Amsterdam's Trojan Horse
A Report on Holland's Pink Pamphlet Movement
The people who work for Jongeren Advies Centrum (Young People's Advisory Centre)
in Amsterdam, don't restrict their activities to helping people adjust to the status quo. If the problems their clients are struggling with arise from inadequacies in the social structure, they take action on those, too.
Since the centre is financed by government and municipal subsidies, the Dutch government and the City Council of Amsterdam now find themselves in the unusual position of paying people to uncover and expose faults in the way they do their job.
This sounds like one of the more useful ways governments can spend the money they take off us in taxes. We hope the Dutch authorities concerned will have the maturity to stay with it and we hope this practice will spread to social agencies and governments in other countries. (A Canadian experiment with some similarities, the Company of Young Canadians, failed to weather government and public criticism and their activities have been somewhat curtailed).
JAC is located in a pleasant old house in the centre of Amsterdam. It provides a nonauthoritarian, "no waiting" kind of help which the clients themselves will be asked to evaluate at the end of the first year's operation. In the following interview, psychiatrist Dr. Donald MacGillavry, JAC's director, discusses the philosophy and operation of the centre with Philip Veerman.
Mr. Veerman: How does JAC differ from some of the more conventional social service or welfare centres?
Dr. MacGillavry: We have organized the centre to suit the needs of the young people who need help, rather than the convenience of the staff. For example, we are open from 7 p.m. until 3 a.m.; after school and working hours. We can be reached by telephone during the daytime and we will open the centre during the day in an emergency, but the staff are concentrated during the evening hours, the most convenient time for the young people we are trying to help. The centre was opened on January 10, 1970, as a place where young people between the ages of 15 and 25 might come, on their own initiative, for information, advice and help.
Mr. Veerman: Is help not available to these young people through other social welfare agencies?
Dr. MacGillavry: Yes, but not in a form which is acceptable to most young people who are put off by a clinical or bureaucratic atmosphere. Many government offices have conventional office hours. Some agencies only see people who have been referred by a doctor or social worker. The staff of many agencies are prejudiced against young people—especially young people with long hair or unconventional clothes—and are rude and unpleasant in their dealings with them. Almost all agencies have a waiting period. Then when, at last, you get an appointment, you have to sit around a waiting room for hours before you get in to talk to someone. Young people flock to JAC because they don't have to make an appointment, they can walk in off the street. They don't have to fill in forms, or take a series of psychological or other tests before they can see someone. They get to talk to someone right away about what's bothering them. The service is confidential. We don't get in touch with parents, school authorities, employers, or anyone else, unless they give us permission. If they don't wish to, the young person seeking help need not give us his name.
Linked to social action
Another way in which we differ from the conventional social agency is that we don't restrict our activities to counselling individuals, helping them overcome their personal problems, or helping them adjust to the status quo.
We look at the individual and we look at the society in which he lives. We always ask ourselves: "What percentage of this problem is due to a failure in the functioning of this person, and what percentage is due to a failure in the functioning of society?" It is always a combination of the two. But too often, in the past, social agencies have concentrated on the frustration tolerance of the individual without considering whether he might have a valid reason for his frustration. For example, a large percentage of the problems which people bring to JAC are a direct or indirect consequence of the severe housing shortage in Holland, particularly in Amsterdam. A social worker who failed to take into consideration the shortage of living accommodation might diagnose a person seeking help as having "a neurotic personality". But we need to face the reality that young people, especially young married people with children, cannot live successfully with older people in crowded quarters. One of JAC's basic objectives is to highlight problems which young people face today, and try to create activities which may help in finding appropriate solutions to those problems. When we have hundreds of people coming to the centre for help with problems that stem directly or indirectly from a lack of suitable living accommodation and we discover that out of 600 people who went to the office of Amsterdam's housing department, only 10 were helped, then obviously some action is called for. Our first approach is to the government or city department concerned. But if we fail to get satisfaction from them we notify the press. You can imagine the stir that was caused when, in an interview with MET PAROOL (Amsterdam's biggest newspaper) I stated that in trying to find solutions for the people who seek our help we receive co-operation from all the official agencies with exception of the housing department of the City of Amsterdam. This is the way we work to get action. Most social agencies gather
these kinds of statistics but the usual practice is to pass the information on to government departments concerned, supposedly to help them formulate future policy. What usually happens is the information is filed away and ignored. The information we gather we hand over to the newspapers in the hope that the publicity will prod the government into action. The government knows where the newspapers get the information. It helps keep them on their toes but it also creates a tricky situation for us. We are a strictly independent, professional foundation
but we receive subsidies from the Municipality of Amsterdam and the Ministry of Culture, Recreation and Social Work. What has happened is that the authorities are supporting an organization which gathers critical information which sometimes forces them to change their policies or their methods of doing things. The Minister of Culture, Recreation and Social Work (the only woman in Holland's present cabinet, incidentally,) supports JAC and understands the longterm value of the work we are doing, but there has been criticism and annoyance in official
circles and there is a strong possibility that our subsidies might be discontinued. But I do not see the point of trying to patch up problems while ignoring the root causes. To get rid of the root causes you have to bring about change. There are two ways of changing things. One way is to talk to the people responsible for the way things are and try to reach an agreement with them about the changes that need to be made. We have achieved quite a lot that way. For example, we talked to the people at the Burgerweeshuis* about the need for a crisis centre and they are co-operating with us to set one up and we will get a subsidy for this. This has all been achieved by discussion and coming to a consensus. However, this way doesn't always work. It hasn't worked, for example, with the housing department of the city of Amsterdam. Then you have to turn to the conflict model. This may mean strikes, demonstrations, sit-ins. When we found we could get no action from the housing department we turned to the newspapers, the radio and television stations, to see if publicity could force them to act. If this doesn't bring results we might have to put an advertisement in the Amsterdam newspapers asking all those who have housing problems to join us in a sit-in at the housing department offices. People may say we are crazy, but when 30 per cent of people who come to JAC have problems which stem from the impossibility of finding somewhere to live, something has to be done. And if you can't get something done through discussion you have to find another method.
Time ripe for change
I'm not alone in this belief, of course. The time is ripe for change. Many workers in the mental health field realize that they have been working for the economic structure of the consumer society rather than for the people they are supposed to be helping. Too often, in the past, we have worked in the service of "establishment" parents instead of in the service of the child. Up to a few years ago I, as a psychologist, saw nothing wrong with parents asking me to test their children to see how many extra lessons they could take through high school. I tested children; I chose, at the request of the parents, to force them into a productivity type of achievement. The end result was that they passed their final high school examinations with high marks but somewhere along the way they lost all their natural creativity. Of course, at that time, any psychologist who counselled parents not to ask so much of their children, would find it difficult to earn a living because once his reputation spread, few parents would consult him. But now one can find more and more workers in the mental health field who have no wish to put their talents at the service of people who think that the good society is based on productivity achievement and the accelerating consumption of material goods.
Mr. Veerman: What kind of people staff the centre?
Dr. MacGillavry: Before we opened the centre we sat down and asked ourselves what kind of staff we should look for. Should we take only psychiatrists and psychologists? Or should we use social workers, too? We decided that social workers who have specialized in adult education and group work, cultural workers as we call them in Holland, would have the right kind of attitude for this type of work. These people have lots of experience in dealing with people and dealing with conflicts. They tend to be critical toward the established structure of society. They also have a very good way of talking to the young people who come seeking help. Why? I don't know. They cannot explain why themselves. But it has been our experience that these cultural workers develop a much
better rapport with our young clients than the highly trained psychologists or social workers with advanced training in casework.
Mr. Veerman: When I looked around the centre at two o'clock this morning I saw people sitting in corners, talking. A girl brought coffee around and pop music was playing in the background. I saw no special rooms for interviews, no clinical atmosphere. It reminded me of the Browndale treatment centre and of the Browndale film "Carol and Dr. Fischer: a model for a psychiatric interview" which shows a psychiatrist talking to a child in the same informal and human way.
Dr. MacGillavry: Yes, we have the same relaxed atmosphere here. Most people sit downstairs to talk to us. They prefer this to special interview rooms. But we do have a few rooms upstairs for people who request a private interview. Couples often prefer a private interview room, and so do people who are very depressed and have attempted suicide. Sometimes a person says: 'I can't talk here, there are too many people around' and then we take them upstairs.
Mr. Veerman: You say that these cultural workers who do not have a special training in interview techniques do better at JAC than the highly trained psychiatrists,psychologists or caseworkers. Would this be because they have a different attitude toward the person seeking help? Would you agree with John Brown that you don't have to be an expert with years and years of training before you can work with people?
Dr. MacGillavry: Yes, I would agree. One important thing which helps our cultural workers is that most of them are around 25 years old—not much older than the clients. I think, also, that the kind of training that most psychotherapists get prevents them from being able to give the kind of help which is needed at JAC. The focus of their training is on long-term therapy. But our focus is on crisis help. In our kind of work you have to get through to the person and get the information you need quickly—perhaps in one interview, if the person seeking help doesn't live in Amsterdam. So you have to be able to talk easily but you also need skill to direct the interview the way it
needs to go. This can be a difficult combination to achieve and my experience has been that cultural workers find it easier than other professionals. However, we are a good team here. From the cultural workers the psychiatrists learn flexibility and from the psychiatrists the cultural workers learn therapeutic principles, the importance played by transference and counter transference and other technical skills.
Another important thing that our experience at JAC has taught us is that a hierarchical organizationalstructure results in an authoritarian way of helping people. A non-hierarchical organization,which we are, produces a non-authoritarian form of help which the young people can accept. JAC is more or less a "working commune". When I open my mouth to say something I sometimes get less response than the cleaning woman when she says something. This was especially true when we first opened. The attitude then tended to be: "When Dr. MacGillavry opens his mouth don't listen because he is still thinking that he is the director. When he no longer thinks of himself as the director we will listen to him." But I say I am not the director except for outside purposes; I am a member of the team.
Mr. Veerman: How does this team approach work?
Dr. MacGillavry: We work in units of four people and the units change every three months. So for three months you are working with the same people for two nights a week.
A young person walks in and I may sit down and talk with him. Now the problem that is presented might be one that I can deal with adequately without consultation with anyone else. Or it might be one that I think the cultural worker is better equipped to handle. If that is the case I will say to the young person: "Do you mind if I call in my colleague? He has more experience with this kind of thing than I have." Then there are three possibilities. The cultural worker might sit in on the interview for 10 minutes or so to give us the benefit of his knowledge on some specific aspect of the problem. He might stay for the whole interview. Or after 10 minutes or so I might withdraw, leaving him to take over. This leads to a very flexible approach. Everyone contributes his own particular skills to the team. This leads to the client getting the best advice and help available for his particular problem.
For this approach to work successfully,everyone on the team must know what he can do and what he can't do. It isn't easy for a highly trained professional person to admit there are some things he can't do or that someone
else can do better. Before we opened we did a lot of role playing to help us find out what things we were good at and what things we didn't do so well. When a professional person can admit he isn't infallible, he can take a non-authoritarian approach to the client. You can discuss alternatives with him and suggest what might be the better thing for him to do, instead of telling him what he must or should do. An important aspect of our work is the follow through. The staff person who has the initial interview with the client (or the person who takes over at the first interview) keeps the responsibility for the client until he gets the help he needs. For example, some people we see need long term psychiatric help, but all the treatment centres have long waiting lists. It sometimes takes months before a person gets in. But the JAC person maintains contact with him and responsibility for him and during the waiting period the young person can come back to see the JAC staff person as often as he needs to.
Mr. Veerman: Do you have any on-the-job training for the staff?
Dr. MacGillavry: We have the usual staff meetings to discuss organizational problems and special meetings at which we discuss the more difficult cases. Then every other week we have a two-hour meeting during which we talk together on a more personal level, about our feelings. A highly trained group worker, Mr. Hirsch, does this with us. For every person who comes in we write down the problem he presented to us and our suggested solution. All the questions and answers are gathered up at the end of the shift and handed over to the staff who come on duty the next evening. They discuss and evaluate the help we gave. We have 20 part time staff persons at JAC so everyone gets 19 critics. In addition to working two nights from 7 p.m. until 3 a.m., each staff member has one day of meetings, in-service training, and at least one day for social action work.
Mr. Veerman: What form does the social action take?
Dr. MacGillavry: Well, first of all, they have to design a social action concept to suit a specific problem. I'll give you an example. On Liberation Day (editor's note: May 5, national celebration of the anniversary of Holland's liberation from Germany during the Second World War) there were riots in Dam Square (main square of Amsterdam) resulting in mass arrests.
Treated badly by police
Among those arrested were 140 young people who had been sitting by the national monument. Many of them were treated badly by the police. Those who were injured had to wait four hours before seeing a doctor. Some who were on medication were not allowed access to it while they were in jail. This was an incident which called for social action. So we got busy. We talked to the young people in this group to find out how many of them would like to join JAC personnel in forming a social action group whose purpose would be: first, to try to find out why the police had acted that way; then, to see if we could make contact with the police and discuss the incident with them; but, perhaps, if we didn't get any satisfaction, to bring a court action against the police. The social action that we undertake is always linked to problems which young people bring to our attention. We believe that an important part of our job is to expose the problems in our society; to highlight the areas in which help is needed but no help is available. Since we opened last January we have been able to highlight, and do something about, several of these shortages. For example, many young people run into problems with the law and they cannot afford a lawyer even if they could find a sympathetic one. So we started a judicial counselling hour at JAC. There is a shortage of information available on hard drugs, so we started a regular two-hour consultation program on hard drugs. Young people with long hair have difficulty in finding jobs. Also many young people don't want to work at a conventional job from 8 a.m. Monday morning until 6 p.m. Friday afternoon. We think it is quite reasonable for a young person to not want to become a slave to the exploitive, consumer society. And we have started an experimental job finding agency to see if we can help them find the kind of jobs they will enjoy doing. Very little help is available to pregnant single girls so we started an abortion clinic. We also organized group meetings for girls who have had an abortion so that they could talk about their feelings with other girls who had gone through the same experience. It is important for a girl to know she isn't the only one who has faced this problem.
We want to work more with group techniques at JAC. We are thinking of setting up therapy groups for young people who are struggling with the same kinds of problems. Some of them need individual help but many of them could be helped in a group. Mr. Veerman: What are the most frequent problems you deal with?
Dr. MacGillavry: A very large percentage are a direct result of the severe housing shortage here. Some young people come because they can't get jobs, some have drug problems, some have problems in relationships with other people. We also get quite a few young people who have run away from home, or from an institution.
They get into a big conflict with their parents or with the staff of the institution and they run away. But they have nowhere to run to. They sleep in the parks, or in the streets, the girls sometimes prostitute themselves to get a bed for the night. Young people reach a period in their lives where conflicts with parents or other authority figures are inevitable. Sometimes they need a temporary refuge in which they can stay while they try to work through their problems. The solution might well be to return home, or to the institution. But if they are forced to return prematurely, before they have sorted things out in their own minds, nothing is resolved. So we are working with Mr. Wim van Halm, the director of the Burgerweeshuis to set up a crisis centre where these young people could stay for up to a week. They wouldn't have to worry about finding money to pay if they didn't have any. The only condition would be that while they were at the centre they would have to try seriously to work through the problem which brought them there and decide what they should do. Such a centre might also be a useful referral for young people who come to JAC and who turn out to be in need of intensive individual therapy.
Mr. Veerman: How do the young people get to know about the service JAC offers?
Dr. MacGillavry: Through other young people whom we have helped. They form a bridge. They are the ones who are in contact with other young people who need help and they can say: "Why don't you go to JAC? They helped me and they could probably help you. I'll take you there if you like." The fact that the referrals come from the people we have helped provides a built-in evaluation service. Because if they hadn't found our help valuable they wouldn't recommend us to anyone else. At the end of our first year of operation we'll do an evaluation on a more formal basis. We will meet with a group of young people whom we've helped and ask them: Are we doing a good job? Is the program valuable enough to be worth continuing? What do you think needs to be added to the program to make it more valuable to young people? From January until the end of May (time of the interview) 2,700 young people have come to JAC for help. Of these, 70 per cent were living in Amsterdam at the time, 15 per cent were from other parts of Holland and 15 per cent from other countries. One criticism that is levelled at us sometimes is that the work we do at JAC is too superficial, that we focus too much on surface problems, on crisis intervention and neglect long-term treatment needs. I don't think this is true. If a person needs long-term, intensive therapy we refer them to a treatment facility which can offer them this. By getting immediate appropriate help to the others, we perhaps prevent their problems from building up. Because JAC offers help in a form that is acceptable to young people, they come to us before their problems become too serious and this enables us to do a lot of preventive work.
Mr. Veerman: Are there any changes you would like to see made in the child treatment field?
Dr. MacGillavry: In many cases we are not convinced that there is a good reason for this particular boy or that particular girl remaining in a child care institution. We think that in an attempt to keep down the recidivist rate, the standard of functioning a child must reach to get out of the institution is too high. It would be better I think, to take a chance on whether a child might make it in order to give him an opportunity to enjoy the normal experiences that every adolescent has a right to. At this time of life particularly it is important that a child live as normal a life as possible. And if he gets into difficulties I don't think this should mean he has to go back into the institution. We can give him the support andhelp he needs while he is living in the community. I don't think we explore these possibilities sufficiently. To prove to yourself and others that you can master something is a normal need at this age, an essential one. Most child care institutions are too rigid in their structure and environment. They don't give a child the chance to show what he could achieve. I admire the things that Mr. van Halm is doing, changing the Burgerweeshuis from a classical treatment centre to a dynamic treatment centre, opening family style houses in the city of Amsterdam, using foster families, helping the child see the possibilities that are available and helping him make use of his potential and achieve self identity. At JAC, we think achievement of an identity and self-determination are especially important for this age group between 15 and 25. Mr. van Halm agrees with us on this.