Cutting the Healing

The emotional triage performed by therapists for the severely disabled is being eliminated by budget cutbacks

The law's impact is also being strongly felt at the United Cerebral Palsy Group Home Number Four in west Davie. For nine months Savits has been visiting this home every Friday afternoon for a joint counseling session with a group of residents who are too badly disabled to visit her office.

Here one finds none of McClain's stoicism. Indeed, when they first learned of Savits' predicament, they hit their computers and started churning out letters.

"Dear Rep. Eggelton," wrote 34-year-old Yung Beckwith, in a typical letter. "I hear that Medicaid will be cut again. This time they are cutting our psychotherapy. Imagine what it would be like when you don't have a professional to talk to, especially when psychotropic meds are prescribed without therapy. I can't do it alone. I feel like somebody cut my leg in half. I don't want to go back to a psychiatric hospital, which might happen if money for therapy is cut. I hope you understand what I say."

The lack of understanding is the big problem for people with cerebral palsy, for many of whom the ability to communicate is so limited that they end up not communicating at all.

"The inability to express feelings is one of the biggest problems I see on a regular basis," says Savits. Often this is manifested in the form of unexpressed grief. "When you've been raised by overprotective parents, as many of the parents of my clients understandably were, the loss of mom and dad becomes the loss of self, the end of the belief in self, the loss of coping skills.

"One of the big things that must be expressed in these situations is anger -- anger toward parents for not preparing their children for the parents' own deaths. Just look at David (McClain). His parents died and left him with just the clothes on his back. This leads to a tremendous polarization -- on the one hand, there's love and grief, on the other hand there's anger. Remember when David said he feels kind of stuck? This is what he means. He's got all these different feelings, and they haven't come out. He's disassociated from them, and he needs to work them out and come to terms with them. Technically, it's called a dissociative disorder."

The loneliness is exacerbated by the fear of being alone. McClain, for example, is trying to succeed outside of a group home for the first time in his life. So is Donna Iavarone, who had never lived away from her parents before their deaths three years ago. "Donna never shed a tear after her parents died. She was afraid she'd break. It took a couple months, but the dam finally broke. Now we're in the process of planning a memorial service for her parents."

Another common set of symptoms she sees is related to the stress of losing friends and relatives -- symptoms that can hide unseen for years before erupting. People who live in group homes tend to make friends with the people who work in their institutions. But workers don't stay in these low-paying jobs for long. One friend after another comes into the resident's life and then abruptly leaves. When you combine this process with the inevitable deaths of close relatives, "life becomes just one loss after another," Savits says. "How many losses can a person take in life without breaking down?"

By far, though, Savits sees helping clients understand, accept, and deal with their sexuality as her biggest challenge. "By and large most of my clients were raised as asexual beings by overprotective parents. So now they're adults, and they have sexual feelings, and they don't know what to do with them. That's typically one of the first subjects they want to talk about."

Robert Salcedo knows how difficult such acceptance can be for someone whose life is marked by repeated sexual and romantic frustration. During Salcedo's most recent counseling session, the theme of sex and frustration dominated the hour.

"When I was growing up, nobody ever said the word 'penis' to me," says the 58-year-old South Florida native. He raises his finger to his lips. "SHHHH! Don't talk like that! But it needs to be brought out of the gutter. I don't think it's healthy to experiment in a dark room. Part of me is an adult, but part of me is underdeveloped. I don't mean the biological part. I mean my feelings."

Except for an occasional question, Savits says little as Salcedo talks about his sexuality. The point isn't so much to provide answers, but to act as a sounding board and to help him understand the context of his feelings. "These are questions that don't really have solid answers," she tells him at one point.

How does Savits help clients deal with such problems? "There's no secret. There's no special method or anything." She emphasizes role-play, the reliving of important experiences, and the expression of emotions. In addition she prefers a humanistic approach "that looks at the whole person: their past, their present, their future, their role in the community -- everything."

She also tries to be flexible in her approach, and one technique she has found effective at times is the "prescription of the symptom." For example, one client had a tendency to get spastic and very loud whenever a question made him anxious. "So I told him, 'Today during our session, I want you to shout and move around.' Like that, he quieted right down."

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