Kim Mueser, PhD

Interview by Jessica Price

In 2014, the APA’s Div. 18 (Psychologists in Public Policy) embarked on several projects that would not only increase awareness of the division but would also give current students interested in careers in public service an opportunity to take a more active role within the division. From that the Members in Action project started. Psychologists who have taken an active role in the areas of community and state hospitals, psychologists in Indian country, criminal justice, police and public safety, veterans affairs and serious mental illness/severe emotional disturbance were asked to submit to interviews with students participating in the project. One of the individuals chosen was Kim Mueser, PhD, of Boston University. This interview was conducted with Mueser on Sept.12, 2014, at his office.

Mueser graduated from Columbia College with a bachelor’s in psychology in 1978, followed by his master’s in 1981 and PhD in clinical psychology from the University of Illinois Chicago. Since then Mueser has contributed a wealth of research and knowledge in the area of serious mental illness. Since beginning his career he has received recognition from the Brain and Behavior Research Foundation (formerly NARSAD) for receiving both Early Investigator and Distinguished Investigator Awards. He participated in the Invitation Fellowship Program for Research in Japan, Japan Society for the Promotion of Science, Tokyo, in July-August 2006 and was a visiting professor at the Institute of Social Psychiatry, Institute of Psychiatry at the Maudsley, London in May 2007. He received the Ken Book Award for “The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life,” from the National Alliance on Mental Illness of New York City Metro in 2007; the Armin Leob Research Award from United States Psychiatric Rehabilitation Association in 2007; the Emily Mumford Medal for Distinguished Contributions to Social Science in Medicine from the Department of Psychiatry, College of Physicians and Surgeons of Columbia University in 2007; and the Trail Blazer Award from the Schizophrenia and Severe Mental Illness Special Interest Group of the Association for Behavioral and Cognitive Therapies in 2009.

Mueser is the executive director of the Center for Psychiatric Rehabilitation and a professor in the Departments of Occupational Therapy, Psychology, and Psychiatry at Boston University, as well as holding an adjunct professor position in Department of Psychiatry at Dartmouth Medical School in New Hampshire. He is also involved in variety of publications and organizations, including serving as a reviewer for the National Institute of Mental Health and Patient Centered Outcomes Research Institute. He is currently licensed as a clinical psychologist in New Hampshire and Pennsylvania.

The first question I asked Mueser was a question many individuals are asked at some point in their lives.

Who influenced you into becoming the person you became today?

When asked this question Mueser explained that his mother was his first mentor. When he was 10 years old, Mueser mother, a master’s-level clinical psychologist, went back to work. She taught psychology at a local junior women’s college for several years and then moved to a position at a large state psychiatric hospital when he was in junior high school in the late 1960s. Mueser describes this period as an exciting time in the treatment of severe mental illnesses due to the widespread use of new medications for serious mental illness (such as antipsychotic medications) as well as the exploration of new behavioral approaches to treatment, such as behavioral modification, skills training and token economy methods.

Mrs. Mueser learned about the token economy as a radical, new treatment approach for people with serious mental illness that involves systematically reinforcing appropriate social behaviors in clients with tokens that could be exchanged for desirable things. She went on to set up the first token economy ward in a hospital in the state of New Jersey at Greystone Park Psychiatric Hospital, which provided long-term care to patients with severe psychiatric illness. As she was developing this program, Mueser visited it several times and stated he had always found it interesting. He was especially drawn to understanding and helping people with more severe mental illnesses. As his mother continued her work at Greystone, she enrolled in the first class of the new Rutgers PsyD program. She eventually completed her dissertation on the topic of social skills training, and even trained her son (as a high school student) to be a rater of the social skills assessments tapes.

With his new interest in mental illness and clinical psychology, Kim began reading and learning more about this topic, using his mother as a resource guide. In seventh grade, he did a science fair project on the treatment of phobias with systematic desensitization—at the time a relatively new treatment approach for phobias. Unfortunately, he did not earn a blue ribbon for this project, but he was not so easily discouraged.

Mueser described the important influence of many of the people he met at a relatively early age through his mother’s involvement in clinical psychology, which further deepened his interest. One of these individuals was Arnold Lazarus, PhD, who became a good friend of the family. When he entered college he already knew he was interested in clinical psychology but did not have a particular interest in research at that time. He was interested in treatment and “just thought mental illness was interesting.” The advice he received from his mother and her peers was that if he wanted to get into graduate school in clinical psychology it would be helpful to get some experience in research methods. He began becoming involved with research projects in college to gain experience. Through his efforts he found another mentor in Daisy Schalling, PhD.

Mueser’s mother is Swedish, and one of her friends she attended high school with later became a PhD research psychologist. At that time, Schalling was a professor of psychology in the Psychiatry Department of Karolinska Institute located in Stockholm, Sweden. She specialized in understanding biological substrates of personality disorders, with a focus on psychopathy (similar to antisocial personality disorder). Mueser’s mother contacted her friend, and during the summer after his sophomore year of college he worked as a research assistant for Schalling, who served as an important mentor, at the Karolinska Institute. From her he learned a lot about research methodology and experimental design. He returned the next two summers and completed an entire study under her guidance. Mueser credits these early, intensive research experiences as being critical to helping him get into graduate school.

In graduate school, Mueser had mentorship from his primary advisor Alexander Rosen, PhD, who was involved in research on the effects of psychotropic medications on behavior in people with major psychiatric disorders. Mueser had always been interested in clinical psychology, and behavior therapy in particular, which he attributes to his early exposure to psychology. Rosen steered him to critical readings on the treatment of serious mental illnesses, and he kept reading more on his own. Mueser stated that he was interested in evaluation of interventions and psychosocial treatments for people with severe psychiatric illness and that, while he had always been interested in the broad spectrum of psychiatric disorders, he was especially intrigued by schizophrenia. This was his first opportunity to be involved in research involving people with schizophrenia.

Mueser described himself as someone who “always followed the data” and said that he was interested in learning about and mastering any interventions which had been shown to be effective for improving the course of severe mental illness, “which back in the 1970s-80s were not very many.” He stated that based on his own following of the literature that it was clear that the family environment could interact with the course of severe mental illness, potentially precipitating relapses when there was a lot of stress in the environment, and he believed that family intervention was a promising approach to addressing that. Mueser stated that by the late 1970s and early 1980s, social skills training approaches had already shown great promise for improving severe mental illness, and family intervention programs had begun to be developed and empirically validated. He studied family therapy in graduate school and selected his internship program primarily based on where he could obtain training in a recently empirically supported family therapy approach for schizophrenia, behavioral family therapy and social skills training. He completed his psychology internship training in California through the UCLA Research Center (directed by Bob Liberman, MD) at Camerillo State Hospital and Brentwood VA Medical Center. Liberman’s important contributions to psychiatric rehabilitation go back to the early 1970s and include developing the Skills for Independent Living Program and being one of the first mental health professionals to work with families in order to educate them about mental illness and improve their skills for communicating and solving problems together. The behavioral family therapy model for schizophrenia was developed by Ian Falloon, MD, who collaborated with Liberman in its development and which Mueser learned during his internship program.

Mueser was first introduced to posttraumatic stress disorder (PTSD) by Terry Keane, PhD (now in Boston), in 1983. He thought the disorder was fascinating and, during his internship, he was also able to receive training in exposure therapy treatment of PTSD by David Foy, PhD. These training and mentorship experiences during his internship year with Liberman and Foy were all tremendously valuable and were augmented by outstanding training provided by other faculty, including Tim Kuehnel, PhD, and Gayla Blackwell, RN, MSW.

After completing his education and obtaining his PhD, Mueser’s “first real job” was at the Medical College of Pennsylvania (now Drexel University) Department of Psychiatry in 1985, working with Allan Bellack, PhD, who was a valuable colleague and mentor for him as a junior faculty member. In 1994, he moved to Dartmouth Medical School, Department of Psychiatry in New Hampshire, where he became a professor and worked for 17 years. During this time he worked with Bob Drake, MD, who he credits with providing very valuable mentoring.  Mueser lists these as his early key mentorship experiences. He has continued to learn from him over the years.

One thing Mueser shared during this interview that I found extremely valuable was when he disclosed “while I feel proud of what I have accomplished, I have never been a prize winner in pretty much anything and I’ve never been an especially outstanding student either. But it does goes to show how when you’re really interested in something and you pursue it you can develop expertise and experience and accomplish cool things even though maybe you’re not the smartest student in the room.”

What advice would you give not only early career psychologist but students as well?

Mueser’s advice is to “follow what you’re really interested in and to look for opportunities to study it and to study things that are closely related that will enrich your understanding and skills. You can sometimes be too focused on getting the exact training you want, which can cause problems when it is not immediately available or because you’re afraid you will miss important opportunities.”

Mueser admitted that early in his career it was hard to get good clinical training in serious mental illness because there was little expertise in this in his graduate school program. However, there was a clinic at the program that provided psychological services to people with developmental and intellectual disabilities. While this wasn’t his primary area of interest, he eventually “saw the light” and realized that it would in fact be valuable clinical experience. He stated that he worked with great people at this clinic and received top-notch training and supervision. Because people at the clinic knew of his interest in severe mental illness, people with intellectual disabilities and schizophrenia were sent to him for treatment.

He is a great believer in pursuing your interests, immersing yourself in experiences related to the, and finding experts in the field that you can work with. He also believes it is critical to learn and to master as much as possible about treatments and interventions that have already been developed and found to be helpful. He said, “You don’t need to always create new interventions when things already exist. Don’t go into the field with the idea that you need to develop something new.”

How do you become more involved in public policy?

When asked this question, Mueser stated he was reminded of the Mark Twain quote “and then I was asked a question to which I could immediately respond and without hesitation answer, ‘I don’t know.’” I appreciated his honesty in this moment. He acknowledged that is a question that he is seeking.

He stated he went into psychology with the intentions of being a clinician. He came from a scientific family and was interested in methodology, the challenges of how one studies psychiatric disorders and treatment. While he expressed a growing interest in public policy, he says he found the questions involving in developing and evaluating effective treatments to be more intellectually stimulating. He also indicated an increased interest in research on the implementation of treatment and rehabilitation programs and the impact of policy on implementation efforts. If he advocated for anything it would be for psychologists to be required to have training in working with people with serious psychiatric disorders.

What are your thoughts on working with individuals with serious psychiatric disorders in the prison system?

Mueser was very firm in his belief in the importance of working with criminal justice involved clients. During our discussion he acknowledged the unfortunate reality that many people with psychiatric issues will be receive their mental health care in prison than in the mental health system. Both the criminal justice and the mental health system are very under resourced. These limited resources can result in poor mental health care, in which effective treatment could reduce recidivism, incidents of violent or self-destructive behavior and use of seclusion and restraints related to poorly managed psychiatric conditions. There is a need for effective treatment both within the criminal justice system, and in the community, and that the integration of the two could reduce initial incarceration as well as recidivism.

Mueser also discussed the potential for court diversion programs to provide alternatives to incarceration for those with a psychiatric condition. Through the National GAINS Center, Mueser worked on a project that provided guidelines and information for judges of drug courts on working with people who have a substance abuse issues and serious mental illness to attune them to special issues in this population. The aim of this was to increase the potential to avoid unnecessary incarceration for persons with serious mental illness who become involved in the criminal justice system through drug use related behavior. The successful implementation of drug courts and other related programs have been very helpful in diverting individuals with mental illnesses and addiction into treatment instead of the criminal justice system.

NH currently does not have mental health or drug courts. However, they do have a Behavioral Health Tracks. In August, the Veterans Behavioral Health Track was added under the existing Behavioral Health Court. I recently had a conversation with someone who believes that this will give veterans a way to use their PTSD and mental health trauma as an excuse so they don’t have to go to jail. What would you say to this person?

Background provided by reviewer: Like all states, New Hampshire has its own set of unique issues. One of these issues is the lack of a full service VA Medical Center. As a result, returning veterans are limited in the services they receive unless they are willing and able to travel to surrounding states. However, veteran advocates have made progress in supporting veterans in other ways. Veterans and military personnel who experience legal trouble that is determined to be related to military service may be eligible for a veteran specific diversionary program. If eligible, the veteran will be required to follow a strict set of guidelines that may involve seeking treatment for mental health or substance abuse, community service and having no further legal issues during a prescribed period of time. The launch of this veteran-specific program was initiated in Hillsborough County and will hopefully be replicated throughout the state.

When I asked Mueser the above question he stated, “Whether it’s an excuse or not the same concern could be said for any mental health condition. This may be an example of the kind of bias that people may have against mental illness, in particular, against PTSD, which is the belief that people are faking their disorder in order to get out or avoid something. It essentially challenges the validity of psychiatric disorders, and sees related behaviors or problems as personal or moral weaknesses.” In his opinion “if there is a plausible reason why some medical or psychiatric condition may have contributed to or be responsible for an individual’s unlawful behavior, and we can address that underlying reason, avoid incarceration and help the person become a law abiding, contributing member of society, then I think it’s to everyone’s advantage to do that.” After hearing this response I believe Mueser makes a very good point and this writer couldn’t agree with this statement more.