Latest / The Medical Mind / Women Psychiatrists Caucus Chats: Dr. Katherine Kennedy on Advocacy and Leadership in Psychiatry

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Women Psychiatrists Caucus Chats: Dr. Katherine Kennedy on Advocacy and Leadership in Psychiatry · The Medical Mind

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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's Psychiatrists Caucus.
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I am Dr. Anjali Gipta, 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. Today I have the pleasure of being with Dr.
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Katherine Kennedy.
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She is a clinical professor of psychiatry at the Yale School of Medicine
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and also in private practice in New Haven,
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Connecticut. She leads the Yale Legislative Advocacy Program,
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co-leads the Advocacy TRAC, and serves as co-editor of Voices in Advocacy
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and Policy for Psychiatric News.
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Dr. Kennedy is past chair of APA's Council on Advocacy
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and Government Relations and chairs the Committee on Psychotherapy.
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for the group for the advancement of psychiatry.
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Thank you so much for being here with us today,
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Dr. Kennedy.
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It's a pleasure to be here, Doctor Gupta.
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So you are very involved with advocacy.
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You teach advocacy to medical students,
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residents, you lead professional societies around advocacy,
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and you've even written a book,
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A Psychiatrist's Guide to Advocacy.
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How did you first get interested in this area and get involved in it?
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So as you know, ~ advocacy ~
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was not taught in medical school or residency training when
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I ~ was a student ~ and resident many,
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many decades ago. ~ and
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so my entry into advocacy really
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~ occurred ~
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in the environmental space when around twenty-five years ago ~
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I became aware that there was going to be an interstate natural
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gas pipeline that had already received Federal Energy Regulatory Commission
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approval that would go from Connecticut across Long Island Sound
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to ~ the eastern end of Long Island.
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I was
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A big environmentalist and I knew that previous pipelines had really degraded
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the water quality in Long Island Sound.
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And so I was very concerned about what this pipeline would do.
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And furthermore, when I learned that there wasn't even that much
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of d of a demand in the eastern end of Long Island,
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I actually heard radio stations from the the
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Energy Corporation were broadcasting suggestions that people
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buy gas-powered pool heaters so they could switch over to natural gas.
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That got me really mad. And that's when I s decided that I was gonna fight
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the pipeline. and I was told I had a snowball's chance in hell because
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it had already s received Federal Energy Regulatory Commission.
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Approval, but I launched and mobilized
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a large grassroots campaign. I had a column in a regional newspaper that
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ran twice a month, and that's how I learned how to write op-eds.
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I started to engage with our state legislature.
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We actually got a law passed that put a moratorium on interstate natural
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gas pipelines. And so all of that work really ~
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Taught me how to approach advocacy from a variety of different ways.
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~ In fact, what happened is our then state attorney general
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~ sued the pipeline company based on one of their permits.
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We actually won at the Second Circuit Court of Appeals.
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The Pipeline Company ~ took it to the next level,
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which was the US Supreme Court.
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We actually they decided not to hear the case,
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and so actually we won. And that pipeline was never built.
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And that really taught me the power of advocacy.
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~ and so people in the Connecticut community knew about that work,
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and in the mid ~ around 2015 or so,
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the residency training director of Yale came to me and said,
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Hey, all these medical students are interviewing,
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they want to learn.
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Advocacy. I know about your environmental work.
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Do you think you could develop an elective to teach them?
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And so I said, well, let me try.
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And so that's really how I got started.
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And that is what led me to develop the advocacy track,
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which is within our department's health equity curriculum.
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~ It also led me to develop the legislative advocacy program or LEAD,
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which is within the School of Medicine at Yale,
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which is
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a a a full year-long opportunity for residents and fellows in any discipline,
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not just psychiatry, to come and learn about legislative advocacy,
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and then led to a lot of the other ~ leadership opportunities ~ that
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you detailed in my bio.
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Wow, that is a great story and so much to unpack there.
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So where in your pr your career or your professional timeline
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did this pipeline occur?
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Like were where were you in your life when this was happening?
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So I would say I was about, I was kind of mid-career.
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~ I had finished my medical school and residency training.
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I had my private practice. I was doing a lot of psychotherapy supervision within
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the department of psychiatry. ~ I had two small children.
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~ so I was I was pretty busy with a lot of other things.
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And ~ and I guess that tells you how passionate I can get about ~ things.
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w about about when I exp feel something is unjust because
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my feeling about wanting to not let something
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bad happen really overtook me and I somehow found the time despite
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all of those other responsibility responsibilities and learned a
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lot and actually had a lot of fun doing it as well,
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which is I think why I really do love advocacy,
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because it is fun, engaging,
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creative.
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and ~ something that really ~ pushes you to do things that might
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feel unfamiliar.
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And
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it sounds like it was an incredible learning and growing experience.
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You mentioned sort of ~ mobilizing people and writing op eds and and doing
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a lot of things that perhaps you hadn't done before.
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Yes, that is right. And I I will say that
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one that that timing is always everything,
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right? And when this happened,
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it was around 20 years ago or so.
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And that was, believe it or not,
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when email was a new online tool.
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And people opened their emails actually back then,
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if you can believe it. And so
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Really, that is a lot of what I attribute my success to was taking advantage
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of the fact that people opened to every email they got.
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So I suddenly had this free way of connecting with people.
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I created all these listservs and that really helped me to mobilize
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the grassroots part especially was taking advantage of that new ~ n so-called,
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you know, invention of email.
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So ~ it sounds like your advocacy began in this environmental cause
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and now a lot of your advocacy work is around mental health.
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What do you see as the structural systemic challenges affecting mental
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health today?
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Sure. And ~ I I wanna say that physician advocacy
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or depending on who is ~ giving it,
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any any healthcare provider can engage in health advocacy.
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I see it as ~ always
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in always benefiting patients,
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their communities, and populations.
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So
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It's important for me to distinguish physician advocacy from
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my own personal political speech,
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which is certainly, at least for now,
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protected under the First Amendment,
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and I can ~ express myself politically,
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but that would be n not be necessarily considered physician or health advocacy.
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So with that in mind, really if we think about the patients
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and when we see them in our
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offices or clinics or emergent emergency departments,
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they come to us having ~ impacts from large systems and structures
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and whether it's ~ the social determinants of health and mental health,
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the zip codes where they come from,
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that their access to food and and
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Education and ~ and nonviolent neighborhoods.
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~ well, who pays for that care?
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Whether they ~ are having the care paid for by private insurance,
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by ~ Medicare, by Medicaid, by the VA,
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~ all of that can really make a difference in terms of what kind of care they
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can access. ~ certainly the health care systems,
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policies, and procedures
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Can also make a difference. And so advocating in that space ~ is often necessary
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for patients. And then certainly in the last ~ few years,
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we've seen all too clearly how the state in which ~ mental health care gets
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~ is provided can really make an enormous difference in terms of what kind
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of care a patient can receive.
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So advocating for all those different,
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you know, in all those different arenas.
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~ are all in my opinion opportunities ~ that physicians
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and psychiatrists can take advantage of.
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So what are ways that psychiatrists can advocate in these different domains?
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So I think ~ it might be helpful
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to conceptualize advoc advocacy as occurring at different levels.
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Because I think it's important to understand that at each level you're going
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to need to need to understand the system that you're operating in,
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the processes and procedures within that system,
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the history of your issue within that system.
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And so centering yourself in the different levels,
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which I'll describe in a second,
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can be really helpful. ~ In addition,
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the ways that ~ psychiatrists can advocate
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are ~ are many. And whether it is through
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op ed writing or giving legislative testimony or signing
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a petition or advocating
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For your patient for a non formulary medication.
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All of these are ways that you can advocate.
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Just getting back briefly to those levels I mentioned,
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I kind of like to start with at the bottom with self advocacy.
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And you always need to make sure that you advocate for yourself
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and your own wellness. You can't take care of anyone else if you haven't attended
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to your own.
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~ emotional, psychological, physical needs.
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~ After that, patient advocacy,
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making sure that patients get the care they need.
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And I mentioned and and probably everybody listening to this is already
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a patient advocate. They've already done whatever they need to do
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to ensure that patients get the treatments and services that they believe
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are medically indicated for their patient.
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~ the next level after that would be institutional ~ advocacy,
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and that would be advocating for the healthcare systems policies and procedures.
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~ or again, maybe a non-formulary medication from the hospital pharmacy.
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After that, there's community advocacy,
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~ where it's ~ it's very helpful for
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~ physicians to work ~ side by side with.
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community organizations to amplify their voices ~ and help them
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get what they believe they need.
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And I I it's really important and I will emphasize working side
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by side and listening to community voices and not imposing your idea
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of what they need, but listening and amplifying their needs.
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Then you get up to kind of state legislative,
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maybe local, state and federal legislative
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levels where you can advocate for ~ for bills.
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And finally there's global advocacy where you may be working on global issues like
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climate change ~ and so on.
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So I hope that answers that question.
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Yeah, I think that was a really nice description because I think
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for the listener who s sort of thinking,
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I'm not an advocate, you've already shown that there are a number
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of ways that within a day's work that people are advocating as they're taking care
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of patients. ~ and that, you know,
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even ~ at the more community and government levels,
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there's a number of levels.
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you mentioned community, local,
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state, federal, and global. ~ so how for someone who
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has been advocating in their day-to-day,
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but wants to get more involved in those levels you mentioned later.
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what are some maybe first steps that they could try?
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Sure. ~ the the first step would be to make sure that you vote.
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~ here in the United States,
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we really have a very low record of voter turnout ~ in presidential years.
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It's around maybe 60 percent,
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but in non-presidential years it's less than that.
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And in many communities there are local elections in the off
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In the odd numbered years, certainly every two years we re-elect US Congress.
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~ and so it's very important to make sure that you
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are registered to vote and you vote.
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If you are not eligible to vote in this country,
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what you can do that is critically important is you can encourage those who can.
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~
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goes beyond just asking somebody who might be registered to vote,
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hey, are you going to vote in the November election?
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It's really about helping them to first of all make sure that they
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are registered to vote, that they know where their polling place is,
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but then to help them mentalize what w how they are going to vote.
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Are they going to going to do mail in votes if those if that's still legal
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and available? If it's going to be on election day,
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Are they going to vote before they go to work?
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~ how much earlier in the morning are they gonna have to leave to be able
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to do that? Are they gonna take a break at lunch?
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Is there somebody who might go with them to the polling place?
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And so on. Do they even know how to vote?
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Sometimes it can be overwhelming to people who've never voted before.
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It can be scary. So seeing helping them to see a ballot in advance
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to understand what they might have to do in the privacy of
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the the voting space ~ can be helpful.
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So in other words, ~ vote. Beyond that,
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what can be really helpful and is an easy next step is to network with colleagues
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who are interested in the same issues that you're interested in.
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And I do want to say something about what you advocate for.
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In when I teach, I will never tell anyone what they should advocate for.
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I strongly believe that
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Whatever you advocate for should be informed by your own personal values,
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your lived experience, if you are a clinician,
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your clinical encounters with what you see.
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If you're a researcher, then ~ maybe your research interests.
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~ but all of that ~ you know,
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will help you recognize what what are the issues that.
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Keep you up at night? What are you worried about?
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What do you, what change do you want to see in the world?
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And then there are lots of different advocacy organizations out there.
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certainly for me, I ~ really am interested in more psychiatric advocacy.
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And so that's why I've been so involved with the American Psychiatric Association,
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why I'm very involved with our district branch,
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the Connecticut Psychiatric Society.
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I'm also involved with some other
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Psychiatric organizations. But the next step for people would be find people
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who are interested, get connected to those organizations,
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~ open up their emails, sign their petitions,
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and gradually, as you feel increasingly comfortable,
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you may find that you're willing to go the next step.
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Maybe you will testify if you're asked before a legislative committee.
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Maybe you will.
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Decide that you do want to write an op-ed about a clinical encounter that
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illustrates a concern that you have.
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So ~ I think the most important thing is to recognize that it will feel unfamiliar
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that ~ and but that by taking that first step and getting support
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and feedback from other people,
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you can start down your own ~ journey of advocacy.
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So as we think about learning some of these skills,
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I want to shift over to the Yale Legislative Advocacy Program
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and TRAC, one for medical students and one for residents.
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It's I know you mentioned it started out of your work,
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and then you got a phone call sort of asking if you'd like to teach some
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of these things. ~ What skills do trainees get?
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when they take part in this program,
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what what skills do they end up with?
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Sure. So ~ so actually the advocacy track
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is for psychiatry residents and it's within our health equity curriculum.
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And I'm a co-leader of that track,
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and I work ~ with my colleagues in the other track,
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which include a history track and structural competencies track
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and a human experience track. And so
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We really try to work hand in glove to explicate
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and open up primarily ~ interest and exposure to the social determinants
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of ~ of mental health and also community
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and legislative advocacy. So within the advocacy track,
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well, maybe I should just say that within the legislative
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advocacy program or lead. ~ the focus there
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is primarily on legislative advocacy skills.
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And that is opened up to not just psychiatry residents,
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but residents and fellows in all disciplines.
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So we have I have people from surgery and pediatrics and primary care
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and OBGYN and anesthesia and ~ ophthalmology and it's it's really
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incredibly wonderful to have all these different residents and fellows
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who have their own passions and interests ~ find each other
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and start working together on different issues.
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It's
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really neat that they that they come together across fields and do that.
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It really does help to break down a lot of silos.
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~ but the skills really have to do with ~ it in
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the legislative advocacy program and lead with understanding we we work
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at the state level in Connecticut,
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so understanding how our Connecticut legislature works so that you know
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the timing of bills and you know how to look up bills on the website.
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Also learning how to
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Engage with state legislators.
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~ Residents in the past have actually had ideas from their clinical work which
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they've pitched to state legislators,
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which have made it into state legislation and become state law.
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~ And so that is can be an incredible experience.
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Also, learning how to give more formal legislative testimony
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to a ~ legislative committee.
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both written and oral testimony,
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~ and finally learning how to write op-eds,
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which ~ and publishing them. And every year people we have residents
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and fellows publishing op-eds in our our local papers.
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And so those are primarily the legislative skills,
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and I would add on, and and those are skills we also try to teach within
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the advocacy track to the psychiatry residents.
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~ and in addition to ~ working more closely with community organizations
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~ and ~ and and maybe doing some
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kind of advocacy projects around research and history and so on.
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So is this how common of a program is this?
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Like d do you have any sense of is Yale one of the very few programs that does this
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or is has this become more common?
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So that's a really great question.
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~ a number of years ago,
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when I was on the Council on Advocacy and Government Relations,
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I did a survey actually with a fellow Dr.
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Mary Vance to see what programs around the US were doing advocacy.
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And at that time, we put out a request for information basically
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on the adpert listserv. And we ended up
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having seven programs respond and we interviewed them to find out what they were
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doing and we compiled a resource document
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~ which basically outlined that teaching social determinants of health
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and mental health, ~ having role models for advocacy,
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whether they are within the department or ~ maybe people like legislators
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or community activists
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outside of the department, getting feedback for your advocacy work,
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and having, you know, having ~ a network of people
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to share ~ kind of the advocacy hurdles with was very important.
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Since that time I've not done another survey,
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but I've been talking about advocacy at a lot of different places and I
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My my sense is that programs are increasingly recognizing that residents
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and fellows need to be taught these advocacy skills during their training,
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~ not only to set that foundation,
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but also to better integrate that with their ~ with their clinical skills
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and their their burgeoning identity as a psychiatrist and what psychiatrists do.
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Okay, I could talk about this for another hour,
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but I'm going to shift us to another one of your passions,
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~ psychotherapy. Where did this interest in psychotherapy and your passion around
26:06
this develop? I know this is also an area that you've written a book.
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and so I'd I'd love to know sort of when you think it all started for you.
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Well, to be to be honest, I I always thought that
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I wanted to be a physician because I just always had this passion about wanting
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to be helpful to people. I loved science.
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~ and when I went to college and was being pre-med,
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~ s I had this experience where everyone seemed to come and talk to
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me about their problems.
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whether it was a breakup with ~ as as a partner or problems with their
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parents, I for whatever reason seemed to be the person
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a lot of my friends would go to.
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And I actually enjoyed that. So I kind of thought,
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well, if I like this and and maybe I have some knack for this,
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Why not go into psychiatry to become a psychotherapist?
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And so when I went to medical school,
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~ that was in my mind. I tried to keep an open mind.
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I did love my pediatrics rotation,
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I love my OBGYN rotation. ~ and and I was thinking about primary care,
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but in the end, I finally decided on going to psychiatry.
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And I have written about this experience,
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but
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It was about 10 years from when I decided in college that I wanted
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to be a psychiatrist in order to be a psychotherapist to the beginning
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of my PGY three year, where I would actually get the opportunity
27:56
to try learning how to be a psychotherapist.
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And I remember that drive on 95 to the West Haven VA.
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It was a really hot day and it was sunny.
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And I remember just thinking, I hope I made the right decision ten years ago.
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But I did. And I have just been in love with psychotherapy
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and its challenges and its rewards.
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And ~ I just believe it's a foundational skill for all psychiatrists,
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no matter how you practice. ~
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you know, even for briefer medication focused encounters,
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you know, psychotherapy allows you to go beyond just managing symptoms
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and prescribing medications. it really helps you to listen more thoughtfully
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and to develop better psychotherapeutic alliances and make more informed
28:53
diagnoses and and so on.
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So my next question is gonna draw off of the title of your book.
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So drawing off that title, which is supervising individual psychotherapy,
29:08
the guide to good enough, what do you see as the role
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of supervisor and drawing on Winnicott's notion of the good enough mother?
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What does it mean to be the good enough supervisor?
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So we thought long and hard about this
29:33
title because at the time that we wrote
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the book w we realized that
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a lot of the psychotherapy supervisors
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who had been psychoanalysts who had been
29:54
in the field for
29:56
40 years were retiring. And a lot of the programs,
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I mean, this is really the reason why we wrote this book,
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because we'd been hearing that programs didn't have psychotherapy supervisors.
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And we were hearing that people who were
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out early career psychiatrists felt uncomfortable.
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Trying to be supervisors because they felt like they were imposters.
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They weren't psychoanalysts.
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They didn't have gray hair and a beard and make brilliant observations.
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And so we really wanted to lower the bar and make sure that people would
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feel that with practice ~ and with a good enough mindset,
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they could develop their psych.
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Psychotherapy supervision skills,
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just like psychotherapy skills.
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You gotta start somewhere. Psychotherapy supervision skills,
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it's a developmental process. You have to start somewhere.
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And good enough, ~ according to Winnicott,
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suggests that being the perfect mother
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is actually not ~ a good idea for the baby.
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It doesn't allow them to separate.
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It doesn't allow them to individuate and become their own person.
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That it's actually good to make mistakes and to reflect on your mistakes.
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So that's why we really settled on this because a good enough mindset
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recognizes that we all are going to make mistakes,
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but if we reflect on them and examine them,
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That's the way that we can learn and advance our psychotherapy supervision skills.
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I love that and I do love the title.
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~ so as you think about supervision now,
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with more with more of the virtual world in play,
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how what kind of effects do you think that has had on supervision,
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if any?
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Well s like anything ~ with Zoom,
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it opens up new opportunities,
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but it also may ~ make
32:32
it hard to recognize that you are not necessarily getting all
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of the information when you think you are.
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So let's talk first about the opportunities.
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I mean, right now, actually we're on Zoom as I'm speaking,
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and otherwise it would be hard for us to have an in-person conversation.
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So ~ we might not have been able to do this if we didn't have access to Zoom.
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And that's the same with supervision,
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especially for programs that might not have available supervisors
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~ in w you know, within a reasonable travel distance.
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They can ~ find supervisors
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that who live farther away and those supervisors can live in,
33:18
~ zoom in. And so ~ giving access to residents
33:24
to to higher quality supervision ~ to replace maybe no supervision at all.
33:31
and
33:36
But I think in terms of problems,
33:39
~ it can sometimes
33:42
be misleading that we really
33:47
are connected when we see the supervisee just on the flat screen.
33:53
So I I've learned actually,
33:58
I I'll tell you I had had an experience with a supervisee ~ at
34:04
the beginning of COVID.
34:05
We were actually not allowed to meet in person.
34:08
And so we met over Zoom from July
34:12
of 2020 until June of 2021,
34:17
when finally the department was allowing people to congregate in dyads
34:22
and sometimes in smaller like in in other sized groups.
34:25
And so I we met in person and my supervisee was
34:33
about I I discovered was about six foot five.
34:36
And you can't tell how tall I am,
34:38
but I'm about five foot three.
34:40
And when I met ~ this lovely,
34:44
wonderful supervisee who had been the most lovely,
34:49
gentle, thoughtful person ~ and really enjoyed
34:54
my my supervisory experience with him,
34:57
but I I realized that my goodness,
35:00
how
35:01
How would this have been if I had understood his height and the role that
35:06
his height played in his identity?
35:08
I realized we never addressed that in the supervision because I didn't see it.
35:13
I didn't know it. ~ And so that might have been a little bit of a disservice to him,
35:19
although he this was so talented,
35:21
I'm sure he d didn't need any anything from me.
35:25
But ~ but I think it means that for me,
35:29
I really think it's important as much as possible to at least meet your supervisees
35:35
in person early on, even if ~ for the sake
35:40
of ~ time and travel you need to meet more frequently with them via Zoom.
35:46
But make sure you've at least had that in person experience ~ a couple of times.
35:53
And I know I mentioned as I introduced you a number of leadership roles that you've
35:59
held. What do you think as you think about your different leadership roles,
36:06
what skills do you think are important in leaders?
36:14
I guess what comes to mind is listening
36:18
and ~ and being curious.
36:23
I think a lot of people may think that leadership
36:29
is about telling people what to do or telling people what your ideas are.
36:35
But I think being an effective leader
36:41
is listening to people.
36:44
~ inspiring them in whatever you're trying,
36:49
~ whatever the mission of the group or organization is,
36:53
~ and empowering them. So,
36:58
and and to just constantly be,
37:00
I guess, curious and and also self reflective.
37:04
~ So I guess I'm thinking this through as you're saying this,
37:08
I would say curiosity
37:11
Self-reflection and empathic listening would be what I would say are
37:16
the three top requirements for an effective leader
37:22
in psychiatry.
37:25
And as you consider your own career,
37:29
what would you tell a younger version of yourself?
37:34
Anything that you've learned along the way that would have been helpful
37:39
to your younger self?
37:42
So I think when I was growing up,
37:47
decades and decades and decades ago,
37:49
women were not listened to or valued.
37:55
And so I think that made me feel like I always needed
38:01
to be super prepared. I always needed
38:05
to know everything and that it was a weakness to ask.
38:12
For advice to ask questions. It somehow meant that you hadn't done your homework.
38:18
And what I have learned over the years is that
38:24
it makes you better to ask questions.
38:28
It's better to get feedback. ~ ask for advice.
38:33
And so now my whole approach to almost anything I
38:38
do is to have trusted.
38:42
people ~ in all different arenas to check in with,
38:47
to get feedback from, to a get advice from,
38:50
~ and that I wish I wish I had known when I was younger that asking advice
38:57
is not or asking questions is not a weakness.
39:03
And then what do you think is the best advice you have received about leadership?
39:14
I I'm trying to remember who said this,
39:17
but someone once told me that there's
39:21
a difference between being a trailblazer and being a leader.
39:28
And y we need both,
39:32
but you need to be clear on what you're doing.
39:36
And a trailblazer means.
39:40
Being laser focused on the mission,
39:42
come hell or high water, you are going forward and forging a path.
39:49
But being a leader is about inspiring others
39:55
to follow you down that path ~ and find ways
40:01
for them to help broaden the path.
40:04
Maybe help them become trailblazers for new paths,
40:08
~ but that
40:10
Being a leader is not the same as being a trailblazer.
40:16
You know, that is so interesting.
40:18
And w when do you w where in do you know ~ the timing of when you
40:22
may have heard that earlier or later in your career?
40:28
around ~ that was around when I was working on the pipeline.
40:32
so probably twenty or so years ago,
40:35
yeah.
40:36
Yeah, and and from what you described,
40:38
you were definitely both. You definitely were were making some huge
40:45
changes, but bringing a lot of people with you and inspiring a whole movement.
40:52
Well, I we we we were I ~ I guess I I
40:58
we all work together and it was it's really gratifying to
41:01
me my to to have
41:06
my residents start publishing op eds on their own or
41:11
to go off and do legislative testimony on their own.
41:15
One of the residents from Leeds just let me know that she's
41:21
kind of introduced the Department of Health Public Health Commissioner
41:25
at an event because of her of what she learned at Leeds.
41:29
So I think for me, I,
41:33
you know, being an educator is really where my heart is.
41:38
And so I think that's the lens through which I look at my leadership.
41:45
Yeah.
41:46
Yeah. Well this has been so enjoyable.
41:49
Thank you so much for spending the time here today to describe some very interesting
41:55
topics and the ones that I know you're passionate about and that passion
41:59
has come through and we've all ~ really learned from your insights.
42:03
So thank you so much.
42:05
Thank you so much, Dr. Gupta. It's been an absolute pleasure.
42:09
You've been so kind.
42:15
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42:18
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42:23
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42:25
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42:31
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