Relocating Authority: How can Professionls & Citizens get in right relationship?

Institutional systems under the banner of what they often refer to as “empowerment”, will relocate some resources in the shape of money (funding) and expertise to those they serve. They are also often quite happy to relocate certain responsibilities (e.g. making people responsible for behaviour change) to those they serve. However, all too often they are perfectly structured not to relocate the very thing that makes enduring change possible: authority. Giving someone money, advice and responsibility, without authority is disempowering. For real change to occur all three must come as a proportionate package although the most important by far is authority.

When by contrast a trusted healthcare professional (as often they do), says to a lay person:

‘you know, you are a primary producer of your own health, you can do things that I or the system I work for can’t, for example I can never help you more than walking for 30 mins every day will, or more than having meaningful connections will, so let’s start there.’

They assume the role of civic/enabling practitioner. They understand that authorities can be wrongly assumed and that with skilled practice it can be relinquished. The are operating to the credo of 'first do no harm'.

Now the next step isn’t to tell the lay person that they should join a walking group, since this would contradict the above message (you are the primary architect of your wellbeing; I’m here as back-up) and undermine the effort that underpins it: to transfer authority. To be a bit more precise the practitioners intentional effort here is to transfer “assumed” authority, in that sense its liberating in tone. The unstated message is “you’ve been sold a dud bill of goods, you’ve been raised to believe that the doctor knows best, that your health is in their hands and that of the hospitals, I’m here to tell you that that is nonsense, it’s actually in your hands and the hands of your community. I’m sorry you’ve been lied to, but if you are to trust me, the first thing we’ve got to get straight is I and the system I work for have been given false authority, like the Wizard in the Wizard of Oz, authority that actually belongs to you, your family and your community, not us. You are the primary inventor of a good life for yourself, and my job and that of my colleagues is to help you with that, and bring our experitise as an extention of your capacities and that of your communities, when needed.”

In admitting the limits of her system this healthcare practitioner is psychologically moving her system out of the person’s life (de-colonising), and thereby creating space for the person to start discovering their own and their community’s health producing capacities. In this way they are no longer treating the person as a client, but as a citizen. You can always tell whether a professional is treating a lay person as client or a citizen. When it is the latter, the lay person exhibits their citizenship authority in three ways:

1.    they define the problem they want to address in their own words/language/way of communicating.

2.    they define the solution they feel best fits their situation

3.    they take some action to produce/create that solution (this does not preclude expert help, rather it is a prelude to it, should it be needed)

In the case of the former, where someone is being treated like a client, the professional takes one or all three of the above functions on for themselves, and in this way assumes the authority that rightly belongs to the lay person (citizen). If you had a mind to, this is how you would operationalise disempowerment, or disablement. If on the other hand you wish to operationalise enablement (I refuse to use the term empowerment because it is fraught with problems-a subject for another blog) as a practitioners you would you would be every anxious and vigilant around which of you is defining the problem/possibility, shaping the solution, and charting the course of action. Where the balance shifts towards you would, you'd have the skills to rebalance the power dynamic and encourage the person you're serving to do so too. To hold you to account and themselves also. Peter Block would call this compassionately confronting someone with their own freedoms. 

This framework asks questions about proportionality. It ask not 'how practitioners can empower patients or clients?', but rather 'how can a helping professional be in right relationship with a citizen?' In doing so it recognises for the client/patient to be liberated the citizen must be enabled to discover their own and their communities power. And that they can't actually truly know what they need from the practioners and the systems they work for until they know what they have themselves and in their communities. That in mind, this process of enablement involves the practitioner being explicit about the limits of the system they work for, and their own limits as a professional, while simultaneously cheering on the capacities and assets of citizens and communities. The professional who proliferates this kind of practice contributes to three powerful outcomes, a) citizen liberation, and b) the appropriate and effective use of their professional expertise when needed. In this way collaboration is achieved, but ample space for citizen to do what they do best is always afforded. c) Reduction in burnout of people working in the caring professional and public service.