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Taking on the formidable middle

February 1, 2008
by Lori Ashcraft, PhD, William A. Anthony, PhD, and Michelle Bloss
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A personal story of embracing recovery principles offers ideas for helping staff members value peer employees

Interesting, isn't it, how one word can start an evolution? Who knew that recovery would be the battle cry for the transformation sweeping the country? Some say not much has really changed, but think back just ten years ago: The people using our services had no idea they could recover—and neither did the service providers who worked with them.

We'll be the first to agree that we aren't where we need to be. We're all at different spots along the way through the paradigm shift, but that's not so bad considering the inevitable resistance that comes with any change.

So how can we keep up the momentum? How can we keep ourselves moving in the new direction long enough to reach the tipping point—where there's enough of us standing on the other end of the teeter-totter to shift the balance?

We attended a conference last year at which one of the key speakers discussed ways to change a system. Richard H. Beinecke, DPA, ACSW, an associate professor in Suffolk University's Department of Public Management and an internationally known expert on the dynamics of change, concluded his speech this way:

Once the top leaders in the organization get the vision, and once the receivers of the service or product at the bottom understand what they should be able to expect, all that's standing in your way to transformation is the formidable “middle.” Getting the middle of your organization onboard is the “deal breaker.” If you get them onboard, there will be no stopping you. If you don't, forget it. They can stop the whole show just by being passive.

Maybe this is where most of our organizations are now. Many of the top leaders are onboard, and many of the people who use our services are beginning to understand that they can expect more from us than stabilization. So how can we bring the “middle” onboard? Have we really done a good job helping our doctors, nurses, counselors, case managers, technicians, and other clinicians to understand and embrace recovery principles and practices? Or are they still reciting excuses such as:

  • “The people we work with are sicker than yours and can't recover.”

  • “We already do all this recovery stuff” (yet their outcomes don't reflect it).

  • “We'd like to start taking a recovery approach, but our doctors will never go along with it.”

  • “We really don't have time to do the extra work” (even though we know that overall it doesn't take more time).

If this is where your organization is, you aren't alone. We'll be focusing on ways to move the middle in our next few columns, so stay tuned. This month we want to share an example of how transformation worked for one program manager.

Michelle Bloss has spent the past ten years of her career being mostly in the middle. Below is Michelle's account of how she, as a “middle” person, traveled the road to transformation.

Michelle's Story

“From 1998 to 2000 I was employed as a direct-care technician. I considered myself good at my job, and my goal was to be recognized by my supervisors as ‘the best tech around.’

“During this time, our organization began to transform, shooting beyond the long-held goal of stabilizing patients to the goal of helping people recover. I wasn't impressed. I felt I already knew all of this. After all, I knew how to treat people the way I would want to be treated. I went along with it all just enough to look like I was onboard, but I really wasn't changing much of what I did or how I did it.

“Then our organization started to talk about hiring peers. I began to worry that the peers would take over my job. I thought the company might have a hidden agenda to phase us out and bring in peers. Selfish thoughts started to invade my mind, such as, ‘I can't compete with them because I have not had personal experiences.’ Then unkind thoughts arose: ‘Oh, this won't last long. The doctors will never let this last.’ I was wrong.

“The day came when talking about hiring peers was over and working with peers was reality. When I met our first peer-support crisis specialist, I must admit that unkind thoughts began to rear their ugly head again: ‘I have seen seasoned counselors quit this job before. That guy will never last. He is not like us.’ Not only did ‘that guy’ last, but he taught me more about my job and about recovery than all my years of experience combined.

“The first concept that my peer co-worker taught me was mutuality. He showed me that mutuality was not just being nice. And even more challenging to my personal goal, mutuality was not about me being ‘the best.’ I learned that everyone has strengths, including me, and seeing strengths was the key. My strengths were just as valuable as my new peer friend's strengths. We were equal, and what was important was that the person we supported during the crisis was successful. My goal of ‘being the best’ shifted to being about the person I was supporting being the best he or she could be.

“The next lesson I learned from working with peer-support specialists was humility. It is powerful to be in the presence of someone in recovery, who shares his story from a ‘hero perspective,’ and to watch that person impact the lives of others. During this process I began to learn that even a clinician like myself can ‘recover’ from being a clinician.

“One day I was assisting a person in our crisis program who was having a very difficult time. As I was sitting next to her, listening to her, I thought, ‘She is me.’ I realized that life has struggles and everyone has something that we are recovering from. I could actually offer a piece of me, like my peer-support friends offer. So I did and we connected.