I'm really not trying to suck at this

I was very lucky with my second-year social work internship. The Center for Urban Community Services (CUCS) is an organization that helps house homeless individuals with a history of mental illness. Their Assertive Community Treatment (ACT) team supports formerly homeless individuals now living independently in the community. ACT teams provide psychiatric treatment and counseling as well as help with activities of daily living.

While an intern there, I went with clients to Section-8, the supermarket, and the bank; took them out for coffee or lunch; helped them pick out major purchases like a television set; and provided individual and group therapy. The team had never had an intern before, and they allowed me a great deal of independence in working with the clients.

By and large, my ideas were successful. For example, the team had a weekly substance abuse recovery support group, since most of the clients had a history of substance abuse as well as mental illness. When I attended the group, I noted that the clients who attended were mostly still using — I knew this from the daily team meetings, during which each client was discussed, if only briefly. They tended to go to group, enjoy the snacks, and then fall asleep as the facilitator and clients who had achieved sobriety discussed recovery.

Substance abuse treatment works best when it's tailored to the current needs of the client and their current state of mind. If someone is still drinking and smoking crack, it's pointless to discuss relapse prevention tips. They haven't stopped long enough to actually relapse. They need to develop the skills to stop using before they develop the skills to maintain abstinence — skill sets that overlap somewhat, but not entirely.

The theoretical model I was studying, and now practice, is known as the stages of change. It's a range of mindsets that people who are using and might want to stop cycle through:

1. Precontemplation: I don't need to change!

2. Contemplation: Okay, I might need to change, but I don't know how.

3. Preparation: This is what I'm going to do so I can make a positive change.

4. Action: I'm actively changing my behavior.

5. Maintenance: This is how I prevent relapse.

Clinical interventions at each stage are tailored to the client's mindset. In the precontemplation stage, when people are actively using and not interested in quitting, the best intervention is education. You need to provide the client with information about the impact of their substance use. A client who is HIV positive and smoking crack might not know that cocaine will lower her T cell count; if you present her with that information, it might nudge her closer to a decision to quit.

(My first exposure to crack use came when my supervisor and I paid a home visit to a client who had left a pipe out on his coffee table. Since he was going to undergo a Section-8 home inspection soon, we advised that he find another place for it. Precontemplation-level intervention: no attempt at persuasion, just a reminder of consequences.)

I suggested to the team that we start a different kind of group, what the stages of change model would call a persuasion group, for clients who hadn't stopped using yet. The team's substance abuse specialist and I developed a curriculum and selected clients that we thought would benefit from the group. We scheduled it for Monday morning at 10 a.m. and called it "The Breakfast Club" (forgive me, John Hughes), offering bagels, donuts, and coffee.

It's been more than eight years, and that group is still part of the treatment offered by the ACT team — and still run by students. I'm proud of that legacy. But not all of my ventures were this successful.

Mason was a dignified African-American gentleman, with a history of military service and a mane of white hair that reminded me of Frederick Douglass. He spent many years in the Fort Washington men's shelter, one of the city's grimmest.

"I used to crochet slippers for the other residents, $2 a pair," he said. "Gave me a little pocket money and it helped to pass the time."

I'm not a handy or crafty person; the thought of someone able to actually produce something wearable was intriguing. "How long would it take you to crochet a pair of slippers?" I asked.

"About three hours a pair, if I wasn't disturbed," he answered. Impressed, I remembered that Alicia, another ACT client, had spoken about crocheting during one of our individual sessions; using a manual from SAMHSA, we were working on anger management.

"We should get together and crochet sometime, like they used to do in the olden days, like quilting bees," I mused. "You could teach me how to crochet."

"You don't know how?" asked Mason.

"I never learned," I confessed. "I can knit a baby blanket, but that's about it."

After discussion with the team, I was given some petty cash. Consulting with Mason, I purchased several sizes of crochet hooks and hanks of yarn in a variety of colors. We scheduled a time, and several clients joined me in the large group room. I chose a needle and some yarn, and then Mason and Alicia attempted to teach me how to crochet.

To no avail.

Although I tried to follow their instructions, I ended up crocheting a stunted thumb. The clients at first politely tried to hide their laughter, but since I didn't restrain mine, they joined me.

"I really suck at this!" I proclaimed melodramatically. I wanted to "model" good-natured failure for the clients, a cognitive-behavioral therapy exercise in self-acceptance. Albert Ellis was a big fan of failure — deliberately allowing yourself to do something "unperfectly" so that you learn not to expect perfection from yourself at all times. I also wanted the clients to see that even though I was in graduate school and had never been homeless, there were still things they were better at than I was.

This was difficult for them to believe. "You're pretending you can't do this," Mason accused me good-naturedly.

"I'm really not trying to suck at this!" I said. "I suck without trying!" Eventually they believed me, and we settled down to a nice chat; they crocheted and I watched.

Crocheting reminded Mason of the shelter, and he reminisced. "When I was in the shelter, there was a Chinese restaurant nearby where you could get a little container of rice and gravy for $0.80. Sometimes that was all I wanted, just a little hot food. But you couldn't get anyone to give you $0.80 for something to eat. If you wanted to get high, though... anyone would give you money to help you get high."

Mason didn't need the persuasion group, I'm happy to report. He had decided to stop using before he became a client of the ACT team. But abstinence wasn't a requirement for participating in services. This is part of the "housing first" model — place people who are homeless in stable housing, and then work with them on achieving freedom from addiction.

The Crochet Circle met a few more times and petered out. It didn't become an ACT fixture. But it was a great opportunity to demonstrate that everyone has strengths and weaknesses.