[Alicia Fredericksen]

Question 1

It’s so sad that the mental health system failed Ms. Jennings. The story reminded me of the power of narrative therapy, which has always been one of my favorite modalities. There is power and healing in being able to retell a story, reclaim it, and/or reinterpret it. In my work, I have definitely seen how “symptoms are adaptations to distress”, as clients reenact unhealthy relationship dynamics from their childhood or prior romantic partners. It feels like a familiar role to them, one where they know what is expected of them, and so they return to the same patterns and behaviors because they know how to act/react in that dynamic. This story also made me think about the healing power of relationships, and how that is where the real therapy happens. You develop a relationship with someone by getting to know them—which you do by hearing their story. I think one of the most powerful things we can do is to let someone tell their authentic story.

Question 2

I love this paradigm shift. Some of the most challenging clients we work with are those suffering from Borderline Personality Disorder. It can be so easy to dismiss them as “oh, she’s a borderline”. Instead, I was told by a supervisor long ago that “when you see borderline, think trauma”. It immediately helps me have more compassion for this person, as I see their maladaptive traits as coping skills for the immense trauma they have (almost always) suffered. I think particularly of when clients get angry and push you away/reject you—and how it is their way of rejecting someone who appears to care about them before they get rejected themselves. This is likely born out of their own history of neglect or rejection by pivotal figures/caretakers in their lives.

Question 3

Safety—This is one we’ve struggled with recently, particularly as it relates to psychological safety. We had a leader who was punitive, reactive, frequently changed moods without warning, and you had to constantly walk on eggshells around (I’m refraining from giving her a diagnosis… ). It took some time, but eventually the leadership above her recognized the damage she was doing to the organization, and had her removed. We are now reinvested in a culture of psychological safety, and taking steps to make people feel comfortable and able to speak up again.

Peer Support and Mutual Self-Help—My organization does a great job of this. People are able to come together to problem-solve, decompress/debrief, and validate/encourage each other. There are almost no egos, and people look for opportunities to learn from each other.

Resilience and Strengths-Based—I think this is another area where we do well. Especially in the field of substance use disorders, where there is so much stigma and judgment, it is so important to approach things from a strengths-based perspective. We hold hope for the clients and empower them to believe in their own ability to get better. Many clients have given feedback that they are surprised at how much compassionate and nonjudgmental care they receive, as they are so used to the opposite approach in most other areas of their lives.

[Alicia Fredericksen]

Hi everyone. I am a licensed therapist, currently working in a hospital. I work with the inpatient detox unit, as well as liaison with patients in other parts of the hospital who have alcohol/substance use concerns. I have some training on trauma-informed care, but not as much as I would like. I am always open to learning more. My hopes for this course are that I will come away with practical tools to implement in my practice.

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