Interview between Dr Swim, Emma Mackintosh and a parent about family therapy at Now I See A Person Institute.
Dr. Swim: So we wanted to ask you a few questions and what we’ve been doing is these mini documentaries that we are going to be putting on our website. After so many years we’re building a new website.
I had a guy today say “your website is wonderful but it looks like it’s from 1986.”
Dr Swim: I never planned on retiring from a university and I was the type of person that liked to dress what Emma calls “smart” and I didn’t really know anything about horses even though I had them for such a long period of time, but you left that up to other people.
And so I never saw myself as spending the rest of my life in jeans and boots around horses but it turned out to be really the best work of my whole entire life.
Mother: That’s right.
Dr. Swim: It is. I’ve got questions for you.
Dr. Swim: And I think that you’ve answered these before but you might have a different stance or ideas for these and these are the ones that we are going to put onto the website. And I know that we’ve asked this before but again, you may have a different take or the same take…
Dr. Swim: How is Now I See A Person Institute different than the help that you tried to get before Now I See A Person Institute?
Mother: Well I can tell you, you look at the whole person.
The diagnosis doesn’t necessarily drive your treatment as much as the client does.
As you know your counterparts, whether it’s private practice or within a medical group, are very driven by DSM diagnosis. And from that, then that’s where they build their treatment plan.
You don’t build the treatment plan around a diagnosis.
You treat it around the patient once you get to know them.
You don’t dive in and say “it really must be this diagnosis because that’s the medication they’re getting or this is what they’ve been treated for in the past.”
So that’s the biggest difference that your therapists bring to the table from anybody else’s, which is beneficial to both if their open to that type of therapy.
Dr. Swim: So when you just spoke and I thought about the way that you so eloquently put it I was really surprised until I guess the last couple of years that… Because even when I taught at the university, I taught at a university that appreciated the way that I worked and so when I started getting students from other universities I was really pretty shocked that you wouldn’t treat a person. That you would treat a diagnosis and each person is different for the reason they have that diagnosis. And then you give somebody a diagnosis and then you give them “skills” that will help them manage that diagnosis but never get over it.
Dr. Swim: And then if someone does not get well, and this last year I’ve been thinking about this so much, but if someone does not get well then the client is blamed.
Not the therapist ever.
And then the client has to have more DSM diagnoses because they’re not getting better.
And then if they don’t get better still, they’re not the therapist’s ‘favorite’ client.
And what happens is that then because they’re not fitting in their boxes they are put on medication.
And then if the medication doesn’t alleviate the problem… And we’re talking about people who have trauma, right?
Dr. Swim: So you are putting medication on top of the trauma, which is like putting dermatology medication in your eye. To me, it just doesn’t make a lot of sense. And then if the medication doesn’t work, then, of course, they increase the medication, and then you have someone coming in like your daughter did, on cocktails.
Dr. Swim: And then if the medication still doesn’t work then they are hospitalized and hospitalized and hospitalized and hospitalized.
And then eventually it’s residential care. That’s the name of the game.
Mother: Well I think a lot has to do though with the fact that medical physicians do not work with a psychiatrist and really know the psychotropic drugs. And when the psychiatrist or psychologist is not involved and you’re leaving the medical side to a medical professional, and I do use the term “professional” very loosely, they don’t know what the heck they do. But they do know just as you described that “I’m not helping them I’m just going to give them one medication. They bug me, I don’t know what the hell I’m doing but I’ll pretend that it looks like and do and hey if they’re on seventy-five medications well that’s not my problem.”
Dr. Swim: [expressing nonverbal agreement]
Mother: And that to me is the biggest farce travesty ever because it goes on to this day [voice interlaced with emotion]. This minute. This hour. And it will go on for the next century because nobody wants to work together for the betterment of a human being with mental health. And that I will go to my death bed with, because that’s the honest to goodness truth. I’ve seen it, I’ve survived it and I still go through it to this day. And it’s a travesty. And if you dare utter those words “ wow if you think I’m not doing a good job…” And trust me I had someone once say that and I said “no it’s not that it’s that, it’s that you don’t use your interdisciplinary team to work with these types of candidates. That’s the problem.” And anyone can go and view the run of the mill cash cow and turn patients all day long and make a profit. But you’re not doing that with someone that needs specialized care because they are dealing with emotional trauma or whatever it is that got them to the place that they are in today. I’m really not a poster child for mental health in the clinical setting or private setting or Kaiser setting at all because I’m watching the Three Stooges.
Dr. Swim: I know and the other thing that makes me…Well, we’ll talk about the Three Stooges first. What you have is that there is no knowledge shared between the professionals.
Mother: No, none. Which I think is so funny because a surgeon, if you are doing a big surgery and you need help from other surgeons, you are going to do a case review.
And yet they do nothing for these people except give them a drug, let them go on the streets, and think “hey they’ll be happy, they’re out of our hair.” That’s how we treat them but you’re right they don’t do any consultation with others, nothing. And they only have one specialty and so that’s what they’re good at. That’s great but if you need help in something else seek it. And I don’t think that’s such a shame to go find it, what is a shame is when you don’t treat it. And then you still get stuck with the bill at the end of the year.
Dr. Swim: Right, right. So we have colleagues in fact I was just reading this email right before and it was from one of our colleagues. As you know we have colleagues with International Collaborative Dialogical Practices as part of the team. There are people in Asia, South America, Mexico, Norway, two in the United States, Czech Republic, Finland and many more countries. This Psychiatrist in Finland is doing a lot of work right now and he’s been doing this for forty years. He tries to be inclusive like we are.
Mother: Right, right.
Dr. Swim: And what he does is he puts people on medication, sometimes he doesn’t, but he will put people on medications for short periods of time. Because people in times of crisis can need something especially in coping with the anxiety of their symptoms. And then he weans them off. So these aren’t meant to be medications that people are on for long periods of time. But the psychiatrist is not seen as the leader of the pack. Trauma and it’s resultant symptoms is not seen as an illness or label.
Dr. Swim: He, she or they are one member of the treatment team.
Dr. Swim: And the other thing is the client is never talked about behind their back. So if you have a treatment team meeting the client is there in the meeting with the client’s support system which is usually the family members.
Dr. Swim: First of all everybody’s voice is heard and honored. Also a plan inherently, naturally, organically evolves. And then when that plan comes in that’s what everyone works with.
Mother: Right, because all of the interdisciplinary team members and the person is there trying to help this person to succeed.
Dr. Swim: Yes.
Mother: But when you are not set up for success and you’re looked upon as a dollar with a carriage paid to then what success do you have? None. Except for that facility where the overhead gets paid and life goes on.
Dr. Swim: Mhmm.
Mother: So that’s probably why he’s successful.
Dr. Swim: Absolutely. Because our theory borrows from his ideas and has many similarities. Everybody is different and so you take whatever time is necessary. I was on the phone for two hours and forty-five minutes with what I thought was going to be a forty-minute call today. You can’t ever predict what somebody is going to need that day.
Mother: Right, exactly.
Dr. Swim: And just because you have clients behind you, you can’t short-change somebody.
Dr. Swim: Because they are going to go home in the same way or worse.
Mother: Exactly, exactly. Well I know plenty of times with my daughter you were there and that’s for sure. Again it just goes with the mindset, organizational set and where the professionals are. That’s what I believe really drives how well a client does or not. And yes they have to participate and do their thing but it’s really how well the professional does his or her job in conveying to a person how good, and achievable life can be.
Dr. Swim: And when your daughter left that facility she had survival skills.
Dr. Swim: But she did not have any other skills. She didn’t have any academic skills.
Dr. Swim: She had no socialization skills.
Dr. Swim: She had no skills to prevent her from killing herself.
Dr. Swim: She did not want to live.
Dr. Swim: She hated herself.
Dr. Swim: She hated you guys.
Dr. Swim: She hated us.
Dr. Swim: She hated the horses.
Dr. Swim: She came only because her father was forcing her to come. Someone should have known because she told us this, so I’m sure she told a million other professionals, that when she used to see her therapist was when she had some of her most significant suicide attempts.
Dr. Swim: That she would go in there and take a whole bottle of pills because she was wanting to punish the people because she knew they weren’t really trying to help her.
Mother: Right, right.
Dr. Swim: It was something that they would checkmark off of that list, the suicide boxes to show they did that with her and she had no choice that was what was being done to her anyways.
Mother: Right and that’s what I told the head doctor at the facility and he got very irate with me. He said, “are you saying I’m not doing my job?” I said “are you saying that you don’t want a license?” I don’t care what it is because I went toe to toe with him. And he’s going “well there’s nothing we can do with her because she’s this way.” And I said “I think her therapist is too young and not seasoned” and they got mad at me. But then I figured well I’m not paying her bill either so it’s better to get a new grad in and get her at face value and then we’ll go from there. But my daughter was not that way so I don’t know how much more damage they caused her.
Dr. Swim: Well we have just begun finding out (about how she suffered in the residential facilities and consequently made serious suicide attempts and successful self harm). We are happy she can share what she considers abuse from prior ‘treatment’ facilities with us…she’s the one that’s been informing us.
This young person is now an adult finding enjoyment in life and is hopeful about her future.