TandC Associates, LLC

Core Values Enhance Relationships

One of the first things I learned upon joining Fountain House was the value system key to the survival of the clubhouse community.  The WANA group was responsible for the first three of these values: self-help through mutual help, member ownership of the program, and membership has no time limits.  There will be much to say about self-help through mutual help as a specific lesson later.

Member ownership is a key component of this community.  It can be best understood by presenting two examples.  Early in my career at Fountain House, I had the opportunity to travel to a psychosocial rehabilitation program in Philadelphia.  The staff worker who conducted the tour strongly requested that I should not look into the eyes of participants, as this would make them nervous as if they were “animals in a zoo” (the staff worker’s expression).

In contrast, the tour I was given when I applied for employment at Fountain House was conducted, as all tours are, by a member.  Miriam was my tour guide and the pride of ownership she expressed as we went through the program was clearly evident.  Of another tour, the wife of the Governor of Massachusetts noting the presence of the same pride commented that she felt like she was really being shown the tour guide’s home, not an institution.

Mark had this to say about the idea of no time limits in his speech in Maryland:  “You can proceed at your own pace…At this point I felt the program wasn’t for me and I left for about two years…The problem was I couldn’t find a job… So I went back…and was warmly received… A member can always return…

“This time things went much faster and I was out on a placement…(then) to my next placement for eight months…(and to a third) placement… At this time I stopped going to Fountain House during the day. This was a mistake that many members make…I found myself in such a state that I had to…return to the hospital…

“I returned once more to Fountain House upon leaving the hospital… It’s four months now since I left the hospital and although my life is still sometimes like a roller coaster ride I do have stability.”

Other core values evolved after John Beard became Executive Director.  The basic activities offered in the daytime had to do with the essential care and maintenance of the clubhouse environment.  These included cleaning, lunch preparation, reception and various clerical functions such as answering incoming phone calls, filing, and record keeping.

From the very beginning of Beard’s tenure, he made sure there was more work to be done then there were staff to do it on their own.  Thus, members were needed in order for the clubhouse to function.  This need meant that members were expected to be in attendance; if they weren’t available the work could not be completed.  If a member did not attend on a given day, reach-out efforts were made to ascertain why and to convey the message that the member was missed.  At the end of the day, after the needed tasks are completed there is opportunity for staff to express appreciation for members’ contributions.

It should be noted that these values represent a staff-consumer role reversal from almost all other mental health service delivery systems. Typically, in clinical settings consumers need the clinician, there is little reason to expect an appointment to be kept, and little effort is made to reach-out if there is no attendance. Any appreciation felt in these settings is that which the consumer has for the provider. It should also be noted that many clinical programs are purposefully designed to be time limited.

In another key way, the clubhouse system is diametrically opposite of most clinical settings, in that staff and members work on tasks together, based on the dynamic of “working with” rather than “working on”.

Mark’s comment on this:  “The idea of ‘working with someone’ as opposed to ‘working on me’ is fascinating. The concept we speak of all the time is working ‘together’ as the ideal but you have to wonder about how much shifting of the psyche of the staff takes place and the ‘working on me’ takes place.”

Because there was so much work to be done each day, staff will accept any help at all, and show appreciation for even the smallest contribution – a place setting for lunch, the planting of one flower, the answering of a telephone.  It is with the expression of need, expectation, missing and appreciation that provides the basis for the development of a longer-term relationship.

John summarizes the results of such an approach in the following way:  “The growth process I went through at Fountain House is similar to what hundreds of other people (fellow members) experience. It is made possible by the organization of a service delivery system which provides normalizing opportunities frequently unavailable to people coming out of the hospital. These deinstitutionalized patients are professionally designated as chronically ill or severely disabled, something which may well contribute to the continuation and maintenance of the disability that traditional delivery systems try to overcome.

“The…program achieves a variety of short- and long-term objectives. Initially the clubhouse setting provides patients with a place to go, away from an often troublesome living situation, and gives them something to do which is satisfying and rewarding, both to themselves and to others. It also brings together a range of people with different strengths and weaknesses who offer each other support, encouragement and, very importantly, friendship. In the long run, the delivery system allows the individual to undertake gradually increasing responsibility to the extent they feel able to handle it. And the clubhouse environment promotes the growth of close relationships which help sustain the willingness to change.”

Again, TCA advises the reader that this posting is part of a larger body of work  in process for publication.  Any references to it, or quotations from this or other postings on this website must be with the express permission of the authors.  Readers may contact us through the space provided below, or at

tandcassociates@gmail.com

As always, we welcome your comments and suggestions, through which dialogue we hope to expand our knowledge in all aspects of psychosocial rehabilitation including the clubhouse model.