#GirlbossTherapists: Dr. Amy Funkenstein, MD

Dr. Amy Funkenstein, MD  in her office in Belmont, Massachusetts

About the #GirlbossTherapists series: As a female founder, I love having the opportunity to support so many female therapists in private practice through Zencare. In this article series, I interview outstanding therapists on their journeys to becoming clinicians and businesswomen.

Did you always know you wanted to be a psychiatrist? What was your path to medical school and residency like?

I always knew I wanted to be a doctor (for reasons I think that may have had nothing to do with being an actual doctor, but that’s a story for another time), but I did not think I would be a psychiatrist. Despite having multiple family members who are  psychiatrists, I wanted to be a “real doctor.” But once I was in medical school and started my third year rotations, I realized that a lot of medicine is algorithmic. As a physician, much of your time is spent checking potassium levels and repleting them or interpreting small squiggles on EKGs and then ordering more tests. When I started my psychiatry rotation though, I realized how much more dynamic and exciting psychiatry can be. It was an opportunity to look at the bigger picture, debate ideas about diagnoses and think about the structure and function of the brain. It felt as though I finally had a chance to care for the whole patient instead of just their blood-counts and cardiac rhythms. At the time, I didn’t really understand the breadth of what psychiatrists did; I imagined myself working with clients as they lay on a couch and talked about their childhoods. Only after rotations did I realize how effective and rewarding it can  be.

The ratio of male to female practicing physicians in the US is nearly double. How has that impacted your career path or training experiences?

Despite there being significant gains by women in the workforce in every sector, medicine continues to be a male-dominated field. Even though my training colleagues and peers in my department are mostly women, the heads of departments, the CEOs of the hospital etc. are mostly men. And, while I have benefitted tremendously from having  female mentors who  had a genuine and selfless interest in helping me become a better doctor and advance my career, I have unfortunately run into an equal number of women who attempted consciously or unconsciously to undermine my growth. It has become a priority of mine as a young woman in medicine to speak truth to power about the sexism that remains in medicine and to mentor and empower, to the best of my ability, women in training. They will be my colleagues in just a few short years, and what an exciting thing to be along for the ride as another woman reaches professional success that you helped build! There is no greater accomplishment.

It’s important to note that despite being undermined by women I have worked for, I have probably learned more from those experiences about my own competence and worth than I would have had they never happened. That’s something I try to pass along to the trainees that I mentor without them having to go through it!

How has the transition from hospital work to private practice been? What do you know now about starting a business that you wish you knew sooner?

Private practice is a lot of fun and a lot of work ☺ I love my patients, and I feel grateful that they are part of my practice and not attached to an institution, so that I can follow them as long as I want. I wish that I had purchased an electronic medical record (EMR) sooner. I am just now getting an EMR that I held off purchasing because I wanted to keep my overhead costs low, but if I could go back and start over, I would happily pay the money to set up an EMR before my practice opened. I’m excited for it to streamline my workflow and make it easier for my patients to access prescription refill requests, appointment reminders etc. The moral of the story: even if it’s expensive, it’s prudent to spend money on things that make your life easier ☺

What’s your advice to college age women who are considering a medical or business profession?

I think many people who have their own business or go through medical school do it right after they graduate from college, and I think there is an artificial pressure to be productive right away in your life. I was a waitress for several years after college in NYC. I scraped by financially but had a fantastic, relaxing and exciting couple of years before attending medical school. Give yourself a break before starting something this intense. Wait until you’re hungry and curious for work. Rest is not idleness.

Can you tell me about how you use exposure response therapy (ERP) in OCD treatment? What does it entail, and how quickly can a patient expect to see improvements in their symptoms?

I am biased, but I think Exposure therapy is one of the greatest therapies out there. It is resilience training for the anxious brain. When we get anxious about something (obsession) we tend to avoid it or do things to make ourselves feel less anxious (compulsions). Unfortunately, this trains our brain that the best way to not feel anxious anymore is to either avoid things that make us uncomfortable or to do a complicated ritual to feel better. This sounds like a good idea at first, but over time, it turns into a vicious cycle of avoidance and compulsions.

Exposure therapy is the step-wise exposure of the patient to things they feel anxious about. For example, if you were someone who were afraid of germs and so you didn’t touch door handles, we might make a list of exposures for you to try, including touching a tissue to the door and then having you touch that tissue while thinking that you might get sick from it… sounds strange, right? It’s kind of like getting into a cold pool — it feels uncomfortable at first and then after a couple of minutes, you feel like the water is warm and comfortable. Pretty soon, you’ll be licking doorknobs and acknowledging that you might get sick from it, but not having an anxious response. This kind of therapy, on an existential level, trains us both to acknowledge the inherent uncertainty of the world and feel as comfortable as possible with that uncertainty while facing our fears, whatever they may be.

Patients tend to see an improvement within a couple months of starting the therapy, depending on how often they are doing the exposures and coming to therapy. Often it can be longer because we are undoing a pattern that has been developed over a lifetime, but it does get better.

How do you balance prescribing medications with talk therapy?

If I had a bumper sticker, it would say, “why suffer?” Many of my patients are not on any medication at all and they get symptom relief with therapy alone. If people are really suffering acutely, I tend to use medication early in treatment to provide some relief. Sometimes I will wait to see how they do in therapy, and if they are struggling to do the therapy because the symptoms are so intense, I’ll use medication to minimize the symptoms so they can do the therapy with more ease. Medications on their own are not my favorite strategy because they do not provide a cure. They provide temporary symptom relief. Once patients have been in treatment that combines therapy with medication management, they will often decide to come off their medications. Clients  who  have been in therapy often do not experience a return of symptoms, while those that have not, occasionally do.

OCD can range in severity, but it is generally pretty disruptive in people’s lives. What message do you have for individuals with this diagnosis?

There is hope! OCD/anxiety is one of the most treatable disorders in psychiatry. There is help out there but it needs to be the right kind of help. Unfortunately, OCD tends not to respond to traditional talk therapies, but if you’re not near someone who does exposure therapy, there are some great books out there to help, and exposure therapy is something that you can do on your own. Not only does the therapy work but it provides a greater tolerance of the uncertainty we all encounter in daily life and provides us with a better outlook and tolerance for the difficulties we face.

To contact Dr. Funkenstein, visit her Zencare profile.