by Jessica Lula and Zelda Alpern for CSAC
My personal, mental health journey started with my father’s struggle and eventual loss to what was at the time diagnosed as depression. In my twenties, I came up against my own experience of a diagnosis of bipolar manic depression. These encounters have led me on a healing journey of awareness, spirituality, and self-discovery.
It has also put me on a path of wellness which has transformed my pain into purpose and passion. The reflection above is from a piece I wrote for an Intentional Peer Support Training through the Howard Center about my experiences.
I believe it is essential to state that much of my journey has been centered on loss. Each time I emerged from the hospital I was met with the reality that my identity, community, and loved ones (except for my mother), were gone. With each encounter, all meaning and connection disappeared from my life, as if they were never there to begin with.
Some of these experiences have been very important to the direction my life has taken. These experiences have also been essential in helping me find my purpose. I believe with great hardship and difficulty comes even greater lessons.
I find myself extremely blessed to have landed in a place where I can explore these lessons and write my story. This place is the Counseling Service of Addison County (CSAC) and the Collaborative Network Approach team.
Collaborative Network Approach
Over the last seven years, CSAC has worked with over 120 families and networks utilizing the Collaborative Network Approach (CNA), inspired and informed by the Finnish approach and system of care called Open Dialogue.
CSAC has found this way of working helps to embody long-standing values of person-centered responsiveness—and shared humanity—which can make all the difference in building community, safety and the trust necessary to foster experiences of growth and healing in times of crisis and duress.
Open Dialogue began its evolution in the 1980’s in Tornio, Finland, akin to Addison County Vermont in its rural nature and population density. Open Dialogue was conceived to address long waiting lists for psychiatric services and deinstitutionalization of its psychiatric hospital.
Through analysis of their most and least successful experiences with clients and their families the team arrived at the seven principles of Open Dialogue: immediate help, engaging the social network/family, flexibility and mobility, taking responsibility, psychological continuity, tolerating uncertainty and dialogism (hearing all the voices).
While service users in Tornio have access to a range of therapies and services, the hub of treatment is known as the “network meeting.” This initial meeting, co-facilitated by two staff people offers a space to foster mutual understanding and to support the resilience of the relationships among those involved during times of crisis.
Rather than consulting behind closed doors, the staff who co-facilitate the meeting share their thoughts with clients/families present through a “reflecting process.” It is this transparency that lends the approach its name: “Open Dialogue.”
Implementing CNA in Vermont
Vermont’s mental health care landscape changed profoundly in 2012 after Hurricane Irene flooded the State Hospital. As part of a response, the state made Act 79 funding available to strengthen designated community mental health agencies so that they could provide outpatient crisis services to reduce the need for hospitalizations. CSAC had an opportunity to dive into a different way of providing support through the principles of Open Dialogue. Which they did.
Two of the central questions the Tornio team asked themselves as they began their innovations: 1) how has the way we have met with people and organized our services contributed to their difficulties, and 2) how do we meet with people differently going forward?
With the support of the Department of Mental Health and international trainers, CSAC has worked with the Howard Center, the United Counseling Service and the Vermont Psychiatric Care Hospital to offer intensive statewide training in what they are now calling, the Collaborative Network Approach (CNA) but based on the principles of Open Dialogue. Staff from other designated agencies, University of Vermont Medical Center, Pathways Vermont, and the co-founder of Intentional Peer Support have also participated in the training. Additional agencies have expressed interest in participating in an upcoming training cycle.
CNA provided a space to explore what happened to me. This is in contrast to what I’ve internalized from a society where I was taught to not talk about my experiences, to only take my meds, and move on. Inpatient treatment, although sometimes necessary, is often involuntary and traumatic. This was the case for me.
Recovery using CNA
As an involuntary patient, I was surrounded by doctors and medical staff who saw me as no more than my symptoms rather than as a whole person. This setting and these people, generated the only story I had once I was released back into the world I left behind.
The hospital labeled my experience with a diagnosis to explain my symptoms. This diagnosis was steeped in stigmatizing language, emphasizing “psychotic” and “mentally ill”. Paired with the severe isolation that often follows a mental health crisis, I sat alone with these powerfully negative labels which quickly became internalized, taking root in my psyche and creating even more harmful outcomes than the original hospitalization.
I now recognize how detrimental this model of treatment is for one’s mental health. I find it ironic that we are suffering from mental health issues, yet we are treated with a model that reinforces and exacerbates these problems, primarily emphasizing only medication as a way out.
When I first came out of inpatient treatment, I was met with darkness. I felt the very bottomlessness of it. I felt fear, discouragement, shame, and guilt. But it is also in this space that I found the people to walk with me through this darkness. I found the Collaborative Network Approach team.
These people fostered and served as connections that I no longer had in my own life. They believed in me when I couldn’t possibly believe in myself. They validated feelings that no one else could understand. They provided a space for me to sit with uncomfortable emotions, pain, and uncertainty while offering presence and empathy. This was a space that was mine to invite others to join me in, to cultivate new shared understandings and possibilities or to be heard.
The system of care provided by CNA is client-centered and team-focused. This means that care spans across all settings that I am a part of: inpatient, outpatient and community.
For example, after I established a team at CSAC, they could reach me in the hospital and treated me as a person with my own needs, wants, and desires. My CNA team prioritized my voice and decisions about treatment. The team-centered approach of CNA enables anyone I choose to be a part of my care and fosters a shared awareness of what my needs and goals are. The private therapist who was a part of my care prior to hospitalization participated in meetings with me and my CSAC team. This therapist restored my roots and my wings, and to add her voice to these gatherings further established the psychological continuity necessary at this time.
The dialogic practice of the Collaborative Network Approach aims to eliminate the top-down power dynamic which I often experienced in the hospital setting. It strives to promote collaborative listening that allows everyone to have a voice. This includes the voice of my mother whom I must acknowledge. She has been central and vital along this journey, always by my side, loving and accepting me unconditionally. Initially, our relationship was tested by this crisis. In the aftermath of my hospitalizations, we found ourselves disconnected and without mutual trust. We faced enormous misunderstanding which made it impossible to hear one another’s perspective.
This dynamic changed when we entered the CNA meetings together. The space allowed both of our voices to be honored, heard, and validated. A dialogue began to emerge for us, once we could hear each other’s perspectives from other voices in the room. The experience was profound and led to healing and restoring the trust that had been lost along the way.
Most importantly, the Collaborative Network Approach allowed me to create my true narrative which was more than a diagnosis. I began to form a broader understanding of my experiences and explore the higher meaning of it all.
A shift in mental health care
I am sharing my story in the hope that it will spread awareness about the need for system reform in mental healthcare. I believe the Collaborative Network Approach’s humanistic model of care is the portal to a vital shift in our attitude toward mental illness and recovery.
Once our attitudes change our recovery changes. We are all here together and must give ourselves and others love, compassion and connection.
The unconditional support I received, along with the time to heal, brought me back to myself. I awakened to the need for balance between body and spirit and opened to that which is seen and unseen. I continue to recognize that doing my best simply means growing with each new experience.
Jessica Lula is a resident of Addison County. Alpern is a licensed clinician and CNA coordinator at the Counseling Service of Addison County in Middlebury, Vermont.