As young faculty members at Columbia we recall our Chairman asking us to develop a clinical program for patients who had failed to respond to treatment. With an equal amount of excitement and trepidation, we launched the Columbia University Day Treatment Program in Midtown Manhattan.
We learned the importance of connecting with our patients’ panic and despair, their frustration and demoralization. Their pain was beyond the imagination of anyone who has never experienced mental health symptoms. Their clinging to self-defeating behaviors such as substance use had to be recognized not as acting out, rather as last ditch efforts to survive. Only when patients felt that we understood them did they share their secrets and open the door to collaboration.
Once a bond was established patients shared details of their downward spiral. Many viewed themselves as disabled or ill. It was imperative to break their mindset of negativity so they could rediscover their values and formulate their vision for the future. As the great New York Yankee Yogi Berra said, “If you don’t know where you are going you might not get there.”
Demoralized patients often place blame for their problems outside themselves. They could blame their illness or others who had let them down. It was essential to persuade them to stop allowing their past to define who they are. It was pivotal when patients put aside their grievances and assumed full personal responsibility for their lives. That accelerated their progress and made it possible for them to regain their voice and their confidence.
We realized that more important than the type of therapy provided were our therapists’ personal attributes: in particular integrity, humility, and creativity. We learned also to value diverse life experiences. To find these special therapists, in addition to reviewing carefully credentials, we increased the number of screening interviews as well as our focus on assessing their prior work with patients.
Patients usually faced multiple problems. So, we assembled a close-knit team of experts in refractory Depression and Anxiety Disorders as well as the co-occurring conditions that complicated treatment, for example ADHD, substance use and eating disorders.
We needed experienced psychiatrists who were familiar with the latest research and knew the risks of new treatments. We developed relationships with companies that provided services that our patients often requested, such as tutoring or legal assistance.
Without outcome data we were operating in the dark, so we relied on measures not only of symptoms but also social and work functioning. Over the years we worked with more than 3,500 patients. Of patients who completed our program 90% said they were improved. Over 80% reported maintaining their gains two of more years later.
As the Day Program’s reputation grew, we got referrals from all over the country. By 2013 we had moved twice to larger spaces and were running over 100 therapy groups a week. We shared our treatment model with other professionals interested in starting similar programs.
Rappore brings together colleagues and friends from Columbia and other leading institutions – providing a bridge to our past and to our future. A company is as good as its people, and our highest priority is to assemble the finest therapists and psychiatrists.
Our clinicians are able to devote more time to each patient because they have more administrative support and are assigned fewer patients. They are stimulated intellectually because we provide extraordinary opportunities for professional growth including consultation with the most sought after supervisors. They are challenged to test their limits because we give the opportunities to lead.
Even with our experience we don’t have all the answers. But we know where to look for clues – within you. Even with our expertise we can’t promise “rapid improvement” or “therapy made simple”, because depression and anxiety are formidable foes and at times difficult to treat. But when you have the courage to seek help and if you place faith in us, we fiercely commit to serving you.
Some say it is impossible to build a health care company when the primary criteria for every decision is what is best for patients. For us, it is impossible only until it becomes a reality.