A Need for Providers who Specialize in “Psychosis.”

This story is for the mental health providers or peer counselors who are invested in developing treatment for people who have experienced “psychosis” across diagnostic categories. I know firsthand that this can be achieved. I want to help other interested parties develop their own practice so that an important need gets addressed.

Maybe the reader can relate to me! I was hired straight out of college into work in the counseling field. I started to work with an adult mental health population at my second job at the age of twenty-three. Since that time I have been increasingly focused on how to make therapeutic engagement meaningful when working with people in “psychosis.” In the field there are many who will say or imply this is not possible. They may argue that the mental health system is the best we can do.

I believe uniquely talented specialists are needed primarily because the mental health system fails so many people. We need outreach specialists with lived experience who can meet sufferers wherever they are at to encourage them to seek out therapy specialists, competent in group and individual practice. The more people with lived experience the better! Even better we need a system of self-support to sustain people outside the system, like the hearing voices network.

 

***

            Working my way through graduate school, I can still remember struggling to get my footings as a professional counselor.

“Oh, you’re good,” said this vagabond homeless man who sticks out in my memory.

“What do you mean?” I asked perplexed by how he could affirm me with such confidence.

“Well, I can tell because you just asked me what was going on with my schizophrenia, like you really wanted to understand it.”

I did a little double take on this man standing before me. I couldn’t understand how when he lived such a deprived, sunburned, and sweaty existence that he could respond to this young, privileged and nervous person in front of him by trying to use support. I didn’t sense that he was doing this to butter me up. In fact, he was far more supportive than any of my friends.

I recall making an internal commitment to him on that day. Hence started my desire to learn about and heal schizophrenia. I felt I owed that man something for his kindness.

By the time I got my degree so that I was promoted to a case management position, I found it a wonderful opportunity to get a picture of what life was like for the schizophrenic clients on the streets, in the boarding homes, away from the clinic. It was not a pretty picture, but I reasoned that now I could provide a service to earn their rapport. Then, I could use my little theoretically informed counseling skills to get at their truth. In many ways, I did not actually know what to say other than, “Did you take your medication?” However, I tried and I was happy with the arrangement.

 

 

***

            In my personal life, I got really tired of being in and around my hometown. Sure I went to school in a ghetto was able to build up the rental history to take up a lease on a suburban flophouse with some acquaintances. Sure I fled that shelled-out place into a pad in the city. But, somehow this plus getting dumped in all the female relationships that I barely managed to make wasn’t enough for me.

 

***

            I switched coasts and accepted underemployment in a new city where I could pick up where I left off at understanding schizophrenia. Here, I really wasn’t expected to do therapy as I monitored well-tended housing for clusters of mentally ill adults, but I did anyway, much to the chagrin of my supervisor, who I often challenged about standard care.

It’s true the clients seemed to have it pretty good in the west coast city. The facilities I monitored were much nicer than the ghetto ones back east. But within six months, after another heartache, I took a promotion in a pilot program setting up services in a notorious section eight housing authority complex.

I have to admit as a kid who grew up in a private school, the streets and the ghetto, much like schizophrenia, had always been a lure for me to wrap my head around. I set up shop in a notorious section 8 housing project and got some real exposure to what people who end up homeless and destitute due to schizophrenia have to deal with. Let me tell you, it wasn’t a very safe holding environment.

Six months in, I was talking with a resident I trusted very dearly. He had once told me who the for-real drug kingpin was about the complex. He paused a minute and said, “You know, one time we had a person like you work for us before, someone who really cared and fought for the residents. That person, ended up losing his job and having to come and live with the residents. I just don’t want that to happen to you.

I looked at this schizophrenic resident who worked a minimum wage job. It was true that since I had leaked stories to the media about some of the suspicious violence and fear that the residents were subjected to, that I had been picking up on random threats and feeling very unsafe.

 

***

Within a week, things escalated into my personal life. I got threated by someone who I believed had the power that he claimed to have if I ever did him wrong. I started getting interesting takes on mainstream movies. I tried to get to the Canadian border to seek asylum and ended up getting separated from my car. Eventually I surrendered to police in a ditch while ascending a mountain pass. They took me to State Hospital where I resided in barracks three months. Just when I was starting to come to terms with this ridiculous black market sea of poverty I was cast into, I was transferred to the most chronic ward where the overcrowded conditions were comparable to the worst of what I’d ever seen.

I spent two years after that trying to overcome homelessness and underemployment in a full blown psychotic episode. I had come to figure that my father was a famous Irish mafia figure. After three months on the streets trying to fend for myself, the only job I could obtain was at an Italian Delicatessen. I’d had to move again to get that job, an apartment, and help from my Mafia family. While I worked at the Italian Deli, my life was hijacked by poverty, rich, drug-using, teenage bosses, and conspiracy that felt relentless and never-ending. I could barely afford to feed myself if not for the support of my Irish Mafia family. When I returned to taking medication, I was able to climb out of this pit.

To even get back into mental health field, I had to put a just barely attained stability on the line. I was working a new career with developmentally disabled individuals, working seventy hour weeks, (part-time at the deli) but was financially independent at least. The ideal mental health job finally came up, but I had to take a considerable risk.

When I failed to attain fulltime status, falling short of impressing a hopelessly classist supervisor, I could not collect unemployment and had to do something fast. Luckily, I landed a low-paid internship, a part-time gig back at the Deli, and, most importantly, a part-time job at a hospital with a future in it.

 

***

            What I had learned about schizophrenia at that point was that most people had absolutely no interest in it. As a mental health patient, I found that no one was any longer interested in my story or what I had to say. The five-word phrase, I had been trained to use, “Tell me more about that!” was replaced with a famous five-word question: “Did you take your medication?” Nobody believed a word I said no matter how real I was being. And no longer did anyone care what I was subjected to.

For example, to get to work and back at the Italian Delicatessen, I had needed to bike twenty miles and catch a two-hour long train ride, daily. Nobody had cared that I was in back pain through the all of it. I was still the last to go on break. I was blamed and framed for anything that went wrong. There were constant threats against my job. There had been no acknowledgment for my efforts, only complaints about my service from upper-class people, and punk-ass ridicule from my teenage co-workers. Finally, I agreed to take medication.

How was I to transition from being treated like that—from being locked outside the ward mental patient in sub-zero temperatures freezing like the cow patties in the field while the staff returned late from their lazy lunch break—to being a fully entitled therapist? Finally, I could understand why someone who was even a little bit interested in what it meant to be a schizophrenic was a good worker.

 

***

            To be honest I knew I was not a good worker for a little while. I was just barely-making-it, overworked, highly insecure, and protecting myself. When I earned my way back to working with people individually, I was a little better at getting rapport and experimenting with helping out with schizophrenia. I heard a lot of, “Oh you’re good,” comments. At least I knew enough not to approve of the word schizophrenia. It took me six years and a number of side jobs to get my license and be fully grounded in a staff position.

Then it was time to take another risk.

 

***

            Throughout the training for my license, I had not disclosed to anyone what I had been through. Always too busy to make friends, most colleagues tended to think I was younger than my stated age, and perhaps a little over-anxious about making rent.

I soon found among licensed marriage and family therapists that most presumed that there was not much value in treating individuals who had schizophrenia. Many forced into working with them characterized them as just lazy and unresponsive to instructions. Those who picked up on my insecurity said maybe there was a future for me in providing “just” case management services. I often heard it said, that it was debatable whether there was effective treatment. Sitting in licensure lectures, we were taught that in coming across a person with “psychosis,” the standard of care was to hospitalize and refer to programs.

When I passed those sucker licensure tests in spite of my learning disabilities, I was tired of leading groups full of good people who had experienced “psychosis,” and not talking about what was really going on. I decided to get to work creating my own treatment strategies for schizophrenia. I had heard about the hearing voices network movement in Europe and decided to create a curriculum that deconstructed “psychosis,” and emphasized recovery skills. I took WRAP training, and finally started to experiment using my own story with all its minute details.

 

***

            Learning how to navigate the profession as an identified schizophrenic has been full of challenges. A co-worker found a copy of my curriculum, and turned it over to the manager with grave concerns. Another left insulting cartoons on my desk. I had occasion to hear myself being referred to as, “Crazy Tim!” I ignored these and persisted. Eventually, I took a job where I was identified for two years, advocating for change in the county. My name and condition spread like wild fire throughout. In team meetings, I was accused of being against medications. One person who defended me end up getting written up and eventually fired. When I returned to my hospital job, my primary boss, who, thank god, has been supportive of me throughout, once let me know that when I went over to the county’s ward to run groups, that I had little red dots following me on my forehead.

My groups, my popularity among people who I help, and my own little paranoid vigilance has helped me survive the past nine years and thoroughly develop my own eclectic theoretical approach towards helping who I prefer to call message receivers in group and individual settings.

Things have gotten a lot less hostile for me at work. I now know what to do to help out that vagabond homeless man I met two decades ago. Additionally, I wrote a grant a proved that message receivers could be paid as outreach workers, tell their story to providers, and transition to being group leaders, and mental health professionals while they attracted and motivated individuals who might not have otherwise been motivated. I serve on the board of the local hearing voices network, who also repeatedly proves that this work can be done on a regular basis. Perhaps, one day, other interested parties can get to where I am at without having to face quite as much pain. It is a very sorely needed specialty!

 

Author: Tim Dreby

I am an award-winning author and practicing psychotherapist

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