Frequently Asked Questions

Each listed question links to its corresponding response.

If your question is not listed, please visit our Home or Program pages -- we also invite you to Contact Us (or call (215) 997-9959).

What are the history and mission of Project Transition?

How is Project Transition different from other programs?

Project Transition is an open setting…what are the implications?

How are family members kept in the loop?

Why is Project Transition’s approach effective?

How long do people stay, how do they get ready to leave, and what about outcomes?

Who tends to do best?

Who tends to have the hardest time?

What about aggressive behavior?

What about suicidal and/or self-injurious behavior?

What about drug or alcohol problems?

How are romantic and/or sexual relationships dealt with?

Can a member also receive the services of an outside (consulting) therapist or psychiatrist?

What is a Therapeutic Community?

What is a typical week like?

What about funding?

What is the referral and admission process?

What are the history and mission of Project Transition (PT)?

We were founded 23 years ago by Loren Crabtree, MD and Paul Keisling, MSW. The concept of PT evolved in response to years of working with young adults in a private psychiatric hospital. Many of these men and women experienced repeated cycles of complex, debilitating difficulties:

The program started with one young man, an apartment, and several staff members. While PT’s scope and size have grown (three therapeutic communities serving adults of various ages), the founding intentions remain vital and relevant.

Leaders

Today, Dr. Crabtree (Medical Director, left) and Paul Keisling (Executive Director, right) remain hands-on leaders, interacting daily with PT members, families, and staff.

Our mission is to help persons with persistent psychiatric problems live more fulfilling lives. PT’s work is based upon acceptance, hope, relationships, support, and positive action.

How is Project Transition different from other programs?

Our Members: we specialize in working with individuals who have experienced multiple crises, hospitalizations, and/or drug and alcohol rehab experiences. The families have been through a lot, too. While psychiatric diagnoses vary, feelings of hopelessness regarding previous treatment efforts (including medications) are common.

Setting, Services, and Staff: PT consists of three stress-buffering transitional communities that are “open” and nestled within natural communities. Our program is comprehensive, tightly integrated, staffed by seasoned professionals, and tailored to need. Since we provide our own services (including transportation), everyone is in the loop and on the same page.

Activities and relationships are based within the member’s apartment complex: they include therapies, psychosocial rehabilitation workshops, skills-coaching, support with vocational/educational goals, fitness and stress reduction programming, medication management, weekly community meals, a 24/7 crisis response service, fun trips, family support and seminar activities, and more.

For certain individuals, we believe that this approach makes more sense than weaving together separate threads of community services that tend to be isolated from one another. In contrast, PT is a closely-knit community that reflects the very setting where the person ultimately wants to be successful. In this regard, we believe that “the medium is the message”.

Self-management and Recovery: our work balances an awareness of each member’s unique patterns of psychiatric symptoms and acuity with an approach that 1) coaches the person in self-managing them and 2) develops the skills and disciplines to rebuild a life. The objective is to transcend “treatment” and to experience a life that reflects one’s realization of hope and personal goals.

Time, Relationships, and Continuity: the PT environment is one of extended time and focused, helpful relationships. The average length of stay varies (8-16 months is common), and our approach to step-down care and graduation is highly individualized. When the time is right, progress is accompanied by a gradual, planned fading of supports while valued relationships are maintained. This approach contrasts with more traditional level of care changes that often result in new staff and peers. This can be a problem considering the challenge of forging new, supportive relationships during a vulnerable period of transition.

Project Transition is an open setting… what are the implications?

The openness of our setting is intentional. We believe that it makes sense for people with serious psychiatric problems to live, work, and recover in an environment that matches where they ultimately want to be successful. This is why our therapeutic communities are based in attractive apartment complexes. It promotes normalcy, privacy, the expectation to blend in with apartment neighbors who are not associated with PT, and the ability to freely access surrounding communities.

Although we have some basic rules and expectations, many family members and mental health professionals are surprised that we don’t impose more control. This aspect of PT may create initial anxiety - especially among family members. Over the past twenty-three years, we have encountered very few crisis situations attributed to the openness of our setting.

Experience has shown that members of PT tend to rise to the levels of respect, social expectation, and responsibility that are extended to them. Additionally, we have a responsive, user-friendly 24/7 crisis prevention system. Staffed by PT counselors, psychiatrists, and program managers, this safety net actively supports the member in practicing problem solving and coping skills. We offer this service to family members, as well. It provides around-the-clock peace of mind.

How are family members kept in the loop?

We value the central, enduring importance of family. When a person joins PT and provides consent for ongoing family communication, we meet family members during a special welcoming orientation. It’s an informal, friendly get-together that covers important information about our approach. We have found that it’s a great way to begin an effective working partnership.

We also host monthly family support meetings. These are low-key forums for family members to network together and to share their ups and downs. Additionally, our quarterly educational seminars explore topics of interest (family members, staff, and PT members are invited). Family members have mentioned that these activities are a source of support that has a sustaining effect - particularly through times of impasse and distress.

When family members have questions or concerns, our counselors are the primary contacts. Since we consider families as a part of the PT team, they are invited to Progress Review meetings, along with the PT member. During these meetings, we look at progress, problems, and plan for the future. We address family and PT member concerns in a frank, responsive manner.

Why is the PT approach effective?

Over time, our members come to see that their psychiatric problems can be understood, accepted, and managed. Feeling out of control can often be forecasted and managed before things get out of hand. When a crisis situation hits hard, though, people can move through it - including hospitalization when needed - without losing jobs, relationships, and hope.

At PT, supportive relationships are essential, nourishing factors of healing and restoration. As a therapeutic community, we handle our problems, secrets, and frustrations with trust. Our belief in social responsibility promotes mutual encouragement – we have found that the effect of peer support is comparable (and sometimes superior) to the intervention of a mental health professional.

How long do people stay at PT, how do they get ready to leave, and what about outcomes?

Although our average length of stay varies (8-16 months is common), we provide different step-down options leading up to (and possibly extending beyond) the time that one leaves PT. When a member, together with staff and family, identifies that the timing is right, continued progress is accompanied by a planned reduction of supports while maintaining valued relationships. It’s an approach that contrasts with more traditional level of care changes, which tend to result in new staff members and peers. This can be a problem due to the challenge of forging new relationships during a vulnerable period of transition.

Moving on from PT reflects the person’s readiness to achieve reasonable success in the natural community. We don’t rely on static timetables or symptom checklists. Readiness includes the ability to self-manage remaining psychiatric problems, prescribed meds, a job (or college coursework), social connections there, and the tasks of independent living. We support the person in developing relationships that are based on healthy interdependence rather than an exclusive reliance upon family members. Our focus also includes the need for joy and fun.

“Within one’s natural community, a home, a job, friends, and a date on the weekend.” Over the years, these have been the personal goals identified by nearly all of our graduates. When a person moves on from PT, he or she tends to either live near one of our programs (sometimes in the same apartment complex), or relocate further away. Typically, it’s an apartment setting with a roommate. Costs, chores, and friendship are shared. Since the person is usually working and/or going to college, the days are somewhat structured (this is a major focus our work as one gets ready to leave PT). The person has some friends, maintains a linkage with outpatient treatment, and keeps up with prescribed meds. The ups and downs of life (and of remaining psychiatric difficulties) are mostly anticipated and managed. When a crisis hits, coping strategies minimize catastrophe.

Who tends to do best?

Experience has shown us that a number of factors are associated with success at PT and beyond. While a person’s diagnosis is not one of them, we have found that one’s readiness is very important. This awareness is a vital resource that helps a person invest in and sustain healing and restoration. Other success-promoting factors are supportive family members and the ability to get along with others - even in the presence of strong emotions and previous treatment failures. With regard to the day-to-day experience of being a member at PT, the following actions support positive outcomes:

Moving forward in any of these areas can be very difficult, especially while dealing with the interferences of emotional and behavioral difficulties. Moving forward also requires time, which is why our specialized help occurs over the long haul.

Who tends to have the hardest time?

The challenges and freedoms of living in an open apartment setting can be a lot to handle. We have found this to be particularly true for some (not all) of the youngest adults — those in the 18 - 21 age range. Also, individuals who have spent long periods of time in hospitals, residential treatment facilities, or drug/alcohol rehabs may be accustomed to a highly structured environment. Because these situations may foster a reliance on external controls, they sometimes lead to behavior problems that are difficult to manage in our setting. We also acknowledge that a person who has been hospitalized many times will, upon coming to PT, go through an initial process of re-socialization that requires heightened levels of tolerance and responsiveness.

When we evaluate a person for PT, we consider readiness, maturity, timing, needs and strengths, personal investment, as well as the factors above. Our program features relatively few imposed limits, no “lock-downs”, and we rarely physically restrain a person. For these reasons and because we keep a low profile in the community -- our setting requires a reasonably high level of behavioral self-control. Some of our members, however, do experience periodic behavioral and/or emotional “crashes”. When this happens, we coach the person through the difficulty. Afterwards, we help him or her reflect upon the event and what led up to it — clues and cues. This supports a form of self-learning that emphasizes acceptance and the development of self-management skills (“look back and learn — look ahead and plan”). Asking for help before things get out of hand is not only vital in terms of emotional health, it’s also congruent with our expectation that each PT member acts as a responsible adult.

What about aggressive behavior?

We see remarkably little “acting out”. Our open setting, a commitment to social responsibility, and use of therapeutic relationships help our members develop mutual support and self-restraint. If severe threats, violence, or active substance abuse occur in spite of everyone’s best efforts, we may utilize a brief psychiatric hospitalization. There also may be situations when, as a reality-based consequence, we consider a local law enforcement response.

What about suicidal and/or self-injurious thoughts and behaviors?

Many of our members have experienced these problems, which are particularly common among persons diagnosed with Borderline Personality Disorder. These behaviors interfere with healing and recovery, and they require a commitment to abstinence. For some individuals, we use a 12-step recovery approach because it’s effective, and also because we see these behaviors as being addictive in nature. In addition, we practice principles of Dialectical Behavior Therapy (DBT). Examples of DBT techniques include skill development and practice, applied behavior analysis, and mindfulness training. Click here to learn more about DBT.

What about problems with drugs or alcohol?

These are common difficulties. We expect all members with substance abuse problems to maintain abstinence. For a person with a recent drug/alcohol problem, we provide comprehensive substance abuse recovery services within our programs. Our Certified Addiction Counselors have over 20 years of experience helping people with dual diagnoses (sometimes referred to as MICA or MISA). We provide individual and group recovery counseling, recovery skill workshops, AA and NA meetings throughout the week, random drug screens, and personalized step work. If relapse threatens, we approach the situation on an individualized basis. We do not utilize strict policy formulas, such as “three strikes and you’re out”, nor do we impose a communication blackout when a person joins PT.

How are romantic and/or sexual relationships dealt with?

Members of the PT community must be free to be open with one another since close relationships and trust are vital. The effects of romantic and sexual involvement tend to be powerful, distracting, and wrought with tension. The people who are involved with one another are not the only ones who are affected — other PT members (and staff) feel the impact as well. All of this gets in the way of our collective work. These are the reasons why we expect members to refrain from romantic and/or sexual relationships with one another.

Can a member of PT see an outside (consulting) therapist or psychiatrist?

Occasionally, a person who is interested in coming to PT will want to maintain the services of his/her therapist or psychiatrist. While we are receptive to this, we have found that it is important to address these unique partnerships early on, and with all involved parties. This ensures that, from the start, everyone is supporting common goals. If this applies to your situation, please discuss the matter with our Admissions staff before admission is planned.

What is a Therapeutic Community?

At PT, it’s a group of persons who have chosen to organize around core intentions: to accept, support, and guide a person’s recovery through individual and collective practices. By belonging to a group that identifies with emotional injury and healing, PT members and staff function as a community that advocates for growth through relationships, symptom reduction, restoration, self-management, and the realization of hope.

What’s a typical week like?

Our Program page responds to this question.

What about funding?

Please see the Admissions and Referrals page.

What is the referral and admission process?

The Admissions and Referrals page addresses this question.