Ellenhorn New Perspectives Series: Cultivating curiosity and motivation: cornerstones of change behavior in tri-occuring recovery

On May 2, 2022, Ellenhorn hosted the second of five talks in our 2022 New Perspectives on treatment series. This presentation was done by Zoi Andalcio, LMHC, Ellenhorn’s Director of IDDT Services and Katherine Clemens, LICSW, Ellenhorn’s Clinical Director.

Curiosity is something that we are all born with and is foundational to our cognitive development. As we develop from infants to adolescents to adults, however, our curiosity, or our intrinsic desire to know and understand, is subverted by multiple forces. This presentation will address the macro- and micro-level ways in which stymied curiosity results in an environment lacking in motivation to change, as well as examine mental-health treatment for “tri-occurring” recovery. Speakers discuss their own work with clients who are seeking recovery from tri-occurring challenges, as well as the ways in which they cultivate curiosity as essential motivation toward change.

An Interview with Ellenhorn’s Director of Pact Support, Miranda Levy

PACT Support at Ellenhorn

Ellenhorn, the most robust community-integration program in the United States, serves each client in their own home or community via the Program for Assertive Community Treatment (PACT) model of service. PACT, introduced in the 1970s, is now considered the evidence-based best practice for serving individuals with complex psychiatric needs—and rightly so. 

Our intensive multidisciplinary program, an effective and humane alternative to residential or hospital levels of care, is often referred to as a “hospital without walls.” Our individualized treatment approach combines psychosocial rehabilitation, medical/psychiatric care and a focus on physical wellness. From day one, we work toward each client’s reintegration into the community, reengagement with life and rediscovery of a sense of purpose and hope. We believe that psychiatric recovery and a person’s recovery of their sense of self and connection to others go hand in hand. 

That being said, we understand that the struggle with addictive habits and disruptive events of mind and mood does not end at 5 p.m., which is why Ellenhorn provides outreach services well into the evening and on weekends, and has clinical staff available 24 hours a day to respond in person to crises. The majority of our evening and weekend care is provided by our PACT Support team, who work in tandem with our clinical staff. Here to share some details of this provision is Ellenhorn Director of PACT Support, Miranda Levy.

 To start, can you tell us what you consider some of the best features of Ellenhorn’s PACT model?

“We are a multidisciplinary team, which means we take the best of traditional PACT work and add to it. By utilizing interventions like expressive-arts therapy, mentalization practices, occupational therapy, open dialogue and so much more, we are able to operate as a ‘hospital without walls.’ This means that we go directly to our clients in their homes and in the community, which allows everyone we work with to maintain their independence and remain connected to the world—all while receiving the highest standard of psychiatric care.” 

Tell us about PACT Support. 

“One of the things that makes the PACT model so effective, and one of the factors that makes it like a hospital without walls, is the fact that care continues after business hours. Here is where PACT Support comes in. We’re the members of the PACT team who continue the work of helping individuals to preserve their current lifestyle and sense of independence long after typical business hours. By providing support in the evenings and on weekends we allow our clients to retain their autonomy while working toward their clinical and social goals.”

What role does communication play in the PACT program and in assuring that each client’s care is seamless?

    “We recognize how important clear and effective communication is in providing meaningful clinical care—which is exactly why we designed PACT Support to be an extension of a client’s clinical team, rather than a separate entity. As such, communication is cohesive among all team members. PACT Support, like the rest of the PACT team, provides prompt updates and detailed clinical notes to assure that everyone is on the same page while we continue to work together toward each client’s goals. When it comes to PACT Support, communication is what allows us to provide seamless care.” 

Why do you consider PACT Support such a vital part of the PACT program? 

“Many individuals who are seeking psychiatric resources find the evenings and weekends particularly challenging. They can get lonely and feel unsettled without routine support. Our PACT Support team is passionate about mental health and able to bridge these gaps between clinical services by offering care outside the scope of regular hours. It’s so important that our clients do not feel isolated. When it comes to PACT Support, creativity is key. We work collaboratively with our clients to ensure that they feel supported no matter the situation. Whether that means going grocery shopping with them, helping them get to appointments on time, attending an activity together or simply sharing a conversation over a cup of coffee—we do it all. The most valuable parts of the PACT Support program are the meaningful relationships that are formed. I feel that these relationships play an integral role in instilling our clients with hope, and I consider it an honor to help bring PACT Support to Ellenhorn clients across the country.” 

Hope and the Courage to Continue: 5th Community Integration Conference “Turns a Light on a Dark Room.”

Hope is the key driver of personal change. Hope enables us to take action toward a goal and to trust that we can keep moving toward it. However, in the very act of bringing us closer to our goals, hope brings us closer to the potential disappointment of not reaching them. Fueled by hope, the higher the summit we attempt, the more injurious the possible fall into despair.

Thus, when we hope, we risk despair. That risk is at the center of all change. As behavioral health professionals, our task is to help clients take that risk – again and again. 

Despite the key importance of hope to personal growth, it is neglected in standard treatment. There is an identifiable gap in many psychotherapies and skills-based training regarding this concept. Too often, hope is seen as an essential psychological outcome, but not the core of the work.  

The fifth Community Integration Conference, held on June 20, 2019, was designed to start to correct this gap.  At the conference, which took place at The Menninger Clinic in Houston, Texas, attendees were inspired to explore ways of integrating hope-based approaches into their work, bridging the treatment gap in using the value of hope as the central driver of personal growth. Participants also explored how the community integration therapeutic model is a fertile ground for the rebirth of hope – and change — even in people long mired in hopelessness. The event enjoyed record-breaking attendance.

Speakers Hold a Mirror Up to Hope

Conference presenters discussed the various faces of hope and its seminal connection to personal change. They addressed an audience of physicians, psychologists, social workers, licensed professional counselors, addictions professionals, and providers and consumers of behavioral health services.

In his presentation entitled “Hope is a Verb,” Matt Estey, LCSW, Program Director of  Menninger 360, noted that for Programs for Assertive Community Treatment (PACT), “hope is the integral action step, the cornerstone to creating, restoring and enhancing life.”

Dr. Jon G. Allen, Clinical Professor in the Voluntary Faculty of the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, spoke on “Hope in the Menninger Tradition and Beyond.” He considered hope in the context of a “sadly common clinical challenge: trauma in attachment relationships…Restoring a feeling of security through treatment relationships, ideally buttressed by a healing community, is a central foundation of hope.”

In his talk, “Hope, Fear of Hope and Coping,” Kent Harber, PhD, of Rutgers University, discussed his trailblazing clinical research with Dr. Ross Ellenhorn into the new concept of fear of hope. “Our research included the creation and use of the Fear of Hope self-report measure to understand how hope and fear of hope together affect well-being.”

Chyrell Bellamy, PhD, MSW, Associate Professor at Yale School of Medicine’s Department of Psychiatry, Program for Recovery and Community Health, and that program’s Director of Peer Services/Research, spoke on “Hope for the Feared Selves: From the Individual to the Collective. Moving Toward Meaningful Social/Community Inclusion and Recovery.” Dr. Bellamy noted that “For many living with mental illness…individualistic interventions may be a start, but…community approaches offer a sense of belonging and citizenship that are important to our ways of being and living.”

Ross Ellenhorn, PhD, LICSW, president of A4CIP and CEO/Founder of Ellenhorn, LLC, spoke on “Dreams Deferred: Hope, Fear of Hope and the Psychological Consequences of Serious or Repeated Disappointment.” Because treaters often view a client’s inability to move forward as an innate psychological trait rather than situationally based, said Dr. Ellenhorn, “much of the dysfunction and lack of motivation in our clients is not merely rooted in psychiatric problems, but is iatrogenic, that is, created by the way we treat them.”

“The Conference Was Wonderful….All the Work Everyone is Doing!”

(An attendee)

When reflecting on the conference, attendees spoke excitedly about insights gained into the heretofore unexplored areas of hope and fear of hope. They described feeling reinvigorated by collegial sharing about the community integration model and its special value for people who seem profoundly stuck.

Says Matt Estey of the Menninger Clinic, “Since the conference, our [PACT] team has been having rich discussions about hope and fear of hope. Also with clients – and we’ve been quite overt with it, asking: ‘Are you experiencing life this way?’ We work with folks who’ve ‘done’ a lot of treatment, and are often labelled ‘treatment-resistant’ or “failed in treatment.’ This seems unfair. Fear of hope is more helpful in illuminating why a person is so stuck.”

“This illness is stigmatized,” reflects Dr. Bellamy of Yale, “And for many of us, it causes you to go inward. It’s hard to muster that sense of hope. There’s something to collectiveness in terms of hope. Hope doesn’t work in a vacuum, but is inspired and created by being around others. That’s community integration.”

Dr. Jon Allen of Baylor College of Medicine comments, “The conference opened my eyes and my mind to a way of working with people after hospitalization. Community integration means a person is no longer out there alone. They have the support they need. That makes hope possible and less frightening. Our crazy culture is so individualistic in orientation. People who have been ill for decades leave a hospital and are supposed to make it on their own. It’s a profoundly unhelpful way to be, yet one that’s prized.”

Dr. Allen adds, “Therapies lag behind in helping people function in their lives. Health isn’t the absence of illness; health is a whole other continuum apart from the illness continuum. Health consists of flourishing at one end — languishing at the other. Community integration programs are helping people who are free of the acute phase of illness move toward living their lives well.”

Eric Friedland-Kays, MA, Senior Clinician and Senior Administrator at the Windhorse program, notes, “I tremendously appreciated the focus on hope and fear of hope. Dr. Harber said having hope often means committing oneself to uncertain outcomes. I love this way of saying it. In reality, there’s so much uncertainty. We need to have faith in ourselves and the world to take a step. In the community integration setting, we’re able to support folks in dealing with the actual uncertainties of the real world and to play with these real-life scenarios. By supporting someone in taking real steps, forming real relationships, all within a relatively safe setting, we help them move along.”

Dr. Ellenhorn comments, “Hopelessness is now called depression. But the minute you start seeing a human being as a human being, and you think about other words — like hope and fear, connection, feeling valued, purpose – treatment becomes much more world-based. That’s where community integration makes a unique contribution.”

Notes Jeanette Spires, MS, MSED, NCSP, an educational consultant and nationally certified school psychologist, “Before the conference, I had never thought of hope as on a continuum with despair. Much of my work involves convincing people who are resisting treatment to consider it. Now I’m thinking differently about how I might present treatment. You don’t want to create false hope. Yet you also want them to be validated and, in the end, excited about life.”

Dr. Bellamy adds, “A variety of supports! That’s what I love about community integration.”

VIDEO: Laurie Damsky, PMHNP appears as guest on Recovery X

On July 23rd, 2018, Laurie Damsky, PMHNP, appeared as a guest on Recovery X with Dan Sevingy. Laurie and Dan talk about what Ellenhorn does, mainly surrounding addiction, and how it is unique, more effective, and better for the client as a whole than other treatment models. The use of the PACT model, IDDT, A4CIP, and why Ellenhorn does what it does are all topics that are explored in depth in this interview.

“[Addiction and mental health issues] are not separate, they are completely intwined with each other.”

To learn more about any of the topics covered in this interview please visit our website, www.ellenhorn.com. Here you will find more detailed information about all of the topics Laurie and Dan covered in their conversation together. For questions about admissions, please contact Laurie Damsky, PMHNP through email at ldamsky@ellenhorn.com or by phone at 617-491-2070.

Laurie Damsky, PMHNP-BC of Ellenhorn – Integrated Dual Diagnosis Treatment (IDDT)❌ WANT TO HELP US SAVE LIVES? ❌We offer addiction sufferers and their families with free addiction recovery resources, like educational videos and one-on-one help finding treatment.You can help educate and save lives by donating to the show here:➡https://pages.donately.com/recoveryx/donate$1 or $1,000. One-time or Monthly.It all helps!Thank you for your support of the causeMentioned in this episode:Ellenhorn – https://www.ellenhorn.com/Laurie Damsky, PMHNP-BC – ldamsky@ellenhorn.comAssociation for Community Integrated Programs – http://a4cip.org/

Posted by Recovery X – Addiction Recovery Experts on Monday, July 23, 2018

How PACT Allowed Me to Be the Best Clinician I Could Be

By the time I was halfway through my psychiatric clinical training in nursing school, I was sure I wanted to enter this field. I loved the patients I saw and I really enjoyed learning how to provide care for them. People can see a broken leg, but they can’t always see anxiety or psychosis. If they do, they don’t always reach out to help. As a nursing student, I felt empowered to show compassion and empathy to the patients on my unit. I hope I was successful.

This hospital setting was all I had seen of the mental health field. So, as do many RNs once they’re out of school, I applied to work at hospitals. I couldn’t have been more excited when I was offered a job at the prestigious McLean Hospital. Moving from upstate New York to Boston was amazing, but knowing that I would be at one of the best psychiatric teaching hospitals in America made me feel I was really moving up in the world.

Working at McLean was a whirlwind. I saw so much in such a short time. I was constantly learning and the pressure was on. I thrived in my work and loved working with the patients there. They were having acute symptoms, and had so much to share with me. Every shift was exciting.

But there was something missing from the puzzle. Many patients who had been discharged were back within the month. Others were back in six months. I hoped that those I never saw again had a safe and happy recovery But I suspected many did not. I started to think that while my work was important, it was just the tip of the iceberg, and I began to feel restless in my role in the hospital revolving door.

After working at McLean for seven months, I started paying more attention to discharge plans. Where were people going when they left? How were they going to use the information we gave them? Would I be seeing them again soon? It was at that point that I started hearing more about a private PACT program, just 10 minutes down the street. The program was at that time called Prakash & Ellenhorn. I looked it up and couldn’t believe how so many ideas and approaches described on the website echoed what I felt was missing in the care of the people I worked with. The PACT program recognized the social component in people’s lives that is so integral to all humans.

I soon learned they were looking for a new nurse! It was the opportunity I’d been waiting for. I applied and was offered the job. There was still so much I didn’t know. True, at the hospital, I’d learned a lot about symptoms, medications and adverse effects. But I hadn’t had the opportunity to learn about people.

The PACT team changed my perspective in many ways. The people I cared for were not viewed as patients, reliant on what clinicians could provide. They were clients with autonomy, who were experiencing the hopeful beginnings of new control over lives that had felt unstable for so long.

I had found my niche. I was the nurse on a Program for Assertive Community Treatment (PACT) team. PACT is a model of care designed to keep people from being institutionalized through the revolving door of the hospital or in a series of residential programs. I learned that keeping our clients in the community meant they continued to have real lives, even if they were suffering from difficult psychiatric experiences or symptoms. Witnessing the results of this type of community integration care, which has actually been around for over 30 years, has proven to me many times that it should be available to anyone who needs it. I’ve seen so many changed lives because people were given the chance to remain outside the hospital, building relationships and finding meaning and purpose in their lives — driving forces for all people.

I find it disappointing that this model is not one typically taught in school. I would have loved to learn more about community integration work while a student. Instead, we focused on hospital level care, residential care, partial hospital care and intensive outpatient care. There wasn’t room in this very medicalized model to keep someone involved in their life and in their community, while also providing intensive wrap-around services, as PACT does. At the first signs of difficulty, people were sent to the closest emergency room, often against their will, then shipped off to programs where they were in treatment from 9-5, isolated from their families and friends, and often lost whatever traction they had in their vocational endeavors before it all took place.

This loss of traction, or the loss of one’s path in life, often correlates with psychosocial trauma, which is the loss of one’s expected role and path in life due to symptoms of mental illness or addiction. Our PACT team devotes a great deal of its efforts to relieving clients’ psychosocial trauma. Yet treaters in most other models of care ignore it or fail to successfully address it because the client has been uprooted from their home community and for that reason, is unable to form nourishing real-life connections, reclaim a life-track, and regain a social role.

For the past few years, I’ve been practicing as a Psychiatric Mental Health Nurse Practitioner (PMHNP). This role has solidified in my mind the need for more community-integrated care. I hope that insurance companies will come to understand the importance of this treatment model and will start putting their resources into prevention, rather than waiting for acute psychiatric crises before stepping in and helping their customers. Only time will tell.

Ross Speaks on Mental Health News Radio: The Importance of the Social Experience

Last week, Ross sat down with Mental Health News Radio host, Kristen Walker, to talk about the importance of the social experience when it comes to mental health treatment. Click on the link below to listen to the interview and learn more about Prakash Ellenhorn’s unique and integrative psychosocial model.


Assertive Community Treatment, Addiction, and Empowerment

Addiction in the US is a growing epidemic. Everyday there are blotter reports of drug arrests in small towns, overdoses photographed and posted on social media, and headlines addressing the tainted batches of opiates or a new synthetic drug that is circulating. Painkiller use has risen exponentially over the past 20 years and according to the National Institute on Drug Abuse there has been more than a fivefold increase of the heroin death rate since 2002.

With a rise in substance use comes a rise in need for effective and affordable treatment solutions. Any family that has had to navigate the substance abuse and mental health world has experienced a repetitive and taxing process that often results in shuffling an individual back and forth to inpatient settings in hope that this will be the time they see success.

It has become evident that the model for treating substance abuse and mental health issues needs to change to meet each individual more effectively and help people stay out of revolving door hospitalization. This is where we see Assertive Community Treatment as an option. Program for Assertive Community Treatment (PACT) is a model that utilizes the multidisciplinary 24/7 staffing approach of inpatient setting but applies it at the community level. It is heavily person centered, strengths based, and comprehensive, addressing not only psychiatric and psychological needs, but also the psychosocial factors that are critical to the success of a person’s recovery plan. PACT focuses on lessening or eliminating the symptoms that cause an individual to experience recurrent acute hospitalizations. It does this by meeting their basic human needs, improving functioning across all domains of life, increasing longevity in the community, and restoring familial relationships. PACT is not connecting clients with outside service providers, it is providing the full spectrum of support from within the multidisciplinary team, minimizing the need for the client to run around from provider to provider and allowing them to focus on recovery.

Clients also direct their Roadmap for Recovery, focusing on where they see themselves, how they want to get there, and what barriers may exist in making it happen, as well as how to overcome those obstacles . It becomes the job of the clinical team and the family to help the individual accomplish these goals through an unwavering and strengths based support system.

Anyone that works with, lives with, or knows someone that struggles with addiction issues is aware of the level of shame and self doubt that the individual experiences in both use and recovery. It is critical that we as clinicians, family members, and friends re-frame our approach to addiction treatment if we want to see a long term change. We can work to the strength of the person and not contribute to the trauma one experiences being hospitalized repeatedly. That is our charge as mental health professionals and human beings.