However there are theoretical models of treatment such as a systemic or psychodynamic approach where therapy is used to help a person showing signs of postnatal depression, to overcome such feelings. In Jenny’s case she is introduced to Jack, who is a community psychiatric nurse and he becomes very close to Jenny. He was taking control of the situation, comforting Jenny, giving her reassuring cuddles when she was upset.
A therapist or counsellor should not visit someone at home uninvited nor should they make close physical contact with out a person’s consent. (p155) Jack was clearly doing this and this is a form of abuse. “Jack used his power as a professional health worker to take advantage of Jenny” (p154). Studies have shown that this kind of behaviour between therapists and clients may be quite a common occurrence. Sometimes the clients, who are being abused in this way, do not recognise this, especially if the situation develops slowly. (p155) The government have ‘officially recognised the need for regulating services for people with mental distress to try to prevent these kinds of situations from happening (Unit 20, p162).
Another example of the misuse of power occurs in a care environment. Wardhaugh and Wilding (1998) suggest that the people, who seem to be more at risk from abuse, are people in care settings such as the mentally handicapped, children in residential care and the elderly (Reader, p218). An illustration of this could be carers making decisions about clients and those decisions that are made change the clients’ life forever. If this is a bad decision such as punishment for certain behaviour, this can be seen as abuse.
It can be easy for someone who is assessing a situation to jump to conclusions based on their own constructed views of what is ‘right’ or ‘normal’ (Unit 20, p125). This is why adequate training is very important in any professional field. Professionals have to assess each individual case and this can be difficult as they can bring their own ‘baggage’ to their assessments (Unit 20, p135). For example, if a social worker has suffered from post natal depression in the past, they may see one of their clients, who are showing similar signs of depression, to have the same. Awareness of this tendency can minimise the likelihood of power misuse.
In another instance of misuse of power, adults with learning disabilities can be treated differently by professional workers. For example, when a woman visits a male doctor and an internal examination is required, it is common practice for a female nurse to be present during the examination. This prevents any chance of abuse from the male doctor happening or any accusations made toward the doctor. However, if the female patient had learning difficulties, the presence of a female nurse is sometimes overlooked. The doctor is using his professional power to assess the situation, therefore leaving the patient vulnerable and open to abuse. Brown and Turk imply that much abuse takes place behind ‘closed doors’ (Offprint 26, p113).
Wardhaugh and Wilding (1998) talk about a punishment being used in a children’s home called ‘Pindown.’ This punishment consisted of acts where the children who were sent to the home for bad behaviour, had to strip off all their personal clothes and take cold showers on admission. The children were then dressed in clothing which was unsuitable for the climate and conditions and made to do mundane tasks such as doing push-ups in the rain. To be in control of these operations is an act of misuse of power and abuse.
Goffman (1998) suggests that the ‘admission procedure can be characterised as leaving off and taking on’ (Reader, p215). The leaving off of personal clothes and belongings would make the child feel vulnerable, humiliated and embraced. The children have been stripped of their identity then had to take on a new one. This was more embarrassing for girls; especially if the procedure of stripping and cold showers was governed by male carers. (Reader, p215) Pindown appeared to be based on similar regimes which use to happen in institutions and the ‘animistic’ approach to offenders used in prisons (Reader, p216).
Power imbalances between staff and residents where the staff think they have more power over residents, can cause the residents to feel powerless. Clients or service users who have been subject to power imbalances show signs and characteristics of vulnerability and weakness (Reader, p216). Wardhaugh and Wilding (1998) suggest that this power imbalance happens because the management are corrupt. If this is the case, then employees under that management will also be corrupt. Employees need to feel valued and to be involved in decision making.
Some experiences that I have had working in care settings, where the staff who were not involved in any kind of decisions made, did not provide good care for the residents. The residents would not be washed or fed because of lack of time due to short staffing, and if a member of staff was spending time with a resident they would be reprimanded. Wardhaugh and Wilding (1998) agree that ‘batch living, which is where a large number of people dwell in a care home with inadequate staff levels, can lead to depersonalisation and regimentation (Reader, p226). However, in other environments where the employees have been valued and where their opinion counted, the level of care for the residents was of a much higher standard. Resident’s and their belongings were respected and they were bathed and washed on a regular basis. There was no pressure on the staff or residents and therefore encouraged an equal power balance.
One of the ways that power imbalance can be lessened is by having a good complaints procedure. If clients and staff feel comfortable about making a complaint and that complaints are dealt with in the strictest of confidence, it could put a stop to power imbalances and to any kind of misconduct happening. Also having equal power relationships in care can diminish the possibility of abuse happening. Having guidelines or rules in a workplace helps staff to understand what is expected of them, they would then feel they were being treated equally to each other.
Another way of minimising abuses of power could be to ensure the staffing levels are adequate for the number of residents living in the home. The Care Standards Act (2002) states that the ratios of care staff to service users must be determined according to the assessed needs of residents. The minimum standards came into force on 1st April 2002.
In this essay I have looked at different ways in which power imbalances and abuse can happen. I have found that abuse is such a diverse word which can not pin point any one particular event. I have recognised that power imbalances normally happen because care workers feel undervalued in their employment and they need to feel although they are respected in order to perform their role well. I have suggested ways in which power misuse can me minimised in ways to prevent abuse from happening.
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Brown.H, TurkV, (1998) ‘Defining sexual abuse as it affects adults with learning disabilities’ in K100 Understanding Health and Social Care, Offprints Book, Milton Keynes, The Open University.
K100 Course Team (1998) K100 Understanding Health and Social Care, Unit 20, Power and Vulnerability in Care Relationships, Milton Keynes, The Open University.
Smith. J, (2002) Care standards act, Guidance on Staffing Levels in Care Homes, available from http://www.dh.gov.uk/ (accessed 01 August 2004)
Wardhaugh. J., Wilding. P., Towards an Explanation of the Corruption of Care, in Allot, M and Robb, M (1998) Understanding health and social care, London: Sage.