Finding the Right Lever

A primer for Changing the World

Magazine Issue
November/December 2004
Finding the Right Lever

As you read this, the emotional roller coaster of the polarizing 2004 election is presumably behind us, even if the impact of the election’s outcome will be with us for a long time to come. Whatever the results, one thing is clear: it was a grueling campaign that riveted the attention of most of the clinicians I know. Many of us talked politics every day for months, some hosted fundraisers, others devoted long hours to working on the candidates’ campaigns (this being the therapy field, I leave it to you to determine which of the candidates received the bulk of this free empathy and support). Nevertheless, in the past, once the electoral votes have been tallied, even the most engaged of us have been content to return to the relative tranquility of our practices and let the problems of the wider world recede in our awareness. This time, however, something else seems to be stirring within our field.

Despite our ingrown professional culture and frequent sense of pessimism about the direction of the body politic, the hunger to make a difference in the larger world actually seems to be growing stronger. It’s becoming clear that there’s too much at stake for us to retreat into the refuge of our practices again. As a profession, it’s time to recognize the importance of our roles as both citizens and therapists, which, unfortunately, is something that our training has done little to prepare us for.

Like most therapists, I went into this profession not just to help my own clients, but to make the world a better place. When I trained in the 1970s, I thought that therapy was the number-one untapped source of social improvement. I believed in a kind of “trickle up” psychological dynamic, whereby therapy would make enough people healthier to tilt the whole social order toward justice and harmony. Yes, I actually believed this when we sang “All You Need Is Love” under the moonlight in Bethel, Maine, during summer encounter groups. I even entertained the idea that national transformation would begin when everyone in Congress and the White House got into therapy–or at least a good personal-growth group. In my own journey since then, I’ve moved from unrealistic hope to unnecessary despair, and now, finally, to the conviction that we can indeed make a difference as therapists who engage with our communities and tackle issues of public significance.

In the past six years, I’ve learned what it means to become a citizen-therapist and how to navigate some of the unfamiliar territory outside our clinical environments. Keep in mind the limits of my experience: I work in local communities on local issues that reflect broader cultural and institutional forces. You’ll have to look elsewhere for help in becoming a social activist on larger issues, such as war, poverty, and global warming.

I work in my own back-yard, with modest goals that may, in time, create ripples in a larger pond. I make no apologies for this local focus: I believe that it’s where most therapists can do their best public work. What I’ve learned is a series of lessons about the ways that any therapist, regardless of where they live or what their clinical specialty, can get started in trying to make a difference in the wider world.

Discover Your Passion
The first step in getting involved to make a difference is to ask yourself which clinical issues grab your interest most and how they’re connected to larger community, cultural, and institutional issues. Think about the client populations you work with, and how their well-being may be affected by forces beyond the family. For example, if you work with children and adolescents, what bothers you most about the environment we’re raising them in?

My own first foray into community activism emerged from my concern for how we’re turning middle-class childhood into a rat race of overscheduling and overachievement, and how parents have come to see themselves as service providers to their children. I saw this disturbing development in my practice and everywhere in my local community. The desire to get involved came when I began to see this problem as not just a particular family’s issue, but as organically connected to larger social forces (the invasion of competitive, market-driven individualism) and to community institutions (the sports leagues and ballet schools that have increasingly taken over children’s lives). Once we look outside our windows, it’s easy to see how the problems we treat in our offices are integrally connected to broader community issues.

Connect with a Community: Part 1
Once you’ve identified an issue you care deeply about, you’re ready to connect with a community. The first community I recommend is at least one fellow therapist with whom you can share your journey. Start conversations about what each of you is passionate about. See if you share similar interests or get charged up about the same issues. For me, this process began with a series of conversations with my colleague Patrick Dougherty. Over numerous lunches at a local cafe, we brooded, brainstormed, and hatched ideas about how to engage with the world outside our offices. Patrick then introduced me to two political scholars and local activists, who became my mentors. Eventually, I pulled together a group of colleagues and students into an ongoing group for mutual support and mentoring. Like most therapists, I’m not a good Lone Ranger: I do community work only with buddies behind or alongside me.

Connect with a Community: Part 2
The next step is pivotal: finding a community to work with outside your professional world. This isn’t as hard as it sounds. Ask yourself what communities you’re already connected to. It might be the neighborhood you work in, the schools your kids attend and where you’ve given talks to PTA groups, or your faith community.

Be cautious about starting with too large a community, even if the problem seems to beg for something big. A colleague of mine with a passion for promoting good marriages was stymied by the difficulty of creating a supportive environment for couples in his city of 90,000 citizens, where he wasn’t a civic leader. I suggested that he start with his own church community. He did so, and started a vibrant, successful marriage-support project within his Catholic parish.

For me, finding a community was both difficult and easy. It was initially difficult because of my assumption, common among therapists, that community work is needed only in low-income neighborhoods. As I saw it, the problem for me was that most of my contacts were in middle-class communities. It was suburban and well-off urban folks who most often invited me to speak on my favorite topic of overscheduled kids and reclaiming family time. People in struggling urban neighborhoods don’t have overscheduled kids, and they’re understandably skeptical of people like me coming in with schemes to enhance their lives. Feeling stymied, I felt tempted to revert to Save-the-World-Strategy.

Number 1: Stay in your office and support the right candidates and causes, venturing forth every four years to get out the vote.

But I finally realized that the suburbs have plenty of troubles of their own, and that my work could start with whatever community cared about an issue I cared about and was open to working with me. (It’s a little like being a new therapist: you don’t so much choose your clients as you’re grateful that they’ll see you.) An opportunity emerged soon afterward. I was invited to give a talk to a group of parents in Wayzata, Minnesota, a middle-class suburb of Minneapolis-St. Paul, on reclaiming family time. Following my talk, many parents spoke up about feeling out of control of their kids’ schedules and helpless to restore a semblance of connected family life. Afterward, a middle-school principal confided in me, “We school leaders are part of this problem. We offer so many activities to kids that if parents agree to even half of them, they’re not going to have much of a family life left.”

This brief exchange both startled and energized me. It drove home the reality that overscheduling wasn’t just an individual family issue. In a hypercompetitive world where parenting has become a form of product development, family time is a public issue.

Listen for Stories
With my newfound insight into the public dimensions of this problem, I moved to the next essential task of the citizen-therapist: talking with people in the community about the issue. Whenever I expressed curiosity about hockey schedules and missed family dinners and traveling leagues and cutthroat competitive dance, I was flooded with stories from exhausted and discouraged parents. When I asked my clients about their daily schedules (a topic I’d previously avoided as “too superficial”), they told me at length about their harried lives.

I learned to start conversations with parents in my community by passing on stories from previous conversations, which elicited vigorous nods and even more outrageous stories to pass on–like the 4-year-olds who practiced hockey at 5:00 a.m. on nursery-school days (true story). Whenever I got myself invited to speak to PTA groups and church forums, I asked for more stories, while also inviting attendees to reflect together on what’s happened in our culture to bring this craziness upon us. Virtually every parent I talked to was eager to engage with this as a public issue, not just a private, family problem.

Make Your Pitch
A few months later, Barbara Carlson, the organizer of the Wayzata parent conference, invited me back to give the same talk. That phone call changed my career as a therapist forever. I decided on the spot to make my pitch for a community-action project: “I don’t want to repeat the same talk,” I replied. “But if you want to take action on this problem as a community, I’ve been learning a way to do this, and I’d be willing to come back and work with you to figure out how to tackle this problem.” A longstanding local leader, Barbara immediately agreed and sponsored me into the community. During the next year, we pulled together a dozen or so parent leaders to start a new community organization, Putting Family First, the nation’s first grassroots initiative to reclaim family time and restore balance to the lives of overscheduled kids.

A caveat: don’t waste your time, or the community’s, by trying to focus on an issue that’s not already on people’s radar screens.

I personally think that television is a bane on family life, but I’ve noticed that only about 30 parents turn out for talks on this subject by nationally known speakers. By contrast, hundreds of parents show up to discuss such topics as overscheduled kids, child safety, and alcohol and drug use.

There’s an old saw about becoming a leader: find a parade and get at the head of it.  And I have an addendum for partnering with communities: if you get too far ahead of the pack, they’ll turn a corner without you.

Link the Personal to the Communal
It’s relatively easy to get people talking about problems that bedevil their own families; it’s a bigger challenge to help them connect their own stories to the community’s story and to the work that lies ahead.

At a town meeting in Wayzata for the launching of the Putting Family First project, I decided to address this challenge head-on. To the 80-some parents, school-board members, and community officials present, I put four questions: “Is this problem we’re talking about here–overscheduled kids and underconnected families–only an individual family problem or is it also a community problem? Are the solutions only individual family solutions, or are they also community solutions? Do you think this community is ready to take action? And what actions should we take?”

The group was charged up, shouting out answers to the first three questions: “Yes, it’s a community problem! Yes, the solutions must come at the community level as well as the family level! Yes, we’re ready to take action!” In small groups, the noise level grew intense as people discussed the final question about how to address the problem. When the whole group reassembled, hands flew in the air as people vied to speak. Parents said they were fed up with the rat race and were thrilled that we were finally going to do something about it. One mother stood up and said: “I could use something like a Good House-keeping Seal of Approval for organizations I’m signing my kids up with. Something that would show me that this organization will work with me in my efforts to have a balanced family life.”

The Putting Family First
A leadership group came into being that night. A dozen parents, representing a wide swath of the community, went on to develop a Putting Family First Seal of Approval for local organizations that offer activities for kids, and a Consumer’s Guide to Kids’ Activities, a handbook that rates all the community and school sports programs on the family friendliness of their schedules. The key to launching this initiative was the public event that captured the energy of the community and got them working creatively together.

Use Your Clinical Skills
During the night of the public launch of Putting Family First, I also learned how to combine my skills as a therapist with my new role in a public forum. When the discussion veered toward bashing coaches and community leaders, I interrupted with the speed of a family therapist witnessing a session heading south. “I don’t think anybody is setting out to hurt kids,” I said, “and I know that there are a lot of competitive pressures on coaches and parents alike. In my view, we’re all part of this problem, and we can all be part of the solution.” This made sense to most parents and became a mantra for the Putting Family First initiative: no villains.

Another key moment for a quick intervention came when two parents uttered classic energy deflators in a public meeting. A woman sitting in the front declared self-righteously, “This is all well and good, but we’re preaching to the choir. It’s the parents who aren’t here who are the problem.” Then somebody added, “There should have been three times as many people here tonight.” As I watched heads nodding, my heart sank momentarily.

But as a family therapist, I’m used to working with families in which somebody in the room gets anxious and tries to pull the plug on a moment of courage or connection. I responded, “I think it was Margaret Mead who said that it only takes a small group of committed people to change the world, and, indeed, that it’s never been changed in any other way.” After letting this sink in, I piggybacked on the language of the first speaker. “Every social movement begins with a choir,” I said. “And we have a lot of people already in this choir.” I saw people sit up straighter in their chairs and I could feel the energy flowing back into the room. Then I brought it home: “If only 12 people had shown up here with the passion and energy I see in this room, I’d have been happy.”

Later, I’d teach local parent leaders in Putting Family First and other projects how to anticipate deflating lines in public gatherings and how to counteract them. Part of my job as a citizen-therapist is to help other citizens learn public skills.

Identify and “Grow” Community Leaders
Genuine community leaders are originals, grounded in their own families and communities. They’re neither cowed by professionals nor competitive with them. One such leader in the Putting Family First initiative was Bugs Peterschmidt (yes, that’s her name). I remember the morning she showed up at the first meeting of that group. As she sat across the meeting table wearing her cake-decorating uniform before heading to work at a local bakery, I found myself writing down everything she said. She recounted lessons from her PTA presidency at an elementary school where 150 people came to meetings–at a time when most PTAs had trouble attracting 15. She recalled that, prior to each meeting, fathers wearing chef’s hats and aprons with the words “Big Guys of Birchview School” prepared a meal–no mothers were allowed to help–and teens wearing large buttons with the words “Teens Who Must Be Obeyed” served it. After the community meal, teens did childcare while the parents held their meeting. Bugs’s motto: “If people don’t have fun, they won’t stay involved.”

The most effective leaders for community initiatives tend to be those whose own lives are transformed by their involvement. Bugs Peterschmidt’s family had been poster children for overscheduled living. As a result of getting involved in Putting Family First, the Peterschmidts cut back on their kids’ sports schedules, and the father changed his work hours to be home for dinner every night. He also turned down a promotion that would have required frequent travel. The family now takes summer sabbaticals from all optional organized activities, and Bugs sits down each June with her two children to brainstorm fun things to do during the summer. The most recent list featured more than 100 items, including learning to bake chocolate-chip cookies and hiking in the local nature preserve.

It’s a two-way street with grassroots leaders: they teach us how to galvanize a community while we, in turn, can help them find their voices. I was able to validate Bugs as a spokesperson for Putting Family First in the larger community and with the media. She knew that I saw her as a gifted communicator, something she never would have claimed for herself.

In community projects, part of the intervention is finding these exemplars and spreading their stories of hope and change. Cultural change in a community sometimes snowballs almost invisibly from there, with occasional public markers. For instance, the Wayzata community created  new, less intense scheduling options for the local basketball league and kids’ dance program. They circulated a flier with the headline: “Remember when you were in sports JUST FOR THE FUN OF IT?”

Unleash Community Wisdom
Once Putting Family First was launched, I decided to test my wings with citizen work in a second arena–chronic medical illness. This may seem far removed from a problem like overscheduled kids, but the connection for me was the potential to access the biggest untapped resource for social and personal change: the wisdom and experience of community citizens.

I began by approaching a local HMO, offering my services for free. I then pulled together a group of medical and nursing professionals in a mixed-ethnic clinic in St. Paul who were willing to experiment with a communal approach to diabetes care.

At the public-launch event in the clinic, I asked all 60 people present to introduce themselves and say how long they’d been connected to diabetes. A man stood up and said he’d lived with diabetes for 35 years. Next to him was a woman who announced that she’d been diagnosed just the week before. “I know nothing about diabetes,” she said, “and I’m scared to death.” Seeing these two people in my line of vision, I said, “I think it’s a terrible thing about our healthcare system that this woman could sit next to this man in a clinic waiting room with no way to learn from his vast experience with diabetes.” I saw some heads bobbing. “In this project,” I went on, “our aim is to change that, so that what people learn from hard experience isn’t lost in the ozone, but passed on.”

After the public event, we launched Partners in Diabetes, an initiative through which people living with diabetes reach out as “support partners” to others who are newly diagnosed or struggling with the disease.

The support partners aren’t traditional volunteers who take their orders from health professionals, but full-fledged cocreators of the project. One of the original leaders and support partners, a burly truck driver named Joe, was paired with Marie, a soft-spoken, middle-aged woman newly diagnosed with diabetes, who couldn’t give herself insulin injections because she was terrified of needles. The health-care professionals had instructed her over and over, but she still couldn’t bring herself to give herself the injections, and she was deteriorating both medically and emotionally. But Joe could relate: he, too, had once been afraid to inject himself. After a couple of phone conversations, he offered to meet Marie at a local Wendy’s and show her how to give injections. She arrived with her injection kit and Joe showed her how to give him an injection. That’s all it took. As she started managing her own insulin, Joe went on to work with others who needed his support.

In Uncharted Waters, Bring a Guide
Six years into this work, I feel ready to undertake a citizen project in a community quite foreign to me–the Hmong community, a Southeast Asian immigrant group. My colleagues and I have begun conversations about developing a community-outreach project on depression in the large Hmong community in St. Paul. As always, sponsorship into the community by a knowledgeable leader is crucial–and particularly so when you’re an outsider. One of my colleagues, Tai Mendenhall, a therapist at a clinic that serves Hmong people, has strong ties with an existing Hmong men’s-depression support group and with Mai Lee Vang, a nurse and interpreter who’s well connected in the community. We went in with the assumption that the individuals we recruited to be codevelopers of the initiative would have to be at least six months past their own “depressive episode.” Otherwise, we figured, they’d still be at risk themselves and wouldn’t have enough to offer the community.

At our first meeting with Mai Lee, she politely told us that this assumption was bogus. She pointed out that most people in her community move in and out of depression over many years. Some have mastered it–that is, they’ve learned to live well with depression, even though they still have symptoms. I realized that though I’d spent my career trying to overcome most toxic aspects of the Western medical model, this particular virus–an acceptance of the artificial split between health and disease–was still flourishing in me.

As we go forward on this project, I expect to learn even more than I teach. (That’s my consistent experience as a citizen-therapist.) Here’s what I’ve learned thus far: in this Southeast Asian immigrant community, depression rates among adults are running over 60 percent. This isn’t a neurotransmitter-deficit contagion that broke out on the boat ride over; it’s both a community in crisis and a crisis of community among a people who moved from the premodern world to the postmodern world within a couple of decades. Yet the traditional mental health response is to throw more drugs and therapists into the breach.

Based on experience with a group of Hmong men who are already collectively fighting depression by supporting one another and creating a community garden, we’re planning a community-outreach project in which Hmong people will reach out to others who are struggling with depression, drawing people into the community at a time when they tend to dangerously isolate themselves. As with all of our projects, every aspect will be democratically constructed by community members and a team of professionals.

Staying the Course
It should be obvious by now that citizen-therapist work isn’t for the impatient. In my experience, finding an issue and a community ready to act can require a gestational period of nine months or more, with unexpected twists and turns along with way. Sometimes, you end up with a different issue than the one that initially drew you in, because a community you care about asks for your help on it. Sometimes, you end up not engaging with a promising community at all, because local leaders pull the plug or don’t follow through. You have to be willing to walk away when the environment isn’t welcoming. While it’s disappointing to be turned away, it’s not immobilizing if your mission is bigger than a single issue or a single community. Other opportunities will emerge.

But who has time and energy for this work? In my experience, you’ll need to invest a little bit of time over many months, more like a sustainable jog than a sprint. For most of my projects, I put in four to six hours per month, with occasional periods of greater effort and stretches of inactivity during holiday and vacation seasons.  I don’t overfunction by doing more than members of the community have time to do. The projects tend to be active for at least two years, and some of them become permanent. For the most part, we don’t start out on anyone’s budget or strategic plan, which means that the deadlines are self-imposed and flexible.

I reduce my active involvement in projects when they begin to ripen and local citizens become ready to lead. Still, community work does require an investment of time and focused attention. I’d encourage you to drop another outside activity–perhaps the nonprofit board you sit on or the professional-development committee you chair–if you want to avoid overscheduling yourself.

Making a Difference
Sometimes, you hit the jackpot and create ripples far beyond your community. Putting Family First has helped to start the national conversation on overscheduled kids by giving a name to the problem and developing a media plan to stimulate a cultural conversation. It began with a New York Times story in June 2000 (a Times editor had a kid in traveling soccer), and the media attention hasn’t let up since.

By now parents in the Putting Family First leadership group have been interviewed on nearly every national and local media outlet, with many hundreds of interviews in total. (Bugs Peterschmidt and her family have been interviewed so many times that her kids have asked to not have TV cameras taping their family dinners anymore.) Four years ago, the newspaper and television stories emphasized that a local grassroots parent movement was raising a warning flag about a problem in our midst, and taking local action on it.

Now journalists begin by saying, “As we all know, today’s kids are overscheduled” and then focus on what can be done about it. Activity-free nights and family-dinner campaigns have sprung up across the country.

Two Minnesota communities, supported by citizen therapists, are now seeking a thousand families to pledge to do something radical: have at least five dinners together each week.  The citizen-led Putting Family First project is making a difference in the culture.

But I’ve found that whether or not a particular project ripples outward from the local community, citizen-therapist work can reward you–and stretch you–in ways you may not expect. Part of the reward, of course, is the simple satisfaction of acting as a catalyst for meaningful community change. Being useful feels good, but there’s more to it than that. This work requires an identity shift on the part of therapists: you’re no longer the designated expert helper, riding in on your therapeutic white horse to direct change and growth; instead, you’re more like the first member of a tag team, doing your part and then standing aside as others run for the finish line.

The whole point of citizen-therapist work is to become gradually expendable, to begin to recede to the sidelines as community members grow in expertise and confidence. I think of Joe and Marie; I think of Bugs and her family; I think of the people I’m getting to know in the Hmong community, and I marvel at how much we human beings have to offer one another. I’m witnessing in action the extraordinary resources of ordinary people to help and support each other toward healthy, creative changes in their lives. And I marvel at how, given half a chance, a community can begin to heal itself.

William Doherty

William Doherty, PhD, is professor of family social science and director of the Minnesota Couples on the Brink Project at the University of Minnesota. He’s the author of the forthcoming book, The Ethical Lives of Clients: Transcending Self-Interest in Psychotherapy