Interview with Monica Carsky, Ph.D.
By Debi Roelke, Ph.D.
Dr. Monica Carsky was one of the initial faculty members of the former Institute for Psychoanalysis and Psychotherapy of New Jersey (IPPNJ). In addition, she has had a long and fruitful association with the Personality Disorders Institute of the Weill Medical College at Cornell University, where she has been involved in training, research and the development of Transference-Focused Psychotherapy, an evidence-based psychodynamic treatment for patients with personality disorders.
One of the threads running through Dr. Carsky’s early career was the intellectual excitement she found at each of the places she went to be educated and trained, first as a clinical psychologist and later as a psychoanalyst. In her early undergraduate days at Swarthmore, having arrived from a small town in upstate New York planning to study math, she happily discovered the social sciences. She switched her focus from math to psychology when an energetic new faculty member introduced the students to the real life world of clinical practice. From that point on, Dr. Carsky was hooked. Graduate school at CUNY continued the theme. The department wasn’t much to look at, housed in a building over Sloan’s Supermarket at 135th and Broadway. But the program was young, the faculty was enthusiastic, especially about analysis, and the energy was infectious. Dr. Carsky immersed herself in Bion and Kleinian theory of primitive dynamics, writing her theoretical dissertation about the powerful and often regressive experience of people in groups.
This interest in primitive experience is another thread throughout her career, and a tie to the other legacy of Swarthmore in the late 60’s: concern for social justice. Much of Dr. Carsky’s work has been devoted to patients with more serious mental illness: borderline and narcissistic character disorders and schizophrenia. Her exposure to Klein, Kernberg and Searles enabled her to appreciate their disorganized and chaotic internal worlds; training and research since then has given her a platform for educating others – especially other professionals – to dispel the stigma that shadows these patients. The seeds of this work were sown during her internship year at Bronx Psychiatric Center, Albert Einstein College of Medicine, but they really took root in her fellowship on a long-term unit for borderline and schizophrenic patients at New York Hospital. There, she trained with Roy Shafer and Otto Kernberg. It was Dr. Kernberg who especially shaped the clinical and research program that Dr. Carsky has been involved in to this day. This program has been running now for about 30 years, and in addition to the intellectual fellowship and the opportunities to teach, write and do supervision (now even internationally by Skype!), the friendships have been both sustaining and enriching.
Dr. Carsky pursued her analytic training at NYCPT, the parent institute from which IPPNJ separated. When NYCPT, along with several other NY institutes, pushed back at the traditional psychoanalytic establishment that had excluded non-MD’s and applied to be part of the American (ApsaA) and International Psychoanalytic Associations (IPA), the various twists of this story led Dr. Carsky to take some additional training at IPTAR in order to qualify for IPA membership. She credits her analysis during this time as a transformative experience that left her with a deep appreciation for what the full extent of psychoanalytic training offers its adherents. “The benefits seep into your entire life,” she notes, in ways both large and small.
Dr. Carsky began teaching at the very start of IPPNJ with the course on Borderline and Narcissistic Pathology. She remembers how much she enjoyed her first group of candidates, and remained part of the developing institute as teacher, early training committee member, supervisor and training analyst - roles she still enjoys. Her work in all of these spheres has helped her hone her approach to treatment: “You have a certain idea about what a person struggles with, and where they might go. But it’s also about creating a space for someone to grow. So it’s learning to create that balance: being non-directive, but also about taking responsibility for someone’s treatment.” The theme of her practice, study and research has been to continually refine her understanding of what treatments work for particular kinds of patients, and under what circumstances. She feels that the most useful supervision has a focus on conceptualizing what’s going on in and between the patient and therapist, what will be the most useful intervention, and why.
Reflecting on the state of the field, Dr. Carsky voiced her concern that patients are no longer getting thorough enough evaluations to know what they really need; that the rush to prescribe medications, even with the youngest child patients, has undermined the valuable role of psychotherapy. One of the groups she supports is NARSAD, the second largest source of grants for mental health research in the world, and the underwriter of almost all the cutting edge research now being conducted. She cited a current project on OCD in which the principal researcher described his evidence on the benefits of medication for specific OCD symptoms, but went on to emphasize the important role of dynamic therapy: for example,” we never see patients with religious symptoms who grew up in atheist families.” The context of a person’s life and individual history has a central place in treatment.
Dr. Carsky observes that equally important to all of her professional activities have been the hobbies that take her completely away from the field. One interest is gardening, where “hours can go by without even realizing it.” Living close to NYC has also been a boon since she loves the easy access to the ballet, theater and museums. Her move to Teaneck held another attraction that tied back to her early interests in social causes: it was the first town in the country to successfully – and quietly – integrate the schools by involving the whole community. Concern for the vulnerable, be they minority members, clinical trainees or deeply troubled patients, has been a hallmark of Dr. Carsky’s life as well as her career.
Dr. Monica Carsky is Clinical Assistant Professor of Psychology in Psychiatry at Weill-Cornell Medical College. She has been an Adjunct Faculty Member at the Fairleigh Dickinson University Doctoral Program in Clinical Psychology, a Field Supervisor at the Rutgers Graduate School of Applied and Professional Psychology, and a supervisor at the Columbia Clinical Psychology Internship Program. She is a Faculty Member at the Center for Psychotherapy and Psychoanalysis of New Jersey, and in New York, at the Institute for Psychoanalytic Training and Research and the NYU Postdoctoral Program in Psychoanalysis and Psychotherapy. She maintains a private practice in Teaneck, New Jersey and in New York City.