Conversations with Practitioners: On the Verge of a Nervous Breakdown

Over 50 people attended our recent Conversations with Practitioners: On the Verge of a Nervous Breakdown. Here's an excerpt of my talk:

I am Christine LaCerva, director of the Social Therapy Group, a community group therapy center in Fort Greene, Brooklyn, and in Manhattan. I am also the director of clinical training at the East Side Institute, an international training and research center. I have been practicing social therapy for 34 years.

This evening I will be talking about being a therapist and how I practice therapy – what the process is like for me in working with people who are in serious emotional distress. Therapists don’t get much of an opportunity to talk about that. Then there is the question of how to talk about that? What drives the therapy? I want to talk to you about my search for method as a social therapist – searching for how to go around and about creating environments for emotional development. It’s a performance, if you will, of not knowing not coming up with answers – in favor of the activity of exploration with my patients and colleagues.

To read the rest of the talk, click here.

And here's an excerpt of the conversation with mental health practitioners that attended:

Participant 1 (P1): As a psychiatrist, I want to provide an environment for people to fall apart safely, but sometimes it gets really hard.

Christine (CLC): What’s emotionally hard for you?

P1: What’s hard is when the patient gets angry at me. That’s what’s most challenging. That’s tough.

CLC: Yes, that can be really tough. Sometimes patients are the angriest when you’re doing a good job. That’s part and parcel of what it means to do therapy.

P2: I work with elderly adults with severe mental problems. Often they’re withdrawn and private, and I’m not sure what to do with that.

CLC: Build the relationship — create the conditions for something to emerge. You can be thoughtful and patient and giving and see what happens.

P3: Social therapy doesn’t disagree with other psychological theories (e.g., the Jungians) on how people got screwed up, but I think we differ on what we do about this. Do we give advice? Do we provide a safe harbor? I think social therapy helps stir things up! We use people’s pain to create new performances. Christine, what comes up for you when people are really in trouble? It seems like you exhibit a kind of fearlessness and don’t get intimidated by your patients’ emotions.

CLC: It’s not that I don’t get intimidated, it’s that I do it anyway. I relate to everything as a performance. People have good days and bad days. They’re growing and frightened, and the impact of going beyond themselves emotionally is really hard for them. So what I do is make assessments. I work to create a set of conditions where something can happen. The group can have a completely different relationship to someone I’m having a tough time relating to. And in those instances, sometimes the best thing I can do is stay out of it. I keep my eye on the group. I keep organizing and re-organizing. I’m always thinking about people who may be having a hard time. I’m on it. That person is not alone! I work to put demands on people to not be alone. We often choose aloneness when we’re in enormous pain.

P4: Is there ever a case in social therapy for people to “stay where they are?"

CLC: Yes. Sometimes staying where you are is very significant. Often people find it hard to stay where they are when they are being loved by the group. They will do things to mess that up. Sometimes when a person is going through a crisis it’s the time to say, “You have to take responsibility for being the organizer of your breakdown.” We can’t help people by giving up on them.

P5: It’s hard for some people to believe that other people care about them. How do you care about them?

CLC: You can get close to people with pain. You build with it. That’s the caring activity.

Q5: I was shocked that you build something positive out of something negative.

CLC: I’m helping people play with their pain, and learn that it doesn’t belong to them. Pain is in the world, it’s something that’s created. The group can help each other deal with their pain so they’re not alone with it. And even if someone is in a mess, they still have to contribute. That’s really important. They need to learn how to give – to perform as a giver – even in the midst of their pain. They’re still a contributing member of the group and the group needs that.

P6: I’m interested in how you bring people back from psychosis without medication.

CLC: One of my first patients was psychotic and on medication. He saw his psychiatrist regularly but it wasn’t going so well. When this young man came to see me, he asked me to turn down the lights – there were no lights! “Uh oh,” I thought, “this is way beyond what I know how to do!” I sat there trying to figure out what I was going to say. I remembered that I had a pair of sunglasses in my bag. I took them out and gave them to him. He put them on and relaxed. We sat for weeks without speaking but eventually he began to talk. I learned so much from that about how important it was to give him something rather than try to force something to happen that he wasn’t ready to do.