Learning for Leadership Through the Shadow of the Valley of Death

In 1996 I was asked to design a seminar on the psychosocial aspects of Pediatric Oncology for the fellowship program sponsored by Baylor College of Medicine and the Texas Children's Cancer Center. The fellowship involves one year of intense, full time clinical experience followed by at least two years of laboratory research with about a 20 percent time commitment to continued clinical service. The candidate must also publish the results of an original research project in a peer-reviewed journal. If the physician aspires to an academic position they must also display evidence of the ability to conduct grant supported research. You can see that a successful academic pediatric oncologist must have skills in both clinical and research realms. This paper will focus training to prepare for the clinical aspects of the role. Perhaps a future paper can take up the dynamics of the research enterprise. The Director of the Cancer Center and the chair of its education committee thought that general pediatric residency programs did not adequately prepare incoming fellows to take up the psychological and social aspects of the role. In order to organize my thinking about the seminar's design I asked the Director to define the primary task of the fellowship. He said the ultimate mission of the fellowship was to 'produce leaders in the field of academic pediatric oncology'. I would like to think that the invitation to develop this seminar came my way because of my reputation as an innovative teacher of psychology in medical settings. I think, however, the actual reason was the personal experience of the key program leaders, the Director and the education committee chair, with what is called a Balint group during their own fellowship training at the National Cancer Institute in Washington, D.C. (Artiss & Levine, 1973). The chair of the fellowship's education committee described it as the most valuable aspect of his entire training. Perhaps this is a good place to describe the theories that guided the construction of a particular kind of seminar for medical professionals.The base for my work is not a unified theory but rather a cluster of theories in the neighborhood generally referred to as the Tavistock tradition. In my view the Tavistock tradition represents a combination of object-relations, social learning and general or non-linear system theories. For me the term psychoanalytic refers as much to methods and domains of data collection as it does to the models that drive interpretation. I had been applying methods derived from this theoretical lineage to the training of physicians for some time when I was informed that I had to a degree, reinvented a psychoanalytic wheel originally patented by a Hungarian analyst and general physician named Michael Balint. In 1987 Howard Bacal published an article in the International Journal of Psychoanalysis which showed how early British Object-Relations theorists anticipated central components of Kohut's self-psychology. It is comforting to know that you are not the only person who reinvents wheels. Bacal also delineated the differences between some contributors to the British School and Melanie Klein. Where Klein shared Freud's view of instincts as the main motivating force behind object-relations, Ian Suttie and Michael Balint (writing independently in the mid 30's) radically departed from Freud. They saw behavior from the start as an interpersonal overture or demand reflecting a basic need for closeness to the maternal object, reflecting also a state of relatedness, albeit primitive, to an external object. They also rejected Freud's view of love as sublimated sexuality, and instead saw affectionate tenderness as a primary quality. Most importantly, they both saw development as a reflection of the reality of the culturally conditioned interactions between infant and mother rather than a product of fantasized interactions.