Mental Health: Expert Perspectives on Culturally Informed Clinical Practice, Research and Training

Episode Transcript

Vincent Boudreau00:00:13

Welcome to another edition of From City to the World. I'm your host, Dr. Vince Boudreau. I'm the President here at The City College of New York. September marks the start of the academic year at City College and colleges all around the country. It's a great time. Campus looks beautiful. Students are either coming back to campus or coming to campus for the first time. There's excitement.

For some students, it's the very first time they're setting foot on a college campus. Others, they're continuing their academic journey, coming back from summer jobs or vacations or internships. And so there's really something inspiring about seeing the campus come to life after the summer and learning and talking with students about their goals, their ambitions, and how that all feels at the start of a new semester.

At the same time, the start of the academic year is also a time to recognize that students, faculty, staff, and families also carry challenges that aren't always visible. September is recognized as suicide prevention month, the National Recovery Month, and that makes this an ideal time to discuss mental health as a whole, not simply in the moment of a crisis, but what do we do as a society, as a community, as a campus to make sure we are strengthening and making the mental health of our students, faculty, and staff and neighbors more resilient?

In fact, the discussion around mental health is an essential component of wellbeing of individuals, families, and communities. So for example, recognizing when someone may be struggling or understanding where support can be found or reducing the stigma around asking for help, creating communities where people feel seen and supported, all of those things opens the door to a much broader discussion around mental health awareness and how we can strengthen mental health of our friends and family and neighbors. Now, it's true.

Over the last few years, mental health has been much stronger, more vibrant topic of conversation. Without doubt, we are still dealing with some of the consequences of COVID era isolation and how that's played out in terms of people's mental health. There have been, I think it's fair to say, a number of specific stressors on members of our community in the last couple of years that have made navigating mental health a little bit more challenging.

Economic circumstances, cultural backgrounds, trauma, immigration policy, housing, violence, discrimination, even language barriers can determine one's proximity to mental health services and support, and also affects the burden on individuals. So for example, if services aren't available in someone's language, how comfortable that person be in seeking help or finding a safe space to talk about what they're experiencing? So bringing this back to City College, this is a particularly important topic for a campus like ours.

We draw students from all over the world, from all different corners of our society. We have a specific emphasis on educating people who may not be as fully resourced as other members of society. Our mission is to make sure we're educating the whole people, and that means oftentimes students come to the campus from difficult circumstances. Maybe they're new Americans navigating American society for the first time, or maybe they come from families that are having a struggle making ends meet in the current economy.

All of these questions feed into how we address mental health and the kinds of challenges that people bring to the campus. And so this brings us to today's conversation. I'm joined by two members of the City College community who approach some of these questions from different but closely connected perspectives, and I'm happy to have both of them here first. Our first guest, Dr. Sasha Rudenstine, is a licensed clinical psychologist and the program director of the Clinical Psychology PhD program at City College of New York.

She also directs the Intersect Lab, which is a clinical and epidemiological research program focused on mental health among historically under-resourced urban populations. Dr. Rudenstine's research examines the impact of cumulative trauma and chronic stress across the life course, the development and persistence of psychological distress, and factors that shape access to and outcomes of mental health treatment.

Her work bridges clinical psychology, public health, and psychotherapy research with particular attention to understanding mental health within the broader social and environmental context in which people live. She's also actively involved in doctoral education, clinical training, supervision, and mentorship of emerging psychologists. Dr. Rudenstine, welcome to From City to the World.

Sasha Rudenstine00:05:00

It's a pleasure to be here.

Vincent Boudreau00:05:02

Really glad to have you here and glad to have our second guest, which is Dr. Diana Puñales. Dr. Puñales is a Licensed Clinical Psychologist and the Director of the Clinical Training for Clinical Psychology Doctoral program at CCNY, as well as the Director of the Psychological Center at The City College of New York. She's a dynamically trained psychologist with expertise in multicultural psychology, immigration, and a culture of stress, that's something we'll be talking about a lot later, but also trauma and the treatment of racially, ethnically, and socioeconomically diverse populations.

Dr. Puñales has extensive experience providing and supervising psychotherapy and psychological assessment with particular expertise in working with Latino and Spanish-speaking communities. As a clinician, educator and supervisor, she's deeply engaged in training doctoral students and developing culturally responsive clinical practices. Her work at the Psychological Center also includes initiatives addressing barriers to mental healthcare and psychological need of individuals seeking asylum in the United States. Dr. Puñales, welcome to From City to the World as well. I'm happy to have you both here.

Diana Puñales00:06:14

Thank you. It's great to be here.

Vincent Boudreau00:06:17

So Sasha, let's start with something that's pretty fundamental. We hear the term mental health quite often, but your work looks at mental health not only from the individual's perspective, but also through the broader social and environmental conditions that people live in. So when you look at mental health through such both a clinical and a, I guess you'd call it a public health lens, what do we miss if we only focus on the individual? What is it that this other focus on social societal factors bring into the equation?

Sasha Rudenstine00:06:52

Yeah, it's such an important question. I think we miss a tremendous amount of the story. So as psychologists, we're trained to look closely at the individual. We're asking about symptoms, relationships, coping, history, and all of that matters a tremendous amount, but people don't develop depression or anxiety in a vacuum. They live somewhere, they pay rent, they have jobs, they lose their job, they experience racism, discrimination.

As psychologists, we're very good at asking questions. We're asking what happens inside this person, but we also want to ask what's happening around the person and what's happening around them for years. So a lot of the work I've done, we're trying to study urban, historically under-resourced communities that are experiencing what in public health trauma research we might call extraordinary events, but for these individuals, it's a part of their daily life and public health teaches us to move the camera out.

So we're asking why this particular person is developing depression when we want to zoom in with clinical psychology and ask, given all the conditions that this person has experienced, what meaning have they made of it? What relationships, psychological capacities do they have? What can help them now? So to some extent, the mistake we make I think sometimes is actually siloing it and we want to consider the public health with the clinical in order to zoom out at those structural factors, but then also zoom in and understand what that person has been experiencing up until this point.

Vincent Boudreau00:08:34

Mm-hmm. And so I guess the other thing that I've at least started to see over the last, not just the last few years, but more recently, this idea of the accumulation of stress over somebody's life, that you're not really just talking about something stressful is happening today because, I don't know, immigration policy or an experience of COVID, but really over entire person's life, stress accumulates. Could you talk a little bit about that?

Sasha Rudenstine00:09:06

It accumulates, absolutely. And I think in some respects we don't want to demonize stress. Stress is a part of human life, but there's a difference between a really hard week at work and what you're kind of talking about, which is a lifetime of worrying about can I pay rent or food insecurity or an immigration experience? So in some respects, accumulation of the stress will build on itself and we can tolerate an awful amount, a lot, but at some point, it starts to wear us down.

It changes how we can regulate our emotions. It changes how we see the world as safe or unsafe, and we have different breaking points each individual. So with that, I guess I would also just add, Vince, that to some extent, all of that accumulates stress predicts who we are right now. And so we enter each moment with that history with us, and it plays into how we metabolize each moment and look forward.

Vincent Boudreau00:10:11

Nice. Those of you who've been listening to From City to the World know that we typically have one half hour with the first guest and another half hour with the second guest. As I said at the beginning, we're going to go back and forth between Sasha and Diana over the course of this. And what you're going to see is that Sasha's going to talk or I'm going to ask her to talk more about these kind of societal wide intergenerational factors, and Diana is going to talk a little bit more about the individual. And so let me bring you in now, Diana, to the conversation. Sasha's looking at some of these patterns across populations.

You're working with individual who walk through the door and they're seeking care, and I know they don't always arrive knowing how to describe what they're experiencing. Some may simply say, "I can't sleep. I'm exhausted. I'm overwhelmed. I feel stressed." How do you begin to distinguish between the symptoms someone presents and the larger cultural, social, environmental circumstances that may be contributing to their distress?

Diana Puñales00:11:10

Yeah, I think this is one of the most pivotal questions that psychologists have to embrace in their clinical work with any individual that essentially comes through the door. And one of the things that psychologists have to do is to be able to distinguish between what are a person's clinical symptoms and what is the broader sociocultural and environmental context, meaning their lived reality.

And the way that we are able to distinguish or we begin to distinguish is we use cultural formulation frameworks, we look at contextual assessment models, and we really fine-tune or tune in to what are the social determinants of the mental psychological symptoms that the person is experiencing. So instead of viewing symptoms in isolation or in a vacuum, we really need to use and do use diagnostic tools and interviewing techniques that are going to help us understand how did this person make sense of, live in and manage their environment and how these environments then shape and inform the underlying psychological distress.

Vincent Boudreau00:12:28

And Diana, I want just to come back to you because I was really struck by a piece, I don't know if you saw it in the New York Times about 10 days ago. I imagine it's pinging around your professional world where a clinician writes about young people coming in more and more frequently already expressing what they're feeling as a diagnosis. I have anxiety, I have depression. How did that article strike you? Does that resonate?

Diana Puñales00:12:57

A hundred percent it resonated. I often, when I teach adult intake, Sasha teaches child intake, we often hear patients that are coming in to start the psychological evaluation and then we make a determination whether we can treat them at our clinic. They come in already with diagnoses that they obtained either through TikTok or Instagram or ChatGPT or whatever other online social media type of situation and they will come in saying, "I have this or I have that."

And some of the times they may have symptoms that are congruent with what they're thinking, but we still have to conduct a full evaluation. And so one of the tensions is not to be dismissive to what a patient's concerns are when they're coming in, but to create an environment where that particular person is open to a clinical query that really then begins to fine-tune what exactly is going on currently with this person and what has happened in the past that has contributed to the symptomatology that they're still exhibiting.

Vincent Boudreau00:14:07

Uh-huh. I found that fascinating.

Diana Puñales00:14:12

Yeah. Oh. Yeah, yeah, yeah.

Vincent Boudreau00:14:12

So Sasha, before we did our station break, you were talking a little bit about the broader social cultural context of mental health and a little bit about the accumulation of stress or other factors over somebody's lifetime. And now I want to actually focus really on trauma. A lot of times, we think about trauma as something, you have a traumatic experience and so the trauma comes from having passed through a traumatic moment in your life.

But what happens when difficult or traumatic experiences accumulate over the course of somebody's life? Or is there a way of thinking about trauma that's not necessarily this one cataclysmic thing happened in somebody's life and so it resonates from that point on? Are there other ways that you've brought an analysis of trauma into your clinical or your research work?

Sasha Rudenstine00:15:16

Well, I think we're conflating terms a little bit. So to some extent when you're talking about this moment, there are these discreet moments that are traumatic, that make us feel so frightened for our experience in our lives that it shatters our sense of invincibility and safety. That's different than the chronicity of stress that can sort of grade on us over time. And stress, I don't mean just sort of an emotional stress. Stress can be true adversity that accumulates over time.

That compounds to feeling like it shatters our experience of the world is one that feels safe, that feels predictable, that we could tolerate. And over time, the more that there is that accumulation, our capacities get worn down and we stay at a heightened level of what we call stress reaction, and then it gets harder to relax because we're hypervigilant, we're attentive all the time, always expecting something else to go wrong. I would be mindful to not just think of trauma as just an event that occurs in its own little discreet bubble, but actually that the impact of that kind of chronic nature of adversity over our lives can have a remarkable psychological repercussion and make us feel incredibly vulnerable.

Vincent Boudreau00:16:46

Mm-hmm. In the past, I did a fair amount of ... I had a lot of contact with PhD students that were working in the clinical program and got a chance to talk to them about their research. And a lot of them were working on a concept that was new to me at the time, but I found it fascinating, the intergenerational transmission of trauma. Could you talk a little bit about that concept and what standing it has both in the field and in your own work?

Sasha Rudenstine00:17:18

I think we think about it differently, and Diana, maybe this is a place that we can speak about it together. So the intergenerational transmission of trauma is both sort of the way in which one experience of my going through trauma in my life, I pass it on to the next generation through how I take care of them, through my fear structures, through my view of the world is unsafe.

And so we recreate a notion of risk, of vulnerability, of hypervigilance, and so psychically we pass it on, but then more broadly, there is just sort of trauma that gets transmitted. It gets normalized, so adversity can be normalized. And so if I experience one level of adversity, I might bring it on to the next generation. So it actually, my acts, my physical acts, my true acts, I carry it on. It lives in our genetics. It lives in our bones and our psychic experience, and we see it in our patients all the time.

Vincent Boudreau00:18:36

Mm-hmm. Diana, if we take all the stuff that Sasha is talking about, both in terms of the social cultural factors, but also factors over the life course, how does that come into the clinician's therapy role? How important is it, for instance, to understand not only what someone's experiencing now, but what they may have been carrying for years or how they experience or even are cognizant of the kind of social cultural factors that may be impinging on their mental health?

Diana Puñales00:19:15

No, I think that this is where, for example, intergenerational transmission of trauma is so critical in today's existence because there's both the intrafamilial and then the inter with the rest of society. But understanding what a person's carried for years is critically important for psychologists and clinicians because of something so elemental. Past experiences form the hidden blueprint that shapes present day thoughts, feelings, behaviors, survival responses.

And so the past matters greatly in psychology, not to the exclusion of the present, but it helps us then begin to form a treatment plan, for example, that allows us to help the person gain insight and awareness as to how it is that they got to the place they are today. You look at what are internalized beliefs that Sasha was alluding to, messages that we transmit advertently and inadvertently that then have a psychological impact that shape how people are expected to behave or what they think is safe or how they even view their own self-worth.

When we look at the past as well as the present, we're helping individuals who are in therapy really develop self-compassion, to understand the origins of their struggles, to replace harsh self-judgments with curiosity and empathy for themselves before they can even begin to show empathy and curiosity towards others. But that's a skill that needs to be learned, and that's one of the ways that therapy is instrumental.

And then ultimately really creating healing where that awareness alone doesn't just create the healing, but it begins to automatically change the brain, changes how we process past emotional wounds, learns how to integrate experiences from the past to how to do it a little bit differently now. And so being able to do this kind of work is called in-depth work, but it's also not quick fix work. This is the work that really requires a commitment and requires a person to say, "I am ready for this, that I am willing to take the risk to change my life, possibly radically change my life."

Vincent Boudreau00:21:54

The ownership of an individual, of a therapeutic course of action, the fact that they're going to be the architects of their recovery in some ways. It also makes me think about one of the ways you specialize is you specialize in psychology and therapeutic services specifically with Latino and Spanish-speaking communities. And I wanted to ask if the subjective approach to mental health is so important and you need the kind of active buy-in of the patient, what difference does it make if that kind of cultural distinction? Is it simply a question of making healthcare accessible linguistically or are there other kind of cultural, I guess, frameworks that have to be entered into and taken account of if you're going to deliver care to a patient?

Diana Puñales00:22:53

Yeah, I think this is another aspect of mental health care that is really key. It's elemental in how a person can gain a sense of growth and awareness, and language certainly is one piece, but language alone doesn't have the capacity to create change. So you need to have an understanding of what are the cultural beliefs and cultural systems that a person is a part of.

What is their cultural and perceived understanding of what causes distress and what are coping mechanisms and defense mechanisms that the individual engages in, some of which may be helpful and others which contribute to the maintenance of the dysfunction. And you look at interpersonal factors and social factors, you look at spiritual and religious beliefs that either help to maintain the distress or that actually are really pivotal in helping ameliorate some of this distress and not alienating other parts of the individual's cultural beliefs from wellness, from trying to attain growth and awareness.

So language is one piece of it, but putting language aside, you also need the therapist to have cultural humility, to have a commitment to being culturally curious, to being aware of their own biases. And every human being, we have our own sets of cultural assumptions and biases, but really challenging ourselves to think outside of the box, especially with individuals from communities that aren't our own.

Vincent Boudreau00:24:46

Diana, I'd like to turn to another area of your work that's particularly relevant in a city like New York. You've worked extensively around immigration and acculturative stress. Immigration is a major topic of discussion right now, often discussed politically, economically, and legally. Lots and lots of stories of trauma and pressure and even violence associated with ongoing immigration policies.

We don't always talk about immigration as a psychological factor. And so I want to ask a little bit about that. I first want to ask you to talk about acculturative stress, what it is and what can happen psychologically when someone is trying to establish a life within a new country and a new culture, but maybe start by defining the term.

Diana Puñales00:25:41

Yeah, absolutely. Acculturative stress is real, and it involves two things, a psychological strain and a physical strain. And that happens to individuals when they're trying to adapt to a new culture while at the same time they're trying to stay connected to their original identity. And you have what is called a cultural collision rather, where the person feels literally caught between distinct sets of expectations and values and mores and social norms, and it requires the person to do something simultaneously while they're feeling stressed, which is incredibly difficult to do.

We're asking them to adjust. And unlike a brief cultural shock, acculturative stress is an ongoing process where you're constantly trying to balance your home or first heritage with the new host environment. And if the new host environment happens to be particularly aggressive or violent or separating you or othering you in any kind of way, it makes that adjustment almost impossible. And so they're going to be a range of triggers that let you know that you're being rejected by the host culture.

And when that happens, you're going to experience language barriers, financial and legal uncertainty, discrimination, loss of your familiar support networks that aren't available in the new host country. And the very critical thing is that all of this has a real psychological impact. The person just doesn't stand there. It's going to lead to specific emotional and mental challenges.

You have what we call in psychology, identity confusion. The person doesn't feel they belong in the new culture, and yet they're sometimes seen as too foreign. Sometimes that's a phrase that is used that is really stigmatizing. And sometimes as they make an attempt to adapt to a new culture, their own host culture says, "You're becoming too like them, the host country." So there is this real tension that is constantly in place. We also see mood changes, distress, like anxiety and depression and low self-esteem.

The imposter syndrome just thrives in an environment like this, homesickness, grief for what you left behind, the intergenerational tension or traumas that Sasha was speaking about before in which you yourself mentioned, but then you have what we really see as mental fatigue. There's a lot of exhaustion that comes when individuals, for example, have to start code switching between their culture of origin and the new culture in this country. Some people can do it and some people can't, some people are in between, and that in and of itself, it causes mental fatigue.

Vincent Boudreau00:28:58

Yeah. And you've been describing it as if the individual is situated between two culture, but of course on this campus, it's brought into social structures. So many of our students are the one in their family that mediate between American society and old society. They may be the most fluent English speakers in their family or the ones most able to navigate the DMV or social security or any of the other kind of bureaucratic agencies.

So we also, I think specifically with students have this tension between the home life and the life of the world. And sometimes even the act of going to college can be seen as pulling a young person away from their family and their culture. So I imagine this acculturative stress, however it sits down on the shoulders of other new Americans, they're immigrants. It has a particular manifestation for students.

Diana Puñales00:30:05

That's right. Well, when you were just talking, two things came to mind for me. One was being first generation in every sense of the word. And that doesn't only mean first generation coming from another country and being the first ones either born here or going to school here, but you could be a US citizen born in the United States and be the first person in your family to ever achieve higher education. And then it also, the other term that came to mind for me was parentification that happens.

When a child is the first one to learn English, the first one to go to school here, the first one to learn social systems here, that child then gets parentified and acts in ways that are not age congruent. Children should not be, for example, translating when their mother has a GYN or OB obstetrics appointment or being the one having to explain their whole social and financial history if they're seeking public services.

And so all of that is what we call the compound effect of acculturative stress. So it's the person's own process, but also they might be put in roles that compound the effect of acculturative stress precisely for the situations that you mentioned before.

Vincent Boudreau00:31:32

Yeah. Yeah. Sasha, since we've been leaning on you to talk about the broader social and cultural context, I'm curious, given what Diana just said about the kinds of stress or the kind of acculturative stress that, for instance, one of our students who may be new to the United States may be experiencing, how do I ask this?

Is it a good thing or is it difficult that at a place like City College, we've gathered so many immigrants, so many new Americans together where you'd expect on the one hand many, many of them may be experiencing acculturative stress. On the other hand, they're in a community where that's a feature of membership in the community. How does that play out, do you think, in terms of resiliency and mental health for members of our campus community?

Sasha Rudenstine00:32:38

That's a really great question. I don't know, but I'll tell you, to some extent I see both sides of it and I'll try to explain. On one hand, because it's such a shared phenomena, so many of our students might be going through it, there is a sense of it's normalized. We could understand I'm not alone in this. And yet at the same time, each individual student's experience is their own experience. And to draw a conclusion on, "Is it good, is it bad, is it this? It's not that linear."

Vincent Boudreau00:33:14

Yeah, it's a simplistic way of asking.

Sasha Rudenstine00:33:14

But I do think that there is a way in which City College is such a unique environment. It brings together so many individuals that are achieving so much and so many of them, the first in their family. And as Diana so eloquently explained, it comes with an enormous burden and at the same time, hope and excitement and dreams. But our students go through something that many students in our country don't go through who don't have those layers of experience. So I don't know if that's a clean answer for you. I don't think it's simple.

Vincent Boudreau00:33:55

No, it's not simple. But over the years, you hear so many students refer to the support they feel to be in a place where they don't feel like outliers.

Sasha Rudenstine00:34:11

That's right. That's where it feels normal.

Vincent Boudreau00:34:11

And it's not because they're all the same, it's because they all share the experience maybe of being an outlier potentially in another setting. That's not a question, it's a kind of observation, but I wonder for either of you, how you think that plays out in terms of, is it a resource? Probably.

Sasha Rudenstine00:34:33

Well, yeah. I think anytime we have a sense of belonging, and belonging could be simply that something brings us together and that we're not an outlier here, there's remarkable strength in that and it nurtures our capacity to keep putting one foot in front of the other and to ask for help and to realize that some of what's asked of us is taking it above and beyond what other people have to go through. But there's other people in this classroom that are challenged with the same stressors and that helps, that equates it. Diana, you were going to say something before.

Diana Puñales00:35:09

No, I was going to piggyback to what you were saying, which is that sense of not feeling alone in this. And I think at City College, because we have students from so many different parts of the world, but feeling tethered is one of the ways that we can break down profound senses of isolation. And you can feel tethered to your TA, to your professor, to your cohort, to classmates, to individuals that work at City College where our students can find themselves in.

And from staff all the way running the gamut of who are the faces of the people that constitute the non-student part of City College. And I think that is one of the ways that City College is quite special and unique is that when you feel tethered in some way, you are not so alone. And it's when individuals really feel alone that there's nothing to buffer or avenues to express what they're going through inside because I'm already an alien, I'm already an other. And I think that we do that in a really special way. I've been here 18 years, I've seen it. I think we do it.

Vincent Boudreau00:36:34

Yeah. I'm going to ask a question that's, when you talk to non-practitioners about that feeling of isolation and loneliness and being untethered, all the time off the cuff, people are saying it's worse now than it's ever been in the past. And do you agree with that?

Whether it's social media culture or the aftermath of COVID or the specter of climate change, are we living in times that are especially alienating and isolating for people or is it just there's always a pressure for alienation and isolation, it's just happening in a different way now and it'll be different in five years or 10 years? What do you think about where we are right now for all of that?

Sasha Rudenstine00:37:29

I think for sure we're in an epidemic of loneliness, and I think that's been really well documented. During COVID, the rates of loneliness went through the roof. And going back to one of the things that brings us together today, that experience of loneliness is one of the things that leads us most towards a place of desperation and puts us most at risk for suicide and other forms of harm.

There's a lot of research to try and understand where did it come from? COVID didn't help. Social media keeps us apart, breaks down the experience of what is it like to just be in the 3D with another individual and feel their reaction, feel their comfort, both physical and emotional and just general presence. But as a society, I think what we can say is that we are very much suffering to try to reconnect.

And there's a lot of research to suggest that breaking down and reducing loneliness and building bridges and creating connections is a very important next step to helping everybody feel stronger and more filled up in life. But I also just want to actually, I don't want to ignore one other part of it, which is actually that the phone and social media have also been a saving grace for some people and have created community that they may not have had because of where they live in this country or the communities that they're part of where they didn't feel accepted.

It's allowed them to create a community. And so to just demonize it, I think is a mistake, but it's remarkably important to try to use it for what it can be good for, but not at the expense of building true connections with other individuals that make you feel seen and understood and have somebody to speak to.

Vincent Boudreau00:39:30

Mm-hmm. So Sasha, I'm keeping track. So far you've come to the defense of stress as not always being difficult and now social media.

Sasha Rudenstine00:39:43

Yeah. It's crazy how complex life can be.

Vincent Boudreau00:39:43

Yep, yep. I'll put you down as against demonization of these things. We spent much of the time so far talking about these challenges. For the remaining time, I want to talk about what we're actually doing about some of these challenges, particularly here at City College. And I want to start because both of you are your researchers, your clinicians, you're also training a new generation of clinicians.

And I want to start by asking, when you look at the students that come to work with you in the PhD program, are they drawn for particular reasons to your program and to this campus? Is it the orientation of your education? Is it the opportunity to work with our community or in our community, Harlem? What sets your student body and their ambitions for psychology apart, do you think? And this is for either of you or both.

Diana Puñales00:40:37

Sasha, you want to start off with admissions and then what do we think and I can tell you what-

Sasha Rudenstine00:40:41

Yeah, I think they're a hundred percent drawn to us for a very particular reason. We take a perspective that the person sitting in front of us is a very complicated individual who has a lifetime of experience that shapes who they are at this particular moment and that their experiences are not simply psychiatric or psychological, but they're a part of or infused by their neighborhood, their family, their immigration story, diversity, experiences of discrimination, their resources, that all these things play into how we metabolize and understand the world.

I think the people that go on to come to our program want to work with our community at City College, want to work with Harlem, individuals in Harlem and serve and provide psychological services to communities that typically have not had as much access. And they want to work within the consulting room, but they also see the value in going out into the community and bringing the services to where people are, whether that's through prevention, which we haven't spoken as much about today or through treatment. Diana, what would you add to that?

Diana Puñales00:41:56

Yeah, what I was going to say is that I agree with everything. I concur with everything that you said, and I would add that these are the kinds of students that understand that they're making a commitment to working in a very specific way, in a way that isn't only looking at the interest psychic, but they're also looking at the contextual lives of the patients that we treat here. So these are folks that are invested in being trained in a very specific kind of way.

Vincent Boudreau00:42:28

Sasha, you just in passing said we haven't spent a lot of time talking about prevention. I remember years ago when I first came to City College, one of the emerging arguments from within your department is that we have to spend more time talking about how we build mental health as opposed to treat mental illness.

You talked earlier about the kind of epidemic of loneliness, which feels like a great place to start in a kind of preclinical aspect to build resilience and better mental health. Let's say I'm somebody who's not coming in to get clinical treatment, but I'm in the world surrounded by people that are experiencing an epidemic of loneliness. What are the sorts of things that one does to manage and maybe help others in that world?

Sasha Rudenstine00:43:29

Say hello, say how are you? To be present, to not walk the halls like this with our blinders on, but recognize we're walking the halls with other people who we could very well have a new relationship with, a new acquaintance. As a school, we want to break down loneliness, we want to prevent, we want to create spaces where people can come together.

Nothing beats a couch and a coffee bar that helps people come to one spot and run into each other day in and day out and say, "Oh, hi." I think those moments are actually pivotal to not feeling invisible, that we all matter. We all have a reason to be in here and we're all being seen by somebody else. That's magic.

Vincent Boudreau00:44:27

Yeah. You get outside of New York City or outside of Harlem and people can't believe that people say hello to each other on the street. And look, again, you're the person we've been talking to about broader cultural context. What do you think the prospects are for a friendlier New York City?

Sasha Rudenstine00:44:51

Good luck.

Vincent Boudreau00:44:54

I will tell you, my personal experience of New York is I have more on the street conversations with New Yorkers than I ever do. I grew up in Syracuse, nobody talked to anybody in Syracuse. We lived in houses. I feel this is one of the big unjustified wraps against the city is that we don't talk to each other.

Sasha Rudenstine00:45:17

I hear what you're saying, and I think there's something to it. I don't think it's that there's a desire to be distant from our neighbors or the people. I think that there's a hustle and a bustle to us that keeps us going. But I was very moved during the week around 9/11 and all the memories and all the stories about people recounting how we came together.

I bring it up mostly because I think that is true about New York and it's true about human nature in so many respects that when things matter, people lean in. And maybe we could just do a little bit of a better job at leaning in a little bit more often, and that could change things slightly, but we get distracted. Life is busy.

Diana Puñales00:46:10

But you see it in the moments of coming together. And Sasha is going to laugh when I say this, but you saw it when the Knicks won the championship.

Sasha Rudenstine00:46:19

That was another moment. That was a happy moment.

Diana Puñales00:46:22

But it was around, Sasha, you mentioned before people suffering to reconnect with humans. The reason that happens is because human beings are social by nature. So in fact, being socially isolated is not what is inherently, and I hate to use the word normal, but inherently innate. So we want to make those connections. But like you said, there are many things that stand in the way.

But when there is something that is in common, whether it's something obviously as the level of tragedy of 9/11 or a more joyous occasion, but people like the New York Knicks winning the championship, when they won, people who didn't know each other were high-fiving in the subways, were patting each other on the back days and weeks. And still after that happened, because there was something from all walks of life that they could relate to, cultural, racial, socioeconomic, gender, sexual orientation, you name it.

But there was this one thing that folks could really rally around. And when that happens, that's the upstate New York kind of experience where you say hello to people that you don't know, where you look at people with a smile, where you wear colors and people orange and blue and people are like, "Yeah." Or you honk your horn. So that means that we have the capacity to really not be alone in this way, but a lot of stuff gets in the way.

Vincent Boudreau00:47:57

Is there a way to bring that into the clinic either as a practitioner or a teacher of clinicians? Is there a way of teaching what that lesson may mean in terms of healthcare?

Diana Puñales00:48:14

Well, I think one of the things that we do, and Sasha, I'd like to hear it, but one of the things that we try to do is students have to be able to be self-reflective first. That's the very first step. Can I reflect about myself? You can't expect, especially beginning therapists, to learn and be and how to exist with another person that they're trying to heal if they themselves don't even know how to be with themselves. And by that, I mean ask yourself the hard questions.

How do I feel about this and how do I feel about that? And what experiences have I had that have formed me? But really do that deep dive with yourself before you can even begin to go next. And then I always teach students, I said, "I can help you become more empathic, but I can't teach you to be empathic if you don't have empathy within."

It's not something I can insert. I can develop it. I can help you develop it and I can teach you skills to do that, but you sort of have to be much more amenable and natural to empathy. Sasha, do you have your own thoughts about this?

Sasha Rudenstine00:49:16

No, I think you said it really beautifully.

Vincent Boudreau00:49:20

We've spent another hour. I've had so much fun talking to the both of you. This has been so enlightening. I do want to give you though both one last opportunity. We always give people a chance to rep their organization. So you've got a clinic here, you've got a PhD program, and just a sentence or two to people who may be thinking either about a career as a clinical psychologist or might think they may need to talk to somebody in a clinical setting. What would you say to our listeners? Diana, why don't you start?

Diana Puñales00:49:53

Yeah. What I would say is there is nothing heroic about suffering and being in distress. Life is way too short and unpredictable, and it takes a lot of strength to take that first step and say, "I need help." And that's why I say there's nothing heroic in sitting in silence and in distress. And if you can take that step, it can be life-changing in incredible ways.

Vincent Boudreau00:50:25

Wonderful thought. Sasha, how about your program and your students? This is a show that goes out not just to our campus, but to people in the community. I think you've both given people reason not just to think about what care they might need, but also what role they may have in the future as a provider of care. And so here you are, you're running this wonderful PhD program in clinical psychology. What would you say to someone who's considering this as a pathway for themselves?

Sasha Rudenstine00:50:59

That it's humbling, that it's noble, and that there's nothing more special or powerful than helping somebody find a voice and heal.

Vincent Boudreau00:51:12

I want to thank you both for this conversation. It's been deeply enlightening and just thoroughly enjoyable for me to listen to the two of you talk about this work and the care that you give it personally, but also that you are helping us deliver institutionally. So I want to thank Dr. Sasha Rudenstine.

She is the program director of the Clinical Psychology PhD program and the Director of the Intersect Lab here at CCNY, and Dr. Diana Puñales, who is the Director of Clinical Training and the Director of the Psychological Center here at City College of New York. Thank you both for being here. It's been just a real joy and privilege to talk to you both. Until we meet again, be well, and thank you for listening.