I only met one Jamaican psychologist during my two years living in Kingston, serving as a Peace Corps Volunteer. She told me that there were only a few psychologists on the island. The University of the West Indies, on the outskirts of Kingston, didn’t have a psychology department. When Maria and I applied for Peace Corps service after our marriage in 1990, I never dreamed that I’d be employed as a psychologist in whatever developing country invited us to serve. (The more open an applicant is to serving wherever his/her services are needed, the higher the likelihood of acceptance.) With a bachelors degree in English, I thought I’d end up teaching English somewhere near where Maria worked. Maria was a psychiatric nurse – easy to place – and our Peace Corps recruiter initially referred to me as her “ball and chain” – not so easy to place. Maria was selected by Jamaica to serve as an instructor at the University Hospital of the West Indies (UHWI) School of Nursing. It just so happened that UHWI had just opened Jamaica’s first detox/rehab ward (mainly for alcoholics and crack cocaine addicts) and was in need of a ward psychologist. So from 1991-93 I wound up being one of Jamaica’s few practicing clinical psychologists.
The ward was initially run by a young psychiatrist who had just finished his residency at Johns Hopkins, and the staff consisted mostly of nurses, none of whom had experience working exclusively with substance abusers. When I reported for duty I discovered that the 8-bed ward had no treatment model (other than the medical model) and I had no job description. The only thing resembling treatment was several Twelve Step meetings a week.
So I told the staff what I was qualified to do and they encouraged me to write my own job description: I would interview each new patient, review his/her medical record, and write a clinical assessment, with recommendations for the treatment plan. I would serve as a member of the treatment team. I would conduct group therapy sessions (psycho-educational and process groups), and do individual and family therapy as needed.
I knew the program really needed to be based on a valid treatment model if it was to be effective. Other than the ward psychiatrist, I was the only treatment team member to have had training in substance abuse treatment. I knew that my first task as a Peace Corps Volunteer (PCV) was to listen and observe and learn, and to win the trust and confidence of the rest of the treatment team before I started making suggestions. However, I also started to work on a relapse prevention model that I’d introduce once I’d earned my place on the treatment team. I wanted to co-lead my groups with staff nurses, but they repeatedly declined. They were content to monitor the sessions from the nursing station.
I initially felt somewhat anxious at the prospect of leading groups. I was confident that group dynamics would be the same in Jamaica as in the U.S., but I knew that I had things to learn about Jamaican cultural norms, and I hadn’t yet developed an ear for Jamaican patois. English is the official language and all educated Jamaicans speak it clearly, with that unmistakable accent. But all Jamaicans also speak patois, and “deep patois” is initially unintelligible to English speakers. An effective group leader has to stay on top of not only everything that’s said in group, but also the non-verbal communication within the group. My initial test came early-on.
In a group session with all males, after a heated exchange between “Clarence” and “Desmond,” I thought, Did I just hear a death threat? Indeed I had, and I did an immediate intervention: “Threats of violence are not allowed in group, gentlemen. I know it’s almost lunch time, but we’re not leaving this room until Clarence not only takes back his threat, but means what he says.” Before the end of the session, Clarence had retracted his threat, and shook hands with Desmond. Jamaican men tend to be macho, and it took all of my group leadership skills to stay in control during some contentious sessions.
The nurses were relieved to learn that I could stand up to angry Jamaican addicts. They never had to call Security, no matter how heated things got in group. More than once I had to break up fights. Most of the addicts I worked with came to respect me, and most seemed to like me. Some requested that I work with them individually. My psycho-educational group sessions focused on the relapse prevention skills that I was incorporating into my treatment model.
I soon “earned my spurs” with the ward staff, and began to feel like a valued member of the team. Everyone seemed pleased with the quality of the clinical services I provided, and in my second year of service I introduced my relapse prevention model. I’d written a relapse prevention manual with workbook exercises such as “Identifying your triggers for relapse.” I printed and assembled it at the Peace Corps office, and provided copies to all staff and patients. The model and the manual were approved by the treatment team and adopted into practice. When I left, after Maria and I had completed our two years of service, I felt a sense of accomplishment. A fellow Returned Peace Corps Volunteer (“Once a PCV, always a PCV”) later told me that when he’d served at UHWI, a few years after my service, the manual was still in use.
Peace Corps service can be very challenging, and many PCVs aren’t able to accomplish what they set out to do in their assignments, due to circumstances beyond their control. The Country Director said to our training group, “If you feel like you’re ‘giving up’ two years of your life to serve in the Peace Corps, Jamaica doesn’t need you. You’re here to live two years of your life among the people of Jamaica.” The Peace Corps Mantra is “I got more than I gave.” Our lives were enriched by our two years in Jamaica. You can read the whole story in my first book, Two Years in Kingston Town: A Peace Corps Memoir, available online at Amazon and Barnes & Noble. For those with an interest in cross-cultural therapy, the book contains vivid descriptions of some of my clinical interventions in therapy groups. But it also describes places on the island that tourists seldom see, daily life in Kingston, and encounters with all sorts of interesting people.