am in. From my experiences with my brother who was retarded and blind because of medical malpractice relating to Rh Factor Conflict, to family with various psychiatric conditions, and my knowledge/experience with the impact of neurotoxicity in the world today, I find a passion to reach out and try to make a difference. I feel very privileged to have met, studied with, and known so many great men and women in psychology and psychiatry over the years. God willing, I will be able to share this knowledge with the next generation and provide care to my fellow human beings for years to come.

Activity Analysis Status Questionnaire (AASQ)

One of the key reasons given for denial of disability benefits is the mis-quoting of activity level. For example, the individual states that "it takes all day to do the laundry," which is interpreted by the administrative law judge as "the person can do laundry all day." These misinterpretations occur frequently. I developed the Activity Analysis Status Questionnaire to glean the information to provide specific information on function to help combat this issue. This form can be used with the individual applying for disability and to gather collateral feedback.

Pain Management Methods Questionnaire (PMMQ)

Over the last two decades, I have watched as we have forgotten all of what we learned in the 1960s and 1970s. The knowledge and practitioners are there, but their utilization for pain management has been ignored. In putting together a pain assessment, it is important that the patient and physician explore all options. Some patients need opioid medications, but each case is unique and needs individualized treatment. There is no "one size fits all."

Below is a questionnaire which can be used to help the physicians, the psychologists, and the patients examine and explore pain treatment options and history:

Short Thought Piece:

I propose the following. The job of a philosopher, a scientist, and a explorer of life is to consider all options collectively. We use deductive logic to put together the path of knowledge to be able to draw conclusions. Pattern recognition is both a natural gift and a potentially developed skill. If we use both deductive logic and pattern recognition to put the sources listed below, our development of insight is greater. This provides a proposed “skeleton” to “flesh out” further theories.

sources of knowledge

• Learned: knowledge gained from books, lectures or other sources of historical material,

• Observed: knowledge gained through observing the world around us,

• Experienced: knowledge gained through the personal experiences of living,

• Ethereal: knowledge which seems to be present from an unmeasurable source (collective consciousness, intuition, divine inspiration, Akashic records, other),

• Genetic: knowledge that seem to be passed down through, most likely, genetic sources which existed in individual’s genetic line.

Over the years, I have heard the phrase, “the ghost in the machine.” I have also heard that, “the whole is more than the sum of its parts.” Both of these phrases reflect the elements noted above. The American psychologist William James encouraged the exploration of the ethereal realm as part of psychological practice, but those who were attempting to justify psychology as a science were unwilling to take a chance of drawing any criticism by including anything that could not be measured. This mirrored the times of René Descartes when there was a division of science from religion because of political reasons. The age of fear of reticule needs to end so the age of enlightened exploration can exist. It is the extension of this exploration which has been done in secret by governments for centuries. It is time for it to come into the light. This is one reason I enjoy Rupert Sheldrake and other explorers of knowledge.

Copyright © 2019, Rory Fleming Richardson, Ph.D., ABMP, TEP

LETTER SHORT THOUGHT.pdf (PDF — 160 KB)

Sensory Memories & Ghosts of Posttraumatic Stress

Rory Fleming Richardson, Ph.D., ABMP, TEP

Pretend for a moment that you are in tribal days and you are haunted by ghosts and memories of something horrific. The tribal medicine man or shaman who finds out about the problem you are having, perform rituals, and exorcises the ghosts. One technique used by magi and shamans is to have the afflicted party detail the experiences that caused these ghosts, have the individuals create an image or symbol of these event/s, become ready to let go of them, and ritually burn or bury the symbol.

For a patient with Posttraumatic Stress Disorder, there are sensory memories that act as anchors and triggers. These result in nightmares, intrusive memories and flashbacks. The odor of diesel reminding the soldier of the heavy equipment during war, the sound of a backfiring car triggering memories of gun fire, or the image of a child just before a bomb explodes are a few of these sensory triggers. Not all sensory memories of trauma are horrific. Some can be extremely neutral except for the fact that they were present at the time of the trauma. For example, a vacuum cleaner in the back of a car where a woman died. The process used by ancient healers is very much the same as the ones used today. The turning point is to identify these sensory memories, express the emotions around them, do whatever one feels needs to occur to become ready to let go of the memory, and then perform the ritual of letting go. Becoming ready to let go and walking through the steps of making peace with them is the preparation to heal. What is required to become ready is individualized and can only be defined by that which is written on the individual’s heart. This does not simply mean desensitizing to the trauma. Various methods of desensitizing sensory memories so that the individual can go through daily life without profound intrusion have been developed. These include flooding, exposure-response modification, eye-movement desensitization (EMDR), and others, but these simply allow the individual to coexist with the ghosts. It is like learning to live in hell with the trauma without it bothering you. If treatment stops there, the process of empowerment of the individual may not take place. It is through the rituals, confronting, making amends or other actions, and traveling the path started by the trauma that we grow and make the experience a useful part of us. Once we have experienced a trauma or any event in life, it is a part of us. To try to make it not exist, is like taking part of our childhood or school years disappear. If we did, we would be the lesser for it.

For those of you trained in psychodrama, you can see how our creativity and imagination can be used to recreate events, provide things we did not have at that point of our life, and create the “rituals” needed to make peace with our experiences. Sensory memories are recreated and explored. The patient can interact with these memories and experiences, providing corporeal form to that which is without form. Emotions are expressed through various forms of catharsis.

It is not unusual for various sensory memories to come back repeatedly throughout our lives. The reason for this is that as we go through each phase of life (i.e., adolescence, young adulthood, becoming parents, becoming grandparents) the events from the trauma may touch us in different ways. It is not a sign that treatment did not work, but it is the opportunity to deal with a different aspect of our memories.


To be a survivor of trauma is not the end of the path. It is simply one point. When we get to being empowered by the event, this is another point. We need to stay on the path and see how far we can go. For some, it may lead to a point you did not believe existed.

Author’s Note: The reasons that I omitted references is that this article is based in total on my forty-four years of experience working with individuals with Posttraumatic Stress Disorder. I simply hope it provides some food for thought for those in the field.

Beyond Trauma

by Rory Fleming Richardson, Ph.D., ABMP, TEP

Inspired by Gazelle Nicole Richardson (my loving wife)

Once you are able to find your way passed the ghosts and the nightmares,

to that point of strength and power to stand up to the source of the nightmares,

taking back your power and defending that which you could not.

At that point, it is you who have the choice to be kind or be cruel.

If you choose to hold on to the anger and the pain, you tie yourself to the karmic loop.

If you forgive and let go, you free yourself to move on taking with you the strength that you gained from the ordeal. 

Periodically, you may revisit the ghosts as life phases change and mature,

but it is with the strengths that you have gained to that point.

At some point, we realize that the terms victim and survivor are simply points in a timeline of healing. If you elect to live at one point in the timeline, it is your choice. But if you decide to evolve past it to a new point of self, you may find you are more than you ever thought was possible.

Licensed Psychologist, Missouri;

Licensed Psychologist, Oregon;

Registered Psychologist (Clinical, Counseling & Health) by HCPC, United Kingdom; Board Certified Medical Psychologist, ABMP; Board Certified Psychodramatist/Trainer

I am available for teleconsultations for international cases. I will also be providing psychological services directly as a psychologist at the Greater Ozark Rural Psychologists clinic in Mansfield, Missouri.

What We Don’t Think About: Vitamin/Mineral Deficiencies, Nature Interaction & Health

Rory Fleming Richardson, Ph.D., ABMP, TEP

When we are young, we are invincible.

When we are middle aged, we say “Things are not that bad yet.”

When we get to be 60+, we start to take things seriously.

When we get to be 65, we say “Oh crap!” and worry about our children.

When it comes to health practices, the lines written above appear to be the norm for most individuals. Some of us remember grandparents and parents trying to get us to take this vitamin or supplement, do this or that healthy thing, or saying “go outside, play in the yard and enjoy the fresh air.” Once we were old enough to ignore them, we did think that we were invincible. The world I grew up in of the 1950s and 1960s is not the world we have today. The level of pollution, depleted nutrients in the foods, rampant vitamin/mineral deficiencies, and electronic smog is higher than it has ever been. The prose above is what I have found is true for me. Over the last 65 years, the amount of nutrients in our foods have been reduced. A 2004 study of food nutritional value between 1950 to 1999 showed a statistically significant decline in the medians range, from 6% for protein to 38% for riboflavin.1 This study has been further confirmed by other studies in Europe.2 This is further complicated by the herbicides and pesticides that have, at this point, touched every person in the civilized world, interfering in the metabolizing, absorbing, and retention, of the vitamins and minerals.3

What about the “go outside, play in the yard, and breath fresh air” command of our parents? Although some of this was not just for our health, but for our parents sanity, fresh air and being in nature have been proven to be beneficial to health.4 Even people with Attention Deficit Hyperactivity Disorder have been found to benefit from being in contact with nature.5 Health benefits are seen throughout the literature to see for both physical and emotional health.6 But is there more to it than just being in a natural setting? In the 1960s, there was the revolution of making shoes out of synthetic, insulating materials. Prior to that, leather (or skin) was used to make shoes. The leather was a conductive material. Prior to shoes, we were barefoot. Like it or not, we are bioelectrical/biochemical entities. It is not hard to understand that if we have electrical processes within us, we may be impacted by connection with a grounding source, specifically, the earth. The discovery of connection the with the earth stems back into ancient times, but we rediscovered it thanks to Clint Ober, a retired pioneer in cable television, in 1998. Since then, the benefits to reduce inflammation, promote healing, and calm emotions, has been documented in multiple peer-reviewed journals, and various case studies.7 8 One of the things I like about the earthing, or grounding approach is that it does not cost anything. You simply have to have bare skin in contact with the earth. Given the number of diseases that impact people’s lives through inflammation, the free treatment option of spending time barefoot outside or working in the garden using your hands in the soil to plant and care for plants would appear to be the best option to give healing a chance.

How about the play and activity? Our body has three fluid systems: cerebral spinal fluid, which is a slow leak in and leak out circulation; the vascular system, which includes the heart to pump blood; and the lymphatic system. The latter has no pump, except for the movement of the human body. Activity is the way that the fluid circulates. Besides this, there is a multitude of benefits from “going and playing outside.”

I also remember my mother giving me iodine tablets to take. I always thought that it was because of the era we lived in (fear of a nuclear attack), or because I was born in post-war Japan. Since then, I have research some of the information from the International Association of Oral Medicine and Toxicology, who share the impact of parasites, danger of fluoride on health, and recommend simple things like baking soda instead of toothpaste, iodine for teeth and gums, and using a oral water irrigation. Perhaps we need to rethink what we have been taught, and start to look at how the older traditional ways seemed to work.

I have found that studying medical anthropology has improved my understanding of psychology, and medicine because it looks at what worked over many centuries and for thousands of years. It is only recently that we have re-embraced the value of natural honey for health. I have heard critics talk about these things as “new age,” but in fact, they are practices that we have just forgotten for the “newer and shinier approach.” To those who state, “I have not heard of any research to support this,” my response is either learn how to read or read more before you express an opinion.

A Native American saying is “Take only what you need, and leave the earth as you found it.” We have not done this. We all know that we need to improve our attention to health practices. As a civilization, we honestly, and intensely, need to change how we treat the earth and our environment. We need to learn how to find ways of eliminating toxins from our bodies, and provide better support for nutrients, attending to the absorption through probiotics health, reduced inflammation, and making time to reconnect with nature in a way that is more than just watching the Nature Channel. Don’t wait till you become 60 or older to take these things seriously. If you do, you will miss out on more life, and may not have the health you want, during the senior years.

1 Davis, D. (2004) Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999. Journal of the American College of Nutrition, Vol. 23, No. 6, 669–682. http://saveoursoils.com/userfiles/downloads/1351255687-Changes%20in%20USDA%20food%20composition%20data%20for%2043%20garden%20crops,%201950-1999.pdf

2 Davis, D. (2009) Declining Fruit and Vegetable Nutrient Composition: What Is the Evidence? HortScience February 2009 vol. 44 no. 1 15-19. http://hortsci.ashspublications.org/content/44/1/15.full

3 Samsel, A. & Seneff, S. (2013) Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance. Interdiscip Toxicol. 2013 Dec; 6(4): 159–184. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/

4 Berman, M. G., Jonides, J., Kaplan, Stephen. (2008). The Cognitive Benefits of Interacting With Nature. Psychological Science. 19: 1207-1212. http://libra.msra.cn/Publication/6994981/the-cognitive-benefits-of-interacting-with-nature

5 Kuo, F. E., Taylor, A. F. (2004) A Potential Natural Treatment for Attention-Deficit /Hyperactivity Disorder: Evidence From a National Study. American Journal of Public Health. 94(9): 1580-1586. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1448497/.

6 Ulrich, R. S. (1999). Effects of gardens on health outcomes: Theory and research. In C. Cooper-Marcus & M. Barnes (Eds.), Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley, pp. 27-86.

7 Oschman, J., Chevalier, G. & Brown, R. (2015). The effects of grounding (earthing) on inflammation, the immune response, wound healing, and prevention and treatment of chronic inflammatory and autoimmune diseases. Journal of Inflammation Research. 

8 Ghaly, M. & Teplitz, D. (2004). The Biologic Effects of Grounding the Human Body During Sleep as Measured by Cortisol Levels and Subjective Reporting of Sleep, Pain, and Stress. The Journal of Alternative and Complementary Medicine, Volume 10, Number 5, 2004, pp. 767–776

For arrangements to schedule training programs and workshops, please contact me at [email protected]

Mailing Address:

P.O. Box 128

Seymour, Missouri 65746

Please feel free to check out my short articles at:​

Rory Fleming Richardson, Ph.D., ABMP, TEP

Clinical Medical/Health Psychologist & Neuropsychologist