Harm Reduction Therapy as an Act of Love by Irina Alexander, LMFT

As therapists, we’re trained early on to avoid saying we “love” our clients. There are lots of clinical reasons for this – some valid, others rooted in colonized models of mental health. But regardless of whether or not we’re supposed to admit it, what we offered through our Folsom mobile site was an act of love.

I started as a therapist at the Folsom site in 2019, and had the gift of working there with clients in an outdoor drop-in capacity weekly, up until the city asked us to leave earlier this year. I hold so many memories I’ll always cherish about being able to offer therapy on the streets through such a low-barrier access point. We offered a model of support that didn’t require a level of privilege to access, meeting people quite literally “where they’re at.”

Many initial therapy sessions started with a client reflecting on the deep sense of surprise they felt when realizing they could start therapy right now, and didn’t have to jump through hoops to talk to a qualified clinician. Other therapy sessions took years of relationship building to get to, an often necessary step for people struggling with severe mental illness, or for those who have experienced deep systemic harm from service providers. Some came for just the food at the beginning, swearing they didn’t “need therapy,” while building up the courage and trust to finally share their story.

I had a mentor once remind me that we should never forget that every conversation we have might be the conversation that changes someone’s life. I’ve held onto this throughout my career as a therapist, and watched the reality of that idea unfold at the Folsom site. I can say for certain that creating a space where people from all walks of life were welcomed, cared for, and heard left a major impact – not just on our clients, but on our staff as well.

As easy as it is for me to understand on a deep level that what we were doing was right, it’s equally as difficult to understand the vitriol we experienced from people who targeted our site and eventually forced us out.

First, reports were made to the city about our harm reduction supplies, twisted as sensationalized stories of our staff giving drugs to children. While we fully believe in the power of harm reduction supplies to save lives, we had to pick our battles as city politics shifted. Removing the safer use supplies from our site, we continued to focus on what we were there for – providing substance use treatment and mental health support to those who needed it most and had the hardest time accessing it. Surely everyone could agree that was worthwhile?

Yet week after week, people kept coming to our site, harassing our staff and clients with cameras and questions about “free drugs.” We tried to engage people in conversation, to understand where they stood, and where their deep sense of rage came from. Many pointed to the school a block away, screaming and cursing that our presence at the public park was a danger for children. Others said our presence was the root of the issue – that by coming to this park for a couple of hours every Wednesday, we were moving the “homelessness problem” there. And still others yelled at us for having the words “harm reduction” on our van, demanding we change our name as if that was some dirty word.

To this day, I’m left wondering why. Why project these far-fetched negative narratives on the work we do? Why paint a picture of our clients as a “problem,” instead of coming together with compassion to fix the systemic issues impacting us all? Why spend so much energy fighting and hating people you know nothing about rather than approaching with openness and curiosity?

Of course, what we experienced at the site was only a small fraction of the oppression our clients experience on a daily basis. I’m reminded of what bell hooks so beautifully explained: “Fear is the primary force upholding systems of domination. It promotes the desire for separation, the desire not to be known. When we are taught that safety always lies in sameness, then difference, of any kind, will appear as a threat. When we choose to love we choose to move against fear – against alienation and separation. The choice to love is the choice to connect – to find ourselves in the other.”

I can’t help but wonder what it would have been like if the same people who came after our site had overcome their instinctual fear and instead pulled up a chair, sat down, and shared about the fuel to their anger. I can’t help but imagine that deep inside them, there are also unmet needs, pain that doesn’t have a place to go, and parts of them that could soften if they gave themselves the opportunity to experience a real connection.

The Folsom site gave us a chance to envision a new way of being with each other. The community there leaned into difference, found joy amidst crisis, and connected across cultural divides. It showed us how individual healing and systemic change are not two separate battles to fight, but two intertwined paths that strengthen each other. It pushed against the status-quo and gave a glimpse into how things could be, and hopefully someday will be.

And maybe that’s what being a harm reduction therapist is: relentlessly holding onto hope for a better future while actively creating it with people brave enough to begin building it now.

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