Five Considerations that Help Keep Groups that focus on “Psychosis” Inclusive:

I believe with fervor that having survivor-led group therapy that redefines “psychosis” is missing in the system. Over the last nine years I have been leading what I call special message groups in multicultural settings. I have found not only that such groups can be run safely, but that they have the power to transform lives. However, I do have to admit that when it comes to kicking people out of group to maintain group equilibrium and safety that I believe there are a few things to consider first.

First, I believe that a group leader needs to be prepared for the fact that mad people show up in very different ways. Group facilitators need to be familiar with and recognize a wide variety of presentations or manifestations. Perhaps group members may feel like they are being mocked by others in the group via illusionary ideas of reference, or even controlled by them. They may code up their language for protection. They may treat the facilitator as if the facilitator can hear the same voices they hear. They may not believe in spite of stories shared that the facilitator has experienced what they have. I myself have prepared myself for these challenges by attempting to better define what “psychosis” is. I have reconstructed a definition that can sync up a wide variety of what have historically been defined as conditions. I believe if the leader is not prepared to accept all presentations, people will not feel safe talking about their experiences. I believe that intolerance for people who show up in a different or what is perceived as a difficult manner can be extremely hurtful.

Second, I believe the facilitator can take measures to help train the group to be brave and tolerant of each other. I frame coming together with the specific purpose of sharing untold stories to be an oft neglected privilege that has unfortunately been denied because the “they” experts say it is not safe. I am always willing to start out with my own story. I advocate for a spirit of risk taking by acknowledging that people in the group may be so used to dangerous or distressing experiences that guaranteeing safety would be a disservice. I also might point out that despite what “they” say, this is a practice that has been an effective movement in different countries and that I have done for a long time. In my mind, these kinds of comments are treating the “set of symptoms” as a neglected culture that is subjugated. Moreover, keeping the group focused on the things they have in common with each other in the earlier stages of group development can help. Also strongly supporting alienated individuals also helps train the group to be more tolerant and can avoid many problems that come up in a group discouraging them from expecting a trouble maker from getting kicked out.
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Writing for Mental Health: Six Basic Considerations

I like to think that I could recommend writing to some other people who have been subjected to a diagnostic labeling process that diminishes their hopes and potential. Indeed as emotional tension pulses through my back and appendages, I have found few other outlets that are there for me like the mixing and mastering letters.

Sure, I have been sent to a shrink for being who I am. Sure, I have been buried in institutions at different points of my life. Indeed life on that trajectory has filled me with loss and lack. But when I’ve found myself incarcerated immobile, I’ve been blessed to find value in defining it. Initially as a teen, I found  appreciating expressive words through music got me started. The more I switched from song to verse to story, I found the problem-solving that takes place in the editing process satisfying. Indeed for me there are few other outlets that rival writing in terms of learning about life and wellness.

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Letting the Public Know I Suffer from Schizophrenia

When people seek mental health services from me, I routinely break what was once a cardinal sin to me early on in my recovery; I review my diagnostic history. I do this with love in my heart to help inspire recovery, however, in the process, the “s” word, “schizophrenia,” will bubble up.

I do this habitually in the outpatient program I work in. I have done this by redefining the medical model definition of the word so that it more accurately reflects the shared internal process that we with “schizophrenia,” or “schizoaffective,” or “bipolar,” or “depression,” or hosts of other diagnoses experience.

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The Special Messages Project

LEARNING QUESTIONS

Learning Question One: How do in-reach efforts that connect residents of board and care homes, single room occupancy (SRO) hotels and unlicensed boarding houses to social and recreational opportunities in and outside of the facility reduce social isolation and improve quality of life for isolated adults and older adults with serious mental illness?

To answer our first learning question we used several strategies to obtain participants who receive special messages from SROs and Board and Care homes.   Initially, we envisioned providing individual services to people who responded to flyers and presentations in board and care homes and SRO hotels; however we found we had to adjust our strategy.

Instead our strategies included:

  • Passing out flyers to locations where residents in these locations are likely to frequent;
  • Direct emails to the board and care and SRO facilities;
  • Partnering with three social service agencies (PREP, East Bay Recovery, and Bonita House) and providing presentations and groups at those sites;
  • Partnering with Gladman Hospital, a long term inpatient settings, and providing presentation and groups at that site;
  • Outreaching to the homeless population;
  • Presenting at Saint Vincent De Paul Shelter, the Pacific Care Senior Center; the Fairmont Partial Hospitalization Program, and to Villa Fairmont Inpatient Hospital;
  • Coaching board and care staff;
  • Working with families.

The Program Manager pointed to safety issues associated with marching directly into board and care homes and SRO settings and providing groups. Indeed our trainees were transitioning into peer support experiences and promoting safety was paramount.  Instead, we initiated the process of gaining visibility in the community and training via general outreach. Next, we outreached to the homeless and practiced using our stories and strengthening our presentation skills. Once we started presentations and got invited to conduct groups in more staffed and protective settings, the trainees ran groups and initiated one on one relationships with individuals who were receptive.

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Towards More Honest Ways to Teach Counseling Theories

I’d like to think that if therapists like me who have been farting around with psychotherapy for twenty years or so, might be able to improve the way counseling theory is taught in graduate school. Ideally, I would like to support the development of theory that address social ills. I have found myself feeling this way when I think of all the different misconceptions that I have endeavored in over the years. Now that I have established my niche and am advocating for new movements and theories that make most sense to me, I am finding myself wanting to help budding therapists learn how to conduct the art of psychotherapy in ways that help solve pressing issues, not just apply a scientifically proven technique or pass a test.

I think psychotherapy has made a break through to some extent that doesn’t get talked about. More and more theory is being constructed that help therapists solve problems rather than exhibiting panacea proclamations. I consider panacea theory to be what I was taught in graduate school: in its most postmodern form it includes narrative and solution focused therapies. Panacea theory was often remiss to really address social ills as they exists in agencies and on the ground. I think the onset of what I would call problem-centered approaches began with movements like DBT and Motivational Interviewing.

 

Problem-Focused Therapy instead of Panacea Therapy:

And I think if we look at what works about the problem-focused therapies that already exist, we can learn a lot about not only about how to solve real social problems, but also how to create theoretical elements that actually help teach other therapists in ways that enhance their art of psychotherapy.

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When Mad People Become More Mindful of Their Culture

I am convinced that amazing growth can occur when mad people come together and share their mad experiences in a safe and inclusive arena. Over the past eight years, I have led group therapy and trainings that go towards mad experience to explore it further. I have found that in listening to very unique mad stories that cultural themes start to emerge from vastly different kinds of experience. If each kind of mad experience is like a letter in the alphabet, put them together in vastly different lives and the likeliness of unique experience becomes immense. But helping people identify mad experiences and cultural themes in themselves and in others has led me to conclude that in reality we belong to an oppressed culture.

Once participants in groups that I have led learn that they belong to what I suggest is a culture, they start to look at their own stories in a new light. The level of trauma decreases and the flexibility and social functioning increases. In effect, I am convinced that learning more about other peoples’ mad experience and cultural themes in general has many positive effects.

 

Creating Safety and Inclusion in a Group:

For years I operated groups without delving into the details of madness. I concealed my own mad experiences, reasoning that I was not in a safe climate. I had a paycheck to earn. However, once I became licensed, I was introduced to WRAP. I started to take the necessary risks and found not only that there was a whole world of good that I had been missing out on. I was wrong about the safety issues in the group. I found the experience of defining madness with the mad to be inherently safe, but have developed and documented my own style of keeping things safe.

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Three Ethics to Consider when Making Money off the Mad

Making money off the Mad is not a privilege to take lightly when one believes in recovery.  Many of the Mad in the system, depending on how much experience they have, will presume you’re going to treat them like a commodity or property as many provider-folks have done previously in their history. I believe that a large part of gaining trust involves demonstrating that the best interest of the Mad person needs to honored above and beyond the money made.

When I first set my eyes on being a Mad-Recovery-Provider about twelve or thirteen years ago, I saw a lot going on that was not honoring this principle. The level of alienation I felt between myself and other providers was very high. I became effective at managing this aspect of the therapeutic relationship and achieving trust.

As time has moved forward and I have seen the amount of recovery lost to unhealthy clinical families, failure of providers to collaborate, and interagency and interdisciplinary infighting, I have changed my perspective.

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Issues that Divide the Mad Community

As a psychotherapist who works with other Mad individuals in an L.A. county facility, it seems to me that the wider Mad community is not always aware of the diversity that exists within. While I am grateful for every person who has survived in spite of the limits of therapeutic environments available to many, rich and poor; survivors seem to promote what has worked for them without consideration for what other Mad individuals are dealing with. Many of us who have survived may fail to see the privileges that we have that have enabled ourselves not to get sucked into the institutions. We may think our way of making it is the only way. We may take for granted what we have used to survive. And we may not always learn the diversity lessons that we need in order to be there for our brethren.

Historically we are divided by DSM labels and social inequality and we may easily reinforce those divisions without knowing it.  Some of us may consider ourselves members of a spiritual emergence narrative rather than a schizophrenic episode; many even argue that these are separate conditions requiring very different treatment. Others in recovery profess safety in a functioning bipolar community rather than among individuals who are genetically impaired with schizophrenia eugenics.  Some want to divide up into individuals who hear voices verses those who are just delusional. And then there are the individuals who evade intrusion by coding up their words. And of course differences in heritage, class, gender and relation to historical trauma are likewise things that many survivors may not completely acknowledge. And still further, those who are wrapped up in the current debate in the Mad community over the use of medication run the risk of dividing us further without acknowledging the diversity of peoples experience and trauma.

The claim that I really object to is: this works for me, therefore it must be what everyone else needs.

Demands for Inclusion in the Movement: Continue reading “Issues that Divide the Mad Community”

Shortcomings of Evidence Based Practice in Community Mental Health: Part 2

Looking further at evidence based practice, I want to use professional experience to look at how putting-the-cart-first treatment translates into wasted public dollars and second class services. In this article, I take myself out of the State Hospital, and insert myself thirteen years later in the ranks of the mental health workers.  Not only are we perhaps wrongly trained in the universality of counseling theories (as part 1 on this series suggests,) but additionally we are the rank and file that get hired into local systems that use fidelity measures to promote proven recovery practices.

Much like with economics, it can seem to be widely presumed among administrators that recovery services can only transform via academic trickle down guided by research. I contend that this reductionist view is self-serving to the power structure not taking into consideration the nuances of local culture and recovery itself. In this article—part two, coming at you from my work in Shy Town, Illinois, I am here to reflect opinions of the sometimes underestimated rank and file. While administrators depend on evidence that a practice will work, the potential for doing damage and being wasteful rises exponentially.

I have seen evidence based practices in community mental health perpetuate myths, stigma, unstable relationships, and limit healing.  They may be used to fuel programs that are chasing money and more concerned about silos and statistics than the community.

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A Psychotherapist Reflects on Shortcomings of Evidence-Based Practice: Part One | Psych Central Professional

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Source: A Psychotherapist Reflects on Shortcomings of Evidence-Based Practice: Part One | Psych Central Professional

These days, more and more, the concept of evidence based practice is training mental health workers to put the cart before the horse.  Setting up strict fidelity measures to replicate success grossly underestimates the impact of local culture on an individuals’ life. In particular, the widespread practice of CBT for “psychosis” with its set of strict fidelity measures, runs the risk of doing damage in place of really needed work.  Unfortunately, there is rarely longitudinal studies on treatment failures that examine the negative impact of mental health politics and damage that can be done during treatment failures. Often times, big egos and manifest destiny desires of theorists that don’t respect the limits of their work continue to be promoted by administrators. I contend that the cultural art of human connection and the need for psychotherapists to learn more through authentic experiences is not and will never be fully captured in research.

My beef with therapy that follows strict theoretical fidelity measures started twenty-seven years ago when I was first hospitalized at age seventeen for anorexia in Salvador Minuchin’s clinic.  My family was to receive a best practice Structural Family Therapy performed with the highest of fidelity measures with one-way mirrors and expert consultation.  I was expected to gain a half pound a day or my family would be viewed as a failure.  I would later learn that 6000 calories a day would not anatomically gain me a half pound a day.  In therapy I kept making this point but the team was instructed to ignore me when I was oppositional.  In other words, I was to lose my voice in the family system if I behaved that way.  We went through intense and traumatic experiences as a family including my father being encouraged to bully me into eating. While he later did many things that worked, I was not able to conceptualize my rage and started to throw up indiscriminately. I had no idea what we were supposed to do, only that we were failing at an impractical expectation.

In working my way through my Master’s level education I did some extra reading on Salvador Minuchin.  I learned that he was an Argentinian, Israeli Army guy who developed his theory for people of the “slums.” Going after psychosomatic problems like eating disorders and juvenile diabetes was a way for him to penetrate middle class markets and prove that his work was manifest destiny universal.  This way students could learn that they could use his theory with anyone.

Continue reading “A Psychotherapist Reflects on Shortcomings of Evidence-Based Practice: Part One | Psych Central Professional”