Dr. Katie Aafjes-van Doorn is assistant professor of clinical sychology at the Clinical Psychology Program of the Ferkauf Graduate School of Psychology. She received a MSc in Clinical Psychology from the Vrije Universiteit in Amsterdam as well as an MSc in Psychological Research and a doctorate in Clinical Psychology from University of Oxford. Over the years, she has worked clinically in different settings within the National Health Service (NHS) in the United Kingdom as well as at a psychoanalytic community clinic in San Francisco. Most recently, Dr. Aafjes-van Doorn completed a one-year postdoctoral research fellowship at the Derner Institute for Psychological Services, Adelphi University.
YU News caught up with Dr. Aafjes-van Doorn to discuss her work and teaching.
Your research interests seem to focus on psychodynamic therapies. How would you explain what you investigate to a non-scientist like myself, especially if I asked, “How do these improve the lives of people?”
I am interested in the process of psychotherapy, by which I mean the interaction between the patient and the therapist in the session. While the popular term “evidence-based treatments” suggests otherwise, we know very little about how psychotherapy works and for whom, and we know even less about how we can become better therapists.
What we hypothesize is that therapy facilitates a novel emotional and relational experience. The therapist offers a safe space in which patients can become more aware of their own ambivalent feelings (internal conflict), test their painful beliefs about self and others and try out new ways of interacting.
In other words, a patient works hard to understand his/her day-to-day life while the therapist works hard to understand the relational aspects of their interaction (what it feels like to be with this patient in the session). In contrast to some other evidence-based treatments that are mainly focused on symptom reduction, psychodynamic therapies also aim to increase reflective thinking, flexibility and agency in order to develop a more realistic sense of self and healthy relationships with other people, and thus achieve more lasting changes.
What was the road that brought you from Amsterdam to the Bronx? Are your origins in the Netherlands?
Yes, I was born and raised in the Netherlands. After receiving my MSc in Clinical Psychology at the University of Amsterdam, in 2005, I moved to the United Kingdom (UK) to be with my then boyfriend. I order to get licensed in the UK, I earned an MSc in Psychological Research, followed by a doctorate in Clinical Psychology at the University of Oxford. The summer I graduated, we got married and moved to Palo Alto, California, for his business studies. Joining my husband in his move from the Netherlands to the UK and later from the UK to California required me to (re)gain clinical licensure. So I did another 3500 clinical hours of post-doc training in the United States at Access Institute, a psychoanalytic community clinic in San Francisco. In 2016, we moved to New York for my research post-doc at Adelphi University in Garden City, New York. The next year I joined Ferkauf as tenure-track faculty.
You’ve had the chance to work in systems in Europe, the United Kingdom and the United States. What is a major difference you’ve found about how these systems make use of the kinds of therapies you champion?
My clinical experiences in the Netherlands, the UK and the United States have been colored by the local mental health systems. In the Netherlands, all people have a basic insurance that reimburses therapy sessions as long as a clinical need is identified. Several types of empirically supported psychodynamic therapies are available: transference-focused psychotherapy, mentalization-based therapy, dynamic interpersonal psychotherapy, affect phobia therapy, intensive short-term psychodynamic psychotherapy and psychoanalysis.
Similarly, in the UK, several evidence-based psychodynamic therapies are indicated by government guidelines and available within the NHS. Different from doctoral trainings here in the United States, the doctoral training in Oxford was paid for by the NHS. This also meant that most doctoral students continued to work in NHS settings after graduation. Many British people complain about the long waitlists in the NHS, but mental health care is available free of charge, starting with brief treatments offered by Improving Access to Psychological Therapies (IAPT) and more intensive treatments if and when needed.
It seems to me that mental health treatment in the United States is generally harder to get and relies on local charities and community initiatives. This means that university training clinics, like ours at Ferkauf, are important in offering affordable care to the local communities. Although therapy in private practice was an exception in the Netherlands and UK, it appears to be widely available in San Francisco and New York. Prices are high, but people have lots of choice with regards to therapists and therapy approaches, and psychodynamic/analytic therapies are very popular. It is great to be in a city where there are so many psychoanalytic training opportunities to satisfy our intellectual curiosity and interest in the human mind.
What do you like about doing the research you’re doing?
There is so much to learn and to discover. Being a researcher for me feels like being a student forever. Even when I didn’t get paid (due to visa and licensing restrictions), I have always sought out opportunities to do clinical work, teach and collaborate on research projects. I now feel very lucky to be able to do what I love, and call it “work.”
Where possible, my research endeavors have been collaborative efforts with students, clinicians and researchers. Learning from international collaborations (Sweden, Norway, Canada, Argentina, the Netherlands, UK and the United States) is especially inspiring to me and no doubt will continue to broaden my view of clinical psychology as a discipline.
What are some of the more interesting challenges facing your discipline in an age of algorithms, AI and tech disruptions?
I think that the challenge lies in the fact that we are not able to keep up with the current scientific advancements and technical possibilities. Therapists (not patients) tend to be reluctant to record their therapy sessions, which is a critical first step in order to take advantage of AI. Currently in psychotherapy research, the therapy process is usually coded by groups of observers who are not very reliable even after extensive training. Also, therapy outcomes are usually assessed with subjective self-report measures, if measured at all.
In my view it is crucial to video record your therapy sessions, not only for your own review/learning as a therapist and use in supervision but also to enable use of machine learning algorithms to objectively track patients’ symptoms and scale-up psychotherapy research based on sessions in real-life clinical practice. In this way, artificial intelligence applications could and should become part of evidence-based practice as another source of valuable information in addition to clinical intuition, patient’s preferences and existing research evidence.
What are some educational directions you’d like Ferkauf to explore in the next five years?
I am currently writing a chapter on therapist training, and there is surprisingly little research on the effect of professional development on licensed therapists and ultimately their patients. I would like to see more emphasis on continued learning after licensing, including individual deliberate practice, peer-supervision, workshops, webinars, personal therapy or conferences. Similarly, I think it would be helpful to offer more training in how to make clinical use of therapy recordings and session-by-session outcome measures and how to best use telemental health online therapies as these are all important aspects of clinical practice in the coming years.
If possible, it would also be great to facilitate training on how to best use the media to promote mental health treatments and communicate about the work we do with the wider community on social media, TED-style talks, documentaries and news reports. Psychodynamic thinking is not just about therapy, it is a way of conceptualizing the world and people’s development as well as the need for familiarity and connection that could be helpful for all of us.
When you’re not researching and teaching, what do you do that keeps body and spirit together?
Truly, not enough. I was clearing out some boxes last week and one was labeled Books For Fun. All these books contained stories about childhood trauma and adult personality dysfunction.
We have a baby girl, and I enjoy spending time with her, making a mess at home, visiting the library or going for walks in Central Park. When possible, I enjoy weightlifting classes and cycling and keep in touch with my friends in the United States and Europe.