An umbrella policy for psychologists


	Alan Bodnar, Ph.D. is the Co-Director of Psychology Training at Westborough State Hospital, Mass. and a consultant in the field of leadership development.

By Alan Bodnar, Ph.D.

Consider the common umbrella. Webster defines it as a "portable, collapsible device for protection against rain and snow consisting of a fabric canopy mounted on a sliding framework of ribs radiating from a central rod." But it is so much more than that. How much more, I don't think I fully realized until one blustery December day that began with the discharge of one of our long-term patients. For years, this man had been asking when he could go back to his hometown and, on more than one occasion, had to be intercepted at the gates in the process of a self-directed discharge. Then, suddenly, word came that a bed was available in just the kind of community residence our patient needed in the very place to which he longed to return.

As in a favorable alignment of the planets, a successful discharge requires the perfect coincidence of a number of elements. The patient has to be ready when a vacancy occurs in the kind of residence that can provide the supervision and treatment he or she requires. Government subsidies, insurance benefits and appointments with psychiatrists, therapists, case managers and primary care doctors all have to be arranged. And, of course, the patient has to be willing to go. When everything falls into place, there is no time to lose and so, one rainy morning in December, rounds were abruptly cancelled and staff pressed into a different kind of service than many of us were used to providing.

Today our colleagues would not need our learned clinical opinions about changes in our patients' moods or behaviors or our recommendations for further diagnostic procedures and treatment strategies. Today, we had one common goal - getting our patient and the cardboard boxes holding all of his worldly possessions into a waiting minivan and off to the life he had been craving for such a long time. "Well, Augustus," a staff member chirps, "you are finally going home. You must be excited." Augustus growls indecipherably in a rich baritone voice that sounds anything but excited. "OK then, Gus," someone else replies, "it's natural to feel some nervousness leaving the hospital after all these years, but you'll do just fine." Augustus responds with another gruff and surly utterance, still not entirely clear in its content, though some are certain it contains the word, "idiots."

At least our patient is willing to get into the minivan we have just finished loading with his belongings. Never does our clinical team seem more single-minded or democratic as we each do our part in this intricate dance from the hospital to the community. Psychiatrist, nurse, psychologist and intern lift and stow cardboard boxes in the rain; the social worker adjusts the driver's seat and starts the engine. Holding my umbrella over the open van door to shield Gus from the elements, I pull the seatbelt around his considerable girth and into the fingers of a colleague waiting to grab the buckle and complete the circuit. In the time it would have taken us to check on the progress of our house's dozen residents, we have sent one of them off to start a long anticipated new chapter of his life.

My next appointment is a therapy session with a young man so happy to have recently gained the freedom to walk on grounds with staff, that he hardly notices the morning rain. It is raining harder now but he is wearing a hooded jacket and shrugs off my offer to share some of my large black umbrella. Grappling with issues of trust honestly acquired through years of abuse and betrayal, my patient is happy to report that he recently asked staff for help when he was feeling especially distressed. This is something new for him and very different from his usual stoic determination to do everything for himself. As we walk the hospital grounds in the December rain and the hood of the young man's jacket becomes sodden and limp, I notice the umbrella in my own hand gradually drifting and covering more of his head. Whether or not he notices as well, he doesn't say, but he doesn't move away either. When our walk and our conversation are over, he thanks me with a sincerity that suggests this therapy session was especially meaningful.

Bringing my umbrella to work that day was an afterthought. I am usually content to turtle into a warm jacket with a turned up collar, make do with a simple hat or sprint to shelter under an upraised notebook. But the forecast was for heavy rain and it was already starting when I left the house. Besides, I thought I knew where to find a large, black umbrella, a Wal-Mart special that I bought last year on the morning of a winter funeral. It had kept my cousin and me dry enough in a sleet storm at the cemetery and would surely stand up to rainy day at the hospital. My umbrella did all of that and more. It is one thing for a psychologist to speak in metaphors to convey meaning in our conversations with patients. That's why it helps to cultivate an abstract turn of mind and a good vocabulary. It is something else to live our metaphors. That's why we need umbrellas.

An umbrella policy for psychologists (January 2009 Issue)

By Alan Bodnar, Ph.D.

An umbrella policy for psychologists
(January 2009 Issue)