News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences
Two quality solutions to a city’s therapist shortage
The path that Lois Feinblatt and Ellen Halle have chosen for the past 36 years is one some women dream about while they sort socks in a steamy laundry room. Even the way it came about has a fabled feel to it. In 1966, word got out about an unusual Hopkins program to train mature women as “auxiliary psychotherapists” as a fix for Baltimore’s shortage of community psychiatry professionals. The project mirrored an earlier NIMH model.
As then-head of Psychiatry Joel Elkes told the Baltimore Sun, “We’re tapping a great reservoir of talent represented by intelligent married women in their 40s. They’ve become experts in family management just as their families are leaving home.” Those chosen, he said, would be college graduates with “psychological awareness, minimal defensiveness and an ability to empathize.”
So just as the program appeared, Halle and Feinblatt fit right in. The two women, both college graduates in English literature, had seven non-cookie-cutter children between them, had managed active households and had “served sentences” on social service boards. Married to prominent, successful men, they were accomplished and worldly in the best sense. Feinblatt had worked a decade for the city’s Department of Welfare.
Acceptance, however, wasn’t a snap. Some 40 others were as eager, Halle says, especially new psychologists wanting clinical experience. “We survived an avalanche of interviews,” says Feinblatt. The women also role-played and dealt with hypothetical patients. For a month, their every word was weighed by clinicians rapier-sharp to nuance in speech and thought. “It was both intense and dramatic,” says Halle, who remembers it vividly. “But because I’m not a competitive person,” adds Feinblatt, “it was also somewhat terrifying.”
For the next two years, the two spent 40 hours a week in study, gaining an intensive clinical education. Rooming together on campus made them fast friends. And training under the area’s finest psychoanalysts and psychiatrists served them, and the community, well. Then came a third-year internship.
“The program wasn’t without controversy,” says Halle. The trainees were called “the housewives” behind their backs by green-eyed residents put off after seeing women their mothers’ age develop a quick rapport with their patients. It also stung when, in grand rounds, the chief of medicine asked “the housewives” not to ask questions, please.
A dedicated lot, all eight of the Hopkins trainees graduated, most taking jobs throughout the city. The program proved wonderfully relevant.
Ultimately, Halle and Feinblatt earned master’s degrees and certification as licensed clinical professional counselors. At first they worked in private or group practices, but then, in 1970, Hopkins’ Chester Schmidt thought they’d fit well in the new Sexual Behaviors Consultation Unit he was co-heading with fellow psychiatrist Jon Meyer.
In the days of Masters and Johnson, when human sexuality clinics dotted the country, the SBCU was one of few tied to a major medical facility. Its reliance on scientific rigor brought respect that lasts today.
“From the beginning it’s been a place where patients learn about themselves,” adds Feinblatt, “where they’re made to feel comfortable.” First interviewing patients, then adding to their evaluations, the women soon became instructors in psychiatry. They were sought out as therapists, and still are today.
They also weathered the clinic’s three phases: first, after the discovery that women could be orgasmic—a time that couples’ appointments surged, says Feinblatt. Then they began to see men whose impotence, in part, followed from demands of the first phase. Now, says Halle, disorders of desire are more common: “We’ve identified the functional-but-disinterested patient.”
Through that, says Schmidt, “Lois and Ellen have kept a broader, psychodynamic view of mental health. They know how and why our patients do what they do. Their observations are invaluable. They have a depth of understanding that our medical students can’t touch.”
Charmian Elkes: Her Award Goes On
In the early 1950s, for example, they undertook a blinded clinical trial of chlorpromazine, proving its worth as the first “real” drug available for hyperactive psychotic patients.
In 1957, now with the NIMH in Washington, D.C., Elkes conceived a pilot project to give selected women a short course in psychotherapy’s practical aspects—a new way to train mental health counselors. Its success led her to start the program at Hopkins, where she practiced from 1966 to 1969, an undertaking that changed the lives of Lois Feinblatt and Ellen Halle (article, left), this year’s co-recipients of the Charmian Elkes Award for Excellence and Innovation in Mental Health Services. The award will be presented at Psychiatry’s 21st annual Mood Disorders Symposium in April.