• Sarah Anderson

A Unique Perspective on Mental Health with Justin Teerlinck

Justin is such an amazing and unique person. I feel so lucky to have gotten the chance to formally sit down with him and chat about his life and career as an OT!

Here is part of the interview as well as Justin's bio in his own words....

"I have worked in mental health since I took my first job as a group home worker, working with 15 adults with severe and persistent mental illness. At that point in my life I was 19, a college drop out and had been recently homeless and living on the streets. I had no prior experience working with folks with psychotic disorders, but I clicked with the residents right away. The home, Peterka House--was an aging yellow Victorian mansion in a posh and historic neighborhood in St. Paul, Minnesota, just two blocks away from where F Scott Fitzgerald lived.

I was born in La Crosse, a little river town in WI near where my parents met, in Winona, MN. I grew up in the northern and eastern suburbs of St. Paul, MN (which with Minneapolis is known as the "Twin Cities"). I went to Mankato State University for a year, and although I did well academically, personally it was too big a challenge for me, and after completing my Freshman year, I made no plans to return. Instead, I went back home to St. Paul to try to start over. It was then that I landed my first job in mental health. My boss at Peterka House took a chance on me at a time in life when I desperately needed some compassion, and the job taught me many things about how to help people with mental illness, as well as the rigors of working a job with an extremely demanding, round-the-clock schedule. It was on this job where I was introduced to what social workers and case managers do, and I decided that being a case manager was my dream job.

Fast forward to 2008. After going back to school and getting my B.A. in anthropology, I'd had a number of careers in community mental health, including as a case manager. My career had plateaued. My wife read an article about occupational therapy, and it seemed to fit perfectly with my past experience and future goals. Within two weeks of discovering OT I was enrolled in a community college to take the prerequisites I needed to have a shot at getting in to an OT graduate program. In 2011, I was ready, I was accepted to Pacific University, in Hillsboro, Oregon, which would take me to Portland and the Pacific Northwest, a part of the world I'd always wanted to live in.

Even though I'd already had quite a bit of experience in mental health before OT school, I was exposed to forensic mental health on one of my Level II's, when I worked for ten weeks in Oregon State Hospital (the hospital that inspired Ken Kesey's novel One Flew Over the Cuckoo's Nest). I loved the work there. I love the challenge of designing and implementing group therapy interventions. I love the fact that every day the group energy was so unpredictable, and you had to always be on your toes because you could nevr predict how every group would go. I loved the task of inspiring people--some of whom were institutionalized for decades--seeing their strengths, their potential, and their innate ability to inspire themselves. I realized then and there, that a great therapist doesn't "do" anything. Being a therapist is like starting a fire, which is not as simple as you may think. It's not just lighting a match. You have to find wood that will burn, arrange it in a way that it will keep going, and then provide the spark. And in the case of mental health work, there are many times you need to light that fire in a downpour, and keep it going until people see the light inside themselves, and tend to it.

After graduation, I worked in various medical OT jobs and while I liked learning new skills, I hated the emphasis on sacrificing rapport-building and compassion in a never ending quest to increase productivity and efficiency. Doing OT as SNF's and in acute care felt like working in a factory. The best thing about my time working in SNF's was having the chance to perform horticultural therapy interventions with older adults. I'll never forget the time I took a hitherto nonverbal 90-year-old woman with advanced Alzheimer's Disease out to the garden, where she immediately started telling me the Latin names of the flowers, and taught me how to prune rose bushes. In that moment, I truly learned the resilience of the human spirit, and how meaningful occupation has an almost magical ability to revitalize us when we are diminished. The grace and dignity with which that woman touched those flowers in that crumbling courtyard was not simply therapeutic; it was beautiful.

After working as a physical rehab OT I returned to mental health as a forensic occupational therapist at Western State Hospital, founded in 1871, one of the oldest and largest psychiatric hospitals west of the Mississippi. It was at this highly dysfunctional institution, a highly secure area, that I found the dream job I didn't know I wanted. As a forensic OT, I worked along side social workers and psychologists along with other OT's, teaching classes and running groups in a setting that looks a lot like a typical high school. Our semesters were 16 weeks long, 5 days a week, so it was a constant challenge to create new content and classes for the patients--some of whom had been there for decades and been in the same groups multiple times. In addition to that, the limits of our ingenuity were tested to the limit because, for safety reasons virtually the only tools we were allowed to use were flexi-pens, paper and DVD's. No phones, no internet, no computers. Some of the patients had been cut off from the world so long that I had to describe everyday things to them like what texting, social media, and in some cases even the internet were. Many of the patients were actively psychotic and functionally nonliterate, which added to the challenge of trying to reach them. Many had completely given up all hope of getting out, and only attended groups to earn enough "points" to purchase junk food from the vending machines. But it was here that I could exercise clinical autonomy, try new things, and motivate the patients to participate by dint of the fact that they were bored and had nothing to lose by trying. I co-led groups with many other professionals, almost all of whom were not OT's. It gave me the chance to form an interdisciplinary approach to many challenges. One such challenge was the fact that most of the groups focuses on recovery, criminal behavior, sobriety,diagnoses and psychopathology. While I saw the value in all of these approaches (including taking responsibility for one's crimes), I realized quickly that we did a great job of telling people about what happens when they don't follow the rules, but we never teach them why they should follow the rules in the first place. No one is excited to get out of bed in the morning just to stay sober or stay out of jail, and no one can spend all day meditating, filling out CBT worksheets, or practicing mindfulness exercises--these are means to an end, not ends in and of themselves. As clinicians sometimes we forget that our clinical interventions are not the point of what we do, just the outlines of a road to living life to the fullest.

With my supervisors desperate for new content, I slowly developed a program called Building Hopes and Dreams in order to meet the need for a strengths-based, fun way to help people become more grounded, and to find hope. When a colleague handed me a copy of Viktor Frankl's masterpiece Man's Search for Meaning, his ideas and his concept of Logotherapy became the philosophical underpinning of my approach. Many of our patients were quite jaded, and would openly mock groups and interventions that were overly positive, cheerful, and "feel goody." This was a tough crowd and I knew it. One of the things I love most about working with people with mental illness in all settings but especially this one, is their complete honesty. That honesty can sometimes be brutal, but none of us were doing this job for pats on the back or personal validation. Therefore, I approached hopes and dreams not as simply "being more positive" or discounting the things about your life or history that you aren't happy with. I also was careful not to equate hopes and dreams with wishful thinking or passivity. Instead, I saw creating meaning from life experiences--even and especially negative life experiences--as a necessity, and not as something esoteric, mystical or abstract, but as a set of skills that can be taught and learned. I truly believed that intellect has nothing to do with it, and everyone has the ability to do create meaning and find a sense of purpose in their life. The word "building" in Building Hopes and Dreams was carefully chosen. Hope--the way I see it--does not have to be a castle in the clouds, but something we build brick by brick, a foundation upon which all other life tasks, skills, activities and spirituality rest. Therefore, it had better be strong!

Building Hopes and Dreams including a curricula that included book readings, film discussions, self-expression and self-exploration activities like group Haiku, journaling, writing a letter to your past and future self, picturing what you would do on your best day, creating a bucket list, creating a "freak flag" to celebrate your individuality,and using humor as a "modality" to remove some of the solemnity of the subject matter. People said "patients can't handle" subjects like death and dying, grief and loss, so I made those topics part of the program. Talking about death and the fleeting nature of life can be a great tool for helping people understand the value of life, of their life. Long story short, I wrote a book to accompany the group called Finding Your Way, A Guide to Building Hopes and Dreams. It went through multiple editions, revisions, and iterations, with parts of it in use at two different psych hospitals and an acute care setting. The group was a great success, and indeed, a few patients mocked me, said it was "stupid" and that I was deluded or Pollyanna-ish--my worst nightmare! but I simply acknowledged their feelings and continued to invite them to the group. Because I gave them "permission" to reject me, they came back, listened, and some of the naysayers became Building Hopes and Dreams' most enthusiastic participants. Although it took five years, because so many people requested the book, I added to it and rewrote it for a more general audience. It is not like many self-help books out there. I almost militant about telling people that they do not need a guru and I don't have all the answers. They do. "You are the expert on yourself" has always been my mantra. When I rewrote the book, I took out much of the clinical language, and made it so that about half of it is a workbook with activities, and the other half consists of essays with discussion questions. In true OT fashion, it is designed so that each activity can be completed in numerous ways, for visual, verbal and kinesthetic learners. I want people to do more than think or write. I want them to feel, to use all of their senses in their pursuit of hope and meaning. I am pleased to say that Finding Your Way, A Guide to Building Hopes and Dreams went "live" on Amazon in November and it's available now. There is quite a bit of interest from therapists working in mental health, but it's designed for individual use and self-exploration by non-professional people as well (I'll add links below).

After being a therapist at Western State Hospital for a year, it was announced that an occupational therapy department was going to be created for the first time, and they needed someone to create the new position and role of Occupational Therapy Services Manager. After much heming and hawing and self-doubt, I stepped forward, interviewed and was given the honor of being the first OTSM at Western. It was a heculean task without precedent, OT's worked all over the hospital in different departments, with each department spread across a half-mile long campus, and dozens of buildings, in multiple specialized roles. There were 27 of us serving 800+ patients. Not only that, but I was tasked with bringing SLP services to the hospital, creating a fall prevention program, creating a physical rehab sub-department, centralizing OT services, educating the doctors on our role. streamlining the assessment process, creating a fieldwork program, managing unionized state workers as well as traveling contract workers, and creating "hybrid" OT positions to do both physical rehab and psychosocial OT. When I started, there was not even a list of who all the OT's were or where they worked. I had to canvass the hospital to find them. I had no phone, and my office (when I was given one after months on the job) had broken windows and glass missing, necessitating that I literally wore a raincoat sometimes while I worked. To get furniture, I drove my truck to a far away building on my lunch break, and with the help of a sympathetic custodian, I hauled a desk, file cabinets and bookshelves up to my 4th floor office. My proudest achievement in that role was creating mentorship and clinical supervision for all of my staff.

After Western, I moved on to the challenge of starting a rehab department at the newest mental health hospital, the recently built Wellound, in Tacoma. From there, I decided to create a private practice as well as an international advocacy group for mental health OT. It's been a wild ride. Thanks for having me on the show. Below are links to my LinkedIn (for the "short" version of my bio and credentials, as well as links to other books and projects). In addition to being an OT, I write fiction, short stories, Middle Grade books, picture books, and alt-history sci-fi novels. I have had a humor column in a St. Paul literary magazine (whistling Shade) called Fun Patrol, since 008. I also have an article about mental health OT that ill be published in OT Practice in the coming year. My "partner in crime" (and in all things) is my girlfriend Jennifer, who I live with in Gig Harbor, WA. Jenn is an award-winning writer and artist and we frequently collaborate on each other's works. We have a book due to be published soon called Play With Your Partner. When we aren't spinning new worlds together, we're traveling, hiking, camping, and gardening. "-- Justin Teerlinck

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