A walk outside psychotherapy

Being a resident in a psychiatric clinic has many harsh implications, the worse of which is the loss of freedom; the patients are not allowed to leave the clinic without a supervisor. Some have family members who care for them, and not only visit the unit, but also take their relatives for a walk, or for a brief vacation back home. Those are the lucky ones. Unfortunately, they represent also the minority- most inpatients are left, almost abandoned in the clinic, until they forget what it feels like to be outside in the real world.

In the sphere of the psychotherapeutic treatment, in some units patients are taken out for a walk as often as their financial state allows- relatively once a month for a simple cup of coffee. This is a quite stressful process for the supervising therapists, since they have to take care of and be responsible for many at the same time- not to mention that there is always a fear that someone may try to run away. At the same time, it is a process that the patients love, something which makes it worthwhile for the therapists as well. 

Taking the patients out in the first place is not an easy thing to do. First, all must prepare themselves- it may seem easy but due to their disorders many have lost sense of self- care and hygiene. Thus, all must wear clean clothes, and wash their face (hopefully not in a compulsory manner). Then all are requested to gather up and organize. Usually the therapist gives strict directions to all to not walk away from the group, not cross carelessly the street and walk attentively. This is also the time when the therapist makes sure that all are ready to leave the clinic: patients in a relapse phase, or who are sick are necessarily excluded. 

After getting counted with precision, the patients are ready to leave. And their most exciting experience of the month begins. 

It can be seen in their faces clearly. Most are smiling, and seem more talkative than usual. Most prepare what they are about to order before hand- often exaggarating. Most, look at the outside world as if it is something new, dangerous and magnificent at the same time. 

In the transportation, they receive many odd looks and weird glances. But they do not notice. People are strange around them, but they are also often kind- offering their seat, or treating them with sweets- hoping to offer something to them. 

In the cafeteria, the employees are stressed and confused, but never hold back an honest smile. They follow the extreme requests of the patients with no complain, because after seeing, they understand. 

They understand that aside from being patients, they are also people, who can enjoy a cold coffe in a sunny day, joke and laugh, embrase the simple things in life with a greater excitement. 

                                   

This is what the therapists also see upon taking the patients out. As soon as they are removed from the clinical setting, their pathological aspect is minimized and their true character is revealed. That is not to say that they cease being ill or that this is not apparent to specialists and lay- persons as well; it simply implies that upon looking at the clinical population in the first place, there is a tendency to pathologise them- see them as nothing but their disorder. This is apparent in the general population through stereotypes and misunderstandings, but is even more apparent with clinicians, who focus in treating the illness not the person. 

Yet the same individuals that are seen every day moody, silent and staring into the void, can be observed to interact with each other, creating new friends, tell jokes, have fun. Outside the strict structure of the therapy, the patient can communicate in another level, a more honest one. And in fact, so can the therapists: when the therapeutic goal is not achieved through an activity or a discussion, but through enjoyment of the moment, the therapists naturally become less rigit and severe, and more open.

Going out for the patients means gaining hope. It means both remembering and practicing life, and it means that there is a chance to relive it. So many others get stressed on the way (ranging from health- care professionals, to the bus driver and the waiters) yet so many more end up feeling happier, and slightly more complete. 

In short, taking psychiatric patients out for a small walk, may make a large difference in the quality of interaction, in the quality of life. 

Literature: I. Yalom, 2009. Inpatient Group Psychotherapy. Athens, Agra; A. Xristopoulou, 2008. Introduction to the Adult Psychopathology, Athens, Topos.

Note: The walk with the patients was conducted by a specific psychiatric facility in Athens, Greece.