Working at the Edge Without Losing the Center

Containment, Accountability, and Care at the Edges of Experience

One of the questions I keep returning to lately is not whether people with lived experience of psychosis, mania, or extreme states should be involved in care, mentoring, or meaning-making.

That question has already been answered by history. We always have been.

The harder question is how.

How do people who are sensitive, imaginative, and prone to altered states stay accountable when we are also the ones who often understand these states most intimately? How do we work near the edge without mistaking the edge for the center? And what kinds of structures make that possible, not just for individuals, but for communities?

I don’t believe the answer is distance or silence. I also don’t believe lived experience alone is enough to do this work responsibly with other people.

What matters is containment.

By containment, I don’t mean suppression or control. I mean support, supervision, feedback, and shared reality. I mean having people who can say “slow down” and be listened to. I mean knowing when intensity is creative and when it’s tipping into something that needs care rather than amplification.

I learned this most clearly during the three years I spent working in the public mental health system, helping develop peer specialist roles within first-episode psychosis programs. There was real desire to include peers on clinical teams, and the work mattered deeply to me—but it was extraordinarily difficult to do well. Medicalized team cultures, limited respect for peer knowledge, and chronic ambiguity about role and authority made it clear how easily lived experience can be instrumentalized or sidelined when the container isn’t explicit. Peers were often asked to bring authenticity without power, vulnerability without protection, and insight without clear scope. The problem wasn’t peer work itself; it was the lack of structure to hold it responsibly.

In many professional cultures, the solution to risk is credentialing and distance. In many countercultural spaces, the solution is authenticity and trust. Neither, on its own, is sufficient.

Those of us who work at the edge need more structure, not less.

This piece is, in part, a response to the intensity of my last post—a way of naming the containers that make edge work possible, rather than leaving it hanging on its own.

For me, the structure I’m talking about does not come primarily from formal credentials. It comes from relationship. I am held by an extended community of people who know my history, my patterns, and my limits. I know, because it has happenedthat I can only get so far out of alignment before someone calls me back in. That kind of accountability matters. It is not abstract. It is lived.

What I offer is not just work with people, but work that is embedded in a wider relational field. I am in conversation with peers, elders, organizers, clinicians, and fellow travelers. I don’t hold authority alone. I am held in it, and corrected when necessary, by people I trust and who trust me enough to push back. Writing about my experiences is one of the ways I stay in relationship with my own limits, contradictions, and learning edges, and a way of practicing accountability in public rather than performing certainty.

That lived experience, of trying to do peer work inside institutions without adequate containment, is what ultimately pushed me toward working outside them. Private practice has offered clearer boundaries, stronger consent, and more flexibility to build the kind of support structures this work actually requires. And still, I don’t see that move as an ending. I carry a long-term desire to return to training and mentoring people in peer roles, but with far better clarity about limits, scope, supervision, and shared responsibility, so peers are not asked to carry what systems refuse to hold.

That clarity feels especially urgent in this moment. We are living in an era of accelerated meaning. Technology mirrors us back to ourselves faster than our nervous systems can integrate. Certainty spreads quickly. Stories harden. Intensity is rewarded. And altered states that once unfolded in relationship or ritual now often happen alone, at speed, without elders or witnesses.

In that context, the line between insight and overwhelm matters.

I’ve come to believe that ethical work at the edge requires a few non-negotiables: regular consultation, ongoing supervision, clear limits about scope and role, a willingness to step back when capacity wavers, and a culture that understands that needing support is not a failure, but a condition of doing this work responsibly.

This is not about being fearless. It’s about being honest.

Many of the people I work with are brilliant, sensitive, and deeply attuned. They are often coming out of their first serious encounter with psychosis or altered reality. In those moments, certainty can feel like safety. Grand narratives can feel like relief. What’s actually needed is something quieter: differentiation, pacing, and help naming which parts are speaking.

That kind of work requires humility. It requires knowing that just because something feels true doesn’t mean it should be acted on. And it requires remembering that care is collective, not heroic.

I’m not interested in a culture that either romanticizes madness or treats it as something to be hidden away. I’m interested in a culture where people can speak honestly about intensity while also being held to standards that protect everyone involved.

Unconventional work doesn’t mean unbounded work.

It means being explicit about the container, the supports, and the limits. It means building practices that don’t rely on any one person’s stability or insight. And it means valuing people with lived experience not as exceptions or warnings, but as contributors who know the terrain—and respect its dangers.

If we are going to navigate this era with any grace, we will need more people who know how to come back from the edge and help others do the same. Not by dazzling. Not by declaring certainty. But by slowing things down, staying in relationship, and keeping the center intact.

Happy new year and find me in my public/private practice in 2026: