Becoming a VA Psychology Leader

A conversation with Drs. Toni Zeiss, Steve Holliday and Steve McCutcheon

By Anne Klee, PhD

On June 30, 2011, the VA Section of Division 18 held a Quarterly Conversation titled “Becoming a VA Psychology Leader: A Conversation with Drs. Toni Zeiss, Steve Holliday and Steve McCutcheon.”  It was one of those “standing room only” calls, with over 120 people calling in. All three have vibrant careers as public service psychologists and told great personal stories and lessons learned.  It was a wonderful hour. Before and after the call, we received numerous requests for recorded copies and transcripts. Drs. Zeiss, Holliday and McCutcheon graciously agreed to summarize their stories and life lessons shared. As happens with busy leaders, national and local priorities needed to come first, but they are all pleased to share their thoughts on leadership in this newsletter. We are very grateful for their willingness to do so.  

On Leadership: Antonette Zeiss, PhD

While in graduate school at the University of Oregon in 1972-77, I had always expected an academic career. I began work as an assistant professor of clinical psychology in the psychology department at Arizona State University in 1977, after finishing my internship. My husband, Robert Zeiss, and I had gone through graduate school together (marrying the year before we started) and our daughter was born while we are on internship, so ensuring a balance of personal and professional life also was part of my expectation from the start of my career. 

I very much enjoyed my work at ASU and greatly appreciated my exceptional colleagues and students there. However, to ensure the balance that was essential to me, personal decisions intervened after four years on the faculty at ASU. While there were many issues, the main ones for my husband and myself were wanting to raise our daughter closer to family and in an environment that fit for us geographically, politically, and environmentally—which meant being as close to my family home in Santa Cruz, Calif., as possible. That became an attractive option in 1981, when I had an offer to spent a year at Stanford as a visiting assistant professor in the psychology department, which also meant being able to work closely again with my earlier mentor from undergraduate days and work after graduation and before starting graduate school, Dr. Walter Mischel.

The visiting year at Stanford in 1981-82 confirmed that we wanted to stay in the Bay Area, although the fact that Stanford did not have a clinical program meant that it was not a site where I could become permanent faculty. Bob had been employed at the Phoenix VA Medical Center while we were in Arizona, and he left that role so that I could do the visiting year at Stanford, and midway through 1981-82 he started as a psychology staff member at VA Palo Alto. We never looked after that. I resigned my faculty position, with some terror, and determined to find a job in the Bay Area, especially hoping also to be at VA Palo Alto.

That came to pass. I initially worked on a research project led by Drs. Larry Thompson and Dolores Gallagher-Thompson at Palo Alto, and then in early 1983 became director of the interdisciplinary team training in geriatrics at VA Palo Alto. That program [was] created by the VA Office of Academic Affairs (now titled the Office of Academic Affiliations). That program evolved over the years, becoming the interdisciplinary team training program (expanding beyond geriatrics), and then interprofessional team training and development (broadening the scope of activities again). I enjoyed and helped guide each of these transitions. One implication of this position is that I was involved with VACO from the start of my time in VA, with very close links originally to OAA, which held yearly meetings of the leads for the 12 national programs as well as other opportunities for interaction among the programs and with VACO.

Through these links and other professional connections, I also developed linkages to the Office of Mental Health Services fairly early in my career. Some of the professional connections included the American Psychological Association (APA), the Gerontological Society of America (GSA), and the Association for Advancement of Behavior Therapy (now the Association for Behavioral and Cognitive Therapies).

My roles in the psychology service in Palo Alto shifted in 1996, when I became director of training and the assistant chief of psychology service. The key events that led to my move to VACO as deputy chief consultant in OMHS in 2005 came via intersection of VA roles and professional involvement, specifically as chair of the APA Committee on Aging (CONA). I chaired this group simultaneously with the work being done on the President’s New Freedom Commission on Mental Health, with multiple organizations and stakeholders contributing. Dr. Frances Murphy was representing VA as a liaison to the committee, and Debbie DiGilio, the APA staff person for aging, was representing APA. Debbie asked me to review drafts and make comments in my CONA role, and I simultaneously reached out to Dr. Murphy to coordinate with VA responses. I met her personally when I was in D.C. working on other issues related to ongoing contacts with OAA.  Dr. Murphy subsequently chaired a group to implement the new Freedom Commission report in VA, and she asked me to participate as a steering committee member. That plan led to and informed development of the VA Comprehensive Mental Health Strategic Plan (MHSP), for which I also was asked to be a steering committee member. As the MHSP plan was nearing completion, I was asked to come in to VACO for several weeks to lead writing on the final plan. At that time, it also was clear that there would be recruitment for the deputy chief consultant for OMHS, and I started actively considering applying.

When I was offered the deputy position, Bob was again affected; he was the lead for inpatient mental health services at VA Palo Alto, a job he did well and had deep interest in. It was primarily administrative, with strategic planning and program guidance, rather than direct clinical service delivery. We talked together intensely, over a lengthy period, over how to handle the situation if I was offered the position, and then more concretely when the offer came. Ultimately, his decision was to support me and to make the move, but we agreed on several steps to ensure that his career could continue to progress and he could continue to feel satisfaction in his work and its results. He was able to do his Palo Alto job by long distance at first, with the support of the medical center director at Palo Alto and the support of VACO. While that was invaluable in making our transition, the ultimate outcome was even better, as he quickly was hired by OA—and has thrived in that position and served VA enormously.

We believe that our life decisions have led to great outcomes for us, but these decisions—sketched so quickly here—were inherently complex and emotional, and they were definitely not easy. You never know the outcomes when making important life decisions, and yet you need to make them and follow your path–both where you expected it to lead and to the interesting alternatives you had not expected.

I have been guided when I have made these decisions by some general principles. I do not claim they will be helpful to all who might read this—but they have been helpful concepts to me, and I offer them here; there are certainly interrelationships among them:

  • Life is not a straight line. Change—in career paths, relationship choices, areas of emphasis—is not a failure.  Life is full of so many options and opportunities, and you will thrive if you open yourself to those, rather than insisting that life turn out the way you planned.
  • Do what you love to do. Some can build a very satisfying, very effective career by determining what the path to success is and building the career they saw early on as right for them. These individuals can set not only five-year plans and goals, but 15-, 25-, and even 35-year goals, and then make decisions based on the actions necessary to accomplish those original goals. I can’t do that. My history above gives hints of how this has worked for me—it’s great to have an initial goal, but when an unexpected opportunity comes along, the most important question is whether the work this will lead you toward is what you get excited about every day and find fun and rewarding. This takes you down a path that will lead to life satisfaction, you will do better work if you are doing what you love. In addition, more opportunities will open up for you, and you will have more tough—but very rewarding—decisions to make. 
  • As you make those decisions, I think about three main points of a decision triangle that capture how essential it is to balance personal and professional priorities in building a career:
    • What you want to do? This goes back to No. 2: do what you love to do. 
    • Where you want to live?  I deeply wanted to live in California while my daughter was growing up, and then other options became possible.
    • Who you want to be with? In all my decisions, I have never compromised on who I want to be with: my husband, Bob. For those not in a committed relationship, or who weigh things differently, other choices are fully possible. 

In my experience, it is very tough to have exactly what you want on all three of these dimensions. The idea is not to force choices to work on all of them, but to think honestly about each of them and where your priorities are—and they will be different at different points in your life. I compromised once on “what you want to do” (leaving academia—and it turned out wonderfully), and twice on “where you want to be” (Arizona and D.C. instead of California).  As noted above, I knew I would not compromise on the third.  Your choices may be completely different—they have to work for you. But I very much advise honoring the personal implications of professional decisions and knowing where that balance is for you.

  • Never turn your back on a wave. Those who know me know how much this means to me, and I have written about it elsewhere, so won’t say much. Professional life and personal life are full of challenges. Don’t let the waves roll you— it’s much more fun to dive in and live fully with the opportunities that challenges present, not just their obstacles. 

I wish all of you a full, challenging, stimulating career with lots of difficult life choices!

My (Unlikely) Journey to Leadership in VA: Steve Holliday, PhD, ABPP-CN

As a clinical psychology graduate student at the University of Arizona in the late 1970s, I completed a 12-month, half-time externship at the Tucson VA medical center. While I enjoyed the training and many of the staff psychologists there, I left with the firm belief that I never wanted to work for such a large and slow-moving bureaucracy again. After completing my internship at the Oregon Health Science Center and postdoc at Good Samaritan Hospital in Portland, Ore., I joined an emerging private practice group there practicing hospital-based health psychology and neuropsychology. My private practice thrived and I loved working in medical center settings; I had found my niche at last! 

About a year later, my new wife completed her neurology residency and had to pay back the Air Force for financing her medical schooling. She was ordered to Wilford Hall Hospital in San Antonio for a six-year hitch and I was unemployed for the first time in my life. I got lucky and landed a suboptimal job as program director for a small for-profit psychiatric hospital, but lost that job after a few months when I naively challenged the ethics of a psychiatrist who was their biggest admitter. After a few months of fruitless job searching (and growing depression), I got a call from Rod Baker, the new chief of the VA hospital in San Antonio. I had originally sent him my CV back before we left Portland, but this was the first opening that had come up since then. He asked if I could be the psychologist at their psychiatric day hospital program. I eagerly accepted the offer … and then called some of my colleagues to see what the heck a “day hospital” was! 

I had finally started the VA career I never wanted or expected, but was so grateful for the job! Dr. Baker was a great supporter and mentor over the years. He encouraged me to join the local and state psychological associations, and to volunteer for work groups within them. I found ways to work my interest areas of health and neuropsychology into my VA positions, first in the day hospital and later as program director of our inpatient substance abuse unit. I also started a small neuropsychology practice in the evenings and on weekends, attended brain cutting and neurology grand rounds at our affiliated medical school, and collaborated with neurology on several NINDS-funded research grants to keep my NP skills up. Rod also helped me establish a local neuropsychological society and encouraged me to study for and complete my Neuropsychology ABPP. He encouraged me to become their new psychology training director and we developed the first postdoctoral program in the VA to become APA accredited. He regularly sent me to national leadership meetings at our local facility, APA, APPIC, VA Central Office, and the Association for VA Psychologist Leaders (AVAPL). At his suggestion, I ran for President-elect of AVAPL and was quite surprised to win (although I ran unopposed). He also made sure I volunteered for hospital and VISNwide work groups so that our leadership could come to know me and my skill sets. During this time I volunteered to write several VACO and local MH program expansion proposals and most were funded.

When Rod retired a few years ago, he encouraged me to apply for the chief psychologist position and I was selected. Throughout my VA career I followed his advice to be free with my consultation with other program/department leaders, and continued my clinical research activities as my “professional hobby,”  something I enjoyed doing but was not part of my required duties. Shortly after becoming chief, I was asked to be the acting associate chief of staff for mental health at our medical center (over psychiatry and psychology services). About a year later, I was asked if I wanted the permanent ACOS-MH position.  At about the same time, our hospital’s director was selected to become our VISN 17 (regional) director and he specifically asked me to apply for the VISN chief mental health ffficer position.  I chose the VISN position because it was a new challenge and I saw my director as another potential mentor. Now I am responsible for MH services and research at four VA health care systems within VISN 17 which serves about half of Texas. I’m still doing my research and recently volunteered to serve on APA’s Commission on Accreditation and several national MH workgroups (old habits die hard!).

So here are the take home messages from my journey (largely thanks to Rod Baker):

  • Get your foot in the door at the VA in any way you can, even if it’s not your “dream job.” I cannot imagine a better place for psychologists to work!
  • Find a great mentor and follow their advice:
    • Join and become active in local, state, and national psychology organizations with current/planned projects. Just email the current president and ask how you can help.
    • Obtain and maintain credentials of excellence in your area (ABPP, MBA, etc.)
    • Attend local and national VA supervision or leadership training programs and volunteer for facility and national workgroups to enhance systems thinking and become known to leadership.
    • Develop and maintain a “professional hobby” that recharges your batteries and further develops your knowledge and value to the organization.
  • Have fun along the way; I know I have!   

Thoughts on Leadership: Steve McCutcheon, PhD

When I was recently asked to speak to students about my own pathway to leadership, it caused me to think hard about the nature of leadership and the circumstances that make it more likely for one person rather than another. Students frequently have the notion that leadership is something you plan for and set out to accomplish; my experience has been very different.

Folks arrive to positions of leadership from multiple directions, but what constitutes leadership is not mysterious: Leaders articulate a vision; describe a broad outline of the steps to achieve that vision; identify and promote talented people who can implement those steps; motivate others to achieve a common goal; and persistently demonstrate respect and regard for the individual contributions of each person, no matter how large or small. Leaders look forward and enlist others to willingly—and maybe enthusiastically—move in that direction for a common purpose.

The route to attaining leadership certainly seems less straightforward. In retrospectively accounting for leadership, it’s common to overly subscribe to the apparent logic underlying any single person’s achievement, and to heavily weight their rise to personal, intrinsic factors. It’s as though, in explaining leadership, we observe a person’s capabilities and assume that their path was a straight line from novice to leader, successively and relentlessly moving forward like a salmon heading up river. In my own case, I attribute most everything to chance opportunity, the mentoring of others, and the life circumstances that shape each of us in unexpected and unpredictable ways.

Values

Let me start with this latter point: that leadership is less a product of intrinsic characteristics and more a product of lessons learned from one’s environment. I’ll grant that I have skills that helped me along the way: the ability to think about problems clearly, to use language persuasively, and to take the perspective of others with sincerity. But these skills sure aren’t unique to me; countless people possess the requisite skills and yet don’t rise to leadership. In my own case, every skill that’s benefited me has been the product of people who raised me, teachers who mentored me, a public education system that fostered me from kindergarten through completion of a doctoral degree; professional organizations that socialized me in the complexities of achieving common purpose and consensus in the pursuit of solving difficult problems (which is, fundamentally, the definition of “politics”); and to a public sector health care system (the VA) that has provided me a career in which I could both provide service and better myself along the way.

At a time in our nation’s history when the proper role of government is being hotly debated, and in which some folks strongly argue that their success is entirely self-determined, it’s important for those of us devoted to careers in public service to be reminded that—for the vast majority of us—our personal achievements are largely intertwined with a public education system that has provided us with the highest level of professional training and opportunity, and upon systems of health care that have allowed us to practice this profession. In my own case, this has been a trajectory that I now understand was grounded in the values of my early childhood.

My parents met and married in the final years of World War II. My father was a Canadian, stationed with the American Air Force outside Deeping St. James, England. My mother was British, serving her mandatory enlistment in the “Land Army”, a program in which young women served the war effort by working on collectivized farms left abandoned by young Englishmen conscripted for combat duty. She had been born into an Irish-Catholic family, the next to last in a string of 11 children, in a small rowhouse in the City of London (the central downtown occupied by the poor). Catholics had had their problems in England, the Irish were even less popular, and families of 13 multiplied the disadvantages.

My mother’s family was crushingly poor. As a child growing up in poverty during the global depression of the 1920s, the only education available to her was in the local parish convent school. It aimed to provide girls with practical skills needed for domestic life as a wife and mother, or possibly, as a nun. My mother learned to be skillful with a needle and thread and developed a lifelong devotion to cleanliness. During especially hard times, she recalled her own mother telling the children to ignore knocks on the door, knowing that it was the rent collector “come round” for an overdue payment. She remembered her mother accepting with embarrassment a donation of food or clothing from the parish. Given the family’s circumstances in the Depression, my mother left school after third grade to apprentice as a seamstress in a tailor’s shop, making wool coats. Throughout her life, she was a devouring reader of English murder mysteries and American detective stories, but was an almost illiterate speller and complained that she “couldn’t do her numbers.” Feeling deeply the limits imposed by her own lack of education, she wanted more for my brother, Dennis, and me. She couldn’t provide that for Dennis, but made many sacrifices to enable me to become the first member on either side of my family to get beyond 10th grade.

In her words and actions, she also insisted on some definite values that grew out of her experience of poverty, class, war, discrimination, and the liberation and service theologies of Irish Catholicism that succeeded the Irish rebellion of 1916. Those values: always tell the truth—even about the smallest things—because relationships depend on trust and even small deceptions undercut trust; that all people deserve respect, no matter their possessions or lack of them—and in fact, those with the least deserve the most; that all people have equal worth solely based on the miraculous fact that they are people; that even when you only have “two nickels to rub together,” you have an extra one to give; that our task in life is to give more and take less, to make it better and not worse, to have contributed and not to have detracted; that differences can always be solved and force always hurts those with the most to lose and the least ability to protect themselves; that a person’s character is revealed not in how they behave toward the powerful but in how they treat the weak; that we help the least among us rather than favor the most among us.

What does this have to do with my own path to leadership? To my mind, a great deal. If leadership involves the utilization of power, then the beliefs and values in which I was raised (forged in a world as it existed almost a century ago) have created for me an ideology in which service to others, honest engagement with those who disagree, fairness, respect, and reconciliation, and a commitment to solving problems and resolving differences are cornerstones of wise leadership. And wise leadership first of all depends on values of fairness and justice.

Chance

In “A Fine Balance,” Rohinton Mistry puts this wonderful observation in the mouth of his character, a down-on-his-luck lawyer and political organizer: “After all, our lives are but a sequence of accidents—a clashing chain of chance events. A string of choices, casual or deliberate, which add up to that one big calamity we call life.”

It’d be hyperbole to say that my own pathway to leadership has been entirely accidental, but it’d be more inaccurate to say that it’s been the result of some deliberate plan that unfolded logically over time. Students sometimes ask me for advice about making just such a grand plan for their own advancement. While it’s helpful to aim in a general direction—to have a sense of your “true North” —it’s also been very much true for me that the important junctures and opportunities have resulted from seemingly casual decisions that eventually led to large results, and to chance opportunities that unexpectedly opened doors. I’d like to appear deliberate and planful, but the truth is that I’ve often stumbled into opportunities unknowingly and made important decisions for inconsequential reasons. I don’t mean to imply that planning is irrelevant—that’s certainly not true—but instead to suggest that important opportunities arrive from unexpected quarters, and that a willingness to change course and say “yes” to unplanned events—to take advantage of chance—is at least as important as slavish devotion to a plan.

Chance—and the “clanking chain of chance events” —has played a critical role at important junctures in my career. When making the decision about where to attend graduate school, I decided against one program and in favor of another on the basis of which location had less snowfall. I’m embarrassed now to admit this was how I made my decision, but the result was that I landed with an advisor brand-new to the program (Marsha Linehan) who proved to become hugely influential in shaping my outlook and promoting my career. Other schools would have provided other opportunities, but I’m forever grateful that my fear of driving in the snow resulted in my lifelong association with Marsha. Or take another example. Almost as an afterthought, I applied to the Seattle VA for internship. Unable to leave Seattle due to family obligations, my choices were very limited, and so I intended to just complete my year and return to an academic life. But that year proved so unexpected—and so transformative—that it reordered my life. My own internship training director, Kathie Larsen, modeled for me a passion for education that I’d never encountered. Like any great mentor, she helped me to see my own capabilities, provided me with opportunities, and promoted me to others. As one of the early chairs of APPIC, Kathie taught me about the importance of the larger professional world and showed me a different route to making a contribution. I never could have predicted that I’d come to the VA on internship and never leave.

Mentors

Circumstances and chance have provided me with opportunities for leadership, but the greatest role has been played by talented and generous mentors, who by their example have taught me about leadership and through their support and advocacy of me have opened doors that otherwise would have been closed. Marsha taught me more than any other person about the meaning of suffering and compassion, and the role science can play in improving the quality of life. Kathie taught me about the importance of professional education in everything we ultimately do as psychologists. Nadine Kaslow demonstrated for me the passion that can infuse a lifelong career so that it remains meaningful and personally significant. Toni Zeiss demonstrated for me that one can be tremendously effective and powerful but always kind, thoughtful and caring.

Whether or not these folks thought of themselves as mentors to me, they have in numerous ways and at numerous times given me aid and opportunity. Any success I’ve had in rising to a leadership position has resulted from basic values that I strive to enact, from chance opportunities that allowed me to develop my abilities, and by the helping hand of mentors who hoped for my success and gave of themselves to make it more likely.