Dr. Raymond Levy, PsyD, Interview Transcript

The following is a transcript of my interview with Dr. Raymond Levy. To find links to the audio files and more information about the interview, please click here.

These transcripts are made possible by a gift from the NNEAHE.

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Bonica:	Welcome to the force, Dr. Leavy.
Dr. Levy:	Thank you, I'm happy to be here.
Bonica:	You earned a doctorate of psychology degree or PsyD from the Massachusetts school of Professional Psychology in 1982. I believe it's now called the William James College?
Dr. Levy:	It is now the William James College, yes.
Bonica:	Okay. Before earning your PsyD you earned a bachelor of arts in the University of Pennsylvania and an MA from the University of Hartford. Were your prior studies also in psychology or was the PsyD a new thing for you?
Dr. Levy:	Academically, I wasn't really interested in psychology as an undergrad. I majored in history, Russian history. I wasn't quite sure what I was doing with that. My two undergrad courses in psychology, I didn't do very well because they were very boring to me actually and turned me away from psychology as opposed to towards psychology. When I graduated, I got a job teaching at a private school in Connecticut. Because of an area of interest that I was not aware of, I was asked to be on the counseling staff there. That's how I became interested in the field of psychology and the inner workings of people's minds, their psyches. Then I got a Masters degree at the University of Hartford but decided that that wasn't enough, that I really needed a doctorate, which is a terminal degree. I really felt I needed a terminal degree in order to have an expansive career with opportunity.
Bonica:	The Masters degree was in counseling?
Dr. Levy:	It was called clinical practices. It was what I would now call a relatively elementary approach to clinical work without the depth. In many cases the people were not, my fellow students were not going to go on to get doctoral degrees.
Bonica:	It allowed you to practice some sort of counseling or therapy?
Dr. Levy:	Not independently. It would have allowed me to, it did allow me actually to be on the staff mental health center in Gloucester. This is a matter of interest, I was living in Hartford, I moved to Boston because my wife wanted to go to graduate school up here. I sent out 105 letters to various community clinics, mental health centers looking for interviews and jobs. I got one response and one job.
Bonica:	105?
Dr. Levy:	105, I will never forget that. Yes, yes.
Bonica:	Why did you choose the Massachusetts School of Professional Psychology?
Dr. Levy:	That's an interesting question. I was working full time in Gloucester and I decided I wanted a doctoral degree. My wife was here in school, so I had to stay, I wanted to stay in the Boston area. I didn't really, the Massachusetts School of Professional Psychology, William James College was in its early stages, its early days. In fact, I was in the first graduating class. It had a very flexible program as far as time goes. I was able to continue to work either 30 or 35 hours a week and be a full time student in the doctoral program at the Mass school of professional psychology.
Bonica:	You were doing mental health therapy of some sort?
Dr. Levy:	I was, yeah.
Bonica:	At the same time preferring your professional degree, your PsyD?
Dr. Levy:	Exactly, yes. That's right.
Bonica:	Oh, wow. That must have been some good synergies there between your day-to-day and your education.
Dr. Levy:	That is absolutely true. I was studying the very ideas and approaches that I was using during the day. When my classes started at 4 o'clock it was very familiar to me. For my work on the counseling staff at the private school in Connecticut, I had become very interested in psychotherapy, individual psychotherapy. That was really wonderful for me. I very much enjoyed being in graduate school, especially while I was working at the same time.
Bonica:	Did you develop a specialty while you were in your training? You mentioned psychotherapy.
Dr. Levy:	Right, depends what you mean by a specialty. I would say individual psychotherapy is a specialty. Nowadays the term specialty is sometimes used differently. There was no particular age group except adults. I was interested in adults, but no particular psychiatric diagnosis for example, like some people say that they specializes in anxiety disorders for example. I feel I treat anxiety disorders as well as anybody.
Bonica:	When you were in your training, did you choose to work on psychotherapy, were there are other avenues that you could have pursued while you were doing your graduate work, some other kind of therapy?
Dr. Levy:	Oh, yeah. All other kind of therapy, because there was community consultation that I could have done, organizational development. There were other possibilities. I was deeply involved with individual psychotherapy.
Bonica:	Could you explain what that means? To a layperson, what is psychotherapy?
Dr. Levy:	It's a little hard now to have a unitary definition because myself, I think that the concept of psychotherapy has been devalued. Everybody thinks that they can do psychotherapy, including insurance companies whose requirements have decreased over the years for those people who they will reimburse for psychotherapy. It's essentially talk therapy is a meeting between two people in which both people agree to try to understand underlying dynamics, underlying emotions that the person who's in the role of patient is not aware of for the purpose of unlocking the person's energy and capacities and potential. Different people go about it in a little different ways. In the context of a trusting relationship and where a person can talk about things that they might be fearful of talking about or only gradually becoming aware of. They understand things about themselves and enrich their possibilities in life.
Bonica:	What does success look like when you work with a patient?
Dr. Levy:	Great question. Maybe the best way to get at that is to give you an example. I'm just starting to work with a man in his 20s who he and I agree both in his relationships and his work life, he's never really felt free to pursue what he wants, to say to himself, "This is my passion, this is what I want to do. This is the woman I want." As opposed to what he recently had, which was a relationship that he thought was good enough and he could get by for a while and he felt some sense of obligation to the woman.
	He was involved with her, but now he's recently broken up but I think is a good sign, success that he's not settling for being involved both in his work life and his romantic life in something based on obligation as opposed to something that is a reflection of who he is, what he wants in life and a more passionate connection to life. Success would be helping him remove the obstacles so that he can allow himself to allow what he wants in the world.
Bonica:	I was reading in your bio that you do psychodynamic therapy. What's the difference between, if this is the right phrasing, traditional psychotherapy and psychodynamic therapy? That may not be the right terminology. I'm not familiar.
Dr. Levy:	I'm laughing because for many, many decades the only psychotherapy was psychodynamic psychotherapy. What's happened in the last 15 or 20 years is, and I think with mixed results myself, something called cognitive behavioral therapy has become, I don't know, certainly more known, more popular in the public view. The population seems to be somewhat convinced that this is the magic pill that people have been looking for for a long time. The difference is that in psychodynamic psychotherapy, we believe that in our families and in our early experience in life that we adjust to who our mothers and fathers are. We relate in specific ways because it's necessary to please them, to get what you want from them because they get upset if you don't accommodate their values, their ideas, their child rearing strategies. Everybody adjusts to the environment that you grow up in.
	In some cases that seems flexible enough that people can go on and understand what they want, what their niche is in the world, who they are, and they can have a very nice life. In many cases, because of the very reasons that we have made adjustments growing up, we are hiding from ourselves. We don't quite know about levels of feelings, levels of wishes, aspects of ourself that we've had to hide or suppress in order to get along in the world. A psychodynamic approach tries to help people get beyond the ways that they've adapted in the world and get to a level of understanding of themselves that feels to them more genuine, more authentic, more an expression of who they are with the hope that it leads to satisfaction in the world.
Bonica:	It sounds like what you're describing with psychodynamic therapy really goes back to parenting and this theme of fatherhood that you are now deeply engaged with. Is psychodynamic therapy always reaching back to childhood and your rearing, your family dynamics from ...
Dr. Levy:	Good question. In both psychodynamic therapy and cognitive behavioral therapy, it's always good to know what a person's background is, what their mother was like, what their father was like, what their relationships with each of the important people in their lives including siblings were like. That doesn't mean necessarily that every person has to relive their early experiences or spend years talking about their mother or their father. There are patterns that develop in us early.
	It's good for the therapist, me, to be able to recognize those patterns so that when I see them in adults, I can point them out and we can have conversations about whether these patterns, in what ways these patterns are helping in a person's life and in what ways these patterns are hindering a person's life. Do I believe that the source of our adult functioning is born in childhood? Yes, I would say that is the case. Sometimes it's very adaptive. There's no need for therapy and there are no problems, that's fine. I happen to see the people for whom that's not the case.
Bonica:	Right, yeah. They become to you because that's not the case. You completed your doctoral work and you became a staff psychologist at Cambridge Hospital in Cambridge, Massachusetts. You worked there from 1984 to 1994.
Dr. Levy:	I worked there as teaching and supervising. I didn't see patients there. A colleague, one of my mentors, helped me get on the staff because I thought I had ability and potential, so I would teach trainees, psychology trainees and supervise social workers and psychologists.
Bonica:	Okay. Did you also have a separate private practice at that point as well?
Dr. Levy:	Yes. When I graduated MSPP, I set up an office in Cambridge and started to see patients privately without any institutional connection. I've been doing that for 34 years.
Bonica:	You've always had a private practice, and then you've also been involved with institutions for it seems like most of your career one way or another.
Dr. Levy:	Yes. I always wanted colleagues, and also I enjoy teaching but also I wanted to get known because that also would help my private practice. One thing that I'll mention that I've said to so many people over the years actually, I made sure, I've always worked a lot of hours, many, many hours. When I started building my private practice I was also working at a place called General Medical Associates seeing patients. It's an outpatient medical facility affiliated with Mass General, but operating independently in western Massachusetts. They were pediatrics and internal medicine and other specialties, dermatology and psychiatry. I was a psychologist on the staff. The doctors there would refer patients to me.
	I was working, I don't quite remember, maybe 30 hours there, 35 while I was building my private practice. It was absolutely necessary. I tell all the people who are involved in training with me that you can't just hang up a shingle and expect to be busy full-time. You have to be working at some institution and gradually build a reputation and get referrals. While you're doing that you're working many, many hours, 50 to 60 hours.
Bonica:	Is that a fairly standard way of the building a practice? Do most providers, psychology in particular, or do you find follow people the same path you did?
Dr. Levy:	Yes, absolutely. For the people who want to build a private practice after training, they always have an institutional affiliation, maybe on a part-time basis or three-quarter time basis. Then they build their practice out of meeting new colleagues, getting referrals, making referrals, teaching, and presenting papers at conferences local and national, and writing so that they are known. Yeah, it's a lot of work. There's no way around it, it's a lot of hours, it's a lot of work. If you love it like I have, you're very fortunate. I feel very fortunate to have my work as a companion throughout my whole life. Even though I'm actually at or beyond the age of retirement, although that's a moving target these days, I have no interest in retiring, I just like what I do, I want to continue to do it. I recommend to people if you love what you do, it pays dividends over the decades.
Bonica:	I like to as clinicians that I speak to about their sense of competence as a practitioner. When did you look at yourself in the mirror and say I am a doctor? I have achieved the competence and I'm an independent practitioner? Was it when you finished your schooling, before that, sometime after?
Dr. Levy:	I would say after I finished my schooling because when I went back to the doctoral program, I realized as it often happens in life, I didn't know what I didn't know because I had only had a two-year masters degree before. Then when I went to the doctoral program I just met different people and I met maybe a more gifted faculty. I understood that what I was doing, to be good at it is actually more complicated. I was supervised by multiple people. It took me a while. I would say after graduation I felt I was qualified to see patients one year after graduation because we needed a certain number of hours in order to sit for the state licensing them postdoctoral after getting the degree.
	I had a growing sense of competence through my supervision which I continued as I was in practice. The practice of psychotherapy may be a little different than some professions. There are still cases where I get confused, where I'm not certain. I will go for a consultation to my mentor to talk about the feeling that I'm missing something. Usually after a conversation, maybe two, I'm back on track and I understand more about the patient and more about the work that we need to do.
Bonica:	You mentioned mentors, that's a theme that I like to explore with my guests. You said you have a mentor now? Or you did?
Dr. Levy:	He's still alive.
Bonica:	Do you still consult with him?
Dr. Levy:	I do sometimes, I do. Sometimes it's over a meal. It's not as formal, but yes, he likes to hear me present cases or problems with some of my cases. I value that very highly. I met him my first job after my doctoral program at General Medical Associates, which I mentioned. He was the psychiatrist who hired me there. I would meet with him and then be supervised by him, and it really clicked very nicely. I learned a lot of the, if I came out of graduate school 60 to 70% toward full competency, he got me above 90 or 95 let's say. I'm very grateful to him. He's been a very important part of my life. I think I grew personally by being supervised by him on my cases also. He was not my therapist but I grew personally. When I published two books, I was very clear that these books would never have happened if I hadn't met him and if he hadn't been my mentor. I'm very grateful to him.
Bonica:	You mentioned that he supervised you. Is that a requirement for, you had your doctoral degree.
Dr. Levy:	I did.
Bonica:	Were you required to have a clinician, a psychiatry supervisor? A physician supervisor?
Dr. Levy:	No. There's one year after I had my degree where I had to accumulate 1600 hours in practice time being supervised in order to sit for the state licensing exam.
Bonica:	Okay, so he was a supervisor during that period.
Dr. Levy:	Yes, that was required. After that it was entirely voluntary but advisable. Most people in my field continued to be supervised for many many years, developed what's called a peer supervision group. People we've met along the way in our training, who we liked, talked well with, learned from, taught, maybe a group of 4 or 5 who meet monthly, talk about cases. That's in addition to an individual supervisor because we all feel, and this is a little different then maybe the cultural beliefs these days. We all feel our work is very complex and we look at factors that make it complex and we think our work is better for it, although I think the culture now and some of the claims for quicker fixes, don't think it has to be as complicated as many of us who think psychodynamically do believe.
Bonica:	You had a senior mentor who actually had some formal relationship with you that was overlooking your cases?
Dr. Levy:	It was a paid supervision. I would pay him for his time. He didn't have any, he had legal responsibility but he trusted me to present the cases that I wanted help with and that I would learn from him in a way that would help all my work with my cases.
Bonica:	Then you also mentioned a peer group that you built over time. You still use that function?
Dr. Levy:	Yes, and that's entirely, again, voluntary. By now they're thirty year relationships or more and it functions very well. We could talk about the competing new ideas and how to adjust approaches based on some new ideas as needed and a high level of trust and learning that goes in that group.
Bonica:	You mentioned that your mentor was a psychiatrist.
Dr. Levy:	He is a psychiatrist.
Bonica:	Could you briefly for folks who may not understand the difference, what's the difference between a psychiatrist and a psychologist?
Dr. Levy:	Right, good question. Psychiatrists went to medical school for 4 years and then specialized in psychiatry, decided that that would be their specialty and did what's called a residency, a 3 year residency at a medical institution. I'm affiliated with Mass General. I have helped over the years to teach and supervise some of the psychiatry residents there. They graduate residency and then take an exam, and they now are licensed in psychiatry. A psychologist goes to graduate school in psychology and does not have a medical background necessarily.
	Can't prescribe medication except in I think New Mexico and Louisiana where if you take a course with a certain number of hours in psychopharmacology and neurobiology, you're then permitted to actually prescribe medication. These are underserved areas where the culture believed it would be worthwhile to train psychologists so that they could prescribe and work in these mostly rural underserved areas. The education is very different. A psychologist is trained more as a psychotherapist. Some psychiatrists enjoy that and practice psychotherapy, but more these days are involved with neuroscience and psychopharmacology.
Bonica:	The reason I ask, I was interested in you explaining that difference. When you said that your mentor was a psychiatrist, that surprised me because I typically think of you go to see a psychiatrist to get that psychopharmacology usage. How is it that you came to have a psychiatrist as your mentor?
Dr. Levy:	There's a branch of psychiatry that is interested in psychotherapy and interested in becoming psychoanalysts. This was someone who had had advanced training in psychoanalysis and spent his time doing psychotherapy and not prescribing medication. He was excellent and focused in the areas that I wanted to learn about.
Bonica:	Is there competition between schools of thought about using psychotherapy as opposed to pharmaceuticals? Or is it find the right tool for the right problem?
Dr. Levy:	The idea in most cases is find the right tool for the right problem. At its worst, there are those who don't understand that changing the brain through medication for some, through psychotherapy for some, for medication and psychotherapy, that these are the best approaches depending on the patient. There's some that have an ideology that they're following but they've missed the boat because all the rest of us understand that psychotherapy probably changes the brain, and it's the better way to do it for some people. Psychopharmacology certainly changes the brain and it a better way to do it for some people. The combination very often works better than either one alone.
Bonica:	You have maintained overlapping academic appointments along with institutional roles and your private practice. In 1986 you were appointed as a clinical instructor in psychology in the Department of Psychiatry at Harvard Medical School. How did you come to start teaching at Harvard Med?
Dr. Levy:	That could be a little misleading. When I was on the staff at Cambridge Hospital, that comes with an appointment to Harvard Medical School. I didn't actually teach medical students at Harvard Medical School. The same is true when I moved to Mass General Hospital. The same is true, I have an appointment at Harvard Medical School, but it's through a hospital affiliation. I don't personally teach the medical students at Harvard Medical School.
Bonica:	Oh, okay. You were a clinical instructor. Did that mean you were teaching?
Dr. Levy:	I was teaching. I taught psychology students or trainees at Cambridge Hospital and then at Mass General. I've taught, again, psychiatry residents, psychology, interns. In fact, now that I think about it, for a long time once a month I was teaching Harvard medical students who were doing a rotation on the inpatient psychiatric unit at Mass General. There would be a handful, 4 to 8. I would teach them about psychodynamic psychotherapy for one or two hours a month. They would be at the hospital already. I never taught a big Harvard Medical School class. These were the Harvard medical school students.
Bonica:	Who were doing rotations at the hospital you were at.
Dr. Levy:	Exactly.
Bonica:	Okay. In 94 you left Cambridge Hospital and you took an appointment as a senior assistant psychologist in psychiatry and a clinical associate in psychiatry at Massachusetts General Hospital in Boston. What made you decide to change your affiliation from Cambridge to Mass Gen?
Dr. Levy:	Good question. I think the culture of Mass General suited me better than the culture of Cambridge Hospital. I had two very close colleagues who were at Mass General. I liked working with them, I liked spending time with them. One of them brought me on to be a supervisor and teacher in the psychology program there. One was a psychiatrist. Actually, one was the assistant chief of psychology also. She brought me on there. It just seemed frankly, Mass General is a very large place, has a very large department of psychology. It just seemed as though there would be more opportunity there, which has turned out to be the case.
Bonica:	Did you work inpatient, I didn't ask this earlier. Did you work inpatient and outpatient?
Dr. Levy:	I never worked inpatient. During my training I worked at Mount Auburn Hospital inpatient unit for a year. I never was a psychologist on an inpatient unit, no.
Bonica:	Okay. What's the difference between doing that kind of practice and the practice you do?
Dr. Levy:	It's very, very different. The patients of course, inpatients are sicker. That's why they're there. They have more severe forms of mental illness. Treatment often focuses on medication, psychopharmacology. Over the years of course the insurance environment is changed. Patients don't stay on an inpatient unit very long. It's not very satisfying to someone who's interested in psychotherapy because the patient is there for 5 days, 7 days. You meet with them a few times, and then they're gone. I tend to meet with people longer than that in psychotherapy.
Bonica:	What would you say are some of the most common misperceptions people have around psychotherapy that you find yourself having to correct? If you're at a cocktail party and someone says, "What do you do?" "I do psychotherapy." What do they assume that's wrong?
Dr. Levy:	That's interesting because I would say now that the culture has become very educated about psychotherapy. For a long time, maybe in the 70s, 60s and 70s, it was almost necessary to be in psychotherapy to be considered educated, informed, sophisticated person in certain circles. People were in psychotherapy and mostly talk therapy. There's always the group that feels if you have to go talk to somebody, it means there's something wrong with you. That's only for sick people. That's not for relatively healthy people. It takes forever. No, it doesn't take forever. Oh, I think I can talk to my friends and there's no difference between talking to my friends and talking to you in therapy. No, that's not true either. We're trained to hear in different ways than friends are. Those are some of the misconceptions I would say.
Bonica:	In 2010 you received a grant to conduct a study on the role of fatherhood on adult development. This study evolved as I understand into the fatherhood project today. Is that correct?
Dr. Levy:	That's exactly right, yes.
Bonica:	What was your initial focus of your research? What was the grant initially written to do?
Dr. Levy:	It is a grant, but it's a little misleading. We did start, we started as a research organization and we were funded actually buy a private donor. I was funded by a private donor, which made it possible for me to have a small salary and hire 2 people. We did a study trying to determine whether the relative importance in fathering of, supervising your kids and disciplining your kid's versus the warmth and supportive approach. We did a study which I would say was inconclusive and not as important as I would have liked it to be at that point. What we've continued to do and the way that I've changed the organization I think is more vibrant, more important, and more central to the questions about fatherhood that need to be addressed.
	This is interesting because this happened in addition to my continuing my private practice, continuing to be involved in teaching and training at Mass General. This was just an add-on to my professional responsibilities, which I loved. I asked this person if he would fund my work and he said yes. I was thrilled. This is good fortune on my part. How did this happen or why me? Let's see, I had been in practice for almost 30 years. I had built something of a reputation and was well-respected, had worked hard. This person of means respected me and trusted me. It was hard won after 30 years I would say. It's a little entrepreneurial frankly which I'm enjoying, although it's implicated and it's much more pressure than I've ever felt in any other part of my work. I'm sighing as I say that.
	It came from consistent hard work. It's not as though this is what I wanted to do 30 years ago and after 5 years I was just looking for money for it. It came to me after many, many years of work. It also came to me, I should say this. There's a personal element to it because when my kids grew up and where out of the house, I missed them. One of the most critical parts of my life had been my being their father. I was very committed to being their father, very involved in their day to day lives. I enjoyed that very much, found it very satisfying. I thought I could continue to make a contribution to the world as a father and studying fatherhood if I could start this organization.
	That was another reason that I get it in addition to the fact that frankly the culture is changing it this way now. Millennials want to be very involved with their kids all the time. Women since the feminist movement are working much more. A father can't just think oh, my wife's taking care of the kids. He has much more front-line care taking responsibility. Then there's the question, does he have the skills for it? The nature of the culture is changing. Fathers need advice, need programs, need skill building. There needs to be a research on fathers, which we're doing also. This is all very exciting to me. It came to me relatively late age. I hope I'm going to live for 20 more years, but came to me just the terror I turned 60, really. I hope to have this as my work until I can't work anymore.
Bonica:	The original idea in 2010, was it primarily research or was it service-oriented?
Dr. Levy:	It was primarily research, but we didn't have the data. The data we had, actually very interesting, comes from the longest longitudinal study of adult development in the world. It's called the Harvard study of adult development. It was started with the classes of 1939, 40, 41, and 42 at Harvard, which includes John F. Kennedy's class, by the way. The way research was done then was not in nearly up to the standards of modern research. The research had to be adapted, we had to make interpretations of information that had been gathered. It all just seemed a little uncomfortable for me. Not quite up to the standards I wanted.
	After a year where it cost basically a little over $100,000 to publish one paper, I decided that this was not the right way to go. I heard someone who had been doing some work in the field in fatherhood. We made the fatherhood project more program based for a while and developed several programs in the community. I also hired a social media webmaster person research assistant, administrative assistant all rolled into one. We are the core group, been together the longest. As our programs developed, I again saw a better opportunity to do research.
	I hired a senior researcher at Mass General who's interested in fatherhood and had done his dissertation 40 years ago on fathers. We then embarked on a research program and the department of obstetrics at Mass General Hospital, in which we surveyed in 2 weeks 401 men who accompanied their wives and partners to prenatal visits. We got a lot of good data from that. The paper is probably ready to be published. There will be more than one paper but the first one in another month. We are now expanding and doing a similar survey at the community health centers in Chelsea and Revere, which are also Mass General health centers. We have basically pretty a robust research program.
	In fact, I just hired a halftime research fellow to help us. There's been this gradual evolution of this nonprofit business, if you want to call it that, of this fatherhood project within the Department of Psychiatry. I do want to point out to everyone, we don't get any support from Mass General or the Department of Psychiatry. All our money is either earned through our programs, that's a small percentage, or through donors. My original donor has continued to support us every year. In fact, I've been fortunate enough, he says if we raise a million dollars he'll give another million dollars.
	All of this happens just because I've worked hard and things have gone well. People seem to want to help. It's not a moneymaker for anybody. It's not venture capital money by any means. It's social capital money I guess is really what it is. It's been very satisfying for me. I love doing what I'm doing. I love being the executive director of the fatherhood project. There have been challenges. It's going well. What do I do? I supervise my director of programs, I supervise, I help to develop programs with program director, the curricula for applying certain concepts of parenting and fathering, I help develop with him.
	I supervise the social media website person. I collaborate with the researcher in doing this research. I travel around the country making presentations. I was in Richmond, Virginia. I'm going to Tulsa, Oklahoma, of all places I never thought I'd go to make a presentation at a conference of all conferences, the women's empowerment conference in Tulsa, Oklahoma. They want to know about men because they to their credit understand that men have an influence on women. I do that. I make presentations at conferences. These are the American Public Health Association conference in Denver in October. This will all continue.
Bonica:	What is important about publishing in peer-reviewed journals, I'm assuming that's what you mean when you say we're going to publish a paper. It's not something like in Psychology Today or something. What you're describing for the most part I think are academic conferences. Why is it important for you to be participating in that literature and in that community?
Dr. Levy:	Yeah, good question. There are a couple reasons. Essentially it's about spreading the word. Our findings in obstetrics about the men who appear with their wives, I'm hoping that when we present the findings and what this suggests for running an obstetrics service a little differently so that it's a little more father friendly and providing services for fathers who more and more want to be very involved with their infants but they don't know how and they want to be supportive of their pregnant wives and partners but don't know how, that if we can run programs, it will keep families intact more. The data shows that the fathers who are involved early in their kid's development from birth are more likely to stay involved with their families.
	I'm presenting because I'm hoping that the word will get out, there will be other people from obstetrics services there that want to know more, how do you do this, what are the mechanics of it. Will you come consult to us so we can do it? It will basically change the way obstetrics services are run, which I would see as institutional change to get fathers more emotionally involved with their kids, which all the research shows is positive. Any way that we can spread the word and help make institutional changes in ways that we believe are positive, I'm ready to do it.
Bonica:	Why is it important that it go into an academic journal? I'm going to make a, Journal of Obstetrics for example. It's a peer-reviewed publication. Why is it important to do that rather than Boston Globe?
Dr. Levy:	The Boston Globe is important.
Bonica:	I didn't diminish that, but [crosstalk 00:42:38]
Dr. Levy:	You're different, they're right. Number one, a peer-reviewed journal means that the work we've done doing research is respected at the highest levels of science requirements for research, which then tends to give it credibility and validates its significance, its importance. It's different than if I just stood up and say let's get fathers more involved in obstetrics services. Anybody can say that. We've done the science so we have the research that supports it and the value of it. It just has more power. It's about power I guess and authority. Coming out of academia, I think our work can be more influential.
Bonica:	In 2011 you mentioned you started to transition from just doing research to doing some programming. Your initial expansion included working with some schools, some local schools, and then also working with some Massachusetts prisons. How did you come to make that jump, and why those target populations?
Dr. Levy:	That also is a good question. We were told when we got started that fathers are hard to find. They don't like to come to programs. They don't like to come to groups. They're hard to find. They don't think they need any help or they don't want to go out of their way. They're working. It's complicated. What we did was first of all we were interested in of underserved populations. The incarcerated dads that I taught in Shirley and Concord prisons, they are clearly underserved. We wanted to get them more programs. I wanted to teach them about staying involved with their kids even when they were in prison. I wanted to teach them certain things about skills, about child development. I did that 4 or 5 times. They're certainly an underserved population.
	Then teen dads, there are kids who either because they believe that being a man is having a child, get girls pregnant at very early ages. They find themselves having the responsibilities of fatherhood. Many of them don't stay around, but some do. Some take it seriously and they want to be a good father. That's an underserved population. We ran groups for teen dads also. Then we decided, okay, there are teen dads, but why not do a prevention program that could decrease the number of teen dads? We went into 10th grade health classes and talked to some of the kids there about 5 requirements for being a good father, after which they all realized, I'm not any of those things. I can't be a father. I don't know if it's had an impact or it hasn't, but I hope so. We were focused on underserved populations.
Bonica:	The programs that you have today, you mentioned teen dads, incarcerated dads. Some other ones that you have listed on your website include becoming a dad, father readiness for adolescents, which is that the prevention program?
Dr. Levy:	That's the prevention program, yeah.
Bonica:	Dads matter in pediatrics, what's that?
Dr. Levy:	That's a very successful program that we have in which it's held that in the Revere community health center. Chelsea and Revere are often first stops for immigrants who come to the Boston area. They're not well situated and they tend to be lower income dads. They also have difficulty being involved with their kids for various reasons. What we do is 14 times a year on Saturday mornings, we have a group where dads and kids come and do activities, play with their kids for a part of the day.
	These are families who are referred from the pediatricians at Revere Health Center and some of the social service programs that are embedded in the health center. They are at risk families, possibly at risk dads, meaning they have been incarcerated, they're unemployed, they have ADD, they don't really trust the world very well. They get referred to our program and they get involved and come on Saturday mornings, spend time with their kids, which their partners love of course. Then the last 20 to 30 minutes, we pull them out of the program and teach them something about fathering skills, parenting skills. Each week there would be a different topic involving empathy, the importance of attachment, positive discipline strategies, executive function. Things like this that are critical for fathering. It's very successful.
	Then twice a year the program director organizes trips. One trip was to the Children's Museum. There were 17 families that came. Then a trip to the Stone Zoo, and Stone, again, I think 18 to 20 families came. There's a nice sense of community. They feel like they belong somewhere. They're not strangers in a strange land. It's a good way to get them involved in the health center. Maybe their kids get better healthcare, maybe they get better healthcare. Maybe they make use of social services that are housed in the health center. It's a way of getting disenfranchised dads, underserved dads involved in what the system can offer them.
Bonica:	Then the last program that we hadn't talked about was divorcing dads.
Dr. Levy:	Yeah. This is a very good idea. This is a program, a class, an 8 session class that I and my director of programs, but I've been the main force in this, hold for dads somewhere in the process of divorce. The purpose of it is it's the same concept that guides just about all of our work, to increase the emotional engagement of fathers in their children's lives. Even as divorced dads and as nonresident dads, first of all we talk about the critical importance of their involvement and that kids can have very good outcomes even with a nonresident dad, as long as the dad is engaged in their life. Each week we have a curriculum and each week there is a subject that is raised. Again, some of these same concepts, empathy, attachment, positive discipline, coparenting which is often difficult, and the importance of maintaining contact with their day to day lives.
Bonica:	How do you evaluate the effectiveness of any of these programs?
Dr. Levy:	Yeah. Okay, this is a sticky point that I'm not proud of. We haven't done that yet and this is one of the reasons that I just hired a halftime research fellow. She and I and the director of research are going to figure out how to do this, which sounds easier than it really is. We want to make the programs evidence-based and demonstrate effectiveness. This is next on the agenda.
Bonica:	It sounds like a good research project for future publications classes.
Dr. Levy:	Absolutely, yeah. Absolutely.
Bonica:	I'm curious, your professional career leading up to your involvement with the fatherhood project was primarily on an individual basis. Based on your description of psychotherapy you probably got a chance to hear a lot about dysfunction in father-son, father-daughter relationships I assume. How did you make the jump to trying to teach people how to do it positively?
Dr. Levy:	You mean how to teach ...
Bonica:	How to be a father.
Dr. Levy:	How to be a father?
Bonica:	Parenting doesn't seem to necessarily be directly in the field that you had worked up until that point.
Dr. Levy:	I suppose that's true, although often in psychotherapy, a parent might say, "I'm having trouble with my son, my daughter." And then describe situations. We go into the father's own history of his life with his parents. Then there's also room for suggestions about parenting. Somewhere in the back of my mind, maybe that father wouldn't have had to ask me that question or had that problem if he understood more about fathering skills. There is the idea of prevention, which ...
Bonica:	What I'm trying to get it is how does your history inform your practice now with the fatherhood project?
Dr. Levy:	I'm not sure that it's going to be as direct as you might want it to be. Over the years I worked with a lot of fathers, a lot of men. When I started the fatherhood project, the question really was what's important to think about with fathers? What's important is how to be a father, how to be a good father. There is not one concept, there's not only one way to be a good father. If we're serving the underserved population, there's a lot of father absence or superficial involvement and a lot of pain. One of the things I became aware of as I was teaching the incarcerated dads is a huge percentage of the dads had absent fathers, never knew a father. There they are sitting in prison.
Bonica:	Absent as a result?
Dr. Levy:	Yes. Now they're absent, yes. Some of them very painfully so because they know what they've done. The idea came, if we can get fathers involved, maybe we'll save a few people from going to prison and repeating their father's absence.
Bonica:	You said there's not one way to be a good father.
Dr. Levy:	That's right.
Bonica:	There's got to be some baseline ideas you've got. It sounds like being present is one of them. What are the baseline things that you've learned either through your practice or through your work with the fatherhood project that form the basis of what you try to teach as being a good father?
Dr. Levy:	As you pointed out, being present is one. Be in their lives, be there for them. That doesn't mean every day necessarily, but generally speaking being involved, you can have a separate life also. The important thing is that your child feels you're there for them. That's number one. Number two, emotional regulation. In order to be a good father, you have to have certain personality characteristics. One is you need to be able to regulate your own emotions because you don't want to be emotionally disregulated with your child or even in front of your child. This often takes the form of anger. It's just not good to teach your kids.
	First of all, you hurt them when you're very angry at them, when you're disregulated. Secondly, it's not necessary if you're trying to teach them. You don't have to scream at them and yell at them. Thirdly, that's no way to be an adult to go around yelling every time you're upset about something. In order to be a good father you have to be able to regulate your own emotions.
	You also have to be able to read another person. You need to understand your child's experience and you need to know that it's your job to understand your child's experience. Who is this child? Who is this other person? When are they happy? When are they said? What makes them scared? What are their strengths? What are their weaknesses? I would say the more you can actually understand and know your child, the better the father you would be as well. Then there are the basic practical things like supporting, contributing to support of the family.
Bonica:	Economically speaking.
Dr. Levy:	Yes, absolutely. Economically keeping the family out of poverty, which is never good. It makes life hard for everybody. Practical things around the house are with the kids, knowing how to change his diaper. You don't have to, but just being involved in some way I guess is the point.
Bonica:	Talking a little bit about the mechanics of running an organization like this, is the fatherhood project a separate entity, a legal entity like a 501(c)(3) or is it a subordinate organization to the psychiatry department?
Dr. Levy:	That's an interesting question. Okay, we're in the psychiatry department. Why are we in the psychiatry department? Because I'm in the psychiatry department and I started it. I wanted it to be affiliated with Mass General. That's why we're in the psychiatry department. Nobody ever tells me what to do. Sometimes I'm told what not to do but no one ever tells me what to do. I get a lot of help. If I want the chief of psychiatry to come to some meeting and say certain things, he's happy to do it. We are not a separate 501(c)(3). We are under the Mass General umbrella 501(c)(3). All our funding is independent of the department and the hospital.
Bonica:	Okay, so they provide you a place to operate. They must provide you some administrative support in terms of financial management, that kind of thing I guess, but not the actual finances.
Dr. Levy:	That is correct, yes. Sometimes the development office helps with fundraising. Records are kept on an online portal that I have access to where my money is. It's all organized and I can see it comes in and comes out payroll and medical benefits and all of that. That all happens through the hospital, yes.
Bonica:	You mentioned before that you get no funding from Mass General, that you get some small amount from charges, that you're able to get some small amount of funding from the ability to charge for some of your programs, but most of it's donations?
Dr. Levy:	Yes, the majority by far is donations, yes. Absolutely.
Bonica:	How do you go about, you mentioned you work with the development department.
Dr. Levy:	What I did actually is different. I actually hired somebody within the fatherhood project as our development officer who raised money for us. Then when it seemed as though her work was done, I'm just now hiring another person actually within the fatherhood project to raise money, organize meetings that I'll speak at, get people on the advisory board who might make donations or might know other people who will make donations. We do it.
Bonica:	You mentioned an advisory board. Do you have an advisory board for the fatherhood project?
Dr. Levy:	I'm just about done forming it right now, yes.
Bonica:	What advice would you have to folks who are interested in social entrepreneurship, trying to put together programs like the fatherhood project? Based on your experiences, what's been most challenging and what were the secrets of your success? If I wanted to develop a program not necessarily to work with fathers but mothers or some other socially important topic.
Dr. Levy:	Without question the most challenging aspect has been funding our program. The academic aspects, the research, the publishing, the presentations, all that is very familiar to us. That becomes the easy part, the real content of our work. The hardest thing is keeping it going through funding. There have been times where I've been chasing down money because I can see that in 4 months I'm not going to be able to make payroll. I've been able to do it the whole time but it really wears on me. At 3 in the morning, that's what I'm thinking about. I'm not thinking about the group I'm going to run or the next divorcing dads class. I'm thinking about how to get a breakthrough with funding.
Bonica:	That was actually my next question is what keeps you up at night, so it's funding.
Dr. Levy:	That's what keeps me up at night, that's it.
Bonica:	Other than funding, what's the most challenging aspect of leadership and leading an organization like the fatherhood project that you faced? Or is funding really the single issue?
Dr. Levy:	I think I've been good at establishing relationships, working relationships with people, and making sure people were in the right positions and doing what they're good at, which I consider to be part of the requirements of a good leader. Maybe there was one issue early on, because the person I hired to be director of programs had been doing things in the fatherhood field for 10 or 12 years. His involvement predated my involvement. He was working for me. There was some tension about who's the leader, when, is he going to accept some of my ideas which are a little different than what he had been doing. I had to explain that and make it work for him so that he wasn't resentful and angry.
	Now we have an excellent working relationship and we are expanding our programs, just yesterday actually, interestingly in New Hampshire. We'll probably be involved in a lot of the schools in New Hampshire or some of the schools in New Hampshire. We're presenting I think it's August 3rd at a conference, a statewide conference. We're going to present some of our ideas about fathers in the schools. Schools can, if they want, it's not just us. There will be 600 people there. There are maybe 15 experts, and we're one of the experts.
	The schools can decide, oh, we want a fatherhood program in our school. Then they would hire us or they could decide, oh, we want to advance our technology in the school. Then they would hire somebody else. John and I worked very well. We had a wonderful meeting yesterday. That was a challenge at first to make sure our relationship was solid, our working relationship was solid. That was another challenge in addition to the fundraising.
	Then there's always the question of priorities. I've had to mix, I've had multiple considerations, criteria or programs, which ones are going to bring in some money to relieve some of the pressure for fundraising. Is that what we really want to do or do we want to serve the underserved lower income population, which basically we end up being volunteers for? We're doing 30 to $35,000 worth of work at Revere Community Health Center for $3000. That can't go on forever. Then divorcing dads, that actually I charge for membership and we make some money on that program. How to balance that, and our mission has more to do with the underserved population, but we need some money or there won't be any population that we're serving. That's been another challenge.
Bonica:	In conclusion, I teach young folks who are going to hospital administration. What should they know about mental health psychology, working with the psychiatry department? What should they understand about that?
Dr. Levy:	You know how in real estate when you go buy a house, everybody says to you, "Location, location, location."
Bonica:	Yes.
Dr. Levy:	In this work there are two words. I would say the first word, relationships, relationships, relationships. You have to make good relationships so that people want you to be doing what you're doing and will support any kind of our nonprofit work, and then competence, competence, competence. You have to be good at what you're doing or you're not going to be able to have an organization on your own. Even if you are good at what you're doing, then you have to worry about relationships, relationships, relationships. I think that's the magic combination.
Bonica:	Competence and relationships?
Dr. Levy:	Yeah.
Bonica:	Thank you so much for your time today. I've really enjoyed this.
Dr. Levy:	I have too. I'm happy to do it. Thanks a lot.