A psychotherapist thinks out loud about Being Human, and stuff…

Bring It Up On Thursday

In the early 90’s I had the great, good fortune to be a clinical staff member of what was, at the time, the best residential treatment program in the San Francisco mental health system. I’ll skip the name for now, but those of you who have worked in The City’s system over the last few decades will have a pretty good idea of the identity of the program I’m describing. It exists now in name only, and I still grieve its passing.

This was a large facility, located in a multistoried, ex-apartment building near downtown. It housed about a hundred residents, and another hundred and fifty came from all over the city for “Day Treatment”- group and individual therapy, case management, med assessment and monitoring, 12 step recovery groups and more. We were a subsidiary of a large hospital, who sent us a steady stream of people from their ER and Psych Ward, once they were stabilized. We specialized in what was called, at the time, “dual diagnosis” cases: serious mental illness and addictions of all kinds; mostly alcohol and drugs. Very busy, bustling place, with nary a dull, or free moment. Stressful, exciting, rewarding, harrowing. Some of the best training- experiential and otherwise, that I could possibly have received.

In any workplace, especially a place as demanding as this, there are bound to be problems. Our clients had problems, why shouldn’t we? I have worked in unhappy programs where the unavoidable stress was channeled into interpersonal wars- back biting, office politics, factions- and, people, don’t think for a minute that therapists are immune to such things. Pound for pound, we are probably the most unstable bunch of people you’ll ever want to meet. What do you think drew us to this profession? (I hasten to add, of course, that the therapists who are my friends and co-workers are the exception to this rule- all of you. Okay?)

But, I digress, as usual.

This program, as exhausting and demanding as it was, was also one of the happiest, most harmonious environments I’ve ever experienced. We respected ourselves and each other, as we respected our residents and day treatment clients. We were patient and forgiving with each other. We laughed a lot during the day and at day’s end we looked forward to coming back tomorrow- at least, I did. Above all, we were proud to be a part of that program. We were the best in The City, and we knew it.

There were lots of reasons our program worked: the Director was an excellent clinician and a downright decent, authentic person. The large admin staff treated us like slightly addled children and that worked, somehow, probably because that’s how we felt a good deal of the time. The most important thing, though, was what happened on Thursday afternoons. That’s what I want to tell you about.

Every Thursday, at three o’clock, every staff member who could possibly attend- clinical or otherwise, manager and managed, filed into a room, coffee in hand and sat down. The door was locked behind us. Then, we sat in silence until someone had something to say. The rules were simple- basic communication skills we teach our clients: use “I” statements, don’t interrupt, treat each other with the respect you expect to be given. Beyond that, anything could be said to anyone in the room, unless they expressed an unwillingness to hear it, in which case, they were encouraged to make a later date to work out whatever the issue was. This happened rarely. It was, in a word, beautiful. People expressed gratitude for favors and acts of kindness. People expressed fear, anger and resentment. Sometimes it was nonverbal, someone just reaching out and taking another’s hand for a moment, or putting a comforting hand on a shoulder. Hugs were frequent. Sometimes we just sat in silence for long periods. The rule was, we stayed until the hour was over, whatever happened. With the exception of a couple of emergencies, I never saw that rule broken. We all knew how important this was to the maintenance of what we had.

The effect of this hour on the other thirty-nine was amazing. Griping was nearly non-existent. If someone began to complain about something that had to do with the program or a fellow worker, she would commonly be told, “Bring it up on Thursday”. We learned, all through the week, to remember something that we wanted to bring up in the meeting- something tough for which we wanted our peer’s support, or something good that we wanted to share with the others. Even better, we learned to take chances during the rest of the week, not waiting for the safe space of the Staff Meeting. It was not Heaven. Some people handled it better than others and, generally, staff members who didn’t use (or attend) the meetings didn’t last long but, unlike most busy, high stress programs in the field, we had very little turnover. We knew the value of what we had and were determined to protect it.

I offer this experience to you, to make of it what you will. Perhaps, if you are ever offered the opportunity to create a program or a community of any kind,  you’ll remember what a powerful tool it can be to feel safe and supported among your fellows.

Though we were safe with each other, we hadn’t the power to be safe from the larger world. Only a year after I began to work there the hospital, citing financial difficulties, felt the need to divest itself of our program and we were cut loose. We talked of running it as a Collective, but couldn’t find the funding that would have made that possible. Six months later, our program was bought up by a large, well funded mental health organization. The first thing they did was fire us all, (after assuring us for three months that there would be “no changes”), offering us the opportunity to interview for our old jobs. Very few of us were rehired, and those who stayed had to agree to take a significant pay cut, in line with the lower amount the new owners intended to pay their staff. We had seen, loved and worked for an effective, respected mental health program. They saw a cash cow.

The first thing that went, I’m told, was the Thursday afternoon staff meeting.

Thank you for coming by. As always, I cherish and encourage your comments and stories. Until our paths cross again, be well and live fearlessly. Why the hell not?

Happy Trails to you, Buckaroos!

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