The Power of Psychotherapy and Advocacy

It was a morning in July when I drove down I-95 to begin the first day of my psychiatry residency. My hands tightened on the steering wheel as I wondered if I had made the right career decision. My mind wandered back to nearly 10 years earlier, when I had decided to become a psychiatrist.

As a sophomore at Brown University, I had contemplated what to do with my life. I loved my science courses but couldn’t see life in a lab. My studio art class at the Rhode Island School of Design opened me up to color and negative space, but an artistic career seemed unrealistic. I wanted a vocation that would be fulfilling and creative and help make a positive difference in people’s lives.

My cognitive psychology class had captivated me. I was intrigued by how elegant experimental designs could access the mysterious territories of the human brain, often with nonintuitive results. I had been equally fascinated by Harlow’s monkey studies and their demonstration of the transformative power of relationships. I was eager to study the brain, both its manifest behavior and its interior psyche. I decided to pursue medicine to become a psychiatrist.

During medical school, fearing premature closure, I tried other disciplines on for size. But I always came back to psychiatry. And so, on that hot July day, as I sped toward the West Haven VA, I hoped that the past decade of my life focused on this singular goal had been time spent moving in the right direction.

My decision was confirmed when I began to learn and practice psychotherapy during my residency at Yale. I had wonderful supervisors on both inpatient and outpatient rotations. They were insightful, compassionate, and thoughtful. Most were downright brilliant. They taught me how to listen to patients; they taught me how to listen to myself. They taught me about intrapsychic, interpersonal, family, and group dynamics. They were role models who lit my path forward. They inspired in me a passion for psychotherapy, and for that, I will be forever grateful.

I stayed at Yale for a PGY-5 fellowship year in psychotherapy. That experience helped to deepen my appreciation for the unique power of the therapeutic relationship, better understand the critical role that boundaries play in every therapeutic encounter, and expand my attention to transference and countertransference processes.

After graduation, I continued at Yale to teach psychotherapy courses and to supervise psychiatry residents in psychodynamic psychotherapy. I also opened a private psychotherapy practice and worked in a community mental health clinic. Despite the sharp differences between these two settings, in terms of organizational systems and socioeconomic disparities, my work with patients was governed by similar principles: clear boundaries, an effort to build a strong therapeutic alliance, and a determination to understand each individual’s self-narrative.

In recent years, I have renewed my focus on a long-term interest: advocacy. A member of APA since residency and a current member of APA’s Council on Advocacy and Government Relations (CAGR), I believe that psychiatrists have a responsibility to advocate for issues that help patients and support our profession. However, becoming an advocate is not intuitive; effective advocacy requires learning specialized skills and understanding new systems. Today at Yale, I teach an advocacy elective and am helping to develop a new advocacy curriculum for the residency program. In addition, I advocate for the practice of psychotherapy, both as a member of the Committee on Psychotherapy for the Group for the Advancement of Psychiatry (GAP) and as a trustee of the Board of the Austen Riggs Center, a nonprofit psychiatric hospital.

Throughout my career, the complexity and power of the psychotherapeutic relationship has astonished me. I have worked with patients who carry a range of diagnoses and come from all socioeconomic backgrounds; some work has been brief, and some has lasted 20 years. Each patient has challenged me, in unique ways, to create an alliance and understand their story, and then to help them identify distortions, face fears, consider choices, and, hopefully, move forward with their lives. My work with patients has been rewarding and meaningful.

I have learned that it’s not just relationships with patients that make a difference. The relationships forged with my supervisors, supervisees, mentors, and colleagues have gratified and guided me. Today, my professional life is rich. I am excited by the challenges and possibilities presented in my private practice; my advocacy efforts; my psychotherapy supervision; and my work at APA, GAP, and Austen Riggs. I am very happy with the career decision I made those many years ago. ■