The Green House: Marbeh Daat’s Parent-Child Center at Maaynei Hayeshua Medical Center presents a one-of-a-kind model: A “residential unit” to meet the therapeutic needs of large families in a realistic environment
Psychotherapist Nechami Samuel (Parent – Child Centre) has worked for many years in pediatric mental health clinics. Of her young patients, many of whom came from large families, there were some who required a targeted treatment plan of about twenty sessions to treat problems like anxiety and other mental health issues. The medical team would treat these issues until the point where it seemed that the problem for which the child had been referred to treatment had been resolved, and the child resumed normal functioning in the community and in school.
Yet there were some children whose experience was different. “We once had a child from a certain family, and after a few months his brother was referred to us as well, and then another child from the same family,” relates Nechami. “We discovered families of a different sort – those who had a more complex problem. In these families, parental functioning is impaired either because of the parents’ difficult childhood and lack of proper modeling, or because one of the parents suffers from a mental illness. Sometimes the parents’ functioning is impaired because of the children’s emotional or behavioral problems.
“One thing was clear, though. The way we were working, which was good for many of our young patients, was not suitable for these cases. There was a genuine need for more comprehensive work from different professional angles, addressing all the different aspects of the problem. The main question was, how do we do that? How do you ‘recalibrate’ the entire family system and enable these parents to raise their children properly?”
The thing with million-dollar questions is that, when addressed properly, they can move us a step – or many steps – forward. “While establishing our Centre, we investigated the work done in the other centers for parents and children in Bnei Brak. We found their work to be professional and serious, but in all the centres we were told that they cannot provide an adequate solution for families that are also dealing with mental illnesses and are psychiatrically treated. These families could not find a place that would provide them with the necessary treatment, and they were falling through the cracks.
“We researched a lot,” says Nechami. “We allowed ourselves to be open to other possibilities that may not have been familiar to us until then, until we finally reached this model – the Parent Child Centre inside the Marbeh Daat psychiatric unit near Maaynei Hayeshua Medical Centre. It is a unique model that as far as we know does not exist anywhere else in the country and was created to service the families in a true-to-life, realistic environment,” explains Samuel, today the director of The Green House, Marbeh Daat’s Parent-Child Centre.
Creating the Centre from scratch in all areas – professional, functional, and technical – and building the unique work model took a number of years. Today, the Centre operates inside the Marbeh Daat Mental Health Center. It is designed to look like a beautifully furnished apartment with a living room, kitchen, dining area, and a few therapy rooms that look like children’s bedrooms, filled with colorful and exciting toys. The families visit The Green House a few times a week.
The Green House offers the families all the treatments that may help them. Meir Cohen, senior psychologist at the pediatric unit who also took a part in the Centre’s establishment and professional training, specifies, “Our professional team tailors the treatment plan for each family’s needs on a personal and targeted level. The Centre’s goal is to create a respectful, empowering atmosphere for the families treated here. There is tremendous investment both in terms of the therapies provided to the families as well as the variety of therapists who treat them. There is full collaboration between the parents and the professional team.
“The basic premise is that despite the impaired parental functioning, the parents have a deep knowledge of their own families. We try to help them fulfill their roles in the best way possible by utilizing our professional experience and the knowledge that we have accrued over the years. We can truly say that each family is like an only child here, and we treat them with all the respect that they deserve. The attitude here is not one of ‘This is how we do things; this is the right approach.’ The role of the professionals is to learn the family, map their areas of strength and the parts that require further guidance and mediation, and adapt the intervention to their needs.”
It is precisely for this purpose that the Centre employs a housemother, a social worker, psychologists, and psychotherapists, providing different combinations of private therapies for parents and/or children, guidance for parents – either to both together or to each individually, dyadic therapy, family intervention, and more.
The Centre’s associative and geographic proximity to the Maaynei Hayeshua Medical Centre is an added bonus. “The fact that we are affiliated with the hospital enables us to take all the family’s needs into account, including their medical needs, and to work in close cooperation with the medical personnel,” explains Samuel.
House visits conducted by the Centre’s staff deepen their understanding of the full picture and enable the staff to map the needs and tailor the intervention to each family’s unique situation, starting from intervention in daily organizational functions to clearly-therapeutic intervention in higher functioning levels.
The fact that The Green House is designed to look like a regular residential apartment makes the therapeutic environment more authentic, as well as pleasant and inviting. “The families come to the Centre a few times a week. There, in the beautifully furnished ‘apartment,’ they have an opportunity to create positive family experiences around routine daily activities relating to learning or eating. For example, when the family sits down for dinner at the Centre, all members take part in preparing the meal, setting the table, washing the dishes, and then they sit together with no outside disturbances.
“This hands-on experience enables us, the therapists, to identify the mains areas of difficulty and to help them change their behavior patterns in order to improve their relationships and communication skills. In the play area, with all the toys, games, and books, the term ‘quality time’ takes on a depth suitable for therapy. Through these interactions at the Centre, we can identify when parents have a difficulty playing openly and freely with their children without commenting or criticizing. When playing, there is a need for spontaneity, not necessarily a didactic approach which is appropriate in other times and places.
“In this way, routine interactions receive an educational-therapeutic-rehabilitative dimension. There is no division here based on age, but rather an approach that treats the entire family as a unit, according to its own unique dynamic,” concludes Meir.
The intensive and systemic work does not end after the hours spent by the family at The Green House. As they return to the community, they are guided by facilitators who help them assimilate the processes into their daily lives. In order to make the process more efficient, the Centre’s staff members make sure to maintain an ongoing, mutually beneficial relationship with the social services, the psychological-educational service of the Bnei Brak municipality, the National Programme, the Ministry of Health’s rehabilitative services, and targeted rehabilitative services for the Haredi community. Once a month, the Centre’s staff meets with these and other providers in order to promote a cooperative dialogue for the benefit of the families.
The model is so correct and obvious, so multi-systemic and efficient, that we can only wonder where the idea originated from.
The answer is surprising: Marbeh Daat’s Parent Child Centre was actually established as an independent response to the needs of the community, with no existing model to follow – simply because such a model did not previously exist for families dealing with mental illnesses. Nechami Samuel admits that she thought of the idea after seeing the needs that were arising in her work. It is no wonder, then, that preparing and building the Centre took a few years. Like other abstract ideas which slowly take shape and adapt to realistic conditions, this abstract idea, too, had a long journey to undergo before it came to fruition. It is also clear why various entities related to health, social services, and therapy, such as the Ministry of Welfare and Social Services, the Ministry of Health, the Bituach Leumi (Israel’s National Insurance Institute), the Joint, the Bnei Brak municipality, and others show a special interest in this pilot project. Needless to say, they are all excited about the program and fully support it.
The Centre’s staff, with characteristic humility, maintains constant communication with other parent-child centers in the city. “We learn from them, and we offer them of our own experience,” explains Samuel.
Currently, the staff at The Green House is working on creating a rehabilitation forum under the guidance of Frumi Gottlieb, senior social worker at the Mental Health Centre. The forum’s goal is to be in constant contact with targeted rehabilitative programmes and services for the Haredi community.
The Healthy Mind Project – in conjunction with the first psychiatric hospital in the world for Torah-observant Jews, by Maaynei Hayeshua Medical Centre.
In the last week of November 2019, Professor Rael Strous, the South African-born medical director of Mayanei Hayeshua’s Mental Health Centre, and professor of psychiatry at Tel Aviv University’s Faculty of Medicine, was in London for a busy round of meetings and events organised by the British Friends of Mayanei Hayeshua.