PREP©West: Creating therapeutic community together

Imagine sitting in a therapeutic circle that includes friends, family, mentors, counselors, prescribers and the voices that are speaking from within. All have a say in shaping the way forward for those who have recently experienced their first episode of psychosis.

Welcome to PREP© West – the Prevention and Recovery in Early Psychosis program that ServiceNet launched in Holyoke in the fall of 2015. The PREP Program is based on a cutting edge concept to more effectively treat those who experience psychosis, who have historically been given a poor lifetime prognosis. Our focus is on early intervention, the idea being that this will reduce symptoms of psychosis or even allow symptoms to go into remission.

Funded by a three-year grant from the Massachusetts Department of Mental Health with backing from SAMHSA, this outpatient day program for up to 50 young adults between the ages of 16 and 30 uses a non-hierarchical approach to treatment, in which everyone participates and everyone learns.

The centerpiece of our program is a robust milieu – or therapeutic community – developed around program participants’ interests and needs. We begin each day with active community-building, and soon after start getting ready for lunch, which we prepare together and eat together. In the afternoons, we have a variety of structured groups, ranging from drama to writing, volunteering, peer recovery, wellness and “Creating Change”. Program participants connect over their mutual interests and continue making connections throughout the day. We also offer life skills groups, plus several additional outpatient modalities, including individual psychotherapy, medication management, peer counseling and wellness.

PREP is intense, it’s creative, it’s challenging and it’s working. People often come into the PREP© West program shortly after hospitalization and many of them are still symptomatic – hearing voices, having hallucinations and feeling socially isolated. It may take them a few weeks or even months before they are fully engaged, and they may continue to have difficulty with mood changes, lack of motivation and difficulty with cognition.

What they learn very quickly though, is that they are not alone – others in the group have been in the same place and come through it. And this can make all the difference.

When Matt (not his real name) came into the program, he was manic, disorganized and distressed by his diagnosis of

Schizoaffective disorder. He’d been rejected by his local community and soon afterwards suffered a family loss. Still grieving these losses, he soon found others who understood and accepted him just as he was. Matt started participating in groups, cooking meals, participating in therapy, and taking medication to address his symptoms. He’d always been an intelligent, curious young man, and this came through in his interactions with others.

Six months after entering the program, Matt was on medication that worked, had reconnected with his family and community, and had found a fulltime job. He was back in his life, and moving on.

Each person’s experience is different, of course. Some take more time, some less, though all make consistent progress during their time with PREP© West. We believe much of this happens because of the nature of the community we create together. Though the experiences of our program participants may be more dramatic and disturbing than ours have been, all of us have had to sort through and make sense of how we identify in the world. The more we look at ourselves, while checking our understanding of others and consciously developing our own cultural humility, the stronger our shared community becomes for everyone involved. We don’t just provide milieu therapy; we do the work of milieu therapy, alongside the participants in our program.

The same equality holds true in our network meetings. These sessions – which happen as often as once or twice a week when someone first starts the program, then taper off to every couple of weeks – involve anyone the individual might define as a member of his or her support network. Meetings could also include the voices – for the messages they share are all part of the story, like a waking dream analysis, and can help the full network make more sense of the experience. People start a dialogue with each other, bringing their particular expertise and perspective to the discussion. No one at PREP© West has more authority or carries more influence than anyone else. For it is the full therapeutic community that helps in the recovery of the young adults involved.

Melissa Weise, MSW, LICSW, is Director

ServiceNet.

The Provider E-Edition

June 2017