There’s a saying amongst social workers, therapists and helper-types that goes something like this: “What is the goal of an initial session with a client?” Answer: “To have a second session!” Quippy and yet quickly gets at the heart of how clinical services work: in order to proceed with any care, care planning or treatment delivery, providers must establish an interpersonal connection that is positive or helpful enough to allow the person to trust you, or your work setting, enough to come again.

In the mental health disciplines (psychology, psychiatry, clinical social work, marriage and family therapy, professional counseling, etc.) we call this process developing clinical or client rapport. In traditional community based mental health care settings the development of rapport is often facilitated during an initial intake session. Something a person has called and requested, then gone ahead and scheduled, waited and then shown up for, and completed the entire required intake process so the intake clinician can assign them what the clinician determines is the appropriate level of care that is available. Often this will be with a different clinician who will work to establish rapport with the client. Sometimes a screening or insurance eligibility appointment is also required.

While this model works for many people, it often excludes vulnerable people in need of connection, care and treatment. People suffering with symptoms of complex trauma where a relationship was used to harm, with severe mental health needs who also use drugs, with significant medical or other psychosocial needs, many of whom have experienced discrimination and marginalization from social connections and services much of their lives, have great difficulty accessing mental health care through this traditional model. For example, it can be hard to remember and keep an appointment set a month away when you aren’t sure where you will sleep each night. And people may leave an intake experience more distressed than when they arrived when well-intentioned clinicians ask painful questions such as, “Have you ever experienced sexual violence?” These experiences can leave people hesitant to engage in mental health or substance use treatment services for some time, if ever, again. As one HRTC therapy client put it earlier this week, “The clinics, the hospitals and stuff, they’ve institutionalized fear in me.” Oftentimes neighbors, providers, politicians and media blame the struggling person for the after-effects of these experiences by describing someone as “a drug user who doesn’t want services”, or as “service-resistant”—with the common subtext that someone “doesn’t want to get better and is making others’ lives harder on purpose.”

Harm Reduction Therapy (HRT) was created as a direct response to the mental health needs of people who use drugs and for whom traditional models of substance use treatment were not working. The foundation of HRT is deliberate investment in the development of paced, clinical rapport with each client. Practicing HRT in community mental health settings further requires that clinicians and program structures build capacity to not just invite in, but welcome, people with multiple, complex needs without any prerequisites and begin building rapport from the moment of first contact.

HRTC does this by deliberately creating therapeutic spaces designed to meet people where they are–physically, spiritually, emotionally, psychologically and psychically. We welcome all, regardless of an individual’s motivation to change or if someone exhibits behaviors that are challenging for others to be around. HRTC ensures our treatment sites offer friendly faces, beverages and food, comfortable places to sit and multiple ways for people to connect to a therapist (privately, in groups, in casual community discussions or around a coffee pot). We offer on-demand therapy and treatment connections without requiring a scheduled intake or insurance and invite people not only into a treatment relationship, but into experiences of belonging, community and care.

By offering welcoming, hospitable, low-pressure treatment environments we facilitate multiple opportunities for clinicians to build rapport with some of our community’s least connected, most shunned, lovely and complex people. Inviting people in, and back, is what good service provision, good community mental health and good psychotherapy is all about. Welcoming people in (inside, into community, into a treatment relationship) is the foundation of HRT and all of HRTC’s work; it is what allows us to mitigate some of the traumatic historical transference that a client may be holding with regards to past experiences in mental health or substance use treatment. By hosting our clinics on sidewalks, alleys, and navigation centers, rain or shine, by bringing our treatment to locations where our clients live, socialize, and hang out, we are effectively eliminating a significant obstacle to engaging in treatment—the treatment system itself.

-Anna Berg, LCSW, Clinical Program Director

-Nathan Kamps-Hughes, LCSW, Merlin & MBH Program Manager

 

Read the rest of our newsletter HERE

Donate to HRTC HERE

Shop our Amazon Wishlist HERE