Lettre d'appui du Dr. Bret Fimiani

Subject: Support for The 388: A Letter of Endorsement

 Bret Fimiani, Psy.D.

Psychologist and Supervising Psychoanalyst, Lacanian School of Psychoanalysis, SF Bay Area
Board Member, Bay Area Hearing Voices Network
Northern California Chairperson, International Society for the Psychological and Social Approaches to Psychosis-US
Supervising psychoanalyst, Openings: A Clinic for Psychosis, Chicago, IL
5665 College Ave, Suite 340C, Oakland, CA 94601

January 20,2025

 To Whom It May Concern,

I am a clinical psychologist and supervising psychoanalyst of the Lacanian School of Psychoanalysis and, as noted above, I serve as a board member or clinical supervisor for numerous organizations in the U.S. that either treat, or offer support and advocacy to, people who experience psychosis. I am also the author of a recently published book on the treatment of psychosis (Psychosis and Extreme States, Palgrave 2021). The approach developed at The 388 has been very influential on my own research as well as many other clinicians and researchers in the US, and worldwide. The success of The 388 has inspired the creation of more humane and effective approaches to the treatment of psychosis in the U.S. I know of at least two clinics in the U.S. that have, in many respects, based their approach to treating psychosis on the work of The 388, e.g., “Openings” (part of Depth Counseling in Chicago) and “Constellations” (part of The Greene Clinic in Brooklyn, NY).

I am writing to express my strong support for the continued operation and preservation of The 388 (Center for the Psychoanalytic Treatment of Young Adult Psychotics) in Quebec City. I join a growing number of professionals, researchers, and clinicians who are deeply concerned about the closure of this vital institution, which would have significant repercussions for the field of mental health care and the many individuals who rely on its innovative services.

The 388 is a pioneering and internationally respected institution. It has developed a unique and innovative approach to the treatment of psychosis, which, by the well-known accounts of external reviewers, is remarkable in its quality of care and its successes. The comprehensive and holistic model of treatment it offers is rare and invaluable. So, too, is the rigor with which all aspects of this treatment are informed by psychoanalytic perspectives and designed to support each patient’s progress through individual psychoanalytic therapy, which is at the core of this treatment. This approach has proven to be both safe and effective for a patient population that often faces significant challenges in accessing meaningful treatment and achieving positive outcomes.

Having dedicated my career to the psychoanalytic centered multi-modal treatment of psychosis, I have seen first hand the limitations of one-size-fits-all approaches to mental health treatment. Facilities like The 388 play a critical role in broadening the scope of available care options, addressing gaps that traditional models often leave unfilled. Its emphasis on holistic and individualized care aligns with best practices in modern mental health treatment, which prioritize patient dignity and long-term recovery.

Beyond its immediate impact on the local community, The388 serves as a model for mental health innovation with implications that extend far beyond Quebec. Its integration of diverse treatment modalities provides a valuable framework for addressing complex mental health conditions, particularly in a time when the field is recognizing the importance of complementing biomedical approaches with psychosocial interventions. Losing this institution would mean losing a vital source of inspiration and learning for mental health professionals worldwide.

I urge the decision-makers to consider the broader implications of this closure and to explore alternative solutions that would allow The 388 to continue its important work. Preserving this institution is not merely about maintaining the status quo—it is about safeguarding a unique and highly effective approach to mental health care that has proven its worth through decades of dedicated service.

Thank you for your attention to this critical matter. Should you require further information or wish to discuss this endorsement, please feel free to contact me.

Sincerely,

Bret Fimiani, Psy.D.

Psychologist and Supervising Psychoanalyst, Lacanian School of Psychoanalysis, SF Bay Area
Board Member, Bay Area Hearing Voices Network
Northern California Chair person, International Society for the Psychological and Social Approaches to Psychosis-US Supervising psychoanalyst, Openings Clinic for Psychosis, Chicago, IL