Occupational Therapy

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Seven years ago, Tom Hameline, a family therapist and vice president of HELP USA, New York City’s largest nonprofit provider of transitional housing and services for homeless families, approached a psychologist named Peter Fraenkel and asked him for help with a problem of his own. Welfare rules required residents in his housing to get jobs. Yet most of them weren’t interested in cooperating with job counselors.

It was clear people wanted to work. When Hamelin talked to shelter residents, he says, “they’d sound like a meeting of the Republican Chamber of Commerce.” Still, for every 15 residents his staff approached, only four or five would agree to see a job adviser.

The residents had lots to gain from participating. The counselors encouraged clients to hold out for positions that paid $8 or $9 an hour rather than minimum wage, because higher rates, research showed, increase the chance people will stay at a job. And the counselors had experience finding employers willing to take a chance on homeless people. About 7 out of 10 residents who worked with a counselor found jobs. At the end of six months, some two-thirds were still employed–a very decent track record for a welfare-to-work program.

But Hameline couldn’t stop thinking about everyone else: the people who never got jobs, those who left quickly, and the majority his staff couldn’t convince to see a counselor in the first place. He wanted more. “How can we get people more engaged in planning for their work futures while they’re still in the shelters?” he asked.

Coaxing residents to cooperate wasn’t a new challenge for Hameline. People in shelters have experienced extraordinarily high rates of trauma, such as experiences of childhood violence, sexual abuse, family violence and dissolution, and drug and alcohol addiction. But even when homelessness is only a bad moment in an otherwise functional existence, “many people are overwhelmed by the experience,” explains Hameline. “They feel their primary focus has to be looking for housing and taking care of their children, and they will think about work only after they get out of the shelter system.”

He thought another critical obstacle was lack of trust. Shelter residents often have had “so many negative experiences with helping agencies, they think, ‘It’s better if we hadn’t met.'” Hameline hoped Fraenkel, a former colleague of his from the Ackerman Institute for Family Therapy who is now a City College psychology professor, could develop a program that would rebuild residents’ trust–and help them find, and keep, jobs.


When the nation took the plunge eight years ago into welfare reform, there was scant information about what approaches were most effective in getting recipients into the workforce. For the most part, programs focused on immediately placing participants in jobs. The idea was that a job, any job, was the best way to start people on the road to steady employment. “Job readiness” emphasized quick-and-dirty attitude adjustment–teaching participants to comb their hair, stand up straight and speak with confidence.

With 33 offices in 21 cities, STRIVE (Support and Training Result in Valuable Employees) is a vivid example of hardcore job prep.

At 10:30 a.m. in East Harlem, the eyes of 40-odd people in the room are on social worker Rob Carmona, and their ears on his steely voice. An ex-heroin addict and ex-con, Carmona started STRIVE in 1984 in the basement of a housing project.

Everyone had better learn to smile, Carmona tells the group. The game-face plays well above 125th Street, but as far as your potential boss is concerned, it just seems like a threat. “If you look like the guy who used to beat me up and take my lunch, I’m not going to hire you,” he instructs.

Carmona seems to dare anyone to defy him, and he’s only been talking a few minutes when one woman does. He has asked people to state their age, and when the woman refuses–it’s personal–he won’t let it slide. “Personal information is who you’re having an affair with,” he retorts. She gathers her belongings and leaves. A few minutes later, Carmona loses another one, a young man who says all this talk about changing your attitude is wasting his time.

Unfazed, Carmona tells the room about his brother–a chaplain in the same prison system where Carmona was incarcerated–to show that ultimately, it wasn’t his mother, neighborhood, friends or a racist society that landed him in jail, but the choices he made. His toughness is love, he tells the group. Love is not the ego stroking you’re going to get when you go back to your block and your friends tell you, “You don’t have to listen to that chump.”

There’s something inspiring about Carmona’s passion. But the two counselors who follow lack his charisma. One barks that the men in the room should take their earrings out. The message is clear: You’d better shape up because the way you are now, nobody’s going to want you.

Just a couple of miles away, a different experience is unfolding. Homeless and jobless men and women, all residents at a HELP USA shelter in the South Bronx, gather in groups of seven or eight to talk about their dreams for the future. This is Peter Fraenkel’s program, Fresh Start. The atmosphere is relaxed and convivial. Fraenkel is protective of his clients’ privacy but is willing to share a video of one of the sessions.

One young woman tells the group she would like to aid other people facing hard times. Recently she was watching late-night television when an infomercial for a charity came on. It featured a woman in Appalachia and her three children. They lived in a shack and used a ditch for a bathroom. The Fresh Start woman cries as she recalls the scene. She says it’s wrong that in this country of plenty, the government doesn’t do more to help people. Then, still tearful, she tells the group how much she wants to be like her mom–a person she has conflicts with–who started out as an activist and now works in a literacy program. It seems the young woman is crying for many reasons, including that she hasn’t yet proven herself to be as worthy as her own mother.

Moved by what’s just been said, a heavyset blond woman talks about how she wants to be a lawyer who provides legal services for the homeless. Her partner adds that he would like to do Big Brother work with children. Both say that in addition to raising their baby, they’d like to take in foster children when they get on their feet: “to do right by someone else’s child,” the woman says. Some participants seem at a loss to define their dreams. But others light up. A young man with little braids and a button-down shirt, who is trying hard to get a job as a janitor and just landed an interview, glows shyly as he outlines a plan to eventually open his own maintenance business. It’s interesting to problem-solve, he says, and he’s good at fixing things.

The group’s homework for the following week is to think about what advice they might offer their fellow group members. They themselves will be the helpers–not the group facilitator or any other experts in poverty, homelessness or job searches.


Fraenkel says he’s not sure why people are poor, or what to do to assist them. “Me? I’m a white, middle-class guy,” he says. “How the hell would I know what’s going on in their lives?”

The Ackerman Institute, where Fraenkel and Hamelin were trained, is a cutting-edge marriage and family counseling center on Manhattan’s Upper East Side. Both psychologists share a progressive vision that people should be partners in the programs that serve them instead of simply recipients of help.

Fraenkel hopes helping Fresh Start participants define their dreams will motivate them when they’re struggling in the job market. He believes, too, that helping people create communities–even ones that exist only for the months people live in a homeless shelter–can provide critical support to help them stay employed and reach other goals.

He also hopes that from the recordings he makes of the sessions he’ll be able to cull quotes and stories. His aim is to show policy makers that homeless people can benefit from the seemingly fuzzy stuff of group therapy: introspection, peer assistance, having a chance to fantasize about their futures.

Fraenkel and his City College psychology students run this nine-week, nine-session program three to four times a year in a family shelter and in a domestic violence shelter in New York City. Residents frequently spend many months in these places while they wait for a permanent home.

Fresh Start isn’t elaborate. Participants meet once a week over dinner. They discuss work experiences they’re proud of. They write letters to their future selves, and design an arts-and-crafts mask to illustrate the face they present to the world to hide their vulnerabilities. Because participants will likely face long bouts of unemployment, facilitators believe that encouraging them to set long-term goals is particularly important. Having dreams, they maintain, will help them through the hard times. So will knowing how to build a support network.

The psychologists also do intensive interviews with each participant before the workshop because, Frankel believes, if people feel listened to, they’ll be more likely to participate. In the first year of the program, four out of five people selected at random to be interviewed agreed to participate in Fresh Start and a roughly equal proportion of participants actually began working with a job counselor. Even accounting for the initial self-selection of participants, those numbers were far higher than for shelter residents who didn’t have an interview or enter Fresh Start.

Fraenkel doesn’t have much more in the way of numbers to show results. Setting up a control group for purposes of statistical evaluation would cost money HELP doesn’t have to spare. Such data does matter. Under their city-government contracts, organizations that provide job training are typically paid on the basis of how many clients they place in jobs, and get paid more for jobs that last. Fraenkel can’t prove statistically that his efforts make a difference. All he and Hameline can do is trust what they already know: People who feel connected, supported and motivated are generally more likely to succeed.


It’s well established by now that more and more people entering welfare-to-work programs have multiple barriers to finding employment, such as substance-abuse problems and mental illness. Others struggle with nonclinical but potentially debilitating problems, like lack of confidence, explosive tempers and garden-variety depression.

As agencies struggled to find employment for people who had serious problems in the workplace, they started embracing the idea that peer support can help people find and keep jobs–even though so far, there’s no definitive research showing they’re right, says David Butler of MDRC, a national welfare think tank.

In recent years, STRIVE, for one, has begun to offer support services for job seekers. Today, it has a peer group for women and one for men, in which graduates discuss such things as self-esteem, anger and parenting.

Compared to STRIVE, Fresh Start’s group therapy for the unemployed seems dreamy and impractical. But Fraenkel believes that dreams have practical value. “We all have to wash up and go to work. But we all have to dream too,” he says. “The providers may say, ‘It’s fine to have a dream exercise in your program, but do people get jobs as a result?’ I don’t know. But here’s the psychodynamic perspective: Without the fuel of fantasy, we grind to a halt pretty quickly, no matter who we are.”

Instead of reading the scholarly literature, Fraenkel and his students spent months interviewing shelter residents about their experiences. Inadequate child care and the problems of being a working parent were their number one concerns. But they also talked about emotional issues, like “my own negative attitude,” depression, anxiety and hopelessness, the frustrations of the welfare and shelter systems and of dead-end jobs.

With those answers and approximately $110,000 a year through the fund-raising arm of HELP USA, the Ackerman Institute, and a number of private foundations, Fraenkel launched Fresh Start.

Dianne Lewis came to her first meeting only because Fresh Start promised a small stipend. “I’m saying, ‘They’re here trying to help the little poor black and Puerto Rican community. Oh, we’re feeling sorry for these people,'” she recalls.

Lewis had been a housewife, married to a car salesman for 29 years. But when her husband died from pancreatic cancer, she didn’t know how to support herself or her two teenage sons. So she decided to make a few drug runs for dealers in her neighborhood in return for $5,000.

During her 14 months in prison, she attended a culinary program, but when she applied for positions after her release, she was always turned down. She once enrolled in a welfare-to-work program, but all she recalls is being placed in a large room with phones and phone books and told to call businesses to set up interviews. “It was like being in an empty space,” she said. “You hear what they’re saying, but you know, ‘Hey, this is not going to make a difference.'”

At Fresh Start, she started to feel different. Lewis liked that each week the facilitators asked how she and her sons were getting along. In the meeting she had a chance to explain some of what had occurred in her life, and in particular to talk about the paralysis that came with all the “shoulda-coulda-wouldas” constantly running through her head. One week, Fraenkel encouraged Lewis to visualize putting her past in a bag and throwing it out the window. For Lewis, imagining that her past didn’t have to define her future felt liberating.

Lewis also made friends. Before Fresh Start, she said, residents at the HELP shelter had avoided each other. (Fraenkel says people in shelters tend to stereotype each other as much as the rest of the world does–shunning one another for fear that they might be a bad influence.) But then they began to sit around and talk. Lewis felt important when, one evening, two younger women told her they liked hearing what she had to say.

Those same women made the difference when she went to her first interview, for a job supervising a playground at a private apartment complex in the Bronx. Lewis was scared. She got up to leave. But the women, also there for the interview, told her: “You’re always telling us what we can do. You’d better go in there and show what you can do.” Lewis got the job, for $7 an hour.

During the five years she has worked there, Lewis has gotten a raise, to $9 an hour. And she has become a neighborhood fixture: “I care about the kids. I take my money and buy arts and crafts,” she says. “On hot days, I turn on the sprinklers and I’m in there getting wet with them.” But the work is seasonal and Lewis has had no choice but to hunt down odd jobs every winter.


Since Lewis left the shelter, she’s stayed in touch with four women from her group who have also done as well as she has. But she has run into a couple of others who haven’t been as successful and have even gone back into the shelter system.

Even though he can’t afford a formal evaluation, Fraenkel does try to stay in touch with people. Six months after the workshop ends, the program attempts to contact former participants and manages to reach about 65 percent. Most, he says, end up much like Lewis: They hold on for their lives in the face of unpredictable circumstances.

He finds himself in a strange position, encouraging people in their job search when the odds against them are high. “I feel awful about the way this country is eliminating living-wage jobs,” he says. “But except as citizen, I’m not in a position to do much about it.”

What he can do, he figures, is provide the poor a space for dreaming that the more comfortable social classes take for granted. Fresh Start, Fraenkel says, gives people a chance “to hang out, to spend hours talking” about their hopes. That may feel like luxury, he says, but it’s necessary–for everybody.

“There are statistics,” concludes Fraenkel. “And there are stories.”

From the videos he has recorded of Fresh Start members at their sessions, he envisions culling word-for-word testimonies. He’s got a dream of his own: He wants to present them to politicians, policy makers and others who could influence the creation of productive, living-wage jobs for the people he works with. “The homeless, the poor,” Fraenkel says, “have complex, laudable aspirations. Just like everyone else. •

Rachel Blustain is a former editor of Represent, a magazine by and for teens in foster care, and currently a student at the Hunter College School of Social Work.

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