The Strengths Model: Meaningful Relationships and Reciprocity

Reciprocity – and the mutuality it implies – is always present in a meaningful relationship……. Each participant sees themselves bringing something of value to the relationship.

Yes, to a relationship between a person with a mental illness and a mentor/other in a helping role. Listen to this wisdom gleaned from The Strengths Model: A Recovery-Oriented Approach to Mental Health Services by by Charles Rapp and Richard Goscha; their chapter entitled “Engagement and Relationship:”

View the relationship as an experience in Mutual Learning. Put the recipient, or the person with the mental illness, in the role as teacher. The mutual learning approach doesn’t only want to know a person’s diagnosis, for example, they want to know about a highly individualized set of experiences. The person being helped, when viewed as a teacher, enters an empowering role. As teacher he/she is engaged in meaning-making and self-understanding. The helper, by listening and learning, seeks to enter the reality of the person by knowing the objective conditions of their lives and their subjective experience of that reality.

Yet the reciprocity inherent in Mutual Learning is easily missed: When the friend/caregiver/mentor/professional is always the giver and the person with the mental illness is always the recipient, the idea is perpetuated that the helper always has what is most valuable. Most helpful relationships have a balance based on mutuality and reciprocity. Refusing offers of reciprocity — whether it is an offer of a cup of coffee, a small gift, or knitting lessons — may be as rejecting as outright stating to the person “You have nothing of value to offer this relationship.” And, as our authors  observe, such condescending behavior “….is downright unfriendly.”

It is interesting to note that actions refusing reciprocity can stay with one for a long time. Here are two examples: Both helpers were excellent psychiatrists and good doctors for me. Both provided me with therapy as well as assessment and medication management.

The first helper happened to retire just as I was beginning to experience recovery. This psychiatrist had been through moderate to severe depressions with me, many drug trials, hospitalizations, and had “seen” my children grow up. He was very helpful to me and I admired and trusted him. Today I think of him fondly and with respect. He got me on the right road to treatment and a progressive, wholesome doctor-patient relationship.

The problem in short is that he didn’t accept a small gift from me of two tickets to a University of Wisconsin Choral Union concert. I was performing in the Choral Union and this doctor had been a backer of my quitting smoking and learning to use my voice, once again, to sing. It was a milestone for me to sing in the University’s acclaimed choir under the well-known and highly regarded Choral Director Robert Fountain. My doctor thanked me for the tickets but mailed them back to me with an apologetic note. Even though our professional relationship had ended, he felt accepting these tickets in any form would violate the professional-patient code of conduct.

I understood, but I cried.

Recently another psychiatrist retired. I had been with this person a long while as well. Through my blossoming periods of experimenting with recovery and hard times as well. Through my periods of NAMI activism and Family to Family service role. Through the empty nest syndrome. There was also a period when Jim became clinically depressed, followed by a period of great doubt and casting about from which, with Mutual Learning, Reciprocity, and Respect, we have since grown and recovered.

This psychiatrist accepted my gifts, which were two. At our last appointment, I bought a picnic lunch, complete with tablecloth and picnic basket filled with delicious finger food. We enjoyed the food and each other’s company. We talked about her future and my own.

I also gave her a book, One Hundred Names for Love, a true story of genuine love in which the author, Diane Ackerman, recounts the challenges and victories she and her husband lived through following his stroke.

The book was appreciated and accepted as a gift. The lunch was relished.

I will always remember that last appointment. It was delightful, reciprocal in nature … and empowering.