Some Initial Thoughts On Establishing “Right Relationship” Between Staff,

Professionals, Service Organisations and the People They Assist

Michael Kendrick

Perhaps the most common complaint one hears from the experiences of people who

find they must rely on formal human services is that they do not feel particularly well

treated. Sometimes this takes the form of decidedly overt and obnoxious conduct on

the part of someone, but more often it expresses itself in more subtle ways that are

nevertheless just as distressing. The rise to dominance of human service organizations

in the past several decades has placed these organizations into a controlling role in the

lives of the many thousands of people who have no choice but to rely on them for

support. This control has greatly accentuated these underlying concerns about getting

the relationship “right” between them and the people supported by them.

 

The obvious temptation would be to whinge ever more loudly about how unfair this all

is and undoubtedly such a temptation is regularly exercised. The more difficult task

would be to ask ourselves what the alternative is to being treated badly and to begin to

sketch out a different vision and ideal for what a proper relationship ought to look like.

In essence, to develop a theory for reforming the mentality and structures of everyday

service practice. Such a view would have the advantage of offering a kind of roadmap

or design for the kind of advocacy and change agenda that will guide us in the years

ahead.

It would be natural to assume that when the word “relationship” is used that it refers to

interpersonal interactions and this would certainly be true up to a point. Nonetheless, a

lot of the difficulty that service users will experience is due to factors that are actually

somewhat impersonal and relate more to the ways that bureaucracies work. The net

effect of these is still poor treatment but one cannot blame the individuals involved in

quite the same way as if it was only their actions that were at stake. The classic

example is where a decision is made about what is to happen to a service user that

does not properly involve the individual, but instead is made by people in the

bureaucracy. Such an action may not involve any malice or personal feeling whatever

but rather derives from the way the particular bureaucratic system is set up to operate.

The remedy in the case of both interpersonal and impersonal relationships is actually

similar. This involves the identification and internalization of ethics suitable for the

establishment of a “right relationship”. By “ethics” I do not mean the usual kinds of

ideals or values that are so routinely expressed by organisations, as these simply

reflect their sense of what they wish they could be. Rather, it refers to the habits of

conduct that they oblige themselves to make part of their daily practice.

 

In this sense “ethics” might be thought of as values that have taken hold in people in

some enduring way rather than just being abstract preferences. When people hold

rather rigorously to an ethic it tends to guide their conduct and becomes part of who

they are. This applies whether the ethic is a worthwhile one or a poor one. For

instance, some measure of lying and deceptive conduct can become habitual in many

environments. It is internalized in the make-up of the people involved such that one

can see that the pattern of conduct is actually being guided by an ethic. The ethic itself

when it gets spelled out in plain speech says that it is acceptable to manipulate others

to get what you want. In a more honorable setting the opposite would be true in that

people would tend to see deceptive conduct as unacceptable thereby revealing a quite

different underlying ethic.

Impersonal or “Structural” Ethics

These terms refer to the way a relationship with a service user gets “structured” in the

way an organisation operates. It typically will involve a pattern that repeats itself with

great regularity and thus establishes over time a kind of “normal” way of operating.

These might be thought of as organisational ethics in the sense that they are embodied

in the design of the organisation and its daily practices. The difficulty with these is that

they are commonly seen as an unchangeable “given” by both the people who work in

the organisation and by those who receive assistance from it. Yet it is usually the case

that these kinds of ethics are changeable wherever there is the will to do so. However,

the will to change might not exist if there is not the imagination present that permits

people to envision how a worthier ethic might work. What follows are some examples

of organisational ethics that are very common in today’s technocratic culture of human

services, as well as a description of alternative ethics.

The Ultimate Authority Regarding a Person’s Life and Supports Being Given to

Managers or Professionals

This refers to the common practice of granting to professionals and managers final

decision-making authority (as so-called “experts”), at the expense of leaving as much

control and influence as possible in the hands of service users and those people who

are close to them. This is not meant to suggest that professionals and experts do not

have valid contributions to make, but rather that their insights and biases ought not to

override those brought by the more “ordinary” people of this world. In this sense the

“better” ethic would be to buttress our current respect of professionals and those in

authority with comparable respect for ordinary people and the many valuable

contributions they could conceivably bring to their lives and communities.

 

It is clear that all professionals are not virtuous as a matter of definition so it should not

be thought that all ordinary people are either. Nevertheless, this should not at all

diminish their status as being co-deciders in their fate and future. There is no

advantage to capitulate to the view that professionals or managers automatically and

unquestionably “know best”. On the contrary we need an ethic that permits a kind of

egalitarian partnership to evolve that sees the person receiving assistance as a

decisive agent in his or her own existence. Their capacity to act accordingly ought then

to be a secondary factor that would influence the relationship, but not fundamentally

deprive the person of their autonomy.

 

Even in those relatively infrequent instances where a given person may be indisputably

established to be impaired in their judgment and capacities, there may well be ways

that their security and that of others could be assured that do not involve the total

Queensland Advocacy Incorporated Newsletter April 2000

suspension of their autonomy as a person. “Right relationship” would require treating

the person as an equal authority in his or her own life. The act of deferring to

professionals and managers would be done voluntarily by the person on its merits

rather than this being a foregone conclusion. In the most practical terms possible this

ethic would mean providing supports or assistance “with” the people affected rather

than “on” or “to” or even “down to” them.

Creating Service Delivery Arrangements That Permit Service Users Sufficient

Powers So As To Be Able To Meaningfully Shape How Service Is Rendered

The average user of services typically lacks the core authority to imagine and plan

optimal supports; the ability to refuse plans prepared by others that they believe do not

meet their needs; the ability to propose and negotiate their own plan; and the ability to

control to a large extent the resources allocated to their support. These powers are

commonly held by other people and often by organizations. The individuals affected do

not have much say except to either reject service entirely or offer comment from an

“advisory” footing since it will be others that hold the decision-making power. This

arrangement is typically predicated on the assumption that those who hold the power

are the optimal people to decide on the individual’s best interests.

This classically paternalistic pattern may have its origins in clinical presumptions about

the service user’s inherent dysfunctionality or incompetence. These would in turn justify

the transfer of the person’s normal powers to decide their life to third parties. Yet when

one looks at how services work where the service user and their family are in a

position of comparable or equal power (to managers and professionals) they work

quite well. This may be true even where the principal person concerned is actually

significantly disabled but still very keen on being a factor in his or her own life. Thus

what is revealed is that there is no good reason to set up a system that reflexively

strips people of normative control and influence in their own life. On the contrary, “right

relationship” ought to begin with a commitment to preserve maximum and normative

personal autonomy unless there is some compelling reason to limit it.

Keeping Services Small, “Grass Roots” and Non-Bureaucratised As Much As Is

Possible

If power and resources are moved “outward” and downward from the professional and

managerial hierarchies that limit their use to only the small elite that control these, then

one can expect there to be a need for various entities that would replace the current

“top down” service delivery patterns. What these would look like would vary, but one

could correctly expect that any number of small community-based and -controlled

bodies would occupy this role. Normally these operate in rather more informal and nonbureaucratic ways so as to better reflect the character of the people and communities

that compose them. Not uncommonly the cultural, linguistic and religious identities of

communities and sub-communities express themselves this way.

There has been much written about what exactly characterizes a “grass roots” way of

operating but all of the following attributes could usefully add much to what might be

Queensland Advocacy Incorporated Newsletter April 2000

meant by “right relationship” in this regard. These include an emphasis on participation,

dialogue, informality, and relationships more than structure or bureaucracy; flexibility;

personal knowledge; “bottom up” decision-making etc. In such environments (usually

small and not overwhelming) ordinary people maintain a fair degree of personal

influence, can see where they wish or need to participate, can achieve any number of

variations on practice that reflect their values and preferences and autonomy and can

establish intentional safeguards in addition to those that might be imposed from

without.

Such a description of a “grass roots” styles of operating only describe a small

percentage of our current services but it does make one wonder why there is not more

of this sort of option made available for those who would prefer it. These options are

practical, affordable and are largely uncomplicated both fiscally and bureaucratically.

Surely, these approaches offer something that is missing in terms of the kind of roles

and relationships handed out to service users in more technocratic models of support.

After all what is to be gained by being made “small”, disempowered, devoid of positive

capacities to shape the character of one’s supports and hostage to the vagaries of

bureaucratic ambiguity and vested interests. Small will not be perfect by any means

but it does serve to make “small” people a bigger factor in their own lives.

Reluctance To Use Standardised Approaches In Favour of Flexible and

Personalised Ones

It is much too tempting in bureaucracies to resort to any number of approaches that

would result in standardised practices, systems and thinking. The difficulty is that a

responsive service and therefore one with the “right relationship” with people will be

one that does what is necessary and relevant for the person i.e. will “bend” or adapt

towards the person. A poor quality service will tend to require the person to fit to it

rather than the reverse. Such adaptations on the part of the service user are not

normally all that burdensome or constitute much of a disadvantage. Nevertheless, it is

important to remember which ultimately exists for the other if “right relationship” is to

not go entirely out of focus. The proper relationship ought to be that the service’s

needs do not dictate the design of service.

Standardised practices, models and systems tend to emphasise the lowest common

denominator, or the theory of “the best for the most”. This claim is dubious since “best”

ought to be worked out one person at a time rather than be imposed by some method

of “averaging” of needs that may be in their essence not at all so reducible to what is

shared across groups of people. Better to have many varieties of choices and options

available to people rather than to have a single size system that supposedly fits all.

This doesn’t work with shoes and it won’t work with other significant human needs.

Systems that are both flexible and designed “from and with” individuals are vastly more

likely to actually work for people than those that institutionalise people into

standardized patterns. It would still be true that there is a place for a variety of

standardised methods where the needs justify them such as in the case of some

diagnostic tests, some well proven sequences for learning particular skills and so forth.

However, in these cases it is still not the practice that dictates the process selected,

 

but rather the needs of individuals. This is the “right relationship” when it comes to

needs.

Reflections

What has preceded this are merely a few illustrative examples of the struggle for clarity

about the personal and impersonal “ethics” that ought to guide our search for “right

relationship”. What hinges on this exploration are the lives of the many people affected

by our broad pattern or paradigm of service here at the beginning of this new century.

Whether we like it or not patterns are now in place that shape people’s lives, hopes

and the details of what is or is not possible for them. If we find we do not like them or

cannot live with them then as advocates, change agents and citizens we need to begin

to see what it is that would be worthy ideals that might serve as the base for a better,

“right relationship” between those who provide support and those who rely on it. These

will be the defining discussions in the years ahead and may well come to dramatically

alter what we now understand as being “service”. In Part B we will examine this topic

further.

Establishing “Right Relationship” Between Services and

                                     Those Who Rely On Them For Assistance

                                                                   Part B

It is clear that our human service agency system is often in deep difficulty in terms of

getting its relationships with its service recipients in proper order. People who use

services and those who are close to them constantly report feeling overwhelmed by

how difficult it is to get services to behave towards them in a way that they feel is

helpful and respectful. It is not that there aren’t instances and individuals that they deal

with who behave commendably, it is that such conduct is exceptional rather than the

rule. Even those who work in such systems aren’t spared the same experiences, as

relationships in the technocratic culture of modern agency life are very much strained

and even disagreeable. It points to the importance of people getting clear as to what

might be the ethics that would provide a guide to what “right relationship” would be if

followed conscientiously. This is not only a question for service providers themselves

as it also has implications for advocacy, service design, the distribution of power and

responsibility and a wide variety of other matters related to our vision of what “better”

could be.

One place to begin is to recognize the principle that people should be expected to take

responsibility for their conduct. Unless people accept this point there is not much one

can reasonably expect from them except the unbridled pursuit of relationship on their

terms alone. This presumptive view of professional, managerial or staff “ultimacy” is

common enough and it usually will mean that whatever relationship does occur will

tend to be largely on the terms of those who are employed in service. The alternative to

this is, of course, the view that all of the people in service provider/service recipient

relationships ought to share the power of ultimate decision-making rather than to

accord it simply to who is able to mass enough power to impose their will. What follows

are some brief statements as to what might serve as worthwhile ethics that could guide

relationships into a framework that is more beneficial and which leaves the service user

with a sense of influence, dignity and respect. They are only a starting point but a

valuable one nonetheless.

Relate “With” People, Not “At”, “On” Or “Down To” Them

Each of these short words expresses a sense of the relationships that service users

will experience when they are treated as being somehow “less than” those who are

supposed to assist them. Similarly, “withness” is generally viewed as reinforcing the

sense of people as being respected, equal, important, credible and resourceful. Even

with some recognition that it is valuable to work “with” people the force and power of

conventional “top down” and professionalized service delivery arrangements should

not be underestimated. These types of patterns may be all that people have seen and

experienced and thus reverting back to them even in the face of hopeful rhetoric to the

contrary is quite predictable. The wiser assumption is that the establishment of

authentic “withness” is likely to be elusive particularly in the early days of attempting

such changes. Such changes are highly dependent on personal authenticity and thus

extend into realms of human personality that are only partially touched by the usual

organizational tinkerings and gestures of well meaning technocrats, managers and

professionals. It is also quite likely that many service users may themselves have

difficulty in imagining what working with people would actually be like since they too

are often deprived of compelling examples of this kind of “rightness” of relationship in

service contexts.

Negotiate With People Rather Than Impose Answers

The sense that people know what is best for others easily leads to the assumption of

control by the one with the answers. Typically, the answers they favour will tend to be

imposed since, to the imposer, they are self-evidently beneficial and warranted. What

negotiation offers the person affected is the chance to counter the views of the other as

well as remind the potential tyrant of the need to respect their will, personhood and

prerogative to determine their own sense of what should be.

In order for people to successfully operate in the context of negotiated conditions it is

necessary for those in authority to unequivocally grasp that the whole service process

for the person would in theory come to an end if the person concerned (as well as their

authorized allies) decides that a particular proposal as to service is unacceptable. This

is quite a bit different from giving the person veto authority over established service

authorities since “negotiation” presumes mutual agreement to proceed rather than the

alternative of unilateral authority resting on either side of the relationship.

Create Mutual And Shared Ideals of “Right Relationship”

It would be decidedly inaccurate to say that staff, managers and professionals do not

have their own ideals for what their relationships with people they support ought to be.

Without such worthy ideals much that is good that we now enjoy would not have been

possible. Nevertheless, why cannot these ideals be developed mutually? It is quite

feasible for there to be considerable reciprocity in the evolving of relationships and one

must always wonder why this important process is omitted from consideration when it

is actually quite “natural” in its own way amongst people who see themselves as

equals.

The answer is not unsurprising in that people in roles of authority in the service

world are not schooled to see such a sharing of the setting of goals, ideals and

priorities as being either possible or necessary for the achievement of good results.

Instead they are systematically reinforced to see that their ultimate “duty of care” is a

responsibility exclusive to themselves and their colleagues. Thus making decisions

apart from those they are supposed to assist seems quite “natural”. Similarly, the

presumption that the people being assisted ought to be part of sorting out what good

support and care might be is rarely reinforced.

Rejection of the Theory of Professional or Managerial Ultimacy Over Service

It is unlikely that most professionals or managers are indifferent to the wishes of the

many people whose lives they encounter. In fact, it would be unwise to typify them at

all as they vary tremendously as individuals. However, it is quite possible to study most

service systems and see that these same people hold in their hands the discretion of

making the ultimate and important decisions of service design and delivery. It is highly

unusual that service users are in a comparable position of ultimate authority.

If only one side of the relationship between those assisted and those doing the

assisting has the final say on important matters then it is predictable that at least some

of the time the less favored party will be subject to the domination of the one with

greater authority. This would be intolerable to many managers and professional if they

were subject to the dictums of those they assist yet they may fail to see this same

effect when the roles are reversed since this is the dominant pattern in service

relationships at present. What may not be clear to such persons is that the authority

over service could just as easily be shared between service recipient and provider. It

would certainly mean fundamentally different styles of operating from what we now see

but quite achievable nonetheless.

Relate To Each Person As Unique in How Services Are Designed and Operated

The rise of increasingly standardized or uniform service and agency practices has

greatly intensified the tendency to treat all service recipients as being somehow like all

other people who share their label or who are in the client role. The preferred behavior

would be to give each person a chance to reveal the many ways in which the person

they are is similar to or different from others. This is in contrast to relating to them only

in terms of a generalized stereotype.

The implications of such a starting point are many but certainly one of the foremost is

that the practice of designing a service in the abstract and the forced fitting people to

such invariant models would need to cease. This is easier said than done given that

almost the majority of services are of this “fixed model” variety with almost all key

elements “rolling over” unchanged from year to year. Nevertheless, there are endless

examples of services that rely on an ethic of “one person at a time” service practices

that belie the alleged impossibility of flexibility. It is also notable that there also exist

many bureaucracies that quite competently manage services in ways that permit high

degrees of flexibility and individualization at the personal level.

Leaving the Core Decisions of A Personal Nature to the Person Served

There has been a trend within modern technocratic human service systems towards

increasing degrees of invasiveness into the lives of the people served. Often this

results in the formal service usurping much of what historically would be considered

private or at least very personal matters. Perhaps the most evident mechanisms that

people may be familiar with that do this are the many varieties of formalized individual

service planning processes that abound. These are often well intentioned but it is

nevertheless remarkable the extent to which these have insinuated themselves into

even the most intimate of matters in people’s lives yet maintained their character as

largely public processes complete with a documentary trail. Even the dreams and

hopes of people are forced into the public record in ways that would be considered

none of anyone else’s business were these people not hostage to the system i.e. in the

client role.

It is an important advance to return to people the greatest degree of control of their

lives that may be possible. This would begin with a commitment by service providing

authorities to a policy or premise of non-invasiveness particularly as it relates to

matters that are generally recognized as personal and private by most of the public.

This is not to say that any given person served might not voluntarily relinquish some

aspects of privacy as suits their interest but this would be done under reasonable

conditions of authentic voluntariness. It would also mean the absence of compulsions

to the contrary. These conditions do not usually apply in the case of most formalized

planning systems (even with most that are described as “person centered”) as they are

usually compulsory and accessing service resources without participation in them is

unusual. Hence, most people feel they have no choice but to participate as instructed

even at the price of deep erosion of their personal space.

Citation: Kendrick, Michael J., “Right Relationship”, Queensland Advocacy
Incorporated Newsletter, Part A and B, March 2000 and July 2000
kendrickconsult@attglobal.net