Online IOP for College Students and Emerging Adults in MA

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A Reflection on Riggs’ Mission

Edward R. Shapiro, MD|
January 21, 2025
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Riggs’ mission has a distinct focus: we aim to help individuals who struggle with the most difficult aspects of human experience and have been unable to use conventional treatments. Riggs has learned a lot about what gets in their way, and our organization is designed to address that. We prioritize patient authority, ensuring that everything from admission to discharge helps patients increasingly take charge of their lives. Our open setting reflects this commitment by maximizing our ability to meet basic dependency needs and minimizing how much we “take over” for our patients.
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Bringing patients to an open setting–often when they are struggling with severe emotional distress, suicidal thinking, social isolation, or hopelessness–means we all share in the anxiety that comes with offering both freedom and responsibility. We collectively work to manage this anxiety with the patients and their families. We do our best to recognize that our patients are competent adults even if they’re entangled in destructive patterns. Our setting provides opportunities for them to take responsibility: at admission, in self-government in our community, in sponsoring other patients, in taking responsibility for their resources and their step-down process, and when they engage in our work and activities programs.
In our clinical work, we help patients learn how their minds work, why certain feelings overwhelm them, how behavior communicates unspoken issues, and how irrational roles can develop in families and relationships. Our operations staff assists with food, housing, medical needs, finances, and daily logistics–support that frees our clinical staff to focus on treatment. Of course, we sometimes get it wrong, either because we trigger old traumas for our patients, or because defending ourselves against the painfulness of our work makes it harder for us to listen objectively.
This mission places significant demands on all of us. We have agreed to serve this mission on behalf of our patients and on behalf of the broader field, which can sometimes reduce patients to their symptoms alone, leaving aside the importance of the whole person.
Many patients come to us with the label of “treatment-resistant.” At Riggs, we understand that label to mean that they have not yet found people who can listen and bear with them the painful experiences that they both carry and enact. We recognize our patients as capable adults and explore with them the barriers they face in stepping fully into their authority. In every area of the Center, we work to help them to acknowledge, bear, and put in perspective the painful life experiences that have limited their progress.
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One patient recently and memorably described Riggs as offering "too little care—on purpose." This mild sarcasm captures the careful negotiation we have with our patients to find the right level of care—too much can infantilize; too little can make patients feel unsafe and abandoned. Balancing the tension between empathy and accountability is core to our mission. In everything we do, we ask, “How is what I’m doing meeting appropriate and basic needs in a way that maximizes each patient’s opportunity to take charge of their own life?”