The Promise of Parallel Process: A Paradigm of Healing for Human Services

 

A Dangerous Paradox in Human Service Systems

In January 2016, I was one month into being a new dad. I was also halfway through graduate school and working full-time at a nonprofit as a program director for a play-based early childhood initiative. Throughout the previous year, our program team navigated a series of challenges in our work: we adopted a more asset-based partnership model despite pressure to frame our work as “fixing” what was wrong with our partner’s programs; we lost an incredible program mentor when she took a job offering her more autonomy at a different organization; and right before the holidays, my executive director shared that our program was on the chopping block after a fundraising shortfall.

Feeling exhausted and defeated, I found myself in the office of my mentor, Dr. Linda Lausell Bryant. Linda’s past roles include Deputy Executive Director of the Partnership for Afterschool Education, Associate Commissioner at the NYC Administration for Children’s Services, Executive Director of Inwood House, and most recently Associate Dean at NYU and co-founder of the Adaptive Leadership in Human Services Institute. When I’m at a loss for what to do next, she’s always the first person I call. Linda recognized that my experiences—feeling stymied and demoralized—were all too common in the helping professions.

She described a “dangerous paradox in human services systems”: we speak about our noble values—recognizing people’s strengths, a commitment to social justice, pushing for greater access and equity in services—and yet struggle to match these values to our professional systems and work lives. While we find ways to honor these principles (particularly in direct practice with clients and community members), it is painfully challenging to live out these same values with one another as professionals given the systems that organize our work.

The most common example of this is the disconnect between the success we expect of the helping professions and the resources we provide practitioners. If excellent programming and services are the goal, how can we justify abysmal pay, inadequate materials, unsupportive leadership, and toxic cultures that mistreat the very professionals we need to perform at the highest level? Given the human-centered nature of our work, these conditions are simply inhumane. In our conversation, Linda stressed that she views the conflict between our values and behaviors as an existential threat that at best maintains the status quo, and at worst slowly undoes our efforts.

If this dangerous paradox posed a risk in 2016, then today we find ourselves in a break-glass crisis. With the confluence of the pandemic, a racial reckoning, political unrest, and the gruesome violence and death that accompanied them all, it’s no surprise that toxic stress and the need for mental health services continue to climb. Research conducted by the Citizens’ Committee for Children last year found that more than a third (35 percent) of New York City youth reported wanting or needing mental health services, and of those, less than half (42 percent) are actually receiving them. This circumstance is particularly worrisome as unbuffered exposure to toxic stress creates significant risk for lifelong health, wellness, and learning problems.¹

The adults who work with children are not immune to the traumas of the last two years, and without changes to better prioritize the mental health and wellness of both children and professionals, the education and human services sector runs the risk of grinding to a halt. The impacts of the Great Resignation in the helping professions have been devastating, as staffing shortages place a growing burden on the professionals who remain and compromise the quality of programming and services at a time of acute need.

According to data from the US Bureau of Labor Statistics, in 2021, job openings in the education and health services sectors were up 39 percent, and the rates of professionals leaving the field were more than 10 percent higher than in the three years before the pandemic.^[2] These trends show no signs of slowing; a recent national poll found that 33 percent of teachers are likely to leave the profession. With an additional 21 percent of teachers saying their resignation is somewhat likely, the potential exists to see over half of the teaching workforce turn over before the end of 2023.

Throughout the pandemic, those in the helping professions have demonstrated heroic levels of innovation, adaptability, and resilience in the face of once-in-a-lifetime challenges. Sadly, the same cannot be said for the systems and policies that manage their work. The organizational changes we have seen often level greater expectations with even less resources, creating misery for these heroes at a moment when their efforts should be lauded and reinforced. The pain and suffering this workforce has endured since March 2020 is reaching a crescendo—and people are headed for the door in droves. My hope is that we are at a tipping point and, before the wheels come off completely, we have an opportunity to reimagine how we support and empower education and human service professionals to more fully honor the values that guide our work.

 

What is Parallel Process?

Throughout 2016 and 2017, Linda and I met weekly to explore the attributes of great programming in the helping professions, and most importantly, what it might look like to turn that work inward. We used our own painful experiences with dissonance in these systems, as well as the answers we found in our work, to begin to make sense of the dangerous paradox with which we worked and to chart a path forward. To give a name to what we were articulating together, we upcycled a term from psychotherapy, “Parallel Process,” which traditionally has a negative connotation and describes the reenactment of client-therapist dynamics in the therapist-supervisor relationship. We used a more asset-based lens to repurpose Parallel Process, redefining it as our consistent striving to practice our values at all levels of our work—with clients, colleagues, and leaders and across work teams. In this new definition, Parallel Process is the work of “walking the talk.”

After yet another fundraising deficit in 2017, my work with Linda inspired the creation of a spin-off of our nonprofit program, Play At The Core. I traded the role of program director for CEO and established a new mission for the organization: to inspire healing and change through play, which enabled collaborations with organizations serving youth across the helping professions. To this day, the most precious legacy of this time with Linda was the creation of Play At The Core’s pillars: Relationships First, Lifelong Learning, Play as Change, Shift Power, and consequentially, Parallel Process.

Linda and I hoped that our collaboration could help us envision more healing-centered systems to buffer the toxic stress experienced by the helping professions workforce. For guidance, we turned to the research of psychiatrist Sandra Bloom, whose work in developing trauma-informed systems draws direct connections between the impacts of trauma on individuals and organizational systems. In fact, Bloom and her colleagues advocate for Parallel Process as a central component of their “Sanctuary Model” for creating or changing organizational culture.³

The body of trauma-informed systems work that already exists helped me and Linda begin to understand the potential of Parallel Process. However, given the depth of the crisis we currently face, the need to examine the ways in which past efforts have fallen short is absolutely vital as we imagine a new path forward. In his research, Shawn Ginwright is critical of the trauma-informed care paradigm’s focus on acute personal trauma rather than collective or shared trauma, its tendency to prioritize individual treatment interventions rather than engage root causes, and its inclination to prioritize “pathology (trauma) rather than foster possibility (well-being).”⁴ The shared challenges of the last two years, in particular, implore us to go beyond current systems and approaches, to consider how we can collectively heal and make meaningful change.

In late 2019, research published by scientists from Johns Hopkins University, The Alliance for Strong Families and Communities, The Montana Institute, and Tufts Medical Center proposed a conceptual model that can help to ameliorate aspects of this tension. The study identifies an association between positive childhood experiences (PCEs) and improved adult mental and relational health.⁵ The PCEs studied include: (1) talking to family members about feelings; (2) feeling their family stood by them during difficult times; (3) enjoyable participation in community traditions; (4) feeling a sense of belonging in school; (5) feeling supported by friends; (6) having at least two non-parent adults who took genuine interest in them; and (7) feeling safe and protected by an adult in their home.⁶

These findings have powerful implications for the helping professions as they illuminate the important role the workforce plays in promoting improved health and wellbeing for children and families.

This notion is a challenge to the legacy of white saviorism and the ethos of martyrdom in the human services, which frame white human services professionals in particular as the protagonists of change for the people we work with and which hold that our efforts are worthy of self-sacrifice.⁸ These myths have been passed down to our workforce through the generations and sustain a status quo of exploitation and suffering.

To illustrate what Parallel Process can look like in practice, let’s take the example of a recent Play At The Core partnership with a child life services department in a large pediatric hospital. Throughout the last two years, the department’s team went above and beyond to support young patients and their families as they navigated the uncertainty of their medical conditions during a time of heightened fear and anxiety due to COVID-19. Like so many others in the helping professions, however, the pandemic put significant strain on their department by limiting opportunities for supportive connections, communication, and collaboration with one another. Over the past year in particular, the severity of both medical and mental health needs among patients have paired with growing concerns about the department’s organizational culture, leading to increased workforce turnover that threatens to compromise patient care.

The ultimate goal of our work together is to strengthen community across the department’s team and the team’s internal capacity to engage with future challenges. Our partnership strives to honor the asset-based “what’s right with you” paradigm and is founded in the belief that the child life team already possesses the skills and strategies needed to overcome their challenges. Parallel Process is leveraged to draw this wisdom out of the department staff and help them make meaning of its applications in their work with one another. Play At The Core operationalizes this work through experiential learning workshops, coaching, and program resource generation that is organized in three phases through what we call the CORE (Collective Organizational Resilience through Empathy) model:

1. “Know Your Power” by identifying and celebrating the existing strengths within the program model. For the child life team, this work is centered on the ways that specialists build connections and a sense of community with patients and families during their hospital stay, by asking:
   • What are the beliefs, behaviors, and systems that help you to form a strong sense of community with patients?
   • What is the impact of these efforts on the care you provide?
2. “Target Your Pain” by articulating and exploring the challenges in the professional context. This work requires the child life staff to hold a brave space for one another to examine the dynamics of their professional community. We ask:
   • How would you describe the professional community within the department?
   • In what ways has this professional community supported you as you confronted challenges over the last two years?
   • In what ways has this professional community made your engagement with challenges more difficult?
3. “Live Your Purpose” by imagining and operationalizing ways to bring the program strengths in phase 1 to bear against the professional challenges in phase 2. This work invites the child life team to envision the changes that they seek within their professional experiences, and the ways that their powerful patient-centered work might be applied to this end. The team’s responses to these questions help them begin to envision new ways of working and thriving together:
   • How would you like to see this professional community be stronger?
   • How might you begin to apply some of the same beliefs, behaviors, and systems that help to build community with your patients with one another?
   • What might be the impact of these changes on both your professional and patient experiences?

Parallel Process work must be deeply anchored in the context and experiences of the professionals engaging it. The inputs of the individual team members involved in this work are critical to the meaning-making and iterative strategizing that results as teams begin to consider how their work together should evolve. Our experiences have shown that with each change that teams put into practice, a growing sense of wellbeing and agency at the organizational level begins to fuel a virtuous cycle with abundant potential for healing, learning, and thriving. Nearly 100 years of research has borne this out, linking the strengthened  organizational culture that is possible through Parallel Process to increased professional motivation, job satisfaction, effective service delivery, client satisfaction, service quality, and overall organizational performance.⁹

Not only can Parallel Process be a potential antidote for the despair and exploitation all too familiar in our profession, it can strengthen our ability to achieve our mission. This moment begs us to use Parallel Process to co-create a new paradigm of healing, to leave the dangerous paradox behind us, and to more fully realize the promise of the helping professions.

 

Envisioning Parallel Process in Practice

In Therapeutic Programs that Serve Youth	In Collaboration with Colleagues	In Leading Organizations and Systems
Celebrate the unique strengths and attributes of youth to support development of positive self-image, self-awareness, and self-love.	Recognize the unique contributions and efforts of team members in order to strengthen confidence, build skills, and help others recognize their professional purpose.	Inventory and understand the assets and strengths of your teams and partners as crucial to any growth or change work you plan to engage in.
Invite open communication with youth about challenges they are confronting and feelings they might have.	Normalize the sharing of questions and concerns among colleagues in team meetings, in supervision, and in informal touchpoints.	Use questions and inquiry to encourage reflection and discovery. Invite questions and dialog from your teams and partners about the purpose and strategies of your work together.
Create a supportive community that reliably shows up when youth are having a tough time.	Acknowledge challenges that impact individual colleagues and the team as a whole, and explore ways to provide meaningful support to one another.	Approach challenges with empathy, and seek to frame them as learning opportunities that can bring your teams and partners closer together, strengthening organizational culture and a sense of community.
Support the emerging agency of youth through choices and opportunities to see themselves and their ideas represented in the program.	Create opportunities for colleagues to lead different aspects of your work together. Invite feedback and adapt your work together to reflect the unique perspectives and experiences of your team members.	Design organizational planning systems to encourage and honor the voices and choices of your teams and partners. Ensure that your teams and partners reflect the diverse backgrounds and experiences of the communities that you serve.
Cultivate both routines to maintain predictability and rituals to recognize important moments with youth.	Support colleagues to create and structure and predictability in their workday. Protect boundaries between work time and personal time. Celebrate successes (large and small) together.	Create predictable structure within meetings and other shared work. Model great work/life boundaries to better support mental health and wellness. Develop shared rituals to honor milestones or moments worth celebrating.

 

 

Notes

1. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.
2. U.S. Bureau of Labor Statistics. (n.d.). Jolts news releases. U.S. Bureau of Labor Statistics. Retrieved March 9, 2022, from https://www.bls.gov/jlt/#
3. Esaki, N., Benamati, J., Yanosy, S., Middleton, J. S., Hopson, L. M., Hummer, V. L., & Bloom, S. L. (2013). The sanctuary model: Theoretical framework. Families in society, 94(2), 87-95.
4. Ginwright, S. (2018). The future of healing: Shifting from trauma informed care to healing centered engagement. Occasional Paper, 25, 25-32..
5. Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA pediatrics, 173(11), e193007-e193007.
6. Bethell,  et al (2019).
7. Ginwright, S. (2018).
8. Sherman, W. R., & Wenocur, S. (1983). Empowering public welfare workers through mutual support. Social Work, 28(5), 375-379.
9. Agbényiga, D. (2011). Organizational Culture-Performance Link in the Human Services Setting. Administration in Social Work, 35(5), 532–547.