What a concept!

Indeed, this is a very profound question. Think about all the time our behavioral health staff spends in school, plus all the money spent for this, and all the years concentrating on various treatment modalities. Turns out, that may just be a distraction from the most effective interventions: building strong relationships and a focusing on the person's strengths.

As we pondered Dr. Bob's question, we started asking ourselves how this may have happened-why would we get side-tracked from tried and true interventions like “relationships” and “focus on strengths” and instead focus on modalities?

Well, maybe because it's easier. Ask your training department what they think about this. Is it easier to train staff about modalities than it is to teach them how to create strengths-based relationships?

How do you teach people about developing “relationships” anyway? Right now, pretend you're standing in front of a group of behavioral health staff who think they already know all there is to know about relationships and you're pretty sure they don't. How would you start? What would tell them about developing strength-based relationships? What will you do when they roll their eyes? See what we mean? It's not like reciting a formula, or expounding on the techniques and steps involved in using various modalities.

The development of healing relationships moves us from our head to our heart; from science to art. Tricky business! Relationships require a more profound investment-we can't fall back on the techniques and rules and roles that various modalities require. We must be present; we must be real; we must be willing to risk caring about someone who could disappoint us. We can't take cover behind the usual hiding places of “professional distance” and “boundaries” and “dual relationships.” Don't get us wrong, we know there is a place for these, but in order to form positive relationships based on strengths, we can't hide behind them or use them as an excuse to protect ourselves.

Real therapeutic relationships can be challenging, but they are definitely worth it because, as Dr. Bob points out, they work.

OK, so the relationship thing is a challenge-but why would we avoid placing an emphasis on strengths? That seems harmless enough: low-risk, non-invasive, and painless, isn't it? So why not just go there? Well once again, we aren't really sure, but we have some ideas, and here's one: If a program hasn't yet embraced recovery principles and practices, staff may not be seeing much hope for recovery in the people they are serving, so to talk about strengths may seem insincere. In cases like this we often hear staff say they don't want to give people false hope or set them up for failure. If this is the mindset, staff is less likely to talk about strengths and more likely to see their role as that of caretaking and controlling.

This lack of emphasis on strengths seriously interferes with a person's chances of recovery. Then, when recovery doesn't happen, we hear, “Well my consumers are more disabled than other consumers,” or “I always use recovery practices and they don't work on my consumers,” or “I don't have time to do recovery practices because my consumers need too much help from me.”

Don't take the bait. Just know that none of this is the case.

There is yet another factor that presents a challenge to developing strength-based relationships. It resides not just within staff, but also within those whom we are serving when they resist recovery. Yep, this one is a two-way street. Here's a description of both ends of the street:

• At one end, we have the person who is resisting recovery and seemingly isn't willing to engage in a strengths-based relationship. They can talk about their problems all day long, but bring up their strengths, and they disconnect. Why would anyone do this? While it may not make sense to you, they have their reasons, one of the most common of which has nothing to do with mental illness. It has to do with being human. When humans are asked to step out of their comfort zone and live at a higher level of potential, they often resist, either consciously or unconsciously, because they are afraid more will be required of them than they can consistently deliver. They are afraid of failure and success both at the same time. They don't want to let others down either, so they resist or sabotage their opportunities.

  The second common reason the people we serve resist engaging in a strength-based relationship has to do with their misconceptions about recovery. They think recovering will cause them to lose things they have come to rely upon. They think they'll lose our help and attention, plus they fear losing their financial support (usually SSI or SSDPI). Neither of these reasons hold water, but they do get in the way of people being willing to engage in a strengths-based relationship.

• At the other end of the street we have staff who may not have been trained in advanced recovery skills and, instead of furthering the relationship, they return to their charts and write “John is not ready for recovery.” Instead of this, they need to kick into high-recovery gear and become even more inspiring and irresistibly optimistic.

As you can see, we've given a lot of thought to the profound question that Dr. Bob asked at the beginning of his workshop: “Why don't we just train staff how to develop strength-based relationship and stop focusing so much on modalities?” (We haven't even told you about the rest of his workshop, but will do so in this column next month when we also highlight the great evaluation instrument he used, developed by Zlatka Russinova at Boston University. Stay tuned, you'll like the rest of what Dr. Bob has to say, and you'll love the tool Dr. Russinova developed to test the effectiveness of our work.)

In closing, a word from Bill, who often sits through meetings on curriculum development and politely (well, usually) listens. Then, at the right time, he leans back in his chair and says something like this: “We can train staff all day long, but if they work in an environment that has antiquated policies and procedures that don't allow for the application of what was trained, we are wasting our training money.”

Don't waste your time and money. Train about relationships that promote strength and create a culture and environment that supports staff in following through.