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#WomenofPenn: Piecing Together the Puzzle of Human Behavior

The following post is part of a year-long online campaign highlighting #WomenofPenn. The campaign, developed by FOCUS on Women’s Health and Leadership and Penn Medicine Communications, promotes the work being done by women at Penn Medicine and aims to inspire early-career women in academic medicine through the examples of successful women role models.

By Marci Foster

For Judith Margolin, the question of what career path to follow was answered at a very young age. Her journey took her to places she never expected—both geographically and professionally—but every decision landed her exactly where she is most happy, helping clients and mentoring and training new psychologists.

Judith Margolin, PsyD, is the clinical director of the Penn Medicine Princeton House Behavioral Health Women’s Program. She is responsible for the clinical oversight, strategic planning, and program development for five partial hospitalization and intensive outpatient sites serving women with acute emotional dysregulation, trauma, substance abuse and disordered eating. She is a foundationally trained Dialectical Behavioral Therapist (DBT), a certified Advanced Schema Therapist and supervisor of Schema Therapy and has received post graduate training in sex therapy and hypnosis. Margolin’s clinical practice specializes in the treatment of interpersonal trauma and dissociative identity disorder.

Jamie Berg, a pre-doctoral intern with Penn Medicine Princeton House Behavioral Health, is a doctoral candidate from La Salle University’s Clinical Psychology (PsyD) program that matched to Mount Lucas/Women’s Program for the 2018-2019 internship year. She is foundationally trained in Cognitive Behavior Therapy (CBT) and DBT with adult populations. Jamie’s previous clinical experience is working with adults in the community mental health setting at all levels of outpatient care, including working as an extern at the Mount Lucas site of Princeton House. Her training is specialized in treating trauma and mood and personality disorders. Jamie currently works at the Mount Lucas site as a therapist on the Men’s Trauma team and will be transitioning to the Women’s Program with Margolin later this year.

Q (Berg): What inspired you to be a psychologist?

A (Margolin): My uncle inspired me. He was doing graduate work in psychology when I was in second grade and he used me as a guinea pig for testing projects. I was fascinated by what he was doing and, as I got older, I found that understand human behavior is like putting a puzzle together, especially when it comes to testing and assessment.

Q: What steps did you take to advance to the clinical director level?

A: It’s been a long journey. After I graduated with my Bachelor’s degree, I lived in Israel for 13 years. During my time there, I got my Master’s degree and worked at the local medical school and at a diagnostic center as developmental psychologist with children under five and their families. When I returned to the United States, I went to graduate school for my doctorate. I started as a school psychologist in a nursery school and my career expanded as I raised my children.

While I was working on my doctorate, I was a coordinator in a clinic and developed an interest in treating trauma. It was serendipitous, really. I was going to work in the area of eating disorders, but the clients at the clinic really wanted a group for survivors of sexual abuse, so I began working with them. From there, I grew my expertise in that subject, and even wrote one of the first books on group treatment for this population called, Breaking the Silence: Group Psychotherapy for Sexual Abuse (1999).

After I focused more on my private practice, I continued to teach courses in sexual trauma at Rutgers University. Then, in 2005, I became the director of the Women’s Program for Princeton House Behavioral Health. It was a very small program at the time, with a very different approach than we use to treat women today. I was there for about two years, working in trauma, addiction, and emotional dysregulation when I decided to return to my private practice. In 2014, I was asked to come back to Princeton House as the clinical director of the Women’s Program, with a focus on developing clinical programs and training the program staff. The program has expanded so much since my first stint as director in 2005. We now focus on DBT, trauma, addiction, and eating and mood disorders.

Q: What challenges have you experienced in the field during your career?

A: At different points in my career, I’ve experienced different challenges. I think most recently it's finding the balance between being in management and an administrator, and being a clinician. Weighing both, and understanding the importance of both in my role as the Director.

As a clinician, the challenge has been setting boundaries with my patients, not taking home the weight of their issues and learning how to find that balance. It’s so easy to take the work home with you, especially when you have patients that are in crisis or suicidal. It stays with you. To continue to do this work you have to learn to leave it at the office. You’re in this profession because you care about people and you want to help them, but knowing when to pull back, and when to leave it is really hard to learn and do.

Q: Having said that, what steps have you taken to create that healthy work/life balance?

A: I try to practice self-care. Sometimes I’m more successful, sometimes less successful. If I can reduce my own vulnerabilities, then I’m more effective in what I do. That means eating well, sleeping well, exercising, and enjoying time with family and friends. I think that helps with the work/life balance. I am a bit of a work-a-holic, so finding that limit, and setting that limit can be difficult for me. But I realize how important it is. Related to what I said before, if you take these problems home with you, you may suffer what we call vicarious traumatization. It’s just so easy to get caught up in our work and have our own worldview change as a result. I have to keep reminding myself of that.

Q: How do you create a support network outside of your job when you need to maintain confidentiality?

A: By reaching out to other colleagues. Most people can go home and talk to their families about their days, but I can’t talk about my clients. Yet, the need to talk about them is there get supervision, or get advice, or just to share the experience of working with different patients. I find it invaluable to have peer supervision, on a regular basis, with many different types of people, where you can discuss cases within the context of the supervision and avoid the breaches of confidentiality.

Q: What are the two biggest lessons you’ve learned as a psychologist?

A: One is to practice what you preach. What we teach our clients, and the work that we do with our clients, is so important for ourselves, as well. If I’m teaching skills to a client, these are skills that I have to use in my life, too. For instance, if I’m talking about how to regulate emotions, I need to do that for myself.

Listening and learning from clients are important, too. I have learned so much about everyday things, and about life, from my clients. I sit and marvel sometimes at these individuals I work with because they bring so much to the table. Patients know themselves, and they’ll guide you to guide them where they need to get to, if you stop and listen.

Q: What has surprised you the most about being in your field?

A: I think realizing the impact you have on other people, sometimes without even knowing that you’re having an impact on them. It can be the simplest statement that you make, or comment or reaction that you have that has the most profound effect. It's only later when they come back and tell you the impact of something you said or suggested that you realize the affect you can have.

We don’t often get the opportunity to hear that feedback, so when it does come along it can feel a little bit more significant, or maybe profound in that way. The nature of your relationship with patients is the foundation of therapy. It never ceases to amaze me how important that aspect is.

Q: What trends have you noticed in your field, and where do you think we’re headed in the future?

A: I think we're headed toward a more integrative approach to psychology, to therapy. It’s really necessary to integrate neuroscience with attachment and with skill development. The mind and body connection and other contemplative approaches are becoming more important. When you look at different models of treatment and you compare them, it's interesting to note that they’re basically all saying the same thing, they’re just saying it differently, using different language. So, we’re moving toward integrating the brain and the body and relationships into a way of working with people and treating people’s problems.

We’re not going to be so distinct as a psycho-dynamic therapist, or a CBT therapist. But we're going to combine them and integrate what works.

Our toolbox is just going to expand. Life doesn’t occur in a vacuum; there are so many factors that can affect one person. You think about their medical background, their childhood and upbringing, their everyday stressors. Then you have to consider all sorts of diversity that comes into play as well. You can’t just look at one person and separate all those things out, as they come in as one human in the room. We use our skills to touch on each of those things as a whole, and not separate them distinctly from one or the other.

We talk about treating people holistically, seeing them as a whole person. But when you focus on one model of treatment it sometimes obscures some of the others. When we can pull it all together and approach the person as a whole person, it’s much, much more effective.

Q: Do you have any daily rituals or strategies that help you maintain your focus and composure?

A: Well, I get up and have my cup of coffee, which I have to have. But every day is so varied. Things I do during every day can be considered rituals, I guess. Before each interaction, whatever the nature of the interaction is, whether it’s a meeting, or seeing a client, I try to ground myself and be in the moment so I can be present with whatever that activity is. So, maybe that's the ritual.

Q: What are your proudest accomplishments?

A: Mentoring and training new psychologists, I would have to say, is my proudest accomplishment. I enjoy it tremendously. I love to see my students and interns grow and develop. And I learn so much in the process. Just being able to supervise and mentor and share my experiences has been so gratifying. And I think, other than treating my clients, it’s the part of this role as a psychologist that I enjoy most.

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