2020 JUN PSYCHIATRIC CLINICAL FACULTY #5 ASSOCIATION AT UCLA NEWSLETTER

Table of Contents 1 PRESIDENT’S COLUMN By Paul R. Puri, M.D., President The Times They 3 2020 DISTINGUISHED SEMINAR SERIES: A PRESCRIPTION FOR OUR TIMES By J. Zeb Little, M.D., Ph.D., DPSS Chair 4 Are A-Changin’ CHILD & ADOLESCENT By Paul R. Puri, M.D., President FELLOWSHIP YEAR IN REVIEW By Elizabeth Dohrmann, M.D. and Sabrina Reed, M.D., Co-Chief t’s with honor and humility 483 program. Child & Adolescent Fellows that I’ve stepped into the role But the winds of change are 5 & 15 Iof President of the PCFA in blowing. HIGHLIGHTS 2020. The PCFA has a long 6 and storied history of not just Amidst the Covid-19 pandemic, TELEPSYCHIATRY DURING supporting the UCLA residency, the needs of patients are shifting, THE COVID-19 PANDEMIC but of being a standalone body and in turn so are the needs By Richard J. Metzner, M.D. of outpatient of the residents from us. The 8 with a wealth of knowledge, dramatic shift to telehealth, CHIEF CHAT especially in psychotherapy, while necessary, has happened By Juliet Edgcomb, M.D. and Dax and thus a counterpoint to a purely without attention to the educational implications Volle, M.D., Co-Chief Residents psychopharmacological approach. In this way for residents, or the repercussions for patients. 11 we both contrast and complement the full-time Residents working in the hospital can get THE PSYCHOTHERAPY PROGRAM: STAYING CONNECTED faculty at UCLA. substantially less patient exposure on the inpatient IN A REMOTE WORLD units, because of the extensive time required to By Caroly Pataki, M.D. But the PCFA may have a disconnect problem. set up patient interactions. On the other hand, 12 In some ways, that’s by design. As a group of the use of Zoom for outpatient therapy visits has UPDATE ON DGSOM AND community psychiatrists, the residents have meant that some residents can record sessions UCLA MEDICAL STUDENTS little direct access to us aside from our events. and get more attentive supervision. But the By Margaret Stuber, M.D. At the same time, anecdotally, many of our technological requirements for telehealth can 13 PCFA members feel they know little about the worsen the socioeconomic barriers to access to ANNOUNCEMENTS happenings of the residency or even the PCFA care, furthering the disparities of justice, equity, 14 board. As such, I wanted to reflect here on diversity, and inclusion in mental health. While HOMAGE TO DONALD A. where we’ve come from, where we are, and the PCFA may not be able to solve the patient SCHWARTZ, M.D. By Richard Tuch, M.D. where we’re going. access issues easily, we can look within to make sure we’re modeling to the best of our ability. 16 SIGNIFICANT FINANCIAL Overall the PCFA continues to be steady, CHALLENGES AHEAD supporting a broad range of programming With the need for social isolation, some of By Alex S. Lin, M.D., Treasurer including an intern psychotherapy retreat, our programming has had to adapt. Our 16 residency recruitment happy hours, direct annual Intern Psychotherapy Retreat, both DONATIONS TO THE PSYCHIATRIC therapy supervision, movie nights, and the a bonding experience for interns, and an CLINICAL FACULTY ASSOCIATION

Psychiatric Clinical Faculty Association June 2020 1 opportunity to dip their toe into the field and if they would be interested in being of psychotherapy, was truncated from two more involved. If you’d like to reach out As a group of community days to two hours and done via Zoom. to me first, always feel free to contact me Hopefully a full retreat will be possible psychiatrists, the residents at [email protected]. in the fall, but that’s to be determined. have little direct access to us Other experiences are moving online as aside from our events. At the In the last year the PCFA became a well, such as Supervisor “Speed Dating,” CME provider. While this was originally same time, anecdotally, many where residents can meet possible intended to give us autonomy for the supervisors for the first time, and our new of our PCFA members feel purposes of our Distinguished Psychiatrist Psychotherapy Boot Camp, a more in- they know little about the Series, it has opened the opportunity to depth intensive for rising PGY-3s. happenings of the residency broaden our offerings to our members, and perhaps even to the broader mental or even the PCFA board. Yet turning our attention online can health community. In the coming year also be an asset. Under the wise work of we will be exploring CMEs that our Alex Lin, our Treasurer and Webmaster, members might find appealing. many of the programs are getting about areas for improvement. This digitized, from payment and tracking in year they indicated wanting a better Growth and Diversity Psychotherapy 483, to making teaching emphasis on education, rather than opportunities available to our members service, in their training. Resident We must grow our membership. In the through our website. Sophie Rosseel, one of the co-chiefs last year we have added a few younger of the Resident Psychotherapy Clinic, members to our Board of Directors, Some key institutional changes have has made real efforts to improve the including Drs. Harrison Lyu and taken place this year. Andrew Russell, the educational experiences and exposure to Ashley Covington, to help diversify our PCFA-Faculty Liaison and administrator psychotherapy for trainees. With our own representation, bring new insights, and of the Psychotherapy 483 program, Richard Metzner, she created an intern- infuse the board with fresh blood. I aim retired. Caroly Pataki graciously took interviewing course, where once weekly to continue this process, reaching out on the position, and has been working the interns will interview a patient and to qualified and interested psychiatrists to find new ways to coordinate the many observe a PCFA psychiatrist interview in our community to help them join the moving parts of the program, including the same patient. She began developing VCF and get involved with the PCFA. digitizing the administrative aspects. a supportive psychotherapy curriculum That will of course require referrals from Within UCLA and the Department of for the PGY-2s including group our members. Psychiatry, Peter Whybrow recently supervision on the inpatient unit, but that retired as executive chair. Alex Young unfortunately has been postponed due to Technology has taken the position as interim chair. Covid. Finally, she identified that RPC would benefit from more organization, We must leverage technology to improve While Westwood has traditionally been oversight, and an updated system for our system. Much of that is underway, the identified “mothership” of UCLA residents to find appropriate supervisors. but we will be exploring further ways to residencies, there has been growth afoot. Currently it’s still an inefficient process. use video technology to improve therapy Harbor-UCLA continues as strong training and supervision, including as ever, with a particular community All of these areas could benefit from more carrying the torch of Richard Metzner’s focus. The new West LA VA program PCFA involvement. But our disconnect video therapy series. continues, growing under the leadership problem makes that difficult. So with of Margi Stuber. And the Olive View those needs in mind, I have made it In short, the PCFA is a stable force residency relaunched under the watch a mission to spend my two years as within UCLA offering a wide range of of Iljie Fitzgerald, now all county based. President with some particular goals. programming and teaching, and yet we And all the programs are eager for more must adapt. With an increased need for PCFA involvement. The UCLA medical Re-engagement PCFA involvement across the multiple school, on the other hand, has plans to affiliated residencies, we must re-engage phase out the Doctoring course, which I intend to reach out directly to all of our our members, recruit new members, will effectively remove the current path active members during 2020 -- all 200+ and diversify the membership. Finally for volunteer clinical faculty to teach of them, to let them know what we’re we must leverage technology in the age medical students. doing, find out what we can offer them of Covid to both improve our teaching (such as CME activities and trainings), offerings, and to lessen the barriers to Every year the residents are surveyed learn about their areas of specialization, access. We can do it together. I hope you will join me.

Psychiatric Clinical Faculty Association 2 June 2020 2020 Distinguished Psychiatrist Seminar Series A PrescriptionFor Our Times By J. Zeb Little, M.D., Ph.D., DPSS Chair

Helena B. Hansen, M.D., Ph.D.

s the pandemic is still unfolding around us, we collectively grieve and society determinants of disease shows it is not just the loss of life and life’s dignities. The pandemic’s consequences cultural and economic differences but also differences of Alay bare a familiar and, therefore, more tragic reality. In our access and circumstance that impair effective problem society, marginalized people suffer disproportionately. As an example, solving and lead to the learned helplessness sustaining the CDC shows the rate of COVID-19 infection being 3 times greater these inequities. She concludes that for physicians to be for African Americans and a recent survey by The Washington Post successful addressing these entrenched disparities we indicates their mortality rate is six-to-one. These statistics are the tragic must develop structural competencies. consequences of overlapping vulnerabilities that affect marginalized communities in our country. These same vulnerabilities remain Dr. Hansen defines structural competency as a process imbedded in our society despite decades of effort and vocal support for of development which will improve the ability of change. What makes meaningful progress on these issues so difficult for physicians to meet patients where they are and engage in a developed nation like ours? productive interactions to address health disparities. It acknowledges that awareness is never enough, it must be Helena B. Hansen MD, PhD, PCFA’s Distinguished Psychiatrist of followed by action. As such, her structural competency the Year, argues these grim realities do not respond to overt efforts to “prescription” asks for physicians to develop an address discrimination or poverty because they are rooted in something awareness of the social and economic realities of our more subtle. Her research shows these problems grow out of an patients as well as a language with which to describe interplay of decisions and structures above the level of individuals and and think about those realities. Structural competency outside their direct perception. These problems, to paraphrase the civil recognizes the need for collaboration and perspective rights activist Stokely Carmichael, arise sharing between physicians and allied from established and respected forces in professionals, and it highlights the society that maintain the status quo, lead Her structural necessity of humility and inquisitiveness to institutionalized biases, and create in these undertakings. And, though disparities of privilege, which are less competency the events of the pandemic were overt and harder to attribute to a specific “prescription” asks for unimaginable when this year’s speaker cause. It is the stratified societal, political, physicians to develop was nominated, the consequences of the racial, and economic conditions, which crisis make clear why her work deserves collectively make up our individual an awareness of the our attention and why Helena B. Hansen ecologies, that create and sustain these social and economic MD, PhD is PCFA’s 2020 Distinguished ruinous discrepancies. Psychiatrist of the Year. realities of our Dr. Hansen’s efforts to confront these patients as well as a discrepancies is informed by the ¡¡This year’s Distinguished Psychiatrist successes, and failures, of cultural language with which Seminar Series will be held on the UCLA competency to address health disparities to describe and think Campus on Saturday, October 10th, from in marginalized groups. Her research about those realities. 10:30 – 12:30 pm. It will be preceded by the into opiate addiction treatment, HIV PCFA Annual Meeting beginning at 9 am. transmission, pharmaceutical marketing ,

Psychiatric Clinical Faculty Association June 2020 3 Child & Adolescent Psychiatry Fellowship Year in Review

By Elizabeth Dohrmann, M.D. and Sabrina Reed, M.D.

n July 2019, the UCLA Child & Adolescent inpatient units, partial hospitalization programs, Psychiatry Fellowship welcomed seven new and consultation services, the second year fellows Ifellows, coming from as far as Boston and as have been rotating through a myriad of UCLA and close as the UCLA psychiatry residency. One of community outpatient clinics. In this second and the greatest joys of this past year has been getting final year of fellowship, our class has been seeking to know and learning from these new colleagues. out additional training opportunities in college They have been busy -- clinically, socially, and mental health, psychotherapy, public psychiatry, academically. Oluwafikunmi Sobowale, for asylum evaluations, and more. Kathryn Weaver instance, has published this year on mental health sought out psychoanalytic training at the New technology, unconscious bias in the diagnosis of Center for Psychoanalysis, and with support from ADHD and disruptive behavior disorders in the Richard Metzner Psychotherapy Scholarship racial minorities, and the psychological toll of from the PCFA, Elizabeth Dohrmann attended Covid-19 on healthcare workers. Embracing the an intensive training in Acceptance and advocacy role inherent to the profession, Laura Commitment Therapy. A highlight of second Halpin developed a presentation on organized year involves a rotation of grand rounds presented psychiatry and political activism, and Marian by each member of the graduating class, which Rain developed a workshop regarding firearms has included Sabrina Reed’s presentation on and suicide prevention. Laura also published strategies for medical teaching, Zara Szeftel’s a case report documenting a startling allergic timely discussion of an integrated mode of reaction to clozapine. And, providing a conduit telepsychiatry, Sameera Siddiqui’s review of to the humanities, Hendrick Soh integrated treatment-resistant depression in adolescents, Greek mythology into his presentation on Kathryn Weaver’s review of family separation understanding suicide as a human narrative. policies from WWII to the present, Glenna Smith’s overview of smartphone apps in the age While the first year fellows have been caring for of digital psychiatry, Jude McElroy’s dive into the youth and their families in the emergency room, role of the bile-acid microbiome in antipsychotic

Psychiatric Clinical Faculty Association 4 June 2020 metabolic dysfunction, and Elizabeth Dohrmann’s discussion of institutional responses to racism from patients. Emily Highlights Wood, a classmate who will be continuing as a research track fellow through 2021, was a recipient of both the AACAP Pilot Research Award for Junior Faculty and Fellows and an AACAP Educational Outreach Award. Additionally this year, she has lectured on mirror neurons and thalamic GABA, and published several articles related to sensory overresponsivity in youth with ASD. She and Zara Szeftel were also honored by the department in their selection for the Ritvo and Gertrude Rogers Greenblatt Awards, for outstanding achievement in research and academic scholarship and clinical care, Guests enjoy the sunset at the PCFA Holiday Party respectively. at the home of Rikki Gordon and Allen Pack.

Looking forward to the coming year, we are excited about the continued Dr. Zeb Little with PCFA's 2019 evolution of the fellowship. Of note is Distinguished Psychiatrist, Dr. Jonathan Salk the development of areas of distinction modeled after the adult residency program, which will include specialized mentorship and didactics in the areas of clinician educator training, community and global psychiatry, and psychodynamic psychotherapy. These tracks will be up and running in time for our new cohort of trainees, who promise to be an inspiring addition to our community of colleagues. They will be ushered into the fold by our rising second year co-chiefs, Nikhil Nadkarni and Ismatt Niazi.

We need to conclude by mentioning that Dr. Richard Metzner with three of the 2019 Metzner Scholars: Covid-19 has challenged the way we learn Elizabeth Dohrmann, Wenqi Fenqi and Sophie Rosseel. and practice child psychiatry. We consider ourselves incredibly fortunate to be in an academic department that was able to transition easily to telemedicine, and that has not been over-burdened. While our clinical responsibilities and experiences will continue to evolve as our systems restructure, at each step our leadership has supported us with transparency. Challenges undoubtedly lie ahead, but we have all chosen a flexible field that lends itself to telehealth. With some continued creativity and collegial collaboration, the future of child psychiatry at UCLA looks very bright. PCFA Board Meeting Pre Covid-19

Psychiatric Clinical Faculty Association June 2020 5 Telepsychiatry during the COVID-19 Pandemic

By Richard J. Metzner MD

s a consequence of the the risk of prematurely reduced social distancing versus the fact COVID-19 pandemic, that many of us feel that a bezel is not the best therapeutic frame. telepsychiatry is now the A 4 dominant form of psychiatric Much has been said lately about the mechanics of telepsychiatry. treatment.1 The blinding speed The logistical advantages are obvious. As for the negatives, with which federal and state many have commented on the sensory distortions and dilution regulatory obstacles were lifted to of the interpersonal field associated with the technology. In bring this about is unprecedented. this limited space I’ll just say that if a movie were to be made Gone are the rules against federal characterizing all the critiques of telepsychiatry, the title might reimbursement for telepsychiatry be “Honey, I Shrunk the Therapy.” services between doctors and patients communicating from home. Gone is the enforcement of strict HIPAA-compliance From the viewpoint of a VCF member, one positive feature of when using teleconferencing apps like FaceTime and Zoom. teletherapy is its contribution to resident video supervision. There Gone is the requirement to provide telepsychiatry services only is a substantial improvement in the quality of recordings made to patients residing in the states where we are licensed. Gone for later review in supervision when they are created with apps are the restrictions of the Ryan Haight Act against prescribing like Zoom compared with those made on residents’ smartphones of controlled substances over the Internet. Some are viewing during live therapy. Zoom automatically switches between this altered landscape as an opportunity for digital technology close-ups of whoever is speaking allowing for better observation to begin playing a larger role in the future of psychiatric care.2 of the participants’ facial expressions. The audio is also much Others have counseled that the virtualization of the therapeutic improved because people are closer to the microphones on their relationship is a complicated process that requires new skills and remotely connected devices. This contribution of teletherapy may not be for everyone.3 Either way, until the pandemic struck, merits further exploration. I suspect that most of us would not have elected telepsychiatry as our preferred modus operandi. My biggest complaint as a clinician would be that, with so many people on the Internet and cellular networks these days, Then came March 19th. That was the day that those of us in bandwidth is intermittently compromised, and teletherapy California were told to “shelter in place.” In what felt like an connections can be interrupted. Losing contact with a patient for instant, remote electronic contact became psychiatry’s new technical reasons makes our work harder and their experience normal. Meetings with patients, trainees and colleagues were all less beneficial. We can restart the session by calling back, sending moved on screen. (Figure 1) In the months since then, the severe another invitation to re-link, or switching between Internet and economic and psychosocial consequences of lockdown have cellular apps, but the damage has been done. Hopefully, future swelled the number of those resisting continued public health technology will eliminate this problem. safety measures. If reopening starts before the pandemic is under control, what is the best course for clinical psychiatrists? Should When all is said and done, it is obvious that the negative we (1) return to work in our offices with increased precautions? consequences of teletherapy pale in comparison with those of (2) pursue telepsychiatry until the pandemic is over? (3) or some the coronavirus. I’ve even heard patients say that they prefer combination of both? This is not an easy decision considering teletherapy and find it easier to talk about difficult subjects at a

Psychiatric Clinical Faculty Association 6 June 2020 Figure 1. (Counterclockwise from top) Telepsychiatry in treatment, teaching and administrative activities distance. This sentiment is replicated in not only all the concentration and effort ¡¡References research showing that some people find it expended in office-based treatment, but 1. Shore JH, Schneck CD, Mishkind CD (2020) easier to discuss intimate material remotely also the counter-intuitive act of looking Telepsychiatry and the Coronavirus Disease 2019 rather than directly. On the other hand, away from the screen towards the device’s Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care, JAMA Psychiatry, some patients report abandonment feelings camera to simulate eye contact with Published online May 11, 2020. doi:10.1001/ during teletherapy and want to return to the patient. We also have to ignore our jamapsychiatry.2020.1643 office-based treatment as soon as possible. own ever-present screen images staring 2. Torous T, Sykes T (2020) Opportunities From the Even with a perfect Internet signal there at us alongside the patient. Perhaps Coronavirus Disease 2019 Pandemic for Transforming can be no doubt that the bandwidth hardest of all, we must constantly use Psychiatric Care With Telehealth, JAMA Psychiatry. presented in face-to-face psychotherapy is our imaginations to transform a day of Published online May 11, 2020. doi:10.1001/ jamapsychiatry.2020.1640 substantially wider and deeper. perpetual screenwatching into the illusion that we are actually “with” our patients. 3. Scharff JS, Editor (2018) Psychoanalysis Online: Mental One last point: Teletherapy can be more It can be done, of course, and right now Health, Teletherapy and Training, Routledge. exhausting than in-person interactions. it must be done; but let’s look forward to 4. Essig T, (2020) “Emergency conversion to teletherapy There are many reasons why this is true. the blessed day when telepsychiatry is a — Making it work.” https://www.youtube.com/ To be a teletherapist all day requires matter of choice rather than necessity. watch?v=hZW1LBrtveo

Psychiatric Clinical Faculty Association June 2020 7 PCFA Annual Newsletter

By Juliet Edgcomb, M.D. Chief Chat & Dax Volle, M.D.

e were both thrilled hardships to our residency when Lela asked us community. In this time, more Wto write this PCFA than ever, we are thankful to be Newsletter “Chief Chat” as championed by the PCFA. Even it gives us the opportunity to as we depart our positions, and reflect on what an amazing in the context of these ongoing year it has been, and to brag on changes, we are confident that our some of the achievements of our program is set up for continued residents. This year, as seems to excellence, due in no small part to be the theme with our program, the ongoing efforts of the PCFA. has been another year of rapid transformation as our faculty and Each academic year our residents adapt residency training residency curriculum improved abilities to obtain food while at UCLA and to the ever-changing demands and structure at affiliate hospitals, fatigue mitigation strategies, and of practicing psychiatry in the incrementally evolves, an expanded family leave policy. We speak on behalf modern era. This continues a of the residents in offering our sincere thanks for the tradition at UCLA of an evolving and this year was PCFA’s letter of support that was drafted and sent to training environment, growing to notable for a number UCLA Health during the contract negotiation process. meet the educational, clinical, and of significant updates. Residents for years to come will benefit from this contract advocacy goals of our trainees, which allows us to learn and care for our patients from a and equipping them with the best At the beginning of the academic position of relative financial stability and ease. possible tools to achieve those year, the residents at UCLA aims. With this in mind, the PCFA unionized under the Committee This year was also remarkable for the retirement of our has continued to serve as a reliable of Interns and Residents of the Department Chair of thirty years, Dr. Peter Whybrow, base of support for our residents. Service Employees International and the appointment of Dr. Alex Young as Interim We are incredibly grateful as Union (CIR/SEIU) in an Chair. As chief residents, we were fortunate to meet on chiefs to see how the PCFA’s attempt to secure salary and a monthly basis with both Dr. Whybrow and now Dr. mission has directly translated benefits comparable to similar Young, who have been gracious with their time and very into palpable improvements in our programs in California and in receptive to resident input. training over the past four years. major metropolitan areas around This tradition of stalwart support the country. This effort has In October, Dr. Jonathan Heldt, a recent graduate of has continued in the light of the resulted in a yearly salary paced our program, took over as one of our associate program current COVID-19 pandemic, to increase in line with inflation, directors, a position previously held by Dr. Yvonne which has brought tremendous a competitive housing stipend, Yang. Dr. Heldt is an attending on the inpatient units changes in workflow and personal robust healthcare benefits, at UCLA as well as in outpatient clinics at UCLA and

Psychiatric Clinical Faculty Association 8 June 2020 the West Los Angeles VA. He oversees of Van and Lela DeGolia for good food, perfect casual end to the day and has been our curriculum committee and has camaraderie, and a good opportunity to universally well received by applicants made major overhauls to the didactic network and meet potential mentors. and residents alike. This could not be content that residents receive during their possible without the monetary support of training. He also heads our clinician- With the interns adequately fed and the PCFA and we again offer our sincere educator concentration and is leading orientated, the first few months sped by gratitude for this. the charge to craft the next generation of and we found ourselves again at Lake master medical educators. The residents Arrowhead for the annual psychiatry We were very proud to match an welcomed Dr. Heldt into this position and residency retreat. In addition to the impressive group of new interns for he has continued to tirelessly advocate for normal range of activities including the Class of 2024, many of whom have resident’s well-being and education. hiking, swimming, and general expressed interest in exploring career merriment, breakout meetings related to pathways with a strong psychotherapy A highlight of our curriculum updates caring for underserved patients at UCLA, component. As the number and depth of include the new inclusion of topics related curriculum, and feedback were held psychotherapy training opportunities in to community and global psychiatry as well which have steered the remainder of our our residency has grown with the support as justice, equity, diversity, and inclusion. academic year. of the PCFA, we believe this evolution has Over the past two years, our program enhanced recruitment of trainees who has developed several specialty tracks are particularly enthusiastic to learn and that residents can elect into to deepen We are incredibly grateful practice psychotherapy. This summer, their education in a specific topic. These as chiefs to see how we will welcome 15 new psychiatry tracks include a community and global the PCFA’s mission has interns from all over the country: 5 from psychiatry track, a clinician-educator California, 2 from Texas, 3 from the track, a psychodynamic psychotherapy directly translated into Midwest, 3 from the East Coast, and 2 track, and a neuromodulation track. The palpable improvements in from the South. As we look toward intern psychodynamic psychotherapy track, our training over the past orientation, our new chiefs (Dr. Sophie spearheaded by Dr. Joshua Pretsky, Feller and Dr. Michael Mensah) are involves a skills-based, deliberate practice four years already planning how to welcome and approach to learning psychodynamic support these bright young doctors. psychotherapy and has been very well received by the residents currently In the fall, the PCFA hosted the annual The PCFA has been instrumental involved with it. Distinguished Psychiatrist Seminar in providing auxiliary support and Series, a perennial highlight. This year, supervision for our resident psychotherapy The residents were delighted this year the invited speaker was Dr. Jonathan clinic, which will be bolstered by to see some of our former classmates Salk, a highly respected adult and child increasing emphasis on selecting a appointed as new PCFA members and psychiatrist. He discussed a clinical case diverse patient population and a growing take positions on the PCFA board. presented by Dr. Sophie Rosseel, a third- diversity of supervisors. To start off the Seeing this evolution has been inspiring year adult psychiatry resident. This event year, the rising PGY-3 residents will be in envisioning future career paths and was well attended, well provisioned, and engaged in a psychotherapy boot camp, has bolstered early career mentorship for the discussion was very lively. Feedback run by members of the PCFA, to begin residents. received from attendees was universally the outpatient experience with a solid positive and the residents noted that foundation in psychotherapy training. During this academic year we they very much enjoyed the in-depth continued many traditions case discussion format, something that is Throughout the year, our PGY-2 and added a few new ones! difficult to do in our fast-paced hospital residents look forward to the weekly services and clinics. interview course, run by PCFA member As we settled into our role as chiefs, we Dr. Richard Metzner, who teaches began to look forward to welcoming our As fall morphed into winter, we shifted principles of the psychiatric interview and incoming interns into the program. A our attention to the yearly ritual formulation in an inpatient setting. highlight of this process is the annual of recruitment. We revitalized our PCFA Intern Welcome Barbeque. This recruitment materials to reflect the many Residents interested in additional year, the PCFA welcomed many of the positive changes that our program has psychotherapy education, now have an incoming interns and residents from the seen over the past year. A highlight of increased ability to pursue this thanks UCLA-Semel program, alongside interns our recruitment is happy hour at the W to the Metzner Scholarship Fund, which from affiliated programs, to the home Hotel in Westwood which serves as the provides critical monetary support for

Psychiatric Clinical Faculty Association June 2020 9 advanced psychotherapy courses and year, Laura Halpin and Nikhil Nadkarni 2020 OFFICERS OF THE seminars. This year, four trainees Drs. fast-tracked to child and adolescent Sophie Rosseel, Sophie Feller, Wenqi psychiatry fellowship at UCLA. This PSYCHIATRIC CLINICAL Feng, and Elizabeth Dohrmann, were year, Nicolás Barceló and Alpna Agrawal awarded this scholarship to pursue will continue research in the competitive FACULTY ASSOCIATION additional training in a topic of their National Clinical Scholar Program at choice. UCLA while Gil Hoffman was awarded a UCLA Neurogenetics Post-Doctoral In these uncertain times, Research Fellowship. Aryeh Goldberg PRESIDENT we are confident in the will be staying at UCLA to complete a bright future of our fellowship. Isabella Paul R. Puri, M.D. Morton will be moving to San Francisco trainees and grateful for PRESIDENT-ELECT for an fellowship at the invaluable mentorship UCSF. Keerthan Somanath will begin Elizabeth Casalegno, M.D. and support of the PCFA. his private practice while completing the UCLA Mood Fellowship and Kate Marder SECRETARY The COVID-19 pandemic has greatly has accepted a position within the UCLA J. Zeb Little, M.D., Ph.D. affected our residency community, Neuromodulation Division. Lindsey Law changing inpatient and outpatient will be continuing the 2020 theme by TREASURER workflows, reducing resident teams to working as a tele-psychiatrist while living in Alex Lin, M.D. streamlined services minimizing in- Germany and Pratik Mehta has accepted a person contact, substantially increasing position at LAC-DMH while also planning — telehealth visits, and shifting scheduled to work with the athletics programs at USC. BOARD OF DIRECTORS events to online. As mental healthcare Last but not least, two of our graduates, providers, our trainees are facing the Maya Smolarek and Wendi Benalt, will Thomas R. Blair, M.D., M.S.Elizabeth Casalegno, increased multifactorial burden of stress be working in the San Fernando Valley M.D.*Ashley Covington, M.D.Sara Hyoun, M.D. experienced by our patients as well with the Adelpha Psychiatric Group as challenges in their personal lives. and Gaby Aguilera will be working as a Sheldon Kardener, M.D. Alex Lin, M.D.*J. Zeb Fortunately, we psychiatrist with Little, M.D., Ph.D.*Harrison Lyu, M.D. Richard are well-supported the Mental Health J. Metzner, M.D.*Sarah Mourra, M.D. Allen T. by our residency We thank all the Intensive Case leadership who have members of the PCFA Management team Pack, M.D.* Joshua E. Pretsky, M.D.* Paul R. worked tirelessly for their investment at the West LA Puri, M.D.* Wayne C. Sandler, M.D., Ph.D.* to ensure residents VA. The program David E. Sones, M.D.* Shirah Vollmer, M.D. have sufficient and belief in our chiefs will take a personal protective residents. detour from adult — equipment and psychiatry while access to testing. staying at UCLA; FACULTY LIAISON

The PCFA rapidly initiated process Juliet Edgcomb will be completing the Caroly Pataki, M.D. groups for all four resident classes, which combined child and adolescent fellowship / have been a source of encouragement NIMH T32 training program and, at the EXECUTIVE DIRECTOR and safe space to discuss the hardships opposite end of Erikson’s stages, Dax Volle Lela DeGolia* facing all of us. The much anticipated will be completing a PCFA Intern Retreat adapted to these fellowship. — changes by moving to an online forum in the spring with the hope of meeting in We are extremely grateful to have the Semel Institute at UCLA person in the fall. In this regard, although mentorship, guidance, and support of 760 Westwood Plaza | Los Angeles, CA 90095-1759 the next year will bring unanticipated the PCFA. We thank all the members challenges, as a residency community, we of the PCFA for their investment and Phone: (310) 206-6335 | Fax: (310) 206-2291 are glad to not walk alone. belief in our residents. We hope that the Email: [email protected] accomplishments, successes, and career Website: www.pcfala.net No discussion about the future would be plans shared in this newsletter can be a complete without mentioning the plans symbol of our gratitude and a token of our of the graduating class of 2020. Last appreciation. * Denotes members serving on the Board’s Executive Committee GRAPHIC DESIGN : KARIM SAHLI - WWW.LOGICALNOT.COM

Psychiatric Clinical Faculty Association 10 June 2020 The Psychotherapy Program: Staying Connected in a Remote World

By Caroly Pataki, M.D.

reetings! I want to extend my received my communications warmly in psychiatry trainees. This year we are best wishes for your health and order to troubleshoot potential obstacles currently serving ? number of residents. Gsafety in these challenging times. and promote the psychotherapy program I would like to introduce myself to all for their residents. The directors tirelessly A Mentorship program has also been of you and thank you for your support advocate for the wellbeing of their trainees launched, especially to provide PGY-1 and participation in the Psychotherapy including the psychotherapy program, trainees with guidance and support early Program. As a UCLA trained child and and I look forward to continuing to in their training when their schedules do adolescent psychiatrist, former training strengthen my connection to them. not allow for weekly sessions. Trainees director, and faculty member who has who are in the mentorship program may devoted much of her career to clinical The Psychotherapy Program provides also participate in the psychotherapy education, I am thrilled to have the individual psychotherapy to psychiatry program as they progress in their training. opportunity to be your faculty liaison and child and adolescent psychiatry to the UCLA psychiatry and child and residents at a reduced cost ($40/session) The Psychotherapy Program is seeking adolescent psychiatry training programs and sets the UCLA psychiatry programs to expand and diversify its faculty and the coordinator of the Psychotherapy apart from the vast majority of the participants, as is the Psychiatry Clinical Program, (course 483). training programs in the country. The Faculty Association. Many trainees Psychotherapists, in turn, receive UCLA have expressed their commitment to The Psychotherapy Program continues teaching credit and thereby meet the learning psychotherapeutic skills as to be very popular with the psychiatry requirements for membership in the well as receiving their own treatment residents from Semel-UCLA, and its UCLA Psychiatry Clinical Faculty. The by participating in the psychotherapy affiliated psychiatry and child and monies collected by the therapists is then program and have confirmed their adolescent psychiatry residency programs donated to the Psychiatry Clinical Faculty interest in having increased diversity including Greater Los Angeles VA, Association and is used to support a variety among the faculty participants. If you Harbor-UCLA, and UCLA-Olive View. of trainee related activities and events. enjoy seeing patients in longer-term While “remote” and tele- psychotherapy Lela DeGolia, the glue that holds our individual psychotherapy and have an may seem daunting at first, the program program together, organizes, maintains, interest in joining the program, please let remains strong due to the dedication and and updates the faculty roster and the me, ([email protected]), Mark generosity of the psychotherapists, the financial books. Clinical Psychiatry Thompson ([email protected]), or Van devotion of the trainees, and the enduring Faculty members Mark Thompson, MD DeGolia ([email protected]) know. conscientious efforts of Lela DeGolia, and Van DeGolia, MD schedule individual Executive Director of the PCFA and meetings with interested residents and The Psychotherapy Program continues to Drs. Mark Thompson and Van DeGolia, personally arrange their assignments thrive and provide a unique educational who connect trainees to therapists. This to available Psychiatry Clinical Faculty and clinical experience for our trainees as combination of talent and commitment Association members who participate in they progress in their residency programs coalesce into the final product. All are the Psychotherapy Program. and develop as clinicians. We believe that invaluable, and we thank them heartily! one of the best ways to learn and refine The Psychotherapy Program continues psychotherapeutic skills is to be treated by I would like to commend the training to be a highly valued educational and an expert clinician. We deeply appreciate directors of all the programs, some have therapeutic component offered to the all who contribute to this program and reached out to me directly, and all have psychiatry and child and adolescent have made it a great success!

Psychiatric Clinical Faculty Association June 2020 11 Margaret L. Stuber, MD UPDATE ON DGSOM at UCLA Medical Students

s usual, there has been a lot Graduation will not be in observation of clinical going on in the medical school. person. All of us hope that work. It is unlikely that AI will highlight four areas. All, of by mid-June, when most medical students will course, are impacted by COVID-19. internships start, it will be be able to do “audition” safe for the graduates to electives at other schools 1. Adaptation to COVID-19 move and to start group in other states early in 2. LCME accreditation visit intern orientations, as well the fourth year, as is 3. Curricular Redesign as in-person clinical care. usual. There is serious 4. Recruitment discussion about delaying The impact on other the usual September Adaptation to COVID-19 medical students is less 15 application date for obvious to the public, but residency, and moving to In mid-March 2020 all United States may have more long-lasting results. Test “virtual” residency interviews. The latter medical schools pulled all of their third centers have been closed, so second year might prove a silver lining, reducing year medical students from clinical medical students who had been preparing the enormous cost in terms of time and work, partly in response to the AAMC to take Step I of the NBME licensing money to students who have to fly all over (Association of American Medical exam are delayed. Step 2 Clinical Skills the country to interview, at an average Colleges) recommendation. DGSOM and Clinical Knowledge exams are also expense of $8,000. Residencies will have had pulled our third year students a day delayed for the current third years, as is to evaluate applicants who had a very before the AAMC statement. All of the Step 3 for current interns. different experience than usual on their first and second year courses at DGSOM spring clerkships. and in many other schools had gone It is the rising fourth years who are likely remote the week before. Each school to be the most effected by the COVID-19 LCME accreditation visit made a conscious decision to keep 4th changes. Many of them are quite worried. year students on clinical services only if They have been in “virtual” clerkships in DGSOM was able to get re-accreditation necessary. For DGSOM this was if it was March and April, with all learning done for 8 years, the maximum, last time necessary for the students to get sufficient remotely. In psychiatry, it is possible to LCME visited, but we are due again now. credit to graduate. In some places in New provide direct clinical care remotely, The visit will be on February 21-23, 2021. York 4th year medical students were given as you have all learned. However, it is The year prior to the visit is “self-study”, early graduation and started working as almost impossible for some of the other an opportunity to bring everything into residents early. clerkships, such as Obstetrics. Many compliance with whatever new rules have of the medical students have had very been created since the last visit. This The lack of public gatherings meant little clinical contact for their last two is always a lot of work, as we evaluate that the Match into residencies, usually clerkships of third year. This has made it and write reports on every aspect of the a public and family celebration, was more difficult for medical students to get curriculum and structure. all done on line. Limitations on travel letters of recommendation for residency have cancelled international rotations, applications. Many clerkships moved COVID-19 has made this all more often done in late March and April. from grades to Pass/Fail, due to lack of difficult. DGSOM has had to create a total

Psychiatric Clinical Faculty Association 12 June 2020 DGSOM at UCLA Medical Students

remote curriculum overnight. LCME curriculum in August 2020. We now plan California needs. This included doing has made it clear that clerkships have to to launch the early authentic clinical holistic review on almost twice as many include direct clinical care of patients, experience with the class of 2024, which of the applicants as in the past, extending while the AAMC has been equally clear starts in August. We expect the rest of offers months earlier than we have before, that we must protect medical students the new curriculum will begin in August and making intensive efforts to recruit from unnecessary danger. Walking 2021, for the class of 2025. those to whom we had offered places. this tightrope is requiring endless Zoom Despite our “second Look” having to meetings for all involved with medical It is likely that the new remote skills go virtual, we think we have been very student education. and experience will alter how we do successful in getting people to choose us. our curriculum this next year, as well as May 1st is the last day for applicants to Curricular Redesign changing some of what we will do with make a choice between multiple offers, so I new curriculum. This is a very active area do not know the final result as I write this. DGSOM has been working towards of discussion. Curricular Redesign for about two years. The Match results for the UCLA/ NPI, A number of decisions were finalized over Recruitment UCLA/ VA, UCLA /Oliveview, and the past year. The new curriculum will be UCLA/ Harbor programs were stellar. set up to include “early authentic clinical In the midst of all this, however, we have We are very excited about the skills, experience”, or meaningful interaction recruited a fabulous new class of medical diversity, and dedication of both the with patients, not just shadowing, within students. We have worked hard to get a DGSOM graduates and the amazing the first year. In addition, a dedicated group which represents the diversity of folks we have gotten from all over the group of faculty will work intensely with backgrounds, perspectives, and experience United States. the first year students to develop their skills in physical exam and interviewing as part of a newly integrated program. Please watch for announcements of Students will then start on the required PCFA’s 2020 annual events clerkships after about 15 months of medical school, rather than the current October 10, 2020 Distinguished Psychiatrist roughly 20 months. The third year will Lecture and PCFA General Meeting then be set aside (between the required (CME offered) clerkships and electives) for “exploration”, which could include research, a Masters PCFA WOULD ALSO LIKE TO CONGRATULATE BOARD MEMBER degree, or community involvement, AND PRESIDENT-ELECT, ELIZABETH CASALEGNO, on receiving this among other options. The fourth year is year’s Volunteer Clinical Faculty Excellence in Teaching Award from the least altered in the plans- although it is the Department of Psychiatry and Behavioral Sciences. The award is possible that COVID may have changed given each year to faculty members for their outstanding and consistent that for the future. contributions to the education of medical students, residents and fellows.

The original hope was to launch the new

Psychiatric Clinical Faculty Association June 2020 13 DONALD A. SCHWARTZ, M.D. (1926-2020)

By Richard Tuch, M.D.

n my 40 years practicing psychiatry and psychoanalysis, I never before felt Imoved to lionize the likes of any of my many mentors . . . until April of this year, when I read of the passing of a truly original and beloved teacher who taught hundreds of psychiatric residents the art of psychiatry during his twenty year tenure on the faculty at the Neuropsychiatric Institute at the University of California at Los Angeles (UCLA).

Donald Schwartz (1926-2020) was widely respected as a consummate clinician. He served as a role model for a generation wisest, most mature and down to earth. Don’s insights about the inner workings of of UCLA residents who were deeply He was humble, extraordinarily capable, organizational life. “His lessons on power, touched by the human way in which and forgiving. He saw through ego, responsibility, authority and other aspects Don went about relating to students, who narcissism and inflated self-importance of group and organizational dynamics,” were universally fond of Don and found that was in abundance among some senior notes Yager, “ have served me well in him traits they admired and wished faculty and senior clinical supervisors.” throughout my career.” to emulate. Don was a one-of-a-kind teacher whose creativity, brilliance, and Don taught two courses that stand out Another of Don’s courses was one that generosity was unparalleled; he loved to as memorable. Don knew tons about provided the most exquisitely practical, teach, and students loved what he had to organizational dynamics. He was schooled nuts-and-bolts guidance to graduating say. Don was a joy to be around; his delight in systems theory and was sufficiently residents about the ins and outs of setting was readily apparent in his eyes, which equipped to teach a graduate course on up and running one’s own psychiatric literally twinkled. And though he retired that subject to business school students practice. Don’s course was a breath of fresh from the University thirty years ago, his had he so desired. One was lucky to have air coming at the tail end of years upon memory lives on in the minds of scores of access to the depth of Don’s thinking. It years of academic education. His course psychiatrists whose lives he touched. was Don who taught that—all too often— offered invaluable information about those who attempt to directly exert such practical matters as negotiating “Don was among my most important power, tend to lose power in the process. office leases, soundproofing office spaces, mentors,” writes Joel Yager, M.D., Talk about an eye-opening insight into culling community referrals, the ins and Former Director of the Psychiatric group psychology. Though few who took outs of insurance, and so on and so forth. Residency Program at UCLA. “Amongst his course expected themselves to end Psychiatric training programs that lack the towering giants of the department, up working in institutions, that did not such a vital course would do well to follow Don stood out in my mind as the kindest, matter to the residents, who were awed by Don’s example by providing their own

Psychiatric Clinical Faculty Association 14 June 2020 residents a comparable course to prepare them for life after residency. Highlights Don’s parting gift to graduating residents became his signature: he provided each with a small white button upon which was printed four simple words: “Don’t be too sure.” That pretty much summed up the core lesson Don wished to impart. He was extraordinarily non-doctrinaire. Not only did he want students to think for themselves, he wanted them to resist the compelling and comforting draw of theories that generated answers, which— in turn—gave one the impression there was nothing left to understand or solve about the case. Don was on a life- long, single-minded campaign to steer students away from the dangers of what two British analysts—Britton and Stein (1994) —would later go on to refer to as an “overvalued idea”—a core concept of PCFA Board Meeting during Covid-19 psychoanalytic training.

Those who teach trainees find the concept of the overvalued idea, or some variation thereof, invaluable because it leads to cautioning students about the danger of placing undue faith in preliminary theories about a case in the absence of sufficient supporting evidence that, if gleaned, could heighten the chance that theory held water. Hypothesis generation—in particular, regarding the dynamic formulation—is central to the work of psychotherapy, but trainees inclined to accept explanations that seem to hold “the answer” must remain alert Intern Psychotherapy Retreat in Oceanside to the possibility that theory is doing little more than assuaging their anxiety over not yet knowing what to “make” of the clinical material. An essential goal of supervision is to help supervisees tolerate uncertainty, to help them keep an open mind rather than rushing to judgment by prematurely settling on a comforting formulation that provides the illusion—not recognized as such—that one knows more about the patient than one actually does. And it was that button Don Schwartz religiously handed out each year at the culmination of residency training that served to remind each and every trainee of this essential lesson. Annual Speed Dating Mentoring Event held last year at the New Center for Psychoanalysis

Psychiatric Clinical Faculty Association June 2020 15 Significant Financial Thank you! Voluntary dues to the Challenges Psychiatric Clinical Faculty Association

Dr. Alex Lin, Treasurer, would like to thank the following Ahead members for their 2019 & 2020 (to date) donations:

By Alex S. Lin, MD Winston Alt Christine Hradesky John Raiss Treasurer Robert Ashley Victoria Huang Karen Reckamp Daniel Auerbach Susan Josephson William Resnick Paul Barkopoulos Harriet Kaplan Vernon Rosario Jeffrey Becker Sheldon Kardener James Rosenblum Investment earnings from the David Bender Anthony Keaton Wendy Rosenstein generous contributions from Christina Benson in memory of Richard Rosenthal the Coffey estate and Richard Paul Benson Carole Edelstein Nancy Rosser Metzner have helped to cover Robin Berman Steven Keys Lee Sadja the shortfall in the past. While Bernard Bierman Jillian Kleiner Jonathan Salk he volunteer faculty there is still a sizeable reserve, Thomas Blair Melvin Lansky Wayne Sandler contributes a great deal the current pandemic has greatly Sheldon Bloch Stanley Leiken Daniel Schaefer of time and expertise in affected the brokerage account, T Elise Block Alex Lin Douglas Schave teaching medical students and and our organization can only Paul Bohn Robert Linden Bella Schimmel residents. An equally important withdraw a small percentage Pamela Summit J. Zeb Little Maria Seliverstov contribution comes from from the funds each year. We Bohn Mark Lipian Joanne Seltzer financial support in the form of expect that the reserve funds Daniel Borenstein John Lundgren Thomas M. Shiovitz membership dues. will increase substantially as the Thomas Brod Hee-Sang Lyu Frederick Silvers economy improves, but, since the Robert Carroll Alicia Maher Joseph Smurda Last year, our income did not timeline for recovery is uncertain, Janice Carter Stephen Marmer Steve Soldinger meet actual expenses, resulting in the PCFA is more reliant on your Elizabeth Casalegno Jeremy Martinez David Sones a shortfall of about $21,000. Our contributions than ever before. Marissa Caudill Kristen Melnyk Leon Sones revenue comes from two main Thomas Ciesla Richard Metzner Brooke Spanos sources: membership dues and It is vital that all volunteer Philip Cogen Samuel Miles Harvey Sternbach the Psychotherapy 483 program. faculty contribute to the PCFA. Ashley Covington Michael Joan Striebel In 2019, the amount collected Our support in terms of direct Van Dyke DeGolia Mirbaba Anoshiravan Taheri from membership dues fell by teaching activities and financial Sibylle Delaloye Mary Moebius Mark Thompson nearly $9,000, so a significant backing for events is integral to John Donlou Robert Moradi Richard Tuch portion of the total loss was providing the highest quality Susan Donner Mohan Nair Shirah Vollmer because of membership dues. education for our trainees. Donald Eknoyan Judith Orloff Andrew Wang Hamlin Emory Allen Pack Lawrence Warick Generally, only about one-third Thank you for your continued Deborah Fein Alpa Patel Esther Wein of the VCF pay membership dues. support. David Fogelson Neil Paterson Allen Weiner The PCFA supports a broad array Robin Frasier James Perkins Diane Weiss of educational programming, and, ¡¡To learn more about all the work we David Friedman Jona Perlmutter Sharen Westin to simply maintain our current are doing or to donate, please visit the June Fujii Edmond Pi Samuel Wilson roster of events, we need to have PCFA website at https://www.pcfala.net Michael Gales Gayle Polsky Robert Winston more than half of our total faculty Irvin Godofsky Charles Portney Nancy Wolf contribute. As of mid-April 2020, ¡¡You can also mail a check to Rhodora Gonzales Joshua Pretsky Farzin Yaghmaie only about 10% of the volunteer PCFA, 760 Westwood Plaza, Room Neil Haas Serena Puga Lester Zackler faculty have paid dues. 48-149, Los Angeles, CA 90095-1795. Robert Hoffman Paul Puri Melanie Zermeno

Psychiatric Clinical Faculty Association 16 June 2020