Introduction

Welcome! We are glad you are reading this book and hope that it will support you in your work and/or studies. This book is about helping people. It is applicable for anyone with the intention to be helpful to others, including people from the many disciplines that work within the broad context of health and human services. However, the people we have had most in mind while writing this book are case managers, outreach workers, family support workers, child welfare workers, home health care workers, and residential workers. We want to particularly honor and acknowledge this vast army of people who are in the trenches of frontline home- and community-based work. We hope that this book provides easily accessible and immediately applicable descriptions of ways to approach helping work that is likely to become increasingly important in an environment of health-care reform. In this introduction, we begin by sharing how this book came to be, where the ideas came from, and what brought us to write it.

How We Came Together

We met for the first time several years ago at a neighborhood café in Cambridge, Massachusetts, over lunch. From that time on, we have engaged in an extended process of exploring, reasoning together, and, at times, even bickering about the nature and structure of a practical framework for helping that can be used across the full range of health and human services. We have been on this journey together for more than 5 years.

Bill is a family therapist with many years of training, consultation, and coaching under his belt related to the development of service models that put families at the center of strength-based, culturally responsive services. Bill’s work takes him to wherever forward-thinking agencies aspire to put families and communities first. Kevin is a nurse with “hands on” management responsibilities for an emerging health and human service organization that addresses behavioral health, permanent supportive housing, employment, and, recently, integrated primary health care.

Kevin initially approached Bill with an immediate need for consultation for his agency but also with a vague idea for a book about helping that would build upon Bill’s prior publications, including Collaborative Therapy with Multi-Stressed Families (1999, 2007a). The idea was to begin by piloting ideas together in the rural Appalachian hill region of Ohio where Kevin works every day and then move across the nation and around the world collecting and creating a patchwork quilt of stories from helpers and those they serve. As an experienced trainer, Bill was able to collect most of the stories since his work takes him all over the world. As an agency executive director, Kevin brought an important focus on the ever-changing forces of health and human services systems. Together, we have written this book. Writing as a team is not easy, but we trust that your reading of our work will provide straightforward evidence of the benefits of a collaborative approach.

Influences on the Development of This Book

This book is based on information from three main sources. Most immediately, we have reflected on our own experiences of doing this work. Between the two of us, we have more than 60 years of experience in health and human services where we have sought to promote collaborative ways of working with individuals and families. Over our careers, we have done frontline work, provided supervision, developed and administered innovative programs, and conducted training and consultation both nationally and internationally. A second source has been writings by others that we have found inspiring and sustaining. This book draws from cutting edge material from family therapy, community and organizational development, and post-modern thinking, always with an eye toward incorporating ideas and practices that promote more respectful and responsive ways of interacting with individuals, families, and communities. Finally, and perhaps most important, preparation for this book has involved extensive interviews with skilled frontline workers as well as individuals and families seeking help. Initially, we asked workers, “For you, what is at the heart of effective helping? Concretely, what does that look like on the ground in everyday practice? What challenges do you run into in helping relationships? How do you respond to those challenges? What might be some lessons from your experience for our field?” We also asked people receiving help about their experiences with helping (both positive and negative), how they thought our field could get better at being helpful, and what they thought would be most important to consider in that process. As the book took shape, numerous workers began to put the ideas into practice. So, we decided to seek out stories of how they were applying these ideas in order to learn from those experiences. Additionally, as we encountered supervisors and managers who were excited by these ideas, we collected stories about how they found ways to support and sustain the collaborative spirit of this work in their leadership roles. Collectively, these stories have shaped our thinking, enriched our own lives, and appear throughout this book. Hopefully, they bring to life a framework to help us find a way forward through the ambiguous, uncertain, and complex challenges of home and community work.

Why We’re Writing This Book

Authors write books for many different reasons with various hopes, purposes, and intentions. Here are two quick stories that begin to capture some of what has brought each of us to this effort.

Kevin’s Story

My own story of helping starts as a hospital nurse. As a young man, I worked mostly in large academic medical centers, at first in critical care cardiology then in hematology/oncology units. There were many specialists and lots of experts. The intense learning was exciting with a pace and energy related to heroic lifesaving technical medicine that was, in a way, seductive. The teamwork of young doctors and nurses working among renowned physicians in a high pressure environment was something to remember. But for me, there was something missing. Our stance with “patients” was too often far from collaborative. Treatment options emanated from a distant professional perspective and were directed into a vacuum of communications. The complexity of personal and family affairs was almost always overwhelmed with the one-way force of medical imperatives. Life and death decisions were reduced to a shallow science intended to extend physical existence, even for a short time, with little regard for the subtlety of life well lived.

I had a dilemma. Although there was much I enjoyed in the atmosphere of the academic medical center, I wanted something more for my life’s work. I didn’t know it at the time, but I was looking for a more collaborative way of helping. So I returned to graduate school to prepare as a health administrator with a fairly clear plan to work my way up the chain of academic medical center nursing administration but also with a goal of helping to change the way people and families participate in end of life decision making. But then as life would have it, things changed. Long story short, while at graduate school I also married, connected with the green hills of Appalachia and was recruited by a visionary behavioral health administrator who had accepted a formidable challenge. He was charged with converting a regional psychiatric state hospital to build a community-based system of care for youth with serious behavioral disorders. We were able to obtain federal support to move fairly quickly and we used part of the venture funds to create the service organization I have led for nearly 20 years. By now we do many different things. We still serve youth and families in partnership with public child welfare agencies and juvenile courts. But we also develop and provide services for permanent supportive housing for people and families who are homeless. And we are on the frontline of integrating behavioral health with primary care as we broaden our scope to include entire communities with a new focus on issues like aging and the years, months, and weeks at the end of life. So as you can see, my journey has come full circle to be thinking now about an entire life well lived. But all along the way, my own story has always been about a more collaborative way of helping.

Bill’s Story

I have a strong conviction that at its core this work is about how we are with people. Much of my life’s work in this field has been about finding and developing helping practices that assist workers (and myself) to ground our work in a spirit of respect, connection, curiosity, and hope. After I wrote the first and second editions of Collaborative Therapy with Multi-Stressed Families, there were a number of people who thanked me for writing the book. They often said some variation of “Your book resonated for me. It had some great ideas about doing this work. But most important, it lent credence to things that I value in this work and it was great to see that in print.” That has been deeply gratifying. However, more poignantly, there were also people who shook their heads and said, “I’d never read that book. Collaborative Therapy? I’m not a therapist, I don’t do that therapisty stuff!” (even though their work was profoundly therapeutic). I found that sad and troubling—particularly since other people in similar jobs were among the folks who found the book so supportive. In my heart, I am a practitioner and even though I spend a lot of time providing training and consultation, I...