There are times when a new path in life appears to almost present itself to you. For psychologist Jennifer Lish, Ph.D., returning to a full-time practice after taking time out to raise her children brought about one of those moments. She had been working mainly in research in her pre-pregnancy years and now, in considering her next steps, she realized that experience was pointing her in a new direction.
This second phase of her career has focused on re-training in cognitive behavioral therapy techniques, opening a new practice and taking steps towards bringing this treatment to a region that had previously had little access.
Lish spoke with New England Psychologist’s Catherine Robertson Souter about the Worcester Center for Cognitive Behavior Therapy and her work in spreading the word about the benefits of CBT.
Q: You were not originally trained in CBT techniques. This was something you pursued in recent years?
A: I matriculated in 1980 and I went to a Ph.D. program that was extremely psychodynamic. My classes were things like reading all of Freud for the year or a whole year of Rorshach.
I did research for years and then I took a break from work for child rearing. I did some forensic work and consulting work for disability insurance companies. When I wanted to re-enter clinical practice, I decided that I wanted to do evidence-based techniques. So I am a complete retread.
Q: You have seen success with CBT?
A: I had someone in my practice this summer who had suffered from unremitting OCD for years. I did not see her very many times, a total of 17 visits. About a dozen visits were exposure response prevention for OCD. Now, she is in complete remission. She is certainly not cured, the OCD will have to be managed for life, but she was spending hours a day doing compulsions. She was avoiding a lot of things. It was impairing her functioning.
Q: How did you go about re-training yourself?
A: I took advantage of many resources. There is a Beck Institute at Assumption College, some cognitive behavior trainings at the Bridge of Central Massachusetts. I selectively looked for rounds at UMass that were trainings in evidence-based treatments, I joined the Association for Behavior and Cognitive Therapy and went to their convention in New York. I went to the World Congress for CBT convention in Boston. I signed up for trainings at Mass General/McLean on how to treat OCD and related disorders. I signed up for a training by the Tourette Syndrome Association in how to treat tics using something called CBIT, comprehensive behavioral intervention for tics. I also did a two-day CBT training at the Yale Child Studies Center. It was extremely well run, excellent training.
I joined the Academy of Cognitive Therapy and my mentor has been extraordinarily generous and helpful to me over the years. The Academy is different from most associations in that you can’t just join and be a member, you have to demonstrate competence, do a case write up, do certain directed readings and have supervision. Then you send them recordings of sessions and they determine if you are actually doing CBT.
The Listserv for CBT has been a great source of education for me. You can post a case, obviously disguising the PHI, and get feedback from people around the world. You get fabulous case consultation.
I also did extensive reading. CBT is very accessible and there are treatment workbooks for everything. Next month, I am taking a behavior therapy training that is run by the International Obsessive Compulsive Disorder Foundation.
Q: Why start a new practice?
A: I wanted to be a force for disseminating evidence-based treatments to the hinterlands. I see patients for whom it is really just not practical to go to Boston for care. These are people for whom mental health care is going to have to be paid for with insurance and whose family obligations and lives are such that the mental health care needs to be within 20 minutes of their small, rural town.
For the average person in Worcester, it was unlikely you could get real cutting-edge CBT, using specialized techniques like habit reversal training for trichotillomania or dermotillomania, exposure and response prevention for OCD with in vivo exposure being done with the therapist or parent/child interaction training with the use of a one way mirror and role playing or graded exposure for phobias.
Most people in these little towns with conditions that had been shown to respond to specialized cognitive behavior therapies were not able to access them. And I wanted to be part of changing that.
Q: You have expanded the new practice, bringing in two other professionals, Helen Turano, LICSW, and Kate McGonagle, Psy.D., RNCS. But you’ve also reached out to the community in other ways.
A: I started by forming an association [for professionals], that I called the Cognitive Behavioral Therapy Association of Central Massachusetts. We have had four meetings so far. We sit down with guests or we consult with each other. Anybody is welcome. One of the four meetings was a panel discussion, where each of us presented a case.
Plus, with the International OCD Foundation and the OCD Foundation Massachusetts, I started a lecture series and support group series in Worcester this fall at UMass Memorial Medical Center. The series is open to the public. We had 30 people last time. It’s geared towards people with OCD and related disorders and family and just the general public. There were also clinicians attending.
Q: Why do you believe that there is not greater access to CBT in central Massachusetts?
A: Today, you can go to a graduate school and get fully trained in CBT. When I matriculated, you could but in fairly few places. It was not as predominant in psychology as it is now. For those of us not trained in CBT, it takes effort, it takes time, it takes money. There is no financial incentive; there is a financial disincentive to get this additional training. It means you are out of the office, which means that you do not get paid for that day if you are in private practIce or you must take vacation time or a continuing ed day, and these trainings cost money.
You don’t get paid any more for doing these treatments. I could be doing psychodynamic and supportive psychotherapy for everybody, even someone who has a condition for which this would not provide as great a benefit.
Q: What are your future goals?
A: Well, I hope to be available to do peer consultation and I hope that there is better access to a wider variety of evidence-based treatments for psychiatric disorders in this country and in Worcester than there is now. Worcester has had a problem with lack of access to care, period, for children and teenagers. Throughout all of Massachusetts, it can be very hard to get treatment of any kind for a child or adolescent and it is particularly hard to get CBT.
By Catherine Robertson Souter