“We’ll use humor to
heal pain and suffering. Doctors and patients will work side by side as peers.
There will be no titles, no bosses. People will come from all over the world to
fulfill their dream of helping other people. There will be a community where joy
is a way of life, where learning is the highest aim, where love is the ultimate
goal.” quote taken from the words of Dr. Hunter “Patch” Adams, UFO Landing
artwork by Brandon Bruce Dellario
After reading Sandra Bloom’s, Creating
Sanctuary, and taking a look at my agency, I feel like I was placed in a
crystal ball of wonder. What are the
ways my agency meets the expectations of The Sanctuary Model of Trauma-informed
Treatment? What are the barriers that
would impede its implementation? Firstly
I think of greeters. They are the
security guards and reception staff that handle daily operations. Even though these employees are the first to
welcome recipients of services, they are often not trained to work with our
clientele in manners of health care hospitality. Since many clients seeking treatment can be
in sensitive states of a healing process, all health care workers are of great
service when responsive to issues of welcoming.
So how can we better provide a healing environment?
The Sanctuary model is based on the
inner-workings of a scaled down community, and we know that each part affects
the whole. This is a premise of systems
theory, that the whole is greater than the sum of its parts. The ecological systems model developed by
Urie Bronfenbrenner regards the client as a part of their larger holistic
environment. Reflection on Sanctuary
findings leads us to the affirmation that all staff and clients, from the
director to the suffering child, should be considered and treated as an
integral part of the therapeutic community.
Relationships within an agency can have a
synergistic effect on the total outcome of operations. Those who have suffered through traumatic
experiences could be dealing with conditions which make it difficult for them
to “fit in” around public places like a mental health agency. Most adults have been through some form of
trauma, and every one of us has our own creative ways of dealing with it. However, we live in an imperfect world. People have problems, no matter what their
lifestyle appears to be. Everyone has
bad days where they act rudely or make other kinds of mistakes. Staff and clients alike may have problems
whose symptoms ripple out into the rest of an agency. Scaled-down communities can be a healing synergy
of support, or a dysfunctional cycle of toxins stemming from the interaction of
the individual in the agency, environments outside the agency, feeding into the
family, or vice versa.
In Creating Sanctuary, Bloom illustrates,
“Our [American] society appears to be in the grips of a post-traumatic
deterioration that could also end in self-destruction, just as it does with
patients who remain locked in the patterns of the past.”(Bloom, pg. 9) Perhaps we can parallel this to our slowly
recovering mental health system, en route to solutions. What questions shall we ask in observation of
a deteriorating culture (such as that of the United States mental health
system, or simply the environment of a small agency)? Apparently many questions of ‘what is working
and how can we implement its usage more often?’
Within the questions lie the answers.
“ . . . the
individual cannot deal with the traumatic experience because it continues to
pose some kind of life threat and the culture (dysfunctional community) cannot
or will not help the person come to terms with the experience. [due to the problems posed by the dysfunctional community] The person is unable to establish a coherent
and consistent sense of identity because the traumatized self is directly in
conflict with the normal self. [due to the problems posed by the dysfunctional community] He or she
is unable to establish a comprehensive and flexible meaning system or
philosophy of life because they harbor too many internal contradictions. Under these circumstances (of the dysfunctional community) dissociation
becomes a way of life and the disintegration of the person continues.”(Bloom,
pg. 32)
Bloom states,“The
person is unable to establish a coherent and consistent sense of identity
because the traumatized self is directly in conflict with the normal
self.” Recently, a personal colleague pointed out that in professional
mental health settings, the professionals are set apart from the clientele and
thus restricted in their ability to relate because they have two different
identities: professional versus client, or because of roles such as ‘normal’
versus ‘mentally ill.’ Could this be one
of the problems posed in the system, or even posed by our mental health system?
Our agency is sincerely dedicated to
furthering our clients recovery. We
continue to demonstrate cutting edge recovery education and practice. We have been engaged in the process of
creating an atmosphere of recovery for years, and it is coming along very
well. We have several peer-professional
employees and volunteers in varied positions throughout our agency. Peers in every staff position. This has several beneficial impacts on our
small society. When someone works with a
peer, they are sometimes given the hope that someone else is in it together
with them, may identify to some degree with struggles, and possibly have some
degree of personal success in recovery.
Regardless of who, how, where, what and why specifics,
peer-professionals are trained to work with clients in ways which have yielded
some of the very highest rates of treatment effectiveness ever recorded. Peer support has become an integral part of
the transformation of our national mental health system. Leading us in the conversion from a
‘stabilization’ view of client status, to a more client-centered and
strength-based recovery focus.
Our agency is rising to the challenge
posed by our emerging peer professional staff and other agencies on the cutting
edge of these incredible person-centered services. Recovery of the system, to provide emerging
services, available to persons engaged in personal change. Possibility of health and change are integral
to a healing process. Possibly a
substitution of spirituality for clinical dissection of the illness? Yet, are we ignoring the reality of the
severity of our system’s failures or flaws?
Do we minimize or overlook new challenges that would be better addressed
head on?
As a peer professional, I have personally
experienced stigma in the way of being a recovering person who is occasionally
viewed as ‘different’ in some ways from other professional employees who do not
regard themselves as peers. As a peer, I
find that I must have acceptance of the fact that most people are not as
entrenched in the recovering community as myself. However, all people who work in the field are
better informed on the healing electricity pulsating from those who are in
recognition of recovery in their own life, community and agency. It’s not especially hard for a professional
to identify and celebrate recovery, it’s what we work for. How does our agency’s culture reflect our
needs for recovery celebration and gratitude?
Does it help or hinder those points?
Bloom tells us that problems must not go
unresolved in the therapeutic community.
They somehow must surface and be dealt with, be they small, unnoticed
relationship struggles or larger systemic flaws. People at our agency, whether they be peers
or practitioners, are always gaining in recovery wisdom and reduction of the
associated stigma suffered by those who acknowledge personal flaws. The Sanctuary Model is inspiration for all
communities to stand up and say, ‘there is something wrong here, now let’s look
at it so we can move on.’ Personally, I
am on fire with gumption to stick up for and role model what I see to be right,
point out what I see directly to an individual by taking them aside. When I feel like a situation is problematic, I
look to the NASW Code of Ethics to find what may be out of place. Thanks to Bloom’s research we know how
damaging the, ‘elephant in the room,’ can be where a concerned voice is
unheard. That voice could be an
important part of communication which all too often goes unidentified. Clients and co-workers alike, we all need to
have a safe place to express ourselves, where it’s okay to talk about
professional, personal or social problems.
There is a systemic dissociation in place
of treatment essential empathy wherever trauma effects are seen as, ‘people
getting what they deserve,’ in light of personal decisions. Stigma asserts clientele to be experiencing
problems which we as professionals would never or could never experience, for
whatever imaginary reasons. All persons
involved in our mental health system should be aware that they are eligible
too. Eligible to experience any human
problem, become a problem or to live in proven solutions. Everyone is susceptible to the ‘sore thumb’
coping mechanisms that stick out among our idiosyncratic teachers, given the
right set of circumstances. Those
teachers being the people who have endured the trauma that often times goes
ignored or passed over by in objectification of the patient. We are all in this together, thoroughly
inseparable. A problem experienced by
one person affects everyone and ought to be treated as such.
In Creating Sanctuary, Bloom argues for
self expression through the arts.
“Creative expression is the voice of our nonverbal self.”(Bloom, pg.
53) Our agency produces and supports a
myriad of programs for artistic endeavors, community activities including
fitness and recreation, all complimented by alternative, self-directed
treatment techniques. Though many
peer-professional staff members are involved in these groups themselves, maybe
there is another side of stigma that draws a boundary between recovering
persons and those who would like to be involved in recovery activities, but are
not self-identified peer staff. Everyone
needs healing and community inclusion in some form or another. Where does self-care for the practitioner fit
into a regular week on the job? Existent
or non-existent? Observation of systems
theory again suggests possible solutions.
New systems can experience difficulties in implementation without
holistic and balanced interventions regarding all persons, staff and clients
alike. Our agency is beginning to attack
this barrier by forming groups that are open to anyone, encouraging all staff
to become active participants in wellness activities. Though it can be hard for anyone to serve
dual-roles on the job, this avenue may prove advantageous for practitioners and
their practice, lessen burnout rates, etc.
Regardless, vital questions remain of what healing paths are offered to
our healers in this time of systemic transformations? Group and community involvement is essential
to self-development in trauma recovery for those in recovery. How might this staff involvement in the
agency’s culture work for: Clients
(first and foremost); client families; agency functioning; practictioners who
have personal and job-related stressors such as counter-transference; staff job
performance; the community and society at large?
“The social group
apparently has the obligation to provide a mechanism for conscious integration
after any kind of dissociative experience, . . . When done properly, the social
group provides various, often ritualized, ways for the victim to put their
experience into words using language.”(Bloom, pg. 69)
Overall, our agency is catching up to the
healing system portraiture of The Sanctuary Model. A small opus of recovery atmosphere is
developing inside and all around us.
Recovery Innovations of Phoenix, AZ, The Appalachian Consulting Group
and Community Mental Health are a few of the organizations at the forefront of
this movement for the rebuilding of agencies and employee training nationwide.
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