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.

In my last post, I wrote about the Strengths Model – a progressive attitude about mental health thinking, care and services put forward by Charles Rapp and Richard Goscha in their book The Strengths Model: A Recovery-Oriented Approach to Mental Health Services, Third Edition, 2012.

The first proposition of their Strengths Model is: “The quality of niches people inhabit determines their achievement, quality of life and success in living”.

Here I address an equally important principle underlying the Strengths Model: “People who are successful in living [with mental illness] have a meaningful relationship with at least one other person.”

As a person living with mental illness, I have been fortunate. I’ve had two relationships especially meaningful and empowering to me at most times throughout my adult life. One meaningful relationship was with my husband, Jim. We had the great good fortune of always being able to talk over the hard issues of mental illness. He was, and is, my sounding board and advocate, too. Important also to me was the relationships I’ve had with a succession of strong women mentors. Sometimes that second person was a colleague; sometimes that person was one of my psychiatrists, but a second meaningful relationship was nearly always there.

Why was that second meaningful relationship so important? At times I was unsure just how objective my husband could be. “Of course,” I might (and sometimes did) think, “my husband will encourage and believe in me; he is my husband.” Jim would “have” to be on my side. In the face of negative thinking, a second meaningful relationship was very helpful.

These Meaningful Relationships are characterized by a partnership which is Reciprocal, Empowering, Genuine, Trusting, and Purposeful. Partnerships that intentionally strive to avoid Spirit-Breaking words and actions and focus on Hope-Inducing Behaviors.

It’s also a partnership characterized by continuity in the face of struggle.

For little did I know then how many persons with mental illness lose the support, understanding, respect and love of those with whom they had meaningful relationships, as they progress through life.

I will continue to write about these special partnerships and their characteristics. For these are relationships that can ignite and fuel successful living with mental illness.

Here’s a statement that intentionally “turns around” our usual way of evaluating mental health outcomes: If we want a successful mentally ill person, we could create a group home and help the ill person thrive within it. But if we want, simply, a successful person with mental illness who thrives in the same community with everyone else, we should help them find persons and resources in the community that will empower their strengths and also help them persist and persevere in working to minimize the disabilities brought on by their mental illness.

You help them persist and persevere by engaging them in their areas of strength, not in focusing on their deficits and defeats.

This suggests we should use a strengths model, rather than the problem-based or deficit model for providing services to those suffering from mental illness or disorder.

I first heard of the Strengths Model back in 2000, when I was in graduate school studying community mental health from Professor Charles Rapp’s perspective. A recent text co-authored by Charles Rapp and Richard Goscha, The Strengths Model: A Recovery-Oriented Approach to Mental Health Services, Third Edition, 2012 simply reaffirms its importance in my thinking. I learned to focus on an individual’s strengths as building blocks to manage a situation or a life. I believe that people with mental illness would be >much< better served if all of mental health services had a strengths-based foundation rather than the traditional deficit- focused orientation.

“The strengths model posits that all people have goals, talents and confidence.” Furthermore, “All environments contain resources, people and opportunities.” (Link) But with the deficit-mindset, our perceptions of these are limited and modest and full of considerations of barriers and pathology. Strengths pale in comparison to the deficits.

“The strengths model then is about providing a new perception. It allows us to see possibilities rather than problems, options rather than constraints, wellness rather than sickness. And after being seen, achievement can occur.”

It is Rapp and Goscha’s belief that if those involved in mental health services and policy insist on the “muck and mire of deficits” perception, we cannot be of effective help to all of those affected with mental illness.

I learned that the Strengths Theory has nine key propositions. Several of the nine are block-busters that can explode our current ways of thinking about mental illness services.

Here is their first key proposition: The quality of the niches people inhabit determines their achievement, quality of life and success in living.

A niche is defined as the environmental habitat of a person or category of persons. There are two types of niches at the extreme: entrapping and enabling.

Here are four characteristics of entrapping niches (there are others):

• Entrapping niches are highly stigmatized; people caught in them are commonly treated as outcasts.
• People caught in an entrapping niche tend to “turn to their own kind” for association, so that their social world becomes restricted and limited.
• People caught in an entrapping niche are totally defined by their social category. The possibility that they may have aspirations and attributes apart from their category is not ordinarily considered. To outsiders, the person is “just” a bag lady, a junkie, a schizophrenic….and nothing else.
• In the entrapping niche, there are no graduations of reward and status. …… Thus, there are few expectations of personal progress within such niches.

Here are four describing enabling niches:

• People in enabling niches are not stigmatized, not treated as outcasts.
• People in enabling niches will tend to “turn to their own kind” for association, support, and self-validation. But often the niche gives then access to others who bring a different perspective, so that their social world becomes less restricted.

• People in enabling niches are not totally defined by their social category; they are accepted as having valid aspirations and attributes apart from their category.
• In the enabling niche, there are many incentives to set realistic longer term goals for oneself and to work toward such goals.

The strengths model proposes that finding, cobbling together or creating enabling niches should be the major focus of work for mental health services and professionals. The authors continue, “There is good reason to believe that the niches available to people with psychiatric disabilities influence the recovery process and their quality of life.” (pp. 37, The Strengths Model)

I am thunder-struck, when I think of my life and the quality of my life and its influence on my recovery process. A few thoughts:

I have been very fortunate, that the niches in my life have been enabling in my recovery journey with mental illness. I’ll look at a variety of life domains: home or living arrangement, work, education, recreation, and spiritual . Yes, I did a lot of work to gain recovery….but I had a stable set of niches or habitats. Read on:

I lived in a home all the years I have had an illness.   And since the very time of diagnosis and onset I had my own family …… a loving supportive husband and 5 year old daughter and I was pregnant with our second child. We still live in our own home, although it is a different house now, for after 30 years our children are grown. They are fine and healthy and love and care for us as do our two grandchildren. Jim and I continue to enjoy a rich relationship with each other and with our family.

I have had rewarding work. I was employed at St Mary’s Hospital Medical Center and at two nursing homes and one small alcohol and drug rehabilitation hospital as a Registered Dietitian (RD). For 15 years I also taught as a clinical instructor and later lecturer in Nutritional Sciences Department at the University of Wisconsin-Madison. After this career within dietetics, I turned to the mental health field.

I had been able to earn an undergraduate education without much trouble. But much later, when I returned for graduate school, I had a relapse and asked for accommodations. My request was met professionally and I was able to complete the work after some delay but with full effort. I am happy to say that I received my Masters Degree in 2003 from Southern New Hampshire University. In 1993 I had begun a 20 year career of volunteer work with NAMI. After 2007, I joined the staff of NAMI Wisconsin as their Coordinator of Family Programs.

All this work was challenging with a mental illness, but I certainly had roles I valued and that other people valued which were separate from the “role” of being a person with a mental illness. AND NOW, recovered and moved by my life experience I write about mental illness issues and affirm the lives of those who live with them. Today, this website is my vocation in more ways than one.

I’ve lived a whole, stimulating and enjoyable life in large part because the places and people – the niches – I lived in and among were consistently empowering. We must strive to have these empowering environments available in reality for all people with mental illnesses!