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Sheppard Pratt Opens The Retreat: A First Class Setting for World Class Care

"Combine every feature that science and experience might indicate as requisite or desirable to minister to the greatest possible advantage of the patients." These are the words of Moses Sheppard, founder of Sheppard Asylum in 1853, later to become The Sheppard and Enoch Pratt Health System. These words have provided vision and inspiration to Sheppard Pratt's mission for well over a century. In short, "Do all that is best for the patients." These are words that a dedicated psychiatrist can hold close to the heart.

But today’s world is full of third party involvement, requiring modifying clauses. Do all that is best for the patients that is within the realm of medical necessity, that takes into account the value of cost containment, that requires the least restrictive environment, and that makes the most efficient and effective use of multiple care givers in an integrated continuum of care. Do all that is best for the patients within the regulations of federal and state mandates and watchdog agencies. Do all that is best for the patients, paying close attention to critical pathways, evidence based medicine, and expert guidelines for treatment. Do all that is best for the patients, and make sure that everything you do is documented, because, as our malpractice attorneys remind us, “If it isn’t in the chart, it didn’t happen.” Today, the modifying clauses often overshadow the primary clause. Yet, the ideal of doing all that is best for the patients still calls to us. Sheppard Pratt will respond directly to that call with the opening of The Retreat on June 1, 2002. The Retreat at Sheppard Pratt is a six bed unit, licensed as a halfway house, but located within the hospital building, designed to give the finest care of which we are capable. Patients will be admitted for stays of one to several months. Payment will be entirely out of pocket, without insurance or other third parties.

What is best for the patients? What is that combination of “every feature that science and experience might indicate?” The Retreat will focus on four such features: 1) diagnostic assessment, 2) therapeutic engagement, 3) a safe and comfortable setting, and 4) transition to aftercare with follow-up.

Diagnostic assessment will be the primary focus during the first two weeks. It will be comprehensive and expert. Headed by the patient’s personally assigned psychiatrist, and involving a hand-picked treatment team, it will include all that is necessary in the way of neuropsychiatric consultation, psychopharmacological review, psychological testing, medical and neurological consultations, family interviews, dialog with previous treating mental health professionals, and, of course, regular individual sessions with the patient. The diagnostic period will culminate in a comprehensive diagnostic and treatment planning conference involving the entire staff. The diagnostic findings and a set of clear treatment recommendations will be presented to the patient and appropriate family members immediately after this conference.

Therapeutic engagement will begin with the first phone call and continue the first day at the Retreat. The general outline of treatment will involve at least three foci: psychopharmacological interventions, individual and group psychodynamic psychotherapy, and, as desired, engagement in Eastern movement and meditative practices. Psychotropic medications will be used with the highest degree of clinical expertise, taking into account the needs and wishes of the patient. Education around medications, including formal didactic sessions and handouts, will be a consistent part of the treatment. Psychodynamic psychotherapy will begin for each patient with individual 45-minute therapy sessions three times per week and one hour group sessions twice a week. Psychoanalytic principles of object relations theory and self psychology along with selected cognitive therapy techniques may inform the treatment. Each therapy relationship will evolve based upon the needs and capacities of the individual patient. Psychotherapy will be intensive and focused, allowing work with both symptoms and deeper-seated personality issues. The milieu will encourage high standards of ego functioning, providing ego support and promoting the patient’s strengths in order to minimize regression. Eastern techniques of meditation, centering, and therapeutic movement can complement the more traditional psychiatric and psychotherapeutic approaches. Training in mindful breathing, yoga postures, and movement exercises derived from t’ai chi chuan will help the patients develop skills in relaxation, centering, and affect containment. As each patient is better known on the unit, more specific therapeutic interventions will be tailored to his or her needs. By the time of the comprehensive diagnostic and treatment planning conference, a highly individualized therapy will be established for each patient.

A safe and comfortable setting will be provided on a completely remodeled unit within the main hospital building. Each patient will have a private room and bath with top quality amenities. These will include individual television, DVD, and internet hook-up. Many of the special architectural features of this classic building will be preserved (e.g. - high ceilings, fireplaces, vaulted windows with dramatic views). There will be a large common area, with two rooms set aside for quiet interactions or private discussions. The nursing station will be on the unit, with staff available at all hours. There will be individual and group therapy rooms and a dance studio for movement classes located in the larger hospital building. An indoor swimming pool will be available for exercise and recreation, and beautiful grounds allow for reflective walks. Patients admitted to the Retreat will need to be functioning at a level where they do not need a locked unit, seclusion, or restraint. Patients who are acutely suicidal, violent, or acting out in self-destructive ways may be transferred to an inpatient unit within Sheppard Pratt, where such acute problems can be addressed within the safety of such a locked unit. At the Retreat, patients have the rights and responsibilities commensurate with an open door and free access to leave the grounds during unscheduled periods.

Transition to aftercare with follow-up is an essential aspect of the Retreat. We understand that a month may start a therapeutic process in motion, but, for many patients, full success will only be possible if this process continues after discharge. Many of our patients will be coming from around the country and abroad. Careful attention to the referring psychiatrists and identification of necessary resources in their community will be essential. During the diagnostic phase, and again as discharge approaches, we will have a number of consultations with the mental health professionals working with the patient in their home town in order to plan the very best transition. A summary of the diagnostic work up, course of treatment at the Retreat, and further treatment recommendations and plans will accompany the patients as they return home. Finally, the Retreat will provide follow up phone consultation with patients, their families, and professional care givers for up to a year after discharge as part of the comprehensive treatment package.

Donald Ross, M.D, will lead the Retreat as Medical Director. Dr. Ross is a psychiatrist and psychoanalyst who has been on the staff of Sheppard Pratt for 18 years, most recently as the Director of Education and Residency Training. He trained at Duke University and is Clinical Associate Professor of Psychiatry at the University of Maryland. In addition, Dr. Ross is a Teaching Analyst at the Washington Psychoanalytic Institute and has studied and written about narcissistic and borderline personalities, among other areas. His years of work with complex patients, both in the hospital and in a private office setting, gives him a breadth of clinical experience that complement his leadership skills.



The Retreat at Sheppard Pratt is scheduled to open June 1, 2002. Any questions can be directed to Dr. Ross either by phone at 410-938-4811, or email at dross@sheppardpratt.org.


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Last modified: Tuesday, April 22, 2014

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