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Book Review   |    
The Strengths Model: Case Management With People Suffering From Severe and Persistent Mental Illness
Mary Ann Test, Ph.D.
Psychiatric Services 1999; doi:
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by Charles A. Rapp, Ph.D.; New York City, Oxford University Press, 1998, 224 pages, $36.95

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In an era when terms such as "strengths," "empowerment," and "recovery" are beginning to pervade the rhetoric, yet only superficially the practice, of those working with persons with severe and persistent mental illness, The Strengths Model is an essential and rewarding read for staff and trainees of all disciplines who assist these individuals. It is a well-written, thought-provoking volume that explicates in great detail one approach to putting these emerging principles into daily practice. Whether or not one decides to implement the exact strengths model detailed here, which has been developed, refined, and implemented by Charles Rapp and his colleagues at the University of Kansas School of Social Welfare over the past 15 years, the book is likely to open one's mind to radically different ways of doing things in daily work with both clients and their communities.

The strengths model as Rapp conceptualizes it is not simply an "add strengths and stir" attachment to existing pathology- or problem-focused paradigms. Rather, it is a real paradigm shift to a strengths and resilience focus that "allows for new and creative ways to work with clients that honor their skills, competencies, and talents as opposed to their deficits."

The book begins with a history and critique of the "dominance of deficits" in both the orientation of societies and the foundations of the helping professions, then presents the theory, principles, and research results of the strengths model. The guts of the book follow—that is, detailed chapters on each step in the implementation of the model: the engagement phase, strengths assessment, creating the personal plan, and resource acquisition. The chapters are nicely organized, highly useful practice-methods pieces that provide a wealth of how-to details about content, process, and style, with use of brief but incisive clinical vignettes for illustration.

Interestingly, as the author notes, several of the highlighted practice methods—such as assertive outreach, assisting clients in normalized rather than segregated settings, and "one-team integrated services" rather than service brokerage—are similar to those of other effective models such as assertive community treatment. Yet the strengths model stands alone with its virtual total focus on strengths, with almost no attention paid to the illness or symptoms. Indeed, the book would be improved by more direct explication about how the model does deal with these issues and how the psychiatrist best collaborates with this total "strengths approach," as these are frequently asked questions.

Potential readers should not be put off by this shortcoming, however, as the strengths model is not antipsychiatry, nor does it deny that mental illnesses are biologically based and result in serious problems and much pain. Rather, it proposes that a radical shift of illness to the background and strengths to the foreground is the most effective path to recovery. Indeed, many consumers have recently been telling us the same thing! The Strengths Model focuses our attention on this possibility and serves as an exceptionally fine, detailed practice manual for how such an approach can be implemented.

Dr. Test is professor in the School of Social Work at the University of Wisconsin- Madison.




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