Back in 2016, I received a rude awakening from my doctor after reviewing my lipid panel lab results from a few weeks earlier. He said I would have to make substantial life changes if I wanted a chance to reach my retirement years. He pointed out that my LDL “bad” cholesterol and triglyceride levels were way too high, and my HDL “good” cholesterol was way too low. These results, combined with my family history, put me at high risk for heart disease and other chronic health conditions. “So, what kind of changes are we talking about?” I responded. He said I would need to start exercising more and implement a heart-healthy diet. And find more life-enhancing ways to respond to stress. As I walked out of the doctor’s office, I kept muttering to myself, “I don’t have time for all that.” I mean, doesn’t this doctor know that I burn the candle at both ends from the time I get up in the morning until the time I go to sleep? My days are packed already! I can’t fit more things into it. And if I start swapping things out, then what if everything collapses completely? Yes, I can get dramatic at times.
We have all been there (or are there). “I don’t have time” is probably the most widely used phrase when confronted with change. For many programs that implement Strengths Model Case Management, it’s a common phrase from staff when they are introduced to the model. Even when they initially get excited about the philosophy and approach, once they start thinking about the Strengths Assessment and Personal Empowerment Plan (and then multiply that times the number of people they are working with), they quickly get overwhelmed and out comes the phrase “I don’t have time.”
Ok, let’s start with some basic math. There are 168 hours in a week. We can’t add more hours to the week if we try (though when we include daylight savings time, we can sneakily add one extra hour in there once a year). And work weeks are typically 40 hours, unless you are a salaried employee, or you find yourself taking your work home after hours. So, let’s focus on the hours you get paid to work (glance at your paycheck if you need to double-check that).
Now, we need to subtract:
- the hours for meetings that you are required to attend
- travel time when we are not with the client
- Documentation time (we will deal with that beast in another blog)
- And any other non-direct client work the organization may require you to do.
What you should have left are the hours you spend directly interacting with clients. No, I’m not going to try to guess your number since this isn’t a magic trick. Whatever number you arrived at, these are the hours that you have some control over. I say some control because we can’t control everything that occurs within a session with a person. However, we do have agency around what we DO during a session. These are also the hours when doing Strengths Model practice applies.
Let’s get this out of the way first: Case management in behavioral health is HARD work. We typically work with a number of people who have immediate, pressing needs and are often experiencing a significant amount of internal and external life stressors. As workers, we may also be experiencing our own life stressors (from work, home, and our surrounding environment). Many case managers have an exorbitant amount of responsibility, carry unwieldy caseloads, receive the least amount of training/guidance/skill development, and are often among the lowest-paid staff in an organization. So, yes, you may be stressed for a reason.
While there are things organizations can do to make things structurally more manageable for workers and support them in ways to give them more guidance and direction in their work, there is no way to completely eliminate stress from the case manager job repertoire. It’s a difficult job.
It’s also one of the most rewarding jobs that is out there. Very few positions in behavioral health afford the opportunity to impact the life of another human being in the way a case manager can. While the care manager’s scope of work doesn’t include building houses, creating jobs, manifesting supportive relationships, changing the social and economic fabric of society, or eliminating all the causes of human suffering, the case manager brings to the table three indispensable elements to the helping relationship to support people in navigating life challenges: Presence, Hope, and Opportunity for committed action. Let’s talk about each of these briefly before returning to the main dilemma of this article: “I don’t have time.”
Presence – Sometimes, all we have to offer people in a session is our presence. Some challenges have no easy answers or solutions. Sometimes, resources aren’t immediately available. Sometimes, circumstances are overwhelming to the person and the worker. When that presence is accompanied by genuine empathy and validation, it goes a long way in helping people feel heard. In our rush to fix things or avoid discomfort, we frequently miss those opportunities to connect with people on a human level. Presence is also about establishing a thread of continuity between sessions that demonstrates acceptance without judgment. Our investment is in the person, not the choices that have been made.
Hope – Hope is not just a passive feeling of anticipation, as in “I hope something good will happen.” Hope is a byproduct of an action that helps us envision possibilities for a way forward or toward something we value. Sometimes, it is difficult for people to see possibilities, especially when mired in current life challenges and pressures. Hope is diminished when people perceive they have lost agency to effect change. Case managers have an opportunity to open an avenue of hope, even if it is just through a willingness to explore possibilities. These possibilities are generated through an intentional focus on desired values or goals (where you are trying to get to), the acknowledgment of efforts or capabilities that align with desired values or goals (what you are able to do), and the identification of useful/helpful personal and environmental strengths (what can be used to help you get there).
Opportunity for committed action – Efforts to promote hope are quickly dashed when not accompanied by a committed action. A committed action can just be a small step toward something. It’s not about the full achievement of the goal; it’s the recognition that a mindfully exerted effort can produce a result, even if that result is merely a new set of questions or decision points. Case managers have the opportunity to help people re-engage with their sense of agency and empowerment just through the result of a successful action that is tied to the person’s effort. Committed action leads to results, further fostering hope and opening a pathway to further action. Combined with our intentional presence as a case manager, we create potential conditions that can facilitate positive change.
While this all sounds simple and easy, working with people is a complex endeavor, and contextual factors make every encounter unique. Therefore, incorporating these overarching elements into our practice does take learning and developing an array of skills that allow us to apply diverse interventions to idiosyncratic situations. These skills are embedded in Strengths Model Case Management, and the model’s tools provide a vehicle to structure and reinforce the use of these skills with people. Over four decades of behavioral health research has demonstrated that when we consistently employ certain skills and practice behaviors in our work with people, we increase the likelihood of achieving positive outcomes.
Yet, even when we know something is effective, it’s still difficult to put into practice. So why don’t we do it?
Let’s return to the statement, “I don’t have time.” While we always have competing demands for our time, we do have some choices with the time that is under our direct control. The time we already spend directly interacting with people is one of these areas.
So why wouldn’t we want to incorporate effective strengths-based interventions into these precious time spaces? Particularly when we already feel overwhelmed in our work, responding to continual problems and challenges that arise in our work each week. It’s more than just being a matter of desire to do something that is effective and impactful with our time; more fundamentally, it is a natural resistance to change. Change is more than a simple cognitive exercise. It’s a complex array of neurochemical activity. The same neuroscience involved in making practice changes is involved when making any behavior changes, like I was faced with in 2016, related to my health and well-being.
You see, when we are at any decision point and faced with choices, our brain considers the difference in value between. Some choices may allow us to remain on familiar ground, including the choice to stay on our current pathway. Others may require us to move in an unfamiliar direction. Uncertainty is one thing that brains don’t naturally gravitate toward since its primary function is to keep us safe and alive. So, when we encounter change, our brains can quickly shift into a protective mode. While Strengths Model Care Management isn’t a life-threatening danger, our sympathetic nervous system can still be engaged when we encounter any stimulus that disrupts the status quo. Brains desire both routine and parsimonious resource use. In fact, the routines (habits) we currently have (whether in our work or home life) have been carefully crafted and hardwired over the years to help our brains maintain some sense of equilibrium, even if that equilibrium feels like survival in the midst of chaos. Our brains can convince us that sticking with our biochemical status quo is safer than venturing out into the unknown.
The good news is that change is possible. We do it all the time, even when we don’t initially want to. The first step is to recognize that our brains aren’t a monster inside of us that controls us. Our brains and their entire neural networks are us, and they are both the source of protection and growth. So, in order to overcome the cognitive inertia of change and incorporate Strengths Model practice into our work routine, we must do a few things:
- Acknowledge a desire to make a change – It’s okay to be ambivalent. It’s even okay if you haven’t taken a step yet. In order to move toward growth, we must at least signal to our brains that we intend to make a change. Change will require biological resources, and guess who manages those? Correct, the brain. So, we need our internal resource manager on board.
- Acknowledge why you want to make a change – Change is hard work, and who wants to work hard just for the sake of working hard? There has to be a reason that helps ignite intrinsic motivation. For Strengths Model Case Management, it could be that we want to learn how to more effectively help people take steps toward things they value or want in life. Or I want to be able to practice in such a way that my efforts feel grounded and intentional rather than reactive. Or I want to learn new skills that will help me further my career path in behavioral health.
- Have some compassion for ourselves – Change can also be painful. Routines can become comfortable, and we can be defensive of challenges to our accustomed way of doing things. Making a change to a new way of doing something doesn’t have to be seen as a complete disruption from the past. Everything you have experienced and how you have responded has collectively culminated into this moment where you currently are. Making a change isn’t leaving the past. It’s the same you, continuing into the present and opening the doors of possibility to your next future moments. Having compassion on ourselves is appreciating how your mind and body have always done their best to keep you as safe as possible, and moving forward, working with what they knew at the time in the best way they could. Appreciating our past helps us mindfully prepare for new learning that bridges our past experiences with future opportunities for growth.
- Start with small changes – Learning something new can be overwhelming, even when we are excited about making a change. If we want to incorporate changes into a routine that will have long-lasting effects, we need to start slowly and build “muscle memory.” In Strengths Model practice, we recommend initial testing on a small scale, incorporating the learning from those experiences, and then going back out and practicing some more. If we don’t build in opportunities for mindful learning, we end up just doing things and leave ourselves vulnerable to quickly reverting to our previous ways. Remember from earlier, brains like routine, but first, we need a structured way to establish that new routine on a small scale before expanding.
- Build a support network into your change process – Making changes in a vacuum is difficult, if not impossible, for most humans. We are social beings, and for better or worse, our routines are often learned and reinforced in the company of others. Even when we have one person in our life who knows about the changes we are trying to make and is willing to stay engaged with us throughout the change process (for feedback and support), then we greatly increase the likelihood of making a successful change. In Strengths Model practice, this key person is often the supervisor, who is well-positioned to support your ongoing skill development and the creation of an effective practice routine. When an entire team is open to making a change together, then the likelihood of successful change increases exponentially. So, keep in close communication with the people who are most supportive of the changes you want to make.
- Adopt a learning-for-a-living framework – Making changes is not about perfection; it’s about learning and growth. Often, people thwart their learning when they beat themselves up for not being flawless after committing to a change. Making mistakes and learning from them contributes more to growth than the things that come naturally and easily to us. So, embrace mistakes and setbacks and stay focused on forward movement. That’s the pathway to eventually being a gifted and proficient Strengths Model practitioner.
- Take time to celebrate small achievements – Our brains are wired to seek rewards. I’m not talking about a huge trophy or a financial windfall (though positive external recognition of our efforts can be welcome and useful), but rather intrinsic feedback that what we are doing is leading to a more efficient state of being. Intrinsic reward is actually a more powerful driver of sustained change than extrinsic motivators, anyway, because we align with the values we already hold. In Strengths Model practice, this could be successfully using empathy to help one person feel heard, using the Strengths Assessment to help one person see they are more than the anxiety they experience, using the Personal Empowerment Plan to help one person mindfully take a step toward something that has overwhelmed them, or using an idea from group supervision that creatively opened an opportunity for engagement. Each week offers multiple opportunities for small, albeit impactful, achievements if we are open to them.
It’s been eight years since I walked out of that doctor’s office and rationalized all the reasons that I didn’t have time to make a change. I would love to say I am now the epitome of health, and it was a simple, linear journey to get there. Over those years, though, I made substantial life changes, and I now look forward to reviewing my lab results to confirm my efforts are productive. What I value more than my lab results is how the changes I made have led to new ways of engaging with the outdoors, healthier food options, and stronger relationships with my family, my dogs, and my friends. I have also learned more effective ways of responding to life stressors. It’s all still a work in progress. What I learned most from this journey is that time was never my real enemy; it was my own resistance to change. Once I stopped battling with my brain and recognized that we were actually on the same team, I could at least begin the journey forward. It’s the same with learning Strengths Model practice. The same brain that is resistant to change (being the wonderful protector that it is) is also our potential partner in growth and development. As we take steps to learn Strengths Model practice, we may still find external pressures demanding our time. However, we may also find that we are slowly becoming more productive and effective with the time we do have, and achieving the outcomes that we desire in this field.
