How Work Works
By Robin JacksonRobin Jackson was formetly on the staff of Fountain House, New York.
I am going to talk today about how work works in the clubhouse model. In many traditional day treatment models of rehabilitation, work is ignored as a rehabilitation tool, either because it does not occur to the staff that there is any merit in work, or they believe that it is basically inhumane to ask that people with mental illness strive for useful occupation. There is also the deep-seated belief that the mentally ill can't work at any meaningful task, and it is therefore inappropriate to ask them to do so. Instead, their time is to be filled with group therapies, occupational therapies heavily dependent on arts and crafts that have little practical value, and "skills training" for situations in which clients may or may not find themselves, since skills training is not expected to relate to utilization.
The clubhouse model, pioneered by Fountain House in New York, regards work in an entirely different way. Work is the medium out of which clubhouse relationships are created. It is the source of interaction, satisfaction, a sense of accomplishment, and the basis of friendship among members themselves and between the staff and the members, Relationships built around shared work are among the least artificial available to adults in most societies.
Young children are free from this artificiality. When young children meet, they immediately begin to try to play. They don't sit and talk, exchanging guarded social banalities. If they are without toys, they throw sticks, or run and jump and climb and leap, talking all the while as their play works to mediate their relationships. They have little history and no facades and meet each other spontaneously.
Older children and adults lose this spontaneity. By then relationships are built around status, sexual attraction, proximity, profession, or whatever in very prescribed and proscribed ways involving immensely complicated learned behaviors. Building a relationship is an arduous and often painful business filled with doubts and hesitancy in the best of circumstances. The new neighbor, new boss, new wife, or husband of a colleague can loom like an ogre to be placated with all the social skills that one can muster, all the while protecting one's own self-esteem.
People with mental illness are very much more handicapped in this arena of relationship building. The illness may have denied them many opportunities for creating successful relationships. Their own bizarre feelings and behaviors, the stigma placed upon them by society, and the resulting isolation are discouraging. Further, if they have been hospitalized for a long time, or repeatedly, their pathology and its control is the only thing that has been of interest to those doctors and nurses to whom they might have attempted to relate.
Besides the calamity of symptoms and their consequences, people with mental illness are often poor, only partially educated or even illiterate, unskilled, unemployed, unmarried, and cut off from the sustaining institutions that form a bulwark for the ordinary citizen.
This is a rough description of the social state that many potential members are in when they come to the clubhouse. They are neither wanted nor valued. Their lives have been marked by a number of shocking failures and mishaps brought about by their illness. The usual progression of life that is offered most people in their society is closed off for them. They have been labeled incompetent. Worthless, and, at best, inconvenient. All too often they have accepted their stigma and try unsuccessfully to cope with it.
Through its guarantees, the clubhouse offers to change all this. The guarantees that all clubhouse people know- a place to come to, meaningful work, meaningful relationships, and a place to return to-are fine to state. How are these promises kept? I believe through the relationships built around the work of the clubhouse.
When people first come to a clubhouse, through referral, out of interest in trying a new program, or for whatever reason, what they find, if the clubhouse is operating at all well, is a community in which the members are needed and vital to the operation. No good clubhouse has so many staff that staff alone can accomplish all the work that keeps the place going. The work must be shared with the members and the members must find sharing the tasks enticing and interesting. If they don't, there isn't a clubhouse.
The work at hand is the source of the relationships. How does this process occur? In a very simplified statement, as follows: there is a task at hand and two or more people who are somehow motivated to do it. What this motivation is not important for the moment, nor is the nature of the task. What happens between two people is this: as the jobs gets going, mutual dependence begins -you hold the ladder, I'll wash the window; shared decisions are made- yes, the soup needs more salt; common hopes and anxieties come into being- we hope that the rose bushes will grow and bloom; satisfaction with one another's activity is expressed-we've collated and mailed the newsletter. The completed task visibly before them, they share rewards-now that the mess is cleaned up, let's have a cup of coffee.
Throughout this process the focus has been on the task, not on the people. At the same time, without having to discuss it, or measure it, or even contemplate it, a relationship is coming into being. Mutual respect, shared history, and future anticipations are being molded, and the work at hand is the medium through which the relationship is growing. The completed or ongoing tasks of the clubhouse form the concrete, visible, palpable, and pragmatic evidence of the worth of its members and staff. The rose bushes and the soup, not some vague, abstract statements about human values, attest to what we can all accomplish together in the clubhouse.
Through this process of working together and being valued in so doing, members begin to gain, or regain, some self-respect, some sense of self-worth, and respect and value for others. They begin to form friendships and to be able to be friends themselves. Skills that were of little consequence in the hospital are important and useful to the community of the clubhouse. New competencies are learned and new possibilities investigated through the relationships that are forming. With a reservoir of success. Failure is not quite so devastating a fear, and the attempt at something different not as fraught with worry.
It may be said that this is too rosy and optimistic a picture of the reality of the clubhouse as members and staff struggle together to make it all happen, so I want to turn for a moment to some of the negatives and stumbling blocks of this process.
There are some people who come to the clubhouse and do not seem to want to join in its work, or even sneer at those who do. Don't worry about them. John Beard, the founding director of Fountain House, constantly greeted members by saying, "It's nice to see you here." This was not a social pleasantry, but a real expression of a profound truth; the clubhouse community is grateful that someone finds it an attractive place to be, even if that person does little but sit in the lounge.
We must keep in mind the series of chosen, voluntary acts that led the person to get out of bed, get dressed, travel a distance, and arrive at a place. These simple acts can represent, to people suffering severe mental illness, such an outlay of energy and such a high level of psychic expense that little more can be asked of them. Certainly prodding and hectoring them to participate beyond their strengths will gain nothing. Their being there is enough. If other members and staff can have the patience, the participation will come, and the solitary, just-sitting members will get up the courage to join, if the busy atmosphere around them quietly and persistently entices them to.
Some clubhouses have made the mistake of insisting that members enter into contracts about clubhouse attendance, participation, etc. This is a mistake because the very nature of contracts stifles the development of relationships. In such a contract the member promises to do so much- come 3 days a week, or whatever, and no more. The clubhouse should be an entirely voluntary in nature, because only then can there be room for all that people potentially can give to the situation and to themselves. This becomes more obvious if one considers the relationship in terms of the contract -do we agree to like someone 3 days a week? Or respect their capabilities 5 half-days a week? Or a minimum of 5 days a month? No, we don't; relationships don't operate that way, for they are based on human emotional ties that can be turned off like light switches or measured by clock and stopwatch.
There is, as I have said, no need to fear the voluntary nature of participation in the program, because this very freedom is creating an atmosphere that will entice the shy, unwilling member to join in the activities. Even when surrounded by people who are obviously there by their own choice, there must sometimes be freedom to resist in order for one to accept freely. The learning that, as a clubhouse member, one will not be coerced into any part of the program can give rise to taking the chance of joining in. It is the responsibility of staff to communicate constantly in the relationships they are able to develop that this is the opportunity of the clubhouse and it is available to all.
There must be a constant willingness to be open to the abilities and talents of the members, even of those who seemingly have none. That openness is best expressed by consistently and optimistically seeking to engage people in the tasks at hand. That may seem a difficult thing to do, and it may be occasionally, but it is always easier to accept the rejection of the work offered: "No, I won't help make soup," than the rejection of the person asking for help: " I don't want to have anything to do with you. " By placing soup making between them, the focus is on the task, not on the two people involved. There is still space to maneuver on both sides. The staff person can come back again with another task; the recalcitrant member, who may be filled with enormous anxieties about the whole situation of any interaction, has another chance to gain the courage to join in.
The whole question of work becomes, "What can we do together?" The relationships in the clubhouse are work-mediated and based on external, mutual experience. Members and staff constantly share tangible opportunities for success, and the possibility of failure is made less harmful by this sharing. The sharing of failure is as important as the sharing of success/ Failure hurts, but if you have someone else to help shoulder the blame if the rose bush dies or the soup tastes like glue, it isn't quite as bad as isolation.
Sharing Decisions
A further large function of the relation-building nature of work lies in the whole realm of choice in the clubhouse. The first choice, as I have said above, is the choice to be there- the voluntary nature of the clubhouse itself. Another vital part of choice lies in helping to shape decisions regarding what needs to be done. Decision-making about those tasks needs to be shared and offers another concrete reality to place before one another and to use in interaction. Choice needs to be a very broad concept that includes all the activities of the clubhouse. It begins with planning. Members and staff together should resolve every question possible about the clubhouse. What shall we plant in the garden? What color shall we paint the walls, and how shall we spend the money that we have for furnishings? Is it better to buy a new van or repair the old one and use the money another way? Should we hire another staff person, or can members and staff together take on a new responsibility? This list is endless and absorbing.
The activity-shared work of making choices is a vast arena for building relationships and testing one another's strengths. It also brings into play opportunities that people with mental illness have probably long denied, opportunities to have some control over part of their environment. No mental hospital ever queries its patients about the lunch menu or the color of the walls, let alone how finances are to be allocated. Patients are seen as too sick or too stupid to care, and their opinions would never be sought.
By seeking opinions and by asking for preferences from all concerned, the clubhouse gives its very ownership to the members and the staff who are part of it. This opinion seeking, discussion, and meeting together take a lot of time and can be frustrating, but this frustration is mitigated by the realization that it is not only the color of the walls that is at issue but also the very healing and strengthening process of making the decision. Also, it scarcely need be said that we much more likely to participate in the tasks that need to be done to carry out a decision, or set of decisions, that we have helped to make.
I have been in attractive clubhouses that opened their doors as completely furnished and finished as environments, done with taste and misplaced goodwill on the part of the staff. The idea was to create an attractive place to come to, and perhaps they have. I have also been in clubhouses whose very walls depended on the energy and planning and skills of the members and staff working together. The immediate sense of ownership and pride in the place is, of course, much more acute in the latter, built upon the mutual accomplishment it represents.
I have tried to expound on some of the ways in which work actually operates in the life of the clubhouse: as a means to mutually respectful relationships, as a buffer between possibly over-charged interpersonal exchanges, and as the medium through which members can make building blocks to create a strengthened and enhanced sense of self-worth and confidence. Staff gains a profoundly evidenced sense of themselves as successfully enabling, and being in turn enabled by, clubhouse members. Work-mediated relationships are based on the solid reality of mutual struggle and accomplishment through which the clubhouse lives.
