7 Year Itch

By W. Walker Peacock, Psy.D.

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“It’s what you learn after you know it all that counts.” - John Wooden

This past September, I celebrated my 7th year working with The Tarnow Center. When I joined TC as a post-doctoral candidate, it was my first “real” job coming out of graduate school. Looking back I can see that Dr. Tarnow took a significant chance bringing me on board. He needed a child and adolescent psychologist, and most of my experience had been working with high school and college students. So the team stepped in to train me up on therapy with different age groups, and also to train me in Dr. Tarnow’s Self-Management approach to treatment. One by one, each clinician took time to have me in to observe a session, to walk me through a treatment plan, or just to stop in and discuss cases with me. In a profession where we are paid by the hour, it’s no small sacrifice to take time out of your day to teach someone how to do what you do. But it was a sacrifice that all of them made in an effort to make me a better clinician.

In my second year another post-doctoral candidate joined us, and everyone put forth the same effort to train her in our treatment model. And there I was, bringing her in to observe intake sessions, grabbing her to sit in on groups, and checking in on her case load. It’s funny how taking time out of my day to train her didn’t feel like a sacrifice. I guess it didn’t feel that way because I saw everyone doing it, from Dr. Tarnow teaching about the medical model to the administrative staff giving suggestions on how to schedule clients. It was just how it’s done. But just because I was no longer the new kid didn’t mean that they were done training me. Not by a long shot.

A good bit of my previous training had been in institutions like counseling centers and crisis centers, where unfortunately it’s easy to become jaded and fall into a routine. They were the kind of place where completing your paperwork for insurance companies can become a bigger priority than the actual care of the client. Sadly, I think I brought some of that attitude with me when I joined the Tarnow Center. I still remember a staff meeting in my second year at TC where I said something cavalier along the lines of “Hey, I’ve done everything I can do. It’s up to [the client] now.” Dr. Havasy, our senior psychologist, shot me a look. If you’ve ever worked with Dr. Havasy, you know the look. Yeah. That one. She stopped by my office after the meeting.

“So you’ve done all you can do for this client?” she asked, casually.

“Yes, I have,” I stated with confidence.

“Then you’ve already spoken to the school counselor.”

“Well… I haven’t had a –“ I started. Confidence waning.

“And you’ve interviewed the grandparents.”

“Oh, yeah. Ummm…” Confidence gone.

“And of course, you already spoke with his pediatrician.”


She knew she had me. Her tone softened and she stated quite simply, “Walker, there’s a reason that our clients come to see us instead of going through insurance. We do more. We ask more. We look more. We expect more.” The last line was delivered with a little added inflection and a single raised eyebrow that let me know that the line was intended for me. It was a wake-up call that I needed.

So they kept expecting more. They kept pushing me; they kept challenging me to get better. And I have. In fact, I decided that my seventh year at The Tarnow Center would be my last. I felt that I had gotten to the point that I was ready to leave the group practice and make a go of it on my own. My decision to leave wasn’t based on anything negative or lacking with the Tarnow Center. The practice is thriving; my colleagues are amazing. It’s an ideal situation. So why leave? Two reasons. The first is pure ego. I wanted to do it on my own. I wanted to prove that I could hunt the sabretooth, bring home the bacon, and make fire all by myself. I wanted to silence the doubts in my head that told me, “They’re carrying you.” The second reason (that I didn’t acknowledge at the time) was laziness. It would be so much easier to run my own practice without anyone there always pushing me to improve. I would be able to run my cases the way I wanted to, and the only person I would have to answer to would be me.

The lease was coming up with the Tarnow Center offices anyway, so I figured it would be a good time to make a clean transition. One day I was out looking at office space when I found a nice office in a great location, and it was in a suite with other clinicians. When I was looking it over, I noticed that all of the doors in the suite were closed. I made a comment about how busy everyone must be, and the office manager said that no, a couple of them were with clients but that the others tend to keep to themselves in between sessions. When I asked the office manager if I could see the conference room, she looked confused.

“Where does everyone have lunch?” I asked.

“Oh, they mostly do that in their offices,” she replied.

“But where do they discuss cases?”

“Well, this isn’t really a group practice, so they don’t have much need for that,” she said.

I had a similar experience at a different office. Another group of professionals who were working in proximity to each other rather than working with each other.


It just didn’t feel right, and I couldn’t make sense of it. This was what I wanted. I wanted to lone wolf it, to do it all by myself. Then again… Suddenly those thoughts of how easy I would have it in solo practice were replaced by the reality of how easy I have it now. I really like the open doors at TC. I enjoy being able to pop in on Dr. Gonzalez to brain storm a case with her, or sit down with Lesley to discuss a client I want to send her way. If I went out on my own, I’d be playing phone tag with clinicians and physicians to make sure we’re all on the same page regarding the client’s care. At TC, I just have to walk down the hall. Selfishly, staying where I am makes it easier on me. But professionally, staying where I am means that I can do more for my clients. They expect more.

I’m happy that I decided to stay. Sure, they’re going to keep pushing me, but it works. And when I sat back and thought about it, I realized that they push themselves just as much. How can I tell a group this talented that I’m done growing when I see them working to get better every day? The only thing I can compare it to would be working out with J.J. Watt. He’s arguably the best player in the NFL, and he’s never satisfied. To give you an idea: he wakes up before the sunrise, practices all day in August – in Houston – and then caps it off by doing this. And then he does this. 66 times. Are you going to tell this guy that your effort is “good enough?” Didn’t think so.

I realized something else. The voices in my head are right. My colleagues do carry me. Just like I carry them. That’s one of the great things about this team: there’s always a fresh mind and a fresh set of eyes and ears ready to jump in and give a new perspective on a case. Solo practice works for a lot of clinicians, but not for me. One of the core tenets of Self-Management is to learn how you learn, and I’ve learned that I learn best when I’m surrounded by really smart people who disagree with me. I think I’m in the right place.