Latest / The Medical Mind / Women Psychiatrists Caucus Chats: Dr. Theresa Miskimen Rivera on Leading with Purpose

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Women Psychiatrists Caucus Chats: Dr. Theresa Miskimen Rivera on Leading with Purpose · The Medical Mind

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The organization has been a place where I have met so many friends over the years.
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Friends, mentors, sponsors. It has provided me with opportunities for honing
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in on leadership and doing things that I really don't think I would have been able
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to do if I had not been involved.
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Welcome to season three of the Women Leaders in Psychiatry podcast
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by the American Psychiatric Association's Women Psychiatrists Caucus.
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I am Dr. Anjali Gupta, president of the Women's Psychiatrists Caucus,
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and I will be interviewing women psychiatrists across the country who lead
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in a variety of ways so that we can hear their stories and learn from their
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insights.
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Okay.
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Today, I have the pleasure of being here with Dr.
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Teresa Muskeman Rivera. She is clinical professor of psychiatry
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at Rucker's Robert Wood Johnson Medical School.
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Her list of roles served for professional societies is pages long,
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but the one that we're going to focus on today is her current role
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as president of the American Psychiatric Association.
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Thank you, Teresa, for being here.
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Well thank you, Anjali. And it's an honor and a pleasure to be here today.
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And I really appreciate the kind invitation to share my thoughts.
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So let's start out with what drew you to psychiatry
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and then more specifically addiction psychiatry.
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You know, ~ f first of all, let me say that thank you for doing this podcast because
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I think it's a fantastic opportunity for us to learn from each other and
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how is it that we got to where we were?
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Our stories are very different.
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Hey, I've been listening to the podcast for a while and I know how different it is,
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but at the end of the day is about making sure that we hear our stories
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and and take away what we can and what serves us.
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So thank you for doing this. I appreciate you for
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No, thank you for saying that.
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I think look, the idea behind the podcast is really I think that it's important
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to amplify women's stories. And I think that sharing those stories
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is really important. It's a collective form of mentorship.
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So that you learn not only from your own supervisor and mentor,
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but from the w women before you and the women around you that carve these paths.
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So that's really
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how this podcast got started.
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Well, thank you for that. And you know,
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your first question is so how how did I get here?
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And so I I think that I I gotta start off with where I'm from,
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right? So I'm I'm from Puerto Rico,
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was born and raised in Puerto Rico.
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As as you well said, I'm Esquiman Rivera.
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So my dad is actually from Ohio,
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my mom is born and raised in Puerto Rico,
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but they met in Puerto Rico doing this project,
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and and long story short.
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I was born and raised in Puerto Rico.
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And from ~ from a very early on,
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I was very interested in science.
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I I thought I was going to be a marine biologist at first.
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Hey, I'm in an island and I'm interested in science.
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And my major in in school in college was actually biology.
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So for a long time I thought, yep,
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this is going to be me. I'm going to be marine biologist,
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and and that's it. But then
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During college years, I started taking anatomy,
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~ genetics specifically. Those two classes really opened another whole world for me.
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And I ended up then going to med school in Puerto Rico.
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And when the opportunity came,
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I then accepted a residency position in New Jersey.
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And it was a path that was ~ the outcome
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was really because of.
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That interrelationship between what you do in your life and how it's really focused
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in your family. So what ended up happening,
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how I got to United States, to New Jersey,
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is that my my husband had a job in New Jersey.
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And I said, yeah, you have to take that job.
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It's a really good job. Go to it.
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And one thing led to another. And in order for us to be together,
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then
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I had to move out of Puerto Rico and into New Jersey.
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And I thought for a long time that we would go back,
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but it didn't work out that way.
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So it it just ~ one thing led to the other.
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Our career started to blossom.
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Thank goodness, right? That that we had that privilege of having
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the careers blossom. And I stayed on and and here I am,
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30 plus years later. Connections in Puerto Rico,
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but I'm
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Definitely in in United States.
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It sounds like when you came,
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you thought it was going to be temporary.
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Mm-hmm. Not only that, I think that after after after
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I did my residency and you know,
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my husband and I were were talking about,
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okay, so what are the next steps?
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And it turns out that I I was offered a position in academic center right after
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my fellowship, my residency. And we decided that this was a really good opportunity
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for me. So it was ~ it was
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one of those ~ you know times in which you're like,
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well yeah, we're we're gonna do this,
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we're gonna stay. This is really good for your career.
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Let's go with it. And looking back,
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one of the things that, you know,
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and I have two kids, and one of the things that I'm very grateful is
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for that role of my family. So I know how difficult it is
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for some people not to have that support.
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And having my family really live in Puerto Rico.
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So it was hard. So I thought it was going to be permanent because I really wanted
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to be back with my family in Puerto Rico.
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So it was hard. And having that family support was really important and helpful.
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~ One of the things that I mentor,
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~ you know, residents and fellows specifically,
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~ as you are moving along and you have to make that decision,
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leaving where you are from or leaving your home state or or your home country.
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~ to make sure that you have that family support as much as possible
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if it's available, I think that that has been instrumental for me personally.
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So when you say have that family support because they're in Puerto Rico,
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do you mean supporting that decision that you're coming to the United States?
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Mm-hmm. Yep. And it's funny because a lot of my family has moved since
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has moved into United States. Now it's it's easier for for us.
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We're in close proximity of mainland USA.
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~ We have citizenship. So I I know,
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and that's why we were talking about it's different stories,
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right? So everybody has their own path.
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How did they get to United States and and you know what are
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the opportunities and and the barriers and challenges?
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So for me personally, it was a challenge of leaving family behind
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and and that vacuum that is created.
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And the fact that they were like,
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yep, you gotta do this, go for it,
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was important to me personally.
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And and I one of the things that I do when I when I mentor,
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especially people that are coming from outside of mainland USA.
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is how to navigate that, how to ensure that you have that bridge to and
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and it's a vacuum and and how do you how do you account for it in in your story?
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And and how do you continue making those bridges whenever possible?
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You know, you've described this so well.
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I mean, it's almost like you're describing a little bit of
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a void because something or or someone who people who are very important
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to you and you sort of grow up
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not thinking that you won't be right there with them.
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And it sounds like
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like you you described a a a you know a mix of factors,
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both professional and personal,
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change that trajectory,
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and then how to sort of understand then
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who what people in your new space or who's going
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to help you with that.
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Support, that love, that reassurance,
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that you know, all the things that families give.
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You know, it's as you were talking,
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I I could not help but it's it's almost like a like a movie in my in my
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in my head right now about all the non-family members,
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but there really are family, right?
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It's my extended family of all those faces that provided me with support over
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all those years. And you're right.
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It's you have to you have to make sure that your
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you're filling in that void because it is,
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right? So how is it that you're you're gonna have that extended family where
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you are now growing roots?
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Yeah. And it is in some ways, you know,
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I I'm thinking of my parents now.
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It it it is in some ways it it can sometimes build a very strong community because
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you're sort of creating family here w w when
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you don't have biological family.
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Yeah, it's right. It's that biological versus your extended family.
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And and you know, I think that for for us,
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~ my personal situation for us,
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and because the same thing was happening to my husband,
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because his family's also from Puerto Rico.
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And ~ they're still there. ~ and how is it that you navigate that across
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the years? ~ so I I hear you.
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I hear you.
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So
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So sort of i you know, it it sounds like that
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has been something that's been a challenge,
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~ figuring out how to, like you're saying,
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navigate that, find those people.
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As you've sort of thought about the course of your career,
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have there been other challenges?
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I know for a lot of women, work-life integration
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Tends to be one, has that been a challenge or anything else?
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You know, I think that challenge my my first challenge really is
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as I've already said it was that jumping into this new culture,
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right? So that that I think really it was was main ~ my early career.
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Yep. As I was because now I'm not early career,
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even though sometimes I still think of myself,
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I'm mid-career, early career. No,
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no, no. I'm already late career as I stand here.
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Amazing how that happened.
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I
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know, I know, and I don't feel it.
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But I think the first thing is that ~ because a lot of people ask me also about
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so so where does APA as an organization fall?
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So APA became a and I I joined the organization when I
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was a resident and it was interesting how
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~ looking back that became a family as well to me.
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And I've been a member for 30 plus years.
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And that was so instrumental to me.
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So that challenge of feeling kind of like not belonging.
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It's like, well, my family's not here.
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It's, you know, I I it was first,
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you know, you know, my husband and me were here alone.
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But having that, and it was very fast.
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I was like, wait a minute, there's her anticipation and dear psychiatrist.
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Fantastic. Let me join.
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And that camaraderie, the collegiality,
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being able to serve in committees and just have that support there
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was so instrumental. So it did address that big challenge of feeling
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not part of something as as I was coming in.
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So I I think that that was a challenge and the APA was there for
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me to fill that need of belonging.
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Well, I I have a couple thoughts.
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One is, you know, it's it sounds like you've sort of grown up within
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APA because you're describing residency and here you are now later
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in your career as president. And it's touching,
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you know, to think that you have sort of spent I mean,
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I I I saw your resume, so pages and pages of roles within this organization.
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But as you're describing it, it's so much more than simply that.
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You really describing you know,
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another family, your sense of belonging,
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~ having left Puerto Rico.
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You know, it's yes, resounding yes on that one.
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And I remember when when I and I was a resident and I remember that first meeting
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at the New Jersey Psychiatric Association.
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And it was it was very comforting to be there and it
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was like whole days. It was a whole day,
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it was leadership. I remember
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and that dr block was there a dr vora was there
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and and it's it's already the mentors that i already had secured within
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my residency they were part of that and having then of course other other residents
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were there which is great but it was sitting there and having a whole day
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in which i was with others and in that community and just
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it was a feeling that
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never ceased to be very close and dear to me.
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I remember when I then, you know,
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I had kids and I have pictures of me at the annual meeting with a carriage,
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you know.
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And ~ I had when I became ~ the you know a fellow of the organization,
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I was pregnant with my second child.
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I was two weeks before my delivery date.
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It was in New York, so I was like,
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I am definitely attending. So I have these beautiful pictures of me about
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to deliver my second child.
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But I was at the annual meeting and that's such a joy,
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even today thinking about it, it brings me a lot of joy.
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So to me, yes, the organization has been a place where I have met
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so many friends over the years,
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friends, mentors, sponsors. It it has provided me with opportunities
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for honing in on leadership and doing things that I really don't think
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I would have been able to do if I had not been involved,
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because I did a lot of community work.
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at the local level. that that was one of the the best things that I have ever done.
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Like we had this brain and behavior expo in the Jersey Psychiatric Association.
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We did this for about I don't know five years.
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And we went to this beautiful place,
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it's Liberty Science Center, and we invited community kids,
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we had an arts ~ and ~ so they they would draw posters
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and we would have other colleagues
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then do the competition. It was fantastic.
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Yes, it is. I did,
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Sounds lovely. Why don't we
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I did. So and it was all done in community.
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And that has again it it brings me a lot of joy.
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Even right now, I it just brings me a lot of joy.
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And there's so many people that that I remember dearly.
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And so yeah
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And and you know what, I still meet with some of them.
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I'm still very grateful and will always say thank you for what you have done because
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you gave me so much and they were giving so much of themselves,
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right? Especially my own mentors.
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So yeah, I'm very grateful.
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Now and now you are paying it forward to so many.
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~ so at what point in your career did you think
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I want to be APA president? Was there a moment?
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Was there an experience? Did you know ahead of time or was it more recent?
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Like what when did you think you wanted?
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this. So I did not. I did not.
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You know what what I in thinking about my my progression within the organization,
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it was very gradual. I mean I started as I as I said I started as
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a resident and there was the opportunity to be
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the resident chapter representative,
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right? And I was like, ~ wow, okay,
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I'll I'll run for that.
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And and I became the chapter representative.
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And it it again, it really resonated with me to be part
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of that process. So over years,
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I I think I did everything at the New Jersey Psychiatric Association.
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I have been, you know, the counselor,
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~ you know, secretary, treasurer,
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vice president, president.
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And then the opportunity came to work within the assembly.
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So I was the New Jersey representative at the assembly.
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So this kind of progressed over the years.
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And back in 2015, ~ I was approached,
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you know what, what about running for recorder of the assembly?
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So I ran and I became the recorder,
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then ran again, became speaker elect.
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And then I became back in ~ 2016,
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I became the speaker elect for the assembly.
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And 2017 I was the speaker.
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And within a year there was the opportunity to run as president.
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And it was at that time that when the opportunity knocked on my door,
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I said, I I will definitely do that.
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I didn't win that year, but it really showed me
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Another aspect of what we could do as psychiatrists for
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the organization and other opportunities.
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So it's like one door open another.
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So it wasn't like, I want to do that.
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It was more as I'm working with this and other opportunities come in.
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So it kind of unfolded.
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Yeah, it sounds almost like a stepwise.
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Yes. And it can and it took years in the making.
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So I that that's the other thing is as I'm thinking back on my career within
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the organization, it really was one opportunity opened up
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and and I took it and I enjoyed it,
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which was very critical for me.
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Is this going to bring me something?
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Because you know, it's these are volunteer positions and there has
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to be something that you're getting out of it as well.
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In order for this to work. And yeah,
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it worked for me. And you know,
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when I ran the second time, here I am.
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And so as you think about the past year as president,
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what have been some of the highlights for you?
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For sure, 100%, has been the opportunity to have that direct engagement
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with members in a in a grand scale.
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Over this past year, I have visited so many district branches.
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I have been invited to talk you know,
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grand rounds and it has been an an incredible honor and that.
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Opportunity also to contribute to new initiatives.
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I mean, we just completed the strategic plan,
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which is something that I had ~ put in my platform back when I ran
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my second time because I thought that this is where the organization had to go.
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But being part of that initiative and partnering
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not only with our members within USA but also international members.
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has been an absolute honor,
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pleasure, highlight of the past year.
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And as you think back, what is do you think
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has been your biggest area of growth?
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I'd say and it and this this has been years in the making.
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It's becoming more deliberate and thoughtful.
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I believe that what all of all of my work
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in an academic center with my patients,
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with my peers, everything has kind of worked
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to be more deliberate and and and
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Just how is it that I use my time?
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How do I show up for for like today?
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How do I show up? And it's that sense
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of it's not about me as much as it is
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of how I in a space. And and it's very generative for me.
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And I've had this conversation.
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So my kids are already grown, right?
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They're adults.
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And I've had that conversation with them and ~ and people that I mentor,
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especially early career or resident fellows.
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And it's you've you've come to a time in your life when it's about giving back.
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And I've it it's a privilege to be able to do it.
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So I think that that's that's where I've had my biggest growth.
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And it sounds almost like you're describing a mindful presence
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of simply sort of being in a space.
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Which has been very difficult for me to do.
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I remember maybe about I I want to say about 10,
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15 years ago. And I remember because it was it was a time
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in which I I realized that
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it wasn't a race.
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And that happened to me for a long time.
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I was like, wait a minute. So I'm an academic career.
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So I have to do this, I have to do that,
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the, you know, what where's my next,
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where's my next project? Where's my next this?
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And so I was always next, next,
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next, next without actually kind of relaxing and breathing
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and just it's okay to look at what you have done.
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Pause. So it's it's a hard thing to do,
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especially when, and I think for women particularly.
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Because there's so many things,
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right? There's so many roles that you're doing every day.
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You're doing so many things for so many people.
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And yeah, I wasn't I wasn't good in doing that for many,
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many, many years. And it's it's just a very intentional thing that I
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but I I struggle with it. So taking that pause
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to think and to listen to myself.
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has been hard, but I'm doing it.
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Yeah, and I think like you said,
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I think for a lot of women who might be listening in are in their early career
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years, there is a lot of doing,
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right? You're you're setting yourself up professionally.
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It's often the years you also have small children.
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So there's a lot of doing in a lot of directions.
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We know that women still do more of the invisible work on top of their,
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you know.
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main jobs, they have these second shifts.
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And so it's easy to sort of get on this doing,
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doing, doing. And what you're describing is that that pause
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and that simply being is different.
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and that that mindfulness is so important.
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But you can get stuck in this,
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like going from thing to thing to thing.
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It's very easy actually. Cause it's almost like a default,
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right? And and even today,
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when I know it, and I I've been practicing this for so many years,
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if I am not like every day,
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it's like, okay, where where am I?
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And I need to do my mindfulness.
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I I have my apps to remind me to do this type of
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~ inner work and inner
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inner listening, which is I I prefer that.
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I prefer it so it's it's that listen to yourself.
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It's that inner listening. I like that.
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And and I know it's hard. And this is something that I also discuss not only with
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my kids, but also with people that I mentor because it's hard to do.
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Yeah, and if you think about the course
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of your career and kind of your roles and where you are now,
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if there is one habit you would tell your younger self to build,
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what would it be?
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Taking time for yourself straight out.
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And that for me now is carving out time
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to do yoga specifically. So I I have been doing this for about two years,
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two and a half years almost. And ~ that carving out time because I used
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to do sumba for many, many years,
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which I love and I still do. But that it it's a different,
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it's a different skill.
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'Cause I I'm looking at it as a skill and it forces you
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to just slow down.
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Yeah. mean, so the basis of yoga was really when it started 5,000 years
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ago in India, the basis was really that
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you did the yoga to sort of prepare your body
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for a seated meditation. Right.
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So you're sort of getting your body and your mind ready for the stillness that
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you were just speaking of. Yeah.
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And that's that's stillness. That to me personally is so hard.
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And and that's why I'm really trying very hard to cultivate that.
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So so yeah, that's something that that I've been doing.
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And I'm very grateful. I have a great yoga.
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~ you know, she doesn't like to be called teacher.
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~ But ~ so she has been so instrumental.
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Anyway.
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So is there something unexpected or challenging in your career that
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ended up having a positive outcome for you?
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Hm, a positive, unexpected.
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Sometimes, you know, sometimes we sort of you know,
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we I think in medicine things can sometimes be very linear and very sort
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of you know what the next step is.
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And I've been hearing stories that just inspire are so inspiring sometimes
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of unexpected turns,
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but when they happen you think
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no, this is happening, but really leads to something wonderful.
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And I didn't I just didn't know if there was something challenging that actually
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Interesting.
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led to something positive.
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So I can I can definitely ~ think about when I switched from clinical work
29:57
to administrative work. And and that was unexpected.
30:02
So how how I made you switch? So so I how I stumbled,
30:06
it was almost like a stumbling into it.
30:09
Because I had been doing clinical work for many,
30:10
many years in an academic center.
30:12
And how I so I had I had ~
30:18
just come back actually I wasn't even back,
30:20
but I was about to come back from maternity leave.
30:24
And this opportunity came up of being the
30:29
the chief of an inpatient unit.
30:32
And so I was like,
30:36
~ interesting. I had always done outpatient care and I had not thought about being
30:43
unit chief of anything.
30:45
And then this opportunity, I I remember distinctly,
30:48
it was about a month before I got back too from maternity leave.
30:52
And and I was like, okay.
30:55
I hey, it's an opportunity, it's different.
30:58
I'm gonna give it a try. I'm gonna try it for a year or two and see
31:02
how that works out. Because up until that point,
31:05
I really had had been doing clinical,
31:08
clinical and research. That that was it.
31:09
And
31:11
Go figure. I loved it. It was one of those things that I s that's why
31:17
I'm saying I stumbled onto this administrative psychiatry quote unquote track.
31:22
And one thing led to another.
31:25
It's almost right, it's that progression,
31:27
right? That we're talking. So my whole career,
31:29
if there's something constant,
31:31
is that I progress, it's one thing leads to another and another.
31:35
And that's why one of the things that I do talk to people that I mentor over
31:40
the years.
31:40
is that there are opportunities.
31:43
Try it. If you don't like it, you then pivot to something else.
31:48
But sometimes opportunities come in and it's at those times when you say,
31:53
you know what, I'm going to try it.
31:54
I'm going to give it a go. I personally I usually say I'm going to give it a go.
31:59
I'll try for a year or two and see what happens.
32:01
And I have, you know, many years I have not once looked back and said,
32:06
I should not have tried that.
32:09
'Cause it's usually something good.
32:10
So yes, it's it was a positive outcome for sure.
32:15
Yeah. So you've had these administrative roles,
32:19
you've had these leadership roles.
32:21
What are your thoughts on I mean,
32:25
the world is innovating. You can't even keep up these days with how fast things
32:31
are changing. As we think about psychiatry a decade out,
32:37
what should we be thinking about?
32:40
I mean, AI comes to mind quickly,
32:42
but like what
32:44
What other what what should we be thinking about in terms of our field?
32:49
For sure AI. And and it's it's mostly because it's already out there.
32:54
And I think that for us in psychiatry,
32:59
we should be at the forefront of ensuring that specifically for
33:04
our our the individuals we serve is how is it that we're gonna
33:09
be protecting and providing guidelines on the ethical use of
33:13
AI and respecting privacy, especially because of
33:18
the population that we serve. So more than anything.
33:21
But the other things that come to mind are precision psychiatry.
33:26
How is it that we're going to leverage the new technologies coming in
33:31
on how to be sure that we are utilizing the resources
33:38
as best as we can to advance evidence-based precision psychiatry.
33:42
And the other thing that I have been championing for the past year
33:46
is collaborative care.
33:48
I truly believe that that is not only an immediate workforce multiplier,
33:54
but that is where we have to be.
33:57
This is the space where we have to be because the majority
34:01
of people ~ will need to have better access
34:07
to psychiatric care. We know that post-pandemic the demand for our services
34:13
has only increased.
34:16
That particular type of integrated care with collaborative care model
34:21
is the one that we as an organization and me personally have been championing.
34:26
And it's mostly because it is a really good use of our resources.
34:32
It will improve access to the patients that really need us.
34:36
And will it it's already a paradigm shift,
34:40
but I think that where people get caught up is that.
34:46
They believe that it's the only path forward for psychiatry.
34:51
It's one path forward. And this would be what we need to do for people,
34:57
especially with mild to moderate psychiatric conditions,
35:01
especially when they prefer to be seen in a primary care,
35:05
or they're more used to be seen in a primary care.
35:08
And ~ but not forget that we also have to continue to advance better.
35:14
services for people diagnosed with severe psychiatric disorders.
35:20
So I think that it is a combination of leveraging technology,
35:25
better utilizing resources, and not forgetting the population that
35:31
we serve to make sure that we are then providing the gamut of services needed.
35:38
As you think of this last year,
35:40
you you mentioned the collaborative care model.
35:43
What have been some of the highlights that you sort of have loved being
35:50
a part of in this capacity?
35:52
Bringing this information to the the the international organizations.
35:57
I've had the opportunity to bring this message about how is it that we're gonna
36:02
leverage collaborative care specifically.
36:05
And I've had the I had the the honor of working also with
36:11
~ from Washington University with Anna Ratzliff.
36:16
And she has been a pleasure to work with and it it learning it from from
36:22
the team that actually got it is so well ~ you know it's
36:28
a really good training to to work with her.
36:30
But having that particular message and that
36:36
we as an organization are going to be able to also work with
36:40
interorganizational and especially international.
36:45
To bring forth the fact that as psychiatry,
36:50
as a as a ~ profession,
36:53
that we also have the responsibility to bring the message that
36:58
for governments in general, that you have to include mental health in
37:04
any type of proposition that you do.
37:06
It is, you know, in the United States,
37:09
it is not a partisan issue. ~ Mental health is something that
37:14
Is for anybody that you have to make sure that you're including
37:19
in your financial propositions.
37:21
How is it that we are going to be able to make sure that
37:27
the resources are available, the access is available,
37:30
that we continue to normalize seeking care for mental health,
37:36
decreasing that stigma, and ensuring that we are getting paid.
37:43
For the work that we do when we do it.
37:46
So it's a combination of things.
37:50
At the end of the day, and this is where where I think we all
37:55
are together with this, that there is no health without mental health.
37:58
And how is it that we're gonna be advancing this to normalize,
38:03
decrease stigma, and ensure access to those that need us?
38:08
Yes, I could talk to you about this for much longer.
38:11
Yes, Me too.
38:15
as we finish up, any last thoughts,
38:19
pearls of wisdom, things you would
38:24
You know, I and and and I know that for this particular type of ~
38:29
of interaction and I've I've heard some of the other ~ you know some
38:34
of your other sessions, I've learned so much through this
38:40
particular way in which you can interview people and and they're bringing their
38:47
their pearls of wisdom. And my pearl of wisdom is listen to yourself.
38:54
And at times it's it's just that listening.
38:57
Remember how we were talking about that listening to yourself and take
39:02
the time to listen to yourself more than anything.
39:07
Figure out where is it that you want to go,
39:11
figure out your path.
39:15
and be kind to yourself.
39:18
Thank you. Those are great words to end on.
39:22
Thank you so much, Teresa, for taking the time to be here with us today.
39:27
Thank you, Angelia. Really appreciate the opportunity.
39:30
Take care. See you soon. See you in the annual meeting.
39:35
Yeah, see you with me.
39:37
Thank you. The views and opinions expressed in this podcast are those
39:42
of the individual speakers only and do not necessarily represent the views
39:46
of the American Psychiatric Association.
39:49
If you are having a medical emergency,
39:51
please contact your local emergency response now.
39:54
~