Almost a year ago, Dr. Richard Bernstein arrived at Spruce Mountain Inn to serve as our psychiatrist. Prior to coming to Spruce, he was the Director of the Psychiatry Training Program at the University of Vermont and the Director of Inpatient Psychiatry at Fletcher Allen Healthcare. Dr. B wrote some reflections about his work here and we decided to include excerpts on our newsletters with the full versions posted on our web-site….stay tuned!
THE VIEW FROM DR. B’S OFFICE
The psychiatrist’s office at Spruce Mountain Inn is an eight by ten foot space. There are windows on two sides and a door on each of the other walls. When the president of Goddard College owned this house, he welcomed his guests through here. It was the front vestibule.
Recently I have been discovering new things in the office which, because it is called Dr. B’s office, I had (foolishly) assumed was “mine.” For instance: a rolled sock under the table; a psychology textbook on a chair; a pillow on the couch, still slightly rumpled with the imprint of having been recently slept on. There have been knocks on the door, timid, respectful, because the knocker knew I was speaking with another resident, but at the same time needing to be answered: “Have you seen my water bottle? I need it for class.” I get a kick out of these things. They remind me that I am working in a community, part of a family, albeit a temporary one, yet at the same time functioning in a way that emphasizes both sharing and respect. I have four grown children and seven grand-children. It all feels very familiar and right.
I have never talked with patients from behind a desk. For many years as a hospital-based psychiatrist, I visited with people in their rooms, or, if one was available, a non-descript “interview room.” And I have spent hundreds, if not thousands of hours, in the analyst’s spot at the head of the couch. This experience has allowed me to entertain many points of view and to think carefully about what is going on between another person (or persons) and myself during a “session.”
Some of the new residents at Spruce are puzzled about, and sometimes resent, my asking personal questions. “Aren’t you just supposed to be talking with me about my medications? I mean, I have a therapist and a case manager.” And, they are correct. Yet my view of what I think should be the psychiatrist’s role at Spruce Mountain might be different from what they have come to expect from their previous experiences.
My favorite view from my Spruce office is not a view at all, merely a short journey of a few steps; out the door, turn right, through the french doors into the living room where on Wednesdays from eleven till noon I get to participate in T and T meetings. That stands for Treatment and Transition. It is just one of the many interdisciplinary gatherings held during the week, but the only one that coincides with my schedule. Here, the staff get to talk together, think out loud, share experiences, problem solve and plan, all collaboratively focused on the issues of individual residents whose well-being is the sole agenda of the meeting. I like how these meetings feel. I value the openness and the honesty of professionals willing to share their clients’ progress and backslides as well as their own mistakes. I enjoy how these meetings run; the mutual respect for the ideas of others, the rotating facilitator’s role and the sense of both history and tradition that informs the group wisdom.
Although I have been consulting at Spruce Mountain Inn for less than a year, I have been referring patients here for many years. Now, as a member of the family, I am seeing the program from the inside with new eyes. It gets two thumbs up. Why? That will take some time because the answer is complicated but will, I hope, allow you to better understand the workings of this unique place. Over the next months, I will use the SMI INSIGHTS NEWSLETTER to tell you about psychiatric care, one piece of the treatment pie. And I don’t want it to be only my view. Windows go both ways. The topics I write about will not be cut and dried. They will invite your input; comments, questions. If you e-mail or write, I will include your portion (appropriately disguised) in my response.