Our Wellness Podcast

We’re very excited to share with you our new Wellness Podcast Series.

Two members of our communications team, Agathe de Pins and Jonathan Chien, sit down with the helping hands of our Mt Sinai community over Zoom to discuss virtual one-on-one counseling and mental health resources that are available to students and postdocs.

 

To listen to the interviews, click here:

Dr. DePierro, Clinical director of the Center for Stress, Resilience and Personal Growth (CSRPG)

Jordyn Feingold, MSc (leading a Positive Psychology course for students)

Dr. Sukumaran, head of STMH

Acanthus Fairley, LCSW

Rachel Potter, LCSW

Craig Katz, MD

Mickie Brown, RN, HN-BC

 

To read the full interviews, see transcripts below.

 

 

Interview with Dr. DePierro: January 2021

Jonathan: Hello everyone, and welcome back to another episode of the Wellness Podcast. Today Agathe and I are excited to be joined by Dr. Jonathan DePierro, an Assistant Professor of Psychiatry here at Mount Sinai and the clinical director of the Center for Stress, Resilience and Personal Growth, or the CSRPG. Dr. DePierro’s doctoral training was in clinical psychology and he worked for many years as well at the Mount Sinai World Trade Center Mental Health Program. So he has a lot of experience treating trauma based mental health issues as well as PTSD and fostering resilience. 

Dr. DePierro, we’re really excited to have you here with us today. Thank you for joining us.

Dr. DePierro: Thank you for inviting me. I’m excited to speak with you both. Absolutely.

Jonathan: I wonder if you could start off by speaking a little bit about some of professional training and background: how you ended up coming to Sinai and moving into the roles that you currently hold.

Dr. DePierro: So, I’m a clinical psychologist by training. I got my PhD in clinical psychology at the New School, which is in lower Manhattan. I was there for a really long time getting my PhD, and then as part of that process of training and becoming licensed, I did a post-doctoral fellowship at the NYU World Trade Center Health Program, which got me involved treating and doing some research with individuals who’d been responding to the 9/11 disaster and had trauma related symptoms from that. So a lot of experience there, and I also did some training during my PhD at Mount Sinai’s World Trade Center Program. So that got me really involved in trauma treatment and really looking at and mitigating the long-term effects of a real community level trauma, like 9/11. So that’s how I got into trauma treatment.

And in terms of trauma research, that’s really what I’ve been studying for a long time in graduate school. I was part of a research lab that looked at the effects of repeated traumatization on the body. So folks who’d been experiencing traumas in childhood and in adulthood, and how they’re different than other folks in terms of their stress response. They might be different than folks who had only one major trauma in their lives, like a car accident. So comparing what we call single incident trauma to multiple incident or chronic or lifetime trauma, and really understanding the differences and different treatment needs of folks with a lot of trauma history and folks with a more circumscribed, single incident experience, to get to a point where you’re functioning OK. That the experiences, rather in the short-term or long-term are no longer affecting your day-to-day functioning. So that’s really thinking about it as a trauma, as something that is naturally distressing and after a period of time, that stress dissipates and it’s no longer affecting your day to day. And in fact, you might’ve grown from the experience by finding a positive in the experience by connecting to something bigger than yourself, building new social connections, and connecting to inner strengths that maybe you didn’t have. So that is acknowledging that distress is present and that you might struggle in that distress for a while, but out of that pain and suffering you might grow.

So that is a sort of a realistic definition of resilience, really more along the vein of recovery that I like to think about. People have different recovery stories. 

Agathe: It’s focusing more on the positive aspect or like what makes us stronger rather than what makes us weaker, which is also an interesting approach.

Jonathan: Right definitely, and it seems like it has a bit of a cognitive, but also like a behavioral and functional component to it as well.

Dr. DePierro: Mm-hmm. So then we can ask the natural question of what fosters that growth and what fosters that recovery. And there are lots of things that we know there are, what we call genetic or dispositional factors.

Some people are sort of born to be more resilient or sort of born to be more hardy by nature of some genetic factors, some levels of circulating hormones in their body that might help foster resilience. They’re biomarkers of resilience that are dispositional. Some people have characters or temperaments that help them be more resilient.

People who are dispositionally cheerful or more optimistic just by nature tend to be more resilient. People who have greater social support or build that social support network, or are part of faith communities tend to be more resilient. Folks who have less of a significant family history of psychiatric issues, probably tied up in genetics, tend to be more resilient. And there are some things that we can change, such as how one thinks about the difficulties they’ve been through. We could change what resources people engage with. We can provide more resources to people so that they could engage with them.

So one of the top predictors of resilience, that is sort of better coping after difficult situations, is social support, the extent to which you have a network of people that you can lean on. It could be one person you can lean on a lot or a lot of people you lean on a little, but social support and finding that community wherever it is in your neighborhood, in your church or mosque or synagogue, in your academic community, in your job, having someone you can lean upon or multiple people you can meet upon is really protective. We call that a protective factor and that’s something we could teach people to do. We can teach people to make use of resources they have in front of them or help them build out their networks better. And that helps protect them against future stress and mitigate the stress they might be feeling now. You could just imagine like being lost in the woods by yourself and how scary that feels and actually less scary if you’re with somebody. And less scary too, if you’re like with a party of people who are lost in the woods, hopefully, because you’re all in it together and fostering that sense of we’re all in it together, and we’re here for you and other people are here for you too, is really, I think, quite helpful. Also fostering, people’s connection to something bigger than themselves. This could be a formal religious practice like church or mosque, synagogue, or other religious temple, or other religious practices, or it could be something like engaging with a martial art or one of the fine arts, or poetry: connecting to that something outside of yourself, connecting to a bigger entity, and having that spiritual connection and building up that part of your life can be really protective.

And also coping skills, right? We could teach people how to cope with the stressors ahead of them, or at that they’re facing now, like, thinking about their challenges in a different way. Reframe some of the thoughts that they’re having that are overly negative, reframe some thoughts that they’re having about the future of being bleak or there not being any hope. We could teach people things like meditation or deep breathing, or other kinds of strategies, like exercise, for example (a really good one to mitigate some of that stress). So there are some resources people have going into traumas and some resources that we can give people as they’re going through it and as they’ve left a traumatic situation to build them up a bit.

And that’s really what we hope to do in the center, through our resilience workshops, giving people these tools, talking about these resilience factors, like active coping, like social support, like faith meaning and spirituality, self care. All of those things we know from the research, that you all might do, these are things that one can build up like a muscle. And the more you have these muscles built up, the more you’re able to sort of lift the weight of the distress and to go through something challenging and come out the other side OK, or, you know, distressed for a while, but then able to recover. 

Jonathan: Awesome, yeah, thank you so much: that was an incredibly informative and exhaustive answer. And I think you probably already kind of answered a bit of my next question, but I guess speaking of resources and social support, I think Mt. Sinai to its credit has a lot of these organizations for the students in place. And of course like many institutions, Sinai loves its acronyms: we have, you know, STMH (Student Trainee Mental Health), we have THAW (Trainee Health and Wellness) which people may be familiar with, the Office of Well-being and Resilience (OWBR), which sounds a bit similar to Center for Stress, Resilience, and Personal Growth (CSRPG), and then there’s the postdoc office, HR; so, I guess, specifically for the average member of the student or postdoc community, when they hear about CSRPG, how should they understand that center’s role within this bigger constellation of organizations. And I know you touched on all of these wonderful strategies and perspectives for fostering resilience, so I’m guessing that’s part of the what the CSRPG, but more specifically, how is the CSRPG unique in terms of what you guys are up to?

Dr. DePierro: Right. So this is a really good question. You raise a good point. I’ll try to be briefer in this answer. There is alphabet soup in terms of acronyms and letters and different offices in part because there’s 47,000 people plus who worked for Mount Sinai in some capacity or another, and they all have to some extent unique needs. Graduate students and post-docs and fellows and medical students might have unique needs relative to nurses and PAs, and then ancillary supportive staff. And there are different offices driving different kinds of initiatives at different levels. And the one thing that I’d want a listener to understand is that we’re all working together with a common goal; we’re all structurally unique or separate. So for example, we’re not part of OWBR, we’re not part of STMH. We all work together, and we meet fairly regularly to coordinate efforts and initiatives. We’re all distinct with somewhat different, some overlapping responsibilities, but some distinct responsibilities. I was just thinking about how to explain it this morning, and I have an inelegant way of explaining it: one way to think about it for me is that OWBR is a strategist. If we’re thinking about a battle plan or like an army, they’re like the strategist, and they really are concerned a lot with structural issues, issues around physician burnout and initiatives around workplace experience. During the pandemic, they really–and I really need to point this out–they stepped up quite a bit and did a lot of on the ground work and continue to do that on the ground work. We (CSRPG) were started in May or June of last year. And to some extent, I think about us as like the troops on the ground, we do a lot of face-to-face care in some way: we do resilience workshops, we do a lot of walking rounds and outreach, and now we do clinical care. So there’s like the coordination, and to some extent, the execution of some very important support efforts by OWBR. But I think of us (CSRPG) to a large extent as the troops on the ground, providing a lot of that face-to-face interaction.

And there are efforts by OWBR that do the same. For example, they have wellness champions in different departments that you might be familiar with. But you know we (CSRPG) are all clinicians, in our service, all mental health clinicians, that are providing Mt. Sinai workers treatment services, as well as nonclinical services like resilience support. 

And this raises I think one of your next questions (I’m going to, I guess, preempt it) which is: should a graduate student or trainee or postdoc come to us or STMH? (Yeah, another acronym!) And I would say that STMH is a dedicated service around postdocs and students and trainees. If a trainee or student or post-doc, or resident were to call us, we would encourage them to make use of that service because it’s just for them. Not that they could not be seen by us, but that service is just for them, and especially for them with resources devoted to their care: staff resources, a physical location. So that’s what I would recommend, and we have certainly made referrals to STMH and in my experience folks get appointments fairly quickly and get seen quickly. So that’s what we would encourage. We’re still enrolled in that we’re still able to see students and trainees, but really that resource is for you at Sinai. So I would encourage you all to make use of that as a first stop.

Agathe: Thank you, yeah. And so more generally, you said that students should mostly seek care through STMH, but does your center also have some things that it can provide to students that are different from STMH?

Dr. DePierro: Absolutely. So there are services at our center that are somewhat unique to us. So for example, we have these resilience workshops around five resilience factors. I think I named four or five of them a few minutes ago, maybe all of them. The resilience workshops are not a clinical treatment service; they’re seminars about resilience. They’re in a group setting over zoom; we’ve done some in-person work. They’re available to graduate students and trainees, and postdocs. And so if you’re interested in that you could certainly contact us. We can organize one around a quorum of folks who want to talk at the same time. And that’s, co-led usually by a chaplain or a social worker, but we can certainly train graduate students or other trainees to co-lead these workshops with us, that would be an exciting partnership, and I’d certainly love to speak to THAW about that and those partnerships in the near future, that would be exciting. 

And then we have an app called Wellness Hub, which we’re really further developing. I know my colleague, Dr. Katz talked about that a bit in his last meeting with you, I guess a few months ago. So it’s an app that’s available on Sinai Central. It’s anonymous, so that means that any responses you put in we can’t link to any personal information about you as a student or employee. And right now, there are two main buckets of things that you can engage with the app for. One is that you could confidentially assess yourself. So you can do measures of depression, anxiety, of spiritual struggle, of resilience, in the app right now, by downloading it and get feedback right away about how you’re doing. It’s a color coded feedback where green is OK and yellow is a note of caution. And then you get some suggestions about things that you can do with that score being in mind. And in the app, there are resources you can engage with. There’s our contact information. You can contact us directly. You can engage with chaplaincy, you can engage with the numbers for STMH or the faculty practice there. There are videos that you can watch. We recorded five or six, I think actually six, videos about resilience that are on our website that you can watch in the app; they’re embedded in the app. So I spoke for 30 seconds about social support, but we have a three or four minute video clip about social support. We have video clips about faith, meaning and spirituality that we recorded professionally. And you can engage with those both on our website and in the app. And we’re moving in the direction of making this really a full tool for resilience, a full digital health tool that one can engage with that has action items, or we might say homeworks that you can do to enhance your resilience really as a way of offering something to the entire workforce, when the reality is that folks can’t always come to our workshop with us. So we want to put that tool right in the palm of their hand, as a way of fostering resilience, confidentially.

Jonathan: Gotcha. Yeah, I do remember talking to Dr. Katz a couple months ago, and it was really exciting to hear about all these things. Specifically the resilience workshops and this app, because they are tangible things that I think are readibly available to the student population and great resources. 

I wanted to circle back to the idea of grad students being trained to lead resilience workshops. If somebody is interested, are there currently avenues for them to get involved in that right away? Or is that something that we’re still kind of looking to introduce more in the near future?

Dr. DePierro: So we typically do trainings for co-leaders or co-facilitators in a group setting. So once we have a list of folks who are interested in getting trained, we put together a training, and then the idea is sort of from a grassroots perspective, those leaders would help bring in folks from their community, from their circles to participate in the workshops And they’d be the trusted co-leader. And, you know, we would come in and co-lead with them. So certainly anyone interested in the student trainee community can contact us through our email and set up times to meet or tell us that they’re interested in being trained as a workshop co-facilitator, and you know, also down the road, there are going to be opportunities to participate as part of our research as a research coordinator or a collaborator with us. So there are plenty of opportunities for grad students to be involved right now, but also in the future, as we build out this service.

Jonathan: Gotcha. And is the email that students should contact if they want to get involved the  MS-CSRPG@mountsinai.org? 

Dr. DePierro: That’s correct. 

Jonathan: Okay. And if I remember correctly, people interested in the app also need to email the same email address to get a download link, or is that no longer the case?

Dr. DePierro: No, we made that somewhat more streamlined. So it’s actually on Sinai Central. So those of you who use Sinai Central, you just go to login to Sinai Central and there’s an employee self service on the left-hand panel. And then we have a tab built in there that says Wellness Hub. So you have to check that, then you put in your email address, you’ll get a link to download it on your mobile device. So it’s semi automated. 

Jonathan: Gotcha, and so Sinai Central, is that a method available for everybody or–I’m not quite familiar–for example if a student isn’t an employee do they have access to it through the same way?

Dr. DePierro: I can confirm that if there’s any difficulty using that interface (you typically log in using your Sinai email credentials) if you have any difficulty, you just email us and we’ll get you a link.

Agathe: And so you kind of touched upon the future of the Center for Stress, Resilience, and Personal Growth with maybe doing more research around that, but could you maybe elaborate a little more on what you see as the future of the center?

Dr. DePierro: Yeah, so the future of the center, at least in my mind right now, is a couple of different avenues. One is to more fully develop and test and roll out our app, our Wellness Hub offering as a digital resilience tool. Another is to do many other research projects, looking at resilience and treatment approaches, even biological markers of resilience in our healthcare workers, partnering with the Depression and Anxiety Center for Discovery and Treatment (DAC) at Mount Sinai led by Dr. Murrough, the Ehrenkranz Laboratory for the Study of Human Resilience led by Dr. Charney, and OWBR. So really partnering in research with many collaborators at Sinai. We’re planning a study of a certain kind of meditation, so mantra based meditation with healthcare workers as a stress reduction and resilience building technique, a couple of other research studies that we’re planning as well.

And then down the road, whether it be this year or next, we’re really thinking about offering our resources to the broader New York city community, offering this resilience outreach and education, offering even our clinical treatment services, specialized around trauma and resilience, to the broader community. In fact, we just recently got funding from the Robin Hood foundation to do our resilience workshops with churches in the New York City community. So training local leaders at these churches buildings on some health education programming that Mount Sinai already has to engage with their parishioners around different resilience topics. So the ones that I mentioned to you are going to be sort of disseminated among the church communities in New York City, at least in the churches that we’re partnering with. 

Jonathan: Awesome. So we are running a little bit low on time here, so I was just wondering if there are any final thoughts you’d like to share with us or anything like that before we wrap up today.

Dr. DePierro: Yeah, I just want to emphasize that we’re fairly new. I guess we would be seven months old, and we wouldn’t be able to function and do what we do without collaborations. So pretty much every department at Mount Sinai, and all the ones you listed at the beginning, OWBR, STMH, many others, the psychiatry department overall, has been integral to our success. Outreach and awareness is integral to our success. And we’re not an island unto ourselves: we function as part of a greater system and we work as part of that greater system. And there’s ongoing planning and collaboration around how to best offer and respond to the needs of the workforce. The pandemic is still ongoing, but most if not all of what I just discussed are services that we plan to extend even years into the future to really build resilience as part of the average employees experience.

Agathe: Encouraging. And also, I know that the center was at first created for the COVID-19 pandemic, but you see the center going even further than that.

Dr. DePierro: Absolutely. We’re even for example partnering with human resources to integrate some of these resilience concepts into the orientation that employees get, as they join the health system.

Jonathan: So there’s some really exciting things ahead. Dr. DePierro, thank you so much again for taking the time to join us. It was a real pleasure talking to you today.

Dr. DePierro: Sure. Thank you again for inviting me and I’m happy to talk to you again. I’ll keep in touch. 

 


Interview with Jordyn Feingold: January 2021

Agathe: Hi everyone. Today we’re very excited to be welcoming Jordyn Feingold who is a fourth-year medical student here at Sinai. She has a master’s in positive psychology and is involved in multiple initiatives to promote mental health around New York City, but also especially here for Sinai students and trainees. We invited her here today to talk to us about a course that she created and is leading about positive psychology and it is in part to help students gain techniques that will stay with their wellbeing among other things that she’ll talk about. So welcome Jordyn, thank you for being here today it is a pleasure to have you. We were wondering if you could just start us off by telling us a little about yourself and some of your interests and hobbies. 

Jordyn: Sure. It’s a pleasure to be here. Thank you so much for having me. So honestly, I can just beat us to the punch. One of my biggest passions is positive psychology, and that is the science of wellbeing and human flourishing. It is one of my favorite things to talk about and introduce to others. I love teaching positive psychology and it affects everything I do: journaling, writing…  Really the way I engage with my friends and family. So it really kind of permeates my whole identity. And in addition, I love to work out, physical activity keeps me sane, going to classes now, you know, in the age of the pandemic doing a lot of that from home and I love to sing and dance. I used to be a big performer and musical theater person. A lot of that I’ve been, you know, rechanneling into teaching and a lot of things like this, which, you know, kind of scratches that performance itch for me.

Jonathan: Wow. That’s quite a diverse and very awesome range of activities. Um, so I’m wondering with this positive psychology and the science of wellbeing, I feel like these are terms that maybe we’re hearing a bit more these days, but I was wondering if you can, maybe, you know, especially as someone with a master’s in positive psychology give us a bit more of a specific idea of what exactly people mean when they say positive psychology and you know, what makes it unique within the field of psychology, but also, you know, within this larger conversation on mental health and wellness that we’re having. 

Jordyn: Totally. It’s a really good question and Jonathan, you’re totally right. I think wellness and wellbeing and mindfulness, all of these things have become real buzz words in the last couple of years. And sometimes when, when that happens, they can lose a lot of their true essence and meaning from the scientifically valid perspective from the field of positive psychology. So I’ll talk about the uppercase W of wellbeing, which is what we talk about in positive psychology. A lot of this field formerly came into psychology in its current form in the late nineties, when a psychologist named Martin Seligman, who works at the University of Pennsylvania, was president of the American psychological association. And he and his colleagues hadn’t thought a lot about this idea that psychology to that point had been so fixated on dysfunction, on getting rid of what was wrong with people, treating things like depressive disorder and generalized anxiety disorder, post-traumatic stress disorder, and all of these things that afflicted people and really led to the absence of functioning. And what they wanted to do was take a more even handed approach to the human experience and say in psychology, we’re really good at focusing on what’s wrong with people. And it’s also really important both for the treatment of these disorders to uplift the nonclinical general population to focus on what’s right with us too and really look at the positive side of the human experience. So that’s what the field aim to do. And people were doing this before. The humanistic psychologists famously Abraham Maslow and Carl Rogers, they were doing this. They were looking at things like optimal human functioning and, um, what Maslow called self-actualization, but what they were not doing was taking an empirical scientific approach to looking at that. And for positive psychology, what makes it unique from its predecessors and from the ancient wisdom of, you know, from the Bible and the Torah and the ancient Greeks, which all talked about it. So a lot of these concepts was that positive psychology was the first empirical scientific approach to measuring wellbeing with the capital W. That is what we’re talking about and that’s what I got the honor of studying. I took my master’s year between graduating college and going to medical school. And what I realized is that just like psychology is quite fixated on dysfunction, you know, traditional psychology, that’s also the prevailing notion in medicine and in healthcare. It is a lot about getting rid of what’s wrong with people and treating disease, getting people along this metaphorical numbered line of life from negative 10 to about zero or maybe positive one. And what I hope to bring with applying positive psychology into the field of medicine and teaching the course that I teach the next course is really starting to think, how do we get our patients not just from negative 10 to zero or one or two, but really from baseline zero to positive 10, and really getting them to health as something beyond the absence of disease or infirmity. So I think I answered some of your question in that. Maybe not the whole thing, but let me know what follow up questions you have.

Jonathan: No, that was a fantastic response. I really loved, you know, clearly the passion you have for it, but also all of the depth of your historical knowledge. And I really liked that positive psychology is quite a fitting name because of the way that it distinguishes itself from its predecessors within the field of psychology. By focusing again more on the flourishing aspects, rather than maybe just the correction of you know, pathology while it also is obviously distinct from maybe some other forms of wisdom and its empirical nature. So that’s very cool, I really liked that, thanks.

Agathe: Yeah. And also learning that it is more scientifically based as well is also very interesting knowing that there are a lot of techniques of wellbeing out there, but knowing that it is backed up by evidence is also more entailing to practice. So I think you kind of answered my next questions, but I’m guessing that your work with positive psychology informed your goal to pursue medicine and so I was wondering if you could talk about how you want to, if you have any more to say about how you want to kind of intertwine positive psychology with your goal of pursuing medicine. 

Jordyn: Sure, and I will say I wanted to become a doctor long before I ever knew what positive psychology was. So I grew up really loving the sciences and being absolutely fascinated with the human body, from my very first biology class in high school and always sort of like being a person who my friends came to for advice and just being able to think about things objectively. And it makes sense that I am pursuing psychiatry within the fields of medicine. But what I realized when I was really thinking about applications of positive psychology in our field is that physicians right now, and this is nothing new, this has been a problem long before the COVID pandemic. We’ve been suffering from an epidemic of burnout and really threats to physician and clinician wellbeing. And burnout has been documented in the literature for, I think over 30 years now. And it’s nothing new. It’s not even specific to medicine, but the consequences of burnout for doctors are really grave because we are responsible for taking care of the health and wellbeing of other people. And if we are suffering ourselves that really undermines our ability to do our jobs. It causes physicians to die by suicide at rates that are quite drastically higher than the general population. I think there are two basic pathways with which that I will apply positive psychology and medicine in my career.

The first is working to intervene, understand and address clinician burnout and not just aim to get rid of burnout, but really to also promote clinician thriving and flourishing through teaching through having some sort of administrative role in a hospital or health system where I could be responsible for overseeing some of these things.

And then there is the pathway of patient care and of teaching fellow clinicians, how to embrace principles of positive psychology for ourselves so that we can translate them to our patients. So I’m really excited about being a psychiatrist and an educator of other psychiatrists and other physicians. I would love to teach med students one day and residents how to really approach self-care and the way we take care of ourselves as a clinical skill, as something that is actually necessary for us to deliver high quality, sustainable patient care. And then for us to actually teach our patients how to embrace positive psychology principles and practice positive psychology skills, just like we would prescribe them a medication. So I really see that there’s a pathway here of, we need to do these things ourselves. So that we can do them for our patients and then teach them to our patients. So that they can go on and practice these things and not just have less disease, but really have greater wellbeing as well.

Jonathan: Yeah, I think it’s really interesting this phenomenon of burnout and how pervasive it is, and certainly for students as well. You know, I can imagine that the importance of finding an appropriate measure of kindness, in our dealings with ourselves and with others is super important. I would imagine, because obviously THAW is Trainee Health and Wellness, I would imagine that is a relevant part of positive psychology for trainees as well. I was wondering if maybe I’m speaking more about students now, if there were parts of being a students and basically how students could in particular benefit from positive psychology and the perspectives that it brings. 

Jordyn: Yeah, I think students are the perfect population to benefit from this. We are relatively new learners. We’re relatively young in our lives. And I think really open to forming new habits. And we’re still discovering a lot of aspects of our identities and what we want in our careers. And I guess that never really stops, but I think as learners, we’re in a position where we are taking in so much knowledge and could really use these skills in particular.

So I think for graduate students and medical students who are in such a competitive environment and surrounded by excellence all the time, it’s like, we’ve been sort of at the top of our class and everything we’ve done. And now we’re really, we bought into this environment of just absolute excellence and it can feel like, I think there was a lot of imposter syndrome that happens when we get to this, this level of our education. I think that there is often this illusion that everyone is doing super well around me and I’m the only one going through all of my struggles. I think positive psychology principles play a huge role there in helping us have a common humanity with what we’re going through and take a step back from sort of this treadmill that we we’ve been on for our whole educational lives to really stop and pause and, and practice skills like self-compassion. So this is something we actually teach our medical students in our PEERS curriculum, which is how do we, how do we treat ourselves with kindness and treat ourselves the way we would treat a close friend? I think as students in this environment, we can be really hard on ourselves and the negative, and always focusing on our deficit, what we’re not doing, how we’re not being productive can really take over and dominate the way we feel about ourselves and the way we engage in the world. So meeting ourselves with self-kindness and self-compassion is I think a huge application of positive psychology for students. Another is like the simple practice of gratitude, just pausing in the day, or developing a practice in the evening before you go to bed to reflect on what’s going well in your life and what are we grateful for and who in our lives are really helping us get to where we want to be. There are countless applications, but I think really slowing down to appreciate what we do have in this environment that can be so fast paced and just really bring out all of her own insecurities is something really fundamental.

Agathe: Yeah, I agree and thank you for bringing up all those benefits that it could also give to graduate students, because I know that some graduate students might think that these Nexus courses might be more for medical students and more geared towards that, but we thought it would be a good idea to introduce this course to them because we know under how much stress they are as well and how it could also possibly benefit them. And so just going back to your course. I was wondering what led you to create this positive psychology course at Sinai and if that was a goal of yours since the beginning? 

Jordyn: Yeah and I do want to just emphasize that this course really is for everyone, for medical students, for graduate students, for postdocs, for residents, anyone in our community is welcomed.  I’ve had research coordinators join our class, because really it’s about being a human being and learning how to care better for ourselves. A secondary goal is being able to take care of others, but primarily it’s about caring for ourselves. So absolutely applicable for everyone. Yeah and what drove me to want to build this course? I think when I came to medical school, I had just finished my master’s year. I just written my master’s capstone on this topic. And I came in and just realized that, talking about this with my fellow classmates, my new peers who I just met, there was such an interest and such a lack of knowledge about this topic. If I walked into a room of 140 of my peers, maybe 20 had even ever heard of what positive psychology was. So I was really excited and motivated by filling a gap and bringing some of my newfound expertise to which I thought would really benefit medical students. And what I ended up doing was for the summer, between my first and second year where most Sinai medical students do research that year, I ended up collaborating with the Academy for Medicine and the Humanities, because this is going to be a psychology course, Dr. Suzanne Garfinkel and Dr. Beverly Forsyth in the elective’s office. They put me in touch with my now mentor, author, Simon, who is a psychiatrist. And he mentored me in building this course.

So we made it by doing pre and post test metrics of our students. Unfortunately, we didn’t have a control group, so it wasn’t as robust a study. But we did find that even in our first cohort who took this class, we found significant improvements in their personal growth in there after taking this course, after six weeks and we found non-significant, but improvements in burnout, resilience and wellbeing, so that we did move the needle on some of these concepts, even in a short six-week overview of positive psychology. So I I’ve taught this class for three years now this year will be the fourth iteration and every year we learn more. The curriculum gets even more exciting because we iterate, we build on the stuff that the students really like. And, this year we’re bringing actually a new leadership angle. So not just learning the concepts for ourselves, but how do we then go out and bring these into the world and inspire others with these concepts? Because the whole world needs positivity right now. I think this pandemic has revealed that in such a big way. And we want to train all of our learners, not just how to internalize these things, but really how to bring them to other people’s lives. 

Agathe: Yeah, and I think it’s important also to kind of destigmatize mental illness and make it a topic that it’s okay to talk about and to teach others.

Jordyn: I think it’s super important to try to reach more and more students and people in the community as well. A hundred percent. And I want to emphasize too that positive psychology and wellbeing, these positive psychology principles, that the presence of wellbeing can actually absolutely co-exist with the presence of a mental illness. So I love this model that shows that the presence of mental health and so mental health being on a continuum with mental illness. So, you know, if we’re moving from maximum mental illness to minimal mental illness or the presence of mental health and minimal wellbeing with the presence of optimal wellbeing, those things are very much related, but they’re very distinct. So someone with a mental illness can have high wellbeing that wellbeing does not mean someone does not have a mental illness and someone without mental illness may not have very high wellbeing. So someone who’s not, you know, depressed might also might not be thriving or flourishing in life, but these are interrelated sort of orthogonal dimensions rather than the same dimension.

I want to just emphasize the building wellbeing building the elements that we talked about in the positive psychology course can build wellbeing and also move people along the trajectory. We know that these things do buffer against mental illness, but that these concepts are related, not identical if that makes sense.

Agathe: Yeah, thank you for the clarification because I definitely mix them up sometimes. 

Jonathan: That’s such an interesting way of thinking about it too, as you know, two separate orthogonal dimensions. It’s a really nice visual way of clarifying that I’m circling back really quickly to the course. First of all, it is awesome to hear that it is open to everybody and everybody’s welcome. I’m wondering more specifically if I were a student thinking about attending this course what exactly might I expect? You know, how is it structured? Could we get maybe a bit of a teaser of like what might actually go on?

Jordyn: Yeah, absolutely. So, the class, it’s a really magical space. When I was teaching it last year, we did convert from in-person to virtual cause the pandemic happened in the middle of the course. So, we do have some experience in the virtual environment, not to worry when you logged on to the class, there will be music playing, I have a playlist for every session that matches the topic. And it’s a combination of, I always do a little bit of a lecture and I try to keep it as engaging and fun and just like move it. We cover a lot of ground and not a whole lot of time. But then there’s a lot of engagement with the class. We really try to create a community and really get to know one another and self-disclose and share as much as people feel comfortable. It’s a good combination of didactic with conversation and discussion. And then there’s always some kind of experience and that experience sometimes takes place in the course hours and sometimes takes place as homework. I always assign homework, but it’s like the most fun homework you’ll ever do. And it always relates to the topic of that day. So I have a class all about love and relationships and like personal, personal, loving relationships, professional relationships as well. So I’ll assign a homework assignment to go practice a skill that will teach in the class to build more positive relationships with other people. And then on our next class, we’ll come back, we’ll debrief, we’ll talk about how it went, we’ll get into the next lecture of the next topic, we’ll experience something together, we’ll really get into it. So it’s really multimodal. I have slides, I send them to all my students at the end, so they can go back and review and I will say that there are some homework assignments that I give and, you know, the assignment is to like do something for five days in a row, like write down three things you’re grateful for before bed every night. And I have students who have made a habit of doing this for years. So a lot of the stuff just ends up transcending the course that we have together and becomes habits that people integrate to inform their whole lifestyle. It’s really cool and the sessions are 90 minutes. It always feels like it’s too short. I guarantee 90 minutes is not enough, but I think it’s really the most I can ask out of folks who are very busy and the homework should never take more than like 30 minutes per week. So that’s what to expect.

And of course, if students have any questions they can email me or people can drop in on the first course, the first class, just to see if it’s for them. And folks, if they can’t make a course time, now we have the beauty of being able to record this class so they can absolutely also let me know, like I can’t make Monday evenings, but I really want the want the course content, is there a way to send me the recordings and I’d of course be happy to do that. 

Agathe: That must be super rewarding to have people continue those habits for years afterwards and knowing that you actually made a difference in their daily life. I’m wondering if it is more suited towards students who are interested in wellbeing and developing those skills, or if you have all types of students that come, who do you think might be more responsive to your course?

Jordyn: Yeah, so I love it when we can convert someone who doesn’t believe in some of these things. I always joke. I came out of the womb an optimist, like I just did and discovering positive psychology felt to me like, Oh my God, there’s a scientifically validated way I just feel about the world that has an evidence-based to it. Like that’s amazing and incredible. So for me, discovering positive psychology was like a calling. It was like, Oh my God, like, this is how I just see the world and now I have a language to describe it. A lot of people are not that way. And even the founder of our field Martin Seligman describes it like a self-described curmudgeon.

He’s someone who is a little on the cranky side and a little bit naturally on the pessimistic ruminative side. And so, if that is you, if you are listening to this podcast and thinking like I am a skeptic, like I don’t believe in the power of quote unquote positive thinking like I want to see the science of things before I just subscribed to them. This class is also for you because it’s going to lead to richer discussions. If you are a little bit skeptical, it will challenge me to really present everything with the evidence, rather than just teach the concepts. Like I will cite the studies. I have citations all over my slides. So I really do think this course is for the believers and the non-believers.

Jonathan: Yeah, that’s awesome. Thank you for that. So you did earlier mention this idea of gratitude and, you know, I’ve definitely found genuine gratitude to be such an incredibly power within my own life. And you also mentioned that there is this homework assignment in the course such asthree things that you’re grateful for before bedtime. So I’m sure you have a ton of things you could say about this, and it may be a challenge to ask you to talk briefly about it, but if possible, for people who are maybe reading the newsletter or listening in if they wanted to maybe try this particular exercise, can you talk a little bit more about the motivations for how to do it and why it’s beneficial?

Jordyn: Absolutely. It is called the three good things or the three blessings exercise, and it’s one of the earliest studies and positive psychology interventions. And by the way, when I say positive interventions, or like one of these assignments, these are intentional acts aimed at cultivating wellbeing. So this one focuses on gratitude, appreciation, and cultivating positive emotions. That’s sort of the rationale and how the exercise works is, and you can totally do this with a partner, a friend, a parent, like it doesn’t have to be solitary, but you can do it on your own. You can keep a diary next to your bed or a piece of paper, or you could do it on your computer and before going to sleep, write down three, any three good things that happened that day, or even just three good things in your life and why those things happened. So not just the good stuff, but why the good stuff happened. So for example, I could maybe tonight I’ll write down, I got to do this great podcast interview and that was because Agathe and Jonathan emailed me. They are working on THAW and they found value in the work that I’m doing. So that would be one of my three good things. My second good thing could be my friend is visiting me from Philly, we’re able to do this because we both got COVID tested. We have our vaccines and we both got two tests and we really planned very well and we’re going to be able to see each other safely. So then I’ll write my three good things, go to sleep and maybe not think about them. We only prescribe it for five days, but what we know about this is that once we get into this habit of writing down three good things, a s I go through the rest of my week, I actually start to notice the good things as they happen in real time, rather than simply retrospectively before bed. So now when I go through my days and a stranger smile at me on the street through a mask and I can just see their face light up. Like, I’ll notice that instead of just keep going because I’m thinking, that’s a thing I could write down tonight as three-good things. What happens is our neurocircuitry starts to pick up on the positive things as they happen and our default normally is really to focus on the negative things, not the positive things. This is a way of retraining our brains to focus on the positive, not just retrospectively, but also in real time.

Jonathan: Yeah, that makes sense. I’ve been practicing also to focus on the good things and you definitely start feeling different, it’s a little complicated to do at first, but then as you continue it, you see your perspective kind of changing and that’s all, that’s all we can do, right?

Jordyn: Like there’s so little in this world we actually have control over our perspective is one of the things that we do have control over. So really this is a shift in perspective. It’s something that we can learn it, you know, it’s, we’re not necessarily changing the things that happen to us. We’re really just changing the way we react to the things that happened to us.

Agathe: Yeah and most often people don’t realize that they are in control of changing their perspective as well. And so kind of on that note, um, right now we’re going through very unusual times socially, with the climate, politically, injustices, all of this. So these are major stressors for, um, an already very stressful student life and so I was wondering like, for those specific times, if you had any tips for students on how to go about those things, to deal with such times? 

Jordyn: Yeah and I wish there was like an easy answer to this. I will say for myself that like over these last few months, you know, being a little bit more socially isolated, even and grappling with everything going on in society right now, especially this was most poignant for me around when George Floyd was killed.  I was like at a personal low, like I felt depleted of energy, I felt like I was reckoning with myself, my world, I felt like everything I once knew was very turned upside down. So I will say, this is, this is a really hard time for people, for people of color for, for everyone, quite honestly. And I’m like this isn’t an easy time and I think part of being able to embrace positive psychology is recognizing it, recognizing that it’s not. You know, like it’s not just putting a band aid on, we have to first acknowledge that healing needs to happen. And that the pain we’re feeling is real and be validated. Like I can’t just change my mindset. That’s not going to solve my problems. I just want to first acknowledge that the world is hard right now. And we have to validate the suffering that is very real and happening around us.

I think one thing that I really tried to do is to try to see the best in people and have. Have compassion for others and what they’re experiencing and have compassion for myself for what I’m feeling. There’s this great concept that I teach in our relationships course called the Michael Angelo phenomenon and it’s this notion that when we treat our partners or close people like their best selves, they actually become more of that best self. We have friends or people in our lives who we might disagree with about certain things. I think it’s really important to see them for their humanity and see them for the strength that they have and treat them well. The tendency is to be like, you’re such an idiot. Like this is wrong. Really trying to treat people as their best selves even if it feels a little hard or disingenuine sometimes, but when we treat people as their best and see them as their best, they often rise to the occasion of being their best. So I think that’s something I’ve really been trying to apply in my own life with people who I may not always agree with, but I can really see their humanity at the end of the day.

Jonathan: So Jordyn, we’ve touched on so many great topics today. Just to wrap things up as, a future clinician yourself, especially one who’s interested in working with topics like mental health and wellbeing, you’ve touched briefly on how you would like to maybe concentrate on positive psychology, for example, focusin on flourishing in addition to thecorrection of pathology.

And you also talked about the importance for clinicians to emphasize compassion both for themselves and for others. I was wondering if you have anything to add to that,  finally, like big picture, how you would like to see the fields in medicine, in psychiatry specifically, or just mental health and wellness, generally, how you would like to see that continue to grow because it is still like a new concept and a growing thing.

Jordyn: Yeah so I think we hit the nail on the head. I think it was Agathe who said we need to de-stigmatize discussions around this and I think that’s absolutely true. I think a big step to moving forward is acknowledging that mental health and mental illness is just as real as physical illness. And historically we’ve treated a lot of these things that we cannot see with an imaging modality, with an x-ray with pathology slides. If we can’t see it in medicine we’ve typically treated these things as though they’re not real. And, you know, I think we need to treat the symptoms, both positive symptoms and the negative symptoms that people are experiencing depression, anxiety as though they are real.  And we really need to validate people who are suffering have a more nuanced approach that, you know, just because I might be suffering in this one domain doesn’t mean that, you know, I can’t find solutions in some of these positive psychology problems, like looking at things like positive relationships and actually prescribing interventions to patients, to clinicians that are specifically designed to bolster the things that we know contribute most to wellbeing. So things like prescribing social intervention, like going for a walk with a friend or practicing some mindfulness. Doing something you’re good at to build a little bit of self-efficacy and a sense of accomplishment. And so I think broadening our set of tools with which to treat trainees, to treat patients using positive psychology as a base for that. I think ultimately what I think needs to happen is that we teach these things to people, not just when they’re in graduate school or medical school, but from preschool and elementary school that we teach about positive psychology in these environments. So that it becomes part of the cultural narrative that people understand how to focus on their strengths from a very young age, so that we’re not unlearning these deficit-based ways of thinking when it’s time for us to go out and take care of people and to do our science. So I think I, you know, obviously these are lofty goals, but just looking at how quickly this field has blossomed in the last few years and how medicine and science have been so willing to uptake these principles. I really do think it’s possible in our lifetime that our kids will be seeing these things in public school at a very young age and that medicine can be something in the future that is a little more positive and can focus on really health and wellbeing promotion in addition and in service to preventing and curing disease.

Agathe: Thank you. Yeah, I agree. I think that we’re seeing so many more people getting interested in promoting the wellbeing of everyone and especially at THAW we have a lot of people who want to get involved more or people who are interested in wellbeing, and especially now that people are starting to realize that it is also a very real thing. I think it’s very commendable of you to make that your goal, to put all your time and effort in promoting positive psychology and helping with burnout and everything. So thank you for all that. 

Jordyn: Thank you. It’s heartening to see more and more people interested and willing to have discussions about these topics.

Jonathan: So it’s really been an amazing conversation. It is really clear I think the passion and expertise you have in the field. So it’s always a pleasure to be able to hear and learn from somebody like that. 

Jordyn: It’s my pleasure. And I hope that I can actually see you in the class. It’s a pleasure and I’m so grateful in all the work that THAW is doing and has done over the years to build the health and wellbeing of trainees and postdocs and students, I think it is absolutely fantastic. And it’s so great to see these efforts happening. 

Jonathan: Definitely. So, yeah, once again, thanks for joining us today, Jordyn. 


Interview with Mickie Brown: October 2020 

Jonathan: So good morning, everyone. We’re really excited today to have an old friend back with us we’re seeing on this morning with Mickie Brown, who is a registered nurse and board certified holistic nurse, and the clinical manager for education, mindfulness, and patient wellbeing and at the Center for Occupational Health, and the World Trade Center health program here at Mount Sinai in New York City. Mickie first came to Mount Sinai actually back in 2001. And since then her path has really intersected increasingly with mindfulness practice. And she now teaches mindfulness not just to members of the community, but also helps leveraging occasion settings. So I don’t want to steal too much of her thunder. But just to give a quick background on so Mickie, thanks so much for joining us today and being with us.

Mickie: Thank you for having me. I’m very excited to be here.

J: So I was wondering if you could get us started, maybe just by giving a quick background on your career, especially here at Mount Sinai? And, of course, how did you end up kind of crossing paths with mindfulness stumbling across that, and designing to incorporate that to such a large degree in your career?

M: Oh, thank you for that question. It’s dear to my heart. It was actually my patients that brought me into the mind body realm. Working with the World Trade Center responders, I very quickly realized how anxious they were about their health outcomes because of their exposures. And so I would teach them things like how to alter their breath to do diaphragmatic breathing, to reduce their anxiety. And they really appreciated that. And so I wanted to learn more myself about the mind body connection. And so all the way back in 2007, I attended my first seminar at the Center for Mind Body medicine, it was in Minneapolis, I believe.
And the Center for Mind, Body medicine has several modalities, imagery, autogenic training, which is almost like self-hypnosis, meditation, writing, drawing. So it’s a different protocol than the mindfulness protocol is. But what I quickly learned when I attended my first seminar was that it was not about how we were going to teach this to our patients, it was how we were going to incorporate it into our own lives. And most of the health care providers that were there were rather dismayed by that, because we all went so that we can help our patients. And that’s what we do in health care, right? We want to help others. And there’s a lot of joy that comes from that. But if our own being is not balanced, and calm and present, it’s very difficult to help others. And so what I learned was that they were spot on, I really needed to practice this stuff. And because of that, I feel like I’ve had a wonderful career in healthcare, I haven’t burned out. And it’s really because of these practices and my own meditation practice that has really allowed me to continue to be present for many years beyond what I ever dreamed that I would still be in the healthcare field.
And so I really thank my patients for leading me to this path. And then I started teaching them at the World Trade Center health program. And as I began to delve into the science of meditation,
and mindfulness was beginning to get more press, I could see the wealth of research that pointed to mindfulness. And of course, in a medical institution, we want to see the evidence for these practices. And so my own practice began to shift to mindfulness. And I began studying at the University of Massachusetts
under the Mindfulness Based Stress Reduction to teach that particular protocol. And so today, to my amazement, we teach the Mindfulness Based Stress Reduction protocol, to faculty as well as employees. And if you would have told me this 10 years ago, I would have said, I don’t think so. But here we are today. And so I think in this age, over stimulation, and increase
stress, it is so necessary to incorporate it into not only patient care, but the health care providers and the employees.

J: Well, thanks so much for that thorough response. I think it’s really interesting you point out this, the need sometimes for practicing and incorporating it into your own life first, and having that good foundation. And it makes me think, too, about how sometimes you emphasize too much this idea of practicing kindness towards others, and yet somehow we’re able to kind of skip over for ourselves in some way, you know? Now, before we get too much further, since, you know, considering how much words like meditation and mindfulness are popping up all over the place today, you know, in our everyday speech, I was wondering if you can maybe tell us really quickly by giving us a bit more of an exact sense of what exactly you mean, when you’re talking about mindfulness, and meditation, and maybe how these things are or aren’t the same?

M: Yes, so mindfulness is simply being present. And it’s quite the opposite of how we as humans, function, because research has shown that 46.9% of the time, we are not present in this moment, we are multitasking, we’re thinking of what’s already been done, or what is going to happen in the future planning for the future. And the research also shows that when we’re not present, we are not happy, we are happier when we are present, whether it’s washing the dishes, or feeding the dog or walking from one place to another. If we can actually establish a sense of presence, then we are going to be happier, there’s going to be less stress. So it behooves us to practice. And so there’s two different types of practice. There’s formal practice, and there’s informal practice, the formal practices of meditation that we often think of when we think about mindfulness, and that actually trains our mind to come back to a central focus, whichever we choose for that to be, whether it’s our breath, whether we’re doing a body scan, whether we’re doing walking, meditation, there’s so many different types of meditation that we can do. But that’s how we train our brain is kind of like going to the gym for your body. you train your muscles so that you’re highly functional. As you walk through the streets of New York. We train our mind so that we can be present in our lives. Does that make sense?

A: Yeah, it does. I guess it’s when you say it’s about being present. It’s not only about being present, but acknowledging that we are present. And feeling what we are doing. Enjoying just a moment. Is that what you mean, right?

M: So yes, and no. Um, so it is being present in a particular way, the classic definition by Jon Kabat Zinn is being present in a particular way. And that is on purpose in the present moment, and without judgment. And of course, as humans, we are really good at judging.
But that moment, could be a wonderful moment. And so we, when we’re present, we can’t really relish those beautiful moments in our life. But just as we have beautiful moments, on the other side of the spectrum, we also have moments that are not so beautiful, right? And so it’s really the acceptance of both and being able to be present. Acceptance is one of the attitudes of mindfulness, there are several attitudes, but acceptance is one of them. And so we accept the good and the bad, and everything in between, but we can actually create the capacity to be present for all of it. And through that acceptance, we can then explore possibilities. But until we accept, this is the way it is right now we’re kind of battling against whatever we don’t want to happen, rather than saying, Ah, this is the way it is. And so, okay, I accept that. And now what can I do about it? So we really open ourselves up to possibility when we can accept what’s present. Does that make sense?

A: Yeah, it does. It clarifies it much more. And it’s a really good philosophy I find. I’m just wondering now like since this podcast is really for students and trainees, how do you think incorporating that in their daily life can benefit them?

M: So the challenges, of course, that students have is, is huge in that you’ve got a lot of demands on your time, right. And so sometimes we tend to think, Oh, my gosh, there’s never enough time, when we can actually be present for all of the moments of our life, time tends to feel like it’s expanding, versus when we’re not present. We’re always thinking about what just what happened before, or planning for the future. And time seems to escape from us. And so the actual acknowledgement or the actual intention of being present, and really focusing on what is in front of you can really tend to expand time more than contracted.And so there’s various ways that you can do this. You can establish your own meditation practice, and you probably will say, Oh, my God, Mickie, I have no time, how can I possibly fit that into my day. But I would say, even if you sit down at your computer and say, you know, I’m just going to follow my breath for one minute before I begin, and I’m just going to notice, where is my body tense, what am I holding in my body, because the body is always telling us what our stress level is. And we all feel stress in a different way in our body. And so if we can be present for that for just a moment, before we begin, that’s a little act of self care. And it’s being intentional about your practice. And so ideally, I would love to say to you practice for 20 minutes every day, but that may not be possible for you. And so we have to be realistic, how can we fit it into our day, so that you can
increase your capacity to focus, you can decrease your stress. And so that’s one way that you can do it.
And another way is use your transitions wisely. So often, when we’re going from one space to another, we’re actually looking at our phones, right? Have you noticed in New York, how everybody’s got their face, in their phone, constantly even walking down the street, walking across the street, yeah, put your phone in your bag, or put your phone in your pocket, and just be present, take a look around you. Our body is always in the present moment, we are not feeling a sensation of yesterday or a sensation of tomorrow, we are feeling the sensation of this very moment, we are taking the breath of this very moment, we are seeing what is available to us in this very moment. We are smelling we are hearing what is here in this very moment. And so it’s through these pathways of our body in our sense doors, that we can come into presence into awareness of this moment right now. And so taking the opportunity, it’s not going to add any time to your to your day. But rather, you’re going to be living rather in a different way. So you can actually take a look around as you’re commuting from your home to to to school,
or vice versa. And make that your challenge. Make that your commitment. I’m going to turn off my phone, I’m not going to have my earbuds in my ears, I’m going to be very present. And I’ve given this challenge to people in my classes. And they do come back and say, Wow, that was a whole new experience. At first they kind of go, oh, Mickie, I can’t do that. Wow. Really? Yeah, really. And they come back and they say, you know, I did feel less stressed when I got home. And you’ll notice that your mind is going to be thinking about what you did during the day, or planning for what you’re going to do in the evening. But the point being you bring it back into focus of what am I seeing, looking around, noticing the colors, the shapes the sounds, and feeling your feet touching the ground, feeling your legs moving through space, so really grounding yourself in your body. And when we can do that we become more balanced, we feel more balanced, the mind and the body are one.
And to acknowledge that and to really live in our body can really provide a sense of balance and grounding.
I think a nice, quick, concrete exercise I use just to make you seem to be to just take minutes for getting started sitting on your computer to kind of do a body scan and notice any areas of tightness be fueled by breath for the body.

J: So it also sounds like you’re describing a lot of just, you know, being more tuned in and aware of surroundings during the day to day, would that be more in line with the kind of informal practice that you were talking about earlier? So I did have one question that I wanted to kind of interject real quick as well. So it seems, you know, at least for me, that sometimes mindfulness is described in these such wonderfully simple terms, you know, just being present and aware. And, you know, as you were mentioning earlier, it actually is something that is counter intuitively not always what we as humans want to do. But it kind of sounds simple on the face of it. Oh, it just seems like sometimes it’s easy to say, you know, Wow, that sounds awesome. And when a minute, say, you know, half an hour, 45 minutes every day, you know, in a formal way, but then kind of fall short of that. But I was wondering as well, for those who are interested in maybe in developing more formal practice in their life? Do you have any advice on a good way to start integrating that into their life in a way that’s realistic and feasible? Maybe some resources on that?

M: Yes. Thank you for that question. Creating a habit can be challenging, as we all know,
when we’re just creating the habit of going to the gym, how often does our bot just wake up in the morning and we go, Oh, no, I’m so tired, I really need to stay here and sleep. And so the same thing holds true for any habit that we’re creating. But, again, creating our intention around that habit, this is what I want to do for me, can kind of be motivating to get us through those periods when we don’t have a memory of it. And so there’s nothing in our mind that says, Oh, yes, you’re going to get a reward at the end of this. And mindfulness builds slowly. And so I always say meditation is not like medication acts very quickly, meditation builds. And so you begin to see the results of your practice over time. Today, we are fortunate to have so many apps and apps that I refer my patients and my students to our there’s two free ones. Mindfulness coach is one that was developed by the VA, it’s totally free. It’s very linear, I would recommend that one. And then there’s another that was developed by Richie Davidson at the University of Wisconsin, who’s a neuroscientist, and it’s called Healthy Minds. And I believe they’re also doing research around that, too. So that’s another totally free app. headspace is an excellent app, but you do have to subscribe to it after I think it’s 10 sessions. So for many people that’s not within their budgets. So there’s plenty of them out there that are free. So those two mindfulness coach Healthy Minds, and insight timer is another one that I really love. Yeah, so there’s plenty of meditations on there that you can access, or they have a wonderful timer. And I like the timer too, because I kind of do my own meditation, my own guidance often.
And so the timer has many different sounds of bells. And a bell is really like a call to presence. Throughout the day, they will ring a bell. And that’s a call to presence. Everybody in the monastery on the ground stops.And they’re just looking around, just like I suggested earlier, opening their sense doors to what is here presently coming into presence in this moment. And so I love the sound of the bell, it kind of brings me into presence through my hearing. And so I use that. So those are three that I would highly recommend and the fourth one being headspace.
But there’s many, many apps. And so the idea is to try it to set your intention. And if all that you think that you can do is two minutes to begin with, that is not to be scoffed at that is to be embraced and to say I gave myself those two minutes to just be we are human beings, but we tend to be human doings. And so how can we come back to that human being and it is through this pathway of really coming into stillness coming into presence, that we can really
fully embrace our life, all the moments of our life, whether they’re the challenging ones, or whether the beautiful moments.

Agathe Thank you for that. It’s very soothing to hear you speak and to hear all that advice. It is very useful. So thank you. I know that you lead some classes through Sinai Calm?

M: Yes.

A: Could you talk maybe about those if students would be interested in hearing more about you or practicing mindfulness with you? And if you have, if you do other stuff on campus, do you also want to talk about those?

M: Yes, thank you so much for that opportunity. I get the classes through Mount Sinai calm, I often say to people, we are so fortunate at Mount Sinai to have this wellness program. And Mount Sinai calm has many offerings. And you can go to their website, Mount Sinai comm.org. Or you can also just send me an email, I send out an email for each of my classes I teach on Monday from 530 to 630. Tuesday from 1230, to one and on Thursday, from one to 130. And so for each of those classes, I send an email talking about what is the topic for today, and like today is around acceptance, one of the attitudes of mindfulness. And they’re drop-in. So you can if you arrive 15 minutes late, that is not a problem. If you have to leave 15 minutes early, that is not a problem. If you can only stay for 10 minutes, that’s perfect. So we’re, you know, their flexibility is key to really allowing people to just take advantage of what’s available to us. And then there’s yoga classes, I send out the schedule for the week, each Monday. But again, you can go to Mount Sinai calm website and you can take a look at their classes. I also teach for faculty and I know that we had a session at the beginning of the pandemic, which I would be happy again to explore that opportunity for the students. So I teach for graduate medical education and for faculty as well. So there’s a lot happening at Mount Sinai around mindfulness, I am so happy to say, again, I feel very fortunate to be part of this institution part about Sinai calm and for the programs that that GMA offers.

A: Yeah, for sure, because we might take it for granted here. But it is very rare that schools integrate so much mindfulness or meditation practice into their program or have offerings for that. So yeah, I think that’s a, that’s really great. And I was just wondering, kind of what your sessions entails, the classes that you teach?

M: So what we typically do is we begin with an arrival meditation, because oftentimes, we arrive in a space and our body is there but our head is someplace totally different. And so coming again, through the body, through the pathway of the body, in the senses, we arrive in the space. And then we talk a little bit, I talk a little bit about what the what the what the subject is for the day. And then we do a longer meditation around that. And that’s about it. That’s as much time as we have time for in the Monday session. Because we have a full hour, we typically do some movement, as well as some sitting meditation. And movement, of course, is a wonderful way to meditate, we really bring our mind into the sensation of moving, which, fortunately, as humans, we do automatically. But when we bring our mind into that movement, it becomes a meditative process. And so we do the movement, we do the sitting meditation and didactic portion.
So anybody can come in, like I said, at any point.

A: Yeah, I remember sitting through one of your sessions, and I really enjoyed it. I think it was pretty mind blowing.

M: Yeah, thank you. I think that was a session that we did on a Friday, wasn’t it for? It was mindfulness Friday. Yeah, that was really, we started that a group of mindfulness teachers started that probably about seven years ago at Mount Sinai, and typically, there were a lot of people from the Martha Stewart center that come and they continue to come. Our oldest.
The person who was the oldest, I believe, is 95. And you know, there’s there’s a really hard core group that started with us and continue and what is so wonderful is that they came into mind
illness is really a late stage in their life. And they have really embraced it, it’s really helped them to, to be present for the aging process, which is wonderful.

J: See, I think I remember you could, you know, hear how, I guess passionate about it, these community members were in their questions, and you know, the way that they engaged with it. And of course, also remember, as I was saying, the way that you are able to have this really awesome, you know kindness in the room. And I remember that one time we did the zoom meetings, that zoom facilitates mindfulness session, even though we didn’t get a lot of people, I think it’s, it’s really great that you’ve been able to kind of also keep that up over zoom as well, not an easy task at all.
Yeah, I would like to maybe, again, if you don’t have any other questions, or I would like to circle back to one last thing, just before we end up in for today on this idea of acceptance, I think, can be such a powerful and even radical one. And I guess the idea of radical acceptance to sometimes used in, as far as I’m aware, in therapy in dealing as a tool, I guess, for dealing with trauma. It does seem to me though, that it can be the idea of acceptance is something that often, it seems like it has to be more organically motivated by the person, it’s kind of hard to tell someone you accept this has happened to you. And it’s something that is a lot more powerful when it comes from the person themself. But I imagine mindfulness has a role in facilitating this right? I was wondering if you had any perspectives on that?

M: Yes, that’s a really great observation, Jonathan, because when somebody tells you, you just have to accept this, I think that’s when our resistance goes up. But when we begin to understand when we can internalize the benefit of acceptance, that when I can just say to myself, this is what is present, right now, going back to that definition of mindfulness being present in a particular way, on purpose, in the present moment, and without judgment.
That is, what acceptance is about is really just saying, this is what’s happening. And with everything that’s happening in our world today, once we can accept this is what is happening, then what can I possibly do about it? What can my role be, rather than railing against it? Which is our tendency, right? We talk to our friends about it, we, you know, talk to about the others that don’t think the way that we do? And honestly, what good does that do us? We become
overwrought with emotions. And yet, if we can just step back for a moment, take a breath and say, this is what is happening? How can we, as a population learn from this? What is my role in this? And, you know, there’s a ripple effect of everything that we do. I’m sure you’ve walked into a room where there’s somebody that whose energy is so toxic. And we noticed that, and so energetically, we’re all connected. And so how can we be present within the turmoil of our world today? And, you know, in a positive way, in a way that’s nurturing ourselves and nurturing our community around us? And so acceptance is one of those pathways to having that positive energy.

J: Absolutely, I think a couple great ideas that you highlighted, there seems to me to be this idea of observation and suspension of judgment in particular.I think a lot of people point out this is aphorism that, you know, we can’t control much about things that happen to us doing things that generally does fall under control is our response to goes on around us. And I think that’s another example of that thing that you really have to kind of discover for yourself more, I guess, but, and another thing being this idea of, of remembering their connection to others, and the fact that we are part of a whole and so you know, of course we have a responsibility and we need to take care of that in the way we deal with others around us. But then I think past that sometimes there can be too much anxiety you know, once we’ve done what we can do. I think it can be helpful to remember that we are part of the whole and you assimilate us to certain extent to make our peace with what we what is beyond us, you know and to just do our best to show love.

M: Absolutely, yeah. I love what you said Jonathan about responding rather than reacting. And that’s really what we learn. I think you’ve used you’ve heard me use this quote before between Steven Victor Frankel’s beautiful quote, “between stimulus and response, there is a space”. And that space is our power to choose our response. And in that response lies our growth and our freedom. And so I really think that this is what we’re being called to in this in this chaos in our world, how are we going to respond rather than react? and agree?

J: Yeah. And mindfulness practice can help us grow that space.

M: Right. And maybe it’s only Yes, a slight little bit in the beginning, but we can get more and more able to stand in that space and be able to, to extend it.

J: Okay. All right. So I think that’s about all the questions we had for today. So once again, for anybody listening in, I really, really highly recommend that you go ahead and check out some of Mickie’s workshops, especially mindfulness, Mount Sinai calm that’s currently available, just you know, for the general community. She’s obviously fantastic at really facilitating these kinds of things. And Mickie, thank you again, so much for joining us, for sitting down with us again today. I really appreciate getting the opportunity to talk to you again, and I you know, of course, again, I hope that you know, we run into each other again someday soon.


Interview with Dr. Craig Katz: September 2020

Get the wellness app that Dr. Katz mentions in his interview by sending an email to Lindsay Katz.

 

Agathe: Okay, so hi everyone! Today, we are talking with Dr. Katz, who is a psychologist here at Sinai and a clinical professor of psychiatry. He’s also the head of the global mental health program at Sinai. And today he’s gonna talk to us about the resilience center that opened at Sinai for students and employees to learn about resilience and work on their resilience. And yeah so he’ll be talking more about this today. Hi, Dr Katz, good morning. So would you mind introducing yourself and maybe what you do at Sinai and how you promote student wellness for students here?

Dr. Katz: Sure. Yeah. So my name is Craig Katz, thank you for the introduction and for having me. I’m a psychiatrist here at Mount Sinai and I’ve been here at Mount Sinai for a long time now, about 20 years. I’ve done a variety of things in global health, in medical education, and actually in public health education where I run a few courses in the MPH program. I have a background in disaster psychiatry from way back when I got involved in disaster work when I was a psychiatry resident. And it was because of that, that I became involved in our new Center for Stress, Resilience and Personal Growth, which is a center that was started here at Mount Sinai in April as the pandemic was hitting, hitting us real hard, as a center that would address the psychosocial needs of our employees, our faculty and our students, everyone, basically across the whole Mount Sinai health system. The center is run by Dr. Deborah Marin and Dr. Jonathan dePietro,  the clinical director. I’m serving as what we call a special advisor, I’m the smarty pants from previous experience, because I’ve helped set up our 9/11 program, our world trade center program, after 9/11 for our responders. So it’s based on that experience that I’m involved in helping set up the center. And the center is meant to be a place like we said that would address all pandemic-related issues. Certainly the mental health needs of everybody who works or learns at Mount Sinai.

Jonathan: Awesome. Um, so it’s really interesting that you mentioned that. I actually wasn’t aware that this was started during the pandemic to address that particular stress that, you know, particularly disaster, I guess. So, of course, I would imagine that you guys plan on sticking around even after the bulk of this crisis rolls past. So I guess, like, more generally, how do you guys understand resilience in the context of an academic institution like Sinai? And for trainees, even, you know, like, just generally in the long term as well, what might that look like, in terms of a community like Sinai?

Dr. Katz: Yeah, it’s a good question. I mean, we certainly plan to stick around as much as our resources permit. Of course, you know, saying after the pandemic, right now, it’s a little hard because we don’t know what the answer is right. And it’s actually very different from other, you know, large scale events, other disasters, because it’s an ongoing thing. So yeah, so we don’t know how long this is going to go on. But we do know from past research and experiences that the aftermath of a large scale trauma can go on for years, right, our world trade center program is still operating, its focus on rescue and recovery workers is still, you know, quite busy 19 years after 9/11. So you know, when a disaster happens and even when it’s a one day event like 9/11 the mental health ramifications can go on for a very long time. In fact, some experts say that the mental health recovery goes on about this estimate about 10 times longer than the structural recovery, like, you know, the infrastructure recovery. So yeah, we’re planning to be around for a while. I mean, we hope that the needs don’t last that long, but we project otherwise. And we are particularly trying our hardest to work with other programs at Mount Sinai, right?  There’s the Office of Well Being and Resilience, which I’m sure you’re familiar with, with Dr. Ripps work, and we are particularly working with him because he was focusing on, you know, wellness and resilience more broadly in the day to day of life before. And I myself used to be one of the advisors to the student wellness committee in our school of medicine for a number of years. So we know that, in addition to the exposure to an event that causes a potentially traumatic impact, we know that people have vulnerability factors, risks, right. And so we know that whatever people brought to the table before the pandemic is going to potentially make them more or less vulnerable to its mental health impact. And in that sense, talking about resilience that’s in our name. And the idea of resilience is very much at the core of our program. Because we know that our students and our employees, our faculty, demonstrated remarkable resilience in responding to this event. And we want to nurture that and we want to be able to help people build on their strengths, right, we don’t want to just focus on the mental health impact, because we know that traumatic events can spark our  resilience within us. So we want to kind of rebuild it a little bit for people to fill up the resilience reserve that they have for the future. And we also know that people can often go through what we call post traumatic growth, you know, in the struggle to get through a traumatic event, like the pandemic and actually grow from it. So we want to foster that as well.

Agathe: I see. And so how exactly do you help to foster growth and resilience, more concretely, what is the center going to offer to students? 

Dr. Katz: Yeah, we have very specific offerings. Thank you. So one is we’ve developed an app called the wellness hub, which is a design that we print out, we have it available for iPhones, it’s going to be available for Android soon. And it’s meant to be an app that’s completely anonymized. It’s confidential. And it enables you to self monitor for various mental health issues related to trauma, the pandemic or otherwise, it also has a number of resources, ways that you can contact us, or contact the Office of Well Being or, depending on the context, Student Trainee Mental Health. It just has links to all that. And we’re slowly building on it so people can do journaling as part of it. So the Wellness Hub, that app, is one aspect of it. The second aspect is that we have resilience workshops. So you may be aware that Dr. Charney and his colleague wrote an incredible book on resilience. That’s more of a popular book, but it’s not surprisingly evidence-based. So it’s a really, really good read. And we developed a curriculum of workshops based on that book. And the book talks about 10, different resilience factors. We have written a series of 11 workshops, one, an introduction to resilience, and then one on each of the resilience factors. And we’ve been training people to lead these groups, and actually having people participate in them. We’ve been working so far with physician assistants and nurses. So far, we didn’t expect people to attend all the workshops, we’re not sure what the right dose of workshops is, this is a completely new idea. But we’ve also found, practically speaking, that people find it hard to attend a lot of workshops. So we’re probably going to be condensing them down to five workshops, combining some of their resilience factors that overlap. And to give you an example, some of those factors would be spirituality, finding meaning and purpose is another resilience factor, facing fears and other ones. So we have those workshops. And those are being led right now by social workers and chaplains. And we are trying to have them co-led by PEERs from different peer groups, like for example, a fellow graduate student. And then we also offer mental health screening. So the same social workers that are co-leading those workshops are also available. They do two things: one to meet with you to discuss your resilience plan individually. There’s an idea of focusing on writing up a plan to focus on the different resilience factors that one would like to nurture and how you’re going to do that. So the social workers can meet with people to do that. And they could also just do a mental health screening, based on whether you screen in on the app, or you just have the idea, I think I need help. You don’t need to go through the app. Our social workers will meet with you remotely, all this is still remote and conducted evaluation. And then we offer treatment, of course, either in our collaboration with the Department of Psychiatry or various outpatient programs.

Agathe: Yeah, that’s a lot of offerings. It’s great for students, I’m happy we get to advertise it.

Jonathan: It is much more than just the resilience workshops that I think people are focusing on.

Dr. Katz: It is. I think we’re tending to maybe highlight the resilience workshops, because that’s really the, I’d say, the fairly unique aspect of this, I think, and one that we think might have the broadest appeal, if people feel that they could fit it into their schedules.

Agathe: And what do people do during those workshops?

Dr. Katz: Yeah, I mean, the workshops are a mix. It’s kind of a mix of some learning, but mostly sharing. In other words, we sort of prompt people to think about, for example, one of the resilience factors is “ funny,” resilient role models. So we asked people to really, you know, think about, you know, who’s been a role model for them in the course of the pandemic? What is it about them that’s made them a role model? Have they thought about trying to emulate them? And how have they spoken with him about what makes them resilient? We’ve had very lively discussions around that, actually. And so yeah, so it’s a mix of little blurbs from the book, like little facts about role models, quotes about, let’s say, role modeling, or whatever the resilience factor and getting people to be thinking about it. But mostly, you know, what we want people to do, is to share, we just believe that, and one of the resilience factors is social support, but really, what the workshops are about across the board is support, right, just in the sense of sharing and connecting and engaging and hearing what your fellow students, co-workers, with their experiences, like, and not feeling so alone with what you might be going through, and kind of normalizing it. So I think that beyond the actual details of the individual resilience factors, it’s that that aspect of the process that might actually be the most, maybe especially helpful for people.

Jonathan: And so, you know, having been around the medical and scientific community for so many years, I’m sure you’ve encountered this fact that sometimes, I guess, perhaps particularly in the scientific community, that people can be perhaps a bit more private or like, feel like you need to present this image of objectivity, professionalism, and perhaps be a bit maybe skeptical or a bit nervous or worried about maybe engaging with these kind of things with people from the community as well. Is that something that you’ve ever encountered? And is that something that perhaps you might be able to speak to a little bit or I would imagine that it’s a little bit self selecting that if you know, you’ve shown up to the workshop, you’re presumably, you know, started out as well. So I don’t know if there’s anything you’ve ever run into? 

Dr. Katz: No, I think it’s a really good question. Yeah, I actually agree with you. I mean, if you’ve shown up for the workshop, then probably the hardest part is over. And in some sense, people are going to self select for their willingness to do it. And that, in some sense, we kind of want to reach out to the people that don’t self select, although it may not be for everybody. We’re not, we don’t want to be too prescriptive here. But yeah, I mean, the idea that at the Medical Center, you know, we’re science based, and we’re objective, and, you know, we put on our professional attire and our professional demeanor. And it’s certainly, you know, I think, a pretty pervasive tone in the medical academic medical centers. But I think I’m inclined to say we’ve probably shifted a little too far towards that kind of idea of sort of science and facts and neutrality, in a way from actually what medicine often used to be, which is much more spiritual and synthetic, and, and less analytic and more inductive. And I think events like this, where people almost, whether they like it or not, where their emotions are on their sleeves more and where it becomes more acceptable to be emotional. And to be more, I guess, less analytical. It’s essentially an opportunity to open up awareness about mental health. We certainly saw that after 9/11. And I think these are moments where you can reduce what you think might even be referring to some sense of stigma about mental health and stigma about sharing, opening up. This is an opportunity to do that.

Agathe: And so what kind of students do you think do sessions would benefit more?

Dr. Katz: Well, I mean, firstly, anybody, well, if anybody is kind of struggling emotionally in any way, not that these are meant to be mental health treatment, but it’s a good place to kind of start sharing and thinking about it. Depending on how much one is struggling, one may want to not just pursue the workshop or skip over the workshops and, for example, seek out student training mental health. But so, I mean, one is if you’re struggling, but two is if even if you’re not, right. And if you’re someone that wants to think about what makes you tick, what gives you your, your backbone, and what helps you to bounce back or be strong in the face of adversity. These are great, great places to be thinking about that. And they’re also a place to, I think, learn about your fellow students and staff. We’ve gone back and forth between whether we think the group should be homogenous. In other words, like, you’d have a group of all MPH students or Masters of Science and clinical science students, or just all students or do you have a mix, and you have a mix, even with employees, I personally think a mix. A mix is a good thing. We work in a center where it’s multidisciplinary, and I think mixing with others, and maybe getting outside of our bubble a little bit would be a good thing. And so it’s a chance also, I think, to feel closer if you’re the kind of student that wants to really know, immerse yourself in the Mount Sinai community in a way you haven’t before. I’d like to think the workshops are a chance to do that.

Agathe: I had a few other questions, like more technical, but, um, so you mentioned up the Wellness Hub app? Is it completely confidential? I feel like students might be worried about using it and having Sinai use their data? Or do you know what privacy there is for that?

Dr. Katz: Yeah, I mean, it’s not research. We’re not doing any research. So all your responses are, or anonymize it or not, and I’m not being you know, we don’t know who you are. So you need an email to be able to register with the app, but the app doesn’t then record it.

Agathe: Okay. And are any of the meetings and workshops of any kind recorded? 

Dr. Katz: Yeah,  they’re not recorded. What goes on in the group should stay in the groups now for, obviously, for the mental health screenings, we have to that’s a different story. That’s a clinical activity. But even then we don’t. We have a separate HIPAA compliant record in redcap. Not in epic, so it doesn’t go into your medical record. 

Agathe: It’s a great way to identify students also, who may need help. And so my last question is, so you mentioned it would be like five workshops. Do you know how long those workshops are, and if they’re all in one week, or if students can choose?

Dr. Katz: Right now, they’re scheduled to be 45 minutes, we found, some people suggest we do 30, it just just can’t do 30 minutes with the group. an hour some people suggested was too long. But as to when, we’ve been scheduling according to different groups’ needs. So there’s not a set schedule. I mean, we’ve generally found, it seems like maybe lunch or certainly late afternoon seems to work for a lot of groups. But like, I know, for example, for public health students, a lot of classes will be happening in the late afternoon. So we are prepared to work with different groups to figure out the timing that works best. And again, ideally, with different groups, let’s say, you know, graduate students of different stripes, we would have some of them undergo a training to become a workshop leader. So you could co-lead it with one of our social workers or chaplains, for example.

Agathe: Oh, yeah, that’s nice. And so yeah, how can we sign up for those workshops?

Dr. Katz: I can introduce you to Lindsay Katz. No relation to me. She’s our coordinator. And she can give you more information about participating in workshops and also getting access to the app. 

Agathe: Okay, sounds good. 

Jonathan: Okay. Well, thank you so much, Dr. Katz, for this interview.

Dr. Katz: Thank you, thank you for your interest in it . THAW clearly does some really great work and is very present. And I’m really, really glad you guys are on the case.

Agathe : Yeah, we hope students will find it interesting and will want to join but we’ll do our best to advertise it because it seems like a great resource.

Dr. Katz: Thank you very much. Thank you. Bye.


 

Interview with Rachel Potter: August 2020 

 

R: Rachel

A: Agathe

J: Jonathan

 

A: Hi students and postdocs. My name is Agathe and along with Jonathan , we are responsible for THAW Communications. Today we are interviewing Rachel Potter who is a social worker here at Sinai and who offers free one on one counseling sessions for us students. We thought it would be helpful for you guys to understand what Rachel Potter does and how she can help you throughout your grad school journey. Hi Rachel, do you mind introducing yourself and your work?

R: Hi, yeah! I am a licensed social worker at Sinai in the patient pulmonary department so I work with patients with lung disease. I’ve been doing wellness groups and different wellness initiatives throughout the hospital over the past years. Sometimes that is doing groups on specific topics with trainees, residents, fellows, sometimes it is individual sessions and we can address all different issues including things like burnout and work life balance

J:That’s awesome. And for any folks listening I want to let you know that they started drilling on top of me but I will try to stay on mute as much as possible. Alright so I think we can go ahead and get started with questions. So Agathe, do you want to take it away?

A: Sure, yeah! So, in general, thinking about an institution like Sinai, what role might a social worker play when it comes to supporting trainees’ health and wellness and especially during those one on one sessions?

R: I think that the role of a social worker in this kind of wellness program is more for short term intervention, helping people get access to resources. Maybe someone is struggling and they’re not sure where to find certain resources or they need a quick brainstorming session on how to handle anxiety around the pandemic or adjust to working form home or something like that. It is quick problem solving sessions, it might be a couple sessions, it might be one and if somebody is really needing more ongoing care or really struggling with depression or anxiety or other more severe mental health issues then STMH would be a great fit for them. 

J: Got you. Is that more similar to what you guys do overall more generally with a diverse population as social workers or is that more aimed towards more the student/postdoc community?

R: That is some of what we do overall. Social workers can do  a lot of different things, we work with adult and children. In the hospital we help with discharge planning and accessing barriers to care ,issues with getting access to medication and transportation and mental health and coping with chronic or acute illness. The scope of what social workers is pretty wide but when focused on students and postdocs this is how we can best serve you guys. 

J: Definitely. And you mentionned that during these one on one sessions are more of short term solution. I would imagine that would be one of the differences between doing these counseling sessions vs. therapy but are there other main differences between counseling sessions and therapy that might make one more appropriate for a person in a particular situation over the other?

R: I think the severity of the situation can be part of it and the length of the relationship, those are definitely things that can be part of it. I think if somebody is looking for, if you are dealing with an ongoing situation that is troubling and there isn’t a way to solve it then counseling or therapy might be a better fit. If you are looking for more coaching and concrete way sto go through a situation then I think the counseling or working with someone like me might be a better fit. It is a little tricky because social workers can also be therapists so in certaincontexts they do provide therapy but with the student trainee program we are doing more of the short term coaching and STMH is the great mental health ressource for people

A And so when you say that you direct them to different resources do you mean ressources within Sinai or more ways to cope in general in daily life?

R: It can be both, depending on what the person needs. If somebody is struggling with burnout, we might talk about what is contributing to their burnout and ways to shift their focus or change what they are doing to lessen their burnout. That might include STMH, it might include reaching out to people within or outside of Sinai. 

A Yeah and I guess that maybe a social worker might be less intimidating thatg going directly to STMH and can be a gateway into that as well. 

R yeah, absolutely 

J Yeah so I guess thinking of people who might be new to the counseling/therapy scene in general and who might have reservations about starting something like this, more in general for housekeeping purposes, are these sessions anonymous or can they be if they’re interested in them?

R So, if somebody is at risk of hurting themselves or somebody else then we have to address that, that is a safety issue and it is not anonymous in that way. Outside of that, I don’t think I can make a blanket statement, but things are generally relatively anonymous. Right now I am doing zoom sessions with people. Nothing is recorded, they are password protected sessions and this is what we do with patients at the hospital as well. We are taking appropriate precautions to protect people’s privacy and it is not being reported to anyone unless there is a real safety concern. 

J: Got you. I think also I was wondering that if somebody didn’t want to reveal their name or something like that? I know that some friends are sometimes concerned about talking to people in the Sinai network because they are afraid of bumping into somebody later on. Would somebody be able to keep their name and their identity hidden I guess or is that something that has to be established as a therapist/patient relationship?

R: I think I would need to know the name of somebody when I am talking to them. I wouldn’t necessarily need to share that with anybody else but I think I would need to know who I am talking to. I am kind of outside… occasionally I have done some groups for postdocs and graduate students but other than that I am outside of that world so I am a little removed within Sinai so hopefully that gives people some sense of protection and if they want resources outside, I don’t know if you guys have a list of resources, but PsychologyToday is a great place to find a therapist. 

A Nice. Yeah, and so do you kind of have a student in mind or someone going through some issue that you think would really benefit from these sessions?

R: I think the most common challenges that I see is burnout is a big one,especially as people are getting further into their PhD or postdoc. Work-life balance is one that comes up a lot and the pandemic has also been a source of challenge for many people. Everyone’s workflow is a little bit different and some people are working more or working from home so everything is coming with its own challenges right now and that has been a source of… A temporary situation where people might want some coaching around that. 

J: Before we switch away from this topics about more nuts and bolts parts of it. I was wondering if you guys used apps like DC or other HIPAA compliant apps that are more stringent about not collecting information? I think that many people might have concerns about Zoom collecting data and stuff like that. 

R I’ve been using Zoom so far. Right now because of COVID they are allowing Zoom to be under the temporary HIPAA compliant. Pre-covid I was meeting in person but now for everyone’s safety it is better to do the sessions remotely. I found Zoom to be a pretty good one, facetime is an option if people would prefer that. I usually make the meeting and I send a link so it is not going through anyone else and not recorded so hopefully it is somewhat protected for people

A I think I am good with my questions, do you have any more Jonathan?

J Yeah, I guess my last question would be: Would you have any advice for anybody who has never sought out any kind of therapy or counseling before and might be a little uneasy about the idea of opening up to a stranger to them but they are thinking whether or not counseling would be right for them and what options they have. Is there anything you could say to that type of person?

R: Yeah, I think it is a really hard thing right? For a lot of people, they haven’t been through something like this and I think that in the students and postdoc population, we have a lot of people who are not from the NY area, who are further from home and who are going through not just challenges of postdoc and grad school but also sometimes there are cultural challenges and different types of adjustment that people are dealing with. So, I think asking for help can be the hardest part but I think that if things aren’t working for you, then it is up to you to reach out and ask for help to make the situation better. I think it is worth taking that risk rather than struggling on your own to get through it. It is an opportunity to take control of what is going on in your life. I know that it can be particularly challenging and that STMH takes precautions to help protect people’s identity and not share that information with people. As I said, I am not sharing anything unless there is a risk of safety, a threat to your own life or someone else’s and I don’t share who I am meeting with with anyone else unless there is a reason to and if there was a reason to I would let them know that I have to share something. We are trying to protect people’s anonymity and want them to feel like this is a service for them where they can feel safe. If people don’t want to meet and just have a quick question about a resource then they can email me for a resource and I can direct them to Psychology Today or something like that.

A: Thank you, that’s great advice. I have a last question as well. So I know that you and Acanthus are the two social workers offering free one on one sessions. Do you guys deal with similar matters or do you know if one type of student would benefit more from one of you in certain situations? How do you guys differ?

L: I don’t know much about what Acanthus does so I can’t speak on her behalf but I feel like it is important to feel comfortable with the person you are dealing with and so hopefully doing these interviews will give people a sense of who we are and that might help them decide who is the right fit for them. 

A Sounds good. And do you do any CBT or stuff like that or is that more a student health thing?

L: Yeah, I am trained in CBT and DBT (dialectical behavioral therapy) but it is more for STMH because of the ongoing relationship that they would have. I might use some of those skills and do it in short term way but really for more ongoing things or working through things like that it is better to go to STMH

A Sounds good, thank you!

Thanks and bye

 


Interview with Acanthus Fairley: September 8th 2020 

 

Jonathan: Hi, everyone. Thank you so much for joining us today. Agathe and I are sitting down with Acanthus Fairley, a social worker here at Mount Sinai, and we’re really glad to be able to talk to her about some of the work she does here at Sinai with students and postdocs, specifically with the new counseling services. So, Acanthus, I was wondering if you could maybe start us off just telling us a little bit about yourself, any interests or hobbies?

Acanthus: Sure! So, in general about me, of course, I’m a social worker, and I’ve been at this for almost 10 years now at this point. I’m a native New Yorker, born in Queens, raised on Long Island and came back to the city, and who knows where life will take me? My hobbies include so many different things because I have so many different interests. But cooking is one. Video games are another. I’m very much a nerd. So I read, and I have a thing for documentaries. I want to know and learn about everything. Astrology I’m also into too, so I have such an eclectic palette. And I guess that kind of makes counseling fun because I can relate to people from various backgrounds and have a little bit of an understanding about where they come from and what’s going on in their lives.

Jonathan: What’s a cool book you’re reading these days?

Acanthus: So the last book that I read–well I’m still reading it now– is We Were Eight Years in Power by Ta-Nehisi Coates. So not like a fun read–it’s a dense read, it’s a political read. But it kind of delves into the politics of our current and former president and how we got to where we are today.

Jonathan:  Very cool, very cool! All right. So, I guess, talking about maybe your role here in Sinai, I was wondering if you could share a little bit of what that looks like and how you interface with students and postdocs.

Acanthus: Sure! So my role at Sinai is I’m an employee assistance counselor. So I’m not a traditional social worker. I don’t work on the floors, I don’t work with patients. My role is working specifically with hospital employees as a counselor. So the employees can range from nurses, I do have physicians, those who are research doctors, PhD’s, all the way down to house staff. And I was introduced to the student mental health program and students in the med school through a client that I had. Throughout our work over the course of about a year or so, she said that, you know, there are so many postdocs and students in the school who need support, and we don’t have an outlet, and there’s a lot of stigma behind it. And you’re so open and engaging and welcoming. Would you be willing to kind of host like little lunch and learns and some group [ This is where Acanthus’ audio cut out for a bit] Um, so within Sinai, my work really revolves around employees and students kind of being mentally and emotionally fit to do their job and to carry on their studies.

Jonathan: Gotcha. Very cool!

Agathe: Yeah, great! Um, I think we had a little sound issue, but I think we got most of what you said. So thank you. That sounds super interesting. And it’s true, you seem to have such a great personality for someone to confide in. So, yeah, I mean we’re lucky to have you. Jumping from that, I was wondering what your sessions with students look like and what might be some common issues that you guys talk about and can help students with?

Acanthus: So my sessions vary depending on what somebody needs. The issues range from stress with how to make their studies and their work fit with their personal life, to career-counseling and mapping out their trajectory. What do they want to do? How are they going to make it work? And it ranges from interfacing with other people like their PI’s, or just with other people in the school, if they’re having trouble kind of figuring out the right words to say to the right people. And then also it gets personal. If anybody comes to me and they have issues with where they are in life– if they’re stressed, if they’re depressed, if they’re having issues with people at home, and that’s affecting what’s going on for them in school and at work, we also talk about that. And the work with somebody can be one session where they just need to vent and kind of figure out okay, this is what I need to do; or, it can be prolonged, where it’s a journey and they’re trying to figure out the best way to adjust to life as they know it now. So it’s different. It’s tailored to what somebody needs. No two sessions are alike. No two clients are alike. But that’s the gist of my work.

Agathe:  That sounds really great. And I’m just wondering how you usually provide someone career advice or suggestions on who to talk to? For example, do you know a lot of people who went through the same thing? In general, where does that come from?

Acanthus: Yeah, so if somebody comes to me with an issue or concern about their career–which is super common because we live in an ever changing world where nothing is stable, where everything is consistently shifting and different depending on what your interests are–we really kind of map out a plan. Funnily enough, I just had a session this morning where that’s what we talked about. And it was diving into somebody’s passions. I’m taking a session where we dive into how they see their life, personally, and then separately, professionally, because even though they are very different, they’re intertwined. And you can’t really be happy unless they kind of meld together, almost like in perfect harmony. And then we kind of make a plan as to how to get to where they want to be in the next year, and in the next five years. For some people, you know, making long term plans are really difficult because they don’t know what tomorrow may bring, and that’s fine. Nobody has to have it figured out. So what we do is kind of map out a six month plan, a smaller plan–something that’s more digestible and doable instead of something that’s overwhelming and really hard. And we kind of make action steps so that they don’t feel that they made this grand plan and that they set themselves up to fail and feel really bad afterwards. So that’s kind of what a session or a group of sessions around career counseling and mapping somebody’s course might look like.

Jonathan: Definitely,  Thank you so much. 

Agathe: Yeah, that sounds really helpful.

Jonathan: So, as you know, there are a lot of great providers at STMH too. And so I guess for somebody who’s perhaps thinking of seeking out some sort of support services, are there some circumstances in which they should think more about STMH and others where maybe the services that you and Rachel provide would be a better fit? And in general, do you guys collaborate with STMH in any way, or are these more like separate services?

Acanthus: Um, so they’re more separate services, especially because I know for me and the employee assistance program, our work is more based in the hospital, not the school. But we’re really like counselors; we’re not therapists per se, where we’re doing like intensive psychotherapy. But if you want to have a behavioral counselor or like a group of sessions focused on unpacking and changing behaviors with that behavioral focus, then we would probably be the best place for you. Where there’s like a goal, or there’s something in mind where you kind of want to to make a change, rather than just assessing what’s going on, then I will be probably the best counselor, or the employee assistance program would be the best place for you.

Jonathan: Okay, gotcha. So do you guys do like CBT and DBT kind of stuff as well?

Acanthus: It’s intertwined in what we do. Not specifically CBT but if we have a client where we make the connection that okay, your thoughts and your emotions are really triggering your behaviors and you really want to change one of the three, then we would take more of a CBT approach. DBT if somebody is more emotionally based, we would take that approach. And for some people, it’s like motivational interviewing where it’s okay, you want to do this, but you’re kind of stuck. And you’re pre-contemplative. So let’s see what we can do to get you to a place where you can move further. And that’s completely different than, you know, your thoughts and your emotions. It’s just action-focused.

Jonathan: Very interesting. Okay, gotcha. I feel like another thing that can be sometimes difficult is if somebody is nervous about, you know, seeking out therapy or counseling for the first time and just the idea of opening up to a stranger and being kind of vulnerable. Would you have any advice to give to such a person who might be contemplating whether this kind of thing is right for them?

Acanthus: I think the best advice I could give would be twofold. One piece of advice would be that seeking out counseling or therapy doesn’t have to be stigmatizing. You’re not crazy. You’re not, you know, something’s not wrong with you. There’s nothing wrong with having an outside opinion, because counseling and therapy are literally nothing more than having somebody who is unbiased, who doesn’t owe you anything, who just kind of reverberate what’s happening in your life back to you and who helps partner with you to to figure out what would work best. So that would be like my first piece of advice. The other piece would be that counseling is literally a gift you can give yourself, because there are some people who just don’t have another outlet, or who don’t feel comfortable talking to the people in their lives because of the emotional ties. Holding that in can be–it can be painful. And so if you are at a really dark place or at a place where you feel like you want to change, this is the best gift you can give yourself.

Agathe: Yeah, thank you for that advice. And I think that what you say on the stigmatization of seeking therapy and all of this is very important to say, and that’s what we try to provide with those podcasts. We want to show that it’s fine to talk about it, that it’s fine to deal with those issues, and that there are people at Sinai and all around who care, and who can have resources for them. So yeah, thank you.

Jonathan: Absolutely. And I also like what you brought up in the second point . Sometimes it can be intimidating to talk to a third party, but at the same time, that can be kind of freeing as well, because the rest of the relationships we have with people can often be very complex and messy. So it is kind of an opportunity to get away from that as well and to have that space there. So I think that can be very nice too. 

Acanthus: Absolutely, to be completely honest with somebody else who won’t ever judge you.

Jonathan: Exactly, yeah, yeah. 

Agathe: I think that for those seeking help, especially right now, there are so many stressors that we’re not used to and that the world is not used to right now, such as, obviously, the pandemic, the Black Lives Matter movement, or even international regulations and visa regulations. So these are a lot of new stressors for students. And I was just wondering if you had some advice on how a student could find ways to cope with those different stressors, even though they’re major, and how you can maybe intervene in those moments?

Acanthus: Yeah, 2020 is definitely a year that took us all for a loop and it’s still not over.

Agathe: Yeah, for sure.

Acanthus: I think advice on how to cope with it is to, one, take the pressure off of yourself. We are literally all in this together. Most people living, especially most people under 80 to 90 years old have never lived through a pandemic before. A lot of people who are especially in the student mental health program or who have access to it have never lived through a moment where there was social unrest related to racial injustice and social injustice, economic injustice before. And there certainly has never been a time in modern history where people who come here from abroad to study to look for a better life have been discriminated against by the federal government. So just to kind of take the pressure off of yourself, to fit in in this moment and to be okay in this moment, because this is not by any means normal or okay. To also give yourself moments of breaks from the media, because too much information is overwhelming and it’s really hard to parse through what’s real, what’s fake, what’s opinion, what’s fact. So to give yourself a break from that and indulge in things that really bring you joy in the moments that you have downtime, because it’s overwhelming and to overload yourself is akin to traumatizing yourself. And it’s really hard to live a fulfilling life, get through work, do well in your studies, and to deal with all of this. And how can I intervene? I guess the employee assistance program and what we do can just provide a safe place to talk about it and how it affects you, because I think it affects everybody very differently. And then also, if it’s really affecting you to the point where you’re not getting enough sleep, or you’re not eating, where you’ve kind of lost interest in everything, and you feel like it’s teetering alongside something that really needs significant help and intervention, we’re there to help guide you in the direction where you can get help so that you can recover from how your body and your mind are responding to what’s going on and get you back to a place where you’re stable.

Agathe: Yeah, for sure. Thank you for that. Um, So my last question would be that some people at Sinai don’t really want to seek help within Sinai because they feel like it’s too close to home or that people may talk even though the sessions are anonymous as Rachel told us last week. So do you have any outside resources for students that you think could be helpful for them?

Acanthus: Sure, so I totally understand not wanting to seek help within Mount Sinai because of a multitude of things, even though we are confidential. But if you do want to seek support, and we aren’t an option, but even coming to us to get a referral isn’t an option, depending on your insurance if you have UMR, Psychology Today is a great resource because it gives you every option in your zip code and your insurance and [catchment] area as to who’s available. Also, I think another good option is accolade, they will tell you also who’s available in your area. depending on what’s going on for you, and what’s happening in your life, there are psychotherapy centers that provide sliding scale or very well cost therapy, including ICP, and the psychoanalytic Institute, which I think they’re both located in midtown Manhattan. So those are also two excellent options. And I think another great resource is somebody whose primary care doctor may have a network or a colleague that they know outside of the system who works really well and who might be an untapped resource. So those are some options as to where you can go if you know, support inside of Mount Sinai isn’t an option for you.

Agathe: Yeah, that’s very smart. The part about the primary care physician because we often forget that they can also help us dealing with all of those. But yeah, thank you for those resources. And just for everyone listening, we are trying to put together a Google Doc with resources outside of Sinai that you can reach out to if you need help, depending on your needs and the issue you’re dealing with at the moment. So I hope that will help as well.

Jonathan: Yeah definitely, so that’s about all the questions we have today. So thank you again, so much, Acanthus, for joining us on this over zoom to talk about these things. we really appreciate it.

Acanthus: You’re more than welcome and thank you for having me! 

Agathe: No, yeah, thank you so much. And even like offering those sessions for students, I think it can be so beneficial, like in all the different ways you brought up today and yeah, just thank you for for doing that.

Acanthus: You’re more than welcome my dear.


Interview with Dr. Sukumaran, head of STMH: November 2020 

A:
Okay, so hi, everyone. We’re happy to have you join us today on election day. And today we have a very special guest, Dr. Sukumaran, who is a psychiatrist and associate professor here at Sinai, and who is also the Director of Student Mental Health. And so we invited him with hopes for him to clarify the role of STMH and to give us some insights on what he does, and any updates on STMH’s work. So hi, Dr. Sukumaran, thank you for joining us today. So we were wondering if you could start us off by giving a bit of background on your own career, your clinical training and how you transitioned into your role was director of STMH.

S:
Sure, good afternoon. And thank you both for having me on to speak about Student and Trainee Mental Health or STMH. It gives me the opportunity to get information about the program out to the community in a different way and so I appreciate that.
For your question about my own background and experience: So I’m from India originally and I came to the US to do my residency, I went to SUNY Downstate in Brooklyn for psychiatry residency. And after that, I did two fellowships at Yale, one in addiction psychiatry and the other in college mental health. I stayed on at the Student Mental Health Center at IDEO where we treated undergrads, graduate and professional school students.
During my time there, I also served as the liaison between the clinic and the LGBTQ center on campus, and was also involved in clinical teaching of residents there.
When I learned of this opportunity at Mount Sinai, I was extremely interested as it seemed clear to me that this system was very invested in expanding the services available to students and trainees. And so it was very exciting to come on board during a time of such active growth. I joined the team in January of 2019 and became director in May of 2019.
The process of developing STMH into a more robust treatment service was already underway when I got here. But to be able to participate in shaping STMM, its expansion and future direction, has been incredibly meaningful so far.

J:
Oh, that’s really great. That’s really cool to hear. And I think it’s really cool to see kind of some of your, your interest and experience in the past and how your involvement as the image kind of naturally kind of grew out of that, and an extension of that. So that’s really cool. Thanks for sharing that.
So there’s, there’s also a lot of great information on the STMH website that, you know, we highly encourage everyone to go check out, you know, if you’re interested in some of the things and services that STMH does provide. However, Dr. Sukumaran, we’re wondering if you know, as a director, you could maybe help us first begin by taking a bit of a step back and getting more of like a bird’s eye overview of STMH, especially in the way it’s situated within Sinai. So, first of all, who within Mount Sinai oversees STMH? What department is associated with? And also I guess, what is its mission statement?

S:
Sure. Firstly, thanks for the acknowledgement of our website. That’s something we’ve been trying to more actively develop, because obviously, it’s a pretty common way in which people might look up information about us. It is a work in progress. So we are still building on improving it. But yes, it does have a lot of useful information. So thanks for reminding people that they can always check us out online.
So with regards to organization, how we’re structured: student and trainee mental health comes under the Department of Psychiatry at Mount Sinai. But from a funding perspective, we are funded by the Graduate Medical Education Office, the medical school and the graduate school. Those are our sources of funding. With regards to our mission, we have a mission statement, and that is to provide medical students, graduate students, postdoctoral trainees across the Mount Sinai health system with confidential, high quality and affordable mental health services to improve health, well being and productivity. And we also have what we call our guiding principles. And this is to try and provide access to all regardless of insurance or capacity to pay, to try and provide minimal wait times for appointments, to ensure that there is no cost above insurance payments, to provide as diverse range of services as possible. And to do all of this in the spirit of competency, collaboration and empathy.

A:
Yeah, that sounds like a pretty holistic statement as well. And it seems like you are really focused on offering a range of different services throughout your program and with the help of different professionals. And so, um, we were kind of wondering up if you could elaborate more on the types of services provided there by STMH. And whether or not there were some services that you couldn’t finance, it would be better to go to another place. So just elaborate on those services, as well as if you charge for any of those services or if there are any co pays, or out of pocket costs for students, or if you only take out certain insurance plans or things like that, but it seems like you mentioned that it was usually free of cost.

S:
So yeah, thanks. That’s a very important thing. So maybe I’ll just start with the last part of that first, which is really to emphasize that there is no out of pocket cost to come see us at STMH. So no matter what insurance you’re on, you are eligible for services at STMH, as long as you’re a student at Mount Sinai, or a or a trainee at Mount Sinai. And yeah, no matter what insurance you’re on, so we are not limited by taking only certain insurance, insurances, what we do is we use your insurance if you have insurance, for the cost to come see us, if they pay us, they pay us if they don’t, they don’t. But there is no copay that’s passed on to the student and on training. So again, we might bill your insurance, but nothing gets billed to you. If this ever happens, where you get a bill from your insurance for services that STMH please bring that to our attention. And we will take care of that.
You don’t have to deal with the billing department at Sinai, or with your insurance. Just bringing it to our attention by emailing us or calling us and the admin team at STMH is great. And they will, they will take care of this. So that again, there is no out of pocket cost.

A:
That’s great to hear.

S: Sure, just wanted to emphasize that. But to your point about your question about services. So as we have grown over time, we have been able to offer more treatment options and a broader treatment variety at STMH. In fact, that was one of the areas of focus around the time that I came on board as well, which was to try and hire more clinicians with expertise and training in different areas. So that we can try and treat more issues at STMH.
As a broad overview, we offer consultation and evaluation appointments, we offer psychotherapy, and we offer medication management. Under the rubric of psychotherapy, we provide evidence based treatments. So these are largely based on cognitive behavioral therapy or CBT, or dialectical behavioral therapy or DBT. We also provide supportive psychotherapy, organizational skills training, stress reduction, and group therapy options.
medication management, by itself just involves psychopharmacology and using medications to treat mental health conditions. And that’s done by the psychiatrists in our program. We can also provide referrals to specialized providers, either at Mount Sinai or within the community if, if the need arises.
You have a question about what kind of services where maybe STMH is not the best suited for right and so on, on that point, if someone’s looking for very specialized treatment, so like a treatment program for significant substance use issues, our specialized treatment program for eating disorders, or if they are looking for more intensive treatment, like an intensive outpatient treatment program, where one goes to that for five times a week, for instance. Or if they’re looking for long term, open ended insight oriented talk therapy, these are all different kinds of treatments that, you know, STMH might not be the best fit for. However, we still encourage people to come to us, kind of doing that initial assessment and evaluation helps guide us and figuring out along with the student or trainee what might be the best fit for them. And if STMH is not it, we’re happy to try and help guide them to resources whether at Sinai or in the community that might provide them with what they are looking for.

A
And would those referrals be for cost as well or does it usually come with a call?

S
So that would depend on the situation because again, we are funded in such a way that no cost gets passed on to the student or trainee. But that’s because we are STMH. Whereas if you go to a provider, or if you go to a treatment program, it would depend on what insurances are accepted at that treatment program. We try as much as we can. And to the extent that we have this information, we try as best as we can to connect people with resources that are either free of cost or are low cost.

J
And while we’re on the topic of services, before we move on, I did want to address a question that we actually received from a student in a newsletter, on a survey. And they’re wondering about the discontinuation of family therapy and couples counseling, and they’re wondering about the reasoning behind the discontinuation. And whether there are any plans in the foreseeable future to offer those services, especially because it seems like there may not be many other places that take insurance, this kind of service.

S
Sure. So a slight correction there. Family Therapy has never been offered at STMH. As far as I know, and definitely not in the time that I’ve been here. We were offering couples therapy last year, because one of our clinicians has some experience in that area. However, the need and demand for individual therapy is much higher. And so that’s what we’re focused on at present, especially because this provider is also with us just a few days a week, and again, the need is more for individual therapy. As we continue to grow and expand, however, and have more therapists on board, I’m hopeful that we’ll be able to offer this again, offering the option of couples therapy again. Students who are interested in couples therapy, however, should reach out to us. And again, similar to what I said before we can try and connect them with resources, because there are some people at Sinai, who, you know, who, who do that, that says it is a fairly limited pool, as you are pointing out, it’s not, you know, widely offered. But again, we’ll try and help to the extent that we can.

J
Gotcha. Thank you for that clarification. That makes sense. Yeah. So more generally, seeking therapy, or mental health treatment for the first time can be really intimidating for a number of reasons, I’m sure you’re very aware, including, you know, stigma or the idea of just being vulnerable with a stranger. So is there any advice you might give to students who are considering maybe seeking out counseling, or therapy for the first time but are hesitant to go to STMH? Or to seek counseling? Or who might feel like their issues are not necessarily, you know, important enough? Or maybe too personal or something like that?

S
Great question. And I think this is an incredibly important issue. I think the more dialogue there is within our community about mental health and accessing care, the more it normalizes doing so. And that eventually will then help lessen the stigma around seeking care. So these I think, are vitally important discussions to be had within students spaces, as well. And I encourage those who feel comfortable sharing their own positive experiences with seeking treatment to do so. Because that I think, then enables others to feel less of a hurdle to kind of seek that out for themselves. There is no issue that is too small or, you know, yeah, too small to, to seek care for. And I want to emphasize that, as you say, taking the first step can be very difficult. So I really want to reduce the perception that one should only seek help when things have really dire, which is not what you were suggesting, but I know, often, that’s something that oh, you know, I really need to be depressed or unable to do anything or it needs to be, you know, a massive problem of some sort before I seek help. And really, I want to stress that, you know, I think in many ways, being kind of proactive and seeking help earlier in,
in the course of an illness helps prevent it from getting to those more, quote unquote, dire
kinds of situations.
I think there’s immense value in utilizing a variety of resources, both formal and informal ones. And so really looking at what resources there are at Sinai, I think can be can be helpful when one is going through something and I would want students and trainees to also think of STMH as being one of those resources that they reach out to in those moments, along with, you know, reaching out to friends and family, speaking with mentors, and really tending to self care which, you know, I don’t know, all of us are great with all of the time, especially when things are stressful like these past few months or like today. But things like sleeping well, eating healthily, exercising, are all simple and basic tools, but incredibly useful ones. And just as we think of those as tools in one’s toolbox, I would like people to be thinking of mental health treatment as also being one of those tools.

A
Yeah, thank you. And so I just added a little question on that. So it seems from what you’re saying that STMH does offer like longitudinal care that even if you’re doing better, or if you’re doing fine, at some point, you can still see a therapist, and it can help you like, find techniques to deal with daily stressors and everything. It’s not just like when you’re really in crisis, right?

S:
That is correct. And so what we follow, we typically follow a, we provide evidence based treatments, on the psychotherapy front. And these tend to be time limited treatment, as opposed to, you know, insight oriented, open ended treatment. But what this means is, then you’re working on a particular issue. And so the example that you just gave, and if you’re feeling better, it might be that you don’t see a therapist as often for a period of time. But then if something else were to come up, you check in with them, again, kind of do a refresher on some of the strategies and skills that you’ve learned. And so in that way there is that longitudinal care that you’re talking about.

A
Okay, yeah, that sounds good. Thanks. And so on another note, that’s something that’s been pretty prominent recently, is that there has been an increased interest from students and from people all around in increasing the share of black, people of color, and LGBTQ providers, among STMH’s psychologists and psychiatrists. And so we just want to say to all students that the student council and other wellness groups at Sinai are currently working with faculty to recruit more providers of color and to compile a list of external providers.
But based on both your clinical and leadership experience, would you mind speaking of maybe the importance of this representation and the efforts that are currently underway at STMH for that?

S:
Sure. And yeah I agree with you, this is something that’s hugely important and is something that’s personally of great importance to me. So at present I’m the only clinician of color at STMH, and the only LGBTQ plus identifying clinician as well. And this has been true since I started here, and is something that I’m very invested in changing because I think visibility and representation absolutely matter and is incredibly important in a variety of different ways. A few things on that and I also appreciate the Student Council and the other wellness groups also kind of being invested in this, at this point in time.
There is an under representation in the mental health field of people of color. And so, you know, we don’t have to take time into thinking about the broader systemic issues that that touches upon. And so why don’t we have as many psychologists of color as we do, you know, Caucasian psychologists, for instance. And there is a pipeline and systemic issues over there.
But clinicians of color are underrepresented in the field. And since I’ve been here, we’ve had a couple of recruitment cycles at STMH. And that is something we’ve been on the lookout for a long bit, finding people off diverse experiences, like I mentioned before, to kind of make it a more robust treatment service. And, you know, part of that has also, and unfortunately, hasn’t worked out thus far and kind of expanding the diversity on our staff. We do have a psychologist who is starting in the next couple of months who we hired over the summer, who is another clinician of color, and so I’m excited to have her join our team.
And I look at that as a beginning as a part of this process. And by no means an end point.
And I think we’ve actively within the departments about and by department I’ve been I mean STMH as well as the Department of Psychiatry, have been looking into the ways in which we advertise and try to recruit people, because I think there’s a way in which that also influences who were placed. Right. And I think that’s been part of the dialogue, especially more recently in these past four or five months, within the Department of Psychiatry as well, because it’s not just an STMH issue, it’s brought in the department and then brought in clinical fields all across the system. And so that is a discussion I’m, you know, happy to be a part of, in trying to shape the path ahead. One thing I will, I will say. So, going back to the idea of visibility, and representation, those are incredibly important. At the same time, I do want to stress and emphasize that one can be helped by one and can be helped by a variety of different providers. And so I wouldn’t want to feed one particular idea, which is that one can only be helped by a clinician who is similar to one’s own self, which is not what anyone here is suggesting. But I don’t want that nuance to be lost in the middle of this as well. It doesn’t take away from the efforts at expanding diversity. And at the same time is something important for us to keep in mind.

J
Yeah, I wanted to circle back really quickly to this idea of advertising, you mentioned, could you elaborate a bit more on what those efforts look like?

S
Sure. What I meant is that we have been looking into additional ways, we might perhaps advertise a future position, so that we have better chances of attracting more diverse candidates, for example, sending the job description to listservs, or job banks catering to clinicians of color.

A
And so would there be a way if someone for example comes to you but says that he or she is not very comfortable talking with any of the psychiatrists or psychologists available at STMH? Can you maybe direct them to other psychiatrists that might be more fitted to what they need?

S
Sure. And again, I think that would depend on what they’re looking for. Right. And so
just to give you another example, and, and again, it, it’s, it’s a complicated thing. But if someone comes to us, asking for a clinician of a particular, racial or ethnic background or particular sexual orientation, you know, one of these things is somewhat more visible than the other. And even that leads to assumptions though. And especially in mental health work, clinicians are not necessarily always disclosing some of this information, just by nature of the work that’s done, especially in psychotherapy. So it does make it a little bit more complicated. We live in New York City where this is, in some ways less of an issue, I think there’s more people who openly identify one way or the other. And that allows us to tap into things a little bit more. And so there’s lists that you mentioned a short while back, that, you know, their efforts, that kind of building on this list of providers in the community who, you know, are more diverse, I think, is a great way in which we might be able to connect people to the kinds of people that they are looking for, at least in that moment, to be helped. Again, it’s harder to predict what insurances those people might take, or what the cost might be like. But I think, again, that would be a valuable resource for us to develop.

J
And as, as I mentioned earlier, there are a number of student driven initiatives working in tandem with faculty to, you know, work on more POC providers, and possibly compiling a list of external data providers. But, you know, we were also wondering other ways that, you know, the student body in general could kind of support this effort as well, as specific groups.

S:
Sure, and I think, in many ways, the student and trainee body has already done a lot in that in that sense and kind of bring this to the foreground, within a variety of spaces, including at, like student council meetings and in discussion with school leadership, which I think then puts it on people’s radars in a way that, you know, it might have been, but puts it more in the foreground now, in a sense. And so I think there’s already been valuable contribution by the student and trainee body and other a variety of various committees, at the school within departments. And most of them also incorporate student and trainee representatives. And I think those are the ways in which, you know, your voice gets heard. And so I appreciate the efforts that have been made. In those regards. Absolutely. And that, you know, that reminds me kind of what you said earlier about the importance in fundamental stigma, as well of dialogue and of creating these social spaces, and the effects that can have on you know, on us individually, and of course, institutions as well.

J
So, uh, speaking, I guess a bit of institutions. One of our last questions as we wrap up here. So in addition to what we’ve already discussed, as you know, as director, you’ve talked a little bit about how estimators changed, since you took the helm, we talked a little bit about some of some of the goals that are kind of ongoing, as well. But I was wondering if we can maybe finish off by talking a bit more explicitly as well about some of the specific goals and visions for the way that you would like to see the organization continue to grow, moving forward.
Discuss?

S:
I will say there was a solid foundation laid by the time I started here, which allowed for the growth that has already happened and continues to allow for further growth. And I’m very appreciative of leadership at graduate medical education at the school because everyone is invested in seeing this program expand further and be more accessible. So some of the things that have changed over the course of time, and that we’re continuing to expand on are for instance, offering evening hours. So you know, appointment times up to 5pm. We now have those evening hours every day of the workweek. So Monday through Friday, we have at least one STMH clinician who has appointments each day, in the later hours. Last year, we also started offering psychotherapy off site. So away from the main campus. So we had one of our psychologists at Mount Sinai, Beth Israel one day a week and another at Morningside one day a week. Obviously, in the time of COVID, that has changed but the plan, as we expanded, was also to offer psychiatry services at those sites. And so that remains the plan. But perhaps in a somewhat modified way, if we go back to being physically present at those sites. I think expanding the number of clinicians on staff has, understandably made us grow a lot. So in 2019, we had more than twice the number of visits that we did in 2018. And already in the first nine months of this year, we were above. I don’t have the information for October, but my guess is by the end of October visits, we’ve already surpassed last year’s visits. So all of that has been great, because again, it’s been a lot of investment in being able to hire more people to expand on our treatment team, which has then allowed more people to seek care.
Telehealth, of course, has been something that has, I think, also greatly improved access to care.
You know, we had the emergency to switch to a telehealth model back in March with the pandemic. But what we’ve seen is that our numbers have continued to grow. And I think for a lot of our students and trainees is offered a degree of flexibility that perhaps wasn’t there before. And so one of the things that I want to make sure continues, and the plan is for this to continue, is to still offer telehealth appointments on the other side of this, whatever that might look like and whenever that might be, because especially for the population that we treat, it seems to have been particularly useful and well utilized. And so that’s one of the things I wanted to continue to develop with some of the other areas of development that I’m kind of thinking about. So I will re emphasize kind of expanding on the diversity of our staff
is the focus for me going forward, expanding on our group therapy options, something else that I think can be very beneficial for our students and trainees, this is something I’ve seen
to be the case in the past. And even this year, we’ve offered more group therapies than we had previously. And they have been fairly well utilized. And that’s something that I would like us to do more often to offer more of a robust group therapy kind of program and group therapy offerings at STMH. So just some, I guess, initial thoughts about the direction I had.

A
That sounds great, thank you for all of these answers and all those projects. So to drive STMH forward, it’s very encouraging. Do you have any additional comments you’d like to share? Or you would like students to be more familiar with?

S
I could shoot a couple more things that I’d like to quickly say, just want to remind everyone that we do have a 24/7 mental health support and crisis hotline, that students and trainees across the Sinai system have access to the informations on on our website, the phone number really quickly is 212-241-2400. But more information about that is on our website. The other thing that often comes up is to do with confidentiality, again, as being at Sinai. And, of course, physically, we’re located in Aaron Hall. You know, even though again, primarily, it’s all telehealth at this point. But, you know, students and trainees often asked about confidentiality. And so I want to re-emphasize that the appointments at STMH are like any other clinical encounter, which means that they are confidential and are held to the same standards that any mental health appointments are held to. And so I want to strongly encourage people to come seek us out and seek our help out if they need it. Because, again, that is separate from what happens at school. And without your consent, there is no communication with anyone outside of the room. And that is something that I want to stress. So just those two, those two quick things.

J:
Very important points as well. So with that, I think that wraps up, you know, the discussion we had planned for today’s so I just want to thank you very much again, Dr. Sukumaran for being with us here today. We really appreciate the opportunity to kind of ask you questions and pick your brain a little bit and to be able to disseminate this knowledge of yours with the rest of the student body. So I appreciate that very much.

S
Sure. Yeah. Jonathan. Thank you, Agatha.