News and Events

• Loren Crabtree, MD was honored to receive the "Recovery Advocate Award" at the Oasis of Empowerment: Transforming Trauma into Wellness Conference, presented by Torrance State Hospital.
• Project Transition held its fourth annual Wellness Day. Members and staff from each of our seven locations spent the day in fellowship at a local park where they played games, ate healthy food and learned new ways to "be well".
• Loren Crabtree, MD, presented "About Borderline Personality Disorder: 'BPD 101'" at the Pennsylvania Mental Health Consumers Association conference.
• Rosemary Harren, AAC, and Erin McNally, CPRP, presented "Keys to a Life Well Lived: Wellness, Food Choices, and Eating Behaviors" at the Pennsylvania Mental Health Consumers Association conference.
• Karen Fairman, RN, CHEd, presented "Workforce University: A Model for Recovery-Oriented Staff Education and Development" at the United States Psychiatric Rehabilitation Conference in Norfolk, VA.
• Neal Stolar, MD-PhD, presented "Cognitive Therapy for Psychosis" at the 2009 NAMI National Convention, San Francisco, CA. A book signing followed for his new work entitled "Schizophrenia: Cognitive Theory, Research, and Therapy."

March
March 14th for NAMI-Main Line, Philadelphia, PA
Neil Stolar, MD-PhD, presents "Cognitive Behavioral Therapy and Psychosis"
March 15th for Friends Hospital, Philadelphia, PA
Jack Gomberg, MD, and Trent Tangen, MA, HLC, present
"Elements of Healing: Wellness, Personal Medicine, and Recovery"
March 21st for NAMI-Montgomery County, Glenside, PA
Neil Stolar, MD-PhD, presents "Cognitive Behavioral Therapy and Psychosis"

June
June 14th for the US Psychiatric Rehabilitation Association, Boise, ID
Trent Tangen, MA, HLC presents "Elements of Healing: Wellness, Personal Medicine and Recovery."

Diagnosing Schizophrenia

• lack facial expression
• be unable to speak more than a few words at a time
• have decreased motivation or pleasure
• find it difficult to pay attention
• lack concern about important things 

• major depression
• bipolar disorder
• delusional disorder
• brief psychotic disorder
• schizoaffective disorder

Validating the Fears of Emergence and Change

The hope of someone in the throes of mental illness is to, one day, "get better" - to have a life focused on more than symptoms and treatment. When a patient/member/consumer begins to look at life's opportunities and ask: Can I get a job? Can I have a lover? Can I live independently? - I call this stage Emergence.

Why Emergence is Challenging

The experience of emergence, of facing new opportunities, is often overwhelmingly painful and confusing because:

• Once a person is seen as "better" or recovering, they may be discharged from treatment and the supports that enabled their recovery - leaving him/her feeling vulnerable and alone.
• He/she is expected to be able to accomplish tasks normal to every-day life, but which are new and strange after living as a patient.
• There is little recognition that any change, even positive change, is stressful. This stress tempts the person in emergence to regress or act out in order to get relief from tension.
• Self-frustration arises: "It's clear to everyone, including me, that I'm better. Why is it so hard to do something that should be positive?"

What Can the Person Do?

Recognize what it means to be "normal in emergence." Expect that you will feel stress, confusion and frustration, even though you know you are "better." Hopefully, by accepting that this experience is challenging, you will be less frustrated and confused.

What Can Family and Friends Do?

Whoever is in relationship with this person can validate them! This requires you to acknowledge that the experience of emergence is painful and terrifying. If you don't, you may be tempted to act as a cheerleader, invalidating their experience by saying "You can do it. Don't be so down on yourself. Just try it..." The results of these discussions can be crippling because there has been no conversation about the truth: that the person is experiencing stress and fear.

What Can Clinicians Do?

If we're not careful, a negative language develops in psychiatry: "He/She doesn't really want to get well. He/She self-sabotages, snatching defeat from every imminent victory." Our own frustration further undermines a person who feels strangely disabled and alone. We need to teach the person about what happens during emergence prior to and while in their own experience. In doing so, he/she will feel validated.

Having an Honest Conversation

If you can recognize that acting out, regression, fear and stress are all part of emerging into a better life, then you are in a position to continually validate the experience of terror. Let's look at how that conversation could begin:

Person 1: Guess what, they just called me about a job acceptance!
Person 2: How do you feel about that?
Person 1: I feel really good.
Person 2: How else do you feel?
Person 1: I'm scared to death.
Person 2: Just as I thought. That's the way you're supposed to feel. So, the question is how are you going to manage the truth, not your image, the whole truth? That you're better AND you're terrified.   

Vocational Rehabilitation
More Than Just Resume Writing

One of the most important measures of recovery from a mental illness is successful employment. It is an ambitious and challenging goal with life changing rewards. For many people with serious mental illness (SMI), employment represents hope for an existence that is not focused on being chronically "in treatment." So much of our identity is tied to the work we do.

We recognize that work can be a part of the recovery process - giving structure to a person's day, helping him/her develop social skills and encouraging the hope that he/she can reach a goal, whatever that goal may be.

Like many mental health agencies, Project Transition works with our members to develop vocational skills through weekly workshops and individual training. We have traditionally focused on job searching, resume writing and interviewing skills. These are useful tools for someone who is on the cusp of or has attained employment. But how can we help our clients long before they're ready to sit down and fill out a job application?

This need is the focus of Boston University's Psychiatric Vocational Rehabilitation Certificate Program. Two of our staff members, Erin McNally and Joe Hvorecky, were chosen to attend this year-long training based on William Anthony's Psychiatric Vocational Rehabilitation (PVR) model of Choose, Get, Keep. This model focuses on helping a person with SMI assess and choose the vocation he/she wants. The PVR counselor then works with the person to develop the skills to get and keep that job.

Two years ago, Karen Fairman, Project Transition's Director of Education, attended Boston University's Innovators Conference. "While there, I heard William Anthony speak about ways to help people with SMI choose, get and keep jobs. I was interested in learning more about his techniques and how to integrate his model with Project Transition's." Paul Keisling, Project Transition's Executive Director, adds, "Boston University, and William Anthony in particular, were among the first and strongest voices in the recovery and psychiatric rehabilitation movement. They conducted some of the early research around what best helps people in recovery. Their model is evidence-based, works well and is teachable and repeatable."

Keisling continues by saying "A number of our staff applied to attend the Boston University training. Erin and Joe stood out, not only for their interest and experience in vocational rehabilitation, but because they were able to articulate how they would integrate what they learn throughout Project Transition."

Six months into the training, McNally reflects that "This is a very intensive process between the PVR counselor and individual clients. There's a lot about the mental health system that takes choices away - clients are told what treatment program to attend, where they'll live and what medication they're prescribed. In addition to the various assessments and skill trainings, we also work on ways to strengthen their ability to make decisions about the direction of their lives."

One of the myths of PVR is that professionals know what their clients want. In order to have a comprehensive PVR model, we need participation and perspective from our members. "I would like to see more member involvement in the vocational rehabilitation process - not only in discussions about PVR, but also in leading groups," says Hvorecky. "In one of our programs, a PT alumnus is facilitating a workshop. This is significant because our members get to witness a peer's accomplishment, offering credibility and hope to the group."

"The model of Project Transition is based on the premise that there are skills you can learn and supports you can access to reclaim your life - even in the presence of symptoms. The next steps for our vocational programming will be exciting. This is another way for us to reassert our belief that people can and do recover," says Keisling.