Anthony “Tony” Spirito, Ph.D., has been a fixture of the Clinical Psychology Training Consortium since 1984, when he came from Boston Children’s Hospital to start a pediatric psychology clinical service and rotation for psychology residents at Rhode Island Hospital. In 1992, he played an instrumental role in the formal creation of the Brown Postdoctoral Fellowship Training Program. From 2010-2020, Spirito directed the Division of Clinical Psychology; he currently directs the department’s NIMH T32-funded Child Mental Health Research Program. His own research focuses on adolescent depression, suicidality, and substance use. In four decades at Brown, Spirito, a professor of psychiatry and human behavior, estimates he has mentored or supervised well over 100 trainees.

A Circuitous Path to Brown (and the Beach)

I always wanted to come to Brown. [When I was in graduate school] my in-laws had a summer house in Mattapoiset, 45 minutes from Providence. My wife and I thought it would be cool if we could live there at the beach and not have to pay rent. My preferred location is always the beach.

So I applied to Bradley [Hospital] for internship, and I didn’t get in. I did get into Boston Children’s [Hospital], though. At Boston Children’s, I ended up in all these pediatric rotations. At the time, pediatric psychology was almost nonexistent. People didn’t train in that. But I really liked it. So later, when I applied for the position to start a pediatric psychology service at Rhode Island Hospital, there weren’t a million people who knew how to do it.

A Scrappy Quintet in Child Psychiatry

When I arrived, there were just five of us in child psychiatry at Rhode Island Hospital: myself; David Faust, who was a neuropsychologist; Terry, a nurse; Bev Myers, the chief of child psychiatry; and Dave Pearson, a half-time child psychiatrist. We didn’t even have the clinical psychology rotations yet. The five of us did everything, all the consults and outpatients. There were hardly any male child psychologists in the state, so it didn’t matter if I was the best or the worst, I just kept getting referrals.

Because there were no child psychiatry fellows, we couldn’t cover the emergency room for mental health issues. Now, of course, 40 years later, it’s a huge service for the emergency room. But then, every suicidal or seriously depressed patient, or anyone with a mental health problem, was admitted to pediatrics. We would evaluate them there, which is why our consult service was so busy. It wasn’t that unusual in the ’80s or even much later in rural areas where there’s not enough staff. When you think about now compared to then, it’s just totally different.

Research: The Secret Sauce of Clinical Psychology Training

A lot of internship training programs are straight clinical. But in each area of clinical training, we also had a handful of researchers doing research. Lori Stark, who directed our internship’s community placement program, had the idea to turn the community placement into a research placement. Once we started that four-to-six-hour rotation in research, we started getting really strong clinical-research graduate students. It drummed up a lot of interest in coming here. That’s what made our reputation. Of course, we also had these good clinical placements. If we’d had one without the other, it would’ve been a good program. But with both, it was a great program.

Almost from the start, we were among a handful of top clinical research internships. The other places we always competed against were the Medical University of South Carolina and Western Psychiatric Clinic, which is at the University of Pittsburgh. Southerners would want to go to Charlestown, Northerners would want to go to Brown. Now there’s more competition, because a lot of people took our model and used it in other internships.

An All-Star Lineup of Alumni

The very first class of five interns had remarkable career trajectories. There’s Peter Monti, who’s still here and a very famous alcohol researcher; Carol Landau, who’s been on our clinical teaching faculty forever; Kelly Brownell, who became one of the most well-known obesity researchers in the country; Steve Hayes, who became very famous [for co-developing ACT and PBT therapies]; and Toy Caldwell-Colbert, who became a provost [at Central State University]. And that’s just the beginning. If you go back and look through the list of people who’ve come through, I could put stars next to the names of people who became stars. 

Mitch Prinstein, the first speaker [for Alumni Grand Rounds], was an intern here. He worked with me. He might be the most recognizable name of anyone who’s come through here because he did so much with the APA. In the ’90s, as an intern, he said, “I think I’m going to write this thing called an F32.” It’s basically an NIH grant where you write your own postdoctoral fellowship. I’d never heard of it, but I read his proposal for him and we got it. He established a tradition of getting 18 F32 grants from our interns in a row.

The Staying Power of Collegiality and McGyvering

When Greg Fritz came from Stanford to be the new chief of psychiatry at Rhode Island Hospital six months into my job, I thought, “Oh great, he’s probably going to bring his own child psychologists from Stanford and fire me.” But we got along really well. He was incredibly respectful of PhDs. That’s not always the case that PhDs and MDs have a collegial relationship. And then Larry Brown came. Those first three psychiatrists I worked with – Greg, Larry, and Charlie Zeanah – were all really respectful, nice guys. We referred patients to each other and wrote papers together. That experience in my first decade here really made me never think about leaving. 

I did get recruited twice. Columbia made me an offer, then Boston Children’s. Both were better paid jobs. But why would I leave Brown when I got along so well with the leadership and I’m treated so well? Those other places were MD-heavy. But here we were growing something from scratch where the MDs and PhDs really worked cooperatively. Greg Fritz used to say, “We do everything with bubble gum and a shoestring.” We didn’t have deep pockets, so we did a lot on our own. There’s something to be said for having to figure it out from the ground up. People probably can’t imagine that there were once five people running child psychiatry at an entire hospital 40 years ago without trainees. But really, you couldn’t find a better environment.