The Austen Riggs Center in Stockbridge, MA.

Erikson Institute for Education, Research, and Advocacy

 has announced the recipients of the 2025 Evelyn Stefansson Nef Scholarship, an annual honor that celebrates academic excellence, commitment to the social sciences and healthcare fields, and local community service.

This year’s $1,000 scholarships have been awarded to three outstanding graduates from Berkshire County high schools:

 will pursue humanities and social sciences studies at 

The Evelyn Stefansson Nef Scholarship has been awarded annually since 2000 to one graduating senior from each of the three high schools—Lenox Memorial, Monument Mountain, and Lee—based on their academic performance, plans to pursue social sciences or pre-medical studies, and history of leadership through community involvement. Recipients receive the funds after completing their first semester of college.

Evelyn Stefansson Nef, the scholarship’s namesake, was a multifaceted figure: author, Arctic explorer, psychotherapist, patron of the arts, and a dedicated philanthropist. A longtime supporter of the Austen Riggs Center, she passed away in 2009, but her legacy continues to uplift the next generation of socially engaged scholars in Berkshire County.

Austen Riggs Center

News

The Austen Riggs Center’s Erikson Institute for Education, Research, and Advocacy has announced the recipients of the 2025 Evelyn Stefansson Nef Scholarship.

Riggs Awards Three Berkshire County Students $1,000 Evelyn Stefansson Nef Scholarships

June is Pride Month, a time to recognize and celebrate LGBTQ+ community members, their diverse cultures, their many accomplishments, and to acknowledge the systemic barriers and discrimination that persist. Recognizing that the social context in which one exists can be a critical component of one’s mental health, the Austen Riggs Center advocates for not only equal access to mental health care, but also for a treatment approach that meets each individual wherever they are and however they identify. 

Being LGBTQ+ isn’t a mental illness. However, many LGBTQ+ people experience mental health struggles linked to societal stigma, discrimination, and denial of their civil and human rights.

Below is a list of LGBTQ+ resources and articles from a variety of associations and organizations:

National Association of Social Workers (NASW)

Five Ways to Support LGBTQ+ Mental Health

LGBTQ Youth Face Mental Health Challenges: Social Support and Safe Spaces Make a Difference

National Alliance on Mental Illness (NAMI)

Gay, Lesbian, and Straight Education Network (GLSEN)

Human Rights Campaign - Mental Health Resources in the LGBTQ+ Community

Progress Pride Flag - an image from Daniel Quasar via UnSplash.

Progress Pride Flag

June is Pride Month, a time to recognize and celebrate LGBTQ+ community members, their diverse cultures, their many accomplishments, and to acknowledge the systemic barriers and discrimination that persist.

Pride Month 2025 - Information and Resources

The meaning and clinical relevance of an 

 are essential when addressing therapeutic impasses

 for beginning therapy with a mistrustful patient

Techniques in the Psychotherapy for Psychosis

” – part two in a two-part series – Austen Riggs Center Director of Testing and Associate Director of Admissions

, talks about how psychosis remains one of the most challenging experiences to address in psychotherapy, not only for patients but for clinicians navigating fragile therapeutic terrain. Rooted in paranoia, fear, and emotional disconnection, psychosis can sever the thread of human relatedness. However, a transformative approach rooted in intersubjectivity, openheartedness, and hope provides an essential roadmap for recovery.

Understanding Intersubjectivity: A Relational Reality

Intersubjectivity refers to a shared space of meaning-making between people. It recognizes that our understanding of reality is not a solitary experience, but a co-created phenomenon built through relationships. In the context of psychotherapy, particularly with psychotic individuals, this orientation emphasizes the mutual, relational construction of the therapeutic encounter.

Recovery, therefore, arises not from control or correction, but from compassionate presence and attunement to the other’s experience.

The Power of Openheartedness and Vulnerability

When working with individuals experiencing psychosis, openheartedness and vulnerability are not luxuries—they are necessities. These qualities help establish a secure relational environment where mistrust can begin to soften.

Patients with psychosis often arrive in therapy with deeply ingrained expectations of betrayal or abandonment. Their life stories may be shaped by trauma, neglect, or repeated invalidation. In response, they have learned to protect themselves by retreating into internal worlds or projecting distrust onto others.

To engage meaningfully with these patients, therapists must be willing to show up authentically. This includes acknowledging their own limitations, being affected by the patient’s pain, and relinquishing the need to “fix” them. Compassion is not passive—it is an active stance of non-defensive engagement. Vulnerability in the therapist makes emotional safety possible for the patient.

This compassionate stance also helps therapists manage therapeutic impasses. Rather than reacting with frustration or distancing, an openhearted therapist approaches these moments with curiosity, asking: What is being protected here? What fear lies beneath this anger or silence?

Understanding the Developmental Roots of Mistrust in Psychosis

Mistrust is typically the outcome of developmental trauma, relational inconsistencies, and a life history where others were sources of threat rather than safety.

Children raised in environments where caregivers are neglectful, intrusive, or frightening often develop maladaptive internal working models. These models teach them that the world is unsafe and that others cannot be relied upon. Over time, these beliefs can crystallize into paranoia or delusional systems—attempts to make sense of a world that feels inherently dangerous.

As a result, the very presence of the therapist—someone who offers interest or concern—can be experienced as deeply threatening. The therapist may be perceived as manipulative or part of a broader conspiracy. Recognizing this developmental trajectory helps therapists remain patient, grounded, and compassionate in the face of extreme reactions.

Strategies for Engaging a Mistrustful Patient

Starting therapy with a mistrustful patient requires a nuanced, slow, and respectful approach. Here are three key strategies:

Early in the therapeutic relationship, emotional safety must take precedence over interpretation or confrontation. Trying to challenge delusional beliefs too quickly can reinforce the patient’s sense of danger and distrust. Instead, offer consistent presence, respect boundaries, and prioritize emotional containment.

Rather than dismissing or denying the patient’s suspicions, it is helpful to acknowledge them with empathy. For example, saying “It makes sense that you might be wary of me” helps validate their experience without endorsing delusions. This can open the door to more honest dialogue.

When inevitable ruptures occur in therapy—such as misunderstandings or missed sessions—the therapist can model repair. Apologizing, checking in, and demonstrating accountability show the patient that conflict does not always lead to abandonment. These micro-repairs can challenge long-standing expectations of relational danger.

Hope is often confused with blind positivity or the expectation of a good outcome. However, in the context of psychotherapy—and particularly with psychosis—hope is something more profound and resilient.

Unlike optimism, which depends on circumstances turning out well, hope is an internal capacity to imagine possibilities even in the face of despair. It is a relational phenomenon, born not from logic, but from connection. 

Hope does not require a promise that things will improve. It only requires the belief that one is not alone, that their suffering is seen and honored, and that their pain has meaning. For many patients, simply having someone sit with them in their darkest hour—without judgment or agenda—can rekindle this fragile spark.

What Restores Hope for People with Psychosis?

Drawing from the lived experiences of those with psychosis, several key factors emerge as essential for restoring hope:

Many patients describe profound relief in being met with curiosity rather than scrutiny. When therapists make the effort to understand the patient’s inner world, without rushing to label or fix, the patient begins to feel human again.

Isolation is both a cause and consequence of psychosis. Finding community—whether through group therapy, peer support, or meaningful relationships—offers a vital antidote. Belonging tells the patient, “You are not alone. You matter.”

Empowerment is central to recovery. When patients are included in decisions about their care and given space to express their needs and preferences, they begin to reclaim agency. This contrasts sharply with the often disempowering experiences they may have had in mental health systems.

Conclusion: Recovery Through Relationship

The intersubjective approach offers a powerful lens through which therapists can co-create meaning, nurture emotional safety, and ignite hope.

By meeting mistrust with humility, openheartedness, and clinical skill, we offer patients more than insight—we offer them the chance to feel human again. And in that shared humanity, recovery begins.

To hear Ridenour’s presentation in full and receive CE/CME credits, please visit the

how the Austen Riggs Center treats psychotic disorders

Austen Riggs is a psychiatric residential treatment facility in Stockbridge, MA.

Psychiatric Residential Treatment

A transformative approach rooted in intersubjectivity, openheartedness, and hope provides an essential roadmap for recovery from psychosis..

Intersubjective Approach to Psychosis Treatment

 Making Meaning: Growth and Artistic Expression in the Activities Program at the Austen Riggs Center 

 Thursdays-Saturdays, 10:00 a.m.-4:00 p.m. (Eastern), June 7-October 13, 2025 

 Corner House Community Exhibition Space at 48 Main Street, Stockbridge, MA 

In honor of Joan Erikson’s reimagining of the 

 and founding of the Austen Riggs Center 

 75 years ago, the exhibition opening in June will look at the ways the activities program has shaped the patient experience at the Austen Riggs Center for over 100 years. The exhibition will showcase art of former patients and staff, and in August will host the Alumni Art exhibition in collaboration with an exhibition of current patient work in the Lavender Door.

Visitors are invited to stop by during regular exhibition hours.

For questions, please contact Alison Lotto at 413.931.5249 / alison.lotto@austenriggs.net 

Making Meaning: Growth and Artistic Expression in the Activities Program at the Austen Riggs Center - Exhibition to Open Summer 2025.

Making Meaning: Growth and Artistic Expression in the Activities Program at the Austen Riggs Center

An exhibition looking at the ways the Activities Program has shaped the patient experience at the Austen Riggs Center for over 100 years.

Making Meaning: Growth and Artistic Expression in the Activities Program at the Austen Riggs Center - Exhibition to Open Summer 2025

Six months after philanthropist Harold Grinspoon provided a landmark matching gift to create a patient aid fund, that support has enabled nearly a dozen young adults in Massachusetts to access top-level mental health treatment from the Austen Riggs Center 

The Harold Grinspoon IOP Patient Aid Fund began in November 2024, when Grinspoon gifted $250,000 to the Center. His financial support, which Riggs is matching, provides up to 13 weeks of treatment to individuals who qualify for 

 or who do not have an out-of-network benefit.

To date, 11 patients from four counties (Barnstable, Berkshire, Hampshire, and Middlesex) have used the assistance to participate in the program. 

“Many young adults go without the treatment they need because they lack insurance or have restrictive plans that bring them costs without suitable benefits,” said online IOP Director 

. “The Grinspoon fund is bridging this gap to help deliver outstanding, tailored clinical care to these individuals.”

Established in 2021, the online IOP provides key elements of Riggs’ 

 to patients aged 18-30 who live throughout Massachusetts. Riggs’ approach is centered on 

, in which the patient works to develop enough perspective on their painful past experiences so that they don’t allow those experiences to dominate their lives and are freer to make their own choices.

Since its founding, the online program has treated 124 patients, 47% of whom identified as BIPOC and/or gender diverse. Additionally, 62% of all patients identified as needing financial aid, and 56% of college students identified as needing financial aid.

The online IOP features nine hours of group meetings and two hours of individual psychotherapy with a doctoral-level clinician each week. In addition, it offers medication management, family therapy, and coordination with other health resources, all of which are integrated in three-times-a-week multidisciplinary team meetings. Without Grinspoon’s matching gift, Riggs’ online IOP costs approximately $2,400 per week per patient. Nearly all those seeking treatment lack private resources to support access to the program and approximately 15% do not have applicable insurance coverage. (The online IOP is in-network with 

 and works with other providers on an out-of-network basis.)

“I am pleased to see the impact this aid is having on individuals, as well as in helping to expand the use of psychotherapy, which I have benefitted from personally,” Grinspoon said.“ I am encouraged by these initial results and hope more young adults can take advantage of this type of treatment.”

, one of the top 50 privately-held national real estate firms. He is a signatory to the Giving Pledge, a movement of philanthropists who commit to give the majority of their wealth to charitable causes. Additionally, he has created 

 that bear his name and support a wide range of charitable initiatives nationally as well as in Western Massachusetts.

Beyond his support for Austen Riggs’ Online IOP program, Grinspoon has established the 

Harold Grinspoon Endowed Chair of Psychiatry

 at the Baystate Health Foundation. He is also an accomplished artist, with works on display in numerous public and private venues, including an outdoor sculpture at Riggs’ “Corner House” building in the heart of Stockbridge.

Some 40% of the online IOP patients have a history of prior hospitalization and many have been compelled to drop out of college or halt their careers due to their mental health challenges. Patient surveys have charted significant improvements among respondents, including: 95% indicating their behavior has changed for the better; 93% reporting having benefitted from their treatment in the online IOP; 98% feeling interpersonally connected with their therapists via Zoom; and 97% feeling cared for by their peers. Some 88% of patients who responded to surveys about their health care upon discharge from the online IOP said they went to a lower level of care after treatment.

The online IOP is currently accepting applications for admission and support via the Grinspoon fund. To find out more or to apply, call 

, online IOP Program Coordinator, Monday-Friday, 8:30 a.m.-5:00 p.m. (Eastern) at 833.921.5700 or via this 

 is a vital therapeutic community, open psychiatric residential treatment center, and institute for education, research, and advocacy in the field of mental health. Located in the Berkshire Hills of Western Massachusetts, Riggs has been serving adults since its founding in 1919. Riggs’ mission is to promote resilience and self-direction in those with complex psychiatric problems. In addition to the clinical mission, the 

 of the Austen Riggs Center studies individuals in their social contexts through research, training, and education, and conducts outreach programs in the local community and beyond. For more information, visit 


John Zollinger
Director of Communications
Austen Riggs Center
413.931.5816


Online Training

Nearly a dozen Massachusetts young adults have received care that was potentially out of financial reach.

Harold Grinspoon Scholarships Provide Access to Austen Riggs Center Online Psychiatric Treatment

A man standing alone, looking out of a window.

Common fears experienced by individuals with psychosis, including fear of harm, recurrence of psychotic episodes, and social stigma

How therapists may also experience fear when working with people experiencing psychosis

The difference between loneliness and social isolation, and why it matters

The relationship between psychosis and loneliness

Four common types of losses people face following a psychotic episode

Various recovery styles and how they influence the healing process

Therapeutic strategies for building trust, addressing fear, and fostering meaningful recovery

” – part one in a two-part series – Austen Riggs Center Director of Testing and Associate Director of Admissions 

, talks about psychosis as a deeply complex and often terrifying experience that affects not just the individual, but also those around them—including mental health professionals. He suggests that understanding the emotional undercurrents of psychosis is essential for fostering meaningful recovery and explores key emotional elements—fear, loneliness, and grief—through the lens of psychotherapeutic insights, to help identify the nuanced challenges of psychosis and recovery.

If this topic is of interest to you, check out the 

 in its entirety and receive free CE/CME from our online catalogue.

Common Fears Among Individuals with Psychosis

Fear is a central feature of the psychotic experience, often overwhelming and distinct from anxiety. While anxiety may be diffuse, fear in psychosis is typically linked to perceived threats—either from within (such as voices) or from external agents (like surveillance or persecution).

 Many individuals describe the onset of psychosis as terrifying, with fears of losing control, confusion about reality, and the dread of recurrence. After diagnosis, nearly half will experience another episode within five years, heightening anxiety about relapse.

 Auditory hallucinations can include hostile or denigrating voices, which individuals may interpret as omnipotent and malicious. Paranoid beliefs further exacerbate this fear, leading to an overwhelming sense of vulnerability and a heightened perception of threat.

 Social stigma often portrays people with psychosis as dangerous or irrational. This societal judgment can lead individuals to hide their symptoms, resist treatment, and suffer in silence, further isolating them.

Therapist Fears When Witnessing Psychosis

Therapists are not immune to fear when working with psychotic patients. Their professional role requires them to manage their emotional responses, but this is easier said than done.

Therapists typically encounter three forms of fear:

 Concerns about the potential for violence or exacerbating a patient’s symptoms can lead therapists to become overly cautious or avoidant.

 The disorienting nature of psychosis can induce feelings of destabilization in therapists, including fear of losing their own sense of reality.

 Engaging with psychosis can be challenging, often triggering the therapist’s feelings of helplessness or fear of failure.

These therapists' fears highlight the reciprocal nature of the therapeutic relationship, underscoring the emotional intensity both parties endure.

The Relationship Between Psychosis and Loneliness

Loneliness is not simply social isolation—it's the distress experienced when one's relationships are perceived as inadequate or emotionally unfulfilling. For individuals with psychosis, this is especially acute. While social isolation refers to the objective lack of social contact, loneliness is a subjective emotional state.

In the context of psychosis, loneliness is not only common but also profoundly impactful. It can exacerbate symptoms, hinder recovery, and heighten vulnerability to subsequent episodes. Key contributors to loneliness include:

 Many people with psychosis report feeling discarded or misunderstood by friends and family.

 The belief that one is "abnormal" or "broken" discourages social engagement and fuels isolation.

 Some desire "normal" relationships outside clinical or peer-supported settings but simultaneously fear rejection or misunderstanding.

Psychotic symptoms themselves—such as hallucinations and delusions—often contribute to loneliness. These experiences can be so idiosyncratic and difficult to communicate that they isolate individuals, even when they wish to connect.

Four Common Types of Loss Following a Psychotic Episode

Recovery from psychosis often requires grieving multiple forms of loss. These include:

 Disruptions in work, education, or housing are common when people are acutely psychotic.

 Psychosis can strain relationships. Erratic behavior, withdrawal, or paranoia may push loved ones away, leaving the individual socially adrift.

 Surprisingly, some individuals mourn the loss of their delusions or voices. These symptoms may have offered comfort, identity, or meaning—even if they were distressing.

 Psychosis can shatter self-concept, leaving individuals uncertain of their identity or mistrustful of their own minds. This existential disorientation can be deeply traumatic.

Acknowledging these losses is crucial in helping individuals integrate their experiences into a coherent and resilient sense of self.

Reactions and Recovery Styles After Psychosis

Following a psychotic episode, people adopt different coping and recovery styles:

 Individuals may deny or downplay their psychotic episode. They avoid discussing it and reject its relevance to their identity. While this may preserve a positive self-image temporarily, it often hinders long-term healing.

 Here, the individual accepts the psychosis but internalizes stigmatizing beliefs, developing an "illness identity." This can lead to hopelessness, depression, and a diminished sense of agency.

 This style represents a more adaptive recovery. Individuals acknowledge their experiences, explore their meaning, grieve their losses, and begin to reshape their identity with greater nuance and self-awareness. This approach enables growth and renewed purpose.

Therapists play a pivotal role in facilitating complex integration by offering a safe, empathic, and reflective space.

Toward Healing: Building Trust, Vulnerability, and Hope

Therapy for psychosis is emotionally demanding but also profoundly transformative. Key practices that support healing include:

 Both patient and therapist must tolerate ambiguity and fragmentation. Naming fear—rather than avoiding it—can be a catalyst for connection and understanding.

 Therapists who speak vulnerably and authentically can model the courage required to face terrifying realities. This reduces the power imbalance and nurtures a stronger therapeutic alliance.

 As individuals process their experiences, they can start to reconstruct their identities around resilience rather than pathology. They move from feeling damaged to feeling human.

 As trust is rebuilt and shame lessens, individuals can begin to pursue the “social goods” they long for—friendship, love, community—and decrease the chronic loneliness that so often accompanies psychosis.

Psychosis is not just a clinical condition—it’s a deeply human experience shaped by fear, loneliness, and loss. But with thoughtful, courageous therapy, it can also be a pathway to transformation. Recognizing the complexity of these emotional landscapes—both for patients and therapists—is essential to fostering recovery that is not just symptom reduction, but also the restoration of meaning, dignity, and connection.

To hear Ridenour’s presentation in full and receive CE/CME credits, please visit the 

A man standing alone, looking out of the window.

A Man Standing Alone

Jeremy Ridenour, PsyD, ABPP, talks about psychosis as a deeply complex and often terrifying experience that affects not just the individual, but also those around them—including mental health professionals.

Understanding Fear, Loneliness, and Recovery in Psychosis: A Therapeutic Perspective

How psychodynamic factors influence medication adherence and treatment resistance.

The impact of transference, identity struggles, and dependency fears on pharmacotherapy.

Strategies for cultivating a psychodynamically-informed therapeutic alliance.

The role of ambivalence and unconscious resistance in medication nonadherence.

Practical techniques to integrate psychodynamic insights into pharmacotherapy for better patient outcomes.

As a psychiatrist working with complex cases at the Austen Riggs Center and the author of 

Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient

, I have often found that understanding treatment resistance in pharmacotherapy requires more than just prescribing the right medication. It necessitates a nuanced appreciation of the patient’s psychodynamics, relational patterns, and internal conflicts that undermine the patient’s healthy use of pharmacotherapy. This article is based on a course I presented for the Erikson Institute of the Austen Riggs Center. In that presentation, I explore a case study to illustrate the complexities of pharmacotherapy and to provide insights into an integrated psychodynamic psychopharmacology approach. If you wish to see the course in its entirety and receive free CE/CME, you can access it easily via 

Case Study: A Complex Pharmacotherapy Challenge

The patient in focus is a 23-year-old, single, trans woman, an art history graduate student of Lebanese Christian descent. She initially presented with a manic episode five months before her admission to Riggs, where she was prescribed olanzapine and lithium. However, as soon as she became euthymic, she stopped the olanzapine and reduced her lithium dose, prompting a second manic episode. This second episode was marked by religious delusions, culminating in a suicide attempt intended to redeem the world.

Her psychiatric history included gender dysphoria, social anxiety, self-harm, anorexia, chronic depression, and perfectionism. A pattern of nonadherence to medications was evident, reflecting deeper psychological resistance rather than straightforward pharmacological failure.

Determining the Most Pressing Intervention

From a narrowly biomedical perspective, approaches to treatment-non-response often focus on dose-optimization, ensuring trials are of adequate dose and duration, and trying treatments with different neurobiological mechanisms, as well as diagnostic re-evaluation, to ensure that medications are used for the correct psychiatric condition. In this case, however, the diagnostic evaluation that seemed most relevant was developing an overall diagnosis, a patient-centered evaluation which attempted to understand empathically those life-historical factors that made it difficult for her to use both medications and her doctors.

Social and Developmental History: Shaping Pharmacotherapy Approaches

The patient’s background revealed significant psychosocial stressors. She grew up in a high-achieving family with a critical, controlling father and an emotionally absent mother. Her struggles with identity, social alienation, and bullying in a conservative city in the US South contributed to her emotional and psychological distress and distrust of authority.

Understanding her relational patterns provided critical insights into her pharmacotherapy resistance. She exhibited sensitivity to authority figures and systems, often experiencing power struggles and oppositional behavior. These factors influenced her ability to trust medical recommendations, including medication adherence.

Psychodynamic Challenges in Pharmacotherapy

The case highlighted several key psychodynamic challenges:

Her experience with paternalistic authority figures shaped her mistrust of treatment recommendations.

 She feared that taking medication would alter her sense of self, exacerbating her identity diffusion.

 She expressed aversion to feeling “tied to something,” leading to counter-dependent behavior against both people and medications.

 Given her baseline dysphoria, manic episodes provided temporary relief, making her less inclined to adhere to mood-stabilizing treatments.

A Psychodynamic Approach to Addressing Treatment Resistance

Understanding and addressing treatment resistance requires a framework that goes beyond prescribing medications. The 

 model developed at Riggs offers a structured approach:

Understanding that response to medications is always complexly determined by biological and psychological/interpersonal factors.

Attempting to link pharmacotherapy to the patient’s developmental goals.

Knowing Who the Patient Is, Not Just What They Have

Beyond diagnosis, understanding the patient’s internalized models of caregiving and relational patterns is crucial.

Exploring fears, fantasies, and experiences regarding pharmacotherapy in order to illuminate underlying sources of ambivalence about treatment.

Cultivating a Psychodynamically Informed Therapeutic Alliance

Recognize and address negative transference, helping the patient to differentiate past and present caregiving figures.

Actively involve patients in treatment decisions to enhance their agency.

Very early in the treatment, directly explore patient concerns by asking exploring questions such as, 

“What is it like for you to take medications?”

"What might you stand to lose if treatment works?”

Address fears that medications may undermine their identity, autonomy, or coping mechanisms.

Recognizing Counter-Therapeutic Uses of Medications

Identify instances where patients use medications to suppress emotions or avoid developmental challenges.

Differentiate between treating symptoms and enabling maladaptive coping strategies.

Managing Countertransference in Prescribing

Recognize that clinicians, as much as patients, are under the sway of the unconscious, and grappling with irrationality. Avoid reacting to challenging countertransferences to complex patients with impulsive or irrational medication changes.

Understanding and addressing treatment resistance requires a framework that goes beyond prescribing medications. The Psychodynamic Psychopharmacology model developed at Riggs offers a structured approach.

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