Understanding the various roles that are played in assisting families with mental health concerns is a first step in addressing these complex problems.

To fix the wiring in your house, you need an electrician. To fix the pipes, you need a plumber.

To address mental health problems in a multi-generational family, you need to engage with persons with specific roles and functions and specialities.

Let’s look at 3 roles: the therapist, the coach and the mental health advisor.

The therapist ( a social worker, psychotherapist or psychiatrist) enters into a therapeutic alliance ( relationship) with the patient.

This role is carefully defined by the provider’s approach to mental health. The provider’s regulator ( College) has much to do with how the relationship unfolds. It is essential that the provider use motivational interviewing strategies to engage the patient with the objective of getting healthier. The therapist can’t push too hard or the therapeutic alliance will be damaged and the process will stop.  The process is typically incremental. Small steps over time.  The goal is to keep the patient involved over time.  And there are over 300 therapeutic models that can be employed to assist the patient. Maybe more than 300 models. So this choice of therapeutic model is complex.

The coach takes a different approach. Coaching is goal oriented. There is a goal and an outcome. The coach is there to reinforce this process of trying to reach those goals. Consequences or alternative strategies might result if the patient fails to attain the goals.  The relationship with the coach is about negotiating the goals and then reinforcing the process of attempting to attain them. There can be friction in this relationshp but that is factored into the approach. Coaching might be shorter term than therapy because it about clearly defined goals over a certain time horizon.

The advisor is different. The mental health advisor for the family is the architect of the entire solution. This relates to both the family system and the person of concern. The mental health advisor defines the problem or problems involving both the family system and the person of concern. Then the mental health advisor orchestrates the solution with an integrated team of providers. These can be therapists or coaches using many different modalities from family system coaching to music therapy to wilderness therapy. The mental health advisor must have a complete understanding of all the options available to address the problems. The approach has to be comprehensive. It is sometimes costly and the mental health advisor will help with the budget for these services.

Case Study:

Andy was 9 years of age. He had a bad temper and would act out periodically. His older brother would taunt him. His father had big expectations about his sports performance.

One day, he ran screaming into the kitchen, grabbed a sharp knife and threatened to self harm.

That is a crisis for this family. Our job at RCM Health Consultancy was to take the role of mental health advisor for the family.

It took a village to address this set of problems because it involved all the members of the family.

Our job was to mobilize an integrated team of providers to assist and to address the root cause of Andy’s acting out.

Our process worked to assist Andy and the family.

This is often a work in progress requiring tweaking over time as the children grow and mature and the family system seeks to adapt.

Raymond Rupert


RCM Health Consultancy Inc.

647 350 5500