!!!!!*****WORKING DRAFT*****!!!!!
Dr. Klein was right, my thesis defense proved anti-climatic. During my zealous preparation, not only had I memorized the entire dissertation, the key points of all 63 references of the references and also new papers more recently published. From the first question, it was obvious I knew more about adolescent mothers’ relationships with their infants than anyone else in the room. The conversation quickly devolved to a relaxed exploration of my compartment and ability to remain poised while the committee grilled me with mock seriousness.
The psychology Board exam demanded even less. Billed as a rigorous test of my general knowledge in all clinical psych fields, others had remarked on how 4 hours, 15 minutes was not nearly enough time to finish all the questions, much less review answers. All my life, though, standardized tests had come embarrassingly easy. With only four choices per question, and what seemed like a lifetime of immersion in the field behind me, I breezed through in a little over three hours, checked each answer twice more, and still finished before the proctor called “Time!” A month later, I learned my score of 787 had been the highest in the state that year.
As I methodically added to my supervised clinical hours during a post-doc year at Beth Israel, I divided time between the Consultation Liaison program there, and seeing clients in a state-run clinic in Wellesley. I approached the Boston Institute, hoping I could convince them a Ph.D. could be just as effective a psychoanalyst as an M.D.
Dr. Goldman, as the Director of Medical Education for all the psychiatric residencies associated with Harvard Medical school, was far to busy to respond when the National Institute of Mental Health sent out a request in June of 1979 for information about the measures and methods used to evaluate the effectiveness of C-L education in the programs. So naturally, as the newest member of the staff, I got the job. I dutifully canvassed all the program directors, and discovered no one had any systematic way of instructing the residents, much less evaluating them. NIMH scheduled an initial conference for San Antonio in March, and sent out the responses they’d received to all 120 programs they’d invited to respond.
“This is worse than embarrassing, Sarah,” Dr. Goldman told me when I shared the news with him. “We’re Harvard, for crying out loud! See if you can put together something I can use to move the program directors on this. Go to that conference, learn all you can, and we’ll fix it. We’re supposed to be national leaders, not followers…”
Pursuing what I regarded as busy work, I daydreamed as I wrote the proposals. Here I was, ready to finally practice independently, and now part of a national effort to advance how psychiatrists are taught. I imagined I’d return from the conference, recognized for my expertise in educating residents to work effectively with obstetrician-gynecologists, going on to become an expert in teen-age pregnancy. As my dreams became more baroque, by age 50 I’d become an advisor to the government, testifying before Congress, with a teen-ager – a chaste teen-ager – of my own.
The conference proved to be much less exciting that my fantasy. For two days, medical education directors and their staff analysts droned on while displaying endless variations of evaluation forms on transparencies, nearly unreadable when projected 100 feet away.
When I brought all the forms back to Dr. Goldman, I told him, “I’ll try to pull something together from all this, and help you get the programs to develop a standardized training module, with follow-up evaluation, but…”
“There’s always a ‘but’ with you, isn’t there, Sarah,” he joked.
“In this case, it will be my final ‘but’,” I replied.
“Oh?”
One evening, in the unnatural warmth of south Texas, walking along the Guadalupe River, wondering why the Paseo reminded me of the Seine, with stately [BOATS?] slowly gliding under arched bridges, I had a sudden realization about my life. Working in a vast institution, where there was always another person above the one to whom I might report; hiding out in the cocooning safety of academic castles like Harvard and BU; searching for research topics, then gathering data and reporting it – it all felt stifling now that I had my doctorate in hand. At my core, I knew that improving the world through policies, papers, and politics was not what had drawn me into psychology. I needed to leave that world, I needed to help people one at a time, on a personal level.
After explaining all that, I told him I would stay through the follow-up conference, set for February, 1981, in Burlington, Vermont – “New England, somewhere I understand, where it actually snows in winter” – and then set up my own clinical practice.
He beamed when he heard that. “You are so ready, Sarah. You don’t need to hide here anymore. It’s time, it’s surely time, for you to fly on your own. Anything I can do to help, let me know.”
I rented a small office in Brookline, ordered a telephone, and began calling insurance companies, to make sure I was on all their lists, the HMOs, the PPOs, the entire alphabet soup that was taking over mental health care just as it had medicine. I sent announcements to every psychiatrist, pediatrician, family doctor, and psychologist in Suffolk County. With my job in Wellesley, and the C-L work at Beth Israel, I had one day a week free to see clients. I was on my way.
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