‘Sacred Conversations’: A Talk with Susan Swim and a Father Whose Daughter Found Healing

We have two guests today. One is Susan Swim, executive director of the Now I See A Person Institute, which she created in 2007 to provide therapy and counseling to kids, teens, adults, families and others who haven’t found healing in the usual approaches to therapy and treatment. From its base in Los Angeles County, California, the Institute provides both in-person services, including equine therapy, and virtual sessions—and offers training as well. 

An expert in collaborative dialogical practices, Susan Swim is also a researcher whose topics include family reunification, helping people recover from trauma after previously unsuccessful treatments, and process ethics—which she’s described as “what is right and good for every client in therapy.” 

She’s also on the faculty of the Houston Galveston Institute, where she first started teaching in the early 1980s. In the past she worked for the Taos Institute and taught at Loma Linda University in Loma Linda, California. She’s written extensively on many topics and is the former editor of the Journal of Systemic Therapies. 

Our other guest today is the father of a daughter who was first hospitalized at age 13 and endured years of psychiatric treatment, diagnoses, drugs, and more hospitalizations before embarking on a path to healing at the Institute. 

The father will remain anonymous. 

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Amy Biancolli: Thanks so much for agreeing to have this conversation, which is just so important. 

Susan Swim: Thank you, Amy.

Father: Thank you.

Amy Biancolli: I want to start off with a question for you, Dr. Swim, just to define something so that people listening will know what you’re talking about. The term “collaborative-dialogical practice”—that’s what you do at the Institute. For our listeners who aren’t familiar with these different approaches, could you define it and could you describe it in everyday terms?

Swim: Collaborative-dialogical practices used to be called collaborative language systems approach, and it was a type of theoretical—we call the theoretical posture—that we developed in the early ‘80s. And it was along with various other theorists, clinicians in the field, that we all came together, and we’re trying to understand how we could work with people in a different way than what was the traditional diagnosing and treating somebody. 

Our premises were that the diagnoses, and the deficiency language around the diagnoses, led to more trauma than the original trauma that people came in for. There were a lot of people, at that point in time, doing research about this, and studying this, and the basic premises were that through conversation and relationships, people get better—and it’s through normal, everyday conversations that do not contain even words that describe people in efficient ways. 

So if someone comes in for our services—and I use the word “therapy” loosely, because I think that some of us are trying to get away from even calling us therapists, or healers, or any of those types of things—but for people who want to engage in helping people overcome hopelessness and severe obstacles—we work with them as people. We talk with them in common language. We don’t say, “Hi, I heard your story. I think you’re bipolar, and this is something that you’re going to have to understand that you’re going to be limited through life, but you can find techniques to help you with it.”

Those conversations never take place. Our conversations are client-led, and what they feel is going on with them, and so most of the time those are conversations of pain and hopelessness. And collaboratively collectively, we generate new meaning through the participants that are talking about the suffering.

Biancolli: Thank you for explaining that. My follow-up question for you is also a question for the father who’s with us, which is: How does that play out? For the Father, how did your daughter, your family, experience this? How is it different from the usual treatments your daughter got? But to lead into that, if you could tell us a little bit about your daughter’s backstory and her difficulties—what she had gone through—and then what her treatments were, and how it was different at the Institute.

Father: Well, it first started from the school. The school wanted her to go to a psychiatric hospital, actually, and that was the beginning. Of course, now, they put her on medication. My daughter started finding other people that have issues, and they educated each other with the wrong ideas, and that’s how it started. And there was never-ending, never-ending, hospitalization after hospitalization and different medications that never healed her. 

And I was seeing the changes in her all the time, all the time: different medications, different doctors. Four years ago, I met Dr. Swim and her team, and it was right before COVID. So, we started taking my daughter to the horse ranch, and she felt really good at that time— till COVID came up and they had to close the place, and then things started getting worse again. She was getting better at the Institute. Then my daughter got bad again—and again, hospitalization after hospitalization. 

But almost two years ago, things started changing towards the better. When it opened up after COVID, we started going back to the ranch. She really liked horses, of course, animals—because it’s nature, and she’s a nature person. She always has been. It’s a beautiful life right now that we have. And she’s back to herself—like, my daughter, how I used to know her when she was a kid. She always is a helping person, wanting to help others. I wish you could see her now. She helps people. She goes to church now, and we’re so happy. We have our family back. It’s a beautiful thing.

Biancolli: It is beautiful. I’m curious about your daughter’s entry into the system. What was she going through? What was the distress that first signaled to people around her—whether it was teachers or whoever—that she required treatment? What was her initial distress, and what was her initial diagnosis? What triggered it?

Father: So in the beginning, it was bullying from the school, actually. Supposedly, she was going to hurt herself. That’s what we heard from the school. 

They don’t do anything about it, and they want to hospitalize her—because she wants to hurt herself. So that’s when the law came in, as police removed her from my house for a 72-hour hold. And that was the beginning. That was the beginning of all the bad things that started happening to her.

Biancolli: Thank you. Thank you for explaining that.

Swim: I moved here in 2002, and we started working with a lot of children that were very hopeless. And what happens is that these children tell a friend, right, that “I thought about hurting myself.” There’s no means, no plans, no intent, but there’s a zero-tolerance policy. 

Then it’s very easy for these children to be hospitalized—because they don’t know they’re going to be hospitalized. They’re taken away from school, sometimes in a police car, and they’re put into holding cells at local hospitals. So a lot of times these are locked rooms where the children go in. They’re 12 or 13, they can’t see their parents, they’re crying for their parents.

And then, because of these reactions—not only from the screening at the school, but what happens at the psychiatric facility holding area—those symptoms are seen as very escalated, right? So then something that might have been going to school one day and talking to a friend now has a massive, major diagnosis and treatment. I think this was something similar to what this family found themselves in very rapidly, and they weren’t really prepared for the loss of autonomy in trying to help their own child.

Father: Actually, that’s exactly what happened, Dr. Swim. Because the school, and the school district, heard it, and they put her in a psych ward for a 72-hour hold. That was the beginning.

Biancolli: So what you’re describing is a situation in which teachers and administrators are making a decision for your daughter based on something that somebody heard—but then they’re not listening to you as the father. I’m guessing, correct me if I’m wrong, that probably your daughter didn’t really feel heard. And does that point to the significance of having a conversation with the young person in distress? Is that what Now I See a Person Institute is trying to prioritize? Just see, literally see, that young person as a human being, as a person?

Father: Exactly. That’s what it was, actually. [With the school and the law] we didn’t have say-so, they didn’t listen to us. They have the power to do whatever they want, and that’s what they did. They didn’t listen to us. No matter what we said—even our minister came to our house, he was with us—they didn’t listen. They just took her away. “We have to hold her 72 hours.” And, exactly, they took her to a holding cell. Not jail, but it looks like jail, a 72-hour holding cell. And there you go. That was the beginning, yes.

Swim: I’m sure your listeners know the trauma that’s involved in this: A young child being put in a police car, taken and locked up, not being able to be with their parents, being told that they’re a diagnosis, and that they’re mentally ill. And it’s insinuated that their parents did something wrong. 

Just the very nature of separating the parents starts to chisel down that trust between the child and the parent—versus the child and, kind of, the new parental role models, who are the mental health professionals or the clinicians. This is not in any way an isolated incident, and the parents automatically, unfortunately, are suspect—that they did something wrong, that they did something negligent. 

When you have a young person, and this happens to them, the whole self-identity is so shaky. What they had known one day is much different than what they knew the next day, and people try to say it’s through the trauma, right? Through the trauma of what had happened before. But in our eyes, it is the trauma of the treatment. The treatment is so severe that it’s like being caught in a riptide. They don’t know what’s up, they don’t know what’s down, they don’t know who to trust. They are so fragile, and in that fragility, they’re hopeless that life is ever going to get better—and they eventually just do want to kill themselves because the pressure of living every day is so difficult. 

So a lot of our clients will be put in a hospital, and then out for a couple of months. Put back in, out for a couple. And by that time, they are seen as not being able to get well. And they have to have conservatorship, because they will not be able to take care of themselves.

In talking with all of our clients, they have this history of what happened when they entered into the mental health field. They thought they were going to have someone to talk to, to support them, to kind of comfort them —and not that they were going to learn a completely new language that describes themselves, the world, and their family. In our state, and most states, whenever a child is hospitalized, there is an automatic report to the Department of Children and Family Services [DCFS], and so can you imagine, if you have so many hospitalizations, how many times the Department of Children and Family Services is called in.

Biancolli: I would like to ask about the nature of trust, which is a word you used, Dr. Swim. And from what I’ve read about the Institute, and listening to your podcast, it seems like building trust is a huge piece of what you do. How difficult is it to acquire, maintain, and encourage trust with someone like the daughter that the father here is describing? And also, with the father? After having been through all of this systemic difficulty, trauma with the system, how do you manage to convey to these people that “we’re not going to judge you. We’re going to listen to you. We’re going to let you direct this conversation.” How do you do that?

Swim: At first we started doing this with horses—and one of the things, on that first day, I knew that we had something profound happening. It’s that when you go into a horse ranch, and you’re dressed in a pair of jeans and a pair of boots and a shirt, and everybody else is casually dressed, it very much evens everything. Even though there’s inherent power and hierarchy, it’s not screaming and yelling at you. You come into a normal, ordinary place where everybody is the same—except people are suffering more than others. 

There’s an abundance of ordinary things just to talk about, like the horses or squirrels or rabbits, or—oh my goodness, it’s endless, the conversations. And it goes so much with our theoretical presence of not being on problem-talk, of not talking about deficiency all the time, because that deficiency is just a little bit of who we are. We are so many other things that happen to us. This isn’t psychoanalysis.

This is about having real-life conversations with everybody about how each person is suffering, and how each person wants to be able to have a different type of path, a different way of participating in the world, both individually and with each other. So that’s why we incorporate a therapeutic team, because this is hard to do for one person—to honor and hold all of these narratives. We do see that as that we’re honoring the person, because we are hearing things that, perhaps, they’ve never spoken out loud before. 

We have called it “sacred conversations,” and the term “process ethics,” because whatever somebody utters is sacred to them, and so we want to have the reverence to meet that sacred space where generative conversations can occur. So if I’m thinking back to how this trusting relationship evolves, just being in what we call out of the office, it occurs just like it does if you’ve met somebody in a restaurant. 

You know, [marriage and family therapy pioneer] Lynn Hoffman used to call it “kitchen table talk.” Like you go to a family, and let’s just say that family’s getting along well, and people are talking right and left. There’s no rote ways of doing anything. We don’t replicate one client with another client. We do not replicate one session with that client and think that the next session is going to have even the same themes. It is all client-driven on what they want to see happen.

The therapist’s ego has to be very deflated in favor of what these people want to talk about. Even though I went to college for more than 12 years, I don’t care. Those things don’t matter. What matters is that the person that’s suffering is going to be able to get some type of alleviation. And you never know how that’s going to happen, because the pathway from that comes from the participation of everyone. 

The other thing is that because we are so different, just from the first few minutes engaging with people, automatically there’s this wanting to trust the newness that is there.

Father: Yeah, that’s very true, actually. It is very true. Again, at the beginning, we weren’t that jazzed about it, because we’ve seen so many different psychiatrists, psychologists, and nothing was working. But in the first-second week we really enjoyed it, because honestly, my daughter liked it—and we’ve seen the change in her, the calmness. Of course, maybe it was the horses, definitely the horses had something to do with it.

Biancolli: So you saw a difference in your daughter pretty quickly, then?

Father: Oh, definitely, very quickly, actually, first and second week. Yeah.

Biancolli: That’s remarkable. Was it because, as you said, she really liked the horses—but did she get a sense that she was being heard? She was being heard and seen, was that the difference?

Father: Yes, and she couldn’t wait to go. It was Wednesday that we used to go. She’d put her boots on because, you know, there’s horses there, and she wanted to feed the horse. But it wasn’t an office visit. It was an outside visit. 

I think it was the people. She was being heard, and she really enjoyed it. Yes, she did. I’ve seen it.

Biancolli: So Dr. Swim, I’m curious. You had written about “not-knowing” as a big piece of it, and the humility that’s required. And I realized that this was maybe a significant part of the founding, the origin story, of Now I See A Person Institute. If you could address that a little bit right now—how you came to this understanding of what actually would be healing for people, and what your hopes were from the beginning when you founded the Institute.

Swim: So I always say that I was very fortunate to be at the right place in the right time when I was going through my graduate school. And it was a time where you’ve read books like Psychotherapy: The Hazardous Cure—that people got better on a waiting list than going in for therapy. It was a time where you were critical of research. You know, you were taught to see how research tried to present what they thought they should present even before the research was started. 

So it was a time of—I don’t want to call it enlightenment, but maybe logic. And it was also a time where marriage and family therapy was just starting, it was just budding, and marriage and family therapy never focused on a diagnosis. It focused on the system, and how to help the system. So when I had the opportunity to open up the nonprofit—that was just on a whim, and I started with a couple of horses and my students at the university that I was teaching at. And I remember on the first day that we were there with the horses. I had owned horses all my life, so I had an idea that this was going to go well. 

And it was like night and day. It was night and day. The type of authentic, generative relationships that happen in a naturalistic environment that doesn’t yell “clinician” was massive. 

So that’s what we’ve been doing since 2007. With COVID, we couldn’t go to the horse ranch, unfortunately, and so we started doing what we call “out of the office.” So we would go into people’s backyards, or telehealth, or meet at parks—or anywhere that does not scream pathology-deficiency language.

Biancolli: Dr. Swim, this is going to sound like a really, really basic question. But is the ultimate aim just trying to help people figure out how to be happy? I mean, again, that sounds so basic, but is that ultimately what you’re after?

Swim: Yes, we have to get close enough to understand the type of pain that people are going through so that we can all talk together on how that pain can be alleviated. It’s not from a script of a theoretical treatment plan, you know. I was around when everybody was making the theories, right. And theories were never meant to be followed in steps of “You do A, B, C, and then you go this way, and then you come back.” You know, they were just ideas of what we can do to be helpful with people. 

But what I see, especially with younger students, is that this theory gives them so much self confidence that they can’t see the client because they’re just seeing the theory. So it’s not about bashing clinicians. It’s just the way that they’ve been taught. And I think that what we want to do is offer training to clinicians that helps them to see people, that helps them to be able to listen, because my friend Tom Anderson used to talk about this—listening always involves prejudice.

It’s so easy to have prejudice in our minds. You know, I always talk about how we have to be in the conversation. This is not a field to take lightly. It’s not just to have that 45 minutes, and then get paid by the insurance company and get the next person in. You know, we’re dealing with life-and-death situations here. And so we need to know how to listen. And for me, I know I’m not listening if I have other ideas that are coming up, like, if I’m getting frustrated with somebody. We need to ask ourselves, why am I frustrated? What’s happening? And then we can answer and say, well, maybe I’m worried about them or maybe this or that, and then you can bring that into the conversation. It can be an honest, transparent, genuine process. “I’m worried about you. How are we going to make sure that you’re safe?”

Biancolli: A two-way human conversation that acknowledges the complexity of the other person. That makes so much sense hearing you describe it.

Swim: I just had one more thing that I thought was important. This child was taken away for a year while they were watching TV. They were placed in foster care, and then they were placed in residential treatment. And residential treatment wanted this father to take conservatorship because [they said] this child would never get well, and would be a risk to themselves and to their family. I don’t know if you could talk about that.

Father: It’s so true. That’s what happened. I remember that somebody from DCFS comes. It was about one o’clock, and she knocks on the door. I open up the door. I said, “What are you doing?” She goes, “Well, we heard something.” I said, “Heard what?” And she opens up a case that my eyes were red. 

I’m a father. My daughter has been in a hospital. I just took her out of the hospital, I haven’t slept very well, my eyes are red, and she tells the court system that my eyes were red, maybe I was on medication. Just after that DCFS removed [my daughter] from our house. We cried so much. We didn’t have a chance to argue. And she got taken away, and she was about hour and a half away. 

And after that she went to residential. The court system put her in residential for almost six months. Finally, after two months we had visitation—to go visit her once a week. For almost a year, that’s what we did. It was terrible, terrible, a very terrible time that we had.

Biancolli: So essentially, they took your daughter away because you were so exhausted that you had red eyes?

Father: The psychiatrist told the DCFS that there was an issue at home. At 1 o’clock or 1:30 she came and knocked on the door, just somebody’s banging on the door. It was cold. I remember that night. And supposedly she says in a court filing that my eyes were red, you know. I’m not doing drugs, I don’t do drugs.

But that’s how the system works. Unfortunately, this is our system. That’s how the kids—they get taken away. And a lot of kids, they get lost in the system. We’re some of the lucky people, and I am lucky. I thank God. I thank Dr. Swim. 

Swim: I think it’s important to know that they wanted the parents to take conservatorship of this child.

Father: They did. And we almost thought about it, and I did talk to somebody. And he goes, “Are you sure?” But this is not the right thing. 

Biancolli: Your daughter is doing much better now. You said she’s not on medications. And she’s also in college right now, right?

Father: All together in the last five years she did a whole [180].

Biancolli: So as a father, this whole experience must have been incredibly difficult for you. 

Father: Not just for me. My wife, she suffered a lot. We all suffered, all of us. Not just my daughter, not just my wife or me, all of us suffered. Of course it was terrible, terrible. But we got lucky. We’ve seen the light [at the end of] the tunnel and our fate kept us going, and we’re here now.

Swim: I would like to say that this is something that is not common, but I have been in the field since 1983, and it’s very common: The child is removed from school and put into a situation that is very scary. And then, often—I’m not talking just about this case, but cases in general—they don’t know who to trust, right? Do they trust their parents? Do they trust the clinicians who are very, very convincing about what is happening? And pretty soon, these children are very, very confused. And it’s a journey for the whole family of reuniting, and how that reunification can occur. For us, this is an example of—and I hate to say this, but probably the majority of clients that we do see.

When we first see our clients, we have a lot of hope, because we have seen these types of situations over and over and over again. But they go through a lot of trauma within a system that’s supposed to be a little bit different. We see these families as heroes and heroines, you know, and they’re amazing. They’re wonderful. They’re loving. 

Biancolli: So, a question for both of you: What would you say, or do you say, to other parents to give them hope?

Father: Parents should be a parent first. Spend more time with your kids, listen to them, and if you have rights, don’t fall into the system. Don’t have a big ego as a parent—that “I’m right, you’re just a kid.” No, you have to listen to them. It would help a lot, I think. 

Again, in our situation, we didn’t have that many rights, you know, unfortunately. You got to fight on this one. It’s almost a fighting situation with the system. And don’t give up, no matter what. Don’t just believe the psychiatrist. And probably, if my daughter got taken away when she was 13, I really doubt that we could have got her back.

But she was going to be 18 when they put her in a facility at the end. They had to release it. The court had to release it. They go, “Okay, she’s going to be 18 in three months. Okay, you have to do this, this, and this.” If she was much younger, we wouldn’t be this lucky, probably. I really mean it, bottom of my heart. But again, don’t lose your faith. That’s it.

Swim: So this is the type of work we’ve been doing for 40 years, a long time. I age myself every time I say that. And the majority of our clients transcend. They heal. Their children come back. I’d say most of our clients do not continue on medication. Our clients do not continue to be hospitalized. Our clients, they’re redesigning their lives in the way that they want to redesign their lives, and we don’t see ourselves as therapists or psychologists or clinicians that we have the right to do that redesigning. This is for the families to do.

I know especially for the people involved in the story that we’ve been talking about today, it’s a wonderful outcome. Everybody’s super happy. We get to hear about college graduations and amazing, wonderful things. And things can turn around so incredibly rapidly as well. And so I guess my hope is that people do not lose hope.

Biancolli: That’s terrific.

Our guests today were Susan Swim, executive director of the Now I See A Person Institute and a father whose daughter found help and healing there. You can find out more about the Institute at www.nowiseeaperson.com. 

Thank you so much the both of you for this conversation. It was really powerful.

Father: Thank you.

Swim: Thank you.