Daily Excerpt: From Deep Within (Lewis) - Blackjack
Excerpt from excerpt from From Deep Within (Lewis)
Blackjack
My first clinical experience was
working in a state psychiatric hospital with a group of individuals who were
diagnosed with schizophrenia. I was a new, inexperienced therapist. I had no
idea what I was supposed to be doing. On the afternoon of our first group meeting,
I came to the waiting area and figured a welcome to the new patients was a good
start. When in doubt, be polite! I never even finished the first sentence of my
greeting. As soon as I opened my mouth they stood up in unison and walked away
from me toward the meeting room. I was surprised. I ran to the front of the
parade and led them to the end of the hallway. No one looked at me or said
anything. They shuffled, single file, into the room we had been assigned and
plopped themselves down around a circular table. The space was small and
cramped. We were so close together that the body odor of some people whiffed
through the room.
I hoped it might
be easier to get everyone’s attention now that we were sitting. The group was
made up of four men and two women, and I started by asking them to introduce
themselves. Immediately, each person started talking over the next, but they
weren’t introducing themselves. Three of the men were talking to voices they
heard in their heads. An elderly woman was explaining to the others, who were
not listening, that the television was sending rays into her head, and another
woman stared at the ceiling, waving at no one, at least no one I could see. The
only one who remained silent was the fourth man in the group, he just stared at
the table.
The fundamental
goal of the group was to help the members learn everyday skills such as
greetings and light conversation. After years in the hospital interacting only
with staff, their social skills had deteriorated. Most wandered the grounds
alone, only socializing when they wanted a cigarette. Smoking was still
permitted on hospital grounds at that point, and the patients would come up
close to strangers, violate their personal space and ask for cigarettes.
Whether they received one or not, the patients would usually end the
conversation with a grunt and walk away.
I had been a
clinician for all of two months at this point, and I thought my task was
straightforward – have the group members interact and learn the cadence of
conversation. I planned to model how to engage in an ongoing conversation by
simply talking with them and encouraging them to talk amongst themselves.
Toward this end,
we met weekly – rain, snow, hail or blazing summer. On rainy days, I could hear group members walking down the
hallway by the squishing of the water in the soles of their shoes. When I
suggested they take them off and place them on the radiator to dry, no one ever
responded. Each meeting was the same;
the group members walked in, sat in their usual seats and stared at each other.
The silent
patient never even smiled or indicated that he heard anything that was said.
When I asked my supervisor about him, she told me that he had been silent since
she met him six years ago. It was her idea to try and engage the group in
activities.
The next
session, I brought in the game Monopoly, still freshly sealed in its wrapper. I
thought Monopoly was a good idea. The ability to use money was a skill the
group would need if they re-entered the world, and at least it would urge a
sentence or two.
“The goal is to
try to become the wealthiest person by buying, renting and selling property on
the board,” I told the group. “Each of you gets $1500 to start.”
I asked one of
the women to open the game and then I passed the money out to each person. The
silent patient didn’t reach out to take his, so I placed it on the table in
front of him.
“Does everyone
understand the instructions?”
Everyone but the
silent patient nodded. I took out the dice and asked each person to throw them
in unison to determine the order of their turns. I asked someone else in the
group to keep a list of the numbers each person tossed.
“I’ll be the banker,”
one of the men piped up. I was feeling pretty pleased with myself, someone had responded.
“Let’s go,” I
said.
One of the women,
who was wearing three layers of clothing, I assumed to protect her from the
cold, threw the dice towards the ceiling and they scattered across the floor. I
asked her to throw the dice once more, but this time across the table. She did so
with such force they went flying into the people seated across from her. What a
beginning. For the next six weeks, I attempted to teach the group to play the
game, but to no avail. At most they finally figured out how to throw the dice
on the table. Frustrated, I tried to think of something simpler.
I thought Pick-up
sticks was a clever idea, so I brought them in one afternoon. I slowly
explained the guidelines. I felt like my words were molasses. “The dealer holds
the bundle of sticks loosely then releases them on the tabletop. One by one,
each player must remove a stick from the pile without disturbing the remaining
sticks. If a stick moves, the player’s turn ends and the next person tries. Any
player who successfully picks up a stick can take another turn and keep
removing sticks until one moves and then their turn is lost. The winner is the
player who, at the end of the game, has the most sticks.”
The game started
out well, and the patients seemed to enjoy themselves. They seemed to be paying
less attention to their inner stimuli and more to each other. They weren’t
looking around the room as much, and they even made eye contact. I was
ecstatic. We played without incident for several weeks, although the silent man
sat staring at the table and didn’t participate, even with enthusiastic requests
for him to join the group.
Meanwhile, the
group’s therapy advanced with glacial speed. Amid the games, six months into
our meetings, I couldn’t detect any improvement in the group members’
interpersonal skills. Everyone periodically continued to talk to himself,
herself or the air, and the silent patient still hadn’t uttered a peep. “Change
happens in small increments,” my supervisor said when I turned to her for
advice. I was so disenchanted; maybe the thing to do was for all of us to stare
at the ceiling together. What was the point?
I tried to
comfort myself with the reminder of the new and exciting clinical experience I
was getting. This, however, had little impact.
Each group
meeting lasted an hour and a half, and since the games ended quickly, we often
played six games or more. One afternoon, a loud argument broke out among three
members about whether someone had moved a stick during their turn or not. The
argument became a screaming match, as the session was about to end.
“We’ll talk this
over and figure out how to solve the problem at the beginning of group next
week,” I said. “Maybe over the week people can think about what might be a fair
compromise to each person.” My efforts had bombed, and I so desperately wanted
to succeed.
I was frustrated
with the results for both Monopoly and Pick-up Sticks. Leaving on a Thursday
evening I traveled to Las Vegas for a weekend and my struggles with the group
flew out of my consciousness. Each day while in Vegas I took $20 to the casinos
and, without fail, lost the money on the slot machines. On my last day, I
decided to change things up, and I took a $100 bill to the Blackjack table. The
croupier smiled and invited me to sit down. It felt like a group activity. I
laughed and talked with the other participants, each of us trying to help the
others to beat the house. I had fun with the rowdy group, and even more fun
when I won $300.
At our next
group meeting, I brought in four decks of cards and a Las Vegas style deck
holder. I wore a bright green hat, laid a sheet over the table, and then asked
everyone to sit across from me. I gave each person twenty-five pennies,
explained the rules, and started dealing the cards.
The group
immediately figured out how to play. I added up the cards for each person and
then they decided if they wanted another hit. Since math isn’t my strong point,
there was always a delay while I added up the cards for each person. To my
amazement, while I was counting, members started talking to each other, asking
whether they should or shouldn’t take a hit. They split aces and eights. They
doubled down on some cards. I was amazed. Even the silent patient began to
play.
As the months
passed, I got quicker at adding the cards without errors. Whenever our group
met, I asked what game they wanted to play. The answer was always a resounding,
“Blackjack!”
Occasionally,
however, my addition was still wrong. One day, when I dealt a hand to the
silent patient, without realizing it, I added up the numbers incorrectly. That
day, he stood up, looked at me and said, “You gave me the wrong total. Are you
cheating or was it an honest mistake?”
I was
dumbfounded. From that time forward, he spoke in every group. He asked to be
the croupier, and I handed over my hat. He dealt the cards with lightning speed
and added them up for the other members. Whenever anyone had difficultly
choosing what to do, he slowly and clearly explained the pros and cons of each
choice, and then softly added, “Hope that helps. Go ahead and choose.”
I was so happy.
My dog mindedness and desire to help had paid off.
Group therapy is
meant to allow people to develop bonds with each other in ways that they can’t
in one on one therapy. I believe that the silent man’s breakthrough and
subsequent activity in the group spoke to his developing a willingness to reach
out and participate with those around him when a game was fun. Maybe, after all
that time, he felt comfortable.
The group
continued on for all the years I remained at the hospital, and I was certain
the experience made their bleak lives better. To be honest though, I still have
no idea why exactly the group became moderately successful, but I felt hopeful.
On the other hand, I was saddened by the realization that something so small
could make such a monumental difference.
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