The Origins of a Paradigm Shift: From "What's wrong with you?" to "What happened to you?"

joseph_foderaro

Pictured: Joe Foderaro, LCSW, BCD, program director and co-founder of The Sanctuary Programs from 1980-2001. 

 

 

From Sandra Bloom, M.D., The Sanctuary Model:

We (the treatment team for Sanctuary) were in a team meeting sometime around 1991 on our inpatient unit, trying to describe the change that had happened to us in recognizing and responding to the issue of trauma, especially what has become known now as childhood adversity - as a causal issue for the problems of most of the people we were treating and Joe Foderaro, LCSW, always good at pithy observations, said "it's that we have changed our fundamental question from "what's wrong with you" to "what happened to you" and we all thought it exactly captured our experience.

I think I first wrote it down in a chapter published in 1994 that was the first time I tried to articulate the enormous change that had happened to us. That citation is page 476 of Bloom, S. L. (1994). The Sanctuary Model: Developing Generic Inpatient Programs for the Treatment of Psychological Trauma. Handbook of Post-Traumatic Therapy, A Practical Guide to Intervention, Treatment, and Research. M. B. Williams and J. F. Sommer, Greenwood Publishing: 474-491.

From Ann Jennings, PhD, executive director of The Anna Institute:

I believe the source for this now widely used way of describing the paradigm shift that needs to happen in the mental health and other fields – is one of Dr. Sandy Bloom’s colleagues – Joe Foderaro.  He said this around 30 years ago!

In Dr. Bloom’s book “Creating Sanctuary: Toward An Evolution Of Sane Societies” published in 1997,  this is referred to on page 191 as follows: “Our program director (Joe Federaro) said it best when he observed that we (the Sanctuary program) had stopped asking the fundamental question “What’s wrong with you?’ and changed it to “What has happened to you?” (Foderaro, 1989). 

In a recent keynote recorded March 2014 at the 2014 Jefferson Population Health Colloquium entitled “The Heart of Trauma Theory: Sickness vs Injury Model: Changing the Fundamental Question From “What’s Wrong with You” to “What Happened to You” - Dr. Bloom talked of being in a team meeting of a psych unit in 1985 when one of her colleagues said, “you know, we really need to change our fundamental question from what’s wrong with you – to what happened to you” and then spoke of how understanding what happened changed the way they thought, which changed everything.  Link to her talk is https://www.youtube.com/watch?v=X9zEb1YCprg – its worth listening to!

In the attached article by Bloom dated 1995, in reference #14 to (on page 9) “we really need to change our fundamental question from what’s wrong with you – to what happened to you”, she says “Thanks to Joseph Foderaro for this succinct way of explaining a profound interactional shift”.

Attachments

Photos (1)
Files (1)

Add Comment

Comments (6)

Newest · Oldest · Popular

In 1980, I worked on the only "Patient-Governed" Ward, at New Hampshire [state] Hospital. We didn't have a "Psychiatrist" assigned to our ward. We had a National Health Service Corps "Family Physician". We also had a [Black Lab] Puppy, "on the ward" [during the day shift]-with his own "treatment plan" posted on the wall-above the newspapers he was being "paper-trained" to use. "Mammalian Attachment" was not a term I remember the team discussing, back then...but it all makes sense now. Many "patients" seemed to delight in interacting with the puppy. We didn't even have a "restraint bed" on that ward. I remember one "patient" who was permitted to have knitting needles and yarn-while on "suicide watch" with a staff person attending [one-on-one] her. When we learned of her father's incestuous relationship with her, during her childhood, his visits with her began to be "monitored". The Family Physician had "written an order" to that effect, in her chart. We were also making a hospital wide transition to using NAPI (Non-Abusive Physical Intervention-developed by Kurk Lalemond of Lewiston, Maine, and in use in [state] hospitals in Georgia, N.H., and Maine, and possibly elsewhere). The Neurology Unit at that hospital had some Psychologists doing "Neuro-feedback" at least two years earlier. I don't know if any of this was ever chronicled or published in a professional or scholarly journal. 

And here's Sandy Bloom's clarification:

Hi everyone, 

Thanks for asking and for the accurate responses! I can be a little more exact:  We (the treatment team for Sanctuary) were in a team meeting sometime around 1991 on our inpatient unit, trying to describe the change that had happened to us in recognizing and responding to the issue of trauma, especially what has become known now as childhood adversity - as a causal issue for the problems of most of the people we were treating and Joe Foderaro, LCSW, always good at pithy observations, said "it's that we have changed our fundamental question from "what's wrong with you" to "what happened to you" and we all thought it exactly captured our experience. I think I first wrote it down in a chapter published in 1994 that was the first time I tried to articulate the enormous change that had happened to us That citation is page 476 of Bloom, S. L. (1994). The Sanctuary Model: Developing Generic Inpatient Programs for the Treatment of Psychological Trauma. Handbook of Post-Traumatic Therapy, A Practical Guide to Intervention, Treatment, and Research. M. B. Williams and J. F. Sommer, Greenwood Publishing: 474-491.

Hope everyone has a safe and relaxing holiday weekend,

Sandy Bloom

Thanks Alicia,

I enjoyed listening to Dr. Bloom speak. I have worked in so many traumatizing medical settings from medical school to small rural community hospitals. Gosh it would be so wonderful if her work could be brought to medical and all organizational settings. It is bad enough to have experienced severe trauma as a child but then to never really be allowed to heal by working in terribly retraumatizing environments can be almost impossible but today I have decided to longer blame myself or feel as if I am somehow at fault for these massive systems failures.

Thank You
×
×
×
×