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Dr. Tom McMahon Looks Back

December 21, 2021
by Lucile Bruce

Standing six feet, four inches tall, with a deep voice and low-key demeanor, Thomas McMahon, PhD might be described as a gentle giant.

“My original career plan,” he chuckles over Zoom, “was to play Division I college basketball at Temple University.”

Fortunately, his lack of success on the college court led to Dr. McMahon’s great success in caring for, and about, other people.

Forty-six years after he graduated from Temple with an undergraduate degree in social work, he pauses to reflect on his long career in mental health care. Stacks of paper and journals and half-empty bookshelves are visible in the background, signs of a life in transition. And it’s a big transition: this month he retires as director of the West Haven Mental Health Clinic, director of clinical research at Connecticut Mental Health Center, and professor in the Yale Department of Psychiatry and the Child Study Center.

After college, young Tom McMahon went to work in New Haven at the now-closed St. Francis Home for Children. It was only eleven miles from his self-described blue-collar family of origin in Shelton, Connecticut, but in other respects, a world away. There he worked with children who had been removed from their parents’ care by the Connecticut Department of Children and Families (DCF). Soon after, he served as a “psychiatric technician” on a large inpatient service for adults and adolescents at Waterbury Hospital. His experiences on the unit sparked his interest in working with adolescents, a passion that continued throughout his years in clinical care and as a scientist who pursued important research in the area of fathers in substance use treatment.

In 1981 he returned to graduate school at New York University, where he earned his PhD in child and school psychology, a field he chose “because at the time, there was no licensure in Connecticut for social workers to practice independently.” After completing his internship at Mount Sinai Hospital in Hartford at the adolescent inpatient and intensive outpatient treatment (IOP) programs, he came to Yale to work in research.

Dr. McMahon frames his career in person-centered terms. He uses the pronoun “we”; his stories feature his many collaborators, such as his friend Nancy Suchman, PhD, whose final study he completed after her death one year ago; his colleagues at the West Haven Clinic; and substance use researchers Stephanie O’Malley, Tom Kosten, and Richard Schottenfeld, whose teams he joined as a young psychologist when he first arrived at Yale.

“It was during the AIDS epidemic, before treatments were available,” he recalls of those early years. “We were focused on IV cocaine and heroin use, including among people with HIV infection.”

In 1994 he joined Dr. Suniya Luthar and Dr. Bruce Rounsaville, who were researching adolescents and parents who used substances. It was an important turning point into what would become the focus of his career: the impact of alcohol and drug addiction on family process and child development. Seeking to keep a foothold in clinical care, in 1996 he accepted a position as part-time director of the child program at the West Haven Mental Health Clinic, a satellite clinic of Connecticut Mental Health Center. The clinic dates to CMHC’s early years in the late 1960s and is one of only two programs within the large CMHC system to serve children.

In 1998, Dr. McMahon was asked to apply for a new director position at the West Haven Clinic, overseeing both the child and adult clinical teams. He wasn’t sure he had the experience to lead the adult service. His colleagues convinced him that he did.

“After saying no twice,” he laughs, “I agreed.”

The rest is history, including the clinic’s highly successful Young Adult Services (YAS) program, one of the larger such programs within the network of the Connecticut Department of Mental Health & Addiction Services. Launched under his leadership, YAS serves young people who have aged out of the DCF system. It has grown from 20 to 80 clients, all with complex clinical presentations. Dr. McMahon also oversees two residential programs linked to CMHC-YAS. Today YAS receives referrals not only from DCF, but also from inpatient hospitals, courts, and community providers.

Especially in light of the current child and adolescent mental health crisis, a national emergency accelerated by the COVID-19 pandemic, does Dr. McMahon think that mental health care helps children, even those in very challenging situations? His answer: yes.

“Kids are pretty adaptive,” he explains. Long-term therapeutic relationships in particular can be effective. And, he notes, “Many kids have an ability to bounce back and cope with stress, especially if they have adequate support at home, at school, and from their friends. I think people have cause to be concerned about the impact of the pandemic on this generation of children. But kids generally do get better over extended periods of time.”

Dr. McMahon’s unique combination of skills—practitioner, administrator, researcher—has made him a treasured teacher and colleague in the Yale Department of Psychiatry, in which he has won two prestigious awards: the Sidney J. Blatt Award for excellence in clinical work, teaching, and research, and the Stephen Fleck Award for conscientiousness and humanitarianism as a clinician and an educator.

While he was working with Dr. Luthar and Dr. Rounsaville—collaborating on a series of research projects looking at mothers with substance use problems—his research took a more personal turn.

“Suniya (Luthar) was interested in the concept of resilience,” he explains. “She was trying to understand, as well as she could, what kinds of things led to children doing well and what seemed to be associated with poor adjustment.” With two children of his own, at the time Dr. McMahon was more than a decade into his own fatherhood journey.

“At one point during a research team meeting, I said—almost off the cuff—‘You know, each of these kids has a father, and we don’t know anything about their fathers.’”

Dr. Luthar challenged him to look at the research literature. When he did, he found almost nothing about the adjustment of men with substance use problems as parents.

The revelation led him to pursue a new research direction: fathers in drug treatment. They comprise a large but invisible group. One early finding in Dr. McMahon’s work was that fathers in local methadone treatment outnumbered mothers by a 2:1 margin. “This surprised a lot of people,” he recalls. He continued to conduct research on fathers in methadone maintenance and won federal grants to develop an intervention for men who wanted to become better fathers. Over the years, he has come to understand the men’s stories well.

“Most of them are non-resident fathers who live apart from their children,” he says, “but many are more involved with their children than anyone would ever guess.”

Many fathers in Dr. McMahon’s studies had traditional ideas of fatherhood. “They saw themselves as providers and disciplinarians, with less emphasis on caregiving, emotional support, and spending time with children,” he notes. Yet many fathers did stay involved with their children, often providing more informal support when they had the resources, rather than monthly child support or other formal requirements.

“Many fathers had a perception, not unfounded, that there’s a lot of bias against them in the human services system, whether it’s the welfare system, the family court system, or the treatment system,” says Dr. McMahon. “They perceived that they were usually viewed negatively by providers and professionals in terms of their role as fathers.”

One factor remained consistent across his research.

“They all said, ‘No one’s ever asked about these issues. No one’s ever talked to me about my role as a father. It’s never been brought up in treatment.’ We heard that repeatedly.”

Over the course of his career, Dr. McMahon has come to see fatherhood as a generational process. “My father had pretty traditional ideas,” he recalls. “He was a good father, but like many men, I promised to be a better father to my kids than my father was to me. And I believe my son is already doing a better job with his kids than I did with mine.”

“The thing I’ve learned,” he continues, “is both how difficult it is to change things across generations, but also how there is promise to change things across generations. Many of the fathers we talked to said they wanted to be a better father than their father was to them. I think unfortunately many of them came without the skills or resources to do that. But the promise is there, if people are motivated and have the resources.”

Despite his retirement, Dr. McMahon doesn’t plan to disappear from the field. He will continue to edit a monograph series on child and family policies and practice for Division 37 of the American Psychological Association. He has volunteered to help the new leadership of the West Haven Mental Health Clinic, and he has “some papers to finish.” Most importantly, he plans to spend more time with his friends and family.

After all his years of working with children, two are currently top of mind: his grandchildren, ages 11 and 9. He smiles broadly.

“They missed their February vacation trip with grandparents last winter,” he says, “so we have some making up to do."

Submitted by Lucile Bruce on December 21, 2021