In training, as residents and fellows dash from rotation to rotation, clinic to on-call shift, emergency room to inpatient unit, juggling new and often dizzying responsibilities and challenges all the while, many details in our environment tend to escape notice. For example, the academic titles boldly printed across ID cards of professors, attendings, and supervisors seem incomprehensible, or hardly worth noting. Clinical instructor or associate professor? Assistant professor or volunteer faculty? These aren’t the specifics that grab house staff officers’ attention as they contemplate an upcoming lecture. What trainees want to know is simple: can this person teach? Will I walk out of here smarter, wiser, less green than I was an hour prior? And on a deeper level, other questions percolate as we take stock of a new teacher or supervisor: What are you all about? Are you an able doctor? Do you like your work? Can you inspire me?
I’ve nearly concluded my own training in Child and Adolescent Psychiatry, and in remembering these often-posed questions I think back to one teacher, a voluntary clinical faculty member at NYU, who made a lasting impression upon my classmates and me. We spent thirty-odd hours with Dr. Rachel Phillips over the course of our first year of fellowship in her course on play therapy, and in those hours she offered a rich perspective on how to connect with and think about children, while heartily encouraging us to trust our instincts and to dare to be creative. In the intervening year I’ve had a recurrent thought during moments of uncertainty that occur during therapy sessions with young children: “What would Dr. Phillips do?” This thought reliably reassures and emboldens me in my work.
I am also continually reminded of my admiration of her sweetness with her students (made manifest by the home-baked treats she offered up each week, the perfect antidote to the astringent fare at the Bellevue Coffee Shop), and most especially of her obvious love of her own work, a powerful motivator for trainees often at a loss for tangible evidence that we will each have the chance to make our way, creatively and boldly, in Child and Adolescent Psychiatry when we complete the long road of training.
I interviewed Dr. Phillips about her course, her interest in teaching, and her experiences as a volunteer clinical faculty member.
Q: Dr. Phillips, can you please describe the play therapy course that you teach at NYU? How long have you been teaching the course? How did it come about?
Phillips: I have been teaching the play therapy course at NYU for the past seven years. The “official title” of the course is “How To Talk To Children”. I named it that because I remember when I started my Child Psychiatry fellowship (after just starting to feel competent in the world of Adult Psychiatry), I asked myself the question, “How in the world do I talk to children in a therapeutic way?” I felt quite lost and in need of new therapeutic tools. The goal is the same for working with a patient at any age: establish a way of communicating with a patient so that we can learn about the patient, understand our patient, and express our understanding back to the patient, within an ongoing interactive relationship. The primary form of communication for children is via play. Therefore, the Child Psychiatrist needs to learn how to understand the communications of the child patient that are embedded in their play, and also how to communicate back to the patient, using the child’s language: the language of play. I never had a course like this one; I just learned the hard way: through experiences made up of many failures to communicate with my child patients! I thought that a course in the first year of the child fellowship would make some of the therapeutic challenges of working with children more explicit, and then more of a focus of learning.
Q: You certainly speak to my experience—your course was a special opportunity to openly contemplate the difficulties that often seem to accompany the process of connecting therapeutically with children. Has the course evolved over the years?
Phillips: The course changes somewhat from year to year, depending on the feedback from the fellows the year prior. I want the course to be useful and practical. I want the course to be fun (I find it fun- every child is a new challenge to understand!). I want the fellows to feel free to experiment with play styles over the 30-week course, and to develop their own personal style with child patients, as well as to get ideas from each other. I want them to feel how hard it is to understand a child- I still find each new patient a challenge. That is one of things I like about my work- how much I have to think about each case. It is very demanding work: a Child Psychiatrist needs to be “on one’s toes” mentally and emotionally throughout the play session, constantly wondering, “What is the child communicating and how can I respond most usefully and most clearly?”
Q: What is your own training background? How did you come to Child and Adolescent Psychiatry? Do you have a particular theoretical orientation with regard to working with children, as it applies to teaching the play therapy course?
Phillips: I am a psychoanalyst, trained at the Psychoanalytic Institute at NYU, as well as boarded in both General Psychiatry and Child and Adolescent Psychiatry. I have a strong identity as a physician, as my father was a physician, and I feel that becoming a Child and Adolescent Psychiatrist was a true calling for me. Relieving the suffering of a child changes that child’s whole future, and I am very committed to doing that. I want to do everything possible to that end. I do not think it is useful to divide a person into the psychological or the physical, the cognitive or the emotional, the individual or the family member. When I agree to treat a child, I feel responsible for the whole child: the individual, their family, their educational needs, and their physical wellbeing. I do not want to do the patient the disservice of limiting their treatment options because of my own limitations. I think that since all Child Psychiatrists work with children, it is an essential tool of our trade to be able to communicate fully/playfully with our patients, regardless of one’s theoretical orientation. One of the ways in which I listen to my patients’ communications is within a psychodynamic framework. I find it extremely valuable and useful. As a matter of fact, it seems to me that a play therapy session with a child is more like an adult analytic session than an adult psychotherapy session is like an analytic session. The child shares a slice of their inner mental experience in the safe environment of the play therapy session. This is something I like to demonstrate in my course. The trainees see that they can learn more about their patients if they also utilize these play therapy techniques. These play techniques can easily be used outside of a “play therapy.” They add a clinical richness of information that is always useful.
Q: Can you describe your decision to get involved in teaching in such an involved way? Was teaching always part of your vision for your career?
Phillips: I started supervising child fellows ten years ago at NYU, but felt frustrated because I thought the fellows and I were working with their patients without the framework that I felt was necessary. I felt that before we focused on a particular child, we should focus on context: how does one work as a psychiatrist when our patient is a child? After three years of teaching in individual supervisions, I decided that I would like to reach out to the whole group of child fellows and to work on some techniques that they could practice in their first year and then utilize in their second year. I had a hunch that I would like teaching because a large part of my practice is, for lack of a better term, “psycho-education”. I spend a lot of time with my patients’ parents, “teaching” them how to better understand and relate to their children. I enjoy the parenting work very much.
Q: Speaking of your clinical work, would you please describe your clinical practice? How you manage to integrate teaching a weekly course with your practice?
Phillips: I am in full time private practice and I specialize in children and adolescents. My morning hours are spent seeing the parents of my patients. This is when the parents give me much-needed information about their child on an ongoing basis, and I share with the parents what I am learning about their child, as well as forging a plan with the parents for how they will use this new information to help their child. The afternoon hours are reserved for seeing children, and early evening hours are for adolescents. It is very hard to tear myself away from my office (appointments, telephone calls, paper work!) and run down to NYU to teach a class on a weekly basis, but when I am in the room with the fellows, I feel that it is a worthwhile sacrifice of my time and energy. It is a pleasure to see the child fellows starting to form their professional identity. Their intelligent questions are always a source of intellectual stimulation for me. And although I read rigorously in order to keep up on psychopharmacology, I like to know what is currently being taught in the program, so I will ask the fellows questions about various medications that I am considering for particular patients.
Q: Have you maintained relationships with any of your former students who have entered “the real world” of clinical practice?
Phillips: I have maintained relationships with some of the fellows from each year that I have taught. At the very beginning of the course, I tell the fellows that I will take any fellow to lunch if they would like to explore the idea of psychoanalytic training. I also encourage questions throughout the year on private practice, and I am happy to share vignettes from my practice during class time. When a fellow goes into private practice, I encourage them to meet with me so they can ask me whatever questions they may have. I have sent many private practice referrals to my former students, and it is very helpful for me to have them as a resource. I am happy to return telephone calls to newly minted private practitioners who are having a crisis with a patient and need some quick advice! I have developed a tradition of giving a gift to each graduating fellow- a book that I have a special fondness for- and the book I choose changes from time to time.
Q: Trainees at NYU often speak glowingly about your course and about you as a mentor and role model. Were you particularly influenced by any teachers during your clinical training?
Phillips: I was strongly influenced by my teacher and mentor, Dr. Clarice Kestenbaum. When I needed to choose a child fellowship program, I was looking for a role model, an important professional relationship. What is amazing to me is that I am still learning from what Dr. Kestenbaum taught me in the fellowship, many years ago. There were many things that Dr Kestenbaum taught me that I initially rejected. I was very opinionated and stubborn, and I had my own ideas about how I was going to practice Child Psychiatry. Over the years, I have changed my mind many times about many things. I still find myself saying sometimes, “She (Dr. Kestenbaum) was right!” Dr. Kestenbaum is a great teacher and a great clinician who was generous to me with her time, her insights, and her referrals.
Q: Can you speak to your experience as a voluntary clinical faculty member? What do you enjoy about this role?
Phillips: I enjoy being a voluntary clinical faculty member at NYU. It affords me the opportunities to teach and to learn in a wonderfully stimulating and exciting academic environment. In addition to the full year course that I teach to the first year child fellows, I teach a 10 week segment in the Child Psychotherapy Program that the Psychoanalytic Institute at NYU sponsors, and I teach a brief course on Dream Analysis at the Psychoanalytic Institute. My private practice informs my teaching, and my learning at NYU informs my private practice. I am a better clinician because of what my colleagues and students at NYU teach me, and I am a richer person because of the relationships that began at NYU.
Matthew Biel just completed his training in Child and Adolescent Psychiatry at New York University, where he also did his training in General Psychiatry. Post-training, Matthew will be joining the clinical faculty at Georgetown University Hospital, where he will help to start a clinical teaching service in Child and Adolescent Consult/Liaison Psychiatry. He will also be starting a private practice.