INTERVIEW WITH JEANNE SONVILLE

Jeanne Sonville, a psychiatric nurse and counselor, is a founder and former Director of the Free Medical Clinic of Greater Cleveland. She is presently the 'Clinic Coordinator and Director of the Free Clinic's Drug Abuse and Mental Health Program. This is the last of a 3-part conversation with Jeanne.

What type of counseling caseload do you experience at the Free Clinic?

I see about 25-30 people a week. Some are young people referred to me from Safe Space Station [Free Clinic's Runaway Youth Program]. I see 12and 13-year-old drug abusers and counsel people on up to 65 or 70 years old. They are from every socioeconomic background, bottom to top.

I see more women than men. Many women are referred to me by other women. I do carry a caseload of male clients. I have 4 cases right now that are marital problems, so that includes 4 males.

When you do marital counseling, you counsel the couple?

I usually do if it's agreeable to the couple. I prefer to see one or the other first, then bring them in together. Sometimes they have things to say that they're not comfortable saying in front of their mate, or that they want to rehearse with me and put in the most diplomatic way to get the least amount of defensive answers from their mate. It seems to work out better that way.

Do the people you counsel come directly to the Free Clinic for counseling, or have they been in some other mental health system first?

Both. I'm the first counselor some people have sought. But most of the people I counsel have previously seen someone for mental health problems. Some have been through the mill, as far as psychiatrists and mental hospitals.

What's the range of problems that you see?

I see them from one end of the scale to the other-survival, drug abuse, sexuality, interpersonal, intra-psychic. They're just as varied as the people

are.

Do you see any more of one type of problem than another?

I probably see more depressed people than anything else. Sometimes drug abuse patients are really depressed people. You would think that people who are depressed would go for uppers, but instead most go for downers-it runs the gamut of central nervous system depressants. I've found that people who are depressed and can't deal with things are looking for drugs that will depress them even more, so they don't have to deal with things.

Very often, when counselors hear of people taking drugs, they say, I can't handle that, I don't know anything about drugs. I'm not so sure they have to know anything about drugs, except in certain instances where the patient needs some type of medication for de-toxing.

I haven't seen the person yet who was doing drugs when it wasn't symptomatic of something else. I immediately look beyond the drug taking and try to assess what the basic problem is. In my experience, if we start working on the initial problem and people get to feeling better about themselves, the drugtaking starts to abate, except with the very addictive drugs. People feel more like they can cope with their problems themselves and don't need all those "helping hands". Sometimes it takes a long time to get to that point.

Do you see heroin addiction as something special? No, except that it's a monetarily costly addiction. Supporting that addiction may mean forging subscriptions and checks, stealing and fencing. It

may be almost anything. In the case of women it becomes a double burden, because the road that's easiest and open for a woman to get the kind of money to support a heavy habit is prostitution. Then they not only feel badly about being an addict, but also about the prostitution. So that's another major step in helping them regain their self-esteem.

Where is the depression coming from in the depressed people you see?

Some of it's circumstantial-caused by what is going on in their life at the time. Some people are in crisis-type situations, such as a depression you would expect either from a dissolution of a relationship due to death, divorce or just separation. Others are in very long-standing depressions and have been chronically depressed most of their lives.

The easiest people to help are the ones whose depression is situational, or those people who are in crisis. Then there are some people who are almost always in crisis, and I have to question that. The crises become what I term a smokescreen, so they don't have to deal with the real issues. Maybe there's something going on in their personal lives that they don't want to admit even to themselves. For instance, one young girl I saw was in a crisis every time she came in. One day I just said, "You've been in here with enough crises that you know what steps you need to take." This smokescreen was put out there so we wouldn't deal with her sexuality, but we got to that during the counseling. This was someone who was doing all the "normal" things-she was engaged, she was in college. She was finally able to admit to herself that she was a lesbian and wanted a relationship with a woman. It took her a while to get comfortable with that. She's doing very well now.

by Gail Powers

there or not, they can deal with it. I believe people have control over their lives, and I try to get the people I counsel to recognize they can exercise that control. I try not to discharge a patient until they're comfortable with the idea. I think if they feel that the counseling agreement is terminated by mutual consent, it's really their decision; they do much better. I like people to be comfortable in their lives, and not only that—not to have to come back.

How do you schedule counseling?

I try to allow at least an hour per patient. For marital counseling I try to allow 2 to 3 hours depending on what kinds of interactions are going on. A lot of people I just see once a week. Now I have somebody I see every day, so it depends on what kind of support that person needs at that time. It varies with the person, the situation, and the problems involved.

You have a reputation as a "kick-ass" counselor, which is in contrast to your motherly demeanor. What do people mean by that?

I put a lot of energy into counseling, and I let people know right from the onset that I expect them to work, too. What does on in the counseling session is incidental. It's what they do between counseling.sessions that counts. I assign homework. Sometimes it's written, sometimes it's tasks to do, sometimes it's role-playing a situation with them and then expecting them to go out there and be able to re-create that role in a given situation. So, it's not just talking to Jeannie once a week and feeling good during the counseling session. In fact, some people feel rotten after seeing me, and I wonder if they're going to come back. Most of the time they do. I like people to feel good when they leave, but if it's necessary for them to feel uncomfortable about something, in my judgment, I let them feel that discomfort, and then I expect them to let me know how they worked out that discomfort.

Do you draw on certain techniques or schools of thought in your counseling?

I tend to draw more on personal living experiences and experiences with other people. I don't use any one particular modality, but I do draw on what I've read. Sometimes I use reality therapy, behavior modification, gestalt, transactional analysis, and hopefully tailor-make the modality to fit the person's needs at the time. If one thing doesn't work, we move on to the next. It varies with each individual I see. There are a lot of things that come with experience that you don't read out of the books. I believe each person I see in a counseling situation is unique and has to be treated as the individual they

are.

Do you ever consider anybody too “sick” for you to see? There have been several instances when I've felt

"I believe people have control over their lives, and I try to get the people I counsel to recognize they can exercise that control."

She kept coming for counseling, though? She must have wanted to maintain that contact.

Oh, yes. She kept coming. Sometimes it's hard to discharge someone. They panic at the thought of being discharged, because it can become a dependent type of relationship. I think all therapists have to guard against that.

How do you guard against that?

I try to be attuned to what's going on with that person, and when it seems as if they're becoming too independent, I start lengthening the distance between their appointments, or I'm not so readily available to them on the telephone. They learn that whether I'm

I've been over my head, and I've asked for a consult and co-counseling situation. I consult with Dr. Ardvaryu [Free Clinic staff psychiatrist), and he usually sits in for a few sessions. Usually these people do need medication prescribed. For instance, severe depression, severe anxiety, schizophrenia, might need the appropriate medication to take the fire out from underneath the boiling pot, so we're able to see what's in the pot. In some instances, people see Dr. A one time, me the next, and so on. Then we check back and forth.

Do you and Dr. Ardvaryu usually agree on diagnoses?

(continued on page 12)

January, 1979/What She Wants/Page 7