Hi everyone! Welcome back to another episode of the NEGOTIATEx podcast . Our guest today is Dr. Kenneth Dekleva . Dr. Ken is a practicing psychiatrist in Dallas, Texas, and a senior fellow at the George H.W. Bush foundation for US-China relations. He has also served as a US diplomat and regional medical officer (psychiatrist) with the US Department of State overseas.
Apart from that, Ken has served in a leadership role as director of the US State Departments worldwide and the Diplomatic Mental Health Program. Ken has been published on several platforms, including the Diplomat, 38 North, Cipher Brief, and Journal of the American Academy Of Psychiatry and the Law .
He has also been interviewed by various news outlets, including CNN, NPR, and Voice Of America.
Nolan starts us off by asking Dr. Ken about the difference between psychiatry and psychology. In reply to his question, Ken highlights that the difference is mainly based on the practitioner’s training.
While a psychiatrist goes to medical school for four years and then does four or more years in fellowship training after they get their MD degree, psychologists get a Ph.D., which can take anywhere from four to seven years. Then they do an internship where they specialize in different areas of psychology.
Ken further mentions that there are different areas of psychology, such as clinical psychology or child psychology, or industrial-organizational and that he mainly works with clinical psychologists.
Ken claims psychologists and psychiatrists are not supposed to be negotiators for various ethical reasons. However, his observations over the years suggest that a good negotiator should always be humane and curious about people. They have to like people and be good listeners.
They also need to have lots of soft skills and openness, curiosity, tolerance of ambiguity, patience, and cultural sensitivity. That’s because they may be negotiating with people who don’t look like them or who are from different walks of life or different cultures, ethnic groups, or countries.
He then shares a story where he convinced a mentally ill woman to sign a plea deal by building an environment of trust with her, which beautifully encapsulates the importance of trust and sensitivity in both negotiations.
Next, Ken states that good listening skills are crucial in psychiatry because psychiatrists need a lot of empathy in hostage negotiations, and good listening skills can help one develop empathy for the other.
Good listening skills and cultural sensitivity are also required in forensic psychiatry because the practitioner often has to interview, evaluate, write reports and testify about people who have done terrible things. And these skills can make the process easy.
When asked what makes a negotiator successful, Ken shares the story of his colleague, who ensured the safety of some hostages by providing them shelter in his apartment.
It was a difficult hostage negotiation where people had escaped a violent situation and were too terrified to return to their homes. When Ken’s colleague (the regional psychiatrist) was informed about the situation, he called Ken (the director of mental health) up. He said he wanted to help those people by letting them stay at his apartment for a few days until they found a safe place.
Now, many professional psychiatrists would consider this a boundary issue, but Ken trusted his colleague’s judgment because it was the right thing to do, even though it meant working around bureaucratic rules.
So, the lesson here is always to do the right thing regardless of the situation or consequences.
Ken, Aram, and Nolan discuss a lot more on this episode of the NEGOTIATEx Podcast. Write to us at team@negotiatex.com and share your thoughts on this very informational podcast episode.
Thank you for listening.
Nolan Martin : Hello, and welcome to the NegotiateX podcast. I am your host and co-founder Nolan Martin, and with me today is my good friend, co-host, co-founder Aram Donigian. And then Aaron, we got a pretty important guest today.
Aram Donigian : We sure do.
NM : Yeah, let's go ahead and just jump right into this. Wanna introduce our guests?
AD : Great folks, thanks. We are joined today by Dr. Kenneth Dekleva. He is a practicing psychiatrist in Dallas, Texas, and a senior fellow at the George H.W. Bush foundation for US-China relations. From 2002 to 2016, Ken served as a US diplomat and regional medical officer psychiatrist with the US Department of State, mostly overseas, and that included assignments in Moscow, Mexico City, New Delhi and Europe.
He also served in a leadership role as director of the US State Departments worldwide and Diplomatic mental health program. He is published in the Journal Of American Academy Of Psychiatry And the Law, The Hill, The Cipher Brief, 38 North, and The Diplomat, and has presented numerous times in both academic and US government settings in the field of leadership analysis, uh, which includes profiles of Xi Jinping, Vladimir Putin, and Kim Jong-un. He has been interviewed by CNN, NPR, Voice of America and others. Ken, thank you so much for taking time outta your very busy schedule to join us today.
Ken Dekleva : Thank you, Nolan and Aram for having me, it's a pleasure to be on your programme.
NM : Let's just start off with the, with the softball toss up to you, Ken. What is the difference between psychiatry and psychology? You know, how are they similar? How are they different?
KD : The training is different. Psychiatrists go to medical school for four years and then do anywhere from four or more years in residency and fellowship training after they get their MD degree whereas psychologists, typically the ones who I work with and have worked with both in the government and in academia, get a PhD, which can take anywhere from four to six or seven years. And then they do an internship where they specialize in different areas of psychology. And there are different areas of psychology as well in their PhD, such as clinical psychology or child psychology, or industrial organizational what's called IO psychology. So, they may follow different paths. The psychologists I typically work with were clinical psychologists.
NM : Okay, great. Thanks for clarifying that up front. And then what we'd like to kind of do at the beginning of the podcast kind of warm up our guests is we want to talk about your path to get where you are today. So, what key developmental milestones or other key influencers have you had in your training to become a psychiatrist?
KD : Let me talk about the real influences where I went to medical school in residency in terms of preparing me to be a physician. And I'm very proud of being a graduate of UT Southwestern, both in medical school and training. And I worked there during the earlier part of my career for almost a decade as well. It's a terrific medical school, I had terrific experiences there and wonderful teachers that really prepared me for what I did later, both as a forensic psychiatrist and as a physician diplomat with the US Department Of State in the current work I do as a practicing psychiatrist. But the key influencers, I would really sort of touch on the three areas of my career. The first one would really be in the earlier part. The forensic work was the late Dr. Jim Gregson, who was a legendary forensic psychiatrist in Texas, and really an expert in all areas of forensic psychiatry, but mostly criminal psychiatry.
KD : And that's the area I focused on evaluating criminals, who were charged with very serious offenses, such as murder, capital murder, aggravated assault, robbery, rape, child sexual assault in various areas of, of their cases, either for competency to stand trial in some cases insanity. And in other cases, looking at sentencing, either aggravating circumstances or what are called mitigating circumstances.
So, I did that part of the work and Dr. Gregson was very influential and was kind of a mentor to me when I entered that field in the area of leadership, which I got into leadership analysis, such as the work you mentioned in the very kind intro. I was really honored to work in, in the mid nineties, it really changed my life and my career with the late Dr. Gerald Post, who was a psychiatrist at George Washington University at the time where he taught for about three decades. But earlier he had been a psychiatrist at the CIA for 21 years where he founded a center that specializes in leadership analysis of foreign leaders.
And he's really the founder of that discipline as we know it today. And he was deeply influential in meeting him, it really changed my life.
And diplomacy, I'll highlight my dear friend and colleague and mentor Dr. Esther Roberts, who served with great distinction in the state department and is now a, on the faculty at George Washington University. She served for about 28 years and was one of the founders of the mental health program that I served in. And what may be of interest to your listeners is one of her first major duties that set her career up was she was one of the three US government psychiatrists that traveled with the 52 released Iranian hostages in 1981 on January 20th when Ronald Reagan was inaugurated as president.
These hostages had been in captivity for I think 453 days and Dr. Roberts and our colleagues traveled with them from Algiers, where the plane landed to refuel to Wiesbaden and Ramstein air force base in Germany, where the hostages were medically treated and debriefed by this team and by others, those were huge influencers, people that I knew personally.
The other influencers that for your listeners intellectual influencers have been in the areas of forensic psychiatry and hostage negotiation would be folks like former FBI, special agents, Gary Noesner, who you had on your show, a wonderful podcast. And the writings of another FBI agent Chris Voss, and other writings by Mattia Schraner in Switzerland and Laura Combabaire in France, and a teacher who I took a course from and learned at Harvard, Prof. Michael Wheeler and, and the writings of Giandomenico Pico, who was a brilliant hostage negotiator with the UN in the late eighties and the early nineties. Those are my biggest kind of influencers.
AD : Thank you for that. And it's, you know, insightful to go back and, and look at the works of the folks you mentioned. And I hope that in the time that we have, we can dig into the role of negotiations in each of those kinds of aspects of your career, forensic psychiatry, the leadership analysis piece and the diplomacy.
I just certainly, you can imagine the application in each one, maybe we can start with the forensic psychiatry piece and just ask in that aspect of life and that part of your career, what were some of your observations around human psychology that gave you maybe perspective into negotiation and key considerations for negotiators?
KD : Yeah, I, that's a great question. I also wanna point out that by and large psychiatrists and psychologists aren't negotiators, but we provide support to negotiators. There are complex ethical reasons why a psychiatrist shouldn't be a negotiator with, let's say a hostage rescue unit. Although in the past, in the seventies, there were psychiatrists when this type of work was being developed, that did that. But there are ethical issues because of the risks that you may be negotiating with someone for the purpose. You know, there, there may be a SWAT team that has to take other actions while you're negotiating, and that's problematic ethically for a physician.
But I had the fascinating experience at a conference in the nineties of meeting Frank Bolts, who was a negotiator who started one of the first negotiating units with the NYPD with the police department in this country.
And he gave a talk and it was fascinating. And I said, can I buy you lunch and a beer? And he was very open and warm and friendly. I was just a, a, nobody, a junior psychiatrist among thousands of people at this meeting. And he said, sure. And I asked him, how did you pick your team?
And this is what's important. I think for your listeners, what makes a good negotiator? And what I've seen with people I've worked with and observed is they have to have curiosity about people. They have to have a certain type of humanity. They have to like people, they really need to be good listeners. They need to have lots of what we call soft skills and openness, a curiosity, a tolerance of ambiguity, lots of patience and cultural sensitivity, because they may be negotiating people who, who don't look like them, or who are from different walks of life or different cultures, ethnic groups, or countries, and Bolts certainly had that in spades, that's what made him so great, but he hired people like him.
So, I think those kinds of characteristics are really important. It's really interesting when you take courses from these negotiators that I've mentioned that teach seminars and courses, they run people through a lot of tests. And one of the things I learned when I took those tests about myself is I'm not a great negotiator, I'm good at understanding negotiation and I'm good at supporting negotiators, but psychiatrists are too accommodating to be negotiators in the most difficult challenges, negotiations, because we wanna get to accommodation to yes, if you will.
Now, have I negotiated in my work? Yes, I negotiated in, in the world of forensics with defendants to help them figure out a plea bargain, or I negotiate with patients every day. Trying to get patients who don't want to take the COVID vaccine to take the COVID vaccine, especially when it first came out at the beginning of the pandemic.
KD : And even now we all engage in daily negotiations as clinicians. But let me share a story for your listeners of a forensic negotiation, which was really kind of striking for me. I was one of several psychiatric experts, uh, back in the nineties on a murder case and the young defendant, a woman had no prior record and had murdered her child.
And so we were asked to assess her for insanity at the time of offense, as well as competency. And I spent, I'm relying on my memory, about six hours in separate interviews, reviewed all the records as did my other colleagues who reviewed them for the defense and the court, I had been hired by the district attorney. So, I was the state's witness, a potentially threatening person whose opinion carried a lot of weight against her. She was facing a possible life sentence because of the nature of the offense.
KD : So, I met with this person. I submitted my report to her defense attorney and to the DA and into the court. And then I waited because these things take a long time. And what happened was I sort of followed the case loosely and I got a phone call. One day I was working in the jail where I work in Tarrant county. I worked for several years in the jail, taking care of mentally ill prisoners. And I got a phone call from the DA saying, we need you in court right now in Dallas. I said, well, I'm not in Dallas. I'm an hour away. And I need, if I'm gonna be in court, I have to go home and put a suit on. So, I'll be there in an hour and a half. I got there as quickly as I could. I said, what's the problem?
KD : And they said, the defendant won't sign the plea bargain, unless you're there. I said, she has her own lawyer, who's a brilliant lawyer. She has her own expert, why don't they get her to sign it? And the DA said, we don't know she wants you. So, I drove, showed up in the courtroom. There's a little holding area. And there's a room full of observers, 200 people. The media was there, the jury had been picked and everything was gonna start depending on whether she signed the plea bargain to go to prison, instead of taking the risk of going to prison for a life sentence, or going to a mental hospital for an indefinite time.
And we walked in the room and I asked the permission of the attorney and the expert and the defense and, and the DA, is it okay for me to speak?
KD : And they said, yes. And the other expert was there and I said, why don't you sign the form? And the patient, the defendant patient, cuz she was a patient in the jail, said, I'm scared. I said, what are you afraid of? And she was shaking. And I said, your lawyer has talked with you about the deal. You understand the deal? She said, yes. She said, I'm afraid I won't get help if I go to prison. And I said, your expert and I will talk to the appropriate people to make sure that your medical records are sent to intake so you get the help you need. The patient turned and said, thank you. And signed the form. And then I drove home. This was very unusual. It heightens, it shows the power of what psychiatrists and psychologists called transference.
Something happened in that connection with this defendant during those six hours that I had spent with her many months previously that made her trust me. I'm not even sure why to this day, but trust me, she did. And then she signed the agreement which allowed her to get out of prison. I think she got out shorter than 20 years for good behavior and, and then could resume her life so that shows some of the uniqueness, it's a very unique case in my history.
AD : Oh, absolutely. To play back the six hours to think about the nature of the trust and the environment you must have created with her to have her so reliant kinda on your word and that your word was enough to convince her to sign.
KD : Yeah, it was a very, it was a unique, a unique moment in, in my career because normally the state's expert is a hostile, potentially very threatening expert because there was a courtroom full of people and the DAs were ready to take her to trial and they were seeking a life sentence, a 99-year sentence by painting her, not as mentally ill, but as a severe personality disorder as a psychopath, those kind of labels and the risk to her was very real.
AD : And Ken, would you say that you talked about the qualities in picking a team, you know, people that are curious about other people who are good listeners with ambiguity can manage it well to have some cultural sensitivity. Does that apply to psychiatrists as well? Are those things that you try to practice?
KD : I would hope so. I would certainly hope so, especially in our field physicians overall, but psychiatry, we need good listening skills. We need a high tolerance of, we need lots of empathy in hostage negotiations, Gary Neosnner, and Chris Voss talk about tactical empathy, right? So, you really need that in difficult negotiations with difficult people.
And you need that in forensic psychiatry because you're often evaluating and interviewing and writing reports and testifying about people who have done horrible, evil things. Some people can't do that easily for whatever reason in my unconscious or something, I found I was able to do that.
AD : Yeah. I can certainly appreciate the challenge with being able to do it, to do it authentically and yeah. And the ability to, you know, be able to practice it when you need to, it would be so difficult.
KD : I'll share another story, if I may, very briefly with your listeners. I had another situation as a clinician where I was treating a refugee patient, from a war-torn country, a child, it was from Bosnia. And I speak fluent Bosnian because my parents were from the former Yugoslavia. And I had some emergency calls in the hospital where this small child who had been severely traumatized during the war in the early nineties, clearly needed help.
And so I set up an appointment and then I got a phone call and I said, we can't come to the appointment, but please come to our house. We want to invite you for lunch. Now, in my training in American psychiatry, we don't do that. That's what they call boundary issues. But I know that culture well. And I realized that if I didn't go there and let them ”check me out”, the child would never come for treatment.
So, I went there and there was this huge spread I love, I love Bosnia and food. If I had been stationed in Bosnia, I'd be 40 pounds heavy.
NM :
KD : They had food. They were muslims, so there was no alcohol, but they had food and the whole family was there, the extended family. And they asked to see pictures of my family. They said, why didn't you bring your wife, your child? I said, they're busy, but I had to show pictures. So, I had to show who I am and we ate, I spoke in their language, no one in the room spoke English. And then at the end, an older gentleman who was the grandfather of the child, he was in his late fifties, he was wearing a sports coat. He came up and put his arm around me and said, can I have your card? And I said, of course. He said, “I will make sure that the parents bring my grandchild for treatment”.
So, to make a long story short, this patient got better. And the last I heard through the grapevine, the patient graduated from college 20 years later and is married and has a good job.
AD : Wow! What a wonderful story. And from a cultural perspective, my own heritage is as Armenian and having spent time in Afghanistan and Nolan spent time overseas too. The idea of food and language is two ways to connect with people of a different culture and either show appreciation and show interest and to learn it's, I find both of those as being just kind of key pieces. So, thanks for sharing that.
KD : Thank you.
NM : Hey Ken, thanks for sharing about everything regarding the forensic psychiatry part and thanks for those two great stories. We definitely appreciate it. I know during our pre-call we had spent some time talking about your senior US diplomat and regional medical officer time that you spent overseas.
And so, I wanted to learn more about, you had mentioned the kidnapped hostage scenarios and kind of how you were involved with the treatment of those individuals when they came back. Could we talk a little bit more about that and, and kind of the different aspects of psychiatry and how it may be applicable to a negotiator?
KD : Yes, our role was to provide support both to the negotiators at times, and to provide support to the victims once they were returned. So, understanding of the victimology that goes on in a hostage situation and the type of symptoms they may experience is very important. I was privileged to attend both teach in the Department of States course that they teach diplomatic security agents on all the complexities of hostage negotiation and working with victims and working with different countries and the laws and bureaucracies involved. And also to be an attendee and a speaker at seal Psychology Conferences organized by a branch of the US Military that specializes in what's called seal training and seal psychology. One of the things I learned in my leadership role is that there are a lot of stakeholders in complex negotiations like that. I had a case in, in a country that I can't talk about, but I can tell you when I went over to have the meeting, there were about 40 people in the room from different bureaus, offices and agencies that all had some kind of stake, I was the medical person.
KD : So, the complexity and the higher order effects of complex diplomatic and hostage negotiations are really dramatic and profound, but they're quiet and behind the scenes. Many of these cases never make the news and they're not supposed to. Others were on the front page of the newspaper, when the hostage was returned.
The most challenging thing was dealing with the patients who we evaluated because we had to help them with their once they were out of a hostage situation, you had to deal with the patient, the patient's or victim psychology, which is many of them wanted to stay in the country where they had been kidnapped and, and the risks were way too high.
So, you had to really work on skills to persuade them that that might not be the best thing, or in some cases where they had been criminal victims, they would have to go back to testify.
KD : So, my work as a forensic psychiatrist was very helpful in helping them understand those processes. Especially in a country where they had been victimized in the courtroom, you don't want the victim to be secondarily traumatized, what's called secondary traumatization. So, in one case, A diplomat’s wife who had been held at gunpoint in my region, I persuaded them. They were gonna leave the country cuz their assignment was up. But I said, you should not go back into that courtroom, that's not a safe place in that country cuz they don't have rule of law. You can testify in camera from your office in the Department Of Justice or the FBI or the Department Of State. You can testify in camera, back to that country. They can be the video back. And I think that's what ended up happening.
NM : I just wanna kind of dig into that a little bit deeper, cuz I think as a psychiatrist and you're observing negotiators in practice, I'm sure that you have some pretty awesome observations as to what makes a negotiator successful or maybe sometimes that they were unsuccessful. I mean, I know we talked about soft skills already. Was there anything else that just strikes you as like, oh man, when he or she was able to do this, then kind of noticed either a difference in how the negotiation was going or anything like that. I know that's a big question.
KD : I think what you have to do is what I learned and I could talk generally about the thematics, but not the specific country, but when I was director of mental health, one of the psychiatrists in the field had to deal with a very dangerous, difficult hostage negotiation where people had escaped from a violent situation and they were terrified.
And while they were too frightened to go back to the home, the apartment where they were victimized. So, the regional psychiatrist for that area called me, I was in DC and said, I wanna help these people until they get a hotel or something. I'm single, I have a large apartment, they could stay with me for two or three days. Again, normally you wouldn't do this cause they're boundary issues. But I trusted my colleagues' judgment. And I told them that I trust your judgment, that you're doing the right thing for the victim and for the patient.
And that worked, that worked out okay. They were able to do that until they got into a hotel where they felt safe and then got different housing where they felt safe. So, doing the right thing sometimes means working around bureaucratic rules. I worked on a situation at one embassy where the most important thing for these victims is to reconnect when appropriate with family members and still let them know they're safe. This is the pre-cell phone that I'm talking about now.
So, we took care of the released hostages at an and used an embassy apartment, which was empty. And we plugged the phone in, we got them a phone, so they could call home, uh, using the embassy switchboard. And one of the telephone people then said, well, the, when the person was repatriated a few days later said they didn't pay their bill. You know, that sort of thing. So, I had to say, let's not worry about the $10 phone bill here, we took care of the hostage to the victim and did the right thing. So, doing the right thing is critically important. Always.
NM : Hey everyone, Nolan here. I have to jump in and end the conversation right here. If you haven't already please rate, review and subscribe to the negotiated podcast, it definitely helps us out and definitely helps us get this podcast in front of other leaders. Thank you.
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