The 4C Inspiration
When I was a recent graduate from Smith College School for Social Work in 2005, I was focused on my future as a clinician. I took some early roles in inpatient psychiatric hospitals, and doing homeless outreach, then joined as an Intensive Case Management Therapist at a community mental health clinic in the worst neighborhood of San Francisco. (You may have read this story in Tom Insel’s book, Healing.)
We often saw patients not coming in for appointments. These were individuals with chronic, severe mental illness, heavy substance use, and marginal housing. As a care system, we labeled them “treatment resistant”. I said, “Maybe they don’t like what we’re offering.” I mean, after all, these are illnesses that tell people they don’t have an illness, so why would they come to a psychiatry appointment?
I got some knitting yarn and knitting needles donated. I didn’t know how to knit. I started a knitting circle in the basement of the clinic. And sure enough, women from the neighborhood who were not going to appointments, started coming to knitting. In that scenario, I was not a therapist, I was not an expert…I didn’t even know how to knit! We sat there, shoulder to shoulder, week after week, and together, we learned how to knit.
Eventually, a new group came in and the first group taught the second group to knit, there was peer support happening, they started going to appointments, some got on medications for the first time. They started selling their wares at the local farmer’s market, began making money. They gained a sense of connection, a sense of purpose. Their lives were transformed. It wasn’t the CBT or the psychodynamic therapy we were offering in the small treatment rooms on the top floor, it was the knitting in the basement.
I left clinical work after that.
I believe we have the model all wrong. Therapy: once a week, an hour a week, as scheduled when convenient for a therapist. This doesn’t make sense. This leaves 167 hours per week when someone has no support. It doesn’t take into account that motivation is fleeting, and it can actually be dis-empowering. Therapy is important. It serves a role, 100%. But, it is not sufficient in and of itself. And, as demand grows, and workforce shortages cripple communities, it will not be the solution that will allow us to provide access, move upstream, and help prevent mental health crises.
10 years ago, I began thinking about the role of technology to bring virtual knitting circles (and CBT classes, and social support, and mindfulness) to everyone, everywhere. To me, the power of community for mental health lies in infusing downtrodden individuals with a sense of purpose, belonging, and connection. This is a mutually healing, scalable, affordable, and effective treatment intervention.
4C is all about this. We are reaching individuals from all over the globe, embracing them in the warmth of compassion, empowerment, education, and social connection. Lives are being transformed here. Truly.
