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Sharing of oneself and self-discovery are essential components of everyone's experience at Hedwig House Clubhouse (1). This holds equally true for the members, the staff and, as I have experienced over the previous few months, for the volunteers. Because Hedwig House is a member of the International Clubhouse Community Development (ICCD) organization, it conforms to the clubhouse model, wherein staff, members and volunteers are all equal partners in helping the members, people who suffer from mental illness, "to stay out of the hospital, while achieving social, financial and vocational goals" (2), . In this, the second paper in a series of three depicting various aspects of my field placement at Hedwig House, I will reflect upon my evolving role, while relating some of my experiences interacting with the staff and members. I will do this by highlighting certain aspects of the biopyschosocial model of mental illness, specifically cognitive-behavioral perspectives, which manifest in day-to-day interactions at Hedwig House.
One of my first impressions regarding the overall functioning of Hedwig House was absolutely correct, and totally wrong, in that I completely misconstrued an underlying principle of the clubhouse model. It seemed to me that for the number of tasks that were required to be accomplished at Hedwig House (on a daily and long-term basis) such as meal planning, shopping, cooking, cleaning, maintenance, as well as the broader goals of educational, vocational and job development skill acquisition for the members, that the clubhouse was woefully understaffed. Indeed it is, and intentionally so. This is because the members are expected to fully participate in all aspects of accomplishing every activity and goal. They are not just service recipients. The social structure at Hedwig House is built upon a foundation that is so familiar to me, that at first it was not readily apparent. Just as in every family (or other similar social unit), the participation of all persons is necessary for smooth operation of the entire unit, so too is it at Hedwig House. Therefore, it is incumbent upon everyone involved to participate in every aspect of planning and implementation of every activity at Hedwig House. Laziness is never acceptable, nor is not wanting to participate, in spite of the fact that some days or for long periods it is incredibly difficult for some members, because they are acutely ill or heavily medicated, to be fully involved. However, a fundamental principle at Hedwig House is that everyone is a capable person.
Each weekday promptly at 9:30 AM, a designated member begins the morning meeting at which the day's activities are announced, and the responsibilities are divided. Most days the division of labor is seamless and quite invisible. Effortlessly, there just are enough people who want to work in the kitchen preparing lunch, which is clearly the most anticipated daily activity. And the group meetings all have a specific topic, a leader, and people who wish to participate. Almost magically all of the member's appointments are set and the accompanying transportation needs are arranged. But on other days, it takes a bit of gentle peer pressure to assemble enough hands to successfully execute all of the kitchen duties, or to complete the shopping required to stock the kitchen and the snack bar for the coming days, and the scheduled groups have no topic or leader, and lack a sufficient number of participants. When such situations arise, the members will gently remind each other of how important it is to them all to eat lunch, and about how much pride they take in the quality of the meals served at Hedwig House. Although I have seen some close calls, I have yet to see any activity that was planned fail to find enough participants, albeit with sometimes less than enthusiastic ones. On days when I don't have a specific activity planned, I like to wait and see where help is needed. Although I don't do it very often, I find it interesting to participate in the Hedwig House kitchen. When I'm there I assume a secondary position, I become an assistant, not the director, a very different role than the one I fulfill at home where I am responsible for planning and implementing most of my family's meals. From this vantage, I enjoy observing the members take pride in their culinary abilities, under the very creative direction of the long-time staff member Marianne. Men and women, staff and volunteers find pleasure in food preparation and presentation, as well as in the harder to define, and quantify, bonding and kinship that are also products of a communal kitchen.
Of course, much more than meals and domestic chores are shared among Hegwig House staff, members and volunteers. Some of the most important activities at Hedwig House are the various "groups," such as double recovery (mental illness and substance abuse), skills for living, and reintegration (how to move back into the larger community outside of Hedwig House). These groups, which generally involve a dozen or more members at a time, employ a cognitive-behavioral therapy model (3), . The use of cognitive-behavioral therapy techniques at Hedwig House is rather ubiquitous (if not always overt). Each group meeting begins with a question to ponder, such as, "How do you view your abilities or talents?" or "What goals have you had in the past, what goals do you now aspire to?" In the process of reflecting upon these types of questions, it is not uncommon for the members to put forth appraisals that are self-deprecating, if not outright expressions of self-loathing. At the root of the members' negative self-perceptions are their underlying genetically based illnesses, such as schizophrenia, manic depression and obsessive compulsive disorder, coupled with medication side effects, such as weight gain, memory, and cognitive difficulties (4), . Once a member's disordered cognitions (that they are worthless,) are put forth, the rest of the group seems to assume the role of pseudo-cognitive therapists. Invariably, immediately following such expressions of self-doubt will come a chorus of mutual appreciation. Then, in their collective cognitive therapeutic role (5), , the members will offer each other positive suggestions for changing the expressed negative appraisals, and provide assistance in behavior alteration (such as positive reinforcement) and help in breaking habits (perhaps in the form of gentle diet reminders).
One of the tasks that I have assumed at Hedwig House is to help the members have positive outcome expectations (5), . I try to do this both in group settings, and on a one-on-one basis. In reintegration groups especially, I seek to present positive role models, people who have suffered severe mental illness and who have gotten back on successful paths. With the presentation of one of the examples (my own daughter) I was also able to share something very personal-the story of how mental illness has affected my family. I read my daughter's college personal statement essay, in which she details how (in spite of her acute bouts with bi-polar disorder) she has achieved academic success at Bucks County Community College, and is now ready to further her studies with the intention of establishing a career in environmental science (6), . I believe that sharing her story was especially helpful to those members who are currently taking courses at local community colleges.
Some of the other group activities that I have undertaken with the members have included what I think of as purposeful skill building. We have worked on improving (or acquiring) letter-writing skills, while exercising our rights as citizens. There was a sense of empowerment that came with writing our Congressional Representatives in support of legislation that would help those who suffer from mental illness-Representative Patsy Mink's (D-Hawaii) alternative welfare reform bill H.R. 3113 (7), . We have also worked on developing Internet research skills, and used our findings in areas such as job searches, and in the development of interview skills, which we practiced in our groups. However, in light of the post 9/11 difficulties in the job market, we have (following the cognitive-behavioral model) begun to adapt our employment expectations. Currently we are exploring unpaid opportunities. This situation has facilitated my creating, and filling, a new position at Hedwig House, volunteer job counselor/coordinator. I have been assisting members, collectively and individually, in finding volunteer opportunities. Several of them are currently volunteering at Bryn Mawr Hospital, and others are exploring possibilities at Saint Edmond's Home for Children in Rosemont (8), .
Helping the members find meaningful work has also bolstered my self-esteem, as well as caused me a moment or two of embarrassment and sentimentality. I'm afraid I almost lost my temper with the volunteer coordinator at the Greater Philadelphia Area Food Bank (9), . I'd been working on arranging what we all hope will become an opportunity for four or five members to work there on a weekly basis. I slipped into a very old, if not instinctual, role when the woman at the food bank, condescendingly inquired as to whether the Hedwig House members had the mental capacity to distinguish between cans of tomatoes and cans of tomato sauce. With as little sarcasm as I could allow to come forth, I related that most of the members had college degrees, some graduate degrees, and those who didn't were pursuing them, therefore I had high efficacy expectations (5), regarding their ability to sort food items. The conversation did however end in a positive tone, as I proudly described to the food bank employee how capably the members manage the daily affairs at Hedwig House. After I hung up the phone, staff member Marianne commented that, hearing only one side of the conversation, she imagined that the woman had insulted my children. "No," I replied, "She insulted my friends." I suppose she's correct in that I hadn't been too successful at keeping my maternal tendencies in check (ok, I sometimes do behave as the house mother). Therefore, it's not really surprising that a particular member often tells me that I remind her of her mom (a concept I find amusing, in that I am her senior by only four years). What also is not surprising is that she and I share the same outcome expectation (5), for the end of the semester. I too will miss them all a great deal.
1)Hedwig House Home Page
2)International Standards for Clubhouse Programs
3)What is Cognitive-Behavioral Therapy
4)Tell Me All About Psychiatric Drugs
5) The Cognitive Approach: From Seligman, Walker and Rosenhan, 2001, pages 110-118.
6)Ashley Plotnick's autobiographical college essay application
7)H.R. 3113 TANIF Reauthorization Act
8)Saint Edmond's Home for Children
9)Greater Philadelphia Food Bank