What is Care Consultation?
Before I began working primarily with older adults, I worked in a residential treatment center for the chronically mentally ill. I started as a counselor and worked my way up to Program Coordinator, and for a time, Executive Director.
Our approach, at the treatment center, combined the distinct but complementary contributions of 30 staff members. The staff was highly educated, and I could count on each of them highlighting their particular ideas and contributions. My challenge with this talented but diverse staff was not like herding cats — that would have been easier — it was more like conducting an orchestra where all the members thought that they should be featured soloists.
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Who’s the Client
(with Gary Bloom)
In the mid-80s, Larry Bird was the most brazen and competitive player in the NBA. The Boston Celtic forward was so dominant that, to avoid boredom, he would find ways to challenge himself during games. The right-hander once handicapped himself by spending an entire half shooting with only his left hand. Care Consultants who find their work an insufficient challenge can, likewise, provide themselves with a major handicap by taking advantage of an opportunity that presents itself at the beginning of a contact. Before we get to that, please read the following scenarios with the following question in mind: Who’s the client?
In the early era of marriage and family therapy (MFT) there were no such professionals as “marriage and family therapists.” Pioneering practitioners were drawn from a number of disciplines: psychology, social work, medicine, the ministry, and juvenile justice, and brought with them the dominant mind-set from their core training. The theory and practice of MFT comprised a hybrid of these backgrounds. Not, however, a hybrid like a Toyota Prius whose electronic and internal-combustion engine hums, almost silently, and in perfect harmony. The MFT hybrid was more like the early, clunky skateboards that were patched together by cutting a two-by-four and bolting on salvaged skate wheels that rolled down the sidewalk clicking and clacking.
You, noted care consultant and mediator, and elder’s children, are moving through the session smoothly when, what seems to come out of nowhere, one sibling lashes out at another. Ouch! Where did that come from? Unless you were one of the five people on Earth who grew up without a bit of resentment towards your parents, siblings, or the family’s pet hamster (and those five people are lying), you know exactly where that came from. Family members, sitting in a room, discussing sensitive family-related issues? It feels like therapy, and we all know that during therapy it’s okay — expected — to reveal hidden and sometimes powerful emotions. Family therapy and care mediation have so much in common that both care consultants and their clientele often confuse one with the other. Care mediation suffers from the if it looks and quacks like a duck, it must be a duck syndrome. But care mediation is not family therapy.
Messy
When I get referrals from family members or professionals, I grab the phone to gather a sketch of the situation. Depending on the circumstances, I may or may not make phone contact with additional involved parties — i.e., family members, health professionals, lawyers, and, if he or she is capable, the client. Following the phone contact, I arrange a meeting with the involved parties who are able to attend.
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Like a frog in a pot
You may have heard this before: Put a frog in a pot of water and set the burner to simmer. If the change in temperature is sufficiently gradual, by the time the frog experiences pain, it will be too late to escape. (Please don’t try this at home.)
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Why are they doing this to me?
A 78 year old woman, living alone in her condominium, begins to notice that her keys sometimes aren’t where she recalls she left them. She is uncertain if she paid her phone bill and can’t find her checkbook. She puts a pan of soup on the stove to heat, remembers that she was cooking only when she smells burnt food. She forgets a lunch date with a friend. Although these incidents of forgetting are occurring more and more, she doesn’t mention them to anyone. She certainly wouldn’t want her children to think she needs help managing the details of her life. And she is not interested in making any changes. No big deal, she thinks. She finds her keys. She finds her checkbook and pays her phone bill. She throws out the burnt pan. She apologizes to her friend and schedules another date to meet for lunch.
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