T-MAPs

T-Maps

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Transformative Mutual Aid Practices (T-MAPs) is a set of community-developed workshops that provide tools and space for building a personal “map” of resilience practices and local cultural resources. Each participant collaborates with the group to complete a personalized booklet (or “T-MAP”) of reminder documents that can be used as a guide for navigating challenging times and communicating with the important people in their lives. Through a mix of collective brainstorming, creative story-telling, theater games, art/collage making, and breath/mindfulness practices, the group is guided through a process to develop greater personal wellness and collective transformation.

 

T-MAPs: Transformational Group Practices Outside the Mental Health and Criminal Justice Systems

Sascha Altman DuBrul
Clinical Practice Lab #2 Final Paper
Silberman School of Social Work

Abstract: In this paper I will use a number of sources from our Clinical Practice Lab syllabus to intellectually scaffold the importance of the T-MAPs (Transformative Mutual Aid Practices) project, an emerging clinical tool I will be using to facilitate workshops at Recovery Connections, a project of the New York City agency Community Access. Using a synthesis of theories and concepts from social work including Mindfulness, Popular Education, and Critical Race Theory, I will provide a context for my work and show how the existing literature can guide the process of developing liberatory spaces and concrete tools for empowering communication and action. While T-MAPs originated in a more traditional peer-based community organizing (CO) context, from the beginning it has had overlaps with clinical practice methodologies, and I will discuss the inevitable tension and potential productivity between the two. I will also discuss the tension and important distinction between oppression and suffering which needs to be articulated and reconciled in the development of T-MAPs for it to be an effective tool of liberation. I will conclude with a tentative proposal to align T-MAPs with the structure of Participatory Action Research (PAR) (Smith, 2009) and to develop it into a tool that can be used in a supervised clinical setting in New York City in the Fall of 2015.

 

Introduction:

This paper will articulate details of some contract work I have been hired to do for Recovery Connections, a project of the non-profit mental health agency, Community Access.  Recovery Connections has existed since 2013 and supports people who have a  history of mental health conditions and involvement in the criminal justice system, “to engage with their community by fostering personally meaningful connections to people, places, and opportunities outside the system.” (Community Access, 2015.) In the spring of 2015 I proposed to Community Access my facilitation of workshops, Transformative Mutual Aid Practices (T-MAPs) for Recovery Connections, which I developed based on my experience of more than a decade of work with The Icarus Project (DuBrul, 2014.) This paper will explore the context and theoretical basis of these workshops, which will be taking place in June of 2015.

 

The Workshop Description:

Transformative Mutual Aid Practices (T-MAPs) is a set of community-developed workshops that provide tools and space for building a personal “map” of resilience practices and local cultural resources. Each participant collaborates with the group to complete a personalized booklet (or “T-MAP”) of reminder documents that can be used as a guide for navigating challenging times and communicating with the important people in their lives. Through a mix of collective brainstorming, creative story-telling, theater games, art/collage making, and breath/mindfulness practices, the group is guided through a process to develop greater personal wellness and collective transformation.

 

The Social Context:

For individuals who have been involved in the criminal justice or public mental health systems, finding a welcoming place in the larger society can pose an enormous challenge. Institutionalization is fundamentally alienating and disempowering (Goffman, 1968) , and lack of financial resources combined with the social stigma for those who have fallen through the system’s cracks most often means that people get lost and ostracized (Watkins, 2008.)  Our society, influenced by neoliberal economic and social models, currently uses a biomedical language to talk about mental health issues divorced from social context (Lewis, 2006.) While “biological brain diseases” and “severe mental illness” become an excuse to exclude many people from participating in society, repeatedly it has been shown that the pathogenic influence of structural oppression on the emotional well-being of people is enormous (Smith, 2009) and is rarely talked about in public without referring back to the brain disease model. (Whitaker, 2010.)  Whatever challenges people are facing, they are never simply just personal challenges. If it is the responsibility of the society to include all of its citizens, then it is a measure of a sick society when so many of its members are pushed to the margins. In this context trying to find a healthy and supportive peer group who has lived experiences of successfully grappling with mental health issues and incarceration can be incredibly challenging.

Many traditional social work agencies working with such clients will attempt to help integrate those who do not fit into the system to follow a traditional societal path of success by assisting them to find low skill work (Beard, 1982) or attend supportive education (SAMSHA, 2002)  . They do not address the larger questions that too often go unaddressed when working with the socially dispossessed and formally institutionalized:

  1. Do the reasons people end up in the criminal justice or mental health systems in the first place need to be challenged and critiqued?
  2. Do the people who have personally suffered from the effects of a dysfunctional system have an integral role to play in changing how it functions?
  3. Is there critical healing work that  needs to be done outside the institutional system?
  4. How can we develop supportive community structures to enhance the capacity of vulnerable people to take control of their lives so that they  see themselves as subjects who are agents in their own lives rather than objects being acted upon? (Freier, 1970.)

Transformative Mutual Aid Practices

The context of this work is an institutionalization of “healing” which  attempts to repair the damage done by “correctional institutions.” (Chu, 2010.) T-MAPs workshops ask some basic questions: What if instead of just talking about “recovery” from mental health issues we actually talked about the potential for “transformation” and growth? What would it like look  to question the individualistic nature of our society, and in response help create spaces where we practiced sharing and cooperation with one another? What if we practiced embodying new forms of living together in the present moment? What if the pieces of ourselves which society considers to be damaged or “diseased” in fact have the potential to be cultivated and honed in order to be whole? This is the spirit and vision of the T-MAPs workshop.

In the following section,  I will describe some of the tools, strategies, and methodologies I have be exposed to in Clinical Practice Lab, which I believe will be useful for implementation of the T-MAPs project:

Mindfulness (Epstein, 2003)(Wong, 2012)(Burghardt, 2013)

According to the seminal article by Epstein (2003) on Mindfulness in Clinical Practice: “Mindful practitioners use a variety of means to enhance their ability to engage in moment-to-moment self-monitoring, bring to consciousness their tacit personal knowledge and deeply held values, use peripheral vision and subsidiary awareness to become aware of new information and perspectives, and adopt curiosity in both ordinary and novel situations.” (Epstein, 2003).

The goals of mindful practice are to become more aware of one’s own mental processes, listen more attentively, become flexible, and recognize bias and judgments, and thereby act with principles and compassion. As a practitioner of yoga and a student of somatics, one of the key lessons I have learned in my time of study has been the importance of developing intentional practices in order to transform the way I show up in the world. To make sustainable shifts in my behavior and ways of thinking, I have to “embody” new behaviors. The path to achieving that embodiment is established through a series of recurrent practices of mind, emotions, language and body. This new embodiment is integrated by building new interpretations of meaning and future possibilities. Embodiment allows for new action.

Epstein states: “Although mindfulness is a practice that derives from a philosophical-religious tradition, the underlying philosophy is fundamentally pragmatic and is based on the interdependence of action, cognition, memory, and emotion. These connections represent a relatively new idea in neuroscience research. Western approaches to the understanding of mental processes historically have separated mental activity from action in the world, and the schism between behavioral and psychodynamic psychology has reinforced some of this separation. However, in the East and in phenomenological traditions in the West,philosophy has linked cognition to emotion, memory, and action in the world” (2003).

It is this understanding of mindful practice that we want to bring into the program of T-Maps. bell hooks speaks of education as “the practice of freedom” (hooks, 2014). Yuk-Lin Renita Wong (2004) suggests that critical social work has the potential to be this “practice of freedom”: to “transgress” the mind/body duality and create a wholeness and groundedness in our work.

Popular Education – Moving from Object to Subject

Pablo Freire’s popular education method, experimental and participatory learning model and coalition building through group projects (Freire, 1970) has had a huge influence on the vision of T-MAPs. In 1970, Freire published his groundbreaking work, The Pedagogy of the Oppressed, in which he argued that knowledge is not neutral; it is the expression of historical moments where some groups exercise dominant power over others. Oppressed groups of individuals often experience life as “objects” being acted upon rather than “subjects” of their own lives. “Objects” often lack certain critical skills essential for influencing the institutions that have control over their lives. “Subjects” not only have skills for influencing institutions, but also have the opportunity to exercise these skills. The learners are the subjects in the learning process and not the objects – as they have to be subjects of their destiny. The learners and educators are equal participants in the learning process; this process is developed by a continuous dialogue between the educators and learners. The objective of the learning process is to liberate the participants from their external and internal oppression; to facilitate learners becoming capable of changing their lives and the society they live in (Freire, 1970.)

Critical Race Theory (as opposed to Cultural Competence)

T-MAPs is grounded in anti-oppression theory and Critical Race Theory. In contrast to a “cultural sensitivity” model, Critical Race Theory (CRT) targets change at the level of a personal beliefs and agency practices, the “anti oppression model” works towards change across the individual, agency, and system levels (Abrams, 2009). In short: the cultural competence framework doesn’t address systemic and institutionalized oppressions.  Critical Race Theory emerged in the wake of the Civil Rights Movement  and challenges liberalist claims of objectivity, neutrality, and color-blindness. CRT argues that these principles actually normalize and perpetuate racism by ignoring the structural inequalities that permeate social institutions. P.250

Liberatory Psychology and Psychopolitical Validity

Martin Baró, who was murdered by right-wing paramilitary forces in El Salvador in the 1980s, inspired the development of liberation psychology in Latin America and community psychology throughout the world. (Martín-Baró, 1994.) Baró wrote of a liberatory psychology, one that involved “breaking the chains of person oppression as much as the chains of social oppression.

Psychopolitical validity was a term coined by Isaac Prilleltensky in 2003 as a way to evaluate Community Psychology research and interventions and the extent to which they engage with power dynamics, structural levels of analysis, and promotion of social justice. The evaluative series of criteria developed by Prilleltensky may be used within any critical social science research and practice model, but can specifically be defined within Community Psychology research as advocating for a focus on well-being, oppression, and liberation across collective, relational, and personal domains in both research and practice. While I haven’t studied the details, these theories seem very useful for our work with Mad Maps.

Racism as Pathogen

The concept of “oppression as pathogen” is incredibly relevant for the kind of narratives we are hoping to create with our work. Here is Laura Smith using racism as an example:

“Racism, still pervasive in US society and culture, has been associated with poor mental health outcomes in association with such variables as self-esteem, perceived control, depression, and generalized anxiety disorder (Williams, Neighbors, & Jackson, 2003.) In addition, experiences of racial discrimination have been correlated with an increased level of stress response, including anger, frustration, paranoia, and fear, and somatic symptoms like headaches and backaches (Clar et al, 1999) Based on this evidence, researches have begun to refer to racist incident-based trauma, positing that racist incidents have traumatic consequences similar to those of rape or domestic violence (Bryant-Davis & Ocampo, 2005).” (Smith, 2005)

Internalized oppression and colonialism

Internalized oppression, which is understood to have its origin in experiences of powerlessness or social degradation, is the condition in which individuals who belong to oppressed groups believe themselves to be inferior to those in the dominant culture (Moane, 2003).

Fanon (1965) argued that by systematically denigrating the humanity of colonized persons, colonialism leads to a deep seated self doubt, feelings of inferiority, and identity confusion among the colonized or oppressed. Similarly, Memmi (1965) stated that oppressed individuals may ultimately internalize an identity consistent with the stereotypes of them sustained by those in power. Freire (1970) suggested that this identity can develop into a desire to distance oneself from one’s own group and aspire to become evermore like the oppressor.

Intergenerational Trauma

“Against the backdrop of US historical trauma (including the genocide and displacement of indigenous groups, slavery, Jim Crow segregation, and the internment of Japanese Americans), the colonial model, with internalized oppression as a corollary, serves as an integrative framework for the toll that intergenerational oppression has taken on the mental health of those who have been oppressed.” (Smith, 2009)

The Tension Between Clinical and Peer Work

While we have many exciting ideas, the work of creating T-MAPs is still in the initial stages and therefore I would like to articulate some of the issues that have come up in the design of the project.

T-MAPs comes out of a recent tradition of peer-based mental health organizing and support. We are allied with The Icarus Project, the Hearing Voices Network (Romme, 1982), Western Mass Recovery Learning Community, and Intentional Peer Support (Mead, 2003) who all mostly reject the clinical model as oppressive and unhelpful. In my studies this semester I have come to understand some basic ideas about what it is to do “clinical” work. According to Hepworth (2009):

“The term clinical practice is used by some as synonymous with direct practice. Clinical social work practice has been defined as “the provision of mental health services for the diagnosis, treatment and prevention of mental, behavioral and emotional disorders in individuals, families, and groups.  (Clinical Social Work Federation, 1997)” The common goal of clinical practice is to “assist clients in coping more effectively with problems of living and improving the quality of their lives.” P.33

There seems to be a standard “helping process” that has three major phases:

“Phase I: Exploration, engagement, assessment and planning

Phase II: Implementation and goal attainment

Phase III:  Termination

Phase I includes:

  1. Exploring clients’ problems by eliciting comprehensive data about the person(s) , the problem, and environmental factors, including forces influencing the referral for contact
  2. Establishing rapport and enhancing motivation
  3. Formulating a multidimensional assessment of the problem, identifying systems that play a significant role in the difficulties, and identifying relevant resources that can be tapped or must be developed
  4. Mutually negotiating goals to be accomplished in remedying or alleviating problems and formulating a contract
  5. Making referrals” (P.34)

I can easily imagine a T-MAPs process evolving to take the form of what is known in the profession as “direct service” The asking of basic question, formulating assessments together, identifying systems that play a role in oppression, developing goals, and making connections are all thing I have grown accustomed to doing in my peer work with The Icarus Project. I am interested in developing a system of support that followed more “clinical” lines, but did not have the oppressive aspects of power relationship found in the standard clinical relationship. Reading

“Clinical Social Work’s Contribution to a Social Justice Perspective (Swenson, P.532)

“Clinical social work should not be equated with practice based on a medical model, a focus on pathology, or social conservatism. Clinical social work includes case management, advocacy, teamwork, meditation, and prevention roles as well as therapeutic or counseling roles. Clinical social workers engage in supervision, organizational change, directing programs, and community education.”

I am very interested in what “supervision” might look like for the T-MAPs project. I believe it would be a very healthy addition to our peer based culture, providing a synthesis of peer and clinical. There are so many clinical tools and psychological concepts that are useful in working with people. In Why We Need a Biopsychosocial Perspective with Vulnerable, Oppressed, and At-Risk Clients, Joan Berzoff states:

“When we work with someone who has been oppressed on the basis of sexual orientation, ability, language, culture, or race, we must also be able to enter into this client’s inner life using an approach that attends to the client’s psychological, social, and biological contexts. In every setting, and with every population, we try to understand how a person has developed psychologically; has taken in and metabolized the social world; has or has not experienced microaggressions based on disability, race, sexual orientation, culture, or language; and might have internalized social stigma. It is important to know how social identities and psychological identities always intersect in any clinical encounter.” (Berzoff, 2011, P.133)

I am really interested in incorporating concepts from drive theory, ego psychology, object relations, attachment theory, self psychology and relational theory into my work with others. I look forward to having supervision from people who can help me along this path of using psychodynamic theories and tools in the service of fighting oppression and suffering. I have visions of using T-MAPs tools and strategies in doing both group work and 1 on 1 work, such as case management and coaching.

 

Differentiating Between Oppression and Suffering

“According to the National Association of Social Workers (NASW), the primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.” (NASW, 1999, p.1)” (Hepworth, 2010, p.6)

I have many years of experience being in a role of support for people who struggle with mental health issues and have learned that often the issues people struggle with are directly related to systemic oppression.  Oppression in the sense I am describing is structural, rather than the result of a few individual’s choices or policies. “Its causes are embedded in unquestioned norms, habits, and symbols, in the assumptions underlying institutional rules and the collective consequences of following those rules.”  (Young, 2004, p.41)  Oppression generally takes the form of racism, sexism, classism, homophobia, or ableism, wherein the dominant group in society subjugates other groups and extracts their labor, wealth, bodies, identity, and dignity, for the benefit of the dominant group. More specifically it manifests as some form of violence, exploitation and exclusion such as police abuse, poor wages, lack of healthcare, homelessness and substandard housing, domestic violence, racial profiling, deportation, etc. (SJL, 2010)

Suffering, on the other hand, is simply a way to describe the painful feelings like anxiety, fear, stress, disappointment, and self-loathing that show up in people’s lives. Suffering is psychological and emotional and often has to do with unresolved issues from our childhoods and deeply imbedded family dynamics. The key difference is that suffering is an internal response to the external conditions that we face. While some suffering is a result of oppression, other suffering is not. In many cases the suffering that poor and working class people, or any exploited group, experience is directly related to the oppression they are subjected to. Police violence, job exploitation, or other forms of oppression can be physically incapacitating (even deadly) and it can also be psychologically and emotionally paralyzing. The fear, doubt, self-hatred, and internalized oppression that can come from these experiences is a form of suffering.

Suffering can be related to oppression, but it can also be generated from other life experiences. My experience, for example, of having so much pressure on me as a child to perform in ways I was never able to, evolved into a paralyzing lack of self-worth as an adult. My mind working differently than most of the other people around me, and struggling with silent disabilities has shaped my identity as an underdog. I have suffered an enormously,, enough so that I have repeatedly ended up in psychiatric hospitals. However, this really is different from being subjected to systemic oppression.

 

T-MAPs has the capacity to elicit a great deal of information. It is very concrete. It was while reading the essay When Oppression is the Pathogen: The Participatory Development of Socially Just Mental Health Practices  that it occurred to me that T-MAPs potentially could use the format of Participatory Action Research project.

Therefore I will quote extensively from When Oppression is the Pathogen (2009):

A Potential Resolution: Participatory Action Research?

“Participatory action research (PAR) is one of the best known variants among action approaches, described by Kidd and Kral (2005) as “a process in which people (researchers and participants) develop goals and methods, participate in the gathering and analysis of data, and implement the results in a way that will raise critical consciousness and promote change in the lives of those involved – changes that are in the direction and control of the participating group or community.” (p.187) In PAR, therefore, the distinction between researcher and research is challenged, so that participants are given the opportunity to be actively involved in identifying and addressing issues that affect them and their communities (Minkler & Wallerstein, 2003). Such challenges pose challenges for professional researchers: Kidd and Kral (2005) noted that participatory projects can be fraught with ambiguities that can tempt researchers to fall back on the comforts of a less egalitarian model in which they hold more power. As such, researchers must be prepared to engage in personal struggle with their own deeply embedded beliefs about what constitutes knowledge. This idea of personal engagement contradicts the relatively neutral and distant posture to which mental health professionals are traditionally trained—a posture that ultimately separates them from from those with whom they work through the establishment of a power dynamic.”(Italics mine) (Smith, 2009 P.162)

I wonder about the potential of being part of the wave of organizations leading the way in Participatory Action Research with our T-MAPs project.

“Participatory action research, therefore, suggests a direction for mental health professionals who, in keeping with a social justice perspective, would like to (1) contradict the dominant/superordinate power relations inherent in traditional research paradigms, (2) transform therapeutic practice in the context of oppression, and (3) incorporate community knowledge into the creation of transformed interventions.” (Smith, 2009 P.162)

Conclusion

T-MAPs has the potential to take many forms, its future will depend in part on how skillfully  the realms of the personal and political, the clinical and peer can be merged. While there are plenty of references to draw upon,  it will also be necessary for me to be thinking outside the box. If something can be created that is useful both for the oppressed, as well as those “not as oppressed” it can be a powerful tool which not only can help bring many people together, but may be more economically viable..

 

One of the most important aspects of what is considered “mental illness” in our society has to do with communication: our ability to be able to talk to one another in ways we can understand. A key strength of T-MAPs is it’s message, which  crosses many boundaries with the potential for cross-racial and cross-class organizing.

 

By next fall I plan to have developed a T-MAPs program, which will be ready to implement in New York City with a diverse group of participants. My goal is to have clinical supervision in order to make it happen. Issues still to be resolved include: will we use the language and format of Participatory Action Research, and how will we balance the complex power dynamics of peer and professional?. In the meantime, I am grateful to have had the opportunity to engage with this thought provoking materials in the context of a social work program at Silberman.

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