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What Enables Us to Provide Excellent Clinical Care?

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by Margaret Parish, PhD, Director of Patient Care

Margaret Parish, PhD, Director of Patient CareExcellent patient care is our most important work at Riggs.  It is what we do best, and it is what draws people – patients and staff alike – to the Center. 

Central elements of our clinical work include understanding individuals on their own terms, understanding the sources and meanings of the problems they bring, and respecting their authority in relation to their own life goals. People live in a network of relationships: our patients often have troubled networks and they bring the troubles with them. We offer a new network of relationships with staff and other patients, in which people can get support but also re-create the troubles in a place where they can be understood and changed. 

Our network of relationships creates a “holding environment” (borrowing a term from British psychoanalyst DW Winnicott), an environment that is safe enough without being necessarily comfortable. It is a social environment that is protected and open and allows for experimentation and learning – an environment that promotes development and resilience. This depends on a coherent and integrated system of staff relationships that support it.

Excellent clinical care is central to the work done at the Austen Riggs Center.This work can be taxing, and it requires time and space. We have to contain strong emotions: experience them, tolerate them, and not overreact to them. We also have to pay attention to unconscious processes at the level of the individual and the group. Time for reflection, for a sort of non-linear, collaborative thinking, needs to be set aside and protected, for patients and for staff. This kind of time, time in which it may look like nothing productive is being done, is essential.  It can be endangered by all sorts of pressures – pressures for achievement, for efficiency, for quick and demonstrable “results.” These pressures originate within each of us as well as in the social systems in which we are embedded.

We continually strive to protect and enhance our core clinical mission, to ensure that we develop and maintain the infrastructure we need to hold us, the patients and their families in the work, and also to promote continued learning from interactions with our patients, with one another and with others in the field. 

You can listen to Dr. Parish and other Riggs clinicians speak about many of the unique aspects of treatment at Riggs in our Clinical Perspectives section of our Resource Center.

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