Psychiatry & Psychotherapy Podcast - A Journey Learning Psychotherapy, with Randy Stinnett, Psy.D

Episode Date: February 13, 2018

This week David Puder, M.D., has a discussion with Randy Stinnett, Psy.D, regarding his journey to become an excellent therapist.  Randy shares aspects of his journey and insights.  His enthusiasm is contagious.  He discusses formative influences including Habib Davanloo, Donald Kalsched, and Todd Burley.  Please follow the link to the website for Randy Stinnett's list of 5 recommendations for someone aspiring to be an excellent therapist. By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Link to Randy Stinnett, Psy.D Short CV

Hello, this is Dr. David Puter and welcome to the Psychiatry and Psychotherapy Podcast. I'm joined today with Dr. Randy Stennett. He is a clinical psychologist, a P.D., which means he has a kind of a PhD level in psychotherapy training. He works at a federally qualified health center for low socioeconomic status individuals. And he's truly an excellent therapist and a friend of mine. and we work together on similar patients at times. He's the type of person you would want to send your family members to, your best friends to as a therapist if they needed a therapist.

And it's really good to hear a little bit of his story, the mentors and the therapists and physicians that he aspired to emulate. And a couple topics that we'll sort of dive into is the interpersonal and how to receive feedback. So I hope you enjoy this episode and here we go. Oh, I'm joined here with one of my friends and colleagues, Randy Stennett. Stennett. You got it. Yes. Yeah, okay. So I'm just going to start out like where are you in practice right now?

And what does your sort of day-to-day schedule look like? Sure. So I practice at the SAC Health System in San Bernardino. And it's part of the Lomal-India University Health Samadino campus. and I have the pleasure of doing psychotherapy throughout the day in many different ways, one in which I do my regular practice, just my traditional psychotherapy clinic. And then the other half of the day,

I get to be in the different primary care clinics throughout the building, doing integrated behavioral health. Integrated behavioral health? Yes. So how would you, like, what does that actually look like, integrated behavioral health?

Sure. So that looks like basically, in a nutshell, working alongside the physicians in the clinic and addressing in basically point of care real time a patient's mental health challenges that they bring into the primary care setting. Okay, so someone comes in and they're seeing their general practitioner

and the general practitioner finds out that they're super anxious or depressed or they've gone through some major stress. Yeah. So for example, we do a lot of screening in the clinic. And so the patients will be screened with something like the PHQ9, the patient health questionnaire, which is a questionnaire nine criteria for diagnosing a major depressive illness, or the GAD 7, which looks at generalize anxiety symptoms. And then, let's say the

patient scores. So we'll put links to those in the show notes if you're curious about those. Sounds good. And so the patient then will, you know, fill out one of these questionnaires, or maybe that's the reason why they're coming to the clinic. We know that, you know, the vast majority of mental health challenges are first identified in the primary care setting. So it makes a lot of sense to put someone like myself, a clinical psychologist, right there into the clinic. And then if the patient scores high or they're symptomatic, then the physician will ask the

patient, would you like to see one of our behavioral health providers? So then the patient will say, yes, that sounds great. And then, so we'll do what's called a warm handoff where, um, the physician will bring me in and they'll introduce me to the patient. This is Dr. Stennett. He's a clinical psychologist here working alongside us. And he can see you right here today, if you like. And so I'll be able to do like a, for example, a 30-minute, same-day behavioral health visit

that's focused on symptoms right there the same day they were there to see their primary care doctor. Okay. Very cool. And so how would you say you would, how would, how would, you describe your orientation to how you practice psychotherapy? So the my orientation will change based on what is the setting that I'm practicing in. I might conceptualize quite similarly, but how I might intervene might be a bit different. So how you understand the world and psychology is similar, but how you might intervene is different. Exactly. Exactly. Okay.

Okay. So what what kind of like, um, When you think of your top three, like, psychotherapists that you idealize or appreciate, like, who would you say those are? Gosh, the top three. I would have to say in that top three would be psychiatrist and psychotherapist, Habib Davanloo, who founded intensive short-term dynamic psychotherapy. I was really captivated when I first was introduced to Davenloos work as a postdoc fellow and just consumed as much as I could of his books and published articles.

And it opened up a world to me to integrate it, I mean, intensive short-term work. Right. From a psychodynamic perspective, gosh, you narrow it down to three is kind of hard. Well, let me just ask you sort of what, when you were a postdoc really sort of grabbed you or pulled you into his work in particular? What grabbed me and pulled me into his work was the clinical precision by which he saw what was going on and his interventions were absolutely specific. to the data in front of him. And Davenloo was a surgery resident that switched to psychiatry

and then was trained traditionally in psychoanalysis and realized that this could go much quicker if I apply pressure to the patient to be aware of and to express whatever feeling is there. And so when he did that, he would find that one of three things or a mix would likely arise. Either the patient would respond

to the question or the pressure that he delivered, which was, what is this your feeling in the moment? They would either respond with the feeling, with anxiety or with a defense. Okay, so they would either respond with actually what he was thinking they were feeling or what they're actually feeling. Or what they were actually feeling. What he requested. How do you feel toward your, let's say, wife for cheating on you. And if the patient would respond with some kind of anxiety reaction or a defense of intellectualization, let's say, or of avoiding the topic or changing it or not responding

basically anything but the feeling he felt toward her, let's say, in that example, then he would know exactly how to respond in a way. that furthered the work quite quickly. Okay, so it was either a defense or anxiety. A defense, anxiety, or the feeling that he asked for, yes. Okay. Or impulse depending on what it was he was getting at. Do you think that you're a naturally assertive person like he is?

Not to the degree that Davenloo was. Davenloo was pretty relentless. In fact, one of the, there was a book that was going to be written about him. I don't think it was ever published, but it was going to be called the Relentless Healer. And I don't think I would feel comfortable. It wouldn't be my personality or my style to be as aggressive, let's say, as Davenloo was. Because sometimes I think we are attracted to what maybe we need to move towards. I agree with that.

but not necessarily to the length of that person. So you need to move a little bit more towards that. But you're not ever going to be exactly like that. And I wouldn't want to be exactly like him, but I think you're right. I think what was also attractive about his style was that it was fearless. I mean, he was fearless with the patient.

And so that really resonated with me. So reading him maybe helped you combat some of your own fear in the room. Yeah, I think reading him, reading him is almost like a permission in a sense. That's one of the facets or the turns of the prism with him. It's almost like this is something that's possible here in the work with the patient. Now, the interesting thing about reading Davenloo is that English, is not his first language. He's Persian.

Farsi was his first language. So there was something really, there's something really raw and organic because all of the work that he would publish, it would be initially an explanation or some theoretical piece and then it would go right into actual transcripts

that were not edited very much at all. So you would see, his English, broken English at times, or a very raw use of a term that we wouldn't use as a native English speaker, but you know what he meant. In his therapy session. In his therapy session, that would come across very aggressive sounding or even insulting almost, but you know he meant no harm or, you know, was not sadistic toward the patient. So there was some attractiveness of that rawness with the patient.

patient that I wouldn't feel comfortable doing necessarily saying the way he phrased it, but it was it was it was almost like a sparring in a sense. And he talked about it quite interestingly. He said, I have no respect for the patient's defenses, but I have absolute respect for that, for the alliance part of the patient that is there to get help. So he was always aligning with the part of the person that was striving to get better. Because there is another part of people that's not striving to get better. Yes, that's the, that's the, he would call it the, the pathological super ego. Okay.

So my translation, and you tell me if this would be your translation of that, is the part of you that's punitive and sort of, dragging you through the mud while you could be up in a palace enjoying yourself. But instead, you're sabotaging yourself and, you know, very critical or self-loathing of yourself. I don't know. How would you, would you describe it differently? Gavin Lou would call it the, I forget his exact terminology, but it would be the punitive, the punitive aspect of the superego.

And actually, I'm glad you brought that up because I, um, I read the works of Donald Colchard, who's a union analyst. Okay. And I have a couple of his works, and it's focused on trauma. And he really brought out this aspect of the punitive, the quality of the superego. Okay. But he, I think, helped to really ground it that Davenloo, I think, leaves out. and one aspect of it is it's protective of the person.

Well, it has to have some sort of adaptive function to be there in my mind. Yes. At some point in their developmental journey. Yes. So, okay, so that was like an early formative sort of experience of yours in psychotherapy. Yes. Are there any other authors, maybe just one more we'll talk about today. sure that that was formative and how so yeah um i won't say an author so i will say a mentor

okay a mentor of mine um the late todd burleigh Todd burley was a professor in the department of psychology and he was an absolute gestalt therapist and when i joined the department of psychology on campus in 2004, he came in and gave a lecture. And I didn't know what the heck he was talking about at all. He scrawled this stuff on the board, the Gestalt Formation Resolution Cycle. Yeah. And it was a foreign language, but I knew in my knower, I wanted to know what he knew and do what he did and understand that because it there was something that was so resonant with me and so I went to him and I said I want to join your lab and he was working on schizophrenia in his lab.

Oh wow. Psychotherapy for schizophrenia from a Gestalt perspective and he was also kind of a maverick in his own right. I think on some things I think he didn't it was a little overreach in some ways and I think through the course of our research and time. I mean, his own projects, I think, kind of brought him back to something. But I think his contribution in many ways to me was watching somebody that you would call,

like categorize in that master level of a clinician. And it was his presence and it was his intense attention to process. And the relational aspect of what is happening in the here and now. How is this person? as an organism forming in the moment. So are we talking about like the interpersonal or what's going on between you and the patient

or what's going on in the patient themselves in the moment in the session? All of that would be part of the process. Would be a part of the process. But one aspect or another would be to use a Gestalt term figural in the moment. Do you think that that kind of turned on a new light for you? you when you started noticing that? It did, but what was really, what was really powerful for me was to watch him work. Okay.

Because in Gestalt training, and this comes out of its inception in the 50s and 60s, but I trained for five years at the Gestalt Associates Training of Los Angeles, the Gatla. Todd Burley was one of the faculty there, and along with Bob and Rita Resnick, who still run the institute. Bob Resnick was certified by Fritz Perl's back in the late 60s. And so I spent five years in that institute for in the advanced group and then I would co-facilitate some of the trios and some of the learning. But the way that Gestal training is, is that you actually, you meet in groups, even though it's not a group therapy training per se, but you, you belong to a group.

And then you'll have somebody volunteer to be patient, somebody volunteer to be therapist. And they would come kind of in the middle. And then the trainer who's assigned to that group would be there. And you do a 20 minute piece of work about anything. And then after 20 minutes, then you would debrief it as the group. But the group would first give their reaction on how to do. the piece of work affect them personally in some way. And then after that, it would be discussed

technically. Okay. So what a great way to learn. Oh, it was amazing. Because you both get to be the patient. Yes. And you bring real stuff. Some of your own real stuff. Yes. And then you get to be the therapist. Yes. And then you get to see the therapist and the patient real time. Yes. Yeah. I like that. Yeah. And it was really powerful, really impactful. Um, but before I even, join the group, I took the Todd Burley's course in the Department of Psychology as part of the psychotherapy training courses. And so he would run the group, the class just like at Gatla, the first portion, like I'd say, hour and a half lecture. And then next hour and a half was the lab. And so he would bring people into the lab. Well, I mean, it was the, everybody was together.

And then later on in the lab's component, he would break up into groups. But he would do a demonstration. So somebody in the class, just volunteer. Okay. And they would go toward the front or the middle, depending on the arrangement of the room. And then he sat right in front of them like this. And when he sat down, like when you go into therapist mode, I mean, he was the same person, but quality changed a bit, you know, and he was just very empathic, very connected, but profoundly attentive. He was a neuropsychologist. by training as well.

So he understood the brains, the brain aspects of cognition, attention, memory. He grounded it all in neurocognition, which was fantastic. But he was so attentive to process and what's happening in the moment, to breathing, to body, to eye gaze, to everything. But not just the nonverbales. as the person would bring what's important to them in the moment,

how do they dialogue it? What is going on with the voice? What is going on with the level of energy that fluctuated? That is an amazing experience to see someone do that and then probably comment on it. Yes. Because a lot of times we're thinking on a very linear, level until you're with someone who's able to think on multiple different levels at once.

Yes, yes. And then you're like, wow, okay, I'm seeing just two people talking here, but there's really a symphony going on. Yes. And I see that the same thing when I train psychotherapy residents is at first they may watch someone else do therapy and it could be even boring. But then once you understand the nuance and what's going on and the tonal changes and the prosody changes and the emotions that are being flashed and the defenses against the emotions,

the anxiety there, you know, all of it just like, it comes together like a symphony. Yes, integrative. And it's beautiful. So I'm glad to use that word beautiful. I remember the very first time I saw him work. He did, I think, a couple of pieces of work that it was the very first lab component of the class. and we were in the big group room over there in Department of Psychology, and he did the piece of work with the student.

And then, of course, everybody commented on it. And then he talked about it technically, and there was like a flip chart in the room, and he scrawled some things out on the Gestalt Formation Resolution cycle and all of that. But when the class was over, I remember myself and a couple other people, It's like, we just sat there. It's like you didn't want to move because you'd break the presence, let's say,

of without being too dramatic about it. But there was a felt sense in the room and a felt sense of watching watching something that both was beautiful because it was artful and skillful and effective. But also at a deeper level for me, it spoke to something that resonated with the core of who I am. Okay.

The core, which is to have that connection with somebody on such a level where personhood is being contacted and the opportunity for change in a way that opens up freedom, that opens up vitality. Connection leading to freedom. Connection leading to vitality. And nuance bringing you there. Nuance and subtleties. You took the second word right out of my mouth.

I was going to say that subtlety. Nuance, subtlety. And also the, this, like the profound level of skill that it takes at his level of working, where he was in his career to be so attentive to those micro fluctuations of presence. Yeah.

And I think you never can engage a conversation the same way again. Yeah. Almost. And you start, I think after you start realizing that there's a capacity to learn how to read people on multiple levels like you're talking about and how to sort of engage in connection at deeper levels, then you go down a journey of starting to notice those things. And at first, it almost, it takes a lot of energy to notice it. But then it becomes like you don't have to use a lot of energy to notice it and you're noticing it.

Yes, yes. I imagine it's kind of like chess. You know, at first, when you're playing chess, you're learning the pieces and you're like, oh, wow, this piece can do this and this piece can do this. and then eventually you're seeing patterns of pieces unfold. Yes. And you're seeing like three moves ahead, you know, with different movements of the pieces, you know?

Yes. From a neuropsychological perspective, it's like what is first in the right hemisphere eventually is assigned over to the left where it doesn't need to be effortful. Whereas not like procedural memory, what is first effortful becomes less effortful. It's like, you know, what fires together, wires together. But there's also like bigger networks that sort of link together. Yes, yes.

And so you're learning to pay attention to those subtleties in new ways. And then as you start to pay attention to those subtleties, it becomes, it moves from effortful to sort of, sort of like learning a language. You're not thinking about, I'm not thinking about speaking English. It's just, I'm speaking English. Yes, yes. Yeah. And with that comes a pleasure. Because when you, when you recognize those subtleties and it's almost fluid in a sense, there's a reward in skillfulness. Is the reward an internal reward for you at this point in your career? or is the reward from connecting with one of your patients in a meaningful way by using your skill and your knowledge and your practice and your training?

It's an element of both, I think. You think it's both? Yeah. Okay. Now, I'm very young in my career. I was licensed to practice in 2011, but of course training since 2004. So I experienced myself still as much. How many years have you been seeing patients at this point?

So my first patient in my clinical training, I saw the first patient. summer of 2005. 2005. So it has been 12 years, soon to be 13. Yes. You know, 13 years could be 10,000 hours,

which it takes to become an expert, supposedly according to some, you know, ideas. But I would say to become an expert, you need to be mindfully spending those hours. Correct. Thank you. I was going to add to something about that. Discipline practice, where it's not just, you're not just doing it mindlessly, but you're doing it and then thinking about how you did it.

Yes. And reflecting on how you did it. So it's sort of like internal coach and external coaches. Yeah. Yeah. Attending to feedback. Internal feedback. Yes.

External feedback. Yes. And then, you know, if you have a coach, a coach's feedback, you know. Yeah. Or like video recorded work where somebody can observe. That was, that's what was really great about the Gestalt training is that the feedback was real time. So, for example,

when you're doing a piece of work in front of the trainer and the group, before the work begins, the trainer will say, do I have your permission to come into the work and to shape it or to give you feedback or something? And the person who was therapist

always had the option to say no, but who would turn down working with, you know, having a masterful feedback. Consent. Yes. is a powerful thing. Yes, yes, it is. And so then the feedback was real time.

And then also the therapist could tell the patient, you know, let's, I want to, I want to go out and consult real quick. So they would go out and say, here's what I'm thinking. What do you think about this? The trainer would say, try this. And then most of the time, that direction would open up. Right. that stuck point and they would go further or something like that. So,

but, but I'm absolutely with you on that point because I read an article called super shrinks where the entire thrust of the article was on quality feedback. Yeah. From multiple domains of practice. And, you know, receiving feedback is painful.

Yes. Yes. So we're not saying this lightly. like this has to be something that is overcome, you know, your ego needs to sort of be able to realize the necessity of it and not be overly punished by it, but to use it for growth and use it for continued growth and continued sort of change in the right direction. But it's hard, it's hard to receive feedback. I mean, I think I aspire for feedback, but at the at the same time, it's hard to receive feedback.

So I think it's like, you know, we're talking about the importance of it, but I think it's also important to talk about how difficult it is and why most people probably don't, you know, obtain as much feedback as they could. I think it's in a very important point because as psychotherapists, it's like it's the very thing we want to be the best at and to be able to feel good about. Yeah. And so when we're receiving or hopefully at some point inviting that feedback and somebody critiques at a, you know, about something for which you want to really feel the best about yourself. It becomes, you know, what you do becomes part of your identity. Yes. And receiving feedback about your identity is innately hard. So I think we have to distance our identity from.

from that which we do. And that makes it a little bit to receive feedback about what we do. But also now we're getting into the spiritual metaphysical side of things, which it can be very exciting too. Yeah. And that'll be for another session. Without pole vaulting over there too quickly, which I would love the pull vault. But yes, I agree with it.

You have to have a good observing ego to receive feedback. Observing ego, meaning... To be able to step back and look at the thing that is being critiqued from a bit of some distance. And to be able to... Not so far that you're almost dissociated and not really fully taking it in, but not so blended with that which is being critiqued that I feel devastated. Yeah. Yeah.

a good way of putting it. Well, okay, so wrapping up our time together, okay, what would you say is one takeaway from the things that we talked about today, which if you were like a young psychotherapist or a young person going into mental health or a young psychiatrist, you would want them to really sort of think through and dwell upon. Many things came to my mind just now, but if I have to distill it, distill it and give a like a good takeaway, that someone could chew on and as they prepare for their training and for their career is connect with opportunities where you can be mentored by people who are very skillful in what they're doing is as early as possible if you have that opportunity so that you can start

that skillful practice so that you can start getting those hours, those 10,000 hours, and not having wasted some of them. So start training as early as you can with people who are excellent in the field, who are masterful in the field. Good advice. Okay. Well, thank you so much, Randy, for coming on. My pleasure, David. And we'll have you back again and talk about some other topics. I look forward to it. But that'll be it for today. Yeah.

All right, we'll leave it there. You got it. So that's the end of this episode. If this was helpful to you, I am very grateful for you leaving up comments on my Instagram page. I will provide a link in the show notes. Find the post relating to this episode.

And if you throw up a comment, something you appreciated, something you learned, or a question that you have that you would like answered in further episodes, that would be amazing. Also, if you leave me a review on Stitcher or iTunes, I would be most grateful. Until next time, take care.