Getting Ready to Help: A Primer on Interacting in Human Service. Martin J. McMorrow. Baltimore: Brookes, 2003.
This is a very short, powerful, simply written, wonderful book for people who provide any type of direct support in human services as well as those who manage or direct them. As a primer on what actually constitutes “helping,” it would also be useful for family members, support coordinators, and people with disabilities themselves because it will help them identify when they are receiving real help and when they are not.
McMorrow's ideas are challenging to many human services assumptions and extraordinarily helpful themselves for providing foundational thinking about what helps and what does not help people. I recommend it to every human services agency and every individual in a situation where they are called upon to help others.
This book is not aimed solely at those who work in developmental disabilities services; examples from two other groups are also specifically included: people with traumatic brain injury and those diagnosed with mental illness. In utilizing these different examples, as well as addressing broad and universal principles of “help,” McMorrow has written a book that other groups in human services, corrections, geriatrics, etc., would also find useful and potentially life-changing. Although the title of the book seems to imply that it is aimed at those new to or just entering the work of direct support, the ideas are also thought-provoking and challenging for those already working in the field. I believe the discussions would be profound even for staff members who have worked for 30 years with people who have developmental disabilities. McMorrow wrote this book because others recommended that he share his methods, which is a high commendation from those who have found them useful.
The author begins by recounting his own experiences starting out in the army as a psychiatric social worker with only 8 weeks of training. He reports being shocked at how the supposed “professionals” laughed uproariously at a young man who apparently had catatonic schizophrenia and at McMorrow's attempts to communicate with him. From that first encounter, he understood that it was not always wise to trust supposed “professionals,” that established assumptions of care and support were not necessarily helpful to people, and that people who are in supposedly “helping” roles often interact in ways that cause more harm than good.
McMorrow brings together two elements: (a) recounting episodes in his own life experiences of his evolving understanding of what would really be beneficial to people and (b) providing principles, rules, and examples for action. He acknowledges that really being useful takes a great amount of humility in the face of “unpredicted successes and unfortunate failures.” He lives the principle of putting himself “in the shoes” of the person being helped. His examples often draw on individuals in extreme situations, such as psychiatric hospitals and state institutions. There is the woman in a rehabilitation hospital with traumatic brain injury who curses and verbally and physically attacks anyone who comes near her; a teenager who pulls hair; a man persistent in getting his caregiver's attention to the point of calling her at home, showing up at her door, and threatening suicide; and soldiers in Vietnam overdosing on heroin. Through his deep empathy with these individuals—many of whom have no verbal skills, have been in difficult situations for years, and engage in seemingly destructive behavior—McMorrow has developed a set of principles and a model of personal intervention based on that empathy and respect for the those he serves.
The book is organized into eight objectives, which are principles and rules to follow, with rich stories of people who have been very difficult to reach using traditional service principles. These objectives are (a) do no harm, (b) don't blame, (c) watch for reciprocity, (d) create a mutually reinforcing relationship, (e) teach the person to fish, (f) bounce off the upsets, (g) be clear of the purpose of your help, and (h) experience the joy of helping.
Although an experienced staff could look at this list and nod agreement, the richness of McMorrow's examples demonstrate the degree to which these principles are not being utilized in everyday services and how commonly used methods supposedly designed to help people are often extraordinarily unhelpful. For instance, there is a dramatic example of how ignoring what is termed attention-seeking behavior dangerously escalates that behavior. He advises staff members to question the experience of people who have been on the job a long time to determine whether what they are doing is not helping. Sometimes a staff member who has built up a rapport with an individual and has made many deposits in the bank of good mutually reinforcing experiences can be more helpful to the more inexperienced staff member who is having a difficult time than can the so-called specialist.
One of the most basic of McMorrow's principles is that there is always a reason why something occurs and that people think, feel, and do what they do for good reasons. Although readers may have heard this, and even say they agree with it, that principle is not followed in many supposed “treatment” programs. McMorrow's understanding of behavior is reminiscent of Herb Lovett and John McGee (as Allan Bergman notes in the foreword), and those readers who appreciate the work of these authors will find this book very enjoyable as well as useful for explaining these principles in simple and understandable ways.
McMorrow demonstrates how building reciprocity and mutually reinforcing relationships will aid in assisting the person to realize goals of greater autonomy. He explains what “proactive treatment” can be and how a helpful approach would be to assist the person gain more independence and autonomy rather than expect only compliance. His goal is to “help people have the outcomes that will empower them to have the highest quality of life they can have.”
There are a couple of minor drawbacks to this book. One is that at a couple of points in the later chapters, the material gets a little too technical with too little explanation. Another is that some of the stories movingly and emotionally demonstrate that what is done in the name of being helpful can be quite destructive, but there is no corresponding recounting of what was done or could have been done. In these cases, some explanations of proactive approaches that might have been used would have made a difference as they do in many of his other stories. However, both of these are very minor points and do not detract from the overall power of the book.
The main caution or concern I have is that I do not know whether direct support staff members, the main audience for the book, could simply read it and start applying all of the powerful ideas. I am not sure how just reading the ideas would change a potential helper's behavior or whether the author even intended that. McMorrow himself writes that it was his experiences that changed his perception of reality. A very beneficial and effective way to use this book would be to have staff members meet together to discuss their experiences with learning and applying these ideas. Direct support staff might need coaching and assistance in working through the concepts with their supervisors or with people who care about a particular person. Supervisors themselves might need the support of their direct support staff or other caring people to fully understand and implement these principles in their daily approaches. I would highly recommend that a group of staff members or an interdisciplinary team work through each chapter or principle together. A manager on a ward of a type of facility described, a group home coordinator, a supervisor in a day program, a coordinator of a supported living program, or a lead staff member in a drop-in center for people diagnosed with mental illness could read sections or examples and have the staff members discuss the ideas. The individuals who receive help and their family members could be included in discussions. The eight objectives and elements of the personal intervention model could be dealt with at weekly or monthly staff meetings, applied in planning meetings, and implemented in agency practices. To be applied on a broad, agency-wide scale would take significant commitment and leadership.
Family members, support personnel such as case managers, and individuals with disabilities could also take the ideas and understand which types of programs would be most helpful to those who receive support and actually use the ideas to advocate for more helpful supports for themselves. In addition, the fact that the author is male is helpful in reaching more potential male helpers with what might be considered some fairly “feminine” ideas, such as the idea of “helping” itself, connecting with others, and mutual reciprocity in relationships. Even without agency commitment or support of others in their workplace, however, it is highly likely individual staff persons would find the ideas very useful in their own daily interactions.
McMorrow ends his book with a call for the fun there is when a staff person has success in his or her helping interactions and in reducing the pain of difficult life situations as well as the pleasure of having the opportunity to participate in the life of someone he or she is attempting to help. This is a wonderful book with deep insights, celebrating the joy of connecting with others and being truly helpful. It is a reminder of why we want to do this work, and how, in the face of often insurmountable attitudes and barriers, the joy of connecting and really helping even just one person makes it all worth it.