Teaching "Severe Mental Illness" to Counseling Students
One of the things I'm the most proud of from 2022 is that I taught this semester long class at the Community Mental Health program at CIIS called "Severe Mental Illness." The students were in their final semester of the program, either already working in the public mental health system in San Francisco, or about to jump in. I brought with me 20+ years of experience, from both sides of the system, as well as many years of peer based organizing and support. And I made it as interesting as possible. Many of the students said it was the best class they took in the whole 2 1/2 year program. I would love to figure out how to teach it again, it's a required class in many counseling programs, and I'm pretty convinced my friends and I do it better than it's normally done! What would it look like if we could change counseling programs all over the country?
Course Syllabus
COURSE INFORMATION
Course Title: Advanced CMH Practice: Severe Mental Illness and Early Psychosis
Credit Hours: 3.0
Semester: Fall
COURSE DESCRIPTION
Clinical practices in the mental health field are often driven by a reductionist and outdated disease model that categorizes acute emotional distress as merely disorders of the brain. The language of “Severe Mental Illness (SMI)” often ignores deeper conversations about structural inequity, trauma, and poverty in our society, and fails to humanize and acknowledge suffering. This dynamic of addressing mental illness without relevant social context can make it confusing and challenging to work effectively in the public mental health system.
This course will introduce students to transformative frameworks, collaborative strategies, and creative practices for working with people labeled with “severe mental illness” and “psychosis.” It is designed to help new and emerging clinicians draw on their background and personal experiences with the aim of humanizing those who have received diagnoses such as schizophrenia, bipolar disorder and borderline personality disorder. We will integrate skills and practices from experts by experience and individuals with first-hand experience working in and outside the mental health system.
The foundational clinical framework for this class will be the Internal Family Systems (IFS) model created by Dr. Richard Schwartz. Other models covered in this class include narrative, somatic based trauma therapy, process oriented psychology, Neo-Jungian/Humanistic models, Open Dialogue, Compassionate Focused Therapy, and CBT for psychosis.
We will engage with Transformative Mutual Aid Practices (T-MAPs), which is a tool developed by a group of people themselves diagnosed with SMI. It allows those in crisis to draw on their communities to provide support for each other as an additional option to traditional clinical treatment. Students will be asked to develop a personal T-MAP document over the course of the semester with the aim of building awareness of their own mental health needs in order to better relate to and serve people with SMI diagnosis.
COURSE GOALS
Students will demonstrate an understanding of what constitutes SPMI (severe persistent mental illness).
Students will demonstrate an understanding of the role of licensed therapists in working with clients with SPMI diagnoses.
Students will engage in learning process that asks them to explore internal biases, cultural contexts, and social messages related to SPMI diagnoses.
Students will demonstrate an understanding of empirically supported clinical interventions for SPMI diagnoses, as well as understanding of the limitations of such.
Students will demonstrate fulfillment of coursework at a level befitting a Masters’ level student clinician.
STUDENT LEARNING OUTCOMES
Students will be able to recognize what constitutes SMPI diagnoses.
Students will be aware of etiological theories of SPMI including psychosis/schizophrenia, mood and personality disorders.
Students will be aware of cultural factors that influence the diagnosis and experience of SPMI diagnosis
Students will be familiar with evidence based practices for approaching SPMI diagnosis and treatment planning of such.
COURSE TEXT AND MATERIALS
Schwartz, R. C., & Sweezy, M. (2019). Internal family systems therapy. Guilford Publications.
Weiss, B. (2013). Self-therapy workbook: An exercise book for the IFS process. Pattern System Books.
COURSE ASSESSMENT MEASURES
Students are expected to attend sessions having read the assigned readings and willing to meaningfully engage in discussion of such. Students will be assessed according to the evidence of their engagement with class materials. Class participation should demonstrate that the student is thinking about class content, cultural factors, and other students’ contributions. All assigned papers and case write ups should include APA format and be legible.
Criteria for evaluation:
Class participation in discussions: 30% final grade
Demonstration of Transformative Mental Health Skills in four case write ups: 40% final grade
T-MAPs: 30% of final grade
Participation is evaluated on the following criteria: on time and full attendance in the class as well as weekly participation in the Canvas discussion post.
For this course you will be creating your own T-MAP in some kind of electronic format. During the course of the class we will go through 5 T-MAPs modules, with time to reflect and revise them, so by the end of the semester you will have a completed T-MAP which you will submit for review. If there is personal information you don’t want to share with me that is totally fine, you can just leave it out of my copy.
The four case studies paper: I will be sending you 4 clinical vignettes that demonstrate people with a SMI. You will write 2 to 4 pages per case, demonstrating what clinical skills and interventions you would use from the transformative approach. (what we’ve been learning in the class all semester.) Obviously the more notes you take from the beginning of the class and the more you participate in discussions, the easier a time you will have writing the final paper.
I want to make it very clear that if this class is stressing you out I want you to reach out to me and we can discuss it. I want you to get as much out of this class as possible and use it as an opportunity for reflection and growth.
COURSE CALENDAR
9/19/21
Welcome to class.
We will review course syllabus, goals, assignments, plan, and then dive into the reading.
Discuss:
Outside Mental Health: Voices and Visions of Madness by Will Hall (preface pp.1-16)
Transformative Mutual Aid Practices (T-MAPs) Section 1 - Connection and Vision
Transformative Mutual Aid Practices (T-MAPs)
Section 1 - Connection and Vision
On Sunday, having read the Will Hall book, get into discussion groups of 4-6 people and discuss your understanding of SMI and what you hope to learn about it from this class. Please record a 40 minute discussion and post it on canvas by the end of the day.
9/25
The Politics of Insight
Internal Family Systems Therapy - Chapters 1 & 2 Individuals as Systems
IFS Self Therapy Workbook pp.1-12
Is America Really in a Mental Health Crisis
The Politics of ‘Insight’ - The New York Times.pdf
Canvas
Reflect on IFS reading and respond in the discussion forums.
Respond to the two brief opinion pieces from this week's New York Times in the discussion forums.
from last week:
Transformative Mutual Aid Practices (T-MAPs)
If you haven't already finish Section 1 of T-MAPs with other classmates and discuss experience on discussion forums.
10/2
Trauma and Madness in Mental Health Services
Putting the Pieces Together: 25 Years of Learning Trauma Treatment By Janina Fisher
Transformative Mutual Aid Practices (T-MAPs)
Section 2 - Wellness Practices
Internal Family Systems Therapy - Chapters 3 The Self
Self Therapy Workbook 13-26
Transformative Mutual Aid Practices (T-MAPs)
Section 2 - Wellness Practices
Sunday
10/9/22
10am - 1pm
2pm - 5pm
Lecture:
Unraveling the Biopsychiatric Knot - Learning from the Past, Grounding in the modern history of mental health.
What is useful for us to know about the modern history of radical therapy in the US? Why is this history so hard to find?
This will be our first in person meeting and I’m looking forward to getting to know you better and answering lots of questions!
The Icarus Project: A Counter Narrative for Psychic Diversity
Unraveling the Biopsychiatric Knot: A Future History of the Radical Mental Health Movement
Internal Family Systems Therapy - Chapter 4 Burdens (recommended )
Self Therapy Workbook 27-35
10/16
CANVA
The Buried Legacy of the Human Potential Movement
When the Dream becomes Real, A Conversation with John Weir Perry
Psychosis as Renewal Process (John Weir Perry) (from Rethinking Madness) pp.99-108
Writing by Michael Cornwall:
Responding to Madness With Loving Receptivity: a Practical Guide
Remembering A Medication-Free Madness Sanctuary
Internal Family Systems - Chapter 5 IFS and the Body
Transformative Mutual Aid Practices (T-MAPs)Section 3: Life Lessons and Personal Stories
Self Therapy Workbook 37-44
Canvas
What lessons did you learn from reading about Laing, Perry, and Cornwall?
Transformative Mutual Aid Practices (T-MAPs)
Section 3: Life Lessons and Personal Stories
10/23
Process Work and Extreme States
Useful existential reflections on psychosis and madness
The Process Paradigm - Arnold Mindell (from Rethinking Madness)
Overwhelming Exposure to the True Nature of the World (Ernst Becker)
Overwhelmed by Death Anxiety - Irvin Yalom (from Rethinking Madness)
Self Therapy Workbook 44-56
What are the key principles from Process Oriented Psychology?
How might they be useful in working with people in extreme states or severe mental illness?
Sunday
10/30
10am - 1pm
2pm - 5pm
Lecture: “Schizophrenia,” Systemic Family Therapy and First Episode
Psychosis - Learning from the history and politics of family therapy
Internal Family Systems Chapter 6 - The Role of the Therapist in IFS
So Many Wing’s interview with Richard Schwartz:
Key Elements of Dialogic Practice by Mary Olson
Transformative Mutual Aid Practices (T-MAPs)Section 4: Slipping off the Tracks
Self Therapy Workbook 57-65
Transformative Mutual Aid Practices (T-MAPs)
Section 4: Slipping off the Tracks
11/6
Working with Personality Disorders
Depathologizing the Borderline Client by Richard Schwartz
Internal Family System Chapter 14 - The IFS Model View of Families 185-195
Self Therapy Workbook 67-72
11/13
Voice Hearing - “A sane reaction to insane circumstances”
Hearing Voices Network
- TED Talk by Eleanor Longden
Broadcasting and Schizophrenia by John Durham Peter
Video: Compassion for voices: a tale of courage and hope
Transformative Mutual Aid Practices (T-MAPs)
Internal Family System Chapter 15 - Family Therapy Con't 199-215
Self Therapy Workbook 73-85
Sunday
11/20
10am - 1pm
2pm - 5pm
Reflecting on the Use of Force with the SMI Population
THERAPY WITHOUT FORCE: A TREATMENT MODEL FOR SEVERE PSYCHIATRIC PROBLEMS by Daniel Mackler
Treatment Advocacy Center
https://www.treatmentadvocacycenter.org
Self Therapy Workbook 113-120
Internal Family Systems Therapy Chapter 16 - 216-228
Canvas discussion on the issues of force. Read the Mackler article and look at the TAC website and I want you to discuss your idea of how you what to use force when you’re working in the public mental health system.
This is the week I will give you the four case studies paper: I will be sending you 4 clinical vignettes that demonstrate people with a SMI. You will write 2 to 4 pages per case, demonstrating what clinical skills and interventions you would use from the transformative approach.
11/27
CANVAS
Being a politicized healer
On Becoming a Politicized Healer by Jacks McNamara (pp.116-120)
From We’ve Been Too Patient: Voices From Radical Mental Health - Stories Research Challenging the Biomedical Model (Green& Ubozoh, 2019)
Transformative Mutual Aid Practices (T-MAPs)
Review and Revisions
Internal Family Systems Therapy. Applying the IFS Model to Social and Cultural Systems 240-254
Self Therapy Workbook 88-99
Canvas discussion on clinical identity and social engagement. Questions forthcoming.
Transformative Mutual Aid Practices (T-MAPs)
Turn in for review
12/4
Democratizing Mental Health and Connection to a Larger Movement
Harm Reduction Guide to Coming Off Psych Drugs - Will Hall, Icarus Project
Mad Resistance/Mad Alternatives- Democratizing Mental Health Care
Institute for the Development of Human Arts
Self Therapy Workbook 101-112
Canvas discussion on working in the public system while being connected to movements outside of the system.
Sunday
12/11
10am - 1pm
2pm - 5pm
DEMONSTRATION OF CLINICAL SKILLS:
Everyone is going to present pieces of their final papers, their writing on IFS, and pieces of their personal T-MAPs and we’re going to reflect together on what we’ve learned over the course of the semester.