Walking and Talking

Community Behavioral Health Workers are not traditional “therapists,” though their work is profoundly therapeutic. And they are not simply “case managers.” That phrase does not do justice to the complexity that goes into their work. There has been a historical distinction between “therapy” and “case management” or “concrete services.”

We want to suggest a new way of thinking about this work.

Historically, talk therapy has consisted of a series of scheduled appointments where patients or clients come to a clinic or office to talk with a therapist who is considered to be an expert. A common approach has been to provide a compassionate space where people can express themselves, work through issues, and develop insight into inner conflicts. We’ll refer to this as “sitting and talking.” If done well, there is no doubt that talk therapy can be life changing.

Supportive services or case management, on the other hand, is most often seen as a process where helpers link people with services and provide practical assistance to get the daily work of life done. Helpers are frequently cautioned not to become “junior therapists” and yet home-based and community-centered work is strongly influenced by the dominant themes of traditional therapy. Helping efforts are often divided into these two categories of doing therapy or providing case management.

We want to suggest a new way of thinking about Collaborative Helping that introduces the idea of walking and talking.

By this, we mean stepping into a person’s everyday life to engage in conversations over time while also assisting with routine needs, helping to solve problems, and taking on life’s vexing dilemmas together. If you are already doing this kind of work, you know what we mean. Practical helping combined with purposeful conversation can work best when it is organized around the stories that shape people’s experience of their lives. This approach draws on a narrative metaphor that has become increasingly popular in our culture and focuses on the stories that people tell about their lives and that organize how they make sense of their lives.

Within this frame, the work is not about sitting and talking with people to work through theirs issues but
Walking and Talking alongside them in ways that open up opportunities for them to experience themselves differently and change their life stories. The new possibilities that this process can open up are potentially quite powerful.

Essential Elements of Community Behavioral Health Work

  • Motivational Interviewing Basics
  • Collaborative Helping (Relationship-Based Care)
  • Harm Reduction
  • Resilience & Self-Care

Adapted from Madsen, William C. & Gillespie, Kevin (2014). Collaborative Helping: A Strengths Framework for Home-Based Services