Professional Experience: Continuing Day Treatment Program

This entry begins a series of reflections on the professional experiences I had prior to private practice. My first position after earning my doctorate was to work as a Staff Psychologist in a Continuing Day Treatment Program at Pesach Tikvah, a mental health agency that serves the Orthodox and Hassidic Jewish communities in Brooklyn.

In a Day Treatment Program, clients attend not only their weekly therapy appointments, but also attend the program five days a week for intensive treatment of chronic psychological disorders. It’s a middle ground between psychiatric hospitalization and complete independence. The therapeutic relationship takes on added depth and intensity when clients and therapists see one another all day, every day. The relationships that clients form with one another and the program as a whole can ultimately be transformative and healing.

I accepted this position because I was intrigued by the possibility of practicing long-term psychotherapy with people who struggle with serious conditions such as schizophrenia and personality disorders, particularly given the added complexity of doing such work within a totally unfamiliar cultural environment. Entering this environment felt like going to work in a foreign country, where nothing can be taken for granted regarding language, custom, and meaning.

While I personally hold a cultural identification with Judaism, I had minimal religious education as I grew up, and certainly no exposure to Orthodox beliefs and practices. So joining this agency demanded a great deal of cultural competence and openness to being a minority among both colleagues and clients. I feel proud of the close working relationships I formed with colleagues and the culturally-sensitive therapeutic relationships I developed with clients.

I practiced psychoanalytically-informed individual and group therapy with clients whom I treated for several years. These were some of the strongest, most resilient people I have ever met. For people living with a serious and persistent mental illness such as schizophrenia, it can be challenging to keep up with relationships, work, and self-care, yet seldom have I witnessed such courage as among these individuals. Their religious devotion was inspiring as well, since most had life circumstances that would have made it perfectly understandable to lose all faith.

I experienced the satisfaction of seeing the clients with whom I worked make meaningful progress, some even becoming able to live independently for the first time in their adult lives. Psychotherapy can have a tremendous impact on a person’s life, particularly among those who face the greatest imaginable emotional and mental challenges. It was a privilege to play such a part in clients’ lives, and remarkable to have an opportunity to do so with people whose cultural experience has historically been closed to psychological intervention because it was viewed as an element of the secular, rather than religious world.

My responsibilities in the Day Program also included implementation of programmatic changes as dictated by the state Office of Mental Health. This aspect of my job inspired my interest in critical dialogue regarding public funding of mental health services, particularly with respect to the rhetoric of ‘evidence-based practice,’ as discussed in this blog.