Holding the Keys to Care with Dr. Ross Ellenhorn

What if the key to mental health recovery isn't about fixing what's broken but nurturing what's already there? Join us on Mental Health Matters as we chat with the visionary Dr. Ross Ellenhorn, a distinguished sociologist, psychotherapist, and social worker who challenges traditional psychiatric approaches. Dr. Ellenhorn unpacks his pioneering work in psychiatric hospital diversion and the transformative idea of "holding" in therapy. Discover how his innovative programs are reshaping mental health care.

Our discussion ventures into the heart of Dr. Ellenhorn's philosophies, emphasizing the importance of social inclusion, the dignity of risk, and the power of community-based support systems. We also delve into his thought-provoking books, particularly "Purple Crayons," which draws inspiration from the beloved children's book "Harold and the Purple Crayon" to explore creativity and drawing outside the lines. 

We look beyond the realm of therapy to the broader societal impact on mental health, from the role of community in a child's development to managing personal and relational egos. Dr. Ellenhorn's insights illuminate the pitfalls of over-reliance on diagnoses and therapist-centric solutions, advocating instead for environments that foster independence and personal growth. Tune in for a compelling conversation on navigating the complex landscape of mental health care and the essential elements of healthy human connections. https://www.ellenhorn.com/ross/

Transcript

The Art of Being Held

Todd Weatherly 0:00

Hello folks and welcome back to another episode of Mental Health Matters. I'm Todd Weatherly, your host behavioral health professional and therapeutic consultant, here on WPVM 1037, the voice of Asheville. I'm here today with a person I'm glad to call a friend and just a really decent guy in general as well, Dr Ross Ellenhorn. I'm so excited to have him on the show.

Todd Weatherly 2:14

My favorite of his books is the Seed and the Rock, a very short book about how people are not rocks, and there might be more to it than that. I t And finally coming out, he's working on it now. The Holding, dr Ross, welcome to the show. Please tell me about the Holding.

Dr. Ross Ellenhorn 2:40

Oh yes. Well, first of all, purple Crayons is actually for adults. It's reflecting on the children's book Harold and the Purple Crayon, and so it's using that book to talk about the importance of what it means to live a creative life instead of a life that conforms to others, to others. And there's a chapter in that book on the importance of the experience of being held, as we call it in psychotherapeutic terms, in order to be creative. And holding is really what you can think of as the thing a person does for you to give you comfort when you're in states of insecurity, right? So we're always trying, in different ways, to hold one another in that way, and it is a real art form. It is not an easy thing to do, partly because none of us are great at being held. Most of us struggle with the ability to let people hold us and comfort us, um, and so holding becomes this whole fascinating area to study.

Todd Weatherly 3:47

I need my pain. It makes me who I am.

Dr. Ross Ellenhorn 3:49

Right, right, right and also, you know, most of our insecurities are caused by other people. And, um, you know, we're the animal that needs holding provided by fellows in our species more than any other animal, but we're also the animal with the greatest interspecies conflict. We're famous for murder and war and things like that. So the people that are holding you are also from the species that put you most in danger, and so we're always having to struggle with risk when we're being held by.

Todd Weatherly 4:20

It's a delicate balance.

Dr. Ross Ellenhorn 4:21

Yeah, it is a delicate balance, so that's sort of what I'm writing about in this. This new book, yeah, wow.

Todd Weatherly 4:27

Um, you know, it's funny that you, you talk about that and of course, I think that if you, if you spend a lot of time especially in this field and then at the field, at levels of management and leadership and everything else, you, you have no other choice but to just really act, act with, interact with a very large spectrum of people.

Todd Weatherly 4:44

you know, People seeking help, people needing help, people giving help, um, and you know the, what I've done in the work that I, the work that I do for myself, my inner, my deeper inner work, is like, okay, why does this interface look the way that it does? And you know, it's the, the, the wounded healer, the chiron's disease, and it's a help because of the help that I need. Or, you know, I help because of the of the pain that I experience. And recently I've discovered a piece of that in my own psyche and I'm just like, wow, I've kind of been carrying this for somebody else who's been my father, who's been passed away for 20 some odd years, and it's like what happens when I let that go and it changed the framework of how I did everything. I did so, um, and doing that, you know it took me 50 some odd years. It's okay, um, doing that work.

Todd Weatherly 5:38

You know, I think for most people's terrifying yeah what do you say to a person that's kind of at the front end and it could be clients that you're, that you know, Ellen Horn, of course, is some is a as an organization that they serve. But I think we're really speaking about everybody now. What would you say to a person who's beginning that process and beginning this kind of how do I be held and still feel safe? And yeah, yeah, yeah.

Dr. Ross Ellenhorn 6:03

Well, if you start with that question, you're really starting with what therapy is built to do. What's happened in our field is people have sort of stopped thinking about holding and they've come up with a bunch of techniques to get rid of symptoms.

Todd Weatherly 6:20

Right, but psychotherapy, Symptom management yeah, symptom management and that you've succeeded if you get rid of the symptoms Right.

Dr. Ross Ellenhorn 6:23

But psychotherapy, symptom management yeah, symptom management, and that you've succeeded if you get rid of the symptoms. And psychotherapy was really based on the ideas. How do I sit with somebody and provide a comforting environment? And that's not easy. That takes a lot of improvisation. It takes continuous experiences of failure. I tried this that upset the person. Now I'm going to try this. I tried this. Now I'm going to try this. It's about each individual's experience. It's not about applying a diagnosis or an assessment on the person. It's about listening and giving them a sense of being witnessed and respected in that space, and that takes a lot of skill.

Dr. Ross Ellenhorn 7:04

That event is the curative event of therapy. So the question of how do you hold somebody who doesn't want to be held is the question of therapy. That is what therapy is built to do and that's why it doesn't happen the first time you walk into the session. Because really all therapy is about is how do I keep trying to get in that place of holding this person? Because once you feel held, once you feel some level of comfort, you're able to figure out what things you want to lose from your experience and what things you want to gain. You're able to make your own decisions because you're not in the state of insecurity and doubt about oneself.

Todd Weatherly 7:41

That's what holding does well and it it holding does. It's counter to what was. If you look at psychotherapy and historically you look at the analyst, their job was to analyze for you and tell you what you're talking about, and the world of even trauma care and all these other things is let's get to the place where we can share share in safety, where you can feel held and the solutions that you're going to come up with yours. I'm just going to hold the space for you to arrive there.

Dr. Ross Ellenhorn 8:15

Yeah, yeah, although, although you know Freud, freud said that basically the psychoanalysis was a cure through love. So what they were trying to do on some level was to, all of their thinking, create what's called a holding environment. And very quickly after Freud, modern psychoanalysis became about how to create a holding environment. So what's called the British School of Psychoanalysis was all about how do we create the right attachments. In therapy, it moved from drives to relationships, and so there's just a beautiful amount of thinking about how do we make a person feel like they're being held in this way when all of us are colicky all of us.

The Art of Holding Boundaries

Dr. Ross Ellenhorn 9:05

We wouldn't need to be in therapy if the topic wasn't. I'm not able to feel health Right, all of us are colicky. I love that. That really is the event. You know, um, uh, I, I, um, we, we. Two years ago, we had our first grandchild. Oh, congratulations. And this is um, this is the, the, the child of my, my stepson, and um, um, I couldn't figure out who I was to this grandchild no, grandchild sees every grandfather as a grandfather and we were coming up with our names as grandparents and I came up with dude. I thought it would be just hilarious if my grandchild called me dude and along the way, my wife said to me no, you're not going to do that.

Todd Weatherly 10:02

You can't do it.

Dr. Ross Ellenhorn 10:03

You're going to be called grandpa, and I couldn't get to that because I couldn't see that I was held in the minds of these other people as important to them. Wow, right, and so there is an example.

Todd Weatherly 10:21

And this is after many years of being a professional in the field and holding people, yeah, yeah.

Dr. Ross Ellenhorn 10:27

I couldn't see that I was there as an important source in their lives. So there's this other element of holding that's fascinating. Like you're with your father, we hold people in our consciousness and sometimes we don't think we're held in other people's consciousness. We don't think we exist there for them, and sometimes we don't think we're held in other people's consciousness, we don't think we exist there for them, and that struggle over am I in this person's life is also part of holding. People who can walk around with supportive people in their head, even when those people are in the room, feel just as held by those people, as if those people are in the room, and that actually has this profound social psychological effect on us. It makes us see things that might seem scary as just challenges, not threats, and so holding is something that actually supports your autonomy, moves you forward in life, and it's something you can. It's mobile. You carry it with you. After you've gotten it, that person ends up in your head supporting you, whether they're in the room or not. That's the term it abides.

Dr. Ross Ellenhorn 11:26

Yeah, it abides.

Todd Weatherly 11:27

There's the dude Lives it like the dude, it abides, yeah, it abides within you.

Dr. Ross Ellenhorn 11:35

Yeah, holding accompanies you, you carry it and other people carry you in them, and that's where we get a sense of belonging. I belong to that person, I'm in their life, and so it has that kind of amazing quality to it.

Todd Weatherly 11:48

It's one of the most beautiful things about our humanity that we can actually people our heads with other people who support us I, um, you know I it would be easy, I think, for us to kind of like geek out a little bit, so I'll I'll try not to dive into too many rabbit holes, but the the question that occurs to me, as you say that is, you know, the being held by people that are close to you. You've got family members.

Todd Weatherly 12:17

You've got you've got intimate partners, you've got children and each one of them they kind of play these roles right and some of those roles are about that internal process that you have and so you've got you know, in the world of mental health there's also these clean and healthy boundaries that we try to maintain. So my question to you is in working with, with people who are in need, you know somebody, let's say, suffers from from personality disorder or severe depression and has a lot of codependency in their life, but you're going to walk into this person as someone who holds them. You're going to walk in as a professional, but you're going to walk into someone who's hopeful. How do you hold a person and still maintain those boundaries? What does that look like in your world?

Dr. Ross Ellenhorn 13:03

yeah, you know, yeah, well, that's um, that's why holding's an art, because you're constantly trying, because because you, because it never quite works right it's not.

Dr. Ross Ellenhorn 13:14

it's not like this precision, like a surgeon, you know, and part of it is this person needs to be held by me being really structured with them. So that might be someone who's experiencing issues of the self, what's called a personality disorder. I need to really make this person feel safe by them feeling like I know what I'm doing and I'm setting some limits on our content. You might want to go exactly the opposite direction if you're working with someone who's psychotic, which is this person needs to feel not like they're being trapped by rules and norms and things. They need to feel like I'm just there as a listening source and they can say whatever they want, right Yep.

Dr. Ross Ellenhorn 13:50

Yep, and you can, and you should shift your holding depending on the need of the other. So it's, it's not one thing. It's always modeled around what's happening for the person in the moment in the moment. So, uh, ellen horn, our company, discovered this thing called open dialogue, which is this remarkable technique for working people who are psychotic. It's just amazing and it's really fluid and really improvisational and very transparent.

Todd Weatherly 14:21

Now, who's the open dialogue? Is that Bone? Who's the source guy who wrote all about open dialogue?

Dr. Ross Ellenhorn 14:27

This is Yako Sabe, the main trainer, and we loved it. We just loved it, and we became devotees of it and by the end of the year of us doing it, people with borderline experiences were falling apart in our program and the staff were getting resentful and people started talking about how this company shouldn't serve people with personality issues, because we were providing the wrong kind of holding for the particular experience the person had. And that's why we brought in mentalization, because that can contain people in a different kind of holding for the particular experience the person was had had. And that's why we brought in mentalization, because that can contain people in a different kind of way. So different holding for different experiences.

Todd Weatherly 15:07

It's not one thing, it's always improvisational, you know though and I I heard this statement finally from someone another psychiatrist, in a in a treatment program and it's like, well, it's very hard to go for any length of time with an untreated diagnosis like bipolar schizophrenia and not end up with personality disorder features. Do you find that also to be true?

Dr. Ross Ellenhorn 15:35

well, I don't, first of all, haven't met any ordered personalities, so I don't actually know what this concept of disordered personality means, just like I've never an ordered attachment, so I don't know what an attachment disorder is.

Todd Weatherly 15:53

Right. Well, we have that, because we're trying to bill insurance these days right.

Todd Weatherly 15:59

That's the confiscating thing of it. It it really uh it's. It's sent us down a path that ultimately has been needed and, like 95% of it, just needs correction all the time, constantly. You know the mental health field, and so I think that if you've got a person who, who has the experience of living, a person who it, who has the experience of living in their life, um of experience, one experiencing uh these thought processes that go along with schizophrenia, that go along with bipolar disorder, and you're not held and you're not cared for, supported in the ways that you need to go, you'll get down that road and the chances are good. You've got a lot of exploded relationships.

Todd Weatherly 16:44

You've got a lot of unstable work scenarios, school housing, the whole the gamut. And I know from my own personal experience you know, whatever you've done, a lot of has tendency to stick yeah.

Dr. Ross Ellenhorn 16:58

Yeah, yeah, I mean, I mean yeah, as thin as it is thick. But there's another way to look at it too, which is like I agree with that person. Whoever said that part?

Dr. Ross Ellenhorn 17:10

of the end yeah, because the end is yeah, you know what about if you have one of these things? An entire system invalidates your experience by constantly telling you you're broken because you have bipolar or schizophrenia, and you're going in and out of hospitals because the system says you're treatment resistant and the system is constantly, constantly telling you you have to change and that something's wrong with you. That person is not doing so great either. That person is not doing so great either, and they're living in what's called an invalidating environment, because nobody's talking about what happened because of this. How did life feel when this happened? No one's giving the sense of disclose on what it meant to become schizophrenic or to be defined as schizophrenic, and so nobody's validating the existential, emotional response to those things. They're only talking about getting rid of symptoms so that in itself can create a disordered self, a person who doesn't 100%.

The Complexities of Mental Health Care

Todd Weatherly 18:13

And referencing this book again on dialogue, David Bohm. The purpose of dialogue, he says, should be dialogue. Right, if you begin with a meeting with someone and what your initial dialogue is about is about something transactional, I need something from you. Let's talk. And while we're talking, I'm going to try to get this thing from you whatever it is. And if you're buying things at the grocery store, that's fine. But for everything else, I'm going to try to get this thing from you whatever it is. And if you're buying things at the grocery store, that's fine. But for everything else, I think that largely the mental health system this is exactly what you're talking about that they begin their relationship with someone who comes in needing help as transactional what's the fastest way I can figure out what they need, medications that I should put them on and how quickly can I get them out the door and those are all, first, not serving the individual.

Dr. Ross Ellenhorn 19:03

Yeah, it's monologue, not dialogue, and it's not just first, it could be throughout their care. It's all about okay, this treatment didn't work, let's get you this treatment, and there's no dialogue about the trauma of being ostracized and stigmatized and losing your sense of your dream in life and where you're going, and that is, for most of our clients, the number one thing that they're actually contending with. Most clients are a little less interested in getting rid of the symptoms than the terror of their friends moving forward in life and them staying back or a sense that they had a dream and that dream didn't get met, or the feeling like everybody thinks they're broken and there's no room, there's little room in the system to give them a place to disclose about that and think about that and work on rebuilding themselves socially to get back to that, work on rebuilding themselves socially to get back to that. And so that, to me, is a system that creates a lot of symptoms.

Todd Weatherly 20:06

A lot of stress. Yeah, more and more every day, seemingly.

Dr. Ross Ellenhorn 20:11

Yeah, yeah, yeah.

Todd Weatherly 20:12

Well, I think that I mean, I think, the system that we're talking about, and it exists across the board. It doesn't matter what kind of community mental health system there's a few that have got some interesting things going on but by and large they're trying to contain people into these siloed microcosms of resource and time from people and medication they're trying to give them as little as they can and keep them from having to rotate through the hospitals or them from having to draw on additional resources. But the problem is is that it's exactly what drives the system. You know this, this repetitive through revolving door kind of system, and what I, what I see these days, is that it's almost like the. The opposite effect is being accomplished. As much as you, as much as you try to contain it, you wrap your hands around it, putting this little ball the bigger an explosion and problem it becomes yeah, yeah.

Dr. Ross Ellenhorn 21:11

Well, um, find somebody who can prove to me that recovery and growth and human transformation is a predictable, non-improvisational event, and I'll show you someone who doesn't know what they're talking about. So if growth is improvisational, why are we creating all these standards for how to treat it? They harm growth because it's treating a person like a rock. It's saying you're a kind of a thing like a refrigerator that's broken and you're going to the factory because you have a warranty and we're going to fix you and send you back out again. That's not. That's not how life in the life as a thing that courses between us, that moves through our life and helps us grow. That's not how it works. It's a complex ecological event and we're treating it as simple as something that can be fixed with the newest DBT screwdriver or CBT screwdriver or medication wrench. It's just wrong. It's not how it works.

Todd Weatherly 22:28

And I mean, tell me a little bit about and I'm certain you have an idea and an opinion about it but you get a person who ends up in the hospital and psychiatric hospital and they you know this stuff going on and and they do what you're talking about. Maybe they spend two or three days or possibly as much as a week, and then they come out and then we've got this whole environment of residential care right. Um, that even hospitals really don't know about, but I know about it. So you know the clients that come to me. That's part of where we're going, but because one I know that the hospital didn't take long enough or look close enough at what it was that was going on.

Todd Weatherly 23:07

And they need somebody to actually do the care model that they need. But if we lived in a world that looked more like your program, do you think we would even need residential care?

Dr. Ross Ellenhorn 23:20

I don't. I mean I think that I mean my progress was supposed to be, although we're not seen that way enough. We're supposed to be an alternative to residential care, and I actually think we work with people that are more complex in their needs than people that go to residential care. Residential care can take people who can go to. There are people who are having such complex events that they would not live well in the milieu. It would cause all kinds of problems and they get kicked out and so actually, the more acute and the more difficult the problems, the better off you are. Not in residential care. That's the crazy part of the system, right? And I do think that if we could find ways to support people in their own homes and their own communities, but you have to do it with a really robust psychiatric component, so it's like a hospital without walls. That is the way to go.

Dr. Ross Ellenhorn 24:12

I mean I'm kind of devout to that. I really believe in that. It's called the dignity of risk, the ability, because I think that treating a person in a dignified way is central to their recovery, and my program works with highly suicidal clients, clients with extreme symptoms, clients who also continue to use drugs and alcohol, and we do almost zero surveillance and they do fine. And we have these systems now where outreach means surveillance, when we have companion services half the time mean keeping your eye on somebody, right, right, and that's not what it should be. It's about how do I get person to feel included in the world, like social inclusion, the sense of your own social value is the central medicine to recovery and to growth, and we have a system that says you can't have that medicine until you're doing well. Instead of even when you're in a bad state, we're going to try to get you that medicine, your connection to the world.

Todd Weatherly 25:20

Or you have to be doing so badly.

Dr. Ross Ellenhorn 25:22

Yeah.

Todd Weatherly 25:22

You have to get to the place where you're doing so badly that it's obvious that you're getting picked up off of the street before we're willing to give you help. Yeah, because you got to meet the. You got to meet the the disordered diagnostic criterion.

Dr. Ross Ellenhorn 25:36

Yeah yeah, criterion. Yeah yeah, I mean, one of the most remarkable things in the area of addiction is that, um, uh, they came up with this idea that addiction is a disease. That's really a metaphor. It's not like it's a disease. Some people have some sort of genetic thing, most people. It's not a disease in that sense it's a metaphor. They said it's a disease, but this is a disease. Most programs are not willing to treat if you show any symptoms of the disease that's insane that's insane. It's cruel.

Todd Weatherly 26:20

In a way, you're broken as long as you're acting in ways broken express that brokenness you can't be fixed and I I take it you're referring to somebody in a sober home that suddenly relapses and they get kicked to the street.

Dr. Ross Ellenhorn 26:36

Yeah, or somebody that comes to us, somebody sent to a sober home and still drinking. You know, like no, you're not sober long enough, you know. So it's an odd system that way, Instead of saying and part of that system is because so much stuff is done in residential, so you have to keep drugs and alcohol out of residential programs right, you can't have to have abstinence based.

Dr. Ross Ellenhorn 27:00

And so much of that has to do with not being able to handle strange, difficult behaviors in male use. So why not serve people in their own apartments so you don't have these conflicts and then you can actually engage in the dignity of risk and care that's about how do we get them connected to the world, you know.

Todd Weatherly 27:17

And there's a. There's a the concept I use with a lot of people um, regardless of the context, honestly you know whether you had somebody that's coming out of the psychiatric hospital. We've got a career professional that's trying to find something else to do with their life. I mean, like the whole range is um you want to be, just make sure you're going towards something, not away from something. Just make sure you're going towards something, not away from something.

Todd Weatherly 27:40

And I think that when you what you're talking about supporting a person in a person, supporting a person within you know, in their home, giving them a social, giving them a social context, something to connect to, something to feel held by when if you're able to implement something like that, it'll become the most important thing to that person and they won't want to sacrifice it and as a result and largely that's what a recovery model is built on you know the community and you don't want to sacrifice community because by giving up your sobriety. But I think that if you build something for someone and that becomes the most important thing for them, as opposed to it and this never as opposed to I, the I can't, I, you know I can't do this or I shouldn't do that.

Todd Weatherly 28:25

You know, sobriety is the thing and I can't have that because it's a disease and I'm poisoned, etc. It's like it's a it's a diametric relationship that that orients to the thing that you're trying to minimize or, you know, decrease the impact of in your life. Instead, you turn towards something that's important for you.

Dr. Ross Ellenhorn 28:42

Yeah.

Todd Weatherly 28:44

As opposed to making the brain focus, and the brain can only focus on a positive image. Right, yeah, and if you give them something that's more important to them than anything else, the chances are very good they're not going to sacrifice that thing that's important to them by turning over here to these maladaptive strategies they've done in their life. I mean, that's the idea. The only problem is that it takes longer to do.

Navigating Boundaries and Interventions

Dr. Ross Ellenhorn 29:07

Yep, yep, I mean on some level. You're talking about that thing about extrinsic and intrinsic rewards. Right, that it has to be. There has to be an intrinsic reason for quitting, Because once you have an intrinsic reason'll stick with it right towards this thing I want in my life, and that's why harm reduction models and motivational interviewing work on some level, because these models are based on the idea of how do we help you contemplate what you want in your life and where this substance exists in that contemplation, right? Um, yeah, and oh, just one second, I'm just gonna say something else.

Dr. Ross Ellenhorn 29:46

Oh yeah, so look there's research out there that says that more people quit addictive behavior outside of treatment than in treatment. Now, I believe in treatment, so I'm not insulting treatment. More people quit using outside of treatment than treatment. That's true. That's absolutely true. True, that's absolutely true. There's also some research that shows the people that quit outside of treatment stick with their recovery long recovery, longer than people that that become absent in treatment. That might be a story about extrinsic, intrinsic rewards that the people that quit without the pressure to quit did it because they said this is messing with my life. I want a better life and I'm going to start working on this.

Todd Weatherly 30:28

I'm in my own way right, well, and I think that, like, that's one of the biggest challenges I think we run into I know I run into it all the time, which is which is time frame yes, yeah it's like you know this person, this person's in crisis, you know they've started drinking, they're, they're in a bad way, etc.

Todd Weatherly 30:46

Etc. There are risks involved. I'm not saying they're not, they are, um, and they've started drinking, they're in a bad way, et cetera, et cetera. There are risks involved. I'm not saying they're not, they are and they've got to get help right now. You know we've got to do something.

Todd Weatherly 30:55

We've got to get in there, we've got to make sure that they go get help. It's like, well, are you doing that because you feel uncomfortable or because they're uncomfortable with what's going on with them? I'm not saying that it's good that they're doing these things, engaging in these maladaptive behaviors and these things that are clearly self-destructive. Sure, yeah, but you're not engaging in this emergency.

Dr. Ross Ellenhorn 31:18

Yes.

Todd Weatherly 31:18

You're not enlisting this emergency because it's their emergency. It's because it's your emergency.

Dr. Ross Ellenhorn 31:25

Exactly and right, and because you're often dealing with life or death situations, but that doesn't mean you're going to fix it by by doing it. I mean, you know how many people die from OD after going into a detox, oh yeah, so so there's a risk, even though the thing that doesn't feel like a risk, right, which is what we got to get them in the detox.

Todd Weatherly 31:45

Yeah.

Dr. Ross Ellenhorn 31:46

It's massive risk. The only people die kill themselves after they've been put in the hospital for suicidality. So because they become like disconnected to everything around them, they'd be, they'd be.

Todd Weatherly 31:56

They're kind of treated in this dehumanizing way afterwards yeah, I mean, how many people die driving to work? Like you know, the most dangerous thing you're going to do today is go outside and get your car. Yeah, yeah, exactly right, yeah, yeah, I mean we should intervene on you right now because the dangerous behavior you're getting ready to engage in. My wife feels that way about my driving yeah, but the, the, yeah, the, the.

Dr. Ross Ellenhorn 32:22

The saddest group of all of these, these individuals where they're experiencing something that everybody feels like is a crisis, are people that are having the first moments of a psychotic experience because yeah, yeah, psychosis is basically, um, you know, it probably has some, some biological component, but it is.

Dr. Ross Ellenhorn 32:40

It is triggered by stress and isolation and a person who's having a psychotic episode may not even be thinking they're in crisis. And then you get a bunch of people around you who basically stress and isolate you. They say, got to put you in the hospital. The first person of psychotic person usually meets is a cop. It is completely symptom creating the way we treat individuals that are having those experiences, completely stressing and isolating, instead of taking it cool, taking it slow, spending time trying to learn the meaning of their psychosis. Right, you know, and and and that's partly because we feel like psychosis is this dangerous thing when it's not, it's not in our societies, it's. It's. It's a lie that they're more dangerous than other people and things like that.

Todd Weatherly 33:23

And you're not talking about enabling a person either. You're not talking. You know that's not what we're talking about. It's um, I you know. I think that the I have a I have trouble with this word, please help me which is intervention. I dislike it a lot. I also dislike what we've made it into. Um, it's like well, do you do interventions? I'm like well, what do you mean?

Todd Weatherly 33:45

I mean us having a conversation right now technically might be considered an intervention, and I think that, again, the timing thing it's like I think what you're going to do is, you know, set some up boundaries.

Todd Weatherly 33:58

If you're, if you've got a person who's in psychiatric and or addiction and or both crisis, well um, but you're paying for their apartment and you're in and you're paying for all their living expenses and everything else. They've got no reason to want to change that because all their needs are being met. So if you no longer want to co-opt that, then you need to start drawing limits back. It's like, well, hey, you can live your life the way you want to lead it. That doesn't mean that I want to support it, because I think it's dangerous for you, I think it's self-destructive and I think that you might want to get some help, and so this may be a longer process than you think. What we're going to do is just slowly roll out some limits and some boundaries and start establishing the parameters for your relationship with this person some boundaries and start establishing the parameters for your relationship with this person, and the act of doing that is probably going to cause more change than you think.

Dr. Ross Ellenhorn 34:55

Yeah, that's, that's very good point. Yeah, yeah, I mean, I think that's a very good point, yeah, because, well, let me, let me. Let me respond to two things. One is, yeah, the word intervention means to cleave something from something passive. So it's also used for war and it really means that the thing you're intervening on has no agency. You're there, right the thing out of it, and so it is a completely non-participatory word. It has nothing to do with the collaborative relationship. It's a real problem word. It has nothing to do with the collaborative relationship. It's a real problem word, the word that I've come up with for enabling, which I think is a brilliant term is it's this word called love.

Todd Weatherly 35:42

I'm sorry say that again Love yeah.

Dr. Ross Ellenhorn 35:46

Because parental love is a kind of insanity, and if your kids are in trouble you become more insane, and to have someone like you slowly helping the parents learn how to set those limits, to have a compatriot in, that is what they need, because it's just a wrenching, terrifying event. Yeah, when your kid is doing something that's life-threatening or has done something that's life-threatening, everything feels scary, and so you just have to have someone around you coaching you through it. If I were in that situation, I would need it.

Todd Weatherly 36:27

Oh yeah, I mean, it wasn't healthy anyways, but I'm just saying yeah as much as I know. Yeah, I would need some.

Todd Weatherly 36:33

I would say, hey, I, I need somebody to hold me yeah in a space where I can be a reasonable parent, because I'm not going to be a reasonable parent. I can be a reasonable for all kinds of other people, but reasonable parent it's not. It I'll say when my kids are in trouble, when you're you know, when your children are in danger, there's some part of you that just you know. The fire goes off in your brain, yeah.

Dr. Ross Ellenhorn 36:58

Yeah, you can't think straight. You come, I mean for me. I think I understand what it's like to be in a borderline state, Cause that's what it feels like to be a parent.

Todd Weatherly 37:17

Oh yeah, state, because that's what it feels like to be a parent. Oh yeah, yeah, you'll do anything, doesn't matter what you sacrifice what you do, you'll do anything. Yeah, 100, yeah, um, wow, uh, I you know. One more question that I that I did have in terms of, and I asked this question of, of people, of your, of your great accomplishment, sir, is what's the solution? Ellen Horn is a program. I think it's a great solution. I've used it myself for my clients. But for us as a community, for us as a society, where do you think this new way? Where does the solution start in your mind?

Community's Role in Mental Health

Dr. Ross Ellenhorn 37:49

Well, it's really. You know, I'm a sociologist too, so it's really difficult for me to talk about solutions, because I mean the main solution is that the family should not be the focus of their child's mental health. The community should, and so that solution feels like almost impossible to get to in this day and age. You know the nuclear family. There's so much pressure put on it right now and it was never built to raise children. It was built to raise children within networks and communities, and without that it's a real weak response. For your parents to be in charge of your emotional development it's not great. So that's like the longer, weirder, more difficult solution. How do we build communities around our kids? Short term, we already have it. We already have it.

Dr. Ross Ellenhorn 38:35

Psychotherapy talked about this. Motivational interviewing talks about it. Stage-based interventions talk about it. It's already floating in our atmosphere to take a more humane approach to people. It's already floating in our atmosphere to take a more humane approach to people, and the more we can do that and the more we can live with risk in a way that's thoughtful, because it's actually less risky to kind of let people be free and not do so much surveillance, the more that they're going to prosper and bloom.

Dr. Ross Ellenhorn 39:01

It's just a fact about change. That's how change works, not initially, but it's also less expensive in the long run. I think In the long run it's less expensive and the mess it's not new. That's the beauty of it. The messages are already there. It's already part of our ethos to recognize that the source of change is the person, not the intervention, not the therapist. The source of change is the person. So how do we create the fertile ground for that growth? That's already there. We just have to make sure our treatments are back to that. That means a lot of programs that use diagnoses to sell themselves would have to stop doing that. In other words, your kid has this and we are trained in this treatment, for that isn't good therapy, it's good branding and that would have to change. This overselling people on brokenness that only I can fix is a real serious, serious problem. That's that's gotta stop.

Todd Weatherly 40:03

yeah yeah, I've run into plenty not only that from companies, but even even individual therapists, where it's like look what I did. I'm like. You held space for this person to make a breakthrough and the more you take credit, the less impactful that's going to be. Honestly, you're just going to ruin the work If you've done it well, as you say you have. You're going to ruin it now because, in order for this relationship to continue, you're not prepared to let it go. In order for this relationship to continue, you need to continue to be the solution. I've watched that system.

Dr. Ross Ellenhorn 40:35

Oh, totally. Yeah, I mean yeah, totally, I mean it, it, it. It's um a couple of things with. That is like um. First of all, you don't know if you were the solution. You're a right. A person changes and shifts for all kinds of reasons.

Todd Weatherly 40:51

Maybe it's because they found a penny in the street that day. You know, who knows Like what was the thing?

Dr. Ross Ellenhorn 40:55

They got a new friend. I mean, there's all kinds of things that change people's life. Us therapists we do good with some people, we do, you know. And us friends do well with some people, and you people and you know, and my friends have helped me and you know. So that's one problem. The other problem is this if you want to hold right, the hardest part of it is tamping down on your own need for gratification. Right, you need to be there for that person, not to be gratified by them. And the statement that I did a good job because and this person's change is proof of them is about gratifying yourself about their change. And that betrays the ethos of I'm not here for that. I'm here as a host for a guest. My job is their comfort, not mine. You know we all screw up on it, we all do it all the time, but our job is to try not to be in a space of trying to get gratified by the other person. That's what we're supposed to do.

Todd Weatherly 41:52

Hold it in check, you know, watch it observe it and make sure it doesn't get in the way, cause it will.

Dr. Ross Ellenhorn 41:58

It's like the ego.

Todd Weatherly 42:00

It's a friend of mine called the ego, the metaphysical ghost. Like you could achieve something that was you know, let's call it personal development, you, you, you reach a breakthrough, you had some realization and it allowed you to kind of get closer to the, the egoless state. I think that we're trying to achieve and and it'll slide in there and be like look how great you are, you know this is great Actually you did wonderful and I think we should really promote this.

Todd Weatherly 42:27

Your ego is just right there, right on it, following right that's right, yeah, yeah, that's right, yeah so you've got to be in. You got to be in that space, and the therapist has to do this as well as be like I see you yeah I see you're trying to get in here, but look, we're just, we're just going to do our part today.

Understanding the Self and Relationships

Dr. Ross Ellenhorn 42:46

That's right, that's right and and yet to be also to be a self. The ego means self, to also be a self, you know yeah.

Todd Weatherly 42:56

Yeah.

Dr. Ross Ellenhorn 42:57

You know that, that that I'm less interested in egolessness than I am in being related to people, and for me to be related in a state of relationship, there's got to be a me and a them, right, there's no way, with me and a them a separate me and a separate you and I've got to know what that is and be okay with it too. Yes, exactly, yeah, so be okay with that. That's right, yeah and um.

Todd Weatherly 43:19

Speaking of things that you have to do constantly, that's one of them too right, absolutely yeah, um, dr ross, dr ellen, thank you so much for your time today. It's been, as usual, a delight. I always feel like I learned something from the tremendously insightful mind that you have and enjoy spending time with you. This has been Mental Health Matters on WPB 1037, the voice of Asheville, todd Weatherly, your host folks will be with you next time, doc.

Dr. Ross Ellenhorn 43:48

Thanks for being with us, thank you, thank you.