Marshall Field Was Wrong

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The whole ethos of treatment shifted: customer service means saying things along the lines of “I’m sorry for your inconvenience, let’s see if we can fix that for you.” The therapeutic intervention is more like, “I see that you’re angry, let’s see if we can figure out what that reaction is about and also see if we can solve this problem.” The differences are crucial and multi-layered, and I don’t think non-clinicians (in many cases, policy makers) understand the differences. Therefore, managers were habitually striking impromptu bargains with family members, overruling clinical staff that had diligently counseled families about the importance of their participation. Invoking the flexibility mantra, a Saturday floor manager would grant full visiting to a parent that had missed required activities, and who had cited work or other supposedly unforeseeable conflicts. The activities stopped being required, in effect. Meanwhile, the only conflicts in these scenarios were the ones being habitually avoided. These parents that maneuvered their way around program structure: they had impassively heard the rules and structure outlined upon admission; they knew from experience how to maneuver within systems. They’d been doing it for years with schools, social services, employers and drug courts. They promised compliance up front but reserved their resistance for later times, when loop holes in the system had been cunningly assessed.

Claiming that which had been promised by case managers, who were often not around during visiting times, the splitting ruses started working and as a result, patterns of manipulation were reinforced. Flexibility indeed. The team approach was fostering increased instances of splitting, team fragmentation. The solution to this problem was to ignore it, and before long the term splitting seemed to become archaic; shuffled off to a TC concepts museum alongside benches, dusty hospital scrub shirts, image breakers and old man Bobby’s suspenders. If nearby the case managers might have intervened with the visiting day arguments, but increasingly they weren’t available for these kinds of situations either. The availability of case managers, to collateral contacts, to the electronic pull of computer screens, and not the kids in the program was of supreme importance, meaning therapists were sometimes even missing group therapy sessions in order to complete documents, or to meet with collateral contacts who sometimes visited the facility without bothering to make appointments. I’d never been asked to compromise my direct duties to clients—certainly not spontaneously—when I was a case manager. Some kids, meanwhile, complained that they were hardly getting to speak to their therapists. Were they customers? Clients? Consumers? Patients? Kids? I wasn’t sure what to call them any more.

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