Allison Applebaum ’00 founded and directs the Caregivers Clinic at Memorial Sloan Kettering Cancer Center (MSK), the first program of its kind in the world. She also serves as Associate Attending Psychologist at MSK and Associate Professor of Psychology at Weill Cornell Medicine. The author of the textbook “Cancer Caregivers,” as well as numerous research articles, Allison studied Psychology at New York University and earned a Ph.D. in Clinical Psychology from Boston University. She resides in Manhattan.
What was it about psychology in general that attracted you? Is there a memory from your earlier years that stands out?
My maternal grandmother was devoted to volunteerism and spent her later years volunteering five days a week at various hospitals in the Pittsburgh area, including Wester Psychiatric Hospital and what was then called Forbes Hospice. Each weekend she would tell me about her experiences of going from room to room, speaking to patients and families, and providing them with support during difficult moments. She hadn’t received any formal mental health training, but she was certainly engaging in therapeutic encounters. Hearing about her experiences instilled within me a great appreciation for the helping professions, and I recognize now, enthusiasm for the work in palliative care that I do.
How would you characterize your career thus far? Can you describe the accomplishments of which you are most proud?
I feel very fortunate to have a career that is multifaceted. I am an Associate Attending Psychologist at Memorial Sloan Kettering Cancer Center (MSK) and an Associate Professor of Psychology at Weill Cornell Medicine. I spend time each week engaged in clinical care, research, teaching and outreach efforts. I lead a laboratory at MSK focused on addressing the needs of cancer caregivers, and I mentor graduate students, postdoctoral and medical fellows on their research and clinical endeavors. I lead workshops to train other healthcare providers in various approaches to supporting families facing cancer, and do quite a bit of writing, both for scientific audiences as well as the general public.
What I’m most proud of is my identifying early on the critical need for a healthcare system that recognizes and supports caregivers in their role, and my taking steps to bring us closer to a system that does just that. At MSK, one of my initial innovations was advocating for caregivers to receive their own medical records, separate from that of patients. This step addresses the financial, ethical, and legal implications of documenting caregiver information in the records of patients and has been a significant strength of the program. In 2019, I published the first textbook summarizing the state of the science of research on cancer caregivers with Oxford University Press (not surprisingly titled, “Cancer Caregivers”) and am proud to have become an advocate and a voice for caregivers worldwide.
What compelled you to inaugurate the Caregivers Clinic? How has this initiative grown under your leadership?
When I came to Memorial Sloan Kettering in 2010 as a postdoctoral fellow, I was primarily involved in providing support to patients with advanced, life-limiting cancers. So often, I would find that the conversations we had focused on these patients’ loved ones, their family members and friends who were intimately involved in their care and very impacted by their caregiving responsibilities. But these family members and friends – caregivers – were not being offered support that targeted their own unique needs. The field of psycho-oncology (the intersection of psychiatry and oncology) was founded at MSK and our Department of Psychiatry is larger than any other housed in a comprehensive cancer center, but it was clear to me during my fellowship training years that there was a significant gap in what was being offered to families, a gap I realized extended far beyond MSK.
I also explored what was being done nationally and realized at the time that there was no targeted, comprehensive service specifically for cancer caregivers, despite the increasing reliance on caregivers to shoulder tremendous responsibilities and the growing recognition of the significant, negative impact of caregiving on caregivers’ quality of life. So, in 2011, I began offering psychosocial support just a few hours a week to caregivers of patients receiving medical care at MSK, and very quickly the Caregivers Clinic took off. Over the past decade, the Clinic has served thousands of caregivers of patients with all sites and stages of cancer at all points in the caregiving trajectory. It has been recognized as the first program of its kind worldwide, and I’m proud to say it is now being replicated in other cancer centers across the country.
What do you find most rewarding about your work at Memorial Sloan Kettering? Most challenging?
It’s so gratifying to be able to accompany patients and families on their journeys and to help them to live more meaningfully in the face of illness. My work allows me to witness individuals at some of their most vulnerable moments. Knowing that I can help families face these with a little more courage and authenticity is incredibly meaningful and rewarding. The most difficult aspect of my work right now is meeting the capacity challenges of providing care to all families in need. Caregivers have faced a triple crisis of caregiving, cancer, and COVID-19, and they require more support now than ever before. I hope to be able to grow the staff of the Clinic significantly in the next few years so that we can do a better job of assisting families and supporting them in this critical role. The U.S. healthcare system is increasingly relying on caregivers to shoulder tremendous responsibilities, and this shift must be met with correlate support.
How has the pandemic impacted you professionally, both in the ways you interact with colleagues and provide support to caregivers?
The pandemic has absolutely transformed the clinical work I do. Before COVID-19 came into our lives, Memorial Sloan Kettering had begun to offer telepsychiatry appointments, but not yet through the Caregivers Clinic. As of March 2020, we transitioned to providing care completely over telepsychiatry, and I don’t think we’ll ever go back. Historically, there have been many barriers to caregivers accessing mental health services, including the time and financial cost associated with traveling to and from treatment centers, the guilt that arises when taking time for oneself and away from the patient, and what still remains in 2021 a stigma around mental health service utilization. The fact that we have been able to provide high quality care to patients in their homes addresses these barriers. We had more referrals to – and fewer cancellations in – the Clinic in 2020 than any previous year, and I credit this in large part to our use of telepsychiatry. Recruitment and retention in my clinical trials has also been more successful now that we are conducting all sessions and assessments virtually. I think we’re learning that we don’t necessarily need to be in person to do the type of work we do, but certainly I very much miss seeing colleagues and mentees in person.
Did your educational path lead you to your professional pursuits?
Very much so. I majored in Psychology at New York University and after graduation went right into the doctoral program in Clinical Psychology at Boston University. This training provided me with a very strong basis in psychological theory and practice, as well as a solid foundation in clinical research. I began to specialize in health psychology and psycho-oncology during my postdoctoral training and then transitioned into my faculty position at Memorial Sloan Kettering a few years later.
In what ways do you feel Chapin prepared you for college, graduate school, and the adult world? What particular skills (academic, artistic, social, emotional) or interests did Chapin help foster?
I was at Chapin the entire time, from Kindergarten through twelfth grade. The School prepared me in such tremendous ways for college, graduate school and my career in academia. I remember noticing during my freshman year at New York University how confident I felt speaking up in classes, and how much farther along I was in my coursework because of all the AP classes I had taken. In fact, because of those AP credits, I ended up with three minors (French, Math and Sociology). I very quickly found myself taking leadership positions in student government at NYU, which I likely would not have done had I not been treasurer of student government at Chapin. I also am constantly reminded of how valuable the writing skills I cultivated at Chapin have been for me; whether it was my completing my doctoral dissertation in graduate school or my current scientific articles, these skills have carried me through. More broadly, that voice I learned to find early on at Chapin, from being encouraged to raise my hand in fourth grade Math class, to giving a talk at Thanksgiving Prayers about the food drive when I was a senior, is the same that has allowed me to find my way in what historically has been a male – and MD (not PhD)- dominated institution. I feel incredibly grateful to have had the opportunity to have a Chapin education and it thoroughly prepared me for all my academic pursuits.
What other aspects of your life played a role in who you are today and what you’ve achieved?
What comes to mind immediately are my parents. My mother was a brilliant concert pianist and my father a world-renowned composer, orchestrator and arranger.
They both left a significant mark on me, and our world. In addition to instilling within me a love for the arts, my parents modeled for me what it means to live a courageous life. My father, in particular, encouraged me to grow in every way possible, to embrace infinite dreams, and to use each moment to its fullest. His voice is with me every step of the way now. In addition to my parents, my first career as a ballet dancer is something that has really shaped my work. I thoroughly enjoy public speaking (which is the number one phobia in the United States!), and I credit that to my years of dancing on stage. This has helped me embrace the more public side of academic medicine, like the lecturing I do. Perhaps more importantly, the discipline and mindfulness engendered in me through my dance training has truly helped to carry me through many of the challenges of a career in academic medicine – and life! – and to protect me in many ways against burnout.
What advice would you give to current Chapin students or young alumnae who may be interested in pursuing a career in clinical psychology, counseling, psycho-oncology, or related fields? How might you consider yourself a role model for young women…and young men?
I think one of the best ways to find out if this career is for you is to secure internship or research assistant positions early on. I did this starting my sophomore year of college, and it really solidified how right this type of work felt to me. Most hospitals and academic medical settings (including MSK) have positions for college and even high school students, so all you need to do is ask to see what might be possible. Of all the aspects of my work, what I am most passionate about is mentorship, and it’s been an honor to mentor many young scientists entering the field. I pride myself on teaching by modeling and I place a special emphasis on demonstrating the importance of boundary setting, transparency, and self-care. I hope that my path can inspire other young people in the sciences to pursue their dreams, whatever they may be.
How do you like to relax and decompress?
I took a 15-year hiatus from dance, but recently returned to the studio and have found it to be one of the best ways to relax and reconnect to an earlier part of myself. Thanks to my parents, I also really enjoy live music performances and am excited to get back to that in New York soon!