“Direct feedback is fairly easy to digest” With Dr. Anna McCarthy

The first thing that pops to mind is that model of authoritative parenting I previously discussed. If you are warm but firm, fair, knowledgeable, reasonable, and respectful, direct feedback is fairly easy to digest. For example, I assigned a number of tasks to an employee who, after weeks, had seemingly accomplished none of them despite […]

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The first thing that pops to mind is that model of authoritative parenting I previously discussed. If you are warm but firm, fair, knowledgeable, reasonable, and respectful, direct feedback is fairly easy to digest. For example, I assigned a number of tasks to an employee who, after weeks, had seemingly accomplished none of them despite having both the time and knowledge to do so. I told him that I had created a special spreadsheet for him to track his accomplishments, including “by when” dates, and that I and our CEO looked forward to weekly updates. My delivery was warm but firm. It seemed to do the trick.

As a part of our series about “How To Give Honest Feedback without Being Hurtful”, I had the pleasure of interviewing Dr. Anna McCarthy, PhD of The Mental Health Collective.

Dr. Anna McCarthy has been working in the mental health field for over 20 years. She completed her BA in psychology (graduating cum laude) and MA in psychology (graduating summa cum laude) at California State University–Long Beach. She completed her PhD in clinical psychology at The University of Houston, and her pre-doctoral internship and post-doctoral fellowship at the VA Long Beach Healthcare System.

In addition, she has completed certifications in Cognitive Processing therapy, Acceptance and Commitment Therapy, and Integrative Behavioral Couples Therapy. Dr. McCarthy has extensive experience working with victims of trauma, including PTSD, depression, severe mental illness, addiction and dual diagnoses, and personality disorders. Dr. McCarthy points out that there are many treatment programs to help people struggling with addiction, eating disorders, and severe mental Illness. There has been a long-standing need for a non-hospital based treatment program designed to help people who are struggling with other mental health issues (such as anxiety, depression, adjustment disorders and life stress).

She is proud to be affiliated with a program grounded in a commitment to provide ethical, meaningful, and sophisticated clinical care to a currently underserved population.

Thank you so much for joining us! Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

I was born and brought up in London, England. I attended a public primary school as a little kid, but also was lucky enough to travel extensively as a result of my step-father’s work in the world of classical music. From a very early age I had a split life — some of my peers at that primary school were impoverished and living in council estates in a dilapidated part of London, and concurrently I was exposed to people with extreme affluence and international fame — opera singers and virtuoso musicians amongst them. I needed to develop skills to connect to all those people, otherwise I would not have felt a sense of belonging in either world, and so I did. I’m not sure I remember how I did, but just that I did.

Fast forward several years, and my first career was in television, and again, there was a need to figure out how to connect to people, help people to compose themselves prior to appearances on TV etc. This led me to an interest in social psychology, and so a few years later, I started to pursue undergraduate studies in California.

As I was studying psychology, I was concurrently working at a group home for abused children, who were wards of the state because of the extensiveness of the abuse they had been subjected to. I remember one little girl, “B,” very clearly. Prior to coming to our group home, she had suffered multiple forms of unspeakable abuse, and was severely emotionally and behaviorally disturbed as a result. Our group home was her last stop in a long string of failed placements, before social services placed her in a long term, locked psychiatric hospital. The day she came to us, she tried to kill herself by throwing herself under oncoming traffic. She threw rocks at the staff. She had matted hair, lice, and was disheveled. She was wild, aggressive and, ultimately, terrified. Eventually, after hours, I managed to get her to agree to stay in the house, and told her we weren’t giving up on her. A month later, that same little girl, after consistent care, stable and predictable living, came and threw her arms around me before bed, and said, “Anna, I love me….” That is how I became a clinical psychologist……

What do you think makes your company stand out? Can you share a story?

From The Mental Health Collective’s inception, I and two colleagues had the ambition and shared dream to create a meaningful, ethical, and sophisticated residential treatment center. Unlike any other, The Collective is for clients struggling with primary mental health issues. We were all at a stage in our careers where there was no “have to,” but rather “do we want to?” Week after week, we would meet, drink our favourite coffee and set “homework” assignments for ourselves. I remember debating the name of our company, choosing the logo, writing copy for the website, envisioning the programming. Eventually, a building, furniture, a treatment team, an administration team, an operations team, a medical team, a marketing and admissions team all came together. As Co-Founders, we have stood firm in creating a wholesome and welcoming culture for our team, stood firm in our processes of self-examination and evaluation, and stood firm in our vision of providing meaningful, ethical, and sophisticated mental health care. It started with a cup of coffee and a shared dream, and it is that dream that makes us stand out every day.

Can you share the most interesting story that happened to you since you started your career?

I think that “B” was one of the most profound experiences of my clinical life. That little girl showed me the power of context, behavioral modification, stability, and unconditional positive regard on self-concept and mental well-being. She, single handedly, shaped my career path. I have no idea what happened to her after she left the group home. The odds were not stacked in her favour at all. I think about her often, and will never forget her little arms around my waist, her big brown eyes looking up at me, and her telling me that she loved herself. I only hope that she found peace and wellness. She, like all human beings, deserve nothing less.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I initially had an intention to help my colleagues to the point of ribbon cutting/doors opening at The Mental Health Collective. Indeed, I actually interviewed multiple people for the job of clinical director. Ten months later, with no viable candidate, I finally agreed to the job. I’m really glad I did. It has afforded me opportunities that my private practice couldn’t. I might be slow off the mark, but ten months of “no” was worth the final “yes”.

What advice would you give to other CEOs and business leaders to help their employees to thrive and avoid burnout?

Authentically care! Our employees know they are cared for and appreciated. As a mental health organization, our work can be extremely stressful and demanding. We are treating individuals who, as a result of complex and multiple mental health issues, cannot succeed in their home communities. This means that we are helping clients with limited emotion regulation and distress tolerance skills. Sometimes, their behavioral issues can be challenging, even as a psychologist I feel the strain. To me, it’s important that each and every one of our employees feels supported and knows that they are a valued member of a large team. We truly are a collective.

At a practical level, I am always checking in with employees every day. I send notes of thanks, support, and recognition regularly. I encourage our employees to take self-care time if they are struggling. Recently this included encouraging our amazing medical director to spend the day at the beach. I volunteer to take over temporarily when an employee is struggling to make headway. For example, phone calls with an unreasonable family member, or making time to speak to a client who needs containment. I personally call our clinicians and case managers to do wellness checks after stressful events. I facilitate regular training with our “mental health technicians” and thank them for all that they do. They are our foot soldiers who chaperone our clients day and night. I also supply The Mental Health Collective with sweet and savory snacks every week. It’s a token, but my way of saying that I want to nurture and support each and every member of our collective.

How do you define “Leadership”? Can you explain what you mean or give an example?

I put a lot of time into developing relationships with our team, so that difficult conversations can be digested from a place of feeling heard and listened to, while being guided about expectations and boundaries.

Leadership is a multifaceted thing. I believe in leading by example, and see it to some degree as a form of professional parenting. I strive to be open and transparent, which means showing up as a real human being who tries to offer wisdom and knowledge. I embody many of the characteristics of authoritative parenting, not to be confused with authoritarian. I consider myself warm, approachable, and authentically caring, but also firm with good intentions.

In my work, I often talk about how to release and relieve stress. As a busy leader, what do you do to prepare your mind and body before a stressful or high stakes meeting, talk, or decision? Can you share a story or some examples?

I think preparation is a daily practice! To start a stress management/self-care programme the day of a conference, or workshop, or an event where I have to be “on” is a little late off the starting block!

I start my mornings with meditation and daily exercise and my favourite latte! I end my day with family and fun and some atrocious TV. I’m a huge believer in PLAY. I love to play. I work hard, but I will never lose my desire to play. One of the many benefits of parenting is having an excuse to play. I’m a fan of fireworks, snow ball fights, Disneyland, hiking, roller coasters, nature, travel, water balloon fights, baking, coffee with friends, hitting tennis balls, floating in a swimming pool, spending time with the people I love, and a myriad of other playtime activities.

Also, I don’t speak about things that are not within the realm of my competence/expertise. I know what I know, and I’m very clear about what I don’t know. This means that there really are no high stakes meetings, presentations, workshops, conferences, networking events etc. There is just me, showing up as my authentic self, talking about the things that I know. I actually love public speaking and leading meetings!

Ok, let’s jump to the core of our interview. Can you briefly tell our readers about your experience with managing a team and giving feedback?

I oversee programme development, all of our clinicians and case managers, and work closely with our admissions and marketing teams. On a weekly basis I oversee our client case consultation meetings, treatment team meetings, clinical diagnostic meetings, programme therapist meetings, programme director meeting, and ad hoc client staffing. I also meet with our CEO and executive team every week. I give feedback every day!

This might seem intuitive but it will be constructive to spell it out. Can you share with us a few reasons why giving honest and direct feedback is essential to being an effective leader?

Being concise and precise and clearly laying out expectations and contributions actually provides a sense of safety for employees. They know where they stand, they know where they need to stand, and they know a pathway to getting there. Nobody wants to catastrophize and imagine worst case scenarios in their head. The truth is always easier. It really is.

One of the trickiest parts of managing a team is giving honest feedback, in a way that doesn’t come across as too harsh. Can you please share with us five suggestions about how to best give constructive criticism to a remote employee? Kindly share a story or example for each.

The first thing that pops to mind is that model of authoritative parenting I previously discussed. If you are warm but firm, fair, knowledgeable, reasonable, and respectful, direct feedback is fairly easy to digest. For example, I assigned a number of tasks to an employee who, after weeks, had seemingly accomplished none of them despite having both the time and knowledge to do so. I told him that I had created a special spreadsheet for him to track his accomplishments, including “by when” dates, and that I and our CEO looked forward to weekly updates. My delivery was warm but firm. It seemed to do the trick.

The Koreans have a concept called “nunchi” — the art of reading the emotional temperature of a room, and gauging other people’s thoughts and feelings. It is a form of emotional intelligence that Koreans teach their offspring from an early age. Maybe because of my early travels, and my exposures to such broad cross sections of societies, I think I have good nunchi. There is no “one size fits all” approach to giving direct and honest feedback. I use my nunchi brain to figure out the delivery…Humor for some, few words for those who get easily flooded, repeated meetings for others. It’s all in the delivery. I have a delightful colleague who is a little averse to writing clinical progress notes. His wife and I plotted that he wouldn’t get a home cooked dinner if he left our clinic without finishing his notes. He laughed and got the message.

Another thing to contemplate is my own emotional climate. I will delay meetings if my own emotional thermometer is running high. There is a negative correlation between intensity of emotion and sophisticated thinking. I have a great working relationship with our CEO, but he is a business man and I am a clinical psychologist. Sometimes that means that our starting points on an issue are diametrically opposed. Early on, we came up with a plan to tell each other that we would need a separate meeting if we weren’t readily finding a middle ground, and our emotions started to intensify in a large meeting. We just put the issue on hold and pick it up later. It has worked well for us.

I also coach people to use a “sandwich” approach when giving feedback — the slices of bread in the sandwich are positives/affirmations and the filling is the positive request you want to make. For example, “I really appreciate your humor, however when I am seeing clients in my office I need you to keep it down a little, but when the clients aren’t there, your laughter makes me happy.”

Last, but not least, is good old reflective listening. No-one communicates well when they feel under attack. Try it….Have a colleague wear a pulse oximeter on their finger, lean forward in your chair and point your finger at them and yell “you, you, you, you, you……” See what happens to their pulse oximeter! A much more effective approach is to listen to the other person’s perspective, acknowledge that it all feels right for them, even if you don’t buy into one word of it. Tell them what you heard them say, ask if you heard correctly, and ask if they will do the same for you. When we feel we have 100% of someone’s attention, that they understand us, that they have empathy for us, there really is no fight. Reflective listening is about being a great court reporter, not about being a great trial attorney.

Can you address how to give constructive feedback over email? If someone is in front of you much of the nuance can be picked up in facial expressions and body language. But not when someone is remote.

How do you prevent the email from sounding too critical or harsh?

Don’t send emails or texts full of feedback. They are for positives and pragmatics only. In this day and age, it is so easy to set up a face to face meeting — Zoom, Skype, FaceTime. It is all so much more effective, and lowers the risk of someone misinterpreting words, meaning, and intentions.

In your experience, is there a best time to give feedback or critique? Should it be immediately after an incident? Should it be at a different time? Should it be at set intervals? Can you explain what you mean?

It really depends. We had a one off incident where our client’s husband (who lived out of state) called one of our case managers and told her that he was imminently planning to kill himself. She talked him down and really, actually, saved his life. This all took place late at night on a Friday. I called her at 10 o’clock that night to check on her mental health and well-being. She initially told me that she was fine, but quickly became emotional and said, “But what if he’d gone through with it? It would have been my fault.” THAT was a conversation that needed to happen immediately, and a follow up call the next day….

It’s really all about the level of urgency, the nunchi, and finding “teachable moments.”

How would you define what it is to “be a great boss”? Can you share a story?

Oh gosh! I just know that I want to treat people the way I want to be treated. I’ve worked long and hard to earn the title of Clinical Director, but I am a human being first and foremost. My ego and self-esteem are not wrapped up in pulling rank, power plays, or put downs. I try my best to lead by example, guide where I feel competent to provide guidance, set boundaries that keep us aligned and healthy, operate from a place of gratitude and generosity, and not deviate from the shared dream that started The Mental Health Collective over a cup of coffee all those years ago.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

With COVID-19, economic strife, our brown and black friends and colleagues under assault, I think we haven’t ever had a bigger mental health crisis brewing than the storm that is about to hit us. Just a few weeks after the start of social distancing, I had read that online sales of alcohol had risen 243%. So if I could inspire one movement, it would undoubtedly be to provide sophisticated, ethical and appropriate mental health care to everyone, irrespective of their ability to pay. The economic cost of untreated mental illnesses runs into hundreds of billions of dollars annual in this country and the personal tolls are countless. It’s heartbreaking.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Viktor Frankl: “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.”

I was the product of a narcissistic, alcoholic father and a narcissistic mother. They were my initial stimulus, but never my response. I chose, and choose growth and freedom. As I age, I try more and more to exist in a place of generosity and gratitude…They are everything to me.

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