Best Practices: Grant Brenner
Psychiatrist Dr. Grant Brenner on a modern, scalable approach to psychiatry and the importance of compassion and empathy in healthcare.
Dr. Grant Brenner has always been curious about the human mind. Drawn to psychiatry after illness and traumatic loss in childhood, he pursued his passion for psychology in his medical training where he cultivated an expertise in interpersonal psychoanalysis. Using his methodologies for growth and change, Dr. Brenner has developed a creative, results-driven approach to help his patients understand themselves, identify and breakdown limiting patterns, and realize their most fulfilling and complete potential. Read on to learn more about his path to psychiatry and why he believes scalability is the future of modern mental healthcare practice.
How did you get started in medicine and how did you choose your specialty?
I had a lot of exposure to the medical profession as a child because of an orthopedic condition that I developed in second grade and also because my mother was very ill. Both of these experiences gave me a positive sense of what doctors do, and–maybe for some psychological reasons as well–I was inspired to follow in their footsteps. In fact, I think it’s fairly common for people who experience illness in the family to go into a caregiving profession later in life.
Around the age of ten or eleven, it was clear that I had strong curiosities about science and psychology. My stepmother recognized these interests and gave me a lot of amazing things to read, including books on psychology and philosophy. So I continued to gravitate towards the mind and philosophy, which were also helpful for me in trying to understand my own experience.
By the time I entered medical school, I wasn’t sure if I wanted to become a therapist or a surgeon. I ended up applying for surgical residency and did that for two years, which was really formative for me, both as a physician and as a person. In some ways, it was the hardest and most rewarding work I had ever done, but I soon realized that it wasn’t satisfying my intellectual curiosity about the human experience. So I transitioned to become a second-year psychiatry resident at Mount Sinai.
After that, I pursued psychoanalytic training as well as organizational psychology training at the William Alanson White Institute, which is where the interpersonal psychoanalysis model was developed. Interpersonal psychoanalysis is a much more interactive model that takes into account people’s real experiences, which was a great fit for how I wanted to build my practice.
Now, part of my specialty is working with developmental trauma in adulthood and using the interpersonal relational model of psychoanalysis, which allows a lot of room for addressing trauma.
Why is compassion so important in mental healthcare?
Sadly, compassion is often missing in healthcare. I want to specify “healthcare” here and not just talk about mental healthcare, because compassion is a fundamental component of healthcare in general.
Medicine trains people to have a certain clinical distance, which is useful but can also become an obstacle when it comes to cultivating compassion. For most medical students, their education starts with a very dehumanizing experience of being presented with a cadaver and needing to deal with that without any kind of psychological preparation. As the years of education continue, compassion isn’t taught as a requirement for the profession, but in reality, that’s exactly what it is.
That being said, there is a certain level of empathy that is needed in order to work in mental health, both on a cognitive and emotional level. But empathy and compassion are not the same things. Empathy is the ability to see things from the other person’s point of view, whereas compassion is the impetus to act or to try to alleviate suffering. Both are crucial to providing mental healthcare and healthcare in general.
Can you tell us a bit more about the work you do at Neighborhood Psychiatry?
We are different because we’re creating a new practice model that’s somewhere between seeing a prescriber for very brief and infrequent medical checks every six-to-twelve months and going to therapy one or more times a week.
Typically, we meet with patients once a month for a longer appointment, and we almost always manage their medications. But we try to do it in the context of a compassionate, wellness-oriented model.
At the same time, we’re also trying to create a model in mental health that is more common in other branches of medicine, which is to provide accessible care at multiple locations so that people with insurance are able to receive primary care psychiatry. We’re tackling a problem that hasn’t really been solved in the mental health space in terms of both technology and scalability.
In primary care psychiatry, we only work with common mental health conditions, like unipolar depression, anxiety disorders, attention deficit disorder, obsessive-compulsive disorder, and what doctors call lower acuity problems. We focus on what we’re best qualified to treat and refer to specialized care when appropriate. For example, your primary care doctor could treat you for straightforward high blood pressure but would refer you to a cardiologist for something more complicated or severe. We use the same approach, but with psychiatry.
In the long term, our practice involves working with a team that includes a psychiatrist and a nurse practitioner or a physician’s assistant, so that every patient has a team of two people–in addition to our administrative staff–who are working with them to give them a higher level of expertise and larger team of support. This also means that our staff is always learning and growing, which makes the professional environment better and improves the overall clinical environment.
What’s the most difficult aspect of working in psychiatry?
Truthfully, the most difficult aspect of psychiatry is that it is really hard work. The hours can be long, and it’s emotionally demanding time because you need to be empathic and compassionate.
Then there’s the fact that people aren’t always very well educated about their mental health. This means that they might not have a good sense of what the right kind of treatment for them looks like. Aligning expectations can be tricky.
Anxiety and depression are on the rise, and more people are talking openly about mental illness. How has this affected your practice?
Some patients are much more ready to work on stuff and are not feeling the stigma that they may have experienced ten years ago. I think the fact that more high profile people have been discussing their problems openly has set the tone for a more honest approach to mental health.
On the flip side, it also means that it’s very difficult to take care of everyone. Now that the demand is much greater, our profession hasn’t had enough time to catch up in terms of supply, so it can be very hard to say no to people who you’re unable to treat.
The World Health Organization recently reported on how depression is the greatest burden of illness on the planet. And anxiety disorders are not far behind. Basically, there is an unending need for mental healthcare but a limited supply of caregiving. Not to mention that caregivers aren’t machines. This can result in a lot of disappointed and angry people who are unable to receive the care that they need, especially in our increasingly customer-experience-oriented culture.
Overall, we experience a lot of gratitude and satisfaction for helping people, but we also hear the disappointment and sometimes hostility from prospective patients that we’re unable to treat.
Vital Signs
Favorite getaway destination? One of my favorite places in the world is Iceland, but I also love walking around my neighborhood and watching fellow New Yorkers.
Which podcast are you listening to right now? The last podcast I listened to was The Shrink Next Door, which was very disturbing and interesting. I’m also reading dozens of different things at any given time, some of them fiction. I’m a fan of classic science fiction, in particular.
Best way to unwind? Walking, exercise, reading, meditation, and chilling out with my family.
Go-to restaurant in Manhattan? A Himalayan restaurant that I like to keep secret but has great pan-fried noodles.
What’s one healthful habit you’d love to see patients adopt? Self-compassion and cultivating a good relationship with themselves.
