Navigating Relationships
Marilyn is sitting at a picnic table across from Lisa, a social work researcher, who has been helping Marilyn prepare for a move to a new apartment. They are revising a to-do list; and Marilyn is telling her that she needs to save money. She needs to buy appliances and furnishings. She must arrange for a truck and for people to carry moving boxes. She needs to learn how to use a checkbook. She reminds Lisa that she is working with the social service agency to complete the paperwork to get control of finances. Her mother, now managing her money, wants this to end.
The picnic table where they sit is in a park on a hill overlooking Lake Erie, the
shallowest of the Great Lakes. The shoreline, seventy feet below, stretches to the
northeast and to the northwest as far as the eye can see, in one big arching smile that curves toward Canada, which no one can see. Out there is nothing but water: It fills the smile with its mood.
It is a perfect summer day. The sky is a deep, comforting blue, spotted with billowy white clouds. It is warm but not hot, and a gentle breeze pushes the water lightly against the large rocks along the shore. From the hilltop where the women sit, there is no sound, just the view of water and sky. It seems just the right setting for their conversation today.For years Marilyn has dreamed of moving to an apartment of her own. And for the
first time it seems close to reality. The social service agency has placed her on a list for the next available unit. It is exciting; and although she feels the prospect of change, she is calm. She changes the topic with the stutter-start of a question she is not quite sure she should ask. With this question, she invites Lisa to a church festival in the neighborhood where she grew up. Her mother, sister, and two nieces will be there. She looks to the lake before saying to Lisa, “It would be a good time for you to meet them.”
In this moment, Lisa cannot decide whether her attendance will fit into the guidelines of the research study. She is supposed to be observing the interactions between Marilyn and the people helping her recover from symptoms of mental illness, including family members, friends, and health and human service workers; a church festival may not qualify as an observable event. Lisa does not want to cross the line that separates the professional from the personal, a line that gets fuzzy with questions like this. Before directing the conversation back to the list of things for the pending move, she tells Marilyn that she will check her schedule.
Marilyn responds with the stutter-start of another question. She is hesitant to ask.
Again she is staring out over the lake, at that long thin line of nothingness where the
sky and water converge. “What happens to me when the study is over?” she asks. “Do I ever get to see you again?”
This book is written for everyone like Lisa and Marilyn who wonders about the
role of human relationships in mental health recovery. We argue for the importance
of relationship by closely examining its process, that is, the back-and-forth exchange
of attention and information that occurs between people. We will explain how case
managers can use the process of sharing attention and information intentionally to
help clients develop or enhance abilities to achieve their greatest potential for living
independently in the community with hope, satisfaction, and success.
We focus on case managers and clients with symptoms of severe mental illness
because these are the main characters in the story that unfolds on the following
pages. The research project that inspired this book and provided the rich data and
case studies for the telling of Marilyn’s story is described in appendix 1. Lisa is a social work researcher in Cleveland, Ohio, who is a participant–observer case manager.
Marilyn, a client in the public mental health system, is navigating relationships with
others in the community, including family members, friends, and health and human
service providers such as psychiatrists, physicians, nurses, housing specialists,
and employment specialists. The story you are about to read unfolds in a linear time
sequence. Each chapter and reported event has two parts: a scene titled “Observe,”
which describes the interaction between Marilyn and Lisa, and a reflection on the
scene, titled “Reflect,” which explores the work of the case manager and how she used the relationship to draw attention to her client’s strengths, namely, her own feelings, thoughts, and actions.
The story is told in a third-person narrative voice that acts as a movie camera in each scene. Sometimes it hovers close to the client. Sometimes it hovers close to the case manager. Sometimes it drifts up and out of the scene in a panorama to report on larger issues. In moments like these, we draw on what we know about the social, historical, and intellectual context of what the narrator reports. In many scenes, the narrative voice hovers close to the case manager because she is the one who conducted the research and observed, not only Marilyn but also herself. This is why the book is written for case managers. However, it is not written exclusively for them but for everyone with whom they interact in everyday relationships, including consumers, family members of consumers, and other service providers. In short, this is a book about being and having a case manager.