Relationships

I agreed in an article for Planet Advocacy (March 2005, pp.10-11) that advocacy was all about 'relationships, drama and expression'.

It's not really possible to pick out one of these terms and stress it above the others, but I do want to say a few words about relationships at this point. I'm talking about 'professional' relationships between advocate and partner, and I'm also thinking about other types of professional relationship (e.g. doctor-patient, etc.). I also wonder what we can learn from our experiences of all kinds of relationships (including with friends or children say), although sexual relationships are far more complicated and I'm not thinking about them here.

Firstly we do form some kind of relationship as soon as we meet someone. Sometimes we immediately find ourselves in some kind of conflict, occasionally we seem to have a meeting of minds, but mostly there is an initial period of getting to know each other. Whatever, if we are engaging or communicating with someone, there is a relationship.

Very often today as soon as we start to think about relationships in a professional context alarm bells start to ring: there have been so many scandals and abuses of trust that professional relationships are clearly prescribed and objectified - in particular they must be objective and dispassionate.

I think this is the wrong place to start: I've already argued that we need to protect vulnerable people from objectivity, and surely a working relationship should be about identifying some shared goals first of all, and, as advocates know well, this is often irreconcilable with having a dispassionate and objective relationship (where a 'person' inevitably becomes known as a 'client'...)

On the contrary, advocacy has a history of being partial, of being on the side of the partner: the primary goal is to form a relationship of mutual understanding and trust. This is very important as it's the only way to get to be able to really communicate with someone. It's very hard to break through the barriers of distrust and suspicion that many service users harbour, and we need all the benefits of independence and sympathy, loyalty and tenacity, inclusion and respect to be able to support people properly. Yes, boundaries need to be clear, but they come after (or at least during) the informal negotiations about trust.

All I'm going to do in this post is to open up and question the role and type of relationships. They certainly form a key part of advocacy practice, yet I think their role and the way we work with them is far more complicated than most people have acknowledged in writing about advocacy.

Food for thought hopefully...?

Don't write everything...

More christmas drinks...

I met a social worker from another town. Seems like she challenges expected practice. Had a nice chat with her...

One thing that stuck out. She was asked to do a social circumstances report for a MHRT with about 3 days notice. On her first visit to the patient she decided he was too sedated to engage properly, she told staff she would come back the next day and she hoped his medication would allow her to talk to him properly. This didn't happen - his meds were still too high, and she couldn't get the information she needed from him.

The report she wrote was therefore very brief. It mainly said that she had been unable to get sufficient information to be more comprehensive. She then came under some pressure to explain why she hadn't gone into full detail (although she had explained this in the report).

It struck me that very often people are expected to deliver comprehensive reports, but also very often it is difficult to be so comprehensive. Social workers and psychiatrists and others use their professional experience and judgement to fill in the gaps, which is of course what they're trained and paid to do. The problem is twofold: that this gap-filling process is fraught with difficulty (it's hard enough to assess how people are, let alone guess what fits in the gaps); and the second problem is that whatever is written could well be referred to for years after.

These two small problems combine into one big problem: the guesses people make with the best of intentions then become the 'truth' that can dog the patient for years to come.

What a good idea then to produce a minimalist report that leaves gaps where there are gaps - at least there are fewer chances of making mistakes that could affect people for years...

Another way of saying what I'm trying to say: when we work with people with mental health problems, in fact whoever we're working with, there are bound to be gaps in our understanding and assessment of them... what we need to do is acknowledge these gaps and let them be reflected in our reports, instead of trying to be comprehensive and ending up misrepresenting people.

A resolution for 2007? Shorter reports, more gaps?