Personal Introduction:
I am writing this somewhat longer introduction to spare you watching the 12-minute-long video introduction recorded during COVID (available upon request 😊). I offer a more extensive introduction, not only to establish my “bona fides”, but to make a larger point- that if you have a long career as a clinician (for me, now 50 years), the world of mental health delivery will look significantly different than the one you are about to enter. My goal is to provide you with a course that will hopefully still be relevant 40 years from now and provide fundamentals in working with youth that you can build upon as you go forward.
I entered Beloit College in Wisconsin (a liberal arts college which at the time had a progressive approach to how the four undergraduate years were structured with an emphasis on in the field study) with the goal of entering the ministry. I had been raised in both a Roman Catholic tradition (had initially thought of the priesthood, but…) and a protestant tradition as well (attended Presbyterian services in the summers spent with my grandparents, and dabbled in different churches in high school); I hoped to go to Chicago Theological Seminary post-Beloit with a eye towards pastoral counseling. At Beloit, as a religious studies major, I lost my faith (I will spare the class the details, although I am happy to share with anyone interested, outside of class). At the same time, I did a field semester, part of the Beloit program, working at the Essex County Hospital Center in Summit Grove, NJ.
Essex County Hospital Center was the largest psychiatric facility in the country at the time, having over 3000 beds (and a 44-slab morgue). Filled predominantly with adults with chronic mental illnesses, mostly with diagnoses of schizophrenia, in an era where Thorazine was relatively new and there were few other medications, it was a series of buildings comprised of many hospital wards, each having upwards to 80 patients, segregated by gender, with little care for them but to keep them “protected”. It was facilities like these that belied the Community Mental Health Act of 1963 and the “de-institutionalization movement”. ( https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2021.160404#:~:text=The%20CMHA%20funded%203%20years,and%20professional%20organizations%2C%20inpatient%20facilities%2C ), that had started but not quite reached this part of New Jersey (the hospital finally closed completely in the late 90’s).
I was employed to work in the hospital’s adolescent program, its “flagship program” which was composed of three 40 bed units: the Violent/Aggressive unit; the Passive/Depressed unit; and the integrated step-down, pre-discharge, semi-locked program. I worked on the violent aggressive unit, which highlighted the hospitals institutional racism (and sexism, I suppose), as during the four months I worked there the unit was almost all black males (there were three AA girls on the unit briefly at one point, and usually 3-4 white males; the white teens were almost all hospitalized on the Passive/Depressed unit). The treatment approach was a behavior program utilizing a token system. While I found the approach to be problematic, this was the first time I had been with people who were experiencing psychotic symptoms, often unmitigated, and I was both profoundly affected and moved by their pain and courage, and fascinated by their experiences, and realized this was the work I was called to do. This was coupled with a developing sensitivity to issues of race, class, and equity, as most of the youth with whom I worked were from poor neighborhoods in Newark; I learned a great deal from these boys and had the opportunity to visit the homes of two of them. To make a long story shorter, I went back to Beloit and changed my focus to a dual major- religious studies and the social sciences, with an emphasis on phenomenological studies.
When I graduated from Beloit, I was offered a position as an Activities Therapist at the Institute of the Pennsylvania Hospital in west Philadelphia (49th Street and Market) on their 26-bed adolescent unit. The Institute was part of Pennsylvania Hospital, the country’s first, and the second oldest free standing psychiatric hospital in the country. It was a completely different facility than ECHC; most of the patients either came from relative privilege, or had very good medical insurance (CHAMPUS, as one example), which allowed for very long hospital stays (the average length of hospitalization was three months, with many young patients staying 6-9 months, and a number for up to two years!). While the facilities were striking in comparison to ECHC, and there was real therapy going on (mostly from a psychodynamic and systems approach), it was also clear even then that many young patients were being kept in the hospital excessively long to keep the “treatment” going. This wasn’t true for all but was the case for many. My job was an interesting one and also underlies many of the changes, not all for the good, between treatment then and now. I worked from 1-9 pm, with the hospitalized teens after they got out of school (the Institute had its own high school, the Mill Creek School) at 3:30. We conducted different activities in the evenings, on weekends, during school holidays, and the month of August. These included, for me, playing volleyball, basketball, and softball, swimming (an indoor and outdoor pool), judo, yoga, and a poetry group (I also taught health for Mill Creek), as well as leading 3-4 day back packing trips several times a year on the Appalachian Trail. We closed the unit for a week every August and took all the patients to French Creek State Park and Rickett’s Glen for tent camping. I also co-led with a nurse practitioner a twice weekly formal psychotherapy group with adolescents in the hospital but not on the actual adolescent unit; this was a supervised group, and I was also allowed to attend the group therapy training program sessions offered to the psychiatric residents and other clinicians conducting groups.
I worked at the Institute as an Activities Therapist from August 1974 to September 1978, when I entered graduate school at BMCGSSWSR. My fist year placement was at the Irving Schwartz Center for Children, part of the Philadelphia Psychiatric Center at Ford and Monument Road in the Wynnefield neighborhood in West Philadelphia. It was a community mental health facility serving children and adolescents, and most of our clients came from the surrounding neighborhoods; mostly African American youth from neighborhoods of Wynnefield Heights, Overbrook, Mantua, and Mill Creek, and working-class Jewish families from Wynnefield, Overbrook Farms, and Bala. I worked with mostly latency aged boys, and ran a therapy group for elementary aged boys, as well as worked with three families. It was a great learning experience in a number of ways, and I had excellent supervision with a social worker, Robert Mangum, and a child psychiatrist, Dr. Jerry Komisarof MD. The Irving Schwartz Institute closed in the late ‘90’s; PPC has been sold twice and is now owned by the Belmont Behavioral Health System.
The entire time I was in graduate school I also worked part-time for Delaware County’s Crisis Intervention Unit, as a mental health delegate, and on the crisis phone line. I learned a lot about clinical decision making during those two years (I left the job several months after graduation). I also returned to the Institute as a summer rotating psychiatric technician, April-September 1981, when I restarted my second-year placement at BMCGSSWSR. The county closed the crisis phone unit in the late 80's, moving to two (now one) psychiatric crisis units located in hospital emergency rooms (currently CCMS).
My second-year placement was at the Bryn Mawr Hospital Child and Family Center, another child guidance clinic. In this placement I worked with younger children, 4-6 years of age, and worked with a co-therapist seeing two families. I also worked with adolescents at the Presbyterian Children’s Village, with whom BMCFC had a contract to provide mental health services. I saw three teens weekly in individual therapy, two boys and one girl; co-conducted a weekly psychotherapy group for older adolescents ready to “place out”; and did a weekly consultation with one of the resident home teams. I had excellent supervision and remained close to Barbara Foxman MSW for many years after. They wanted to hire me, post-graduation, but my job position was eliminated to help fund a parking lot. BMCFC closed in about 1986. I was invited to the closing party with the existing staff.
I spent 6 months working as the second social worker on the psychiatric in-patient unit in Lankenau Hospital. A general community unit, the typical length of stay was 10-16 days, and most of the work was around discharge planning, although I was often asked to be the lead therapist with the occasional adolescent who was admitted to the unit. I also co-conducted two groups weekly. I learned a lot about concrete services from the other social worker on the unit, Karen Neyer, with whom I remained friendly for a number of years. She helped me to value supportive services work, while encouraging me to pursue my desire to be a psychotherapist with youth. This unit closed in the mid-90’s.
I then went to Life Guidance Services in early December 1980. LGS was the Base Service Unit #1 for Delaware County, part of the community mental health system (Delaware County had 4 base service units), serving Broomall, Marple-Newtown, Radnor, and Havertown areas of Del Co. I was part of the three person Child and Adolescent Team, and as such saw appr. 15 youth weekly in individual therapy, saw some families both alone and as a co-therapist, and conducted 2-3 groups weekly (two older adolescent, and one younger adolescent) both as a co-therapist and alone. I was also the agency liaison to the three school districts in the catchment area. I loved the work, although I didn’t like aspects of the administration. I also met my wife there; a Smith graduate social worker (a fun story which I will share if asked). I left LGS in June 1982 to return to the Institute, for a significant salary increase and an opportunity to do research. LGS is still in existence in Darby, PA, but the Reed Road branch closed with the collapse of the CMHS in Delaware County around 1992.
I returned to the Institute as a clinical social worker on N-4, which was a mixed adult adolescent unit. I was hired in part to be the social worker/family therapist for a new program for dual diagnosed adolescents (mental illness and substance abuse); part of the role included doing research on the family structure and functioning of the families of the youth admitted to the program (limited to 10-12 patients). I used the Beaver-Timberlawn Family Assessment as the research tool, and worked with John Steidl MSW LCSW, who was the head of the Family Therapy training program at the Institute, and with Dr. Harvey Horowitz MD, the co-director of the Adolescent Treatment Program at the Institute. I also served as the faculty social work representative in an ongoing seminar for the psychiatric residents and psychology and social work interns, devoted to exploring the philosophical concepts underlying different prevailing theoretical approaches to psychological development and psychotherapy. I left the Institute a third, and final time, in October 1987. The Institute closed in 1995, and the building now houses the Kirkbride Center. The Mill Creek School continued, as part of the Pennsylvania Hospital/University of Pennsylvania Medical Services, as a certified day high school for mentally ill adolescents until 2020 when it was sold to PHMC (and was a placement for Bryn Mawr social work interns for many of those years).
I left the Institute to head the Psychological Services Department at the Benchmark School in Media, PA. I had been working as a part-time consultant for Benchmark since 1981, conducting family interviews as part of their admissions process, and was approached by them to head the department when my supervisor, Dr. Howard Marcus PhD, a psychologist, left to go into Human Resources work at Merck. Benchmark School is an independent school, 1st – 8th grade, whose focus is with youth who have language-based learning disabilities and executive functioning difficulties. It is quite well known in the fields of elementary education and literacy, as it is a research institution whose approach has been studied and adopted by a number of schools throughout the country. I have been at Benchmark School since, although in differing capacities over the last 37 years. But I will share more about this during the course. Please note that primary mental health services are increasingly being delivered through school systems.
Additionally, I started a small part-time private practice while at Life Guidance Services (we were allowed to see up to three private clients weekly using our offices) which subsequently has grown. I have always worked primarily with children and adolescents and their families but have also seen adults selectively. In 1988 I started my first outpatient adolescent group and have conducted ongoing psychotherapy groups for middle school and high school aged groups since. I currently have two ongoing mixed gender/mixed diagnosis groups for high school students (I recently ended an ongoing group for college students that started in September 2020, and we went through the pandemic together on Zoom).
While my therapy practice is a general practice, I have two expertise niches: the emotional sequelae of neurodiversity, and group psychotherapy. I primarily use a phenomenologically informed relational therapy approach (a school of therapy which represents modern psychodynamic theory) but have formal training in Structural Family Therapy and in CBT approaches, which I use frequently in my work at Benchmark School. I also have a mindfulness practice and integrate aspects of mindfulness-based stress reduction into my work with youth as needed.
I have taught at BMCGSSWSR since 1996; first in the Pro-Dev program (and have continued to do so, mostly offering courses and workshops on group treatment and issues around therapy with youth) and began teaching in the graduate program in 2002. I am a full time adjunct and teach 4-5 classes annually: Clinical Social Work Practice with Children and Adolescents, Group Treatment, and Perspectives on Special Education (soon to become Clinical Social Work Practice in Schools). I have also taught Psychopathology in the past.
Again, I offer this lengthy introduction to save time in the first class, but to also point out that most of the places where I have worked are no longer in existence. The delivery systems of mental health services, the funding of these services, the parameters of engagement and treatment, and our theoretical and scientific understanding of mental illness, have all changed over the course of my career, some dramatically. But what I received when I attended graduate school at this institution is still a strong part of my clinical foundation, and I aim to provide you with the same.
See you Monday the 24th.
Tom