Ways of Helping

3 Working Models to Enhance Engagement and Dialogue

One of the pleasant surprises of our cross-cultural exchange was our shared value of fostering relationships by carefully attending to the nuances of language. A post-modernist reflection is that we live, breathe, work and play in the midst of language, so here we put forth some working language based models to help foster communication across or perhaps through the cultural divides that we are bound to encounter along the way.

Open Dialogue was developed and researched in Western Lapland during the 1980s. It is a non-hierarchical approach to promoting recovery that focuses on connecting and developing a supportive social network to care. It does not follow any one particular model, so the medical model which includes psychotropic medications may work for some, while other approaches may work better for others. The person in need, family, friends, social workers, psychiatrists and others are all on equal footing when it comes to discussions of what works, or what doesn’t work for a particular person in advancing the recovery process.

Seikkula and others have studied effective approaches for people with schizophrenia and have found that the Open Dialogue model focused on building and maintaining psychosocial support networks greatly reduced or in many instances eliminated the need for psychotropic medication as part of the recovery process. Its philosophical roots can be traced back to Mikhail Bakhtin’s work and philosophy on language. More can be found via this video on Open dialogue and Jaakko Seikkula’s work on addressing schizophrenia, as well as Mikhail Baktin’s philosophy.

Ray Middleton- aka: ‘Dialogical’ Ray is an expert from experience and freelance PIE consultant and trainer, as well as systems broker for Fulfilling Lives in the Northeast of England. I had heard about Open Dialogue via the Peer movement in the US. However, it was Ray who initially introduced me to some of the intricacies of ‘Open Dialogue’ by sharing his research on converting hostels into Dialogical PIE’s.  Much about Ray’s work, including his Ladder4Life Approach to helping, can be found via the Fulfilling Lives website.  Ray also produced a Dialogical PIE video that can be viewed HERE.

According to the Center for Appreciative Inquiry’s website (2018), Appreciative Inquiry (AI) was pioneered in the 1980s by David Cooperrider and Suresh Srivastva, two professors at the Weatherhead School of Management at Case Western Reserve University. AI consultants around the world are increasingly using an appreciative approach to bring about collaborative and strengths-based change in thousands of profit and nonprofit organizations and communities in more than 100 countries.

The Center for AI further characterizes Appreciative Inquiry as a way of being and seeing. It is both a worldview and a process for facilitating positive change in human systems, e.g., organizations, groups, and communities. Its assumption is simple: Every human system has something that works right–things that give it life when it is vital, effective, and successful. AI begins by identifying this positive core and connecting to it in ways the heighten energy, sharpen vision, and inspire action for change. As AI consultant Bernard J. Mohr says, “Problems get replaced with innovation as conversations increasingly shift toward uncovering the organization’s (or group’s, or community’s) positive core.”

The five original principles are: Constructionist, Simultaneity, Anticipatory, Poetic, and Positive.

Suzanne Quinney and Tim Slack are co-founders of Appreciating People www.appreciatingpeople.co.uk/ and of How to Be More Awesome, and uses Appreciative Inquiry and Positive Psychology to support organisational and individual learning. Suzanne, Leo Richardson, and others also brought  a particular focus to applying AI to homelessness organizations and communities.  An informative video on transforming hostels to PIEs through the use of AI can be found HERE.

Pretreatment is defined by Jay S. Levy (2010) as “an approach that enhances safety while promoting transition to housing (e.g. housing first options), and/or recovery alternatives through client centered supportive interventions that develop goals and motivation to create positive change.”

It is based on 5 Universal Principles of Care to promote person centered work as follows:  Relationship Formation via the stages of Engagement; Common Language Construction to enhance communication; Ecological Considerations focused on supporting the natural processes of Transition and Adaptation; Faciltating Positve Change by utilizing Change Model and Motivational Interviewing strategies; Promoting Safety via Crisis Intervention and Harm Reduction approaches.

An outreach counseling model based on a Pretreatment philosophy affords us the opportunity to become both interpreters and bridge builders (Levy, 2013). Through the process of common language construction potential resources and services are re-interpreted and reframed so the client can more fully consider these options and their potential impacts. This is the first major step toward building a bridge to needed resources and services that include housing and recovery options. It is a bridge consisting of a safe and trusting relationship between worker and client, as well as a common language that fosters communication. This is in-line with our striving to understand people’s values and stories in a manner that dignifies the meaning or purpose of their narratives.

Common Language Construction is one of 5 simultaneous principles practiced or applied via a Pretreatment  approach.  The stages of Common Language Construction guide us on our journey to better understand our clients’ worlds and bridge their sense of meaning to the pragmatic and achievable goals of accessing housing and/or treatment for both acute and chronic health issues. Through the careful application of common language construction we can uphold people’s values and join with their aspirations, while avoiding the common pitfalls of making offerings that fit our agenda, but are counter to their interests. There are 3 stages to Common Language Construction as follows: Understanding, Utilizing, and Bridging Language. More information on Pretreatment and Common language Construction including narratives that illustrate the homeless outreach process can be found HERE.

This Transatlantic PIE Training Video features Ray Middleton’s interview with  Jay S. Levy on the 5 principles of Pretreatment including Common Language Construction.

7 Ways of Helping 

  • Directly get to know people who are experiencing homelessness in your community and offer support by saying hello, introduce yourself and learn each others’ names
  • Offer a basic need item such as clothes (i.e. socks, hat, gloves, sweatshirt) directly to a person who lacks access to these items
  • Identify helpful community resources such as food pantries, meal programs, and shelters, and share this information with people without homes
  • Volunteer your time at a community meal program, food pantry, or shelter, etc.
  • Inquire with your local faith organizations and city/town officials as to what is currently being done to address homelessness and offer to assist by donating time, money, or helping to organize a fundraiser that is targeted toward a specific goal (e.g. Rental Assistance)
  • Donate money or basic need items to non-profit and faith based organizations whose mission is to help people without homes.  Don’t be afraid to try and target your donation toward a specific worthy goal such as providing rental assistance or supporting transitions to housing by paying for moving costs or needed household items, etc.
  • Get politically involved, while educating yourself regarding current homeless policy on a local, state, and federal level



10 Guidelines for Outreach Counselors (Pretreatment Perspective) 

  1. Meet clients where they are at (literally via outreach and figuratively via stages of engagement)!
  2. The relationship is most important – Promote trust and respect autonomy!
  3. Develop a common language of shared words, ideas and values ~
  4. Be goal centered – Join the person in framing out goals that resonate well in his or her world.
  5. Mutually define or characterize particular difficulties to achieving goals and jointly develop strategies or plans ~
  6. Carefully Support transitions to new ideas, relationships (stages of engagement), environments (desensitization), resources, and treatment (bridge client language to treatment language).
  7. Promote Safety via Harm Reduction strategies and Crisis Intervention techniques
  8. Utilize crisis as an opportunity to promote positive change!
  9. Respect the process of change – understand its stages and relevant interventions.
  10. Understand the person’s narrative and integrate a process of “meaning making” with movement toward positive change!

By Jay S. Levy, MSW, LICSW

Other Ways of Helping

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Thoughtful Donations to Homeless Shelters during the Winter

12 Ways to Help Homeless Pets

4 thoughts on “Ways of Helping”

  1. I had the pleasure of editing Jay’s book for Loving Healing Press, and can thoroughly recommend it.

    This book is a very impressive guide to people working in any helping field that involves interacting with clients who refuse to admit having a problem. Jay’s experience is with working with homeless people who refuse services because of complex mental health or addiction problems, but his respectful attitude will work in other fields as well, as I can attest from my personal experience as a psychologist. He says, “This work is based on principles of common language development and presents three distinct stages on how to acquire, use, and bridge common language. This provides a prototype technology, from the world of homeless outreach, which can be applied to a variety of difficult to engage populations.” This expresses my point.

    The information is presented through a number of very clear case studies, that immediately bring the material to life. I think that any intelligent reader will be able to apply Jay’s approach⎯and is well advised to do so. I am going to recommend this book to Australians working with homeless people.

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