Contribute to My Book
AN INVITATION TO CONTRIBUTE TO MY NEXT BOOK
PLEASE SHARE YOUR KNOWLEDGE WITH ME AND YOUR FELLOW PROFESSIONALS
I’d love it if you would share your knowledge, expertise and experience with me for a book I’m writing called HUMANIZING THE HELPING PROFESSIONS: Focusing Less on Disorders and More on Life’s Challenges.
This book will provide helping professionals—mental health professionals like psychiatrists, psychologists, psychotherapists, family therapists, clinical social workers, and mental health counselors, but also all practitioners who help others, like coaches, nurses, and alternative healers—with a comprehensive, practical guide for shifting their practice from the one currently dominated by a mental disorder-and-chemical fix model to a more humane and helpful “problems in living” model. It will appear from Routledge in 2018.
I invite you to contribute to this book.
Maybe you’re a licensed psychologist, a psychiatrist, a family therapist, a clinical social worker, a mental health counselor, or you’re licensed or certified in some other way. You might also be a coach, workshop leader, alternative practitioner, or other helping professional who deals in a psychologically minded way with the people you see. You are probably very aware of our current paradigm, which describes “mental disorders” in a certain way and which tends to lead inexorably to a chemical fix. You’re probably likewise aware that this paradigm leaves a lot to be desired.
What I would love to hear from you is how you “humanize” your work with clients. I’d love to have you share with me a short piece, in the neighborhood of 300 – 500 words, about any of the following:
+ How a “simple human interaction” made a difference with a client
+ How you helped a client “get out from under” his or her diagnostic label
+ How you helped a client get off meds/chemicals
+ How you “stay with” and “hold” a client who is disturbed or difficult to reach
+ Your top two or three tips for “being a humane helper”
+ An experience that speaks directly to one of the book’s chapters
+ Anything you’d like to share about how you became a “more humane helper”
+ Anything you’d like to share about “humanizing the helping professions”
+ An experience from the client’s side, if you have an experience of that sort to share
Below is the table of contents for Humanizing the Helping Professions. If you’d like to write to a specific chapter, that would be terrific. You need not do that, but if some chapter speaks to you, that would be lovely!
I’m really looking forward to your contribution! Send me your contribution to email@example.com whenever you have it done (no need to check with me beforehand).
If you have any questions, drop me a line to firstname.lastname@example.org. I’m really looking forward to hearing what you have to say!
If you could get me your contribution by March 1, 2017, that would be great. Earlier would also be great and later is just fine; but if you intend to send it along later, do let me know when you anticipate getting me your contribution. I’m really looking forward!
Humanizing the Helping Professions Table of Contents
- Humanizing helping
A movement is needed in the direction of humane helping and away from the twin ideas that mental health helping is biologically oriented and the equivalent of medicine or psychologically oriented and grounded in proven psychological theory. Rather, humane helping must be human oriented and include aspects of a sufferer’s life that are currently minimized or rejected, aspects like his or her current circumstances, sociocultural conditions, life purpose choices, meaning needs, and original personality.
This movement away from prescription pads and labels, on the one hand, and psychological jargon, on the other, and toward warmth, honesty, clarity and increased helpfulness is comprised of the shifts, efforts, and initiatives I’ll describe in this book. If you’re a working mental health professional, the shifts and changes I’ll describe will aid you in moving in the direction of providing care that matches an updated understanding of what helps to reduce emotional suffering and mental distress.
Some of these changes are relatively easy to accomplish (like double-checking to see what your license mandate actually is), some are not too troublesome (like routinely checking in on a client’s life purpose choices and meaning needs), and some are rather more difficult (like letting go of “mental disease” thinking and changing your body language from expert leaning back to engaged helper leaning forward). But all of them are doable—and if you accomplish any of them, your ability to humanely help will increase dramatically.
- Understanding the dominant paradigm
In all places and times there are dominant ways of dealing with human phenomena, whether that phenomenon is breaking the law, speaking truth to power, squirming in third grade, or despairing. That dominant way is called a paradigm: the agreed-upon way to view a thing. Right now there exists a predominant paradigmatic way of viewing human phenomena as diverse as feeling sad, hearing voices, opposing your parents, or fearing snakes. That is the “mental disorder” paradigm.
The predominant paradigm asserts that when it comes to human suffering and many other human phenomena, there is an expert class that knows what’s going on and what to do about it. These experts assert that “mental disorders” are real things (like elephants) and not imaginary things (like unicorns) or metaphors (like spring fever). A “mental disorder” is exactly like a “physical disorder” and shares the same reality, prestige, and tangibility as a “physical disorder.” Our humane helper will make it her business to understand this paradigm, see what she thinks about it, and reject it if she finds it untrustworthy and illegitimate.
- Exploring alternative paradigms
Our humane helper will make an effort to understand the alternative and competing paradigms available to her and make up her own mind about which feel most truthful and congenial to her and which best capture what she believes is the essence of genuine helping. For instance, she might investigate and then adopt a “human experience” paradigm that elevates “human experience” to the center of the helping picture, rather than marginalizing it or eliminating it from the picture. In that way she could focus on “a client’s life” rather than “a client’s symptoms.”
There are many competing paradigms currently being debated. She might opt for a new “difficulties” paradigm that, in asking the question “What are your difficulties?”, expects and accepts many sorts of answers to that question, from “my circumstances” to “my lack of meaning and purpose” to something actually biological that the sufferer can’t identify for himself or herself. By exploring these alternative paradigms a humane helper is bound to deepen her understanding of what constitutes helping.
- Understanding the mental health landscape
A skillful captain knows more than a little something about oceans and winds and weather. He can sense a storm coming by the look of the sky and the churning of the waves. A humane helper endeavors to know more than a little something about the current mental health system, about the different players in the system and their roles in it (that is, about the essential differences among psychiatrists, psychologists, family therapists, etc.), about how to speak about so-called psychiatric medication, and so on.
She understands how, in this landscape, one practitioner can be a Jungian analyst and focus on “archetypes,” another can prescribe pills, a third can administer and interpret “psychological tests,” a fourth can be a psychoanalyst and focus on interpreting dreams, etc. Professionals tend to never allow themselves to think about this essentially contradictory diversity or, if they give it a moment’s thought, they take an ecumenical approach and say, “Let’s live and let live and let everyone do his or her own thing.” A humane helper is aware of the eye-popping implications of such a smorgasbord of approaches.
- Understanding your particular mandate
A humane helper will want to know and understand the actual mandate and wording of her license or certification. If she is licensed or certified, what is it that she is licensed or certified to do? She may discover that she has more freedom to act like a humane helper than she ever supposed. The licensing laws of each state are idiosyncratic—and often contradictory. In one paragraph her licensing law may assert that she is entitled to practice independently and later state that if she encounters “mental illness” she is obliged to refer her client to and enter into a working collaboration with a medical doctor. These are the sorts of tortuous twists encountered in all licensing language.
Is she really obliged to “diagnose and treat mental disorders,” is she somehow restricted to only handling “psychological problems,” or does she have the latitude to frame her work as “dealing with the ordinary problems of living” and practice as more of a humane helper? She may discover that she has much more freedom than she supposed and this new knowledge may help motivate her to make the changes I’m suggesting. On the other hand, she may discover that she is even more constrained than she thought, which will come as a splash of cold water in the face—and maybe motivate her to become an activist in the service of change.
- Shifting away from “mental disorder thinking”
A humane helper will want to make the shift in her own mind from “mental disease thinking” to “problems in living thinking.” Rather than automatically ticking off squirming as a “symptom” of the “mental disorder of ADHD” or gloominess as a “symptom” of the “mental disorder of clinical depression,” she will train herself to ask the question, “I wonder why little Johnny is squirming?” or “I wonder why Jane is gloomy?” She will begin to lead with “What’s going on?” rather than with “What mental disorder can I detect?” and stop looking for mental disorders just because a shopping catalogue for mental disorders, the DSM, happens to exist.
This may not prove a shift that she can accomplish easily or overnight, especially if her interactions with colleagues, HMOs, and even her friends and family pull at her to retain a “disorder label” way of talking. What will she say if her cousin announces that his young son has some new sensitivity mental disorder and asks what she thinks about whether he should be accommodated or mainstreamed in school? It is likely going to prove very hard not to put on a professional face and collude in acting like this new sensitivity mental disorder exists and is a real thing. But over time, and with practice, she can make this necessary shift.
- Shifting your practices as necessary
A humane helper will look at her current practices and honestly decide what portion of what she is doing is the right and appropriate thing to do, what portion she is doing because it is the customary and accepted thing to do (like providing labels that then stick for life), what portion she is doing for her own ego, so that she can feel like an expert and a professional, and what portion she is doing simply to get paid, for example via insurance reimbursement.
After she has teased this apart she may decide that there are certain changes that she would like to make in her practices. She might, for example, create a new intake form that does a fuller job of inquiring into a client’s current circumstances and goals and aspirations; she might stop calling the people she sees “patients” (in keeping with distancing herself from anything pseudo-medical or medical); she might adopt a very ordinary vocabulary that includes words like sadness, disappointment, frustration, resentment, grievance; and so on.
- Leading with your humanity
A humane helper knows what it is like to be human and strives to be her human best. An example of the first is remembering that an objectively small threat, like company visiting, can cause huge anxiety in an otherwise fearless person. It is not ridiculous, strange or pathetic that the person sitting across from her can be made so agitated and upset by the prospect of having some folks over to her home to share a meal. This is just who we are: odd creatures who can bravely confront the enemy in battle and who can also feel woeful, embarrassed and down-right frightened giving a two-minute speech, hosting a get-together, or having to fly across the country.
An example of the second, striving to be her human best, involves exchanging her cynicism and misanthropy, qualities that exist in each of us, for feelings of compassion and respect for the person sitting across from her. It might be nice if she really felt that compassion and respect but whether or not she genuinely feels it she nevertheless leads with it, just as a believer might “love her neighbor as herself” even if she didn’t love her neighbor in the slightest. That is, she makes a certain effort and sets the bar in a high place, demanding of herself that she be respectful, warm, tolerant, and kind as she works with her clients.
- Learning how to be with a person
The essence of helping is not doing but being. A humane helper knows how to be with another person, how to sit quietly, how to accept another person’s reality, how to tolerate another person’s emotionality, how to hold a person’s hand without literally holding it, and how to listen so that the person across from her both feels heard and is heard.
It will naturally tax her if her client is talking a mile a minute, refusing to speak, describing the CIAs effort to spy on him or blaming everyone else for his difficulties. But even though taxed she will have trained herself to remain present, benevolent, and helpful. Whatever there might be for her to “do” at such times, her first and most important offering is the way that she is.
- Holding a large, broad view
Rather than narrowing her view, which the current mental disorder paradigm automatically does, narrowing her focus to “Let’s work on your symptoms of depression” or “Let’s work on your borderline personality disorder,” she maintains the large, broad view that she is dealing with a complicated human being embedded in complicated social, cultural, and political contexts who is not going to be that easy to read or to help.
Our humane helper might begin each new encounter with another human being by murmuring, “I bet a lot is going on.” She will want to know how this individual organizes his reality, how his cultural background colors his beliefs and opinions, what he wants out of life, what he wants to avoid in life, how he typically handles life’s challenges, how he acts on or represses his instinctual needs, and so on.
- Admitting what you don’t know
A humane helper adopts a healthy, skeptical attitude. However, adopting that attitude is not the same thing as knowing what to do or what’s going on. You might, as a nineteenth-century doctor, be skeptical about drilling holes into the brain of your patients to “let the devils out.” But that doesn’t mean that you could possibly know anything about modern surgical techniques that are still a century away.
The same is true for our humane helper. That she is skeptical that a blood test can really “predict psychosis” doesn’t mean that she understands “what psychosis is.” She maintains a healthy skepticism with regard to the claims she hears and the models she encounters, she learns for herself what actually works in helping to reduce human distress and discomfort, and she admits that she, like everyone else, can’t possibly know “what is actually going on underneath” when it comes to human nature.
- Understanding that labeling isn’t explaining
Society can’t allow certain behaviors. It doesn’t matter what is causing the behavior: the behavior can’t be tolerated. We refuse to tolerate drunk driving whether alcoholism is a disease, an addiction, a choice, or a sin. We refuse to tolerate the molestation of children whether a pedophile is a fetishist, is personality disordered, was abused as a child, or is bad to the bone. We refuse to tolerate a “crazy” person waving a sword in public and shouting that he is a Knight Templar on a crusade: we don’t care if it is or isn’t appropriate to label him schizophrenic. Society has the right and obligation to defend itself against its own difficult people.
A humane helper, however, doesn’t presume that because a difficult person is difficult in these ways—drinks alcoholically, molests children, or waves a sword while muttering—that it is appropriate to tack on a “mental disorder” label by way of explanation. We have no idea what is going on inside these folks or what is causing their behavior. To add a label like “schizophrenia” onto what we are observing adds nothing and causes us to falsely believe that we know what is going on when in fact we don’t. That false belief allows us to act as if we have done our investigative work and that we can now wash our hands of the person by providing chemicals or prison bars. A humane helper is clear that labels are not explanations.
- Paying attention to current circumstances
Circumstances matter. If a child has had his own room and suddenly must share it with a sibling and he begins to act out, it should be obvious that knowing about his changed circumstance is relevant, important information. Likewise, if his school lunch program shuts down for lack of funds, if now he is forced to skip lunch, and if “for some reason” he is seems lethargic in the afternoon, surely knowing that he is no longer eating lunch would be information worth having. This is all obvious; yet our current mental health system, with its twin focus on “mental disorders” and “psychological issues,” casts a rather blind eye on a person’s actual circumstances.
Our humane helper will know better than that and will do better than that. She will ask simple questions like “What’s been going on recently?” and “Has anything in your circumstances changed?” and “Paint me a picture of how you’re living.” Her starting place is the presumption that circumstances matter and that as likely as not she will not hear about her client’s relevant circumstances unless she asks about them. She may include this asking on her intake form, as part of her first-session investigating, or in some other way; but however she does it, she will remember to do it.
- Paying attention to key experiences
While she can’t predict how a given person will be affected by a traumatic experience, by multiple traumatic experiences, or by ongoing trauma, a humane helper knows that such experiences matter and that she wants to know about them and pay attention to them. Likewise, while she doesn’t presume that a lack of secure attachment in childhood predicts lifelong difficulties, a humane helper does suspect that the experiences of an abandoned child or an unloved child are relevant in understanding his current troubles.
A humane helper knows that experiences matter. Given that the average amount of time a psychiatrist spends with a new patient has shrunk to fifteen minutes, a humane helper has to wonder whether the dominant paradigm allows for experiences to be given their proper due—or any due. She reminds herself that in her helping practice she will not minimize their importance and she invites the person sitting across from her to describe and explain his lived experiences.
- Paying attention to sociocultural conditions
A humane helper will shift in the direction of paying much more attention than she may currently be paying to the role of socioeconomic conditions and social and cultural realities in the lives of the clients she sees. Living in poverty matters; being a member of a marginalized group matters; dealing with a strict, rule-bound extended family matters; feeling endangered in your own neighborhood matters; facing limited prospects by virtue of the circumstances of your birth matters.
She will likewise understand the power of society to exert control and to inflict emotional distress, for example when it labels a person for life with a mental disorder label, and she will understand that “diagnosing and treating mental disorders” is a societal game. If, for example, her society asserts that refusing to “medicate” a rambunctious child is tantamount to child endangerment, then anyone who disagrees with that vision, whether helper, parent, or child, will find himself or herself on a collision course with the powers that be.
- Shifting from expert to investigator
A humane helper entered her helping profession for many reasons but no doubt among them was the desire to look like an expert, to be accorded the material and psychological perks that professionals receive, and to have her ego massaged by being called “doctor” or “counselor” or something similar. But she has to be wary of this desire, because wearing the mantle of expertise makes it very ease for her to act like she knows more than she in fact knows.
She will want to shift from “expert” to “investigator.” This crucial shift is an internal one, away from acting like you know, a stance more appropriate for her plumber or her accountant, toward an attitude of experimentation, the stance of a scientific researcher involved in some serious investigations. That scientist knows lots of things and has all sorts of tactics and ideas and hypotheses; but he doesn’t act like he knows the answers to his questions until (and only if) he really does know.
- Honoring the naturalness of darkness and difficulty
A humane helper does not start from the place that “human beings are born to be happy and any deviation from ‘happy’ is abnormal and a mental disorder.” Instead, she starts from the following place, not so different from the place where a Buddhist starts: “Life is difficult and produces many challenges and sources of pain, confusion, and despair; all this pain, confusion and despair are of course unwanted but natural enough and should not be ‘diagnosed’ away or minimized away.”
That she honors all this doesn’t mean that she shakes her head and murmurs, “Ah, well, too bad.” She fervently wants the person sitting across from her to suffer less, to feel less emotional pain, to do less harm to himself (and to others), and to feel happier and more inclined to go on living. His pain, darkness and difficulty are natural—but that is not to say that they are acceptable, immutable or incontrovertible. She works to reduce all that: but her starting point is to nod and announce, as she does again and again in her work with struggling mortals, “How very human.”
- Creating and updating game plans
If you are playing football, you know what you are trying to do: score more points than you allow. To do that you create a specific game plan based on the skill set of your players, your opposition’s tendencies, and so on. As easy as that is to say, coaches vary tremendously in their ability to game plan well. One coach gets the most out of his players; another gets the least. One coach has an uncanny ability to call the right play at the right moment; another coach seems always to call exactly the wrong play. We hope that our humane helper is blessed with a native ability to game plan—but if she isn’t, she can nevertheless endeavor to learn how to effectively game plan.
“Game plan” in her context might mean any of the following: that, since her client is presenting “excessive drinking” as an issue, she will use ideas and language from the 12-step recovery movement in her work with this client; that, since her client keeps returning to the theme of “not knowing what my life is about,” she will present him with a picture of “life purpose choosing” that includes explaining to him how he can create a menu of life purpose choices, try each out experimentally, see which seem the richest, and so on; that, since the teenage boy sitting across from her seems only to like video games and nothing else about life, she will use the language of video games and chat about “meeting the challenges at each level of the game”; and so on.
Then, like a football coach who creates an elaborate game plan during the week before the game but knows to chuck it out the window when a blizzard suddenly strikes at game time, a humane helper may create a game plan for a given client but will still retain the flexibility to shift her focus and her energy depending on what is going on. If sadness is suddenly the issue, sadness is suddenly the issue. If marital discord is suddenly the issue, marital discord is suddenly the issue. If a blizzard strikes, that is her new reality. A humane helper learns over time how to do both: how to create a game plan and how to update her game plan in the moment.
- Possessing helping tactics and strategies
Even if a humane helper has no particular game plan in mind, she still has her tactics and strategies to employ. A humane helper’s actual work is tactical. Tactics are simply “the things you say and do.” You may say and do them because you have a certain rationale for saying or doing them or you may say and do them because in your experience they’ve helped, even though you can’t really articulate what principle is being employed. A humane helper’s quiver will be filled with arrows of both sorts.
An example of the first is the following. Because you believe that clarity about life purpose is an aid to emotional health, you make it a point of discussing life purpose with every person you see. This is a “reasoned” tactic of yours, to bring up life purpose. An example of the second is the following. You’ve noticed that to ask a blocked writer to write for thirty minutes a day makes him balk but to ask him to write for twenty minutes a day wins his acceptance. You have no idea what exactly is the felt difference between thirty minutes and twenty minutes but you have learned over time to ask for those twenty minutes. That is one of your “learned” tactics with respect to blocked writers.
Over time a humane helper arrives at reasoned tactics and acquires learned tactics for dealing with all sorts of human experiences and challenges, from sadness and anxiety to job loss and divorce, from loneliness and alienation to career boredom and marital boredom, from dreams deferred and disappointments re-experienced to disturbing world events suddenly intruding. That is the work: employing her tactics and strategies.
- Including homework
A question a humane helper asks herself and the person sitting across from her is, “What do you think we should try?” Maybe she offers her anxious client three or four anxiety management strategies to choose from. Or maybe she asks her blocked creative client whether he might want to start his day creating, rather than waiting for the evening when he is tired and defeated.
Similarly, she might assign a client homework: for example, that he take stab at deciding if he has given up on life and, if he has, try to identify when he decided that life was a cheat; that he write out a business plan for the business he has in mind; or that he research dating sites and pick one to join in support of their co-created goal of adding intimacy to his life.
A humane helper asks her client to do things, in addition to and often rather than think about things. Whatever the size of the thing she suggests that he do—whether she suggests that he “take a small step” this week or “take a big risk” this week—she does not leave him without things to try. She doesn’t say, “Let’s keep talking about this next week.” What she says is, “I look forward to hearing how trying that out went.” Her client may gain important insights during a session; but then there follows necessary work between sessions.
- Co-creating understanding
A question our humane helper asks the person sitting across from her is, “How should we think about this?” She is making her guesses and coming to her conclusions and at the same time she is inviting the person sitting across from her to think about his situation, come up with his own suggestions and conclusions, and be “in it” with her.
For example, she might say, “You say that you have no trouble paying attention to the things that interest you but that you have terrible trouble paying attention at work and to things your wife says to you. How should we think about that?” Then she pauses and waits. She gives the person sitting across from her a chance to actually think about that; she provides a “space” and an “opening” for him to mull her words over and chew on them. With luck, he will have some ideas and will share those ideas with her and the process will continue in this richly collaborative fashion.
- Understanding formulation
A question a humane helper asks herself and also asks the person sitting across from her is, “What’s going on?” By asking the question this specific way, she means to not narrow her client’s responses and to not “pull” for any particular kind of response. “How are you feeling?” pulls for a “feeling” response, “What’s bothering you?” pulls for a “I’m bothered by” response, etc. “What’s going on?” allows the person sitting across from her to start in any way that he likes, whether that’s to complain about his job, wonder aloud about “the meaninglessness of it all,” pick a “symptom” to underline (like sleeplessness, inattentiveness, etc.), or even scratch his head and say, “I don’t know exactly.”
The person sitting across from our humane helper explains “what’s going on” as best he can; and as he provides his thoughts, feelings, and explanations our humane helper begins to hypothesize about “what is going on” herself. That is, she begins to formulate opinions. Her guesses, hunches, intuitions, and “formulations” lead her to her next steps: to the suggestions she makes, to the further clarifying questions she asks, and so on. This tactic is not unlike the well-known tactic of “psychological formulation” widely practiced in the United Kingdom, except that it is not tied exclusively (or even necessarily) to “psychological issues” and can include formulations about anything and everything human beings are forced to face in life.
- Supporting recovery
Sometimes—and really rather frequently—a question a humane helper asks the person sitting across from her is, “How can we help you avoid this?” or “How can we help you stop this?” Many people struggle to stop doing things that they know they ought to stop doing: drinking so much alcohol, watching so much television, shopping so much, eating so much, surfing the Internet so much, seeking out so much pornography, sabotaging themselves with their negative thoughts, sabotaging themselves with their impulsive actions, even exercising so much or being so fanatical about minutiae.
Often what helps a person in emotional or mental distress the most is “stopping something” and utilizing a “recovery model” to help with that stopping: that is, often the key is taking that “stopping” as seriously as does an alcoholic or addict who embraces recovery. A humane helper has a good idea of how recovery works—its logic, its language, and its rhythms—and makes use of that understanding in her work with the people she helps.
There is also an important recovery-oriented movement within the psychiatric survivor community that takes as its core position that a person is not ruined, even though he may look very ruined at the moment; that he is not burdened by a life sentence of the sort that a diagnostic label implies; that, in short, he can recover, release trauma, feel better, live with less distress, and altogether improve. As a tactical matter, it is a good idea for a humane helper to embrace the language, logic and energy of recovery in both these senses
- Investigating in an ongoing way
A question our humane helper asks the person sitting across from her is, “What should we take a look at next?” Maybe the two of them have come to completion during a session on a given issue. Her client knows what his marching orders are: he knows what he is going to try during the coming week and why he is trying it. Our humane helper is likely quite aware that other things are also going on in his life and now is a moment when she can turn to one or another of those other things. But which one should she focus on?
She could say, “Shall we look at the following next?” Or she could ask, “What should we take a look at next?” Either is a plausible way to continue helping. A third, more elaborate way to proceed is to say, “We’ve been looking at a, b, c, and d over these last several weeks (maybe his drinking, his relationship issues, his unhappiness at work, and his general sadness). We just came to some nice closure on ‘a’ for today. Shall we look at b, c or d now?” This is an excellent approach, if a humane helper can pull it off, because it provides a kind of running summary of the work she and her client are engaged in and provides a menu from which her client can choose the next issue to tackle. Whatever specific approach a humane helper takes in this regard, her basic approach is to ask as is needed, “What should we look at next?”
- Marrying warmth and directness
Therapy outcome studies show that it is the quality of the relationship that predicts a successful outcome and that the single most important element of that relationship is the warmth of the helper. Our humane helper is not a “cold” expert but a caring human being. Outcome studies also show, however, that an important predictor of a successful outcome is whether the client is engaged and is “in it” with the helper. For this to happen, our humane helper needs not only to demonstrate warmth but also directness.
A question she asks the person sitting across from her is, “Can we be honest?” She may not ask it precisely that way: she will find her own language for this. She might say, “That doesn’t sound quite right to me.” She might exclaim while smiling a certain smile, “I can’t quite believe that!” She might say, “It can’t be quite that simple.” She might say, “I understand your husband’s part in all this—what’s your part in keeping this problem going?” On a tactical level, she doesn’t flinch. She doesn’t see the social graces of being nice and being polite as necessarily helping the person across from her.
Just as a surgeon might say, “You can have this invasive surgery, which is likely to work, or you can use a catheter for the rest of your life, it’s completely up to you,” a humane helper says what she needs to say. Over time, she learns how to say things in such a way that she is heard and that they sting less. But that something she has to say may sting does not prevent her from saying it.
- Maintaining a short-term focus
A question a humane helper asks the person sitting across from her virtually every time they chat is, “What sort of work do you want to accomplish during the coming week?” or “What do you want to focus on between now and the next time we chat?” One of her tactics is to help her client name short-term goals and other short-term efforts. Our current forms of helping typically do not include a focus of this sort but our new humane helper will incorporate this active and direct way of working into her practice.
This might sound like the following summarizing at the end of a session: “Okay, we’ve decided that you’ll try three things this week to help you shake your sadness. One, you’ll get out every day and walk—no days where you stay home inside please! Two, you’ll either think about drafting that letter to your parents about all the things you want to get off your chest or maybe you’ll actually draft it. Three—and I know this is the hardest—you’ll reach out to that fellow you mentioned and set up a coffee date, even though that feels really, really hard. Okay?” By operating in this way and in similar ways, a humane helper lets her client know exactly what they are working on in the short-term.
- Maintaining a long-term focus
A question our humane helper asks the person sitting across from her is, “What do you want to keep in mind over the next few months?” or “What do you want to try between now and the end of the year?” or some variation of the theme of long-term focus.
+ For an anxious performer, a long-term goal might be mastering one or two anxiety management skills and practicing them in real life performance situations.
+ For an alcoholic businessman who is fighting with his wife, avoiding home, and neglecting his children, the marriage of a short-term goal and a long-term goal might be going directly to an AA meeting after work every day and then going directly home to spend time communicating with his wife and interacting with his children—and doing that for the next six months straight.
+ For a sad, lonely college student, a combination of ongoing goals and long-terms goals might be involving herself in her college’s peer counseling program, spending less time in bed and more time outdoors, and coming to some hard but necessary conclusions about whether her current major actually holds any passion or even interest for her.
A humane helper checks in on these long-term objectives and co-creates new objectives if these turn out not to be quite right or not quite working. She helps the person sitting across from her keep track of these long-term goals and monitors all the roiling that is going on in her client’s psyche as he tries to live purposefully and intentionally.
- Skill building and habit building
A question our humane helper asks the person sitting across from her is, “Shall we work on building your confidence?” or “Shall we get this habit of daily exercise ingrained in you?” or any number of similar questions that support the idea that in order to feel emotionally and mentally better the client will need to learn new skills and adopt new habits.
These skills might include relationship skills, parenting skills, communication skills, business skills, personality trait skills (like increasing self-confidence or reducing negative self-talk), and so on; or habits like daily exercise, diet, recovery work, a daily creativity practice, etc. The rubric for this is: “In order to get from here to where you want to go, you will probably need to learn some new skills and acquire some new habits.”
Another way to say this is, “Nothing will change if nothing changes.” A humane helper helps the person sitting across from her understand that change actually means change. If the person wants some change to occur, like feeling less sad, less angry, less anxious, less down on life, etc., certain significant efforts will almost certainly be required in order for that change to occur. The shorthand for this is her saying to the person sitting across from her: “This will entail work.”
- Including life purpose and meaning concerns
A lot of emotional and mental distress arises because an individual has never articulated his life purposes to himself, doesn’t currently have any life purposes, doesn’t know how to create meaningful experiences or answer his meaning questions, or is otherwise confused or bereft in the areas of life purpose and meaning.
Most helpers haven’t a clue about how to talk about life purpose and meaning or how to help sufferers deal with their life purpose issues and meaning crises. Our humane helper will become adept at not only talking about these issues but also helping the people she sees articulate and live their life purposes and make and maintain meaning. One of the great blessings that a humane helper can bestow upon the person sitting across from her is getting his vague, unaddressed but keenly felt life purpose and meaning needs “on the table,” where they can be aired, understood, and finally addressed.
- Knowing about referrals and resources
In addition to and separate from psychiatric referrals, there are all sorts of other referrals a humane helper might want to make and many resources she might want to point her client toward. She might want her client to know about a wilderness therapeutic community for his distressed teenage son, about an organization like “lawyers for the arts” to help him with his dispute with his record label, low-cost or no-cost community mental health services, resource websites like Mad in America and the British Psychological Society, psychiatric survivor organizations like the Hearing Voices Network, communities of care like Gould Farm, educational and mentoring organizations like Australia’s Rogue and Rouge Foundation, and so on.
Sometimes she may know of a resource and mention it, for example, “I’ve heard good things about the ABC Wilderness Program.” At other times she may advise her client to do the research himself, for example by saying, “We’ve both agreed that a wilderness therapeutic program might be great for Bobby—why don’t you research them and report on what you find out?” In the course of her work a humane helper will naturally come to know about many sorts of resources; and what she doesn’t know about, she can send her client out to research.
- Understanding crisis work and the place of chemicals
A humane helper can’t prescribe medication (unless he or she is a medical doctor or has prescribing privileges) and likely doesn’t believe in the rationale for prescribing so-called medication for so-called mental disorders. But she does know that chemicals have effects and she also knows that sometimes the person across from her might be helped by those chemicals or may want those chemicals (if only for a placebo effect).
If she is not someone who can prescribe and if she believes that the chemicals-with-powerful-effects currently available ought sometimes to be used, then it would be wise of her to make some useful connections with a humane general practitioner, a humane psychiatrist, or a humane psychologist with prescribing privileges, ones who see chemicals as a short-term fix and not a long-term answer, who are as interested in the side effects of a chemical as in its main effects, and who are not very enamored of providing a chemical fix and who do so only with some real reluctance.
- Advocating for an improved mental health landscape
Our humane helper would advocate for a mental wellness movement that includes better conditions for everyone, less poverty, less hunger, less ignorance, less cruelty, more love—fewer of the bad things and more of the good things. In addition, she might pick a particular hobbyhorse to lobby for, for example teaching life skills in elementary school, teaching parenting skills to new immigrants, creating more communities of care, or supporting psychiatric survivor organizations.
That is, she sees that a part of her role as humane helper is activism and that she is required to speak out and stand up. She might advocate for what she sees as necessary and useful change in the staff meetings she attends, in blog posts, and in conversations with her colleagues. She would shift in the direction of advocacy as she disputes the current paradigm and articulates her vision of helpfulness without labeling.
- Expecting and handling pushback
A humane helper, especially if she is actively disputing the dominant “diagnose and treat with chemicals” paradigm, must be prepared for pushback and should be prepared to deal with pushback. Her colleagues may disagree with her; her clients, who, from everything they’ve heard, may be expecting a diagnosis and a chemical fix, may question her approach; the parents of the adolescent she’s seeing may put the same pressure on her that is being put on them.
Our humane helper will have her talking points prepared, will know how to clearly explain why she believes what she believes, will not flinch in the face of institutional and professional opposition, and will accept that telling what she believes to be the truth comes with consequences. By standing up in this way she is further helping: she is helping in her small way to shift the paradigm away from pseudo-medical posturing to actual helping.
- Humanely helping
Becoming a more humane helper is not beyond reach of mental health professionals. Holding a rich, rounded picture of human nature, human reality, and the challenges of life is neither that taxing nor that implausible a task. The main requirement is that you remember what life feels like to you, what sorts of odd messes and moods you’ve gotten yourself into, how small slights hurt so much, the toll that year of hard drinking took on you—and that you keep a clear eye on your basic stance, that you are trying to help while disputing the current paradigm of labels and chemicals.
Just by virtue of refusing to define people in terms of diagnoses and just by demanding of themselves that they remember how odd and complicated it is to be human, mental health professionals will automatically maintain a larger, broader view, refuse to reduce a person’s reality to some set of psychological problems or symptoms of mental disorder, and continually, exclaim, “Wow, being human is quite something, isn’t it?” As each individual mental health professional does this honorable work the whole profession will move in the direction we all desire, in the direction of a more humane and a more helpful profession.