The Visible Hands Collaborative in Pittsburgh, Pennsylvania is run by Alice Fox Thompson and Kenneth Thompson. Together, the father and daughter team is bringing a novel form of community healing developed in Brazil, called Integrative Community Therapy (ICT), to the United States for the first time.

Alice Fox Thompson is currently in her fourth year of medical school at Geisinger Commonwealth School of Medicine. Before medical school, Alice worked in community organizing and advocacy. She is interested in solidarity-based approaches to community and population mental health.

Kenneth Thompson is a psychiatrist trained at the Boston University School of Medicine. He has served as faculty at Yale University and the University of Pittsburgh and has been the director of many different psychiatric clinics. Ken currently serves as the Chief Medical Officer of the Pennsylvania Psychiatric Leadership Council, a unique state-level education policy and advocacy organization that he helped found.

Ken’s focus as a psychiatrist has always been on social medicine and community psychiatry, having written, consulted, and lectured extensively on issues of public service, whole-person treatment, primary health services, health equity, democracy, human rights, and more.

In this interview, Alice and Ken describe how they both came to Integrative Community Therapy and what they’ve learned in adapting it to their context in the Visible Hands Collaborative in Pittsburgh. They also discuss the connection between the emotional literacy and community support developed in their groups and broader processes for political change and social justice.

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


Micah Ingle: Can you introduce yourselves and talk briefly about your respective backgrounds, as individuals in the healing professions, and community organizers—whatever you feel is relevant?

Alice Thompson: I came to medicine a little bit late. I started my post-college professional life as a community organizer. I worked on several political campaigns as a field organizer.

I came to medicine differently than most people do. I had been inspired by the community work that I had done, particularly by volunteers that I worked with regularly who came from a wide variety of backgrounds—often the most historically traumatized communities in Pittsburgh.

The thing that inspired me to go to medicine was that I saw that these folks really struggled. They struggled with access and struggled with having physicians and professionals around them who didn’t quite see the situations that they were living in face-to-face. These professionals didn’t really know how to deal with the types of challenges that they were facing.

I was inspired to go into medicine as someone who would work with those communities in ways that perhaps other more science-based, science-educated people didn’t really focus on as much. I came at the medicine that I was looking at and the type of work that I wanted to do from a community standpoint, and I wanted to find novel approaches that could do this while taking into account the impact that working on a community level really has for people.

I was really excited to hear about Integrative Community Therapy because it was such a beautiful approach to the things that I love the most about the field that I work in: bringing together community members to understand each other and sort of break down the walls that divide us, while also doing it in a way that is trauma-informed and taking into account the ways that individuals experience their own mental health challenges.

Kenneth Thompson: I’ve been working in this field now for almost 40 years. I’ve always been a psychiatrist interested in the relationship between people and the place and the communities in which they live. I’ve had a long-standing interest in what are called therapeutic communities. We used to have this in hospitals—when people stayed in hospitals long enough to be in a kind of community.

That obviously had some very serious drawbacks—that you would actually be in a community in a hospital as opposed to being in a community in a community. But it was still an interesting way of imagining that it was important for people to have relationships with other people for their own healing, and for the healing of the overall community.

I’ve worked in outpatient psychiatry for most of my career. But most of the time it’s always been back into community settings, with a particular interest in public health: trying to imagine what we could do to help people not have to show up with psychiatric challenges in the first place.

What are things that we could do to actually promote health and wellbeing so that folks didn’t have to go through any suffering at all, or the least amount of suffering possible?

Clearly, what we want to do is try to find ways to help people have the lives that they want to live, and on top of that, create places where it’s possible for people to have the lives they want to live.

We need to find a way to create a human network that is stitched together and is based on everybody’s well-being. That’s been the basic premise.

I’ve been looking for ways to figure out how to broaden the capacity of people to find health and wellbeing that would build on what I’ve been learning in recovery, which is that everybody’s got assets and capabilities and capacities that 99% of the time we forget to check and we forget to tie into.

What really got me going with Integrative Community Therapy, or what I originally heard about as called Community Therapy, was inspired by a psychiatrist in Brazil, working in a favela, which is an American term that would be basically a shanty town.

Favelas are places that have been constructed out of anything that people can find and built on land that doesn’t belong to them theoretically, and that can be knocked down by the police whenever they feel like it. Folks who end up there are people who’ve migrated from even worse situations, so you can only imagine the challenges that folks have.

This psychiatrist is in a favela trying to help people, and he realizes that if he’s doing what I’ve been doing for the last 30 years, which is to see one person at a time, he will see the very tip of the finger. He won’t see very much of what’s going on, and he’ll be less able to help people. Not only because his own powers are limited, but because we’re not tying into the challenges that people actually face.

He sat down with the people from the favela, and he noticed that when people were struggling, the other people in the favela would often offer various kinds of comfort, something that we also see. Ways of trying to help people manage very difficult and challenging emotions as well as experiential states—people would comfort others and express a kind of solidarity.

He saw that, and what he started to do with the folks in the favela was to organize that as a process, which is called Integrative Community Therapy.

What it allowed him to do was to work with groups of people that get to be as large as sometimes a couple hundred. Most of the time probably somewhere between 15 and 40-50, something like that, and to and to do what you picked up in your description of this Micah: not just healing individuals, but healing communities.

It’s an exercise in community healing as well as trying to help people figure out how to address the challenges they have. That kind of thinking is exactly what I’ve been looking for, for a long time.


Micah Ingle: You’ve both mentioned Integrative Community Therapy, which—as far as I’ve been able to understand—is a really unique model of practice for community healing. Can you give our listeners a primer on what exactly ICT is?

Alice Thompson: Integrative Community Therapy is an open, large group dialogic practice that is meant to take place with between 15 and 200 people. The purpose is to discuss the emotional distress that individuals bring to a community, but also to create a universal approach to those same emotional distresses. To describe the structure, it’s a five-step facilitated dialogue.

Each participant of the group is there to participate on any level that they feel inclined to do. You can spend the entire time contributing, answering the questions as they come, sharing things as you’re invited to share them, or you can sit there and not say a thing, listen to the entire conversation without engaging specifically based on your experience at all.

The five steps go through a welcoming, celebrations, and a dynamic. We also have rules that we engage in; I can describe those as well.

The first step is composed of a welcome, describing the ground rules that we all engage in while we’re together. With celebrations, we invite people to celebrate whatever is present for them—that they had a birthday party, or that someone was born, or just that they got out of bed that morning. Then we close step one with what we call a dynamic, or an icebreaker, or mindfulness exercise, just something to get us present and in the moment.

Step two is where we ask people to share a struggle that they’re facing, emotional distress that’s been bothering them, weighing on them, or feeling like it’s holding them back in some way. We ask maybe four or five people, depending on the size of the group. We collect what we call pebbles.

This is based on a Muhammad Ali quote that says: “It isn’t the mountains ahead to climb that wear you out, it’s the pebble in your shoe.”

It can be small things, small emotional distresses that are holding you back or preventing you from achieving whatever it is that you want to achieve in your life. It can also be larger things, and ICT is capable of holding larger subjects or deeper subjects as well. So, we ask for people to share those pebbles that are in their shoes.

From our gathering of pebbles, we ask members of the community to vote on the one pebble that resonates with them at that moment, for whatever reason. It could be that they just really want to talk and think about that subject, or maybe they’re experiencing something along the exact same lines.

Step three is where we ask the person who contributed the pebble that received the most votes to share more deeply about their emotional experience. This is really where we ask questions about the situation: how that pebble is making the person feel. This is where we get the emotional articulation that allows people to exercise and build emotional literacy, which we see as valuable practice from this method.

We then move to step four. Step four is where the orchestra comes together. We ask the community to share, based on their own experience, a time when they went through something similar to the person who shared the original pebble.

The key moment here is that we also ask each person in the room to share a strategy for how they overcame that struggle.

It’s really asking people to articulate not only their emotional experience but also the tools and resources that they developed in response to that struggle. It can relate to internal tools—so rewriting our own narratives, thinking or approaching something in a different way, or deciding that that thing is no longer important.

It can also be external, like interpersonal support or relying on a friend or family member. It can be institutional—”I decided to go to an institution, I went to church, I went to my social worker,” or some other external resource. It’s a range of resources, and all of them are right. There’s no wrong answer.

It’s also not meant to be one size fits all. We don’t expect that the person who brought their pebble to the room will necessarily want to use every single strategy that’s contributed in step four.

Even if you walk away feeling like you’ll never use those resources, the simple fact of sharing our stories, sharing our lived experiences within a group, and hearing other people give the gift of sharing their story with you, makes people feel united in harmony, in a cause, in their community—by simply being there with each other.

Step five is all about sharing the things that we plan to take away from the experience, so something that someone shared or a topic that was brought up. What’s key to this step and what I love about it—it’s absolutely genius— is that not only does the individual share what they’re taking away with them but they’re asked to share who gave them the gift of that learning or that contribution. They’re asked to thank that person, to show gratitude for the gift that they were given by name.

The folks who brought something to the room get to see the impact of their words, their story, and their experience on the other people in the community. It’s a really beautiful process. I also think it’s hard to imagine being a participant when you’re describing the steps because it is such an engaging process. It’s an emotional process, and it can be very, very visceral in a way that just hearing about it intellectually has a hard time touching on.


Micah Ingle: It sounds like a fascinating pooling of resources, and it’s a lot of what I’ve been finding in my research as well, especially the community storytelling aspect. I am curious if either of you has anything to say about contrasting ICT with existing models of mental health care in the U.S.

Kenneth Thompson: We’ve talked about the idea that this handles anywhere from 15 to 40 people. It last about an hour and a half. Sometimes it can be shorter, say 75 minutes.

Not everybody speaks. So another way to ask the question is, in the way we think about doing treatment or therapy, we’re either giving people meds, or sometimes there’s some kind of intervention, or we’re engaging them in some form of “psychotherapy.” But the expectation is usually that everybody is going to talk, right, that being there is to be an active participant in this.

While I think talking and participating is an important thing to do, we are actually thinking that it’s not just the talk that makes the biggest difference; it may be the listening and the participation in that process of witnessing and listening, that makes a difference. It’s a little bit as if we conducted therapy, but we had other people sitting in the room just listening to the process of the therapy.

We don’t necessarily do that, and ICT really doesn’t do that because we don’t want to focus on just one person. We want to try to think about how the challenge that they’re facing has elements that other people in the same room faced. The notion is that it is a sort of participating in and listening and beginning to be part of an emotional web, a feeling of connection that I think is really what makes a difference.

The people feel held and welcomed, and they’re part of something, and they get to choose how much they participate. But if they are there and they’re listening, which they’re doing, then we believe that the whole community gains just as much as when the people talk. That’s a little bit of a difference from routine therapy, and obviously, the size of it is much different than how we tend to think of it.

The reason I wanted to go on about the people who were not talking and just listening is that we tend to have a very individualistic model of how we approach psychiatric challenges. Even when we think that the people don’t have the problem, but the problem is around them or on them, we still act as though it’s the person all by themselves and that there’s no real connection to anything else.

This is a beginning, I think, of getting to a place where we see the whole web of people as having a challenge and having a need to learn how, amongst themselves, to be able to live their emotional lives, express those emotional lives, share those emotional lives, and feel okay in doing that.

Alice Thompson: I’d like to add, I think for me the biggest difference is that it asks people to show up even if they don’t have some sort of pathology that they’re dealing with. There’s no pathologizing in the Integrative Community Therapy context. Facilitators are not trained mental health professionals necessarily; they can be, but you don’t have to be in order to become a facilitator. There’s no diagnosis occurring, there’s no professional advice being given, or expertise being contributed.

Dr. Barreto always says: “The only expert in the room is you because you’re the expert of your own experience.”

I think part of what makes that so unique is that we’re not approaching this from the idea that everyone who shows up at ICT is necessarily very sick. Maybe you show up because you like seeing people and you want to be in the community and feel that warmth. It’s not sad. I mean, it’s a very joyful experience at the end of the day.

There can be hard moments where people are expressing deep emotional pain, but the community is there to bring healing and ultimately liberation and levity and joy back into that person’s life, and into the community’s life. There’s music and we dance, we make jokes, we tell stories, and we always finish with a song. It’s a very joyful process, even though it is also a place where people share their hardships.

I think that’s really different from how people assume therapy is meant to be because people think you’re supposed to go to therapy when you’re sad and when you’re really struggling and having a hard time. Not that you can’t engage in Integrative Community Therapy when you do feel that way, because it is meant to be a space for people who are experiencing those emotions.

But it isn’t just sadness, it isn’t just toiling and hard deep inner work. It’s also a lot of joy and fun and lightness that occurs when you can be with other people who celebrate in your culture and feel a familiarity with the cultural signifiers that your community brings to a space. For me, I walk away from ICT saying, that didn’t just feel really good, that was fun.


Micah Ingle: I’m curious about the reception of bringing this practice from Brazil to the US. We’ve been talking a little bit about individualism and the need for community. I read that you’ve trained 35 facilitators so far. I’m curious if you’ve run into any culture-specific challenges bringing it to the US.

Alice Thompson: We’ve definitely run into some challenges. I think the individualistic nature of American culture also comes with a lot of skepticism, and so there’s a desire to see proof of effective outcomes for this type of approach.

There is skepticism here from an American perspective, particularly coming from Brazil where they do a lot of qualitative research as opposed to quantitative research. I read an article the other day that did a meta-analysis of the literature on ICT, and it showed that something like 85% of the research that’s been done has been qualitative. People in the U.S. really want to see numbers, they want to see data, and they want to see randomized clinical trials.

But we see that as a nation, our mental health services are so drastically failing the people in this country that if there is evidence in Brazil, which there is evidence, then it’s worth trying because this is a structure that’s been not only built but developed over decades now. ICT has spread successfully across a country that’s actually really similar to the U.S. in so many ways.

Then, I think people are not familiar with the idea of sharing personal experiences and emotional experiences in a group. It can be vulnerable; it can be difficult. Particularly for men to be willing to acknowledge an emotion that is a little bit taboo for them to feel, and particularly to do that in a public space.

One of the community guidelines that ICT uses is that we say this is not a space to share secrets. Not that you can’t share deep meaningful emotional experiences, but that if it’s a secret that you want to remain a secret, we are in a public space. People can come and go as they please, so there is no HIPAA compliance here, we can’t enforce that.

I think people approach that also with some fear and reticence because they don’t know what the outcome will be. They don’t know if it’s going to be a positive impact if they choose to be vulnerable in that space. I think those are some of the places where we’ve seen resistance.

However, I do think that in a lot of ways this is such an intuitive process. Once people show up and they start participating, it almost just falls out of them, because we all have been going through such extreme global trauma that people really need to engage in these kinds of conversations. When they show up, they do it.

But I think it’s about getting folks to show up, getting folks to understand what it is, what it looks like, what it feels like, why is this helpful. I think those kinds of questions, and just the stigma of going to therapy–the word therapy itself can be a barrier in our culture.

Kenneth Thompson: It’s hard to get a new form of doing anything up and running, so I guess it’s not surprising that we’re bringing something that’s relatively new and running into some challenges doing that. Alice already mentioned the issues around outcomes, and it’s not only just the qualitative aspects of the outcomes but also the unit of the outcome.

We are actually thinking as we’ve suggested, talking to you Micah, that this has got a community-level outcome as much as it does an individual-level outcome or many individual-level outcomes. How do you measure a community-level outcome, and who even has thought that that was important, right? In the United States, we’re so individualistic, that we usually don’t even think about that as a blanket concern.

Another challenge related to the newness is that we’ve kept the ICT that we’ve done free of charge, and we would like to continue to do that. We see this as a community benefit that is part of a way that people can use and learn how to manage and deal with their emotions in a community and how the community learns to manage the emotions that it has as a community.

Making people pay money to do that is going to make that challenging. It’s a society that is based on things getting branded. We’re not keen on getting it branded.

We really want to see this notion of solidarity care emerge as a way of thinking, in which ICT is part of a larger scope of activity for peer support and other kinds of community efforts that support and promote healthy and supportive relationships between people. We want to see that happening but getting there is going to be a challenge.

One last piece: the favela Quatro Barras in Brazil has been working with Adalberto for close to 40 years. We’re the first group that has brought this method to the United States. There are over 40,000 trained facilitators in Brazil. There are facilitators now in most of the countries in Latin America. There are facilitators now coming up in Europe, Africa, and Asia, and now we are bringing some of this to the United States.

It’s not a small thing to jump from Portuguese to English. I think that’s been a challenge. I suspect that it relates to the evidence, but I also bet it relates to cultural condescension—that the idea that you could bring a process that was invented in Brazil to the United States. It’s like, well, why would anybody ever want to do that?

The fundamental thing that Adalberto and the folks in the favela did was that they recognized that necessity had to be the mother of invention. They had to think of some way to move to a different place because the capacity that they had otherwise was never going to be close to what they needed to do.

I’m not going to claim that they’ve necessarily solved the problem of mental health by any means. But I think they’re a little bit closer in their capacities as a result of this.

In the United States, as Alice said before, and even as President Biden has said, we’re in a mental health crisis. Even before the pandemic, people were isolated and disconnected. Rates of distress were high–we were having increased rates of suicide; we were having massive amounts of deaths from overdoses. We’ve had deaths of despair afflicting entire communities all across the country. We’ve continued to have trouble with folks who’ve got long-standing psychiatric challenges.

More and more people with psychiatric challenges are being created every day in the social system we have, so how the heck are we going to get ahead of that if we don’t start trying to be innovative, and if we don’t look for resources where the resources are?

I think the critical thing to figure out is that the resources are in the people. We have to figure out how to help them unleash them. We don’t always know what our own resources are. But we do know that they’re there—if we can help people find them and use them and express them. I think that’s what ICT has really shown. It’s peer support at the next level up. It’s going to the community with peer support.

It gives you an opportunity to stretch your feelings, to exercise your capacity for compassion, to exercise your capacity for solidarity, and to exercise your ability to imagine and think about your own life and how it relates and connects to other people. That’s something that I think is a real value.


Micah Ingle: Another person I interviewed is the Liberation Psychologist Mary Watkins, and I hear a lot of similar principles around dialogical types of thinking and horizontality of relationships. I am curious about ICT’s intellectual background. I know that you’ve mentioned Gregory Bateson and Paulo Freire as big influences there.

Kenneth Thompson: Paulo Freire is Brazilian, one of the founders of liberation psychology in the world of education. Folks may know him from having written a book in the 1970s called Pedagogy of the Oppressed, in which he talked very much about the horizontality of the teacher-student relationship, in which the student is the teacher and the teacher is the student.

He worked with the Campesinos in Brazil, helping them to become literate by helping them have conversations about the real circumstances in which they lived. This motivated them both to learn the language and to read, but also motivated them to have deep abiding discussions about the circumstances they were in, a process called conscientization.

Adalberto will say that ICT is really a conscientization around emotions. It’s emotional literacy; it’s helping people find ways to express and talk about the feelings that they have, share those, and develop. Alice alluded to this before, that people in a community begin to develop a kind of alphabet of emotions by sharing and being in connection with each other.

They can begin to feel and connect and understand each other in ways that they weren’t able to do before.

Some people have come to us and said, “if you do an ICT, are you ready for the revolution? Have you organized the meeting for the revolution as a result of ICT?” What I would say to that is, no, not necessarily, but what you’ve gotten is people who are ready to do the work that they have to do in their lives and in their communities.

They’ve developed the relationships that will allow them to do whatever kind of political, organizational, social, or faith-based work that they need to do to make their lives a better place. It’s the emotional foundation of the work that folks can do with themselves and with others, to move their world and their lives to a different place.

Alice Thompson: The other part of this that relates to conscientization is that ICT asks people to claim their narrative by telling the story of their lived experiences. The theory behind that, going back to Paulo Freire, is that once a person can own their story, they become the subject of history as opposed to the object.

Historically in these agricultural communities, the folks living there and in favelas were people who history was operating through. Elites and the government leaders were the ones who were actually the subjects of history. They were the ones who we need to tell stories about–the arc of history is based on their experience.

But when we invite people to exercise their ability to tell their stories, they start to claim their place in history, which on a community level means that we can get an entire community to claim their subjectivity within history.

That is a population-based approach to allowing people to see that their emotional experience influences the way that society carries out its processes, and thus it empowers them or gives them the autonomy to create change in their society. The idea is that we start by getting people to be able to see themselves as part of the story so that they can begin to change it.

Kenneth Thompson: The Gregory Bateson piece that follows right from that is that in telling those stories, in communicating those stories, you start to have a system of relationships formed that are interdependent with each other and related to each other.

As the capacity grows in one end, that begins to shift the circumstances in the stories and the communications in others. The whole process is an evolving whole. You perturb it in one place and then the process just starts to grow and take off in that sense. It’s really a systems theory that is hard to grasp through individualistic thinking.

This is not about: you go to ICT and you get the solution to your problem. You might. You might get some feeling of support and emotional connection. Those are all important things and we don’t deny them.

But on top of that, you may actually be participating in the creation of a network of humans connecting and storytelling, and communicating with each other. This can have systematic effects that go beyond even the process that brought you in there as a single person in the first place.

Alice Thompson: Cultural anthropology plays into this. That’s why we play music or ask people to share culturally relevant prayers or sayings or jokes or readings because what Dr. Barreto talks about is how people relate to each other based on their shared cultural background. Once we allow people to see those same cultural signifiers shared, and those same lived experiences that we all see as we’re growing up in a similar community, that familiarity breeds—it builds the web.

It creates the ties that we then use to trust each other, rely on each other, to continue to build the community social networks that we are attempting to build through ICT. It’s building the context in which people feel comfortable sharing, but it’s also creating a new community sense because those are the things that—when we go through each ICT round in that space—we’re always going to go back to those same signifiers.

I think one of the really wonderful things about ICT is that it is so culturally responsive. Dr. Barreto says: “Whatever the language is that you need to use throughout the steps that is appropriate for that space and that community is the language that you should use.”

Here’s a good example: Sylvia London and Ñeca Irma Rodriguez were hosting a round in Houston, Texas, but they are originally from Mexico City. They were hosting the round based on what Adalberto had taught them as the language to use in step one, which is the language of celebrations. They said, “I invite you now, anybody who has something that they would like to celebrate, please share with us today.”

The people in the room were silent. They heard crickets. They didn’t really understand that. They said it a couple more times using the language of celebration, and they would meet a wall every time they used that word. They decided to try to switch it to “what do you feel grateful for.” Once they switched it to a sense of gratitude, the room opened up.

I talk about this as like a lock in a key. You have to find the right key to fit the lock that opens the door to that community’s ability to communicate, feel safe, or share in the way that ICT asks them to do. It’s not going to be the same across every single community or culture. Actually, it’s always going to be different, and it takes familiarity with the culture itself.

That’s why we tried to train people who are going to conduct these rounds within their communities as opposed to coming from outside, because those are the people who are going to know the words that work, the culture that works, the music that works to bring people into a place where they feel comfortable sharing, feeling vulnerable with each other, and trusting each other enough to move through with authenticity and openness.


Micah Ingle: I did want to say that the political and critical element here is really interesting to me because my work is actually at the intersection of how group forms of healing can help people build solidarity toward social justice, and social change—so very common goals there! I’m curious if either of you or both of you have any experiences within ICT that you’d like to talk about as facilitators, as participants, or things you’ve seen from other people.

Kenneth Thompson: In our early days, we didn’t have a lot of people who knew about ICT that we could bring into an ICT round. We used to do them just to keep practicing with people in our family. These were not large rounds. You can actually do this even in a relatively small group, and we’ve done that.

One of those groups involved my mother, who is almost 95 years old. She was in this with my kids. The pebble that was in her mind was that she knew she was approaching 95 years old, and that her time on Earth is not going to last necessarily much longer. She just wanted to be able to say that she thinks about that. She wants to communicate to the kids that she loves them a lot and that she is ready for this, and this is something that she can pass on to them as something that they can learn to be ready for too.

I got to tell you, it was just overwhelming for me. I don’t know how my children felt about it, but we’ve had similar situations of real depth with people who had very serious medical challenges. We’ve had folks with very serious interpersonal relationships that they’ve dealt with, family issues, and a whole range of different kinds of things that have been talked about.

I’ve heard in those conversations ways of thinking about things that really opened my eyes and made me think and feel somewhat differently.

We’ve also had a lot of talk about the times that we live in, dealing with COVID, dealing with the ongoing situation with war, dealing with the George Floyd circumstances, and all the feelings that come with that. All those things have been, every single time, both touching and meaningful. People are amazingly good at talking about how they managed to deal with challenges in ways that really are heartening. At the same time, they can express deep despair.

Alice Thompson: The flipside of that is, I feel that I’ve seen people be so generous with their love and spirit when someone has shared a really deep struggle—in a way that I hardly ever see in any other context. People are so inclined to come to the support of the person who is struggling or showing deep emotion and with just love and generosity and warmth. I think that’s been one of the most inspiring things to me.

I will share that one of the first rounds I ever did was through the group that I first started doing ICT with in English: a group of mental health professionals, largely American ex-pats who practice in Geneva, Switzerland.

One of the subjects that came up—I don’t remember who brought up the pebble. I believe it was an African American woman who was joining the Zoom from Maryland. She said something about how she was really struggling with what the murder of George Floyd said about American culture. We proceeded to have one of the most beautiful conversations of people sharing these horrible, traumatizing experiences with racism or xenophobia.

One woman from Scotland shared that her high school boyfriend, who was Irish Catholic, had been murdered in a terrorist attack. She shared with us that her way of overcoming was to, at age 14, start a fundraising program that held events annually to essentially bring together Catholic and Protestant communities. The goal was to build a community in response to this ethnic war.

To hear the international perspective, to hear these people talk about ways that they too are struggling with the horrible things that humans can do to each other and that societies can do to each other, and also the beautiful ways that people have come through those types of challenges—it was more profound than I could have prepared for on a Tuesday morning. I’m tearing up about it, just remembering the experience.

That was one of the moments where I was like this is something really special. In ICT we find that people who never thought in a million years that they could connect on something actually have a very deep commonality and are so grateful to hear another person speak about it.


Micah Ingle:  That is beautiful. I want to thank you both for your time and for the work that you’re doing in bringing ICT to the US. Personally and professionally, I feel like community-based, non-pathologizing, horizontal approaches like this are sorely needed, so I appreciate it.  As a final question, what’s on the horizon for both of you? Maybe that’s to do with ICT or something else.

Alice Thompson: Next year we’re hosting our second virtual training for ICT facilitators. That’s an ongoing training. We’ve got 25 participants who we’re working with, and we’ve just been having such a lovely time. Folks are joining us from all over the country: San Francisco, New Orleans, and Philadelphia. I’m really enjoying that process.

We’re also in the process of getting Visible Hands Collaborative on its own two feet, to really establish this as the Integrative Community Therapy Institute of the U.S. and to start integrating other types of solidarity care. We’re on this journey, we’re on an adventure, and we’re seeing where it goes.

Kenneth Thompson: That’s exactly where we are. We’re making Visible Hands Collaborative a 501(c)(3), and that means we have to find funding and resources to continue to grow the number of ICT facilitators. We have to figure out what kind of ecology they’re going to practice in, and how can they make money.

In Brazil, after many years, they finally got ICT to be one of the primary health services of the National Health Service, so they have ways to support it and continue to grow it across the country. If you go see a primary care provider in Brazil and you present with some challenges that you’re having in your life, there’s a good chance that that primary care provider will refer you to the ongoing ICT meeting, to go participate and see how it might help you.

We’re looking for ways to make it grow and how to help more people get engaged with it. Folks who are interested in hearing more about it can go to and connect with us. We’d love to hear from people and get people engaged.

I’ll end with a statement from Adalberto. Adalberto says:

“When the mouth is silent, the body suffers. And when the mouth speaks, the body heals.”

We also believe that when the mind listens, participates, expresses, and connects with other people, it also heals, so we’re just hoping to bring as much of that as we can to the US.





MIA Reports are supported, in part, by a grant from the Open Society Foundations

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Micah Ingle, PhD
Micah is part-time faculty in psychology at Point Park University. He holds a Ph.D. in Psychology: Consciousness and Society from the University of West Georgia. His interests include humanistic, critical, and liberation psychologies. He has published work on empathy, individualism, group therapy, and critical masculinities. Micah has served on the executive boards of Division 32 of the American Psychological Association (Society for Humanistic Psychology) as well as Division 24 (Society for Theoretical and Philosophical Psychology). His current research focuses on critiques of the western individualizing medical model, as well as cultivating alternatives via humanities-oriented group and community work.


  1. Integrative Community Therapy is one of the ways of supporting the idea that people need to be disclosing their affairs to the therapist sitting in the arm chair across from them. It supports the idea that people need to be reformed, corrected, re-directed. It supports the concept of mental illness. And the mental health system continues because people make up new justifications to continue it.


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  2. ICT could be the foundational transformation away from current models of psychiatric care that emphasizes the individual and medication. A shift to community care would be revolutionary. You are going up against the Psychiatry-Pharmaceutical Complex. Showing by example only wins the already converted. Any success must be built on fighting for funding that is controlled by the same PPC. Start in California where Governor Newsom wants legally mandated drugging for the homeless.

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  3. Gavin’s legally mandated drugging is a nightmare scenario.

    But Integrated Community Care is just a concept invented to perpetuate instead of eradicate the mental health system. That is the only reason for the article.


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  4. Hi Joshua. I see ICT as non-pathologizing and helping the community link together to find ways to deal with struggles in our lives. This seems to be different than the current medical model widely used for mental health. Since you had some strong objections/criticisms of the ICT method, what would be some solutions you see or methods you would see as a step in the right direction? It’s not like we should neglect all mental health care, right?
    Thanks and best wishes on your path.

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  5. This is still an attempt to delegitimate people by saying that they should be disclosing their affairs to a therapist and that the therapist knows something that they don’t already know themselves.


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  6. Well the alternative to “Integrated Community Therapy” and to the “Integrated Community Psychiatry” program at UC Irvine, closely tied to Rick Warren’s “Hope for Mental Health Ministry”, is simply to teach people to stand up for themselves. Don’t cooperate with these programs in any manner at all. Never discuss your affairs with them. If you have to deal with them f2f, handle it as you would when accepting the surrender of an enemy combatant in a war zone. Beyond that, never give out any information until you are represented by a lawyer. And of course the lawyer will tell you to say nothing.

    And then as far as what people are being told to live by moment to moment, they need to see that they need to learn to feel their feelings. The less denial the better.

    Sometimes in crises people will have to go on automatic. But you want to be able to go back to feeling at the earliest opportunity. So you need to allow time and energy for this. And you need to make sense of those matters of long ago which have effected you, and those things which have long remained outside of your awareness.

    And so of course the last thing you want are mood altering chemicals or escapist practices. And those Psychiatric Neurotoxins should be recognized as life threatening. And you don’t want to be exposed to denial doctrines, and often Evangelical Christianity amounts to little more than this.

    It takes a lifetime to learn to live in one’s own skin. But you have to do it. And this means that you have to develop your own emotional resources. You can’t look to therapists, recovery group sponsors, or to clergy.

    Teaching classes that help with this kind of stuff is good. But it becomes psychotherapy when you are encouraging people to disclose their personal affairs. If people are doing this, then they are being taken advantage of.

    Look at the example of the Black Panthers. They worked on political consciousness raising, not psychotherapy.


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    • Teaching people to stand up for themselves would also involve some form of expertise and therefore not be legitimate according to your logic (it’s impossible to teach anything without any kind of interpersonal engagement, otherwise it’s just brainwashing).

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  7. Well the people to do this teaching would be the people who have experience, the people who have been there before, people who have stood up to state authority in other situations.

    I don’t know how this works in other states, but in CA it is 5150, the psychiatric hold. Usually the people are taken in their and they get drugged. And then the main thing, as it always is with the mental health system, is they try to convince the party that they have “Mental Illness” and that they need to be on drugs and disclosing their affairs to a therapist.

    Well, we should be educating people to resist this in all available ways. And we should set the example that each use of this law will result in a law suit, and hospital personnel will be named in the suit too.

    Even if these all get dismissed, it will encourage people to resist, it will tend to discredit the mental health system, and it will discredit the judges too.

    And we should be educating the entire population, because usually the idea that someone is “Mentally Ill” seems to start within the family.


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  8. If no one accepted the Psychiatric Neurotoxins, and no one accepted Psychotherapy, Healing, Recovery, Motivationalism, or Salvation Seeking, then we would not longer have to worry about them being made coercive.

    But as it is today, they often are coercive, and Gavin Newsom in CA is trying to make an overt Psychiatric Police State with Internment Camps.

    We must organize to act, and this has to start with education.


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  9. Hi Joshua. I appreciate you letting us know of Governor Gavin Newsom’s plans. Where can I learn more about the plan specifics and about the Care courts and how do you suggest taking actions to prevent this plan and the Care Court System from becoming a reality? I’ve heard mention of the Care Courts and that it will make it so much easier, “ridiculously easier” to commit people to mental hospitals and I am very concerned as I already feel it’s pretty easy and there already is such a lack of mental health patient rights.

    For example, last time I was hospitalized, there weren’t even court hearings at the hospital that I was invited to attend with my advocate about keeping me for a 14-day hold and then another one. That happened with my last two hospitalizations during the Covid pandemic. I was very alarmed and even asked at API what happened to my hearings? Also, to force anti-psychotics meds? They said they had the hearings, I guess without my knowledge or presence? I’m not sure if that is legal but in the past, I was notified in advance of all hearings, could talk to my advocate beforehand and could be present at all hearings and know the entirety of the hearing as I could be present.

    Thanks in advance for your responses!

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