manual for personal coaching and counseling - p4 - empowering coaching

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Whether you are considering life coaching as a career or for self coaching, Dean Amory's Complete Life Coaching and Personal Coaching Course is your best guide for coaching your coachees and yourself towards maximizing your life potential and achieving a happier and more fulfilled life. This is the fourth in a series of five books. Part 1, “Personal Coaching” offers definitions and models of Personal Coaching Part 2, “Techniques for Personal Coaching and Self Coaching” includes powerful coaching techniques in use. Part 3, “Essential Knowledge for Personal Coaches”, highlights the indispensable knowledge and skills every coach should acquire. Part 4, "Empowering Coaching and Crisis intervention", explains empowering techniques for supporting people that find themselves afflicted by crisis. Since all of us will find ourselves sooner or later in a situation in which relatives or friends need our help and support, we may as well prepare ourselves for the occasion.


Presentation Transcript

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Training Manual For Personal Coaching and Counseling PART 4: EMPOWERING COACHING AND CRISIS INTERVENTION

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Title: Training Manual For Personal Coaching and Counseling - Part 4: Empowering Coaching Motivational Interviewing and Crisis Intervention Compiled by: Dean Amory Publisher: Edgard Adriaens Belgium ISBN: 978-1-326-51856-1 © Copyright 2015 Edgard Adriaens Belgium - All Rights Reserved. This book has been compiled based on the contents of trainings information found in other books and using the internet. It contains a number of articles and coaching models indicated by TM or © or containing a reference to the original author. Whenever you cite such an article or use a coaching model in a commercial situation please credit the source or check with the IP -owner. If you are aware of a copyright ownership that I have not identified or credited please contact me at: 3

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When I invite you into my confidence my secret places introduce you to my devils my ancestors my way of being Show me this much: that you will tread lightly over the graves yield to my wisdom know me as creator lover maker of my life amidst this ruckus. Ellen Hawley McWhirter 5

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TABLE OF CONTENTS INTRODUCTION 8 CHAPTER 1 9 GOALS OF THIS GUIDE 9 THE GOALS OF EMPOWERING INTERVENTION SERVICES 9 CHAPTER 2 10 DEFINITION OF “PERSONAL CRISIS” 10 TYPES OF PERSONAL CRISIS 10 CHAPTER 3 11 EMPOWERING INTERVENTION COMPONENTS 11 1. Importance of the first contact 11 Sample of a telephone script for the correct handling of incoming calls 12 2. The Personal Crisis Intervention SARE Model 13 1. Screening 13 2. Assessment 15 3. Building Rapport 21 4. Empowering 37 3. Empowerment and Change 40 1.Motivation 40 2. The Stages of Change 41 3. Motivational Interviewing 42 4. Empowerment coaching 72 4. Foundations of Empowering Interventions 96 1. Brief Solution Focused Counseling 96 2. Cognitive Behavioural Counselling 103 3.Psychodynamic Psychotherapy 115 4. Empowering Language 120 5. Sample Formats for Sessions 122 CHAPTER 4 124 THE INTERVENTION PROCESS 124 1. What is involved in the crisis intervention process 124 2. Active Listening 126 Emotuial labeling / The five stages of grief 134 3. Identifying a major problem 137 4. Dealing with feelings and providing support 137 5. Exploring possible alternative solutions 140 6. Formulating an Action Plan 140 7. Evaluating 141 CHAPTER 5 142 CRITICAL INCIDENT STRESS MANAGEMENT CISM 142 1. Introduction 142 2. CISM Assessment Criteria 144 6

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3. Assessing the Need for a Critical Incidet Stress Debriefing CISD 144 4. Critical Incident Stress Signs and Symptoms 146 5. Moving Past a Moment of Crisis 147 6. Post-Traumatic Stress Disorder: 147 7. Apprehension Am I Stressed Out... 149 8. CISM Follow Up Protocol 151 9. CISM: How Do I Know When Im Over My Head 152 10. CISM: How to Recover From a Critical Incident 154 11. CISM: Tips to Colleagues and Family 156 CHAPTER 6 157 HARM ASSESSMENT SUICIDE HOMICIDE INJURY TO SELF OR OTHERS 157 1. What should a responder knew about suicide 157 2. What makes depression and alcohol abuse important 162 3. Suggested guidelines for assessment and prevention 164 4. Assessing dangerousness to others 165 5. Legal Implications 168 6. Models of Forms 169 CHAPTER 7 173 EMPOWERMENT AND COMMUNITY PLANNING - DR ELISHEVA SADAN 173 1. Part One: Theoretical Development of the Concept of Empowerment 173 1. Connection between Empowerment as a Personal Process and Community Processes and their influence on powerless people 173 2. Developing a Theory of Empowerment 209 2. Part Two: Community 226 3. Developing Empowerment Practice in the Context of Community Planning 226 4. Individual Empowerment Processes in the Context of Community Planning 235 5. Community Empowerment Practice in the Context of Community Planning 248 6. Community Planning as an Empowering Professional Practice 263 3. References 294 ANNEXES 305 ANNEX 1: SCREENING 305 ANNEX 2 : ASSESSMENT TOOLS 329 ANNEX 3 : HOW TO DEAL WITH AN EXISTENTIAL CRISIS 334 ANNEX 4: HOW TO HELP A FRIEND WITH DEPRESSION 338 ANNEX 5: 101 EMPOWERING QUESTIONS 343 ANNEX 6: MOTIVATIONAL INTERVIEWING TEMPLATE 346 SOURCES: 384 7

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Introduction Therapists Counsellors Coaches Lifeline Volunteers Recovery Coaches Crisis Intervention Operators every day many people provide support to other people that are passing through a diffult phase in their lifes or are affected by crisis disaster or other critical events such as loss or serious illnesses depression burn out living in isolation or being stigmatised ... Although everybody concerned with responding to human suffering will find many useful techniques in this manual the main purpose of the guide is to help coaches counselors providers of personal crisis services lay counsellors relatives and friends of people in need to discover empowering techniques to support the people around them that find themselves afflicted by crisis. The shoulder and ear of a friend or a lifeline volunteer the psychosocial support they provide should never replace professional counselling where this is needed and one of the responsibilities of anybody assisting people in need without having a professional mental health background or formal degree in counselling is to refer the people who turn to them for support and advice to qualified officials when this is deemed useful or required. Yet not all people affected by crisis need or want professional help and even though at times the intervention of a professional counselor or therapist will be absolutely necessary for the individual seeking help at other times the input of a peer: a fellow journeyer or trusted friend or relative will suffice to make the difference and help the person affected by crisis to get back on his feet. Also to all the people that are going through a phase of personal crisis and are treated in an ambulant way it will make a huge difference when they can fall back to friends and relatives who master empowering intervention skills allowing them to provide better support during the time they spend together. Since all of us will find ourselves sooner or later in a situation in which relatives or friends need our help and support we may as well prepare ourselves for the occasion. The skills required of a lay counsellor will differ depending on the situation and the setting in which they are working. For example counselling on a phone line for people at risk of suicide will be different from helping in the immediate aftermath of a disaster which will again differ from counselling grieving or depressed people or people living with serious illnesses. However certain skills apply to all these situations. I am convinced that the techniques joined in this manual provide for a basis that will prove of utmost importance in any kind of coaching or crisis intervention. Dean Amory 8

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Chapter 1: Goals of this Guide Goals of this guide A primary goal of this guide is to offer an empowering basic approach for coaches and providers of personal crisis services aimed at providing support to the distressed and suicidal and more in general to all people going through a phase of personal crisis in their lives. Another goal of this guide is to increase awareness and understanding that a personal crisis often is a situation defined as such by the perception of the individual experiencing it. An outcome of applying the techniques set forth in this guide is increased awareness and utilization of the most appropriate and motivating instruments available to encourage empowerment and recovery of individuals served. The goals of empowering intervention services include but are not limited to: 1. Promote the safety and emotional stability of individuals experiencing a personal crisis. 2. Minimize further deterioration of these individuals. 3. Provide sufficient information to clients for them to learn how to make their own decisions encouraging them to re-take control of their lives and decision making power 4. Assist individuals in rebuilding self-confidence and developing or enhancing better coping skills better problem solving skills and a natural support system. 5. Help individuals find and obtain ongoing support care and treatment 6. Getting the client to see himself as the agent of change capable of using the knowledge and skills of others in furthering their own interest and creating responsible social change. 7. Encourage the use of the best techniques available to meet the individuals needs. 9

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Chapter 2: Definition of “Personal Crisis” Definition of Personal Crisis A personal crisis is defined as an intensive behavioral emotional or psychiatric situation which if left untreated could result in an emergency situation in the placement of the person in a more restrictive less clinically appropriate setting including but not limited to inpatient hospitalization or at the very least significantly reduce levels of functioning in primary activities of daily living. "A personal crisis can be thought of as a system out of balance. Normally all of us maintain our state of equilibrium on a day-to-day basis without too much trouble. Obstacles are overcome because weve learned good coping skills to re-establish equilibrium after some event has temporarily knocked us off balance. Personal crises occur when the balance cannot be regained even though we are trying very hard to correct the problem.” Two Different types of personal crisis occur One is a developmental crisis like a job change retirement having a baby your baby turns 14. The other is a situational crisis like rape robbery sudden death or being diagnosed with a chronic or terminal disease. With regards to a situational crisis the cause is often defined as a “Critical Incident”. A Critical Incident is any event that has an impact sufficient enough to overwhelm the usually effective coping skills of either an individual or even a group. Critical incidents are typically sudden powerful events that are outside of the range of a person’s ordinary experiences. Because they are so sudden and unusual they can have a strong emotional effect. If the critical incident is extreme in nature it may serve as the starting point for the psychiatric disorder called “Post-traumatic Stress Disorder.” Critical Incident Stress services help mitigate this possibility. Critical Incident Stress CIS or traumatic stress is an unusually strong emotional reaction that has the potential to prevent the individual from maintaining their normal duties and responsibilities within their work social and family environments. The reaction may be immediate or delayed. Most personal crises however occur because a person is just overloaded. A reprimand from a supervisor may be accepted without issue one day. However if it happens when you already have several stressors using up your reserve of coping ability it may be the event or precipitator that pushes you off balance. In other words the person is pushed enough off balance that he or she needs assistance to rebalance his or her system. This definition focuses on the needs of a person who is being stressed rather than the cause that evokes this response. 10

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Chapter 3: Empowering Intervention Components 1. Importance of the first contact In a crisis situation each component of working is important however the first few minutes of a contact could determine if the individual will continue to seek out assistance or not. Assuring a supportive therapeutic interaction right from the very first moment of contact will therefore be very important in the outcome of the situation. If the first contact is made over the phone normally within seconds the caller is forming an opinion of the people they may interact with and the possible services they may receive. The service provider answering the telephone must ensure the initial contact is a positive one setting the stage for a successful experience and instilling confidence in the professionalism of the service quality. As each service component is reviewed throughout this manual it is important to understand that although one person may present with a crisis situation family members and/or significant others are also affected by the crisis situation. It will often be important to engage family members and/or significant others for information and clarity of the crisis situation to the extent appropriate. Although this concept is not directly stated through out this manual it is implied and should always be practiced. What are crisis telephone answering skills Often the first contact with the individual experiencing a personal crisis will occur through a telephone call to a crisis service provider or crisis line. The manner in which the crisis telephone is answered sets the tone for the contact. All telephone calls are required to be answered in a uniform courteous and professional manner to be followed by all telephone operators on answering incoming calls. The following are a few tips to assure these requirements are met: 1. Answer the telephone as soon as possible but preferably within at least three 3 rings. 2. All telephone calls are to be answered "live”. No answering machines or other electronic mechanisms are allowed to field crisis calls. 3. All telephone operators of hotlines should answer the telephone in a standardized and courteous way. For example "Good morning Lifeline Services how may I help you" 11

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Sample of a telephone script for the correct handling of incoming calls 1. Welcome Goodmorning Lifeline Services. This is Myname speaking. 2. Caller Identification In case we are accidentally disconnected could I please have - Your full name - Your telephone number - The address from which you are calling - And your Email address. 3. Screening / Establishing the purpose of the call How can I help you today 4. Commence Assessment / Troubleshooting / Empowering Can you describe the nature of the difficulty you are experiencing 5. Conclusion of the call - Is there anything else I can help you with today - My name is Myname. - If you have any further difficulties please do not hesitate to call again. - Thank you for calling Lifeline Services. Have a good day goodbye. General call behaviour rules 1. Always ask for permission before you put caller on hold 2. Provide an estimate of how long they may expect to be on hold Example - “would you mind if I place you on hold for a few minutes while I check some of our systems” 3. If a caller is placed on hold check back with the caller every minute to give him/her feedback regarding the status of the call. 4. When you return from placing the customer on hold say: “thank you for holding” 5. If you need to talk to other staff press the mute button. - Do not place the person on a speaker telephone. - This may make them feel there is no privacy in the conversation and may prevent them from telling you important information. - Using a speaker telephone may also compromise the confidentiality of the callers right to protect their private health information. 12

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2. The Personal Crisis Intervention SARE Model The SARE mnemonic stands for: 1. Screen 2. Assess 3. Build Rapport 4. Empower 1. Screening Prior to initiating any crisis assessment service some sort of screening of the potential crisis situation must be conducted. The screening may be formal or informal occur through a telephone call to a crisis line an appointment with the personal crisis service provider or through information obtained from a third party family member friend or others. The screening determines the problem and needs of the individual as well as provides guidance for crisis prevention and/or early intervention. This screening information which may be incomplete or from an untrained person can help to determine if a formal crisis assessment service is warranted. The screening should not be more intrusive than necessary. It should be done before any details of the problem are elicited and the caller should be told the reason for the questions upon request. What is included in a crisis intervention screening The screener must gather basic demographic information determine whether a crisis situation may exist identify parties involved and determine an appropriate level of response. The screener must use active and supportive listening skills to determine if a crisis intervention is required and which service intervention would best address the persons needs and circumstances. The initial screening must consider all available services to determine. For some individuals information about services or a referral to a local service provider would be an appropriate and sufficient intervention. Others may need telephone or a face-to-face intervention. Based on the information gathered to this point the screener must determine whether a crisis requires further assessment. It should be noted that disruptions in life that may not create a crisis situation for one person at any given time might create a crisis situation for another person. Alternately disruptions that might not have posed a challenge during one time may cause significant turmoil at other times in the persons life. If the person believes that he or she is experiencing a personal crisis it is best to honor that belief. Whenever we screen and identify specific needs we have an ethical responsibility to either provide the necessary next steps assessment or intervention or refer to an appropriate source for follow up. 13

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Screening processes always should define a protocol or procedure for determining which clients need further assessment i.e. screen positive for a condition being screened and for ensuring that those clients receive a thorough assessment. That is a professionally designed screening process establishes precisely how to score responses to the screening tools or questions and what constitutes a positive score for a particular possible problem often called a “cutoff” score. The screening protocol details the actions taken after a client scores in the positive range. In a professional context it also provides the standard forms for documenting the results of the screening the actions taken the assessments performed and that each staff member has carried out his or her responsibilities in the process. Screening alone is not sufficient to diagnose a situational developmental behavioral or health concern. It is one piece of information that may indicate the need for further evaluation by a qualified professional. If the screening raises concerns then the screened individual should be referred to a qualified professional who will perform further evaluation. If the person is eligible the qualified professional will lead the development of an Individualized Service Plan and coordinate services Although a screening can reveal an outline of a client’s situation and needs it does not result in a diagnosis or provide details of how previous experiences have affected the client’s life. Appropriate Screening Tools Screening procedures and tools should be: - Linguistically appropriate. When possible the screening tool should be in the individual’s primary language - Age and developmentally appropriate. - Culturally appropriate. Some developmental skills may look different depending on the culture and background of the individual screened. When possible use a screening tool or procedure that takes into account the person’s cultural context. When a culturally and linguistically appropriate screening tool is not available information from families is even more critical to ensure validity. - Valid reliable and standardized when available to ensure that the tool gives information about the how a person is developing relative to a larger group of their peers. - Identified as screening tools. Screening tools might inform ongoing assessment but a tool created for assessment would not be appropriate for screening. 14

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2. Assessment The Difference Between Screening and Assessment The purpose of screening is to determine whether a person needs assessment. The purpose of assessment is to gather the detailed information needed for an action plan that meets the personal needs of the individual. Screening involves asking questions carefully designed to determine whether a more thorough evaluation for a particular problem or disorder is warranted. Many screening instruments require little or no special training to administer. Screening differs from assessment in the following ways:  Screening is a process for evaluating the possible presence of a particular problem. The outcome is often a simple yes or no.  Assessment is a process for defining the nature of that problem determining a diagnosis and developing specific treatment recommendations for addressing the problem or diagnosis. Assessment The assessment examines a client’s life in far more detail so that accurate diagnosis appropriate treatment placement problem lists and treatment goals can be made. Usually a clinical assessment delves into a client’s current experiences and her physical psychological and socio-cultural history to determine specific treatment needs. Using qualified and trained clinicians a comprehensive assessment enables the treatment provider to determine with the client the most appropriate treatment placement and treatment plan CSAT 2000c. Notably assessments need to use multiple avenues to obtain the necessary clinical information including self-assessment instruments clinical records structured clinical interviews assessment measures and collateral information. Rather than using one method for evaluation assessments should include multiple sources of information to obtain a broad perspective of the client’s history level of functioning and impairment and degree of distress. Assessment is a process that is much more comprehensive than the screening-process. It includes the family and assesses the individual in all life domains including evaluating strengths and family. An assessment should be conducted as soon as possible after the screening results have determined its necessity. - Whereas a screening is always necessary an assessment will only be conducted in the individual needs a more thorough evaluation empowering guidance or counselling and when conditions permit: o Almost always during face to face meeting at the client’s home or in the premises of the service provider o When the client is cooperative that is: able and willing to answer the questions in a calm and rational manner o When the time and the will to achieve a more thorough evaluation is present with all parties. 15

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In case of an intake it usually takes place within 30 days of intake and screening and contains such components as: - It should be conducted by a qualified individual with the appropriate credentials required by the licensing authority. - The assessment should be culturally and linguistically appropriate for the individual and the family taking into consideration the family’s level of acculturation and assimilation their cultural world views of health/wellness illness and treatment and their values traditions beliefs rituals and practices. In addition it should be conducted in the preferred language and in a setting that is conducive to the most cooperation from and ease for both the individual and the family. In general assessment must be individualized to meet the needs and identify the strengths of the person assessed. As with all interventions informed consent must be sought and properly documented. The Assessment Interview To provide an accurate picture of the client’s needs a clinical assessment interview requires sensitivity on the part of the counselor and considerable time to complete thoroughly. While treatment program staff may have limited time or feel pressure to conduct initial psychosocial histories quickly it is important to portray to clients that you have sufficient time to devote to the process. The assessment interview is the beginning of the therapeutic relationship and helps set the tone for treatment. Initially the interviewer should explain the reason for and role of a psychosocial history. It is equally important that the counselor or intake worker incorporate screening results into the interview and make the appropriate referrals within and/or outside the agency to comprehensively address presenting issues. For instance: the notion that a person’s substance use is not an isolated behavior but occurs in response to and affects other behaviors and areas of their lifes is an important concept to introduce during the intake phase. This information can easily disarm a client’s defensiveness regarding use and consequences of use. General Guidelines of Assessment  Similar to the screening process the individual assessed should know the purpose of the assessment.  To conduct a good quality assessment counselors need to value and invest in the therapeutic alliance with the client. Challenging disagreeing being overly invested in the outcome or vocalizing and assuming a specific diagnosis without an appropriate evaluation can quickly erode any potential for a good working relationship with the client.  The assessment process should include various methods of gathering information: clinical interview assessment tools including rating scales behavioral samples through examples of previous behavior or direct observation collateral information from previous treatment providers family members or other agencies with client permission and retrospective data including previous evaluations discharge summaries etc.  Assessment is only as good as the ability to follow through with the recommendations. 16

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 Assessments need to incorporate socio-cultural factors that may influence behavior in the assessment process interpretation of the results and compliance with recommendations.  The assessment process should extend beyond the initial assessment. As the assessed person becomes more comfortable additional information can be gathered and incorporated into the revised assessment. Subsequently this new information will guide the reevaluation of presenting problems treatment priorities and treatment planning with input and guidance from the client.  Reassessments help monitor progress across the continuum of care and can be used as a barometer of effective treatment. Moreover the presenting problems and symptoms may change as recovery proceeds. Looking at strengths Focusing on strengths instead of deficits improves self-esteem and self-efficacy. Familiarity with the individual’s strengths enables the counselor to know what assets they can use to help them during recovery. The use of good self-assessment worksheets that focus on individual strengths are to be recommended. In addition to assessing strengths coping styles and strategies should be evaluated see Rogers 2002. What is included in a crisis assessment A crisis assessment evaluates any immediate need for emergency services and as time permits the persons: - current life situation - sources of stress and acuity level - mental health problems and symptoms - Strengths - cultural considerations - identifiable and realistic support network - drug and alcohol use - current medication use - vulnerabilities and - current functioning. What is a personal crisis intervention service "Personal crisis intervention service" refers to an isolated intervention or to a series of interventions which may be face-to-face or telephonic short term intensive conversations initiated during a personal crisis or emergency to help the person cope with immediate stressors identify and utilize available resources and strengths and begin to return to the persons baseline level of functioning. Intervention settings may include the persons home the home of a friend or family member the service provider’s premises a hospital or emergency room jail or other community settings. Personal intervention services can take place at any time or day of the week. 17

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Possible determinants indicating the need for a face-to-face intervention include:  extreme dysphoria deep sadness anxiety and restlessness  severe depression  suicidal intent  homicidal intent  acute psychosis Others include:  hopelessness  helplessness  extreme tearfulness and  extreme detachment or withdrawal/isolation If the crisis assessment determines that crisis intervention services are needed the intervention services must be provided as urgent or emergent. Who may conduct a crisis assessment intervention Whereas mental health crisis interventions should be always conducted by trained credentialed and/or approved mental health personnel and professionals who have a licensed psychiatrist or physician experienced in psychiatry available for consultation everybody will live through moments in life when the circumstances require of them that they act to help and support people going though a personal crisis. What is the function of hotlines in this context Hotlines are designed to help individuals to handle crisis situations. Hotlines cannot operate alone. They rely on a network of other organisations that offer professional health and counselling services Hotline telephone operators can: - Listen to people without judging support them in their journey by showing empathy for them and their problems - Provide basic information - Connect people to available resources where they may find practical help - Provide limited emotional support Hotline telephone operators cannot do the following: - Tell People what to do - Provide extensive counselling or emotional support - Provide medical care or services directly For all hotline telephone operators and first line service providers in a professional environment a structured approach providing the necessary administrative educational and emotional support must be put into place: information and training should be made available to all operators including up to date referral lists and resources for callers training in 18

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communication techniques assertiveness setting personal boundaries and personal stress reduction strategies as well as offering an outlet to talk about their feelings and a chance to discuss difficult calls. Supervisors should express appreciation for a job well done. Positive feedback is important for operators to feel they are doing a good job. "Debriefing" "case review" or "psychological first aid" are terms used by mental health professionals to describe interventions that should be available when a crisis service provider experiences a completed suicide or traumatic event that involves a service recipient. The goal of these interventions is to allow a crisis service provider to express their personal reactions to the event and to identify steps that might relieve stress symptoms related to their exposure to the event. In some cases emergency mental health interventions may include staff members outside of the crisis service provider. Any of these interventions should be conducted by or in consultation with a trained mental health professional in the area of emergency mental health services. Debriefing occurs preferably in a structured manner occurs immediately after a shift and is mainly supportive and not as formal as supervision. By taking place immediately following a shift operators can discuss feelings about upsetting calls and deal with responding to other issues prior to the next shift. Making a difference in someones life helping individuals improve their lives and find solutions to their problems can be extremely challenging and satisfying for those who enjoy seeing the positive results of their direct action. Another benefit reported by those working in this field is the level of camaraderie that often exists within these organizations. It can be inspiring and invigorating to see what people can accomplish when they gather for the sole purpose of helping others live better lives. However while this work can be highly satisfying it can also be emotionally draining and full of frustrations. One of the reported difficulties of providing services within some bureaucratic systems is the amount of paperwork often required. For people who enter this field because of their desire to help people this can be a significant challenge. In addition this work can be frustrating because change often happens in a slow sometimes almost undetectable way and seeing the benefits of your work may take a long time. For people who are committed to helping others accepting the fact that there is always more to do than could ever be done can be difficult. One of the greatest challenges for people who see themselves as “helpers” is to balance giving with knowing when you have done enough. Working as a hotline operator is a great responsibility and should never be taken lightly. As a hotline operator you dont want to wing it with people whose lives are hanging by a thread. You should only use established procedures and training to get the person back from the brink. As a hotline operator it is important not to place too much pressure on yourself. You are there to help people – you cant diagnose or advise them so rely on your training and people skills to help them find the right people who can help and to make their own choices. Preventing burn- out by setting personal boundaries is critical to longevity and success in the social service field. Things you may need to learn if you want to become a hotline are: - Emergency procedures - what to do if things arent going well with a caller. - State laws concerning the operation of a crisis center - these concern the liabilities and restrictions that are important to know even as a volunteer. - The range of help available out in the community to direct callers to from financial and legal 19

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to rehabilitation or detox help. - Counseling techniques - getting people who are really hurt to talk to you openly or even at all can be difficult. Youll need to learn the ways of helping people to open up and how you can demonstrate trust. Also most crisis hotlines will teach you that your role is to facilitate the callers own decision-making process through prompts and guides. You dont make the decisions for the caller nor do you counsel. How soon must o crisis intervention plan be developed As part of the crisis intervention services the crisis services provider must develop a crisis intervention plan during the initial face-to-face assessment. The plan must address the needs and problems noted in the crisis assessment and refer to identified services to reduce or eliminate the crisis. What if the personal crisis service provider determines that the person requires extra services If the crisis service provider determines that the person requires mental health crisis stabilization services such as crisis respite or crisis stabilization the crisis services provider must arrange for the provision of these services either directly or through other resources depending on his professional qualifications and the circumstances at hand. - Crisis stabilization services are designed to assist the person in returning to his or her prior functional level or improved level of functioning if possible. - Mental health stabilization services are individualized mental health services that are provided to a person following a crisis assessment 20

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3. Building Rapport We all know that “A man convinced against his will remains of the same opinion still ..” That is why every sales- or hypnosis course and every article about dating will tell you that you need to start with creating as much rapport as possible. Only after you have created sufficiently emotional connection and trust will the other person feel comfortable enough to actually listen to you and accept and emotionally respond to images that you are describing. How to create rapport Creating rapport is about establishing a tangible and harmonious link by getting on the same wavelength with another person. You know there is rapport when everything clicks and feels right when it is as if you know and understand each other and your ideas are synchronized. When there is rapport you feel bonded connected and enjoy time together. Link yourself with people and things the other person knows about and likes. Make them talk about subjects that are familiar and enjoyable to them. Search for common ground. If they like gardening and you do too then tell and show hem how much you enjoy gardening. 1. You can develop rapport faster by paying attention to body language mirroring and matching and empathic listening. Body language  Reading body language correctly enables you to identify the individual’s emotions and discomfort.  Using body language appropriately including eye-contact and touch helps you to get the attention desired and can create a positive perception. Be conscious of your body language. When meeting people for the first time it’s obviously important that you appear relaxed and open in your stance and that you make good eye contact. As the conversation goes on it can also help to mirror the body language of the person you’re speaking to not in an obvious way but in a way that gives the impression that you’re “in synch” with each other. Make sure as well that you’re focused on the person that you’re talking to not looking around the room which can give the impression that you’re looking for someone more interesting to talk to. Mirroring and matching A/ Mirror your listener’s body language That is: their posture movements breathing rhythm and physical state. Why Copying their behavior causes them to feel similar to you which in turn will lead to your listener starting to copy you in response  The idea is to align your movements and body image with the other person’s demeanour. Mirroring or reflecting is not the same as imitating but by presenting similar demeanours as the other person’s they will subconsciously feel that you have much more in common with them than may actually be the case.  You can mirror or match language including rate of speech and vocabulary used breathing voice moods movements energy level … 21

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B/ Confirm and match your listener’s inner world. That is: their values perceptions beliefs emotions ideas and assumptions. Why when you copy your listener’s way of seeing the world visual audio … their way of expressing themselves words and expressions he uses repeat their values accept them as they are and confirm them in their beliefs and opinions they will listen to you accept what you are saying and start to like you because they will see you as very similar to themselves and will appreciate the respect you show them. After all you are confirming them in what and how they are and what you are telling is the truth such as they too perceive it. Here is how to do it: 1. Match the persons sensory modality What I mean here is to match and mirror the way that they think and talk. Remember when we were talking about visual auditory and kinesthetic modalities Well this is about putting it into practice. Listen for the indicator words that the person is using and use words/phrases from the same modality. Also look out for eye movements to spot thinking patterns. 2. Mirror the persons Physiology By copying the persons posture facial expressions hand gestures movements and even their eye blinking will cause their body to say unconsciously to their mind that this person is like me 3. Match their voice You should match the tone tempo timbre and the volume of the persons voice. You should also make use of matching the key words that they use a lot. Examples of this may be: "Alright" "Actually" "You know what I mean" 4. Match their breathing You should match the persons breathing to the same pace. Matching the in and out breath. 5. Match how they deal with information You should match persons CHUNK SIZE of how they deal with information. For example are they detailed or do they talk and think in big pictures. If you get this wrong you will find it very difficult indeed to build rapport as the detailed person will be yearning for more information and the big picture person will soon be yawning 6. Match common experiences After all what are you going to talk about This is all about finding some commonality to talk about. Matching experiences interests backgrounds values and beliefs. One point to bare in mind is that you need to be subtle when you are matching and mirroring. Dont go over the top Typically however the other person will be focussing so much on what they have to say that they will not even notice. 22

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Breaking the mirror There are two sides to every coin. If you feel the need to create distance or to break the synchronization because you want the other person to get out of their comfort zone or in order to show disagreement: stop mirroring and behave differently from the individual. Empathic listening Empathic listening or Active listening basically is acknowledging the indivual’s feelings and reflecting them. The subject is treated more in detail in the next chapter of this book. The basis of empathic listening is validating the other person and incorporating their words into your answers and conversations 2. Other techniques include Agree Praise and Confirm  “O.k. right exactly my idea” – “you are great smart good …” Validate the persons concerns struggles perceptions and feelings  No wonder you feel that way…  No wonder you’re so frustrated and stressed out validating feelings. You’ve struggled with this problem for a long time and it makes sense to me that you’re wondering whether it’s best to ... or ... validating concerns and experience of the problem. Compliment people on their courage resilience and other attributes  After everything you’ve been through I’m impressed that you’re still hanging in there and trying to make things better for yourself. Where do you find the courage and strength to stay at it instead of giving up complimenting courage and resilience  How did you manage to get through the whole day giving credit for resilience and improvement  Im really glad you brought that up.  I think what you are doing is really difficult. Im really proud to be working with you on this.  So many people avoid seeking help. It says a lot about you that you are willing to take this step.  What have you noticed about yourself in the past few months since you started coming here This question is designed to prompt the client to self-affirm. Note on compliments: Compliments can be direct: commenting directly on a person’s actions: “You did a great job on this assignment” Indirect: folding compliments into questions: “How did you get yourself to work on time yesterday” or attribution-based: referring to positive characteristics of the person: “You’re a caring person” 23

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Be curious vs. all-knowing: Ask a lot of questions. People trust people who are interested in them. The reason for this is that people tend to feel isolated as life gets more complicated. And when someone pays attention to us we feel safer and less isolated. Think of the car buying situation with the car salesperson being you. The salesperson who focuses on finding out the customer’s needs before trying to close the sale will do much better than the salesperson who focuses on the product. When someone tries to sell us something whether a car or an idea if we feel they know us we will feel safer and be more open to what they have to say. As a crisis service provider the more you use curious information gathering to build rapport the more likely it is that the individual you want to help will trust you and be coachable. “I wonder what would happen if…” Ask vs. tell:  “What might change when ...”  "How are things going"  "What is most important to you right now"  "Hmm... Interesting... Tell me more..."  "How did you manage that in the past"  "How would you like things to be different"  "What will you lose/gain if you give up XXX"  "What do you want to do next"  "How can I help you with that" Offer options not solutions Overall empathic interaction Act as if the other person is your whole world. Focusing intently on them will build rapport. It will make them feel important and make it easier for them to trust you and this trust will make them more sympathetic to your coaching. In order to focus intently on them if possible get into a quiet space. This should be away from distractions. Make it easy on yourself to focus. For example avoid places where there is a lot of action going on. If necessary face a wall with the individual in front of you to make it easy on yourself. If you are distracted during the intervention it is like saying that the other person is of less importance than what is distracting. What does it say to answer a phone while listening to another person Copy patterns of speech words and images used To make someone you’re talking to feel comfortable it is helpful to mirror their demeanour. If they are slow and deliberate they will feel most comfortable if you are the same way. If you’re in a hurry they will feel uncomfortable and less safe. 24

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When trying to mirror someone look for their language pattern. Is it deliberate or fast Try to measure their breathing pattern in the same way. Is it fast or slow Reflect it. Watch out for their body language. If they are relaxed don’t lean in aggressively. Being flexible in how you act around your intervention. In order to obtain a deep contact and influencing power with the other you must let them help you to find the correct ways to achieve your goal. Tuning in to them will help you build rapport by including their feelings of safety and their receptiveness to your suggestions. Tell about similar experiences One other way to build rapport is let the other person know that you understand where they are coming from. When you acknowledge them that is you say and demonstrate that you understand it doesn’t mean you agree it just means that you have heard them. This creates an absence of vulnerability because people want to know that they have been heard. That makes them feel important and makes it easier to trust. To demonstrate that you understand let them know that their words make sense to you and when possible that you have had similar experiences and thoughts. This might be done by telling them about a personal experience that is like theirs. If that is not possible say that you understand or ask them to explain further in a way that lets them know you are interested in their experience. Being heard is a building block of trusting. “I have that same feeling all the time.” – “I was just about to say exactly the same thing” – “I couldn’t agree more” Ask for advice  “How would you … What would you do if … ” Insert pauses between phrases talk slowly whisper When you ask a question deliberately pause to let the person you’re asking answer. This is a sign of respect which builds feelings of safety and trust. Imagine if you had an audience with the Pope. Would you ask a question and then jump in while he was answering No not at all. You would respectfully wait for the answer. It is the same in building rapport. To build trust you must patiently provide an empty space for the answer to fill. Patient open space listening produces respect an absence of vulnerability and rapport. Smile I know that this one’s obvious but we’re much more approachable when we smile. Alternatively a greeting without a smile lacks warmth and makes it difficult for us to connect with others. A solid handshake A good handshake isn’t very memorable but a bad one is. Make sure that your handshake is firm without breaking fingers and doesn’t go on for too long. Hanging your hand out like a dead fish comes across as insipid and lacking in confidence a bad start to any relationship and to be avoided. Whilst you may have 25

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used the same handshake for your whole life so far it’s never too late to change so if you’re conscious that you sometimes don’t come across well in this area start practicing. Get and use their name To assist you to build rapport with others getting their name early in the interaction is crucial. It’s just as important to use it a few times making the conversation more personal and increasing the likelihood that you’ll remember it the next time you meet them. Find common interests but keep it about them People like people who share interests with them so asking questions about their family work background even favourite sporting teams can assist you to find common ground with the other person. However when you’ve found one or two points of affiliation don’t take that as permission to talk too much yourself. Ask questions to get the other person talking enabling them to feel more comfortable and confident with you. Building Rapport: Paving the road to Collaboration Building A supportive relationship always demands giving your full attention to the other person. By doing so you make it easier for them to tell their story and enable them to look at ways that will allow them to handle their problems better or even solve them. Giving attention includes listening actively being genuine and showing respect. In other words: totally being there for the individual. You tune into the other. You tune into his use of language words intonation attitude movements and emotions. Do this unobtrusively. If you tune into them it will become easier for you to imagine what it would be like being him and having his problems. On the other hand the person you want to help will also feel more at ease with you. This can be called Mirroring. One of the active ingredients that makes supportive relationships work is Rapport. More rapport between two people will typically make the exchange and acceptance of ideas go more quickly. Less rapport will make it less effective. What this means is that more time spent by actively listening to the other and mirroring his actions thoughts and feelings up front will lead to less effort later to produce results. Less effort up front to create rapport will mean more effort is needed later to stimulate the other to right action. You should therefore always take the time to establish rapport if your aim is to influence somebody else. Establishing Rapport will make your intervention more efficient and more successful. In extreme circumstances the rapport building might need to be 99 of the relationship. So what is rapport. The dictionary definition speaks of mutual trust. My favourite definition of trust is ‘an absence of vulnerability.’ So rapport could be considered a ‘mutual absence of vulnerability.’ Building rapport is taking steps to create trust by creating an absence of vulnerability. This is done by helping the other to feel safe. Steps to take include being curious creating an open space for answers to questions mirroring the demeanour of the other giving the individual your total attention and acknowledging that they are being heard. It’s all about being an 26

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excellent listener. Rapport is the ultimate tool for producing results with other people and thus it is so vital for effective communications. When you bear in mind that 93 of all communication is down to the tonality of your voice and your body language building rapport is far more than just talking about common experiences. Its an important point to remember but people like people when they are like themselves and when they are not it so much more difficult to have any sort of relationship with that person never mind an effective one How to develop collaboration building 1 : Prepare to compromise. When working with a team it is impossible for everyone to get their way so compromise is imperative. Dont consider it a blow to your ego simply a necessity when you develop collaboration skills and put them to use. 2 : Avoid taking it personally. When collaborating with a group there is always a chance of getting your feelings hurt by insensitive team members or group decisions. Remember that decision-making should not be personal it is just a natural part of the process. 3 : Focus on the well-being of the project. In order to fully develop collaboration skills it is important to keep your eye on the task at hand. Focusing your efforts on the success of a project removes the urge to get your own way and helps a group stay on task. 4 : Communicate effectively. Without communication all sorts of problems are likely to pop up. By communicating in thoughtful ways and remaining mindful of others feelings and motivations you will be more likely to collaborate successfully. 5 : Identify challenges. If you have trouble developing collaboration skills take some time to reflect on your difficulties. By pinpointing the hurdles in your way and the causes of your discomfort you can map out ways to overcome them. 6 : Participate in team building activities. There are a number of team building workshops and activities that are easily accessible online or in person. Take the time to participate in team building activities as a way to quickly and efficiently develop collaboration skills. A-to-Z strategies for building collaboration in organizations Most people agree that effective collaboration is more important than ever in today’s turbulent environment. In a “do-more-with-less” reality it takes ongoing teamwork to produce innovative cost-effective efficient and targeted solutions. In fact the ultimate success of your intervention may depend on how well you and the other person can combine your potential and the quality of the information they possess with your ability and willingness to share that knowledge . So what’s to be done Here from A to Z are the most successful strategies to tear down fences reduce conflicts and increase collaboration. A. Find ways to ACKNOWLEDGE collaborative contributors. Recognize and promote people who learn teach and share. And penalize those who do not. In all best-practices companies those hoarding knowledge and failing to build on ideas of others face visible and serious career consequences. In those top companies employees who share knowledge teach mentor and work across departmental boundaries are recognized and rewarded. B. Watch your BODY LANGUAGE. All leaders express enthusiasm warmth and confidence – as well as arrogance indifference and displeasure through their facial expressions gestures 27

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touch and use of space. If leaders want to be perceived as credible and collaborative they need to make sure that their verbal messages are supported not sabotaged by their nonverbal signals. C. Focus on the CLIENT. Nothing is more important in an organization – whether it’s a for- profit company or a non-profit group – than staying close to the end-user of the service or product you offer. When you build collaborative relationships with your customers you give them power and co-ownership of your organization’s success. D. DIVERSITY is crucial to harnessing the full power of collaboration. Experiments at the University of Michigan found that when challenged with a difficult problem groups composed of highly adept members performed worse than groups whose members had varying levels of skill and knowledge. The reason for this seemingly odd outcome has to do with the power of diverse thinking. Group members who think alike or are trained in similar disciplines with similar knowledge bases run the risk of becoming insular in their ideas. Instead of exploring alternatives a confirmation bias takes over and members tend to reinforce one another’s predisposition. Diversity causes people to consider perspectives and possibilities that would otherwise be ignored. E. ELIMINATE the barriers to a free flow of ideas. Everyone has knowledge that is important to someone else and you never know whose input is going to become an essential part of the solution. When insights and opinions are ridiculed criticized or ignored people feel threatened and “punished” for contributing. They typically react by withdrawing from the conversation. Conversely when people are free to ask “dumb” questions challenge the status quo and offer novel – even bizarre – suggestions then sharing knowledge becomes a collaborative process of blending diverse opinion expertise and perspectives. F. To enhance collaboration analyze and learn from FAILURE. The goal is not to eliminate all errors but to analyze mistakes in order to create systems that more quickly detect and correct mistakes before they become fatal. G. Collaboration takes GUIDANCE by managers who know how to harness the energies and talents of others while keeping their own egos in check. Successful organizations require leaders at all levels who manage by influence and inclusion rather than by position. H. Eliminate HOARDING by challenging the “knowledge is power” attitude. Knowledge is no longer a commodity like gold which holds or increases its worth over time. It’s more like milk – fluid evolving and stamped with an expiration date. And by the way there is nothing less powerful than hanging on to knowledge whose time has expired. I. Focus on INNOVATION. Creativity is triggered by a cross-pollination of ideas. It is in the combination and collision of ideas that creative breakthroughs most often occur. When an organization focuses on innovation it does so by bringing together people with different backgrounds perspectives and expertise – breaking down barriers and silos in the process. J. JOIN the social media revolution. Utilize Web technologies – tools and processes that allow people to share opinions insights experiences and perspectives in order to collaborate and to self organize. K. Realize that there are two kinds of KNOWLEDGE in your organization: Explicit knowledge can be transferred in a document or entered in a database. Tacit knowledge needs a conversation a story a relationship. Make sure you are developing strategies to capture both. L. LEADERS at all levels of an organization can nurture collaboration within their own work group or staff. The most successful of these leaders do so by taking the time and effort 28

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necessary to make people feel safe and valued. They emphasize people’s strengths while encouraging the sharing of mistakes and lessons learned. They set clear expectations for outcomes and clarify individual roles. They help all members recognize what each of them brings to the team. They model openness vulnerability and honesty. They tell stories of group successes and personal challenges. And most of all they encourage and respect everyone’s contribution. M. MIX it up by rotating personnel in various jobs and departments around the organization create cross-functional teams and invite managers from other areas of the organization to attend or lead your team meetings. N. Employees with multiple NETWORKS throughout the organization facilitate collaboration. You can accelerate the flow of knowledge and information across boundaries by encouraging workplace relationships and communities. Use a tool like Social Network Analysis SNA to create a visual model of current networks so you can reinforce the connections and help fill the gaps. O. Insist on OPEN and transparent communication. In an organization the way information is handled determines whether it becomes an obstacle to or an enabler of collaboration. Employees today need access to information at any time from any place. P. Collaboration is a PARTNERSHIP. As one savvy leader put it “To make collaboration work you’ve got to treat people the way you want to be treated. It’s pretty simple really. Treat all employees as your partners. Because they are.” Q. Ask the right QUESTIONS. At the beginning of a project ask: What information/knowledge do we need Who are the experts Who in the organization has done this before Do we have this on a database Who else will need to know what we learn How do we plan to share/hand off what we learn R. The success of any organization or team – its creativity productivity and effectiveness – hinges on the strength of the RELATIONSHIPS of its members. Collaboration is enhanced when employees get to know one another as individuals. So when you hold offsite retreats organization-wide celebrations or workplace events with “social” time built in be sure to provide opportunities for personal relationships to develop. Taking time to build this “social capital” at the beginning of a project increases the effectiveness of a team later on. S. Collaboration is communicated best through STORIES – of successes failures opportunities challenges and knowledge accumulated through experience. Find those stories throughout your organization. Record them. Share them. T. TRUST is the foundation for collaboration. It is the conduit through which knowledge flows. Without trust an organization loses its emotional “glue.” In a culture of suspicion people withhold information hide behind psychological walls withdraw from participation. If you want to create a networked organization the first and most crucial step is to build a culture of trust. U. Combating silo mentality requires UNIFYING goals. Business unit leaders must understand the overarching goals of the total organization and the importance of working in concert with other areas to achieve those crucial strategic objectives. V. The incentive to collaborate is the VALUE of the exchange to both the organization and the individual. When the assets and benefits of productive collaboration are made visible silos melt away. W. Your WORKPLACE layout encourages or impedes the way the organization 29

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communicates. To facilitate knowledge sharing you need to create environments that stimulate both arranged and chance encounters. Attractive break-out areas coffee bars comfortable cafeteria chairs even wide landings on staircases – all of these increase the likelihood that employees will meet and linger to talk. X. Take a tip from XEROX. It discovered that real learning doesn’t take place in the classroom – or in any formal setting. In fact people were found to learn more from comparing experiences in the hallways than from reading the company’s official manuals going online to a knowledge repository or attending training sessions. Y. Collaboration is crucial for YOUR success. We’ve witnessing the death of “The Lone Ranger” leadership model where one person comes in with all the answers to save the day. We now know that no leader regardless of how brilliant and talented is smarter than the collective genius of the workforce. Z. Forget about reaching the ZENITH. Collaborative cultures are learning cultures – and knowledge sharing is an ongoing process not an end point. Practical collaboration building Its amazing how much can be done when it doesnt matter who gets the credit. attributed to George C. Marshal This page contains principles that when put into practice will produce results. Start with a unifying purpose: The purpose may need to be broad enough to bring in enough people with energy imagination commitment resources and creativity to generate success. For example a community council interested in family and children issues or a business opening a new market. Sometimes the purpose may also be very specific and narrow when the energy imagination commitment and creativity are sufficient. Start with two or three or a small group of people who have passion for the purpose. For example drug prevention. This apparent conflict between broad and specific or narrow collaborations can sometimes be resolved by creating an umbrella committee with a more broad purpose and mission and subcommittees with more narrow and specific missions and purposes. For example a community council supporting family and children issues and a subcommittee dealing specifically with drug prevention or a committee working on absentee issues and a subcommittee dealing specific with drug prevention and/or treatment or even a business trying to recreate itself with a number of subcommittees. Start with the End in Mind: Create maintain and update simple and practical Mission and Vision statements. Create short and concise Mission and Vision Statements and possibly a strategic plan. Be willing to update and change as the need arises. Keep the Mission and Vision statements in full view of all of the participants at every meeting. Some organizations place their mission and vision statement at the top of each agenda. Stick with it........however If it doesnt fit any more change it. 30

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Do it by consensus unless a specific and different level of authority has been clearly communicated. Sometimes it can be helpful to create by-laws. Be careful that you do not get caught in the minutia and loose track of the prize goal. Consider creating and displaying a value statement. Set goals and objectives. Goals are where you want to go. Objectives are how you are going to get there. Goals should be measurable and observable. They should have specific achievable steps objectives with built in accountability for accomplishment. Goals should be built upon a consensus and can develop and adapt as the process matures. Some goals should be met quickly and easily others should stretch you and the organization. Celebrate and advertise success. Emphasize both process and product. Document baselines to which you can compare. Evaluate how your results compare with the results of others working on similar goals. Be willing to learn from the success of others. Always strive for improvement evaluate solicit feedback and adjust your course as needed. Believe in what you are doing and the people who are doing it. "If you think you can do a thing or think you cant do a thing youre right." Henry Ford Radiate and speak Optimism. Expect Success Expect the best from people that you are working with. Leadership "What you are thunders so loudly in my ears that I cannot hear what you say." Emerson Someone needs to be responsible for facilitating moderating and managing the meeting and discussion. Value-based dedicated leadership is essential for anything lasting significant and positive to be accomplished. Be supportive consistent and dependable. Set high standards of excellence. True collaboration requires shared leadership. Cultivate leadership in others. Leadership must value an inclusive collaborative process. Coordinate - Organize Seating can be very important. Sitting behind tables can have the advantage of giving people a place to write and providing emotional protection. It also creates an atmosphere conducive to getting down to business and working. Preferably tables 31

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should allow everyone to see each other circle semicircle rectangle or square. Very small groups can often do well sitting on something comfortable such as two or three couches and/or other comfortable chairs that face each other. Very large groups can sit in a circle or semicircle. These formats will increase communication. Avoid rows of people. This cuts down on interaction and communication. Hold regular consistent same place and same time mutually beneficial constructive profitable informative and brief meetings. Take notes from the meeting and provide them to everyone in the collaboration. When there is a discussion write down what is said. Writing on a board or flip chart where everyone can see is often preferred. In some settings writing on a board or flip chart can seem pretentious. Accurately write what people say. Always have an agenda. In most cases it is better to send it to everyone ahead of time. Stick to the schedule. Respect everyones time. When someone brings something up that is not on the agenda write it down where they can see it. Be sure and address it at a later time such as at the end of the meeting after the meeting or during another meeting. Let everyone know ahead of time what the process will be for addressing items brought up during the meeting but not on the agenda. Occasionally in some urgent situations items will need to be addressed immediately this should be rare. Stick to your mission statement. For community collaboration regularly nominate and vote for officers or set a system for rotation. Even when this is a committee within a single organization this can have value. Small subcommittees or groups can often accomplish specific technical work or complete projects more quickly than a larger group committee or collaboration. These smaller groups can receive direction or report to the larger group. Remember to keep Levels of Authority clear.Show Respect for People and Time. Ask for help. Say please and thank you. Demonstrate common courtesy. Apologize when warranted know when its warranted be humble enough to appologize at times even when its not. 8 a.m. is often a good time for meeting with participants from Agencies and Schools. Lunch time can also be a good time. Evenings and weekends are usually best for Church Family Neighborhood and General Community Meetings. I am aware of one community coalition which meets at 4:30 P.M. to make it easier for teachers to attend. If your goal is to involve youth be sure to meet at a time and place convenient to youth. When there is a meeting for a work group with different organizations/agencies who have a mandate for the collaboration the time is usually more flexible. Always start and end on time. Be consistent. Consider logistical needs of others Consider parking transportation acoustics and child care when required. Access and comfort should also be considered. Accommodate needs of individuals with disabilities. Be sure there are adequate restrooms water et. etc. 32

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Be Open-minded Share Ownership. Empower others Share Leadership. Be willing to accommodate others when possible and appropriate. Concentrate on the areas that you have in common with others who are involved. A lifetime of good may be accomplished in the areas that you agree. Sometimes working together towards positive goals can be more important than your specific agenda. As you work together and develop relationships you will likely come to a greater unity of purpose. Encourage and help your organization to grow and change as the need arises. When others feel ownership and empowerment in the organization they become more committed creative and loyal. For many people the process is as important and sometimes even more important than the results. Everyone needs to be heard. Manage/Lead the process dont control it. The process does not belong to any one individual and usually does not belong to any one organization or agency. Allow for conflict and disagreement. Create a healthy atmosphere for disagreement and discussion. As much as possible resolve conflict and support the solution. Members/Participants need to clearly understand and respect each others values knowledge and skills. Knowledge needs to be shared in order to increase the capacity of all the members which in turn extends the capacity of the organization/collaboration. Knowledge shared is more powerful than knowledge kept. Enthusiastically support other peoples successive or intermittent approximations of the goal. As much as possible let it be someone elses idea. If their bandwagon is headed in the general direction of where you want to go jump in and cheer it on. Use genuine compliments and recognition. At times it is wise to put it in writing and make it public. At times it is wise to make it private. Be specific about the behavior that you are complimenting. When appropriate encourage volunteers. Provide everyone who wants it something meaningful to do. Remember that what is meaningful to you may not be meaningful to another. When ever possible encourage and support others in their interests. Share and rotate leadership responsibilities. Support and encourage leadership in others whenever possible. Learn and practice critical thinking skills...without being critical. Build relationships Allow time before and after meetings for visiting. This can often be as important as the meeting itself. Take time to build friendships with members of the organization outside of the meeting times. Serving light refreshments or snacks can help to build relationships and ease conversation. Occasionally you may want to send a simple greeting card or thank you note to participants. This can help to build relationships. Sometimes a hand written note is greatly appreciated. 33

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Get to know and as much as possible understand the needs issues and passions of all the members of the coalition and stake holders in and out of the coalition. You are more likely to have positive influences over a friend than an enemy. Emphasize both process and product. Communicate For many people the process is as important and sometimes even more important than the results. Everyone needs to be heard. Serving refreshments or light snacks can open help to relax people and open communication. Use common language. One of the most important building blocks of collaboration and consensus is communication. Sometimes our differences are magnified in the words we choose when we come together. At times this is because we get used to using certain words phrases or acronyms words formed from the first letter of each word in a phrase such as USA with our peers because these words save time and helps us feel like we fit into a group. When we come together with other people from different backgrounds we sometimes forget that others may not understand some of the language that we use. Sometimes some people may use words phrases or acronyms that others may not understand on purpose. This can be a way to appear superior to others or to hide behind language as a way of self-protection. It is important to understand that we all have fears and concerns and that part of the purpose of this process is to overcome and move beyond fears and concerns together. When meeting together use words and phrases that all will understand. Avoid acronyms. Common language can include words phrases examples and stories which are familiar. Sometimes people dont feel comfortable sharing ideas in a group. Take time to solicit opinions and ideas one on one. Use surveys. Break into smaller groups to increase participation. Go around the group asking each person for an idea or their opinion. As people become more comfortable and feel safer with each other participation will likely increase. Let everyone know that their opinion and contribution is valuable. Promote and encourage open dialogue. Remember that language is more than just the spoken or written word. It is also the way words are spoken timing body language and the way silence is used. Use the media and other communication tools to communicate with stake holders outside of the collaboration. Some times members of the media are great additions to the collaboration/coalition. Send letters e-mails agendas notes flyers et. Etc. to other members of the coalition on a regular basis. Make phone calls and when possible personal visits to other members of the coalition to build relationships keep people involved and communicate. Maintain strong and consistent communication with stake holders outside of the coalition/collaboration. 34

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"Real listening shows respect. It creates trust. As we listen we not only gain understanding we also create the environment to be understood. And when both people understand both perspectives instead of being on opposite sides of the table looking across at each other we find ourselves on the same side looking at solutions together". Stephen R. Covey Motivate Find the commonalities and common passions. Find out what motivates the members of the coalition/collaboration and the stake holders. Remember that what motivates you may not motivate them. Appreciate and respect the differences. Understanding each others Love Languages may be helpful. Take responsibility and give credit. Give credit for success to everyone else involved with that success. Take responsibility for mistakes and when they occur failures that you have any part in. Find and take opportunities to compliment and celebrate the success of others. As collaboration matures both responsibility and success will be shared more evenly. Stick with it...Persevere.. Work. "The only place youll find success before work is in the dictionary". Mary B. Smith "That which we persist in doing becomes easy to do. Not that the nature of the thing has changed but the power to do had increased". Heber J. Grant Building Collaboration requires substantial and sustained effort often without recognition or equal distribution of responsibility. Keep your passion alive. Help others to find and harness their own passions. Complete and encourage the completion of assignments provide accountability. Let Go Forgive. Be willing to "let go" forgive and look past the shortcomings in others. When you do this they will be more likely to do it for you. Sometimes you have to hear before you will be heard. This does not mean that you allow yourself or anyone else to be abused. Everyone must be treated with dignity and respect. Allow for mistakes and even failure. Look for feedback from failure. Dont worry too much about perfection. Participation is sometimes more important then perfection. Let go of preconceptions. Continuity – Consistency - Dependability Even though the organization or collaboration may evolve over time it is important to demonstrate consistency and dependability in values and character. There should be a continuity in programs and message. Changes in direction should be openly discussed understood and consensual. Be honest and trustworthy. Your influence will be greatly dependent upon how dependable and trustworthy you and the organization are over time. 35

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Evaluate - Feedback Develop ongoing evaluations feedback and course correction for continuous quality improvement. Collect and present data which is accurate relevant and easily understood. Find the feedback in failure when it occurs. Eliminate or at least decrease Financial Dependency Stable resources are essential for anything enduring. Consider creating an endowment fund. Sometimes extraordinary results can be accomplished through volunteer efforts and limited funds. Keep good clear financial records. Create sustainability. Celebrate Success Look for success. Learn to recognize success. Celebrate small successes. Celebrate big successes. Celebrate publicly and privately. Acknowledge and reward success. Dont go overboard find out what people really appreciate make it genuine. Be flexible Remember that there are often exceptions. Show gratitude Show gratitude for gifts of every kind. Remember Roberts Rules of Order. There are times when a more formal process can be helpful and times when it can be an encumbrance and times in-between when some formality might help. When some or a lot of formality might be helpful you may want to consider incorporating all or some of Roberts Rules of Order. Underlying these rules always remember three fundamental principals. 1. Everyone needs to be treated with dignity and respect. 2. Everyone needs to be heard. 3. All of the information needs to be clear for everyone. 36

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4. Empowering "Empowerment means increased assertiveness and self-management skills. It is associated with positive human growth and change processes McWhirter 1991. As helping professionals counsellors are committed to the growth healing and development of the clients they serve. Unfortunately the intention to help does not always guarantee that counsellors are helpful. Some have argued that counselling and psychotherapy can actually serve to oppress rather than empower clients. For example Steinbock 1988 argues that helping relationships is oppressive to the extent that helpees embrace a view of themselves as needy and dependent on the helper for solutions to their problems. Further he contends that problem resolution focuses on the individual rather than the systems that create the problems resulting in a very low likelihood of constructive preventative change Steinbock 1988. Prilleltensky 1989 argues that interventions based on traditional approaches to psychotherapy serve to perpetuate the kinds of systemic problems and inequalities that lead clients to seek psychological services preserving rather than transforming an unjust status quo. Caplan 1992 argues persuasively that feminist therapy explicitly created to address womens oppression is also vulnerable to reflecting and preserving the gender inequities of society. These critiques warrant serious consideration. In societies marred by inequality and injustice racism and sexism economic stratification and violence all counselling relationships are vulnerable to subtly and even overtly reflecting these and other forms of oppression Amold 1997. By virtue of our training and education counsellors are in a position of relative privilege that unexamined can contribute to maintaining the presence of oppressive social influences within the counselling relationship. For example counsellors who fail to acknowledge the roles that racism and classism play in creating the environment of a low income client of color may blame the victim" counsellors ascribing to the values of the dominant culture without examining the influence of their values in counselling may define client problems and engage in interventions that are inappropriate for their clients e.g. Arnold 1997 Katz 1985 Sue Sue 1990. In her book " Empowerment and Community Planning: Theory and Practice of People- Focused Social Solutions. " Dr. Elisheva Sadan writes: The process of empowerment means a transition from a state of powerlessness to a state of more control over one’s life fate and environment. The process is aimed at changing three dimensions of a social condition i.e. to bring about a change in: people’s feelings and capacities the life of the collective that they belong to and the professional practice that gets involved in the situation. We therefore talk about: individual empowerment which is the personal intimate change process community empowerment which is the social change and empowering professional practice which is the organizational and functional change that encourages the realization of both the above. A successful planned change process oriented to increasing people’s control over their lives has to achieve outcomes in all three dimensions of empowerment. Dr. Sadan explains that it is important to raise the issue of people’s control over their lives and environments because the concept of empowerment is an attempt to break the circle of vicious social problems which are difficult to resolve. People suffer and are harmed not only because of neglect and apathy but also because of the attention of bad social services. Groups 37

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suffer from powerlessness not only because of indifference cruelty and a shortage of resources in the impoverished parts of the world but also because of humanly degrading social solutions in the ostensibly enlightened portions of democratic society. Empowerment is important to every human being because the danger of deterioration to a constant and systemic powerlessness lurks in wait for any citizen in the society. Empowerment therefore is never a one-time occurrence. It is an ongoing social process with far reaching consequences: people who are in control of their lives and participate in decision-making with regard to their future and their environment make an important contribution to democratic society as a whole. Hence an empowerment policy which makes more control over one’s life possible also increases societal resources – the individual profits the societal profits the physical environment profits the social institutions profit – a win-win outcome in every possible sense. Empowerment Coaching Empowering mobilizing strengths for change. The concept of empowerment was described as the process of helping clients discover personal strengths and capacities so that they are able to take control of their lives. The foundation for empowerment in counselling is the belief that clients are capable and have a right to manage their own lives. Thus an empowerment attitude focuses on the capacities and strengths of clients. Empowerment values and methods challenge counsellors to forgo any need to control clients by taking on an “expert” role that puts clients in positions of dependency. Giving priority to empowerment constrains counsellors from hiding behind professional jargon. Moreover counsellors who empower demystify the counselling process through open and non-jargonistic discussion with clients of their methods and assumptions. Self-determination an important component of client empowerment is promoted by helping clients recognize choices and by encouraging them to make independent decisions. Counsellors should not do for clients what clients can and should do for themselves. When empowerment is the priority clients become the experts and there is “collaboration and shared decision making within the professional relationship Sheafor Horejsi 2008 p. 79. McWhirter 1991 asserts that the potentially empowering aspects of counselling include “an underlying belief in basic human potential and in clients’ ability to cope with their life problems a collaborative definition of the problem and therapeutic goals skill enhancement and development recognition and analysis of systemic power dynamics and an emphasis on group and community identity” p. 226. Often clients come from disadvantaged and marginalized groups where they “have been ‘beaten down’ by oppression poverty abuse and other harmful life experiences. They want better lives for themselves and their families but they feel powerless to make the necessary changes. Some clients have a pervasive sense of failure and feel different from and rejected by other people” Sheafor Horejsi 2008 p. 422. Sometimes powerlessness arises from negative self-evaluation and low self-esteem or from lack of confidence in one’s ability to alter one’s life but sometimes the systems that are set up to assist clients are themselves oppressive and contribute to powerlessness. Describing the welfare system Carniol 1995 observes “As for the clients evidence shows that they often find themselves blamed for the problems they face. They find they don’t get the help they need or they don’t get nearly enough to make a difference—or they get ‘cut off’ ” p. 3. 38

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Racism and other prejudices may also deny clients access to jobs and resources such as adequate housing a reality which reminds counsellors that they have some responsibility to advocate for progressive system and social policy changes. Ben Carniol a Canadian social work educator offers this challenge: “Social and economic and environmental justice demands a transformation of power including a basic democratization of wealth-creating activities—so that the practice of democracy comes within the reach of everyone rather than being manipulated by those who now dominate the heights of our political and social structures” 1995 p. 158. Client self-determination is enhanced when clients have more choices. This perspective draws counsellors into broader activities including working to identify and remove gaps and barriers to service and encouraging more humane and accessible policies and services. In addition as McWhirter 1991 argues empowerment requires that clients “gain some degree of critical awareness of systemic power dynamics” p. 225. One way counsellors can achieve this end is to provide clients with information on groups and organizations whose efforts are directed toward changing problematic elements of the system. Dr Elisheva Sadan emphasizes that creating an ethos of empowerment is important and essential because it is so lacking in the social reality we live in. Societies are saturated with disempowerment—with discrimination with prejudices with the casting of stigmas with blaming the victim. It is permeated with ideals which isolate and exclude individuals inside their private space and place them in confrontation with one another. The individual’s success is measured by her/his capacity to compete in a weak market to be a winner among losers. Social practices which encourage solidarity social integration support of the vulnerable compassion and empathy are rare and the outcome is a society of lonely individuals in the crowd. The creation of a community is both a personal and a social solution. What it means is working as a group to grapple with problems that the individual cannot cope with alone. True there is no guarantee that the collective effort will succeed where the individuals have failed but the very process of collaboration of involvement of people’s commitment to attain a shared goal to influence the making of decisions that affect their lives to improve the quality of their lives and their environment creates a new feeling and new capabilities among the participants—and this is an important outcome in itself. Empowered action means coming out of the alienation marginality and sense of irrelevance that are the lot of those who have no influence over what influences them. The community provides its members with important needs in ways which people who live without a sense of community are not aware of. Alienation can become an existential condition unless a person feels that s/he belongs to a body in which there exist mutual trust and commitment to shared goals. Dr. Elisheva Sadan - "Empowerment and Community Planning: Theory and Practice of People-Focused Social Solutions." The counselling process itself offers empowerment to clients. The beginning phase offers many clients a unique opportunity to explore their situation and their feelings. Active listening skills help clients bring long-forgotten or misunderstood feelings to the surface. Ventilation of feelings can energize clients and it can lead to spontaneous insight into new ways of handling problems that seemed insurmountable. 39

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3. Empowerment and Change : The Purpose of Counselling Clients may have made conscious decisions to change and their motivation may be high but they may also have mixed feelings about replacing established behaviour with new ways of behaving. Sometimes change involves a “selling” job but the results are better when clients not counsellors do the selling. Clients need to convince themselves that the benefits of change outweigh the risks and they need to develop positive attitudes and beliefs about their capacity for change. Counsellors with a strengths perspective believe in the capacity of their clients to change and this belief in them can be a powerful motivating factor. 1. Motivation Motivation initiates and drives the change process. Johnson McClelland and Austin 2000 identify three factors important for motivation: “the push of discomfort the pull of hope that something can be done to relieve the problem or accomplish a task and internal pressures and drives toward reaching a goal” p. 133. Thus not only must clients want to change but they must also believe in their capacity for change. Change is stressful it requires risk and energy to give up established patterns of behaviour and thinking. Clients differ in the extent to which they have the skill or energy to take the associated risks. The following are the essential elements of high motivation: 1. willingness to engage in the work of counselling 2. commitment to devote energy and resources to the change process 3. capacity to sustain effort over time and in the face of obstacles 4. sufficient self-esteem to sustain the courage to change Shebib 1997 p. 252 Counsellors can assess clients based on these four elements and then design appropriate strategies to meet each client’s particular need. These four elements suggest two major motivational tasks for counsellors: engaging clients to commit to change and supporting and energizing clients as they deal with the stresses of obstacles to change. The concept of secondary gain is a useful way of understanding why some people resist change despite the obvious pain or losses involved in maintaining their current situation. Secondary gain refers to the benefits that people derive from their problems. These benefits may include “increased personal attention disability compensation and decreased responsibility as well as more subtle gratifications such as satisfying the need for self- punishment or the vengeful punishment of others who are forced to take responsibility” Nicoli 1988 p. 13. Some clients can be exceptionally difficult and frustrating to work with. Sometimes it’s hard to do but we should discipline ourselves to be nonjudgmental regarding motivation. Although it might be tempting to label some clients as unwilling passive or lazy we should remember that they may have given up for good reason. Perhaps society has not provided the resources or support they need for change. Clients may have given up to protect themselves from the further damage to their self-esteem that would come from repeated failure. In this way their behaviour may be seen as adaptive. It’s normal for counsellors to lose patience with them and give up but it’s important to remember that that’s precisely what they did to themselves— give up. That’s one of the reasons they need counselling. 40

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2. The Stages of Change The stages-of-change model Prochaska and DiClemente 1982 describes a sequence of stages through which individuals progress as they think about and change their behaviors. The stages of change concept gives the counselor insight into the client’s thinking. It is used to measure the client’s readiness for change and to adjust the strategies used to accommodate the client’s stage. Enhancing motivation • Progress in making behavioural changes e.g. overcoming marijuana dependence - getting ready for the first day of abstinence getting through the first 3 months depends on the client’s readiness for change. • Client readiness may shift and evolve and may be influenced by the therapist. The stages-of-change model comprises five stages: precontemplation contemplation preparation action and maintenance Individuals move back and forth between the stages and progress through the stages at different rates. For example in the assessment session the client may be committed to maintaining abstinence but in session 2 he or she may be ambivalent. Once the clients stage is identified the strategies used to support continued progress through the stages are these described in Miller and Rollnick 2002: Motivational Interviewing Stages Characteristics 1. Precontemplation • Is not considering change • May be unwilling to change behaviors • Is unaware of adverse consequences of old habit although others believe problems exist 2. Contemplation • Becomes aware that problems exist • Recognizes causes for concern and reasons to change • Typically is ambivalent and continues to use marijuana • May seek information and reevaluate marijuana use behavior • Weighs the pros and cons of making a change • Could remain in this stage for years 3. Preparation • Commits to changing • Recognizes that advantages of changing outweigh benefits of not changing • Thinks about capabilities of success i.e. self-efficacy • Continues old habits but intends to change soon • May have attempted to reduce or stop old habits • Sets goals and may tell others about them 4. Action • Chooses and begins to pursue a goal • Modifies habits • Can last months 41

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5. Maintenance • Makes efforts to sustain gains achieved during the action phase • Works to prevent relapse • Learns how to detect and guard against risky situations • Requires prolonged behavior change and continued vigilance for 6 months to several years 3. Motivational Interviewing Motivational interviewing is a technique used in motivational enhancement therapy MET. The counselor assesses the client’s motivation by using motivational interviewing strategies which include  asking open-ended questions  listening reflectively  affirming the client  summarizing the client’s views of change  eliciting self-motivational statements  recognizing and addressing resistance  recognizing readiness for change and  identifying discrepancies Once the client’s stage is identified the counselor uses these strategies to support continued progress through the stages. The Context for Motivational Interviewing and Skills Training As the client expresses increasing interest in addressing his or her problems modifying use the counselor carefully supports these efforts to change without prescribing the change. When the client expresses a commitment to change the counselor asks the client about the steps he or she will take to make the change. The counselor provides a menu of self-change and assisted-change options depending on the client’s inclinations and experience in making changes. It is important for the counselor to show genuine interest in the client’s perspectives on and skills for making change. For example if the client has quit smoking tobacco lost a lot of weight or left a destructive relationship the counselor explores these experiences to reinforce and highlight the client’s capacity and desire for self-development. Self-change advice may be in the form of a brief written handout concerning behavioral changes. Sessions 1 and 2 provide several take-home handouts that reinforce motivational advice given by the counselor during the sessions. These handouts are available at the end of this section. Tips for the Counselor • Review relevant sections of the manual before each session. • Develop a natural style of conveying the material avoid reading text to clients. • Maintain a motivational style use open-ended questions and reflections and avoid a directive resistance-building style. • Encourage involvement and participation by the client. • Attend to shifts in the client’s motivation and readiness for change. • Explain practice exercises carefully probe for the client’s understanding. 42

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Close- Vs. Open-Ended Questions Close-ended questions are an efficient way of obtaining information quickly however they allow the client to be passive answering each question and quietly waiting for the next. The interviewer is in control and the interviewee responds to each cue. Open-ended questions encourage the client to express himself or herself and to adopt an active role in his or her treatment. Listening Reflectively A reflection can take the form of simply repeating the client’s words or paraphrasing his or her comments. Sometimes the reflection adds to what the client has said as a way of testing a counselor’s hunch. The skilled listener using reflective listening skills can help the client explore his or her thoughts and feelings: Miguel M: I’ve tried to quit before but have never made it for longer than a month. Counselor C: Keeping it going has been hard. M: Yeah. I can’t help feeling pessimistic about what will happen if I try it again. or M: My wife is pressuring me to quit. I’ve got to want to do it for me if this is going to work. C: Pressure from your wife is distracting you from tuning in to your needs about quitting. M: It’s almost as if I resist because I want to feel that she doesn’t control my life. or M: My buddies say they’ll support me if I decide to quit but knowing that they’re getting high will make me feel left out. C: You’d like to figure out a way to stay connected to these friends and stop smoking. M: I guess I’ve been thinking that’s not possible. A double-sided reflection captures two opposing sides to an individual’s ambivalence: Linda L: I know I’m getting high too much but it’s summer and I want to have fun before school starts. C: On the one hand you don’t want to miss having fun during the summer but on the other hand you’re thinking that you use too often. Affirmation of the Client Admitting drug dependence seeking help by enrolling in a program summoning the courage to change and undertaking other aspects of overcoming a dependence are tremendously difficult. The counselor can be supportive by frequently offering genuine compliments and expressions of awareness: C: You’ve been thinking about quitting for a long time and now you’re taking the first steps. I’m guessing you feel good about that. C: Telling your father that you needed counseling for a marijuana problem must have been difficult. C: Deciding to give up the extra income that came from selling pot wasn’t a minor decision. It requires a real commitment to leave that behind. Summarizing the Client’s Views of Change As the client reveals facets of his or her thinking about change the counselor can be supportive by summarizing key issues. Hearing the counselor consolidate the client’s statements helps the client become aware and ready to resolve his or her mixed motivations: C: If I understand you correctly you’re aware of reasons for changing but you’re thinking of other reasons not to quit. On the side of quitting are being a good role model for your children 43

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and overcoming a tendency to procrastinate. On the side of not quitting are your fears that you’ll lose friends and won’t make it for long. Have I got it right What are your thoughts about this Eliciting Self-Motivational Statements Whereas some clients begin counseling with a strong commitment to stop marijuana use others have considerable ambivalence that may increase over time. Motivational enhancement sessions help the ambivalent client strengthen his or her determination to quit. It is hoped that these counseling sessions lead the client to recognizing his or her problem I guess I really have to face that I’m out of control with marijuana becoming concerned about it I’m worried about whether I can overcome this expressing an intention to change Now’s the time for me to leave this behind and feeling positive about the prospects of succeeding I can picture a time when I’ll be clean and—for once in my life—that seems possible. The counselor elicits expressions of motivation from the client with open-ended questions: • Recognizing the problem C: How has your marijuana use gotten in the way of things that are important C: What convinces you that marijuana has become a problem • Expressing concern C: What aspects of your marijuana use have made you or people close to you worry C: What do you imagine could happen if you continued to smoke marijuana the way you have been doing • Encouraging intentions to change C: When you joined our program you probably had some hope that things would get better. What would improve in your life if your hopes were met C: Why should you stop smoking marijuana Why do you think it’s time to change • Expressing optimism C: What leads you to think that you could succeed in quitting if you decided to do that C: Is there a part of you that feels encouraged about changing With these questions the counselor helps the client take ownership of the problem and elicit expressions of readiness to change. Recognizing and Addressing Resistance A conventional way of interpreting actions of a client who argues with the counselor frequently interrupts or denies that a behavior is a problem is that the individual is not motivated to change. An alternative view is that the counselor does not understand the client’s thoughts and feelings. When the counselor considers these behaviors a signal that he or she needs to understand the client’s experience better a confrontation between counselor and client is less likely to occur. The counselor shows that he or she is listening and is not being judgmental. The counselor’s reflections can prompt the client to explore his or her thoughts and feelings: M: I don’t understand why you folks want everyone to quit smoking dope. Maybe I’d be better off if I just cut back. C: I hear you saying that it’s important to you to change your marijuana use but you’re not sure whether stopping completely is best for you right now. I can see that you’re eager to find the best goals. In this example the counselor might have offered a defense of the program’s abstinence objectives listed reasons why the client ought to change and so forth. Those responses probably would have led the client to become even more resistant. The strategy illustrated above is termed “rolling with resistance” an approach that conveys the counselor’s acceptance of the client’s point of view and invites the client to be open to a slight variation. In the following examples of this approach the counselor accepts the client’s comments conveys empathy for the client’s feelings and reframes what has been said: 44

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M: Most of the people I know get high. Why is everyone on my back C: It’s hard to figure out why you’re getting all this pressure. Kind of makes you wonder how you could be the only one who is having problems with pot. or M: I know I’ll have more energy if I quit but I need it to relax. C: On the one hand you’d benefit from more energy. On the other hand you’d need to find other ways to relax. or M: I can’t see living for the rest of my life without getting high. C: Slow down. It’s too early to be talking about forever. Let’s talk about what you’re working on right now. or M: I think a lot about quitting but I’ve never really tried it. C: You’ve invested a lot of time and energy in this already. Recognizing Readiness for Change Expressions of motivation take a variety of forms. The counselor needs to listen carefully and acknowledge those expressions: M: I hate having so many people angry at me. Why don’t they get off my back C: It’s important to find a way to stop people from being angry with you. or M: One thing that I see happening over and over is my promising that I’ll limit how often I get high and then I go right ahead and break every one of these promises. C: You’d really like to stop disappointing yourself. or M: I’ve got three beautiful children and I don’t want my pot smoking to interfere with my being a good father. C: An important priority in your life is your role as a father. Identifying Discrepancy Clients who are drug dependent have probably seen their reliance on drugs interfere with important aspects of their lives. The counselor helps the client focus on the costs of continued drug use by pointing them out to the client and seeking the client’s perspectives: C: I’ve heard you talk about how important it is that your children grow up in a safe and happy home. That’s a goal. But you’ve also talked about not wanting anyone including your wife to dictate what you do and this is causing tension in your home. Relieving this tension is another goal. I wonder what your thoughts are about these two goals. C: You’ve told me that when you smoke a joint on your lunch break you have a hard time concentrating at work for the rest of the day. You’ve also said that doing your job well is important so that you can get promoted. I’m a little confused. 45

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Samples of Sessions 1 and 2 Session 1 Protocol 1. The counselor welcomes the client and provides an overview of the session. In this session the counselor uses MET techniques while reviewing the client’s PFR and helping the client prepare for change. The PFR or Personal Feedback Report is created for each person from his or her personal responses to the assessment questions and consists of a history of marijuana use recent use patterns of marijuana alcohol and orther drugs normative data on parijuana problems related to marijuana use situational confidence in avoiding marijuana and life goals. The PFR is printed in booklet format with graphics and accompanying descriptions of risk factors for developing problems with marijuana and is reviewed with the counselor utilizing Motivaniol Interviewing skills throughout the session. 2. Assess the Client’s Readiness To Proceed The counselor asks the client to express his or her thoughts and any major changes that have occurred since the assessment session. Some possible responses from the client might be • Abstinence since entering treatment • A reduction in the client’s marijuana use • Seeking additional treatment or attendance at a mutual-help program • Conversations about his or her use or about this program with family or friends. 3. The counselor responds empathically uses opportunities to support the client’s self- efficacy for change and reinforces expressions of motivation. Welcome Counselor C: Thank you for being on time. How are things going Shirley S: After answering all those questions about my smoking I am more aware of it than ever Nothing has changed yet but I am thinking about it. My husband has been very supportive. C: And his support means a lot to you. S: You bet He is someone I can count on. C: That’s good to hear. Let’s be sure to talk about specific requests you might make of him for support in the future. or C: You arrived a little late for your appointment. Is this a good time for you or would a different time work better Doug D: No this is fine. There was a lot of traffic. C: How are things D: Worse. My wife and my son are on my back they are treating me as if I’m a leper. C: That sounds like an uncomfortable situation for you. D: Yeah I feel like everyone is against me. C: How has this affected your smoking D: At times I find myself smoking just to prove that it’s not a problem for me 46

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C: It’s more of a problem for them. D: That’s right. I don’t think either one really understands me. C: You’d like them to understand you that might remove some reasons for getting high. D: Yeah. At least I wouldn’t be trying to get back at them. Review the PFR The PFR review takes approximately 30 minutes. The counselor explains that by reviewing the PFR form AS8 the client will understand reasons for and against changing and what and when problems might arise. The counselor leads the client through a systematic review of the PFR giving the client an opportunity to explore each point. The counselor avoids simply verifying the information obtained during the assessment session. The counselor periodically seeks the client’s thoughts and feelings during the review. The counselor listens reflectively to acknowledge expressions of readiness for change. Reviewing the PFR provides an ideal opportunity to use motivational interviewing techniques for example expressing empathy identifying discrepancy eliciting self-motivational statements rolling with resistance and supporting self-efficacy. The client may respond to elements in the PFR review with arguments about the validity of the items I didn’t say smoking pot was causing me money problems. In such cases the counselor maintains a nondefensive tone acknowledges that the client knows best which areas of his or her life have been affected by marijuana use and moves on to the next item. The counselor may make changes to the PFR based on the client’s feedback during this review. In keeping with the MET approach the counselor uses open-ended rather than close-ended questions. For example Did you say you used in unsafe situations is a close-ended question that invites a mere yes or no answer and possible disagreement with the PFR item. Saying instead Tell me about using in unsafe situations invites elaboration and discussion. The counselor spends more time on the sections that are likely to produce the most constructive discussion. The sections on marijuana problems and reasons for quitting are especially conducive to motivational interviewing. After reviewing the PFR with the client the counselor asks the client for reactions and responds to them with empathy. Before moving on to the next phase of this session the counselor ensures that the following PFR items are discussed: • Age of onset part I of the PFR. The counselor tells the client that substance use disorders tend to be more severe when they begin at an early age. This means that the earlier the age of onset the greater the risk of developing severe problems if the substance use continues. In the PFR the age of onset of regular marijuana smoking is the age the client began smoking marijuana three or more times a week. • Comparisons of use patterns part I of the PFR. When preparing the PFR the counselor uses tables A and B to compare the client’s use with that of others who use marijuana. The percentiles indicate the percentage of people in the comparison group who scored at or below the client’s score. These comparisons allow the client to compare his or her use with that of people who experienced significant problems related to marijuana use. The counselor can present the information in the following way: 47

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C: You smoked marijuana on 24 of the past 30 days. That puts you in the top 98 percentile relative to all Americans. This means that 98 percent of American adults smoke less often than you do and about 2 percent smoke more often. S: Wow C: That surprises you. S: It sounds like a lot. I never thought it was that much C: What are you thinking now that you know that S: I don’t like it. I knew I was getting high a lot but I always thought that a lot of other people got loaded as much as I did. This isn’t good news. C: You’d like this to be different. S: Yeah. • Problems caused by marijuana use part II of the PFR. The counselor tells the client where he or she falls relative to others seeking treatment based on his or her responses to the Marijuana Problem Scale form AS5 and the data in table C. The counselor reviews the criteria listed on the Structured Clinical Interview for DSM-IV SCID-IV form AS4 that were coded as 2 or 3. The results provide an overview of the problems and symptoms that the client identified as resulting from his or her marijuana use. • Tolerance level part II of the PFR. Question 6 of the SCID-IV was used to measure the client’s tolerance level. Tolerance is defined as the need for a markedly increased amount of marijuana at least a 50-percent increase to achieve the desired effect or a markedly diminished effect with continued use of the same amount of marijuana. • Reasons for quitting part III of the PFR. To reinforce the client’s motivation the counselor reviews the reasons the client gave on the Reasons for Quitting Questionnaire form AS6 and asks the client whether he or she would like to add other reasons to the list. • Risk factors for relapse part IV of the PFR. The counselor points out the risky situations the client identified on the Self-Efficacy Questionnaire form AS7 as the client’s risk factors for relapse. The counselor explains that risk factors are warning signs that require the client’s attention and indicate a susceptibility to problems associated with marijuana use. A person who uses substances besides marijuana is at risk for additional reasons. Decreased use of one drug may result in increased use of another a phenomenon called substance substitution. In addition combining different drugs compounds their effects sometimes with dangerous results. Tolerance for one substance can increase tolerance for another people who take multiple substances simultaneously can develop cross-tolerance for several substances and be at risk for injury arrest or overdose if severely intoxicated. Summarize the PFR Review The counselor summarizes the highlights from the PFR including reactions and modifications offered by the client during this session: C: Let’s review and summarize what we’ve talked about so far. How does that sound to you S: I’m ready C: Your PFR shows that your smoking has caused several problems including missing work difficulty sleeping and feeling bad about your use. Is there anything else you want to add S: No those are the main problems. 48

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C: You also mentioned reasons for quitting including so your husband will quit nagging you so you won’t lose the privilege of teaching and because you have health concerns. S: Being a good teacher is really important. C: Being a good teacher is important to you and your smoking gets in the way. You can’t properly prepare for class the kids can find out you can lose your job. S: It’s my biggest reason for wanting to stop. C: When you talk about being a teacher you get enthusiastic but when you talk about your smoking you get discouraged. S: I never noticed that before but you’re right. C: You also stated that high-risk situations for you would include being with others who smoke and seeing them enjoy it. Anything else S: Not really but that is a major concern for me as I try to quit. So many people in my life use drugs. C: You’ve already identified how difficult it may be but you’ve also identified some very strong reasons for changing your smoking habits. S: I know it’ll be difficult but I think it’s worth it. C: Despite the obstacles you’re ready to take on this challenge. S: I really am. Elicit and Reinforce Client’s Readiness To Change When the client expresses motivation to change the counselor acknowledges these expressions seeks elaboration and offers reinforcement: C: You said that your smoking has caused problems including feeling that you have lower energy. Could you tell me about that Miguel M: I find I mean to do things but they never get done. It seems that I’m tired all the time. I can’t help but think it’s related to my smoking. C: Related to your smoking M: I don’t think it affected me when I was young. But now well I’m not getting any younger C: You think smoking is affecting you more as you get older. You feel less productive. M: I think that’s related to the lower energy. I don’t finish my work at my job and I’m not as creative. I feel that I’m drowning in backed-up work at home at my job everywhere. C: And you think that if you quit smoking you will increase your productivity. M: Yeah. C: That’s important to you. You’d like to regain your creativity and productivity. M: I really would like that. Assist Client in Preparing for Change The counselor assists the client in preparing to stop using marijuana by discussing several key issues. If the client has not stopped already he or she needs to select a day to stop. The counselor helps the client consider several alternative stop dates. Topics to consider include what the client will do with his or her marijuana supply and paraphernalia how the client will disclose the plan to stop to family and friends both 49

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supporters and those who might sabotage the client’s efforts and how the client will address possible problems in maintaining abstinence e.g. sleep difficulties boredom anxiety restlessness in the first week. Help Client Identify Specific Behavior Change Strategies The counselor discusses specific coping strategies to handle vulnerabilities to slipping. The counselor gives the client Learning New Coping Strategies form 1A and A Guide to Quitting Marijuana form 1B. If time permits the counselor reviews these forms with the client highlighting sections that seem particularly relevant to the client. The counselor explains that many concepts touched on in the forms are discussed in detail in later sessions and the client should bring the forms to the next session session 2. Because managing one’s stress level is important particularly in the early weeks and months of treatment the counselor advises the client about HALT: • Don’t let yourself become too Hungry. • Don’t let yourself become too Angry. • Don’t let yourself become too Lonely. • Don’t let yourself become too Tired. The counselor asks the client to think about people situations e.g. certain times of day days of the week places moods and thoughts that can increase vulnerability to slipping. Some of these were mentioned on the Self-Efficacy Questionnaire form AS7. For example a client may describe plans to spend time with a smoking buddy. A client may face significant life changes e.g. job or relationship changes illness in the family or of a close friend likely to produce stress that could place the client at risk for slipping. The counselor and client identify and discuss coping strategies for each situation. The counselor helps the client identify people from whom he or she can seek and get support. The counselor encourages the client to consider several options rather than only one or two and to think creatively. With the counselor the client can practice making requests and can benefit from the counselor’s modeling and feedback. Practicing interactions during treatment sessions can lessen the anxiety the client may have about asserting himself or herself with friends and family: M: I’ll be going away for a few days and I have concerns that no one will be watching me. C: What concerns do you have M: I’ll be at a meeting with several people who smoke. For years we’ve gone out and partied after the meetings. I don’t know what I’ll do. C: You just identified a high-risk situation. M: Yeah. What should I tell them I thought about saying I had a cold but that’s lying. C: You would prefer to tell them the truth. What are your concerns about that M: I guess I’m afraid they would think I’m judging them. I really like these people. C: That is a difficult situation for you. Maybe if you and I rehearsed a couple of different ways to tell them it would make it easier for you. Would you be willing to try that M: Sure what should we do C: Why don’t I play the role of one of your colleagues on this trip and you try different ways you might handle it. Ready 50

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Assign Between-Session Exercises The counselor gives the client the Quit Agreement form 1C and asks the client to bring the completed form to the next session. The counselor explains that the agreement summarizes 1. The client’s date for quitting marijuana use 2. The client’s reasons for seeking to change 3. Strategies that the client will use. The counselor also asks the client to review Learning New Coping Strategies form 1A and A Guide to Quitting Marijuana form 1B several times before the next session. Ask Client To Invite a Supporter to Next Session People who are trying to overcome an addiction can benefit greatly from the support of a close relative or friend. The counselor asks the client to invite someone to attend the next session and to think carefully about the pros and cons of particular people to invite. For example a friend who is dependent on another drug or alcohol is not a good prospect. Factors to consider include closeness to the client emotional characteristics of the relationship emotional availability of the supporter regarding the client’s desire to quit marijuana use substance use by the supporter and accessibility during times of stress. The ideal person would be someone who is a good listener cares about the client and is interested in providing support. This person will be asked to sign the Supporter Agreement at session 2. Review and Conclude Session The counselor reviews the content of the session asks the client for feedback responds empathically to his or her comments troubleshoots any difficulties and reminds the client to review the handouts over the next week. Session 2 Protocol The counselor welcomes the client and provides an overview of the session. In this session the counselor helps the client develop a change plan and obtain support from an important person in the client’s life. Assess Client’s Progress and Readiness To Proceed The counselor asks the client how he or she feels about the two previous counseling sessions and responds empathically to his or her concerns. The counselor addresses any client comments or questions that have arisen since the previous session about the PFR or Learning New Coping Strategies. The counselor reviews the Quit Agreement with the client and discusses adjustments e.g. Is the client setting unrealistically high standards that may set him or her up for failure Has the client identified salient reasons for wanting to make changes in marijuana use. The counselor photocopies the agreement to maintain a record of client goals. Welcome Supporter If the client has brought a supporter the counselor welcomes him or her and thanks the individual for his or her willingness to participate. The counselor provides general information about the intervention and asks whether the supporter has questions. In the course of the session the counselor 51

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• Provides the supporter with information and answers his or her questions about the treatment • Fosters motivation by encouraging the supporter and client to discuss the effect of the client’s marijuana use on their relationship • Formulates a change plan • Identifies how the supporter can help the client with treatment goals and abstinence. The counselor emphasizes the importance of the supporter’s participation and indicates that in a few minutes the counselor will want to hear more from the supporter but that first the counselor will talk with the client about what has been happening recently: Counselor C: I want to thank you both for coming today. Shirley has told me how much help you’ve been to her. We’ll meet for about an hour today to discuss your role as a supporter for Shirley. Does either of you have any questions Husband H: I want you to know how proud of her I am I’m willing to do whatever I can to help her out. C: That’s very encouraging to hear. Before we begin I’d like to take a few minutes to ask Shirley how things have been going since we last met. SUPPORTER STRATEGIES Source: Stephens et al. 2000. Maintaining Motivation Help your partner or friend maintain motivation by keeping it from lagging in the first place. Don’t wait for a problem to arise. Let him or her know how impressed you are with his or her success in quitting marijuana. Tell him or her that you know the change requires much effort and that you can see the benefits of the change. Don’t assume the journey away from marijuana is over when he or she has been abstinent for 2 or 3 months. If you see signs of motivation dwindling such as your partner’s or friend’s starting to talk about using marijuana or wanting to visit friends who still use ask him or her how he or she is feeling about marijuana use. Don’t assume that his or her motivation is decreasing until you’ve talked about it. Bring up the topic in a noncritical way perhaps start with a compliment about his or her success. Then ask about his or her motivation for staying away from marijuana. If you see that motivation is on the wane offer to help get it back. Review the list of reasons for quitting or the Quit Agreement together. Ask whether he or she is feeling deprived and needs some help finding fun things to do. Don’t be critical. Motivation is difficult to maintain. Your partner or friend needs support and encouragement to increase motivation. Criticizing his or her lack of willpower or threatening with ultimatums can provoke a negative mood and lower self-esteem. Lifestyle Changes Help your partner or friend make the lifestyle changes that will keep him or her from needing pot. Talk about your observations of his or her lifestyle. Can stress be reduced What activities can he or she do at those times of the day when he or she might be tempted to use 52

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Can you do any of them together such as an exercise program It reduces stress clears out the lungs and can be rewarding in many ways. Having a positive supportive conversation regularly is important. Lifestyles need to be watched so that people don’t slip into old ruts. Talking about the upcoming week and discussing how to build some fun time into it can become a weekly activity. High-Risk Situations Help your partner or friend plan for and cope with high-risk situations regularly at least during the first year. After a while coping with the old week-to-week situations that promote use will become automatic. However you still need to be on guard for those unexpected or unusual situations for which a coping strategy hasn’t been planned or practiced. Examples might include an upcoming vacation a visit with old friends unemployment or an argument with someone. If you see something coming up that’s likely to pose a risk for marijuana use alert your partner or friend. Then help plan for coping with the situation if it should occur. If an event occurs without a chance to plan for it you can go straight to a coping mode distract your partner or friend or offer support depending on the situation. You don’t have to point out that you’re doing it to prevent a return to pot smoking unless you think that would be helpful. Coping With a Slip Chances are a slip will happen. A slip is marijuana use that occurs after a period of abstinence. A slip doesn’t mean a person will return to regular marijuana use. That would be a relapse. Slips occur when motivation is lagging or when a high-risk situation occurs unexpectedly. Slips do not mean that all the success and progress to date have been lost. How your partner or friend responds to a slip can mean the difference between returning to abstinence or going into a relapse. Here are some things to do if a slip occurs: • Ask your partner or friend how the slip came about. Did he or she see it coming or was it a sudden urge related to a situation What was the situation How was your friend feeling before smoking Was he or she feeling down or angry or bored or wanting to celebrate • Ask about any attempts at avoiding the situation or coping strategies used in the situation. If he or she anticipated the situation and made little effort to avoid or cope with it a motivation problem probably exists. Refer to the ideas in the section above on maintaining motivation. • Ask whether any clues could have warned of a difficult situation. If the urge to use came up suddenly or the coping strategies used simply weren’t effective help your friend learn from this slip to prevent more slips in the future. Help him or her find new coping strategies to use in the future. Suggest other ways of coping. • Help your partner or friend regain motivation and learn from what happened. Come from a position of support and encouragement. If your friend says things like “I guess I just can’t quit” or “Smoking pot’s not really that bad” then challenge these statements. You know neither is true. Your goal is to get your partner or friend back on track not to punish him or her for slipping. Attack the rationalization I’m only going to smoke this one time not the person. Say that those statements are rationalizations they’re a symptom of losing motivation and it’s time to 53

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focus on getting motivation back. Don’t put the person down criticize his or her willpower or say the situation is hopeless. Making the person feel bad is likely to promote a return to marijuana use. When you show the person how his or her actions are a sign of losing motivation and show how to get that motivation back you can help a slip stay merely a slip. Feeling Appreciated Does your partner or friend appreciate your efforts Do you feel that you’re working harder at this than he or she is If so it’s time to talk to him or her about it. You won’t be any help if you are feeling burned out and unrewarded. Let your partner or friend know how you feel without accusing him or her of neglecting you. Point out that this would be a good time to renegotiate the Supporter Agreement. Start your conversation with the words “I feel” not “You haven’t.” Make sure you ask for what you want—a little acknowledgment a relaxing or fun evening a chance to talk or whatever you feel is a reward for your efforts. Supporter Agreement In this document ___________________ will be referred to as the Supporter and ___________________ will be referred to as the Participant. To maintain ___________________’s success in quitting marijuana we agree to the following arrangements. Types of Support. Supporter and Participant initial all conditions that apply to the agreement.  Supporter will let Participant know how pleased he or she is with the Participant’s success at not using marijuana.  Supporter will ask Participant about his or her motivation for remaining abstinent from marijuana if Supporter notices that motivation may be decreasing.  Participant will let Supporter know that he or she appreciates the support received.  Supporter will remind Participant of his or her reasons for quitting marijuana and of the consequences that marijuana caused if motivation seems to lag.  Participant will review the Reasons for Quitting Questionnaire or the Quit Agreement with the Supporter if they agree that motivation needs a boost.  Supporter will discuss and participate with Participant in lifestyle changes that will reduce the need for marijuana.  Supporter will ask Participant about upcoming high-risk situations that Supporter anticipates but is not sure whether the Participant anticipates. In addition Supporter will help Participant plan to cope with high-risk situations.  Supporter will help Participant cope with a marijuana use slip and return to abstinence by asking about Participant’s motivation and the circumstances of the slip.  Supporter will help restore motivation and develop a coping plan for future situations that led to the slip.  Participant will negotiate rewards for Supporter’s continued support and involvement. 54

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 Supporter will avoid being critical of Participant in communicating concerns about motivation high-risk situations and slips. Supporter will focus on questioning Participant’s motives and coping plans and on challenging rationalizations for using.  Participant will listen to what Supporter has to say about observations of lagging motivation upcoming high-risk situations or rationalizations for using marijuana.  Supporter may express disappointment if Participant fails to accept Supporter’s input.  Participant will suggest another time within 24 hours to discuss Supporter’s observations or concerns if Participant’s current mood or situation does not allow him or her to be open to Supporter’s comments at the moment. Examine Client’s Recent Experiences The counselor asks the client to describe his or her recent experiences with marijuana: • Did the client stop use since the previous session • Did the client make an effort to stop • Was the client confronted with any high-risk or tempting situations • What strategies did the client use Did the client try any of the strategies in Learning New Coping Strategies form 1A Were they successful • Were there any instances when the client effectively handled a “hot” situation i.e. very high risk The counselor acknowledges client efficacy and reinforces the strategies that the client found useful. The client’s report on the week’s events provides the counselor with an opportunity to use motivational interviewing techniques. As the client talks the counselor’s objective is to elicit information and to use that information to provide reflections express empathy identify discrepancies elicit self-motivational statements and roll with resistance: Shirley S: Well I’ve almost completely stopped smoking since our last session. C: You seem very pleased with yourself How did you do that S: Right after the last session I kept thinking about how pot has kept me from doing the things I want to do. I really want to be a teacher and I realized that as long as I kept smoking I would always feel bad. So I went home and smoked one last time then flushed the remainder of my stash down the toilet During the last week I’ve wanted to get high several times but I didn’t. C: What did you do when you felt like smoking S: Well I talked to my husband. I read about that in the handout you gave me last week. Examine Client’s Experience With Supportive and Nonsupportive Relationships The counselor helps the client reevaluate relationships that have enhanced or impeded change: C: Talking to someone else helped. S: Yes it did. And I kept cards and notes from my students in my purse and would take them out and look at them. Boy I love those kids C: Your love for the children you teach and your husband’s support are powerful tools S: You bet or 55

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Doug D: My wife chose not to come today. She says this is my problem and I need to solve it or find a new wife. After all these years of me smoking around her now she wants immediate change and doesn’t want to help me C: As you work on making changes you may not have the support you would like. How are things different since we met last D: I’ve tried to cut down to a couple of days a week but it’s harder than I thought. C: When you were successful what did you do differently D: I didn’t take pot to work 2 days last week so I couldn’t smoke. It wasn’t that bad. If I didn’t have it in my car I didn’t leave work on an “errand” to smoke. C: You found that you could make changes if you didn’t have marijuana in easy reach and it may have been easier than you thought it might be. Did other things help Discuss Ambivalence The client may be reluctant to disclose ambivalence for fear of disapproval. However strong ambivalence may be manifested in nonverbal behavior and possibly in an impaired therapeutic alliance e.g. missed sessions reluctance to establish treatment goals. The counselor needs to be vigilant about maintaining the client’s level of motivation for change and engagement in treatment. Establish a Change Plan The counselor helps the client establish a long-term plan for behavior change focusing particularly on the next 12 months. The counselor summarizes indications of motivation that the client has made. If the client has given no indications of a desire to change he or she may not be ready to commit to change and the counselor points this out. The counselor explains that articulating goals increases the likelihood that the counseling will be meaningful and useful. For clients whose goal is immediate and permanent abstinence articulating goals is straightforward. However many clients are not at this stage of change early in treatment. If clients say they are not ready to give up marijuana the counselor suggests setting other interim goals such as learning more about the skills that will help them quit or reduce marijuana use in the future. Goals may be general such as quitting marijuana use within the next 2 weeks or reducing marijuana use to no more than four joints per week. Other goals may be more specific. For example the client may set goals of figuring out how to stay away from substance use opportunities identifying ways to get past cravings learning new social skills and participating in activities that are incompatible with marijuana use. Although the program’s goal is to help clients achieve abstinence the counselor needs to meet the clients where they are to avoid alienating them and to keep the door open for improvement and possible future abstinence. Involve Supporter and Review Supporter Strategies and Supporter Agreement If a supporter is attending this session the counselor shifts the focus of the session to the relationship between the client and supporter. The counselor asks the supporter why he or she wants to participate eliciting the supporter’s concerns and hopes for the client. The counselor gives the supporter Supporter Strategies form 2A and reviews its contents. The counselor introduces the Supporter Agreement form 2B and the client and supporter read the list to determine which items they will agree to: 56

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C: We have a list of ideas and strategies that have been helpful for some people. Let’s see whether any of these could work for you two. To husband As we begin to look at ways that you and your wife can work together on this change what concerns do you have H: Shirley has a habit of getting excited about something and then giving up when things get tough. I want to help but I’m not going to nag her. This is something she’s going to do not me. I’ll help but I won’t push her. C: You recognize that Shirley needs to make her own decisions and you don’t want to be a policeman is that right H: Pretty much but I don’t want to give you the idea that I won’t support her. C: It sounds as if you have some ideas of what you would be willing to do. I’ve given the two of you a Supporter Agreement. We’ve listed some ways that Shirley might reach her goals. As we look at these together I’d like you to identify some things you might be willing to do. How does that sound Even if the client has not brought a supporter to the session the counselor reviews the Supporter Agreement. The client may choose to identify a supporter later. The counselor and client can role play ways of asking for support. Assign Between-Session Exercises The counselor asks the client to continue reviewing the forms handed out at this session and last week’s session. Review and Conclude Session The counselor reviews the content of the session asks the client for feedback responds empathically to his or her comments and troubleshoots any difficulties. The counselor should also discuss with the client the likely scenarios for future treatment sessions. For example: C: When we meet next time we’re going to shift gears somewhat. I’m going to talk with you about other areas of your life besides your marijuana use—areas in which you may be experiencing difficulty. These problems may be directly related to your marijuana use but not necessarily. We’re going to work on these other areas of life because doing so may help you be successful in your goal to stop using marijuana. Learning new coping strategies I include this form from Brief COUNSELING for MARIJUANA DEPENDENCE - A Manual for Treating Adults published by the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health because although it is directed to helping change a very specific behavioural habit marijuana use the strategies listed can be easily adapted to suit other desied behavioural changes quit smoking drinking ... ... Alternatives to Marijuana Use You can do many things to stop using marijuana. Some may work better than others. Some help you resist the urge to smoke or avoid tempting situations or satisfy your needs in more constructive ways than smoking marijuana. Expect to try several and add any that may be helpful. Think about what worked when you gave up marijuana before or when you made other changes in your life. 57

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Be kind to yourself as you begin this change process—you’re doing something to take care of yourself and you deserve all the comfort and self-acceptance you can get Remind yourself that learning and changing inevitably mean giving up old ways and that in time you will feel more comfortable. Remember the changes your body and mind went through when you learned to drive got to know a new person started a new job or learned a new skill. Chances are you felt awkward uncomfortable silly dumb scared frustrated impatient or anxious in addition to hopeful excited and challenged. What helped you then How long did it take you to feel relaxed Did you learn all at once or were improvement and progress gradual Actions Avoid or escape from situations that make you want to smoke marijuana. Sometimes this is the easiest and most effective way to resist temptation especially at the beginning. Delay decisions to give in to temptation for example you could wait 15 minutes. Take several deep breaths. Focus on the fresh air entering your lungs cleansing and nourishing your body. Let out tension with each exhalation. Change your physical position. Stand up and stretch walk around the room or step outside. Carry things to put in your mouth: toothpicks gum mints plastic straws low-calorie snacks. Carry objects to fiddle with: a rubber ball to squeeze a small puzzle a pebble worry beads. Have a distracting activity available: a crossword puzzle magazine book a postcard to write. Thoughts Self-talk. Give yourself a pep talk remind yourself of your reasons for quitting remind yourself of the consequences of using marijuana challenge any wavering in your commitment to quit. Imagery and visualization. Visualize yourself as a nonsmoker happy healthy and in control imagine your lungs getting pink and healthy or focus on negative imagery and imagine yourself with cancer emphysema unable to breathe needing constant care. Visualize yourself in a jail made of marijuana cigarettes symbolizing the way marijuana controls your life. Thought-stopping. Tell yourself loudly to STOP get up and do something else. Distraction. Focus on something different: the task at hand a daydream a fantasy counting backwards from 150 by 3s. Lifestyle Exercise or take a brisk daily walk. Get your body used to moving use stairs instead of elevators park farther away from your destination walk instead of drive. Practice relaxation or meditation techniques regularly. Take up a hobby or pick up an old hobby you used to enjoy. Drink less coffee switch to decaf drink herbal teas. 58

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Engage in an enjoyable activity that is not work related several times a week. Change routines associated with smoking marijuana at least temporarily for example don’t turn on the TV when you get home from work don’t spend time with friends who smoke. Social Interactions and Environment Remove smoking paraphernalia pipes papers bongs ashtrays matches lighters marijuana from your home and car. Go to places where it’s difficult to get high such as a library theater swimming pool sauna steam bath restaurant and public gatherings not rock concerts. Spend time with friends who don’t smoke. Enlist support from family and friends. Announce that you’ve quit ask people not to offer you pot to praise you for stopping to provide emotional support and not to smoke around you. Learn to be appropriately assertive learn to handle frustration or anger directly instead of by smoking. Specific Suggestions for Some Common High-Risk Situations Below are several high-risk situations that people who use marijuana confront along with suggestions for coping without smoking. Tension Relief and Negative Emotions e.g. depression anxiety nervousness irritability Develop relaxation techniques exercise write down your feelings or talk to a friend or counselor do something enjoyable that requires little effort figure out what you’re feeling and whether you can do anything about it. Anger Frustration and Interpersonal Conflict Try to handle the situation directly rather than hide your feelings if appropriate be assertive get some release by squeezing a rubber ball pounding a pillow or doing some physical activity write down your feelings or tell them to someone take deep breaths. Fatigue and Low Energy Do muscle relaxations take a brisk walk do something enjoyable eat properly and get enough sleep. Insomnia Don’t fight being unable to sleep. Get up and do something constructive or relaxing. Read a book watch TV or do muscle relaxations until you feel sleepy. Remember that no one dies from losing a night’s sleep. Timeout Read do a crossword puzzle prepare a healthy snack take up a hobby knit or do other needlework things you can carry with you for easy access. Self-Image Try a new image: get a new haircut or buy new clothes. 59

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Social Pressure Be aware when others are smoking. Remember your commitment not to smoke marijuana. Be assertive and request that people not offer you pot. If appropriate ask that they not smoke around you for a while. If necessary be prepared to leave the situation especially when you’ve recently quit. Situations Involving Alcohol After you’ve quit marijuana you may continue to associate drinking with smoking pot. Alcohol can make you less vigilant about resisting marijuana. It tends to make people less concerned about long-term consequences. You might consider not drinking or cutting down during the first few weeks after quitting. If you don’t want to do this be especially careful when you drink. Cravings and Urges The only way to interrupt cravings is to break the chain of responding to them. That is don’t give in. Eventually they will decrease. Do something to distract yourself use the techniques listed under Thoughts breathe deeply call a friend go for a walk move around time the urge and you’ll find that it will disappear like a wave breaking Source: Brief COUNSELING for MARIJUANA DEPENDENCE - A Manual for Treating Adults U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 60

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Motivational Interviewing Strategies and Techniques Source: Sobell and Sobell ©2008 14 TECHNIQUES: 1. Asking Permission 2. Eliciting / evoking ChangeTtalk 3. Exploring Importance and Confidence 4. Open ended Questions 5. Reflective Listening 6. Normalizing 7. Decisional Balancing 8. Columbo Approach 9. Statemens supporting Self Efficacy 10. Readiness to Change Ruler 11. Affirmations 12. Advice / Feedback 13. Summaries 14. Therapeutic Paradox 1. ASKING PERMISSION Rationale: Communicates respect for clients. Also clients are more likely to discuss changing when asked than when being lectured or being told to change. Examples of Asking Permission  “Do you mind if we talk about insert behavior”  “Can we talk a bit about your insert behavior”  “I noticed on your medical history that you have hypertension do mind if we talk about how different lifestyles affect hypertension” Specific lifestyle concerns such as diet exercise and alcohol use can be substituted for the word “lifestyles” in this sentence. 2. ELICITING/EVOKING CHANGE TALK Rationale: Change talk tends to be associated with successful outcomes. This strategy elicits reasons for changing from clients by having them give voice to the need or reasons for changing. Rather than the therapist lecturing or telling clients the importance of and reasons why they should change change talk consists of responses evoked from clients. Clients’ responses usually contain reasons for change that are personally important for them. Change talk like several Motivational Interviewing MI strategies can be used to address discrepancies between clients’ words and actions e.g. saying that they want to become abstinent but continuing to use in a manner that is nonconfrontational. One way of doing this is shown later in this table under the Columbo approach. Importantly change talk tends to be associated with successful outcomes. 61

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Questions to Elicit/Evoke Change Talk  “What would you like to see different about your current situation”  “What makes you think you need to change”  “What will happen if you don’t change”  “What will be different if you complete your probation/referral to this program”  “What would be the good things about changing your insert risky/problem behavior”  “What would your life be like 3 years from now if you changed your insert risky/problem behavior”  “Why do you think others are concerned about your insert risky/problem behavior” Elicit/Evoke Change Talk For Clients Having Difficulty Changing: Focus is on being supportive as the client wants to change but is struggling.  “How can I help you get past some of the difficulties you are experiencing”  “If you were to decide to change what would you have to do to make this happen” Elicit/Evoke Change Talk by Provoking Extremes: For use when there is little expressed desire for change. Have the client describe a possible extreme consequence.  “Suppose you don’t change what is the WORST thing that might happen”  “What is the BEST thing you could imagine that could result from changing” Elicit/Evoke Change Talk by Looking Forward: These questions are also examples of how to deploy discrepancies but by comparing the current situation with what it would be like to not have the problem in the future.  “If you make changes how would your life be different from what it is today”  “How would you like things to turn out for you in 2 years” 3. EXPLORING IMPORTANCE AND CONFIDENCE Rationale: As motivational tools goal importance and confidence ratings have dual utility: a they provide therapists with information about how clients view the importance of changing and the extent to which they feel change is possible and b as with other rating scales e.g. Readiness to Change Ruler they can be used to get clients to give voice to what they would need to do to change. Examples of How to Explore Importance and Confidence Ratings  “Why did you select a score of insert on the importance/confidence scale rather thanlower ”  “What would need to happen for your importance/confidence score to move up from a insert to a insert a higher ” 62

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 “What would it take to move from a insert to a higher ”  “How would your life be different if you moved from a insert to a higher ”  “What do you think you might do to increase the importance/confidence about changing your insert risky/problem behavior” 4. OPEN-ENDED QUESTIONS Rationale: When therapists use open-ended questions it allows for a richer deeper conversation that flows and builds empathy with clients. In contrast too many back-to-back closed- or dead ended questions can feel like an interrogation e. g. “How often do you use cocaine” “Howmany years have you had an alcohol problem” “How many times have you been arrested”. Open-ended questions encourage clients to do most of the talking while the therapist listens and responds with a reflection or summary statement. The goal is to promote further dialogue that can be reflected back to the client by the therapist. Open-ended questions allow clients to tell their stories. Examples of Open-Ended Questions  “Tell me what you like about your insert risky/problem behavior.”  “What’s happened since we last met”  “What makes you think it might be time for a change”  “What brought you here today”  “What happens when you behave that way”  “How were you able to not use insert substance for insert time frame”  “Tell me more about when this first began.”  “What’s different for you this time”  “What was that like for you”  “What’s different about quitting this time” 5. REFLECTIVE LISTENING Rationale: Reflective listening is the primary way of responding to clients and of building empathy. Reflective listening involves listening carefully to clients and then making a reasonable guess about what they are saying in other words it is like forming a hypothesis. The therapist then paraphrases the clients’ comments back to them e.g. “It sounds like you are not ready to quit smoking cigarettes.”. Another goal in using reflective listening is to get clients to state the arguments for change i.e. have them give voice to the change process rather than the therapist trying to persuade or lecture them that they need to change e.g. “So you are saying that you want to leave your husband and on the other hand you worry about hurting his feelings by ending the relationship. That must be difficult for you. How do you imagine the two of you would feel in 5 years if things remain the same”. Reflections also validate what clients are feeling and doing so communicates that the therapist understands what the client has said i.e. “It sounds like you 63

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are feeling upset at not getting the job.”. When therapists’ reflections are correct clients usually respond affirmatively. If the guess is wrong e.g. “It sounds like you don’t want to quit smoking at this time.” clients usually quickly disconfirm the hypothesis e. g. “No I do want to quit but I am very dependent and am concerned about major withdrawals and weight gain.”. Examples of Reflective Listening generic  “It sounds like….”  “What I hear you saying…”  “So on the one hand it sounds like …. And yet on the other hand….”  “It seems as if….”  “I get the sense that….”  “It feels as though….” Examples of Reflective Listening specific  “It sounds like you recently became concerned about your insert risky/problem behavior.”  “It sounds like your insert risky/problem behavior has been one way for you to insert whatever advantage they receive.”  “I get the sense that you are wanting to change and you have concerns about insert topic or behavior.”  “What I hear you saying is that your insert risky/problem behavior is really not much of a problem right now. What you do think it might take for you to change in the future”  “I get the feeling there is a lot of pressure on you to change and you are not sure you can do it because of difficulties you had when you tried in the past.” 6. NORMALIZING Rationale: Normalizing is intended to communicate to clients that having difficulties while changing is not uncommon that they are not alone in their experience or in their ambivalence about changing. Normalizing is not intended to make clients feel comfortable with not changing rather it is to help them understand that many people experience difficulty changing. Examples of Normalizing  “A lot of people are concerned about changing their insert risky/problem behavior.”  “Most people report both good and less good things about their insert risky/problem behavior.”  “Many people report feeling like you do. They want to change their insert risky/problem behavior but find it difficult.”  “That is not unusual many people report having made several previous quit attempts.”  “A lot of people are concerned about gaining weight when quitting.” 64

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7. DECISIONAL BALANCING Rationale: Decisional balancing strategies can be used anytime throughout treatment. A good strategy is to give clients a written Decisional Balance DB exercise at the assessment session and ask them to bring the completed exercise to their first session. A sample of a completed exercise is shown in Appendix 4.10b. The DB exercise asks clients to evaluate their current behaviors by simultaneously looking at the good and less good things about their actions. The goal for clients is two fold: To realize that a they get some benefits from their risky/problem behavior and b there will be some costs if they decide to change their behavior. Talking with clients about the good and less good things they have written down on their DB can be used to help them understand their ambivalence about changing and to move them further toward wanting to change. Lastly therapists can do a DB exercise with clients by simply asking them in an open ended fashion about the good and less good things regarding their risky/problem behavior and what it would take to change their behavior. Examples of How to Use a Decisional Balance Exercise  “What are some of the good things about your insert risky/problem behavior Client answers Okay on the flipside what are some of the less good things about your insert risky/problem behavior.” After the clients discuss the good and less good things about their behavior the therapist can use a reflective summary statement with the intent of having clients address their ambivalence about changing. 8. COLUMBO APPROACH Rationale: The Columbo approach can also be characterized as deploying discrepancies. The goal is to have a client help the therapist make sense of the client’s discrepant information The approach takes its name from the behavior demonstrated by Peter Falk who starred in the 1970s television series Columbo. The Columboesque approach is intended as a curious inquiry about discrepant behaviors without being judgmental or blaming and allows for the juxtaposing in a non-confrontational manner of information that is contradictory. In other words it allows the therapist to address discrepancies between what clients say and their behavior without evoking defensiveness or resistance. When deploying discrepancies when possible as shown in the example below try to end the reflection on the side of change as clients are more likely to elaborate on the last part of the statement.  “It sounds like when you started using cocaine there were many positives. Now however it sounds like the costs and your increased use coupled with your girlfriend’s complaintshave you thinking about quitting. What will your life be like if you do stop” Examples of How to Use the Columbo Approach: While the following responses might sound a bit unsympathetic the idea is to get clients who present with discrepancies to recognize them rather than being told by their therapists that what they are saying does not make sense. 65

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 “On the one hand you’re coughing and are out breath and on the other hand you are saying cigarettes are not causing you any problems. What do you think is causing your breathing difficulties”  “So help me to understand on the one hand you say you want to live to see your 12-year old daughter grow up and go to college and yet you won’t take the medication your doctor prescribed for your diabetes. How will that help you live to see your daughter grow up”  “Help me understand on the one hand I hear you saying you are worried about keeping the custody of your children. Yet on the other hand you are telling me that you are using crack occasionally with your boyfriend. Since you also told me you are being drug screened on a random basis I am wondering how using cocaine might affect your keeping custody of your children.” 9. STATEMENTS SUPPORTING SELF-EFFICACY Rationale: Eliciting statements that support self-efficacy self-confidence is done by having clients give voice to changes they have made. Because many clients have little self-confidence in their ability to change their risky/problem behaviors the objective is to increase their selfconfidence that they can change. Self-confidence statements can be sought from clients using scaling techniques e. g Readiness to Change Ruler Importance and Confidence related to goal choice. For example when using a Readiness Ruler if clients’ readiness to change goes from a lower number past to a higher number now therapists may follow-up by asking how they were able to do that and how they feel about their change. Examples of Eliciting Statements Supporting Self-Efficacy  “It seems you’ve been working hard to quit smoking. That is different than before. How have you been able to do that”  “Last week you were not sure you could go one day without using cocaine how were you able to avoid using the entire past week”  “So even though you have not been abstinent every day this past week you have managed to cutyour drinking down significantly. How were you able to do that”  “Based on your self-monitoring logs you have not been using cannabis daily. In fact you onlyused one day last week. How were you able to do that” Follow-up by asking “How do you feelabout the change” After asking about changes clients have made it is important to follow-up with a question about how clients feel about the changes they made.  “How do you feel the changes you made”  “How were you able to go from a 6 months ago to a now” Client answers “How do you feel about those changes” 66

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10. READINESS TO CHANGE RULER Rationale: Assessing readiness to change is a critical aspect of MI. Motivation which is considered a state not a trait is not static and thus can change rapidly from day to day. Clients enter treatment at different levels of motivation or readiness to change e.g. not all are ready to change many are ambivalent about changing. In this regard if therapists know where clients are in terms of their readiness to change they will be better prepared to recognize and deal with a client’s motivation to change. The concept of readiness to change is an outgrowth of the Stages of Change Model that conceptualizes individuals as being at different stages of change when entering treatment. While readiness to change can be evaluated using the Stages of Change Model a simpler and quicker way is to use a Readiness to Change Ruler Appendix 4.7. This scaling strategy conceptualizes readiness or motivation to change along a continuum and asks clients to give voice to how ready they are to change using a ruler with a 10-point scale where 1 definitely not ready to change and 10 definitely ready to change. A Readiness Ruler allows therapists to immediately know their client’s level of motivation for change. Depending on where the client is the subsequent conversation may take different directions. The Readiness to Change Ruler can also be used to have clients give voice to how they changed what they need to do to change further and how they feel about changing. Examples of How to Use a Readiness to Change Ruler • Therapist T: “On the following scale from 1 to 10 where 1 is definitely not ready tochange and 10 is definitely ready to change what number best reflects how ready you are at the present time to change your insert risky/problem behavior” Client C: “Seven.” T: “And where were you 6 months ago” C: “Two.” T: “So it sounds like you went from not being ready to change your insert risky/problem behavior to thinking about changing. How did you go from a ‘2’ 6 months ago to a ‘7’ now”  “How do you feel about making those changes”  “What would it take to move a bit higher on the scale” Clients with lower readiness to change e.g. answers decreased from a “5” 6 months ago to a “2” now  “So it sounds like you went from being ambivalent about changing your insert risky/problem behavior to no longer thinking you need to change your insert risky/problem behavior. How did you go from a ‘5’ to a ‘2’”  “What one thing do you think would have to happen to get you to back to where you were 6 months ago” 11. AFFIRMATIONS Rationale: Affirmations are statements made by therapists in response to what clients have said and are used to recognize clients’ strengths successes and efforts to change. Affirmative responses or supportive statements by therapists verify and acknowledge clients’ behavior changes and attempts to change. When providing an affirmation therapists should avoid statements that sound overly ingratiating e.g. “Wow that’s incredible” or “That’s great I knew you could do it”. 67

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While affirmations help to increase clients’ confidence in their ability to change they also need to sound genuine. Example of Affirmative Statements  “Your commitment really shows by insert a reflection about what the client is doing.”  “You showed a lot of insert what best describes the client’s behavior—strength courage determination by doing that.”  “It’s clear that you’re really trying to change your insert risky/problem behavior.”  “By the way you handled that situation you showed a lot of insert what best describes the client’s’ behavior—strength courage determination.”  “With all the obstacles you have right now it’s insert what best describes the client’s behavior—impressive amazing that you’ve been able to refrain from engaging in insert risky/problem behavior.”  “In spite of what happened last week your coming back today reflects that you’re concerned about changing your insert risky/problem behavior.” 12. ADVICE/FEEDBACK Rationale: A frequently used MI strategy is providing advice or feedback to clients. This is a valuable technique because clients often have either little information or have misinformation about their behaviors. Traditionally therapists and other health care practitioners have encouraged clients to quit or change behaviors using simple advice e.g. “If you continue using you are going to have insert health consequence.”. Research has shown that by and large the effectiveness of simple advice is very limited e.g. 5 to 10 of smokers are likely to quit when simply told to quit because smoking is bad for their health. The reason simple advice does not work well is because most people do not like being “told what to do.” Rather most individuals prefer being given choices in making decisions particularly changing behaviors. What we have learned from MI is that how information is presented can affect how it is received. When relevant new information should be presented in a neutral nonjudgmental and sensitive manner that empowers clients to make more informed decisions about quitting or changing a risky/problem behavior. One way to do this is to provide feedback that allows clients to compare their behavior to that of others so they know how their behavior relates to national norms e.g. percentage of men and women drinking at different levels percentage of population using cannabis in the last year see Appendices 4.2c and 4.2d for examples of such feedback. Presenting personalized feedback in a motivational manner allows clients to evaluate the feedback for personal relevance “I guess I drink as much as my friends but maybe we are all drinking more than we should.”. When therapists ask clients what they know about how their risky/problem behavior affects other aspects of their life e.g. health—hypertension clients typically say “Well not much” or they might give one or two brief facts. This can be followed-up by asking if they are interesting in learning more about the topic and then being prepared to provide them with relevant advice feedback material that the therapist has prepared or has available. Lastly whenever possible focus on the positives of changing. A good example of providing positive information about changing is evident with smoking. Within 20 minutes of stopping smoking an ex-smoker’s body begins a series of changes ranging from an immediate decrease in blood 68

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pressure to 15 years after quitting the risk of coronary heart disease and death returns to nearly that of those who have never smoked What is interesting with this example is that many smokers are not aware of the multiple benefits that occur soon after quitting. In this regard therapists can ask “What do you know about the benefits of quitting smoking” and follow-up with asking permission to talk about the client’s smoking “Do you mind if we spend a few minutes talking about your smoking”. Remember that some clients will not want information. In these cases if the therapist uses scare tactics lectures moralizes or warns of disastrous consequences most clients are not likely to listen or will pretend to agree in order to not be further attacked. Examples of How to Provide Advice/Feedback often this can start by asking permission to talk about the client’s behavior  “Do you mind if we spending a few minutes talking about…. Followed by “What do you know about….” Followed still by “Are you interested in learning more about…..” After this clients can be provided with relevant materials relating to changing their risky/problem behavior or what affects it has on other aspects of their life.  “What do you know about how your drinking affects your insert health problem”  “What do you know about the laws and what will happen if you get a second drunk driving arrest”  “Okay you said that the legal limit for drunk driving is 0.08. What do you know about how many drinks it takes to get to this level”  “So you said you are concerned about gaining weight if you stop smoking. How much do you think the average person gains in the first year after quitting”  “I’ve taken the information about your drinking that you provided at the assessment calculated what you report drinking per week on average and it is presented on this form along with graphs showing levels of drinking in the general population. Where do you fit in”  “On one of the questionnaires you filled out the Drug Abuse Screening Test you scored a 7. This form shows how scores on that measure are related to drug problem severity. Where do you fit in” 13. SUMMARIES Rationale: Summaries are used judiciously to relate or link what clients have already expressed especially in terms of reflecting ambivalence and to move them on to another topic or have them expand the current discussion further. Summaries require that therapists listen very carefully to what clients have said throughout the session. Summaries are also a good way to either end a session i.e. offer a summary of the entire session or to transition a talkative client to the next topic. 69

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Examples of Summaries:  “It sounds like you are concerned about your cocaine use because it is costing you a lot of money and there is a chance you could end up in jail. You also said quitting will probably mean not associating with your friends any more. That doesn’t sound like an easy choice.”  “Over the past three months you have been talking about stopping using crack and it seems that just recently you have started to recognize that the less good things are outweighing the good things. That coupled with your girlfriend leaving you because you continued to use crack makes it easy to understand why you are now committed to not using crack anymore.” 14. THERAPEUTIC PARADOX Rationale: Paradoxical statements are used with clients in an effort to get them to argue for the importance of changing. Such statements are useful for clients who have been coming to treatment for some time but have made little progress. Paradoxical statements are intended to be perceived by clients as unexpected contradictions. It is hoped that after clients hear such statements clients would seek to correct by arguing for change e.g. “Bill I know you have been coming to treatment for two months but you are still drinking heavily maybe now is not the right time to change”. It is hoped that the client would counter with an argument indicating that he/she wants to change e.g. “No I know I need to change it’s just tough putting it into practice.”. Once it is established that the client does want to change subsequent conversations can involve identifying the reasons why progress has been slow up to now. When a therapist makes a paradoxical statement if the client does not respond immediately by arguing for change the therapist can then ask the client to think about what was said between now and the next session. Sometimes just getting clients to think about their behavior in this challenging manner acts as an eye-opener getting clients to recognize they have not made changes. Therapeutic paradoxes involve some risk i.e. client could agree with the paradoxical statement rather than arguing for the importance of change so they are reserved for times later in treatment when clients are not making changes and may or may not be aware of that fact. Such clients often attend sessions regularly but make no significant progress toward changing the risky/problem behavior for which they sought treatment. Another reason for caution is such statements can have a negative effect on clients. Lastly the therapist must be sure to sound genuine and not sarcastic. When using the therapeutic paradox the therapist should be prepared that clients may decide that they do not want to change at this time. In such cases the reasons can be discussed and the therapist can suggest that perhaps it might be a good idea to take a “vacation” from treatment. In such instances therapists can tell clients that they will call them in a month or so to see where they are in terms of readiness to change. Another way to think about what a therapeutic paradox is doing is reflecting the person’s behavior in an amplified manner. 70

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Examples of How to Use a Therapeutic Paradox  “Maybe now is not the right time for you to make changes.”  “You have been continuing to engage in insert risky/problem behavior and yet you say that you want to insert the behavior you want change—e.g. get your children back get your driver’s license returned not have your spouse leave. Maybe this is not a good time to try and make those changes.”  “So it sounds like you have a lot going on with trying to balance a career and family and these priorities are completing with your treatment at this time.” 71

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4. Empowerment Coaching There are five questions that are central to empowerment coaching: 1. What would a good situation look like 2. What would need to change 3. What are the steps necessary to make the change 4. What help would you need to take these steps 5. Who could provide you with support as you take these steps These five questions can be used as the centerpiece of a successful reference interview as well as a successful coaching intervention. The first question asking for the definition of a good or right situation may address what the patron expects to get out of the reference session. The obvious assumption is that the good or right situation would be having complete and accurate information to accomplish the intended task. The client survivor however might be looking for something in addition to this such as a sense of empowerment that comes from just having information about the issue and knowing that she is not alone. The second question concerning desired changes is also applicable to both the coaching situation and the reference interview. When a patron seeks reference service it can be assumed that he or she is looking to change something. Changes may include making a research paper better getting a better job etc. The client however may be looking for an entirely different kind of change such as getting away from an abusive situation finding coaching to regain her mental health or finding support from peers. For this reason the reference interview must be kept as confidential as possible. She might be extremely sensitive to even being seen in a library asking about options. A librarian should make every effort to get the client into a private area for the reference interview. The third question concerns the steps that are needed to reach the intended “good” situation. This is where the librarian’s research skills are essential. Someone who has been a victim of violence may have no idea what to do and may simply want to know “What do I do now” It is recommended that every library investigate services for survivors in the local area and keep a list of services and contact information near the desk including national or state hotline numbers. The survivor may see the librarian as a kind helpful professional and try to use them as a coach. At this point it is important to gently remind the patron that the librarian is not a coach and cannot give advice on how to proceed but will be glad to help her look for information on all of the options. The fourth question involves the kind of help that is needed in order to make the change. A librarian should be able to locate resources that discuss all of the options available. It is very important not to give the patron advice such as “you should go to the police” but to make sure she has information about all of the options so that she can leave with the necessary tools to make an informed choice. It is a good idea to have some free materials such as pamphlets a local crisis center may be able to provide these that the patron can take with her. Free materials that do not need to be returned are an excellent resource for survivors who may have taken a great personal risk to come to the library. The fifth question involves help and support. A survivor of a sexual assault may be asking for help without actually voicing a question. It is a good idea for a librarian to give any patron who asks about sexual assault contact information for a helping resource such as the number 72

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of a rape crisis hotline. Not only can these organizations assist survivors they can also provide excellent information to researchers. In empowerment coaching the coach is advised not to use questions that ask or imply “why.” Dewdney and Michell advised against excessive use of “why” questions in the reference interview. They explained that the librarian and patron may view a “why” question differently. The librarian may be looking for a motivation for the patron’s query in order to give a more complete or relevant answer but the patron may view the question as suspicious intrusive or confusing. Dewdney and Michell further suggested that these feelings on the part of the patron may lead to hostility and a breakdown of the reference transaction. There is however an additional reason to avoid the use of “why” questions with sexual assault survivors. When asking “why” one is looking for a reason or motivation. If a reference librarian were to say “why are you looking for information on sexual assault coaching” a survivor would be faced with two choices: reveal sensitive information or lie. No one should be forced into that dilemma by someone who purportedly is serving her. Additionally a self- revelation might lead to questions about the abusive event or situation. When one asks a question like “why did he rape you” the question implies that he must have had a reason and this reason may be the responsibility of the victim. It is imperative that anyone in a service role whether librarian coach or even friend avoid “why” questions that may sound like victim blaming. Empowerment in the context of counselling has been defined as follows: Empowerment is the process by which people organizations or groups who are powerless or marginalized: a become aware of the power dynamics at work in their life context b develop the skills and capacity for gaining some reasonable control over their lives c which they exercise without infringing upon the rights of others and d which coincides with supporting the empowerment of others in their community. McWhirter a In fact powerful systemic and structural influences including racism sexism hetero- sexism inaccessible environments and ageism may be reflected within the counselling relationship as well thus the counsellors critical awareness of power dynamics within the counselling relationship and in the clients larger social context is prerequisite to facilitation of client awareness. b Develop the skills and capacity for gaining some reasonable control over their lives refers to skill acquisition as well as the motivation and self-efficacy expectations required to exercise those skills. Counsellors often play an important role in facilitating the acquisition of new skills. It is important to keep in mind however that counsellors are often trained in skill building exercises rooted in European American values worldviews and norms. Thus the nature of each skill as well as the manner and context in which the skill is practiced must be shaped in accord with the clients concerns as well as other salient client characteristics such as personal and sociopolitical history culture interpersonal style level of acculturation and preferences. Further counsellors must not overlook the vital resources with which the client enters the counselling relationship: specific coping mechanisms attitudes knowledge and experiences that sustained the client through life thus far. 73

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c Which they exercise without infringing upon the rights of others addresses the fundamental nature of empowerment as integrative power or "power with others" Hagberg 1984 rather than power over others or power "to do to" others. The exercise of skills that violate the human rights of others is fundamentally incompatible with empowerment. d Coinciding with supporting the empowerment of others in their community can range from interpersonal behaviours such as providing encouragement and support to community consciousness-raising efforts such as participating in marches or helping to organize cultural and educational events. The role of the counsellor is to facilitate and support the clients connections with community and to enhance the clients ability to support the empowerment of others as appropriate for the clients current situation. These elaborations should make clear that empowerment is not a linear process nor one that concludes with the achievement of a particular "empowered" state. Many clients will not be ready for or interested in the empowerment of others- in the form of interpersonal relationships or community participation - when they terminate the counselling relationship. This must not be considered a failure on the part of the client or the counsellor to "achieve" the goal of empowerment. The counsellors role is to meet clients where they are in the empowerment process and work to support increasing enhancing or otherwise promoting empowerment in additional ways that are consistent with the clients goals. Critical components of an empowerment model: "The Five Cs": Collaboration Competence Context Critical Consciousness and Community. 1. Collaboration. "Collaboration" refers to the dynamic relationship between counsellor and client. The relationship should be characterized by collaborative definition of problematic issues goals and development of interventions and strategies for change or growth. These interventions and change strategies are consistent with the clients values goals skills experiences and abilities. The client is viewed a la Paulo Freire 1971 as an active member of a team rather than a passive recipient of services. 2. Competence: All clients have existing skills resources and a wealth of experience to contribute to the counselling process. To overlook these resources is likely to reinforce neediness to foster dependency to discourage esteem-building and is generally contrary to the goals of empowerment and to good counselling. Counsellor recognition and authentic appreciation of client resources is essential. Honest counsellor feedback regarding skill deficits or personal weaknesses is also part of supporting client competence. The vast majority of clients understand that they have weaknesses which they often perceive to be more serious than does the counsellor and counsellor avoidance of constructive feedback is likely to make it hard for clients to believe positive feedback. So too with counsellors themselves: they must learn to identify their own strengths and weaknesses grow in their understanding of how to utilize their strengths more effectively and how to enhance areas of weakness. Counsellors are unlikely to truly appreciate the strengths of others if they are unable to appreciate their own competencies just as they are unlikely to accept others weaknesses without accepting their own. 74

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3. Context. The dynamics of power and privilege shape the clients context as well as the context in which we provide counselling services. This context includes larger social forces e.g. ageism racism sexism classism homophobia able-bodied assumptions and the effects of these assumptions on care providers families and individuals as well as on faculty members departments educational institutions and individual students. Context also includes systems such as families social networks neighborhoods ethnic groups professional and work groups and faith communities. Integration of the context component into counselling means that we acknowledge the role of context in the clients current situation or problem including how the context serves to maintain or exacerbate problems while at the same time acknowledging the clients options and responsibilities related to change. The context component of empowerment is directly dependent upon the critical consciousness component That is without critical consciousness efforts to address context are likely to be ineffective because understanding context requires the development of critical consciousness. 4. Critical Consciousness. Supporting the empowerment process requires that counsellors engage in an ongoing attempt to facilitate client awareness of context through the process of consciousness raising in a manner consistent with the clients situation needs and abilities. Counsellors cannot engage in consciousness-raising without developing their own understanding of the power dynamics affecting both clients and themselves. Critical consciousness can be increased through two overlapping processes: power analysis and critical self-reflection. Power analysis refers to examining how power is distributed in a given situation in terms of race/ ethnicity gender disability status sexual orientation age experience family position etc. McWhirter 1994 . Example: To illustrate power analysis a faculty member might engage students in exploring the personal and professional repercussions of the program / department / universitys adherence to medical economic or sociopolitical models of disability Hahn 1988. According to Hahn 1988 the medical model defines disability in terms of individual limitations while the economic model focuses on the individuals functional limitations. By contrast the sociopolitical model defines disability as a multifaceted product of the interaction between the individual and the environment and emphasizes disabling features of the environment. The economic and medical models of disability arise out of modem day cultural assumptions regarding disability such as: "disability" equals "needing help" disability is a fact of biology alone and people with disabilities as victims of biological injustice rather than social injustice must change their personal behaviour rather than their social context Fine Asch 1988 . Exploration of the extent to which these models are represented in the department and the implications of each model for counselling students with disabilities would engage students in thinking critically and concretely about one important aspect of power dynamics. In addition to raising awareness such a discussion could lead to actions that improve the departmental environment for students with disabilities. 75

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Critical self-reflection overlaps with power analysis in the sense that counsellors must understand how they contribute to specific power dynamics in their behaviours assumptions and interactions with others. In addition critical self-reflection involves developing awareness of privilege and of how counsellors have benefitted from privilege at the expense of those who are not privileged. The vast majority of counsellors enjoy privilege at multiple levels such as age racial/ethnic group membership sexual orientation socioeconomic status disability status education level and gender. This is not to say that most counsellors are young white straight middle or upper class able-bodied males but to say that most counsellors are members of more than one of these categories of privilege. One way to explore privilege is to examine the common assumptions or things that people take for granted by virtue of membership in a privileged group. Of course these will not be true for all members of that privileged group. European Canadians for example usually assume that everyone does or should speak their language English are far less likely to be hated or "tolerated" by persons with greater power because of their ethnicity and generally experience higher teacher expectations than persons of color. Heterosexuals can engage in public displays of affection without their actions representing a political act they also experience freedom from fear of losing their jobs on the basis of sexual orientation and freedom from the threat of being outed or targeted by anti gay hate crimes. Males are less likely to be interrupted more likely to be judged on the basis of characteristics beyond purely physical characteristics and are far less likely to be raped by strangers acquaintances or family members than are females. An exploration of works enumerating these aspects of privilege may serve as a point of departure with students for example the work of Henning- Stout 1994 Freire 1971 and others. 5. Community. Community may be defined in terms of ethnicity family friends place of residence faith sexual orientation common organizational affiliation or other bonds. A community is a source of strength and hope identity and history support and challenge interaction and contribution. Community is fundamental to empowerment in two ways. First the community can provide resources support and affirmation for clients. Second the clients mutual contribution back to that community is essential in furthering the empowerment process. Counsellors work with clients to develop an understanding of the clients sense of community the resources available and the extent and quality of client interactions with the identified community. Often clients will not experience a sense of community with any others in their environment or may belong to communities that undermine their resources and abilities. Thus counsellors must also be aware of potential new sources of community and assist clients in accessing or fostering community. This may include helping clients develop skills for drawing upon the community’s support. Finally counsellors can assist clients in identifying ways to support the empowerment of others in their community. Source: Excerpt of article published in the Canadian Journal of Counselling / Revue canadienne de counseling / 1998 Vol. 32:1 - An Empowerment Model of Counsellor Education By Ellen Hawley McWhirter - University of Oregon 76

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Techniques for creating collaborative relationships and useful goals: 1. Clarify where people are now vs. where they want to be in the future a/ Where are they now what is the problem  Of all these concerns on … which one should we work on first  What does the problem look like Where and when does it usually happen  What would I see if I watched this problem happening on a video having the client describe the problem in “video-talk” What does the problem look like What happens first Next Then what Where/when does it occur How does this problem affect you and your life ….  What have you already tried – How did things work  What’s most important to you b/ Where do they want to be in the future What is the Goal Explore how the goal will impact clients’ lives  What do you want your life to stand for  How will life be different when things start improving  What would you rather be doing instead of the problem  What will you be doing instead start based  What can you do differently self-manageable  What would it exactly look like  If we watched a videotape of you being “less depressed” what would you be doing  What will be the first small sign of improvement and explore clients’ willingness and confidence  On a scale or 0 to 10 how willing are you to change something in order to reach your goal  How confident are you in moving closer to your goal. What are you willing to do this week to move a little closer to that  What are you willing to do to make this mark move up one or two centimeters on the line. 2. Invest in what is right a/ search for exceptions : build on moments when the problem was not – or less - present Techniques for building on exceptions: Identify one or more “exceptions” to the problem When is the problem absent or less noticeable explore details of the exception What was different about that time and encourage “more of” the exception What would it take to do more of this Are you willing to try that 77

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Identifying Exploring and Encouraging “More of” the Exception: Identify an exception  When is the problem absent or less noticeable  Tell me about the moments when you were least aware of / suffer least from the problem  Tell me about a time this week when you and X got along a little better than usual. Exploring details of the exception  What was different about that time  How are you different then compared to other moments Encouraging “more of” the exception  What will it take to do this again  What will it take to do more of that next week  I wonder what would happen if you tried this approach during other moments throughout the day  Are you willing to try it Example: Congratulations on changing your behavior last week. I’d like to learn more about what you did to make things better. Your ideas and advice will help me in my work with other peoples who are struggling with similar challenges. I look forward to learning more from you." b/ Search for other Natural Resources: Listen look for ask about resources you can build on. Listen examine records reports and other information with an eye toward discovering resilience cultural factors special interests and other potentially useful resources Listen look for and ask about “natural resources” in the indivual’s life cultural heritage life experiences resilience heroes and influential people special interests Incorporate their natural resources into interventions inviting a respected grandparent to a meeting building on their solution ideas or advice to others incorporating their special interests and talents into counseling conversations and interventions. Examples: The only thing I care about are my friends and my music. I wouldn’t come to school at all if it wasn’t for art class and Ms. Baxter.”  How have you kept things from getting worse  Of everyone who knows you who would be most surprised that you’re having this problem - Why would they be surprised  Who do you look up to most in your life  Who are your biggest heroes - What would they do if they were in your shoes  Who do you respect the most - What would he or she advise you to do about this 78

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 Who else is on your “support team” and how might they help you with this problem  How have you managed to hang in there instead of giving up  How have you kept things from getting worse  If you were a counselor what advice would you have for others who are dealing with this type of problem Incorporate the natural resources into interventions. Ask how the individual has handled other tough challenges resilience and explore how one or more of the resources that helped them through a previous challenge might help them with the current problem. Request the involvement / advice of influential people in the person’s life by calling them asking them to speak with the individual or inviting them to a counseling session or meeting Explore connections between the individual’s hobbies and special interests skateboarding music and solutions to the problem  I wonder how the courage you developed when you learned how to ride a skateboard / play the guitar … might help you with this current problem. What do you think 3. Empower desired changes by giving clients credit preparing for setbacks exploring their plans to continue positive changes and using therapeutic letters and documents. Examples of Giving Credit Preparing for Setbacks and Exploring Plans to Continue Positive Changes:  How did you manage to remain focused through the whole day giving credit for improvement What will it take to continue this exploring plans to continue positive changes A lot of times things don’t change in a straight line but more like two steps up one back two up three back and so on. So let’s talk about what you can do to get back on track when you hit rough spots along the way inviting to prepare for setbacks. 4. Invite something different by changing the viewing and doing. 1. Changing the view: Invite people to consider a different yet plausible view of the problem Could it be that… Offer a different motive or meaning for the behavior Externalize the problem from the person. For a person who views her aggressive behavior as a sign of strength and independence invite her to consider the possibility that the problem behavior reflects her desire for more attention from and connection with her peers. For a person who views another individual’s disruptive behavior as a personal attack or sign of disrespect offer the possibility that the individual’s behavior may reflect an attempt to avoid public embarrassment about his personal difficulties. 79

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NOTE: In order to be most effective the different view that is offered needs to:  fit the facts at least as well as existing views  be different enough from existing views to make a difference and  make sense and be acceptable to the client. Examples:  Could it be that your boss / teacher gets on you a lot because she cares enough to want you to succeed  Can you think of any other reasons why this person might be acting this way 2. Changing the doing: Invite people to alter their performance of or response to the problem Pattern interruption strategies including altering the sequence tone time of day and other aspects of problem performance “Do Something Different” experiments.  Are you willing to try something really different  I wonder what you could do to be less predictable.  It might be interesting to do something really different next time this happens just to shake things up and see what happens.  Maybe you could think of something really different this week and try it out as an experiment. Encourage clients to alter the problem pattern by doing something...anything…different For a person who argues a lot with her boss invite her to be “unpredictable” by saying something nice to the boss upon entering the workplace for three consecutive days and observing any differences in the relationship For a supervisor concerned about the behavior of a disruptive team member encourage the supervisor to alter the problem pattern in the following way: The next time the problem starts tell the individual that you are going to start at the end and work backwards by saying “I’m sorry I had to do this without you because it’s important to me that you remain part of the team but I can’t talk with you all the time and organize things at the same time.” Examples of “Do Something Different” Experiments For parents who complain about “daily arguments” with their daughter shortly after she arrives home from school invite them to try a “Do Something Different” experiment in which they a do something very different when their daughter arrives home from school and b make careful observations perhaps even notes on her response to the experiment. 80

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Practice Exercise: Invite Something Different by Changing the Doing Instructions: a The supervisor/teacher/parent describes a problem they are having with another person b The service provider invite the supervisor/teacher/parent to consider being unpredictable by doing something different in order to change the problem. 1. The service provider describes the problem in specific terms Who does what when to whom. 2. The service provider and the supervisor/teacher/parent work through the following steps:  What do you usually do in response to this person’s problem behavior What is the usual result  What could you do that would be totally different and unexpected the next time the person performs the problem behavior Brainstorm some possibilities before ruling anything out  Of all the options we just discussed which one would you be most likely to try  On a scale of 0 to 10 where 0 “not at all likely” and 10 “very likely” how likely is it that you will actually do this when you return to work circle one - 0 1 2 3 4 5 6 7 8 9 10 3. Externalizing the problem from the person. Discuss the problem as a separate and distinct entity that is external to the client by giving it a name exploring its power in the relationship and exploring times in which the client has stood up to it instead of yielding to its influence Examples:  If you were to name this problem what would you call it  How long has Ms. Nasty been part of your life  How does she get you to dance to her tune  Tell me about a time that you stood up for yourself and did things your way instead of giving in.  How will your life be different as things change between you and Ms. Meany  What would happen if you switched seats with Mr Nasty the problem so that you became the driver and he the problem became the passenger 5. Questions for Young People Viewed as Reluctant or Resistant “Mandated” Clients  How can you get out of coming here  What would convince your teachers/parents that you no longer need counseling  What would your teacher OR parent/judge/probation officer say needs to happen  What will I need to say or write to the court to convince them that you no longer need counseling 81

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 What are you willing to do to make that happen  Who suggested that you talk to me  Why do you think they suggested it  What makes them think you need counseling - Do you agree with them  Would you be interested in finding ways to get your teachers and parents off your case  What have you found helpful to keep your others from hassling you as much about this Insert the client’s own words into questions when possible—hassling yelling being picked on etc.  How can I help - What can I do to help you  What are you willing to do differently to help your cause  What would be the first small step you could take in that direction  What would be the first small sign that would tell your teacher/parent that you are making progress and improving things  Of all the people in your life who do you look up to and respect the most What would s/he advise you to do about this  What else would you rather work on here Discuss something important to the client to engage their involvement and energy  I can’t force you do anything you don’t want to do and I respect your choice to participate or not participate in counseling. If you choose not to I want you to know that you can come back anytime to make sure you have a say in things. "The process by which the client reconstructs his experience is not one the worker creates he simply enters and leaves... he is an incident in the life of his client. Thus the worker should ask himself: What kind of incident will I represent... How do I enter the process do what I have to do and then leave" Schwartz W. 1974: The Social Worker in the Group in: Klenk R.W./ Ryan R. Eds.: The Practice of Social Work Belmont Cal. 208-228. The Best Way To Empower Someone Is To Show Them Their Strengths and praise them for who they are I come in contact with many people who are really down on their luck or who just feel completely defeated by life. You hear it in their words and you see it in their body language. Listening to them and letting them vent is helpful up to a point. Being non-judgmental and supportive is also helpful up to a certain point. If it’s someone close to you being there for them is helpful. Yes you guessed it up to a point. The best way to empower people who feel down or at a low point starts with listening really carefully. When you listen carefully even if the story is negative sad or tough you can from the words being spoken identify the person’s strengths and qualities. When you then show the person what amazing strengths they have strengths that you can back up by examples of things they said and praise them for what they are doing and who they really are it empowers them in a way far beyond any other method I know about. 82

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Take the case of a 24 year old guy who works in the hospital come into the ER. He was having back pain and he had a painfully stiff neck. It turns out that this guy was working in a job he hated. Okay nothing new there many of us do that at one point or another. He told me about how he had no other option. Of course I felt compelled to point out that there is always more then one choice or option in any given situation. In the end what we do is our choice based on the pluses and minuses to be gained or lost. But that is a completely different post. When I started digging deeper he told me about the mortgage he has to pay as an example of one of his many burdens in life. That intrigued me. A 24 year old with a mortgage. The conversation went on for a while. To make a long story short he was supporting his mother divorced sister and her child who all lived with him. I was blown away. What a heck of a burden for a 24 year old guy to shoulder. I couldn’t leave him like that so I started telling him about his qualities and strengths. Qualities and strengths that I heard during our conversation. I told him about his highly developed sense of responsibility. I pointed out to him how committed he was to his family. I pointed out his selflessness. Many people his age put themselves and their needs before anything else. I also pointed out to him how rare it was for someone his age to be able to plan ahead the way he is. He had bought an apartment because the rent is just as high as his mortgage. The more I pointed out his positive strengths especially ones that connected him with his sense of values the more he perked up. The point of this story is twofold. First even a few minutes can make a big difference in someone’s day and sometimes even their life. Secondly if you really want to encourage and empower someone listen to them carefully. Even within their tales of despair you can find a person’s strength. When a person recognizes remembers and connects to their strengths they are ready to soar. Has someone ever empowered you through emphasizing or pointing out your strengths “Praise is like sunlight to the human spirit. We cannot flower and grow without it.” Jess lair I chose to share this story with you mostly because I found it so amazing to see how things that you learn - in this case things that I learned in my coaching training program - actually come to life in your day to day interactions. I realize what a tremendous difference learning theory as well as certain techniques whether it be listening re-framing or encouragement just to name a few make on the way you view and react to things. Yet another example of why constant learning and self advancement is so important. On our journey through life each of our inner circles is growing and encompassing more people: children significant others friends colleagues and random people we meet and don’t know as intimately. As the circle grows so too does our influence. Every nod every smile every interaction can completely change the course of someone else’s day. We can either wield that influence in a positive or negative way. 83

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The following I would like to dedicate to those special people who identify with their fellowmen and use their influence to empower them.  Empowering others is one of the most important acts of kindness one can do for his fellow man.  Empowering others means not criticizing them.  Empowering others means not judging them.  Empowering others means not being cynical toward them.  Empowering others means praising the struggling student in the class on his or her progress — any progress no matter how small.  Empowering others means curbing your ego.  Empowering others means connecting to the best elements that lie within you.  Empowering others is contagious.  Empowering others means giving them the feeling that they are loved.  Empowering others is to understand that the cashier at the supermarket the waiter at the café the guy who pumps your gas the doorman the street cleaner and the janitor are not transparent. They are people just like us.  Empowering others means smiling at these people inquiring about their wellbeing thanking them for the services they provide and wishing them a good day.  Empowering others means being happy for them and praising them on their accomplishments. Praising them in any way possible. Always.  Empowering others means identifying with them.  Empowering others is easy. It does not require any effort.  Empowering others means smiling when someone else approaches.  Empowering others also empowers us.  Empowering others makes the world a better place.  Empowering others means to be moved by the American poet and author Maya Angelou one of the most important figures in the American Civil Rights Movement who said “I’ve learned that people will forget what you said people will forget what you did but people will never forget how you made them feel.” "Empowerment suggests a sense of control over ones life in personality cognition and motivation. It expresses itself at the level of feelings at the level of ideas about self worth at the level of being able to make a difference in the world around us... We all have it as a potential." Rappaport J.: The power of empowerment language Social Policy 15 1985. p. 15-21. Gutierrez adapted this definition and tried to clarify it by adding four necessary changes which have to be seen in a person before he/she can be described as "successfully empowered" - an increased self-sufficiency a developed group consciousness a reduction of self-blame in the face of problems and the ability to assume personal responsibility for change. That is not relying on other people to help out but trying to take matters in ones own hands and pursuing a change to the better. 84

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Another definition has been given by Solomon who has developed a very good definition of empowerment related to social work adaptable to our focus on migrants and refugees. This is the definition that is used in this text for empowerment. Empowerment is defined as "a process whereby the social worker engages in a set of activities with the client ... that aim to reduce the powerlessness that has been created by negative valuations based on member- ship in a stigmatised group. It involves identification of the power blocks that contribute to the problem as well as the development and implementation of specific strategies aimed at either the reduction of the effects from indirect power blocks or the reduction of the operations of direct power blocks." Solomon B.: Black Empowerment: Social Work in Oppressed Communities New York 1976. In this context empowerment can be best described as a process which can be initiated and accompanied by advice counsel and orientation programmes. Through this process individuals organisations or groups who seem powerless or deprived of the means to reconstitute themselves in an alien society can become empowered. They can become aware of the power dynamics at work develop skills and the capacity to gain some control over their lives exercise this control without infringing upon the rights of others and support the empowerment of others in their community. In summary therefore empowerment can be described as having four goals:  that the client sees himself as the agent of change  that the client is able to use the knowledge and skills of others in furthering their own interest  that the client is able to work in partnership with professionals  that the client is open to developing the problem-solving skills to address their situation. It is important to identify some basic principles of practice with regard to the relationship between the practitioner and client:  interact with the person and not the "migrant" “patient” …  respect the persons right to self-determination accept the clients definition of the problem  focus on strengths respect the diversity of skills and knowledge that clients bring  share power and control respect the clients right to contribute and trust his or her motivation to learn and direct his or her life be aware of cultural differences with regards to hierarchy and superiority.  look for groups: mutual help consciousness raising participation. General Methods The empowerment process can be described as being made up of four elements.  Attitudes beliefs and values. This refers to the psychological aspects of empowerment. It covers self-sufficiency and belief in self-worth. It is concentrated either on individuals or groups.  Validation through collective experience. Sharing common experiences can avoid misinterpreting individual experiences and help put these into perspective alleviating loneliness and isolation. The collective experience can motivate a group to pursue 85

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changes that go beyond the individual.  Knowledge and skills for critical thinking. The ability to access and acquire information is an important element of empowerment. This can enable individuals to analyse their situation independently and critically reducing self-blame and feelings of helplessness.  Action. Through empowerment individuals can develop plans for action to solve a problem. They can develop strategies and behavioural patterns that might help them in future challenges. An increased ability to co-operate with others is another possible outcome. In addition the empowerment process can be said to involve four stages:  Establishing a relationship between the adviser and the client to meet immediate needs such as access to social services and benefits or to other sources of information  Educating the client to improve his or her skills and thereby increasing the ability for self-help  Securing resources. This implies the development of skills to deal with other organisations and agencies joining self-help-programmes and groups or establishing and using social networks. Enabling social and political action. Helping the client to be able to articulate social and political needs at the appropriate time enabling them to understand the basic principles of lobbying negotiation campaigning and so forth. The last stage is the most politicised stage in the empowerment process and might not be relevant to all advisers and organisations. But to ensure real change the social and political context of the individual has to be considered. How far practitioners want to take the four stages of empowerment depends on their objectives. Empowering individuals The blocks to empowering an individual are often psychological. Firstly there is the phenomenon of alienation from the self. This is a phenomenon that has been identified as a psychological and emotional response to oppression. It is manifested through the inability to identify and articulate ones needs and take active steps to meet them. It can lead to low self- esteem and feelings of powerlessness with the perception that one cannot influence and resolve issues in ones own life. Secondly is the use of stereotypes or stigmatisation. The migrants who have repeatedly experienced rejection for whatever reason will feel stigmatised or of being subsumed under a stereotype. This will be exacerbated by their experiences of racism. The migrants might find themselves caught in a vicious circle of stigmatisation rejection and subsequent self-blame. This circle can be quite destructive for the individual. Three steps are important for the empowerment of individuals: The first step is to define the problem. To define the problem different factors have to be considered such as the specific legal framework of each country particularly around their residency status and employment rights. Also the attitude of each country towards migrants and refugees is significant. In a society with an assimilationist approach there is an expectation of complete adjustment to all 86

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relevant features of the host society. In countries where integration is the key-word differences are accepted and even encouraged. The second step addresses the issue of self-determination. It is important to define the criteria of success for every individual. From this perspective it is possible to set targets against which the goals can be said to be achieved. Establishing self- sufficiency and belief in ones own abilities starts from the moment contact with the client begins. As soon as he or she is regarded as a valuable source of competence in dealing with the problem an important step in the direction of empowerment has been taken. This leads us to the third step which relates to consciousness raising. It is necessary to confirm to the clients that they are the experts of their particular situation and the best arbiters of their own treatment. The acceptance of the independence of the client is crucial otherwise there can be no talk of empowerment. An important precondition to any empowerment-process is access to information. A lot of problems arise because of a lack of information on both sides: Those seeking for employment and those able to give jobs. The availability of information on the labour-market and its regulations ensures that the clients are not reliant on the advisor to assess their options. The EMPLOYMENT working group on empowerment has assembled a number of "indicators" for individual empowerment. These are:  Skills: Literacy and numeracy marketable skills having confidence and understanding of ones own strengths.  Actual or real potential: having secure and decent housing being aware of the impact of good health and how to keep it access to decision making processes having choices for career development being able to make decent plan financially being able to get a credit interest in positive change in the host society.  Employment: Having a job better a job with a secure contract of employment establishment of own business becoming an employer in own business. The EMPLOYMENT working group has formulated a number of indicators of success for group empowerment. These are:  Support and motivation: Existence of peer support structures self-help voca-tional guidance emergence of role models within the target group availability of mentors from within the target group skilled trainers from within the target group opportunities to collaborate with other to create common and effective projects.  Relationships with other organisations: Participation in decision making process provision of training to official agencies.  Campaigning: Development of an account of the groups previous exclusion of value attached to direct experience of that exclusion training and skill development for group members in the specific skills needed to engage with decision making processes.  Services: Provision of practical services for target group members development of credit unions. 87

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The EMPLOYMENT working group in empowerment has identified some "indicators" for empowerment within the context of the wider community. These are:  policies respond to representatives of target group  change in public attitudes - the rights of the target group are acknowledged there is indignation when there are not supported target group members are described as having rights rather than needs  removal of obstacles to participation e. g. greater availability of child-care change in time of public meetings etc.  increase in numbers of target group being employed in jobs concerned with maintenance of the state e. g. police armed forces civil service  children of target group members born in the host society do not experience exclusion. Proposed reading Gutiérrez Lorraine et al. eds.: Empowerment in Social Work Practice. A Sourcebook Pacific Grove et al. 1998. Lee Judith A. B.: The Empowerment Approach to Social Work Practice New York 1994. Lewis J.A et al. eds.: Community counselling. Empowerment strategies for a diverse society Pacific Grove et. al. 1998. In life like in business you never get everything you want you get what you can negotiate. Here are five steps to empower people. 1. Know their skills and qualifications. Look over their curriculum vitae and find out what their strengths and abilities are. This will help you decide where to maximize their potentials. 2. Ask them what they are best capable of and find most enjoyment in doing within the scope of their work description. Encourage them to contribute in their areas of speciality and interests. 3. Give frequent praises for good work everyday. Most people with possible exception of those with schizoid personality disorder thrive in positive feedback. It helps them to know what they are doing is appreciated and will encourage them to continue their good work. 4. Avoid criticisms if at all possible. Criticisms has the opposite effect of praises and can discourage people greatly. Always assume good faith be understanding think in terms of good aspects compare their mistakes to mistakes you have made yourself or could have made. If you must give criticism be constructive and always praise first and provide clear suggestions on how to improve. 5. Provide opportunities for further training and education. Allow them to expand their knowledge and skills so they can contribute in greater ways. “The beauty of empowering others is that your own power is not diminished in the process” said Barbara Coloroso. In fact empowering other people puts out the positive vibes into the atmosphere that will be returned to you not in any sort of karmic sense necessarily but in terms of improving your own sense of self-awareness and confidence. This can be achieved in a number of little ways that can range from simply boosting someone else’s mood to helping them realize new aspects of their personalities. We are all in this life together and helping others achieve their goals can get our own on track. 88

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The following are 50 little things you can do to empower other people and get started down this path. 1. Give out compliments that you mean. Most people can see straight through a phony compliment but if you think your friend looks especially nice today with that new hairstyle tell her so. Just be open and direct in your interactions. 2. Speak and act with honesty. If you always speak with integrity and believe in your own words and actions others will also pick up on this and mimic it fostering an atmosphere of trust. 3. Listen to others. Always listen to what other people say. I used to zone out when others were speaking but now make a point of looking into their eyes and listening to their words which has made a world of difference in personal interactions. 4. Help illustrate your points with visual aids. When leading a meeting or presentation realize that many other people are visual learners. My girlfriend can’t understand a concept without a diagram to back it up. 5. Teach a class. If you have a skill or knowledge to share why not teach your own class that helps spread it to others 6. Get involved in community art projects. Artistic projects in the community are a great way to help get everyone involved in making the city a more beautiful place to live instilling a sense of pride in all residents. 7. Mentor a child or student. Getting involved in one child’s life especially if they are at-risk helps you both make connections throughout your lifetime. 8. Volunteer with local organizations. These can be community discussion groups or of a more volunteer-oriented nature. 9. Lead a group on a travel expedition. My friend works for the local art museum leading groups of the elderly on art-oriented field trips around town and abroad which helps everyone connect and learn something new. 10. Donate money to charity. If you have extra money helping organize a fund for a pet cause helps bring the community together. 11. Help the spread of community health clinics. This can be done by volunteering yourself or donating money. Either way it can be vital in helping those who have problems affording health care to realize that they are still valued individuals and that their health matters. 12. Take the time to talk to strangers. That conversation that is simply small talk to you can mean a lot to someone else who is shy or feels that their opinion isn’t taken into consideration often enough. 13. Start a non-profit. This is a project that can be difficult but ultimately rewarding not only for you but for the others who become involved as well helping you all to work together towards an ultimate goal. 14. Travel abroad and make new friends. Getting out there as an ambassador of sorts in the world helps you connect with others who may want to learn more about your culture but otherwise wouldn’t have the opportunity. This ends up being a learning experience for both parties involved. 15. Reach out to friends and relatives at a distance. If you have lost touch with loved ones 89

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give them a call and let them know that someone is thinking of them. 16. Be aware of body language. Your body language sends a strong message to others so be aware if you have your arms folded across your chest while you talk that you are shutting others out for example. 17. Be sincere. Your sincerity will help to make people feel appreciated. 18. Nurture talent in others. If you notice someone has a talent that they aren’t putting to use let them know. Gently offer suggestions of where they may go to learn more. If the child you are mentoring is constantly doodling for example get them signed up for an art class. 19. Go out and support local musicians. In every city there are unimaginable numbers of young struggling musicians who could be the next Beatles if given the chance. I’ve seen some amazing live acts recently by picking a name out of the listings and simply turning up in support. 20. Give thoughtful gifts. When giving gifts during birthdays or the holidays take the time to think about what the person might really need or appreciate. 21. Join a community farm or grocery coop. Working together to provide fresh sustainable food for the community is one of the hot trends in some community organizations. 22. Volunteer in schools. Though it might sound cliché young people are our future indeed and helping out in schools that are struggling financially can make a big difference in a young person’s life. Be a positive role model. 23. Stay in touch with local politics. Helping others get empowered means also being kept up to date with the latest in what is going on in your own town. 24. Throw dinner parties with a mixed range of guests. Get together a group of people who don’t necessarily know each other yet but you feel that their personalities might mesh well together. This is how we learn from one another. 25. Smile more often. There is an anonymous quote that states “A smile confuses an approaching frown.” 26. Use public transportation. Not only is this better for the environment but it gives you a chance to interact more with the community. 27. Organize recycling projects. This helps give back to the community and teaches people about the need to respect our natural environment which is empowering for all. 28. Run a benefit event. Leading a team of volunteers set up a means for raising money for a cause that you all are interested in. This can be a chain reaction with the volunteer team then feeling more empowered to go a step further with its own charity efforts. 29. Project positivity and eliminate negative thoughts. This positivity will then be returned by others. 30. Join a book group or club. The exchange of ideas tends to be helpful for all people involved and can spark new business or interpersonal ideas in between all of you. 31. Start or join a language exchange program. This helps foster feelings of competency in a foreign country for someone who may be feeling like an outsider and also helps you build your own language skills. 32. Lead team-building exercises at work. This can go beyond old-fashioned trust falls to more imaginative retreats. My friend recently led his team out in a wild-mushroom foraging 90

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expedition which was a unique way for them to learn something new as well as get to know each other in a beautiful outdoor setting. 33. Encourage social activities. Get new social activities planned within your group of friends your family or in a larger community sense. 34. Initiate physical contact. In this society in particular there is a hesitance to touch one another. By simply placing a hand on someone’s shoulder you are helping to reconnect with that person. 35. Tell your loved ones how you feel about them. Don’t wait till it’s too late to let someone you love know how you feel about him or her. Life is wonderful but short. 36. Make sure the atmosphere at work is a democratic one. Let everyone’s opinion be heard and be sure to give feedback to their ideas. 37. Nod your head when someone is making a point. A simple piece of non-verbal communication like this can help inspire someone to move forward in the discussion more. 38. Help foster creativity. If someone is talented tell them so. Andy Warhol was notoriously shy as a child and perhaps would never have branched out to become the powerful artist he is now known as if someone had not said a few words of encouragement to him in his early art classes. 39. Run meetings with an open discussion oriented atmosphere. Whether at work or in a larger community sense let everyone know their opinion is valued. 40. Have suggestions ready for those who need advice. This means taking the time to think about your own behavior past mistakes and how you’ve moved forward. With this information in hand you will be well equipped to advise others. 41. Take walks to new areas of town. I’ve met some of my good friends by simply walking around in their neighborhood and having to ask for directions. 42. Spend time planting trees in the community. This helps improve the overall beauty and positive feelings in the city instilling a sense of pride in other residents. 43. Set up a food or blanket drive. This helps others in the community and empowers the other volunteers by letting them see they can make a difference. 44. Learn inspiring quotes that can be doled out. As Bill Gates once said “The vision is really all about empowering workers.” 45. Learn new listening techniques. This can be a combination of proper responses and cocking your head at the right time to show someone else their opinion matters. 46. Study psychology. A friend of mine went back to school to be a psychologist in order to reach out to people on a scientific level but even a few basics of human behavior are both interesting and can help you be more effective in interpersonal communications. 47. Give a helping hand. Whether it’s helping someone who fell to get back up or picking up something that spilled in the supermarket it shows you care which is empowering. 48. Give encouragement instead of criticism. Dale Carnegie said “Abilities wither under criticism they blossom under encouragement.” Every one of us has the magic power of empowering other people simply by generously giving praise and showing encouragement instead of criticism to help them realize their potential. 49. Take time for yourself to help others. By taking the time to sit and reflect upon my own 91

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actions each day I find I’m better able to mentally be available for others when out in public or at home with my family. You can do the same. 50. Learn intervention techniques. In the event that someone you know is struggling with addiction this is a way to help them get over it and empower themselves to get back on track. 92

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Qualities for empowering family advocacy Amended from Marie Sherrett Which Type of Advocate Are You Defender Fights for the rights of individuals children and families Protector Works to keep individuals children and families from physical or psychological harm Promoter Works to cause something to happen Enabler Provides individuals children families with the resources needed to achieve their goals Investigator Searches for facts and information Mediator Listens to and understands all points of view and remains objective Supporter Listens to and gives acknowledgement to feelings and needs without passing judgment Monitor Checks in periodically to see if things are going according to the plan Teacher Assists in trying to decide the best possible approach to the situation. Caregivers are not empowering if they: • Beat around the bush • Fail to describe problems • Feel guilty or are afraid to be vocal • Agree with professionals to keep peace • Ignore the right to services • Leave everything to others • Accept excuses for inappropriate or inadequate services • Beg for what the law says a child should have • Abdicate to others the right to advocate for a child • Depend on others to advocate • Give up because of red tape • Are too hasty to act • Fail to act • Accept the status quo • Give in to defeat • Are comfortable with accomplishments • Discourage your child from having hope for success. Caregivers are empowering if they: • Express themselves clearly directly and without guilt • Are not intimidated • Prepare for meetings • Stay together • Are informed • Keep Records • Collaborate 93

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• Communicate effectively • Demonstrate self-confidence • Advocate effectively • Are self-reliant and independent • Persist • Analyze problems • Organize to effect change • Are positive and strong • Have pride • Encourage others and hold people accountable Resources What is it that you need to know if you want to be an empowering advocate for your child First know that you are the expert when it comes to your child. You know your child better that anyone else. You know: • How your child responds to different situations • Your child’s strengths and needs • What your child likes and dislikes • What has worked to help your child • What has not worked You are the person who decides what services and supports your family and child need. Include your child in decision making whenever possible. You child needs to be an active participant in the services you receive. Every child is different yet there are children similar to yours. You are not alone. Other families have faced similar problems and shared the same experiences. Getting connected to other families who are willing to help you can make all the difference. You need to begin asking the following questions: • What do I need to know and to do to help my child • What agencies in the community have programs or services that can help my child and other members of my family How do I get services from them • How will my child’s health growth and development social interaction and ability to learn be affected by the problem we face • What has helped other children like mine In the context of your interactions with children always: 1. Look through the child’s eyes: Consider the world from the child’s point of view. What joys and challenges exist for this child each day What is their level of ability and support to meet their challenges Who are their friends Is the child’s life basically happy or full of considerable stress and loss Too often as adults we view the child from the adult lens thinking about how the child’s behavior affects our work or our day. Instead remember what it was like to be very young and consider what daily life is like for this young child. When you truly understand the needs of the child then you have a much stronger ability to assist this child with your professional skills. 94

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2. Look for the positive: Develop an extensive list of the skills interests motivators and personality attributes of this child. This becomes essential information when you develop positive action plans to help the child address challenges in their life. Regardless of age we all are much more effective in responding to difficulties when personal strengths are identified and utilized to address needs. 3. Meet at the child’s level: Develop professional plans that start at the child’s level of comfortable functioning. If required skills are above the child’s functional developmental level then the child will not be successful. Since children are unique it is normal for there to be variation in developmental levels across the developmental domains cognitive social emotional behavioral and physical. Assessment should include evaluation of each of these domains independently and is critical for a thorough understanding of the child’s strengths as well as challenges. 4. Plan Success: Interventions and strategies should be designed with success in mind. Don’t create a plan if there is a question about the child being able to accomplish the goal. Behavior plans should include positive incentives which will encourage increased self-esteem and motivation for change and growth. 5. Child as expert: At an early age we all find ways to communicate our likes and dislikes in life. Gifted caregivers learn to recognize these communications and respond to them. Be sensitive to the child’s communication and find ways to include the child in intervention planning. Even small children can choose their own rewards and acknowledge simple rules. As the child grows increase their participation in all decision processes about them. For a deeper understanding read: Empowering conversations: A Resource Guide for Team Building Between Families and Professionals to Support Action Planning for Young Children By Laura Beard Lead Family Contact Michelle Dipboye Sames Early Childhood Empowerment Specialist Kentucky’s System to Enhance Early Development Kentucky Partnership for Families and Children Inc. 20Resources20-20Conversations20with20Families.pdf 95

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Empowerment Checklist for Professionals Use the following checklist to help guide your professional approach with children and their families to be one that is empowering.  The child’s needs are the guiding force for all decisions Evaluate/assess the child within your own skill base training  Utilize best practice approaches for the child’s developmental age and issues that are the focus of care  Seek knowledge and expertise of adult family members about the child  Acknowledge complexity of issues  Provide an honest appraisal of available resources  Refer to other professionals for additional supports assessments that are indicated  Obtain authorization for releases of information for additional service providers so care can be coordinated comprehensive  Include adult family members as full partners in action planning  Include the child at developmentally appropriate levels in action planning  Explanation is given to the child and family about all initiatives and interventions  Provide regular feedback including positive growth to the child family  Reinforce positive social skills for the child  Educate child family about educational legal rights  Encourage family member advocacy on behalf of the child  Support qualities that lead to hope and resilience in the child/family  Facilitate a positive solution focused approach to issues. Empowerment Checklist for Families Use the following checklist to help guide the approach of your family with professionals to be one that is empowering for the child.  Know the Laws and your Child’s Rights  Come to meetings prepared with written questions and thoughts  Never leave a meeting until you are in full understanding of what took place and what is going to be the next step  Make sure any verbal agreements are put in writing  Take along a peer or other support person when needed  Advocate for the best interest of your child  Be willing to negotiate  Take notes and keep a list of people present at any meetings pertaining to your child  Know your child and family strengths  Document phone calls and make copies of letter correspondence  Stay connected to the plan asking for updates and feedback  Provide information to professionals about how things are going at home and any changes whether positive or negative are occurring  Be persistent and assertive  Tell your child’s story  Keep the focus on what will support your child in reaching his/her goals 96

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4. Foundations of Empowering Interventions 1. Brief Solution Focused Counseling Research Support for the Tasks and Techniques of BSFC: The “Change Pie” The tasks and techniques of Brief Solution-Focused Counseling are supported by a large body of research on “common factors of change” in helping relationships. These factors and their percentage contributions to successful outcomes are based on over 1000 studies involving a wide range of clients problems settings and practitioners. Client Factors Accounting for 40 of change the Filling. The client is clearly the most potent factor in counseling some research indicates an even stronger influence than 40. Client factors include the client’s life experiences values opinions interests successes resilience and role models. Counseling outcomes depend largely on the extent to which the client’s strengths feedback and other resources are integrated into therapeutic conversations and interventions Gassman Grawe 2006. Brief Solution-Focused Counseling empowers client factors by helping people discover and apply their strengths and resources toward solutions. Relationship Factors Accounting for 30 of change the Crust. Relationship factors the second most powerful ingredient of effective counseling include people’s perceptions of respect validation and encouragement from the practitioner. Client involvement is the centerpiece of a strong therapeutic relationship. The client’s early ratings of the helper and helping relationship during first couple sessions are highly predictive of outcomes Norcross 2010. Brief Solution-Focused Counseling empowers relationship factors by involving people in every aspect of their care by obtaining their feedback and by adjusting services based on their feedback. Hope Factors Accounting for 15 of change the Anticipation. Hope factors refer to people’s belief that change is possible and confidence in their ability to change in positive ways. Hope plays a key role in effective outcomes though its influence is relatively smaller than client and relationship factors. Brief Solution-Focused Counseling empowers hope factors by treating people as resourceful and capable of changing and by focusing on future solutions rather than past problems. Model/Technique Factors Accounting for 15 of change the Topping. Model/technique factors refer to the practitioner’s theory and related techniques. Given that no single counseling model or set of techniques has proven superior to others in overall effectiveness Wampold 2010 the most successful practitioners are flexible in their selection and application of therapeutic techniques. Brief Solution-Focused Counseling encourages practitioners to fit themselves and their techniques to clients instead of the other way around and to try something different when one idea or technique is not working—in other words don’t marry the model or techniques Note: The factors above are applicable to any change-focused activity including group work behavioral intervention teacher/parent consultation assessment and systems-level change. 97

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Brief Counselling Be kind whenever possible. It is always possible. — Dalai Lama Brief counselling is an approach to counselling characterized by a focus on resources and solutions rather than problems. The purpose of brief counselling is “to provide people with a pleasant experience that turns problems into challenges fosters optimism enhances collaboration inspires creativity and above all helps them to retain their dignity” Furman Ahola 1994 p. 65. How Brief Counselling Helps Often counselling relationships are brief sometimes limited to a few sessions a single session or even a brief encounter. Michael Hoyt 1994 reviewed the literature and found that single- session therapy is often the norm and that a significant number of clients and counsellors found it desirable and useful. In three systematic studies of the effectiveness of single-session therapy SST more than 50 percent of clients showed improvement Hoyt 1994 p. 41. Moreover many people solve psychological problems without professional consultation. For others the “light touch” of a single visit may be enough providing experience skills and encouragement to help them continue in their life journey p. 153. Furthermore a change in some part of a client’s life can affect other aspects of his or her life including relationships with significant others. Thus brief counselling that helps a client achieve some success e.g. insight reduction of painful feelings new skills however small can have a dramatic long-term impact if it switches the client from a point of despair to a position of optimism and a ripple effect occurs. “When clients alter their behaviors ever so slightly it causes a chain reaction in response to the initial change. Those affected by the change find themselves adjusting their responses which in turn elicits further changes in clients” Sklare 1997 p. 11. De Shazer 1985 argues that it is not necessary to spend time searching for the root causes of a problem nor is it necessary to have elaborate knowledge about the problem. In brief counselling the goal is to help clients do something different to improve their situation rather than repeat the same ineffectual solutions. Brief counselling may help in many ways. Because of its emphasis on action and change brief counselling helps clients to become “unstuck” from ineffectual ways of thinking feeling and acting. Clients can be encouraged to reframe by focusing their attention on what’s working thus interrupting their preoccupation with problems and failure. This focus may generate or renew the clients’ optimism that change is possible. In addition brief counselling even a single session can be therapeutic for clients if they are able to unload pent-up feelings. A caring and empathic counsellor can encourage such ventilation and reassure clients that their reactions and feelings are normal. This can significantly reduce feelings of isolation by disputing the belief that many clients hold: “I’m the only one who feels this way.” Brief counselling can also provide important information to clients. For example they can be referred to appropriate alternative services. Or they can be given information that might help them deal with their situation. Finally brief counselling can be used to demystify the counselling process and to help clients understand what they might reasonably accomplish in counselling. In this way brief counselling may be useful for motivating reluctant clients to engage with or to continue with counselling. Brief or single-session therapy is not appropriate for all clients. It is less likely to be effective with these client groups: clients who need inpatient psychiatric care including those who are 98

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suicidal clients with schizophrenia bipolar disorder or drug addiction clients who need help in dealing with the effects of childhood abuse and clients with chronic eating disorders Hoyt 1994. Selected Brief Counselling Techniques Precounselling Change Momentum for change is often established at the moment that clients seek counselling. Carpetto 2008 notes that studies have shown that changes frequently occur in the interval between the time clients make an appointment to see a counsellor and the first meeting. Thus counsellors can make use of the fact that some clients realize progress while waiting for their first scheduled appointment. The Miracle Question A typical miracle question might be formulated as follows: “Suppose that tonight while you’re sleeping a miracle happens and your problem is solved. When you wake up what will be different about your life” Variations of this question may need to be developed to accommodate different clients. For example some clients may object to the religious overtones in the question and a more neutral term such as something remarkable could be used. The example below illustrates the process: Counsellor: Suppose when you woke up tomorrow something remarkable has happened and your problem is gone. How would you know that your problem is solved Client: Well for one thing I’d be worrying less. Counsellor: What might your family see as different Client: I’d be more willing to get involved in family activities. Counsellor: Activities Client: Things like sports family outings—movies and so forth. Counsellor: What else would they find different Note: It is important for the counsellor to use probes such as this to elicit detail. If a change can be imagined the more possible it will seem and the more the behavioural changes to make it possible will become apparent. Client: I think that we’d be happier. Not just because we’re doing fun things together but we’d be arguing less about money and our other problems. Counsellor: How much of this is already happening The above excerpt shows how quickly the counsellor can move the interview to focus on solution possibilities. When clients engage with the miracle question they begin to identify potential changes that might occur and they often become more hopeful about their situation. As Carpetto 2008 concludes “they are already on their way to finding solutions to their problems” p. 181. Since the client has imagined and described some of what needs to happen to solve the problem the counsellor’s next task is to get clients moving in the direction of the “miracle” with questions such as “What would you need to do now to begin to move toward the miracle” or “What would it take to make the first step” 99

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Success Tip Capitalize on the possibility of precounselling change by asking questions such as “Since making your appointment have you noticed that things have improved in any way however small” If the response is positive sustain this change movement by helping the client identify the feelings thoughts and behaviour associated with it. The miracle question can also be used to direct clients to think about solutions: ■ If a miracle occurred and your problem was solved what would be different in your life ■ How could you make that miracle happen What would you have to do differently A variation is to use the miracle question to probe for examples of success and exceptions to clients’ problems: ■ Tell me about the times when part of this miracle has already happened even just a little bit Sklare 1997 Hoyt 1994 Success Tip Use a question such as “What do you want to change about yourself today” as a quick way to set a goal-directed sessional contract. Helping Clients Get on Track Counsellors need to shift their own thinking away from believing that they have to stay with clients until the clients’ problems are solved and their lives are in order. For example counsellors might assist clients to organize their thinking about grieving but the process of grieving is normal and might last a long time and counsellors do not have to be present for the entire grieving process Walter Peller 1994. Counselling ends with the client still grieving but with a much greater sense of control and of being on track. If clients have a plan in mind for dealing with their problems they have the capacity to put that plan into action. Moreover if they are already implementing that process counsellors should consider getting out of their way. Looking for Exceptions Huber and Backlund 1991 propose working with the exceptions to the times when clients are having difficulty. They contend that regardless of the severity of their clients’ problems there are moments when clients are managing their troubles. Moments when anxious persons feel calm acting-out children listen to their parents and angry people are peaceful can all be studied to discover potentially successful answers to chronic problems. Huber and Backlund believe that clients become fixated on their problems and on what doesn’t work. By doing so they often fail to notice those times when their problems have abated. In fact they often continue to repeat or exaggerate “solutions” that have already proved unworkable. Using this exceptions approach counsellors ask clients to focus on those moments however rare when they are coping successfully. So when clients are asked “What is different about those occasions when your child obeys you or at least responds more receptively to your requests” or “What is different about those times that you’re not angry or only minimally upset” the counsellor is requesting that clients report on experiences to which they have paid almost no attention. Consequently they have 100

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given little or no credence to the more successful manner in which they were resolving what at other times they experienced as a persistent difficulty Huber and Backlund 1991 p. 66. Working with exceptions provides a dramatic and quick way to motivate and energize clients to think about solutions rather than problems. In the following brief excerpt the counsellor uses the technique to assist a client who is having trouble dealing with her teenage son. Counsellor: From what you’ve been saying it’s a rare moment when you and your son can sit together and talk calmly. Client: Maybe once or twice in the last year. Counsellor: Let’s look at those two times. I’m really curious about what was different about them that enabled you to talk without fighting. Pick one time that worked best. Client: That’s easy. My son was excited because he was going to a rock concert and he was in a really good mood. I felt more relaxed too. He just seemed more approachable that day. Counsellor: Have you considered that part of your success might have to do with your mood Perhaps your son was more approachable because you were more relaxed. Client: Interesting point. Counsellor: Let’s explore that a bit further. Because you were more relaxed what else was different about the way you handled this encounter Client: I didn’t feel stressed so I think I was more open to listening to him. Counsellor: What were you doing differently Client: I let him talk without jumping in to argue. The counsellor’s goal in the above interview is to find what works and then to encourage the client to apply successful solutions more frequently. The process is as follows: 1. Identify exceptions to those times when the client is having difficulty. 2. Explore what was different about those times including what specifically the client was doing differently. 3. Identify elements e.g. behaviour setting and timing that contributed to a successful solution. 4. Help the client increase the frequency of the success-related elements when dealing with the problem situation. Clients are often more experienced in using ineffectual strategies to deal with their problems. Despite the fact that these strategies do not work clients may compulsively repeat them to the point where they give up and conclude that their problems are hopeless. Consequently counsellors need to encourage clients to apply the elements of success. For example a behavioural rehearsal role play that focuses on systematic exploration of the elements of success can be used. Counsellors also need to encourage clients to pay attention to what they are doing when they are managing their problem as in the following case: Rodney came to counselling asking for help to quit what he described as “compulsive marijuana use.” He was concerned that he might slip into heavy drug use. The counsellor asked him to observe what he was doing when he was not using marijuana and what he did to overcome his urge to use. This technique empowered Rodney by helping him become aware 101

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of successful strategies he was already using. Subsequently he was encouraged to increase the frequency of these successful behaviours. Success Tip When using the miracle question it is important that the client not the counsellor generates the vision of the situation where the problem has been removed response to the miracle question. Similarly it is the client who must describe what changes or solutions need to happen for the miracle to occur. The role of the counsellor is to manage the exploration and solution-finding process. Finding Strengths in Adversity Hardships and difficulties often have positive spin-offs in that people develop skills to deal with their misfortunes or discover capacities that they did not know they had. Below are some sample probes: ■ How have you managed to keep going in conditions that would have defeated a lot of people ■ You have dealt with this problem for a long time. Many people would not have survived. How did you manage to keep going What strengths were you able to draw on ■ What have you learned from life’s trials and tests ■ Have hardships helped to shape your values and character in positive ways ■ People often develop talents or discover strengths from facing challenges. How has this been true for you Using Solution Talk Furman and Ahola 1994 introduced the idea of “solution talk” as a way to evoke a solution- oriented focus to the counselling interview. The goal is to create a climate of discovery and action. For example to get clients to notice their skills and capacities counsellors can use statements and questions such as “When you’ve successfully coped how did you do it” In addition counsellors need to be alert for opportunities to reinforce clients’ strengths. Personal qualities actions that underscore their determination attitudes positive decisions accomplishments effort toward change and courage in the face of adversity can all be used to bolster clients’ sense of capacity and self-esteem. Clients may already have a rich understanding of their problems and the ways in which they might be solved. So counsellors need to tap their clients’ expertise about possible answers to their problems. The central assumption here is that clients have the capacity to resolve their distress. ■ What solutions have you already tried ■ What would your best friend advise you to do ■ Suppose one day you received an invitation to give a lecture to professionals about the kind of problem you have had to live with. What would you tell them Furman Ahola 1994. ■ To solve your problem what will you have to do 102

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Creative solution finding can be stimulated with statements and questions such as these: ■ Let’s try to identify something different for you to do to solve your problem. ■ Let’s brainstorm ideas. Don’t censor anything. The wilder the idea the better. Reframing is another a way to help clients modify their thinking. Reframing suggests another way of looking at problems which in turn generates new ways of looking at solutions. Reframing is elaborated more in depth at another part of this guide. The Change Continuum Often clients are overwhelmed with the number and depth of their problems. Their despair can easily infect counsellors. The continuum is a tool to assist clients to become motivated in the direction of positive change. When clients can gain some control over their situation through small successes this promotes further optimism and change. Counsellors do not have to be involved for the whole change process. Sometimes helping clients head in the right direction is the extent of their involvement. Kim a young woman of 19 who is heavily involved in drugs seeks counselling for help “to get her life in order.” Counsellor: Uses a flip chart to draw the continuum depicted below. Kim think about an area of your life where you would like to make a change. The continuum represents things as bad as they could be if things got worse at one end and your ultimate goal at the other end. Kim: I need to change my whole life. Counsellor: Where are you on the continuum Kim: Draws a circle. I’m about here pretty near the bottom. Counsellor: What direction are you heading Kim: Draws an arrow. “My life is a mess and it’s getting worse.” Counsellor: Maybe you’d agree that the direction you’re heading in is ultimately more important that where you are on the continuum. Kim: Absolutely I can see that. Counsellor: So what’s one thing that would need to happen for you to change directions Kim: That’s easy. I need a place of my own and I need to get out of this area. Counsellor: Let’s start there and make that the focus of our work. Comments: The continuum has a number of useful features. It is visual which makes it easier for some clients to understand. It is a quick way to prioritize complex problems and goals. This helps clients generate a sense of control and direction. Once completed it provides shorthand communication for counsellors and clients. The two basic questions of the continuum can be used at the beginning of subsequent interviews to assess progress and to identify emergent issues: “Where are you on the continuum” and “What direction are you headed” 103

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2. Cognitive Behavioural Counselling Watch your thoughts they become words. Watch your words they become actions. Watch your actions they become habits. Watch your habits they become character. Watch your character it becomes your destiny. —Frank Outlaw Cognitive behavioural counselling therapy or CBT has been empirically tested in hundreds of studies. The results have demonstrated its usefulness for a wide range of social emotional and mental health problems such as mood disorders depression bipolar disorder anxiety disorders obsessive-compulsive disorder post-traumatic stress disorder substance use problems eating disorders gambling problems anger personality disorders stress and unresolved grief Butler Chapman Forman Beck 2006 Chamless Ollendick 2001. American psychiatrist Aaron Temkin Beck 1921– is considered the founder of CBT. The central assumptions behind Beck’s approach are these: ■ Problems/distress is caused by faulty thinking cognitive distortions and negative interpretation thus our thoughts and beliefs affect our behaviour and emotions. ■ People may pay too much attention to anxiety-provoking stimuli rather than to neutral or positive stimuli. ■ Behaviour is learned it can be unlearned. The key to changing problematic behaviour or emotions is to explore and modify distorted thinking and then to learn and practise new responses. CBT focuses on understanding current thinking the present and problem solving to develop new behaviours. Marie and Aiesha are passengers on the same airline flight. Marie is consumed by her fear that the plane will crash thinking “This is a dangerous situation. What if the engines fail And air turbulence will surely tear the plane apart.” Aiesha boards the plane and quickly immerses herself in a book with no intrusive thoughts of dying. Ellis 2004 developed the famous ABC model Figure 7.2 as a tool for understanding why Marie and Aiesha experience the flight so differently. In the model: ■ A represents an activating event in this case the airplane flight. ■ B refers to the beliefs that are triggered by the activating event A. ■ C is the consequent emotion or behavioural reaction. Clearly Marie’s beliefs about flying are markedly different from Aiesha’s. Cognitive behavioural counselling would concentrate on how Marie can modify her thinking about flying which is based on erroneous and distorted beliefs about its dangers. A Activating Event B Beliefs C Consequent Behaviour or Emotion Cognitive behavioural counselling uses a combination of methods to help clients learn more effective coping strategies including: 104

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■ helping clients recognize and modify thinking patterns ■ a wide range of techniques to help clients understand and modify behavioural patterns. This includes such tactics as “autopsies” a detailed review of actions to see what went wrong contingency planning goal setting relationship problem solving anxiety management and the use of homework. As well exposure can be used in real or imagined situations to assist clients to systematically overcome anxiety. Drama Cycle/Drama Buster The Drama Cycle is • a repetitive automatic pattern of behavior that is “thought-driven” followed by feeling followed by action • pattern happens in a 4-part cycle that‟s complete within 30 seconds or less • words issues dishonored values situations /or personalities trigger our “drama cycles.” • when our drama cycles are triggered our communication becomes distorted ineffective – it prevents effective listening • we tune out prejudge criticize condemn speaker situation self. The Drama Buster is a 4-step process to assist you to recognize and bust your drama cycle: Set 1: Thought_______________ Feeling________________ Action_________________ Set 2: Thought_______________ Feeling________________ Action_________________ Set 3: Thought_______________ Feeling________________ Action_________________ Set 4: Thought_______________ Feeling________________ Action_________________ 105

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Recognizing and Modifying Thinking and Core Beliefs Frequently clients have difficulty breaking out of established patterns because of the way they think about issues or problems De Bono 1985. In addition dysfunctional thinking patterns that affect reactions are frequently outside a client’s awareness. Success Tip If one’s thinking changes behaviour and emotions also change. If one’s behaviour changes thinking and emotions also change. If one’s emotions changes thinking and behaviour also change. Understanding how one thinks is crucial to the change process because thoughts precede and influence feelings and behaviours. Momentary thoughts are heavily influenced by core beliefs or schema so it is important to recognize that how one thinks is not necessarily driven by fact. Schema or core beliefs are defined as the “basic beliefs individuals use to organize their view of the self the world and the future” Sperry 2006 p. 22. Maladaptive beliefs can lead to distress inaction low self-esteem depression and reluctance to engage in healthy risk- taking such as initiating social relationships. Cognitive behavioural counselling helps clients to recognize automatic thoughts identify “errors in thinking” and explore how thoughts hinder them from reaching goals. Once clients become aware that an automatic thought is about to happen they can practise replacing that thought with an alternative. This interrupts the repetitive cycle of problematic behaviour. On a broader level clients learn to understand and modify schemas that drive dysfunctional behaviour and painful emotions. Example: A new social setting triggers Troy’s automatic thoughts: “I don’t belong. I won’t fit in.” These thoughts originate from his core belief “I am unlovable.” His automatic thoughts and his core beliefs create anxiety and fear. His strategy is to use drugs to curb his anxiety which in turn lead to the new belief that he won’t be able to cope unless he uses drugs. Maladaptive unhealthy and Adaptive healthy beliefs • I am unlovable. • I am a person worthy of love and respect. • To seek help is a sign of weakness. • I can ask for and offer assistance. • Without a relationship partner I am nothing• I am responsible for my own happiness • I will fail. I am helpless. • I will do my best savour my success and learn from my mistakes. • I have to be loved by everyone. • I accept that not everyone will love me. • I must be perfect in everything that I do • I accept my limitations -they dont diminish me. • I must be seen by others as the best. • I am special I can take advantage of others • My rights as well as the rights of other people need to be respected. 106

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Common Thinking Errors Since major errors in thinking may be outside one’s awareness and can easily lead to faulty interpretations and maladaptive behaviour it is important to understand the major types of thinking errors such as distortion selective attention magnification/minimization perfectionism and self-defeating thought. Distortion Distortion results from misinterpretations faulty assumptions or cultural biases. Here are some common examples: ■ Misreading another person’s silence as lack of interest mind reading. ■ Assuming that others should know what we want need or feel without being told. ■ Interpreting lack of eye contact as a sign of disrespect or lying when in fact the other person is from a culture where direct eye contact is discouraged. Selective Attention Selective attention errors arise from a failure to look at all aspects of a problem or situation. For example: Only listening to information and facts that support your point of view. De Bono 1985 made this important observation: “Unfortunately Western thinking with its argument habits prefers to give a conclusion first and then to bring in the facts to support that conclusion” p. 35. Rigid thinkers act as if to say “We’ll keep talking until you agree with me.” ■ Selective memory: This behaviour involves recalling only selected aspects of the past. We might overlook events or facts that threaten our self-image. Conversely people with low self- esteem may overlook evidence to the contrary remembering only their failures and mistakes. ■ Losing focus on what a person is saying: This happens because of factors such as lack of interest preoccupation with other thoughts or distracting noise. ■ Focusing only on the present: For example prison inmates may overestimate their ability to cope with life outside jail. They may become clouded by unrealistic optimism that they will be able to avoid getting caught again or beat any charges if they are caught. In addition they may neglect to consider the long-term consequences of their criminal behaviour a pattern of thinking that is characteristic of lifestyle or habitual criminals. Walters 1991 reached this conclusion: “Until high rate offenders realize the self-destructive nature of their super- optimism they will continue to resist change because they are operating on the mistaken belief that they can get away with just about any crime” p. 36. Walters sees lazy thinking as the root of the offenders’ problems. Even those with the best of intentions may find themselves in trouble because they fail to think about long-term outcomes. ■ Egocentric thinking: Errors of this kind come from a failure or inability to consider other people’s ideas or to look at how one’s behaviour affects others. People may adopt an arrogant position of self-righteousness confident that their ideas and conclusions are sound. Egocentric thinkers are likely to be seen by others as aggressive and insensitive interested in meeting only their own needs. Egocentric thinkers are not only poor thinkers but also poor listeners. Typically they believe that the purpose of thinking listening and responding is to prove themselves right. De Bono 1985 contends that self-protection is a major impediment 107

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to their thinking: “The main restriction on thinking is ego defence which is responsible for most of the practical faults of thinking”. Magnification/Minimization These types of thinking errors distort facts by extreme and exaggerated thinking. Some examples: ■ Splitting—the tendency to interpret people things and experiences as either totally good or totally bad with no shades of grey. ■ Overgeneralization—drawing conclusions from a single fact or event. For example after being turned down for a job a man concludes that he is worthless and no one will ever hire him. ■ Discounting—rejecting compliments by refusing to believe that the other person is telling the truth. ■ “Catastrophizing”—magnifying small mistakes into disasters or total failures. Perfectionism Healthy individuals set realistic challenging and achievable goals. They are motivated to do their best and they maintain high standards for themselves. Conversely people who are perfectionist set unrealistic standards of achievement with an expectation of constant success. Perfectionist individuals are under constant stress caused by the anxiety to perform or the realization that they have failed to reach or sustain their unrealistic expectations of self. Irrational beliefs that arise from perfectionism include: ■ I can’t make a mistake. ■ I am a failure if I am less than perfect. ■ I have no value unless I achieve the very best. ■ If I can’t be perfect then I might as well give up. ■ I have to be the best. To win is the only option. ■ I’m probably going to fail anyway so why try The personal cost of perfectionism can include chronic pessimism low self-esteem lack of confidence depression anxiety and obsessive concern with order and routine. Perfectionists frequently use the words must only always never and should the MOANS acronym. Self-Defeating Thoughts Self-defeating thoughts are irrational ideas about one’s own weaknesses. Albert Ellis has written a great deal about what he defined as irrational thinking and its impact on emotions and behaviour 2004 1993a 1993b 1984 1962. Ellis argues that people’s belief systems influence how they respond to and understand problems and events. When their beliefs are irrational and characterized by an unrealistic should they are likely to experience emotional anxiety or disturbance. This thinking is often accompanied by self-depreciating internal dialogue: “I’m no good” “Everyone must think I’m an idiot” and “No one likes me.” Ellis concludes that irrational beliefs fall into three general categories with associated rigid demands or shoulds: 108

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1. “I ego absolutely must perform well and win significant others’ approval or else I am an inadequate worthless person.” 2. “You other people must under all conditions and at all times be nice and fair to me or else you are a rotten horrible person” 3. “Conditions under which I live absolutely must be comfortable safe and advantageous or else the world is a rotten place I can’t stand it and life is hardly worth living” Wicks and Parsons 1984 offer a similar perspective when they suggest that many clients are discouraged because they set unattainable goals: “These goals are often based on irrational simplistic views: 1 if a person acts properly everyone will like him and 2 either a person is totally competent or he is completely inadequate” p. 170. Helping Clients Change Thinking Patterns When people learn to pay attention to their thoughts they are more apt to test the reality of the truth of their beliefs. When people learn to recognize those thoughts that are dysfunctional perhaps because they impede action and goal attainment or they cause distress they can take steps to change their thinking. Among the strategies that counsellors can use to assist clients to change maladaptive thinking are the following: ■ reframing ■ encouraging clients to seek out information and data ■ suggesting to clients that they talk with others about their assumptions ■ Socratic questioning targeting overlooked areas ■ direct challenge of the validity of beliefs ■ teaching empathic skills as a way to help clients learn about other perspectives ■ brainstorming to generate new ideas and explanations ■ thought-stopping techniques to overcome self-defeating inner dialogue Here are some examples of questions that can be used to help clients shift perspective: ■ How are your thoughts consistent with the evidence ■ How do you know this to be true Do you have facts or are you assuming ■ What are some other ways of thinking about your situation ■ If a friend thought this way about his situation what would you say to him Reframing Reframing is a counselling skill that helps clients shift or modify their thinking by suggesting alternative interpretations or new meanings. It empowers clients by focusing on solutions and redefining negatives as opportunities or challenges. Client stubbornness might be reframed as independence or greediness as ambitiousness. Example: Carl age 11 is playing baseball by himself. He throws the ball into the air and exclaims “I’m the greatest batter in the world.” He swings and misses. Once again he tosses the ball into the air and says “I’m the greatest batter in the world.” He swings and misses. A 109

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third time he throws the ball into the air proclaiming emphatically “I’m the greatest pitcher in the world.” Success Tip Help clients practise thought stopping to break the pattern of repetitive self-defeating thought patterns. Techniques include thought replacement immediately substituting rational ideas or pleasant thoughts for unwanted ones yelling “stop” in one’s mind until the undesired thought disappears snapping an elastic band on the wrist to shift thinking and activity diversion. Before presenting reframed ideas counsellors should use active listening skills to fully understand the client’s current perspective. As well empathy is crucial otherwise clients may conclude that their feelings are being discounted or trivialized. Moreover reframing should not be confused with platitudes such as “It’s always darkest just before dawn” which are typically not very supportive or helpful. An example of a well- meaning but misguided reframe that people give in times of grief over the loss of a child is “You’re young—you can have more children.” “Because strong emotions of sadness and loss are present most people cannot accept a reframing that does not take into account the most salient feature of their experience—the grief itself ” Young 1998 p. 282. Reframing should not trivialize complex problems with pat answers rather it should offer a reasonable and usable alternative frame of reference. Client’s Perspective or Statement Counsellor’s Initiative to Reframe This counselling is a waste of time. Sounds as if you’ve done some thinking about how our work could be more relevant to you. I don’t fit in. I come from a different culture and Of course. Some people have not had my ideas and values must seem strange. much experience with your culture and they may be frightened. Perhaps you could look at this in a different way. Your experiences might also be fascinating for people who have not lived outside the country. They might welcome your fresh ideas. I’m very shy. When I first join a group I usually You like to be patient until you have a don’t say anything. sense of what’s happening. People who are impulsive are working to develop You also seem to want to develop this skill. alternatives such as being more expressive in the beginning. For the first time in 20 years I’m without a job Obviously this is devastating. At the same time I wonder if this might also be an opportunity for you to try something different. Whenever I’m late for curfew mother waits up for I’m curious about why she might do me and immediately starts screaming at me. this. Perhaps she has trouble telling you how scared she is that something may 110

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have happened to you. It might seem strange but her anger could be her way of saying how much she loves you. My life is a mess. I’ve lived on the streets for the Sounds like you’ve had to survive under last six months. conditions that might have defeated most people. How did you do that Success Tip The fact that a client firmly defends a lifestyle that he knows is unworkable is proof that he is in need of great assistance and support. Wicks Parsons 1984 p. 171 Clark 1998 offers guidelines for using reframing: 1. Use reframing to help clients break out of thinking that is self-defeating constricted or at an impasse. 2. Make sure that clients are not so emotionally distracted that they are unable to hear or process the reframed idea. 3. Offer a reframed idea in a tentative way that invites consideration. 4. Ensure that reframed ideas are plausible. 5. Allow clients sufficient time to consider a reframed idea. Clients with firmly entrenched perspectives may not immediately accept logical and sound reframes but with gentle persuasion and patience they may begin to accept new ideas. Even though it may be obvious that a client’s thinking is distorted it may be wise to hold back on reframing until the client’s problem is fully explored. Moreover as suggested above it is important that the client’s feelings be acknowledged through empathy. Exploration and empathy ensure that the counsellor understands the client’s feelings and situation and they provide a basis for the client to consider reframed ideas as reasonable or worthy of consideration. If counsellors push clients too quickly clients may feel devalued and misunderstood and in response they may resist new ideas. Empathy helps counsellors to establish and maintain credibility with their clients. In addition counsellors can use directives to invite clients to use different language to describe the distorted idea Young 1998. For example when clients avoid responsibility for their actions with statements such as “I can’t get organized” counsellors can challenge them by proposing that they rephrase with statements such as “I won’t let myself get organized.” A client might say “She makes me feel hopeless.” In response the counsellor can propose that the client rephrase the statement by stating “I have decided to feel hopeless.” The latter response underscores the client’s control over personal feelings. As part of this work counsellors can empower their clients by explaining that clients have ownership over their feelings and that no one can make them feel a certain way. After offering a reframe counsellors should check for the client’s questions and reactions to it. Then if the reframed idea is accepted they can encourage further exploration and problem solving based on the new perspective. Reframing can energize clients. When clients are locked into one way of thinking about their problems their solutions are limited. But when they consider new perspectives problems that seemed insurmountable can yield new solutions. Moreover reframing can serve to redirect client anxiety away from self-blame and onto other rational explanations that are less 111

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self-punishing. In these ways effective reframing empowers clients to action problem resolution and management of debilitating feelings. When counsellors “consider the question ‘What’s good about it’ they give clients new perspectives on positive things that are already happening” Miley O’Melia DuBois 2004 p. 327. Cognitive Behavioural Techniques The following interview excerpt illustrates some of the essential strategies of cognitive behavioural counselling. The client a 40-year-old first-year university psychology student has sought help to deal with the fact that she has been “overwhelmed and depressed” since returning to school. Dialogue Counsellor: As we discussed one of the things we will do during our sessions is to explore how your thinking affects your feelings and your behaviour. Analysis Cognitive behavioural counselling requires a collaborative relationship. An important component of this is educating the client on how the process works. This will also help the client to make her own interventions when she recognizes problematic thinking. Client: I’m at the point where if I don’t do something fast I’m going to lose the whole term. I might as well drop out. Counsellor: You’re feeling desperate. Analysis In all phases of counselling empathy is an important response. More than any other skill it tells clients that they have been heard and that their feelings have been understood. Counsellor: Can you remember a time in the last few days when these feelings were particularly strong What was going through your mind at the time just before class Analysis Eliciting and exploring examples such as this provides a database for helping this client understand how her thoughts contribute to her feelings. Significantly probes to discover thinking patterns may reveal “inner dialogue” self-defeating thought patterns or images. Client: Yesterday I was scheduled to make my first class presentation. I was thinking that I was going to make a fool of myself in front of the whole class. Everyone else seems so confident when they talk but I haven’t been in school for 20 years. Counsellor: And that made you feel . . . Client: Stupid and terrified. I finally phoned in sick. Counsellor: So here we have an example of how what you were thinking—“I’m going to make a fool of myself”—influenced how you were feeling and what you did. Does this make sense to you Let’s use the ABC model to illustrate it. The counsellor uses a flip chart: A activating situation—thinking of making the presentation B belief—“I’m going to look like a fool” C consequent emotion—fear feeling overwhelmed. Counsellor: If you agree I’d like to ask you to make notes during the next week when you find yourself feeling worse. When this happens I want you to pay attention to what’s going through your mind. 112

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Analysis Earlier the counsellor and the client discussed the essential elements of cognitive behavioural counselling. Now the client’s example can be used to reinforce the principles. Using a flip chart or drawing is very helpful for many clients particularly for those who are less comfortable in the verbal modality. Homework is essential to effective cognitive behavioural counselling. Here the homework creates an opportunity for the client to become more familiar with how her feelings and behaviour are intimately connected to her thinking. In the next session excerpted below the counsellor uses reframing and thought stopping as tools to help the client change her thinking. Counsellor: Your journal is great. You’ve identified lots of great examples. Let’s try something different for a minute. What if it were possible to look at your fears differently Client nods approval. Analysis The counsellor introduces the possibility of reframing. Counsellor: I think it’s natural when we have a problem to dwell on all its unpleasant aspects. I know that I tend to do that unless I discipline myself not to. For example when you think of how nervous you are you think of all the negatives such as you might make a fool of yourself or your mind might go blank while you’re talking. Client: Laughs. Or that I might throw up in front of everyone. Counsellor: Okay those are real fears. But by considering only your fears you become fixated on the negatives and you may be overlooking some important positives. If you can look at it differently you might discover a whole new way of dealing with your class presentation. Counsellor: Want to try it The client nods. Okay try to identify some positive aspects of your fear. Client: Well I guess I’m not the only one who is scared of public speaking. Counsellor: So you know that there will be other people in the class who understand and will be cheering for you to succeed. Client: I never thought of that before. Here’s another idea: Because I’m so nervous I’m going to make sure that I’m really prepared. Counsellor: Great Do you think it might be possible to look at your fears differently Consider that it’s normal to be nervous. Or go a step further and look at it positively. Maybe there’s a part of it that’s exciting — kind of like going to a scary movie. Analysis The counsellor’s short self-disclosure communicates understanding and a nonjudgmental attitude. One tenet of cognitive behavioural counselling is that people tend to pay too much attention to the negative aspects of their situations while ignoring positives or other explanations. As a rule it’s more empowering for clients to generate their own suggestions before counsellors introduce their ideas and suggestions. In this way clients become self- confronting and are more likely to come up with ideas that they will accept as credible. 113

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In this example the client is able to generate a reframe which the counsellor embellishes. In other situations counsellors might introduce reframes of their own. The counsellor offers the client a reframed way of looking at nervousness. Client: I did come back to school because I hated my boring job. One thing is for sure I’m not bored. Counsellor: So the more you scare yourself the more you get your money’s worth. The counsellor and the client laugh. Counsellor: Here’s an idea that works. If you agree I’d like you to try it over the next week. Every time you notice yourself starting to get overwhelmed or feeling distressed imagine a stop sign in your mind and immediately substitute a healthier thought. Analysis The client’s response suggests that this notion is plausible. Spontaneous humour helps the client see her problems in a lighter way yet another reframe. Another example of counselling homework. The counsellor introduces thought stopping— a technique to help clients control self-defeating thinking Gilliland James 1998 Cormier Cormier 1985. The basic assumption is that if self-defeating thoughts are interrupted they will eventually be replaced by more empowering positive perspectives. At this point the counsellor could also help the client develop different choice strategies for dealing with dysfunctional thinking such as an activity diversion to shift attention use of a prepared cue card with a positive thought recorded imagining success or substituting a different image. Cognitive-Behavioral Therapy: Overview Cognitive-behavioral therapy CBT was pioneered in the late 1950s as an alternative to psychodynamic therapy. It is a general term for a classification of therapies that emphasize the role of thinking in how we feel and what we do. It is a fairly manualized and technical approach to therapy that is aimed at reducing or suppressing a person’s symptoms as quickly and economically as possible. There are a variety of approaches e.g. Rational Emotive Behavior Therapy Dialectic Behavioral Therapy Cognitive Therapy Exposure Therapy Acceptance and Commitment Therapy but most are based on the assumption that our thoughts cause our feelings and behaviors not external things like people situations and events. CBT aims to help the client to uncover and alter distortions of thought or perception in order to change their behavior and emotional state. CBT is a relatively brief or time-limited treatment. However to prevent symptoms from returning the client should continue to practice and develop the skills learned in CBT after the sessions have ended. Although the course of treatment for CBT is briefer it may take months or years of practice to learn to identify challenge and reshape one’s negative thoughts. Research studies indicate that CBT is effective. CBT lends itself to scientific study because it is time-limited and can be focused on specific circumscribed goals with more readily measured outcomes. In addition therapist interventions can be more easily standardized compared to psychodynamic therapy. It has been found to be effective for many conditions including the 114

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following:  depression  generalized anxiety disorder  social phobia  post-traumatic stress disorder PTSD  panic disorder  obsessive-compulsive disorder OCD  phobias  borderline personality disorder  addictions  insomnia  chronic pain Who is Best Suited for CBT CBT is a good choice for people with the following abilities and interests:  the capacity for introspection  preference for a short-term directive treatment  willingness to make ongoing efforts at self-analysis and at practicing coping skills during and beyond treatment Clinical Examples of CBT Cognitive Intervention Below are two examples or clinical vignettes that demonstrate a typical cognitive intervention called cognitive restructuring: Clinical Example 1 A woman seeks help for low self-esteem. The therapist might help the client identify her automatic negative thought patterns called cognitive distortions. This stage of treatment is referred to as functional analysis. Together they identify the client’s automatic thought “I am worthless.” The therapist then helps her learn to interrupt this thought pattern and replace it with a more positive one of her choosing such as “I have value.” They would attempt to do this with other cognitive distortions that contribute to her low self-esteem. Clinical Example 2 A man is having interpersonal difficulties with his wife who is often late. With the help of the therapist the husband might identify the meaning of his wife’s lateness. They discover that it means to him “my wife doesn’t love me.” The therapist then challenges his thought asking him if this is in fact a reality. The therapist then helps him learn to replace this thought when it comes up with an alternative thought that the client feels to be true such as “my wife loves me she is simply disorganized.” Behavioral Intervention Cognitive behavior therapy also focuses on changing a persons unhealthy and problematic behaviors actions and responses. The focus is on replacing the problematic behavior with a more effective behavior. Clinical Example 3 A man recovering from alcohol addiction works with his therapist to identify high-risk situations that trigger the impulse to drink. Together they develop strategies for overcoming 115

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these impulses. The client begins to learn and practice new coping skills and rehearses ways for example to avoid or deal with social situations that might trigger a relapse. These might include relaxation techniques mental distractions or substituting another less harmful behavior. 3. Psychodynamic Psychotherapy: Overview Psychodynamic therapy also known as insight-oriented or psychoanalytic therapy examines the complexities of interpersonal relationships. It stresses two important assumptions: 1. Each individual and their difficulties are unique. 2. Factors outside of our awareness influence our thoughts and behavior. Psychodynamic therapy is the oldest of current therapies and while it evolved from Freudian psychoanalytic theory it is also quite contemporary. It is generally what is meant by traditional “talk therapy”. Considerable research supports the efficacy of psychodynamic therapy. People and their problems are unique In this kind of therapy “one size fits all” prescriptives are not thought to be useful at producing lasting change e.g. "Ten Steps to Manage Depression" or "Five Time-Management Techniques to Stop Procrastination”. If such directive techniques appeal to you Cognitive- Behavioral Therapy CBT may be a better fit for you. Psychodynamic therapy assumes that our personalities are shaped by several developmental stages. What happens when we are infants children adolescents and young adults affects the way we see the world the types of relationships that we have and the way we feel about ourselves in relation to others. Therefore your therapist will try to understand your difficulties in the context of who you are as an individual including your family history and upbringing. Our difficulties often root in factors outside of our awareness Most people intuitively grasp that we all find ourselves behaving at times in ways we dont fully understand. Psychodynamic therapy is in part based on the idea that we are not transparent to ourselves and that sometimes what we do not know or understand about ourselves causes us problems. The less aware we are of these unconscious factors the more they control us and the more we stay stuck in unproductive patterns of thinking feeling and behaving that disable and limit us. These problematic patterns are sometimes more obvious to us in others than in ourselves. It’s easy to notice that a friend keeps getting involved with one troubled guy after the other. Or your brother who has so much potential but never manages to get his act together or your controlling co-worker who is always negative and pessimistic or your insecure over- achieving friend who works herself to death to the detriment of her family. The role of the therapist is to help you come into greater contact with yourself especially with thoughts and feelings that may not be readily visible to you. We all have psychological blind 116

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spots but the more we’re able to know ourselves the less these blind spots interfere with our being able to have nourishing healthy relationships and lead fuller more satisfying lives. Psychodynamic psychotherapy also makes use of the relationship that develops between the client and the therapist as a means of learning about how a client relates to others in his or her life. What types of problems respond to psychodynamic therapy Psychodynamic therapy can be useful for both general distress and more specific issues. Some examples of problems for which it is helpful include:  repeated disappointments in relationships  discouragement depression loneliness  anxiety and fears  low self-esteem  fear of emotional intimacy closeness and trusting others  inability to sustain feelings of pleasure or happiness  self-destructive behavior patterns  lack of goals difficulty in concentrating or feeling motivated  physical problems that have a psychological origin Who benefits from psychodynamic therapy People who tend to benefit most from psychodynamic therapy are generally those who are curious about themselves and seek self-knowledge in addition to symptom relief. Some of the personal qualities that can facilitate this type of therapy include:  the capacity for self-reflection  a curiosity about oneself and one’s internal life  a desire for honesty and truth  a willingness to tolerate vulnerable and painful feelings  and last but not least a sense of humor Psychodynamic Therapy: Clinical Examples To illustrate how psychodynamic therapy works below are examples or clinical vignettes of three different individuals with a similar problem lateness or tardiness. These vignettes were designed to illustrate the therapeutic process and a similar problem was chosen for each vignette intentionally to highlight the unique meaning and motivation that a single issue or symptom may hold for each person. The cases are disguised amalgamations to protect client privacy and confidentiality. Psychodynamic Therapy Vignette 1 A man comes to therapy stating among other issues that he has been late to several recent job interviews though not to other meetings or appointments. He is in the process of attempting to advance his career and being late to interviews is sabotaging his success. The therapist and client discover that trying to advance his career evoked deep feelings of insecurity and fears of failure. While being late for interviews did effectively sabotage his success it was easier for him to write this off in his mind as a relatively minor problem around time-management safeguarding the idea in his mind that he was otherwise capable of and deserving of a promotion. It allowed him to avoid giving his full effort to obtain a promotion and to avoid suffering the associated risks of rejection and failure which he imagined would be much more devastating than the relatively minor embarrassment of 117

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rejection based on his lateness. Once this was brought more into his awareness through therapy he gradually became better able to recognize and work through his insecurities and confidence issues which in part had roots in his relationship with his father freeing him to advance his career. Psychodynamic Therapy Vignette 2 A woman comes to therapy stating that she is chronically late and has done everything that she can to change this through a variety of organizational tools and methods but to not avail. Her tardiness is interfering with her work and relationships. The therapist and client discover that being early or even on time put her at risk of waiting for the person that she was meeting. Waiting evoked uncomfortable needful feelings especially when she was waiting for someone on whom she was reliant. This in part had roots in traumatic experiences in her childhood around being forgotten by her parents and having to wait for them: in those situations she had felt helpless frightened and dependent. With the help of her therapist she gradually grew to tolerate her needful and dependent feelings and with that no longer needed to eliminate these feelings either by being late or through other problematic behaviors. Psychodynamic Therapy Vignette 3 A man comes to couples therapy with his wife and among other issues reports that over the past few years he has developed a habit of being late specifically when meeting or going places with his wife. The therapist and clients discover in couples therapy that the couple developed relationship difficulties during the same period that he began to be late when meeting his wife. One way that the relationship problems manifested was in their sex life. His wife had lost interest in sex leading him to feel rejected and angry about waiting helplessly for his wife’s interest to return. He turned his experience with his wife around quite unconsciously by developing a habit of lateness with her. This effectively put his wife in his shoes making her feel devalued while longing for and waiting helplessly at the hands of another. As these dynamics were brought into more awareness in the couples therapy the underlying feelings gradually could be thought about and expressed productively in words instead of problematic actions. Summary These three vignettes convey how a common problem of lateness can hold unique unconscious motivation and meaning for different individuals. Through these examples you might be better able to grasp what psychodynamic therapy is based on and get a sense of how it works. Cognitive-Behavioral Therapy CBT versus Psychodynamic Therapy What’s the Difference While both aim to reduce symptoms and distress perhaps the most central difference between CBT and psychodynamic therapy is that psychodynamic therapy tries to get at why you feel or behave the way you do i.e. uncover deeper and often unconscious motivations for feelings and behavior whereas CBT does not. CBT simply attempts to alleviate suffering as quickly as possible by training your mind to replace dysfunctional thought patterns perceptions and behavior without asking more about them with more realistic or helpful ones in order to alter behavior and emotions. Advocates of psychodynamic therapy argue that for many issues a deeper treatment is required to produce lasting change. Advocates of CBT argue that their briefer methods are 118

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just as effective. And while a subject of controversy the research data generally support both approaches. Features of CBT:  It is relatively brief and time-limited twelve weeks to six months.  It is highly instructional in nature and homework is a central element.  It is highly structured and directed with the therapist setting the agenda for each session based on mutually set goals.  It focuses on the here-and-now only and not a person’s history.  The relationship with the therapist is not a focus of the treatment. Features of Psychodynamic Therapy:  While it can be brief it is often longer term six months or longer.  It is less structured typically without homework assignments.  The client not the therapist sets the agenda for the session by talking about whatever is on their mind.  It focuses on the here-and-now as well as on personal history.  The relationship with the therapist is included as a focus of therapy. Hear from the Experts: Ryan Howes PhD in “The Seven Questions Project” for Psychology Today recently asked very high ranking clinicians of different theoretical orientations and styles the same seven questions about their approach to psychotherapy. Links to the CBT and psychodynamic interviews are provided below. These responses will give you a sense of the difference between cognitive-behavioral and psychodynamic approaches. CBT Respondents Judith S. Beck PhD internationally renowned cognitive therapist Donald Meichenbaum PhD co-founder of CBT Psychodynamic Respondents Glen O. Gabbard MD internationally renowned psychoanalytic/psychodynamic psychiatrist Ryan Howes PhD psychodynamic psychologist writer musician and professor CBT and Psychodynamic Therapy: Pros and Cons Clinical research generally supports the efficacy of both CBT and psychodynamic therapy. Deciding which one is better for you depends to varying extents on:  Which approach appeals to you  Finding a “good fit” with a competent therapist of either orientation  Your reasons for seeking therapy your level of commitment and your financial resources PROS of CBT While it is collaborative CBT fosters a more independent effort on the part of the client. As such it involves less reliance on the therapist than psychodynamic therapy. Some people prefer this. Many people cannot afford or don’t want to go to ongoing therapy six months or longer and prefer to try to use the more directive skills learned in a time-limited e.g. 12-16 weeks CBT treatment on their own. CBT is particularly good for recent onset and relatively circumscribed issues or specific goals. 119

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CONS of CBT While some people find CBT helpful others dislike it feeling they are being talked out of their emotions. Some find that CBT’s focus on positive thinking feels too superficial to them minimizing the importance of their personal history. Others find they don’t like the way CBT downplays emotions while seemingly overemphasizing the logical and thought-oriented components of ones mental life. Still others find they don’t get the results they desire with CBT and find that while psychodynamic therapy is more of an investment it is more effective for them. PROS of Psychodynamic Therapy Those who find psychodynamic therapy a good fit tend to swear by it. It attempts to address the root causes of psychological issues compared to CBT. As such the benefits are thought to be broader-based and longer lasting. Psychodynamic therapy is particularly good for more general distress psychosomatic conditions and personality patterns or tendencies such as repeated difficulties in one’s work or relationships. CONS of Psychodynamic Therapy While psychodynamic therapy can be brief it does tend to take more time than CBT. Some people don’t find psychodynamic therapy to be a good fit. They may find it difficult to accept that factors outside of their awareness influence their thoughts and behaviors. Others are reluctant to think about their childhood or the relationship that develops with their therapist. Psychodynamic therapy is less structured than CBT and some prefer the more focused and directive approach of CBT. Source: Renée Spencer PhD MFT: Founder - Dr. Spencer has a psychotherapy practice in San Francisco- California: Education:  Psychoanalyst-in-training San Francisco Center for Psychoanalysis 2009-present  M.A. Psychology California Institute of Integral Studies  Ph.D. Pharmaceutical Chemistry University of California San Francisco Credentials:  Licensed Marriage Family Therapist Licensed Marriage Family Therapist 40511  Board Certified Psychiatric Pharmacist Registered Pharmacist Licencse 43623 Affiliations:  Assistant Clinical Professor UCSF School of Pharmacy  College of Psychiatric and Neurologic Pharmacists CPNP Member  California Association of Marriage and Family Therapists CAMFT Member  Member of a directory of the most highly qualified therapists 120

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4. Empowering Language Replacing disempowering language with empowering language can transform our perspective. We can shift how we hold things even if circumstances remain the same. That shift can move us to a place of empowerment. Its part of recognizing that we are always at choice. How often can you replace… …with empowering language I should I ought to I will I choose to I need to Its important to me to I have to I choose to I want to I cant I am not willing to Ill try to I will I intend to I aim to I commit to I should have done Next time I can Next time I will but and I am just I am only I am You know like nothing needed kind of sort of nothing needed I would like to say/acknowledge/do just make the statement these prefaces diminish it Value In Replacing Disempowering With Empowering Language Language as our expression of thoughts and feelings has the power to transform. Its inextricably linked to our view of reality. By changing our language we can affect our view of reality which is in effect our reality. Ive observed significant energy shifts as clients replace disempowering language with empowering language. This means that just by changing our language we can move from playing the victim to having choices from feeling powerless to being in control of our life from fear to love. And we can move into action: "I really want to…" → "I will…" "I have to…" → "I choose to…" But… → Personally I have replaced most uses of "but" with "and". I picked this because when I read the empowering language table above it was the entry most charged for me My initial reaction was "But is a perfectly good and useful word. Why should I replace it" Holding Space For Both The word "but" separates two clauses representing things that are in some way in opposition. The implication is often that one or the other must be chosen or one or the other is true. The word "and" just conjoins two things in a list with a sense of inclusivity. Technically the word "but" expresses more information about the relationship of the things being described AND using an inclusive conjunction "and" serves better to hold space for both expanding the possibilities as Im considering the issue. 121

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"I" Statements Another important piece of using empowering language is using "I" statements. These are claims a person makes about themselves using the pronoun "I" rather than "you". For example imagine I said "You know how you sometimes dont want to get up in the morning Having the aroma of freshly brewed coffee reach your nose can really help" Clean CommunicationI am in fact telling you something about myself: "Sometimes I just dont want to get up in the morning. Having the aroma of freshly brewed coffee reach my nose can really help" Expressed using "you" and "your" Im implying that you should agree. However you may never have trouble getting up in the morning or you may not even like the aroma of coffee. Rather than assuming these things and telling you what will help you its much cleaner if I just claim what is true for me. Then if you notice that resonates with you you can offer your agreement. The value in using "I" statements is ownership. When I use "I" statements I am owning what I say as my view or reality. I am not projecting it onto "you". This facilitates my separating my issues from your issues so that I can deal with mine and dont have to take responsibility for dealing with or responding to yours. Thats a win for me. How about for you 122

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5. Sample Formats for Sessions Sample Format for First Session 1. Orient Client: Small talk State your desire to be helpful and the importance of client feedback. 2. Identify the Problem Determine the client’s main concern and clarify details Who/what/when/where What’s already been tried and how well has it worked How can I help you with this. 3. Create Useful Goals: Use rating scales or other methods to create useful goals What will you do different when this mark moves a little higher What will a 3.5 look like. 4. Identify Exceptions and Other Resources: Exceptions When is the problem absent or less noticeable What is different about those times Other Resources Explore the client’s special talents and interests resilience heroes influential people solution ideas and other resources. 5. Can Interventions Be Built from Exceptions or Other Resources If yes collaborate to develop interventions based on exceptions or other resources. If no move to the next step. 6. Change the Viewing or Doing of the Problem: Viewing Invite client to consider a different view/explanation/interpretation Doing Invite client to “do something different” 7. Compliment Review Session Rating Scale Wrap-Up: Compliment the client on positive attributes coping persistence and other assets Review/refine intervention plans and responsibilities Address closing questions or comments from the client Administer/discuss rating scales 8. Thank client for cooperation and input 9. Schedule next meeting. 123

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Sample Format for Second and Later Sessions 1. Assess Progress: Use rating scales or other client feedback/scaling technique to assess progress from the client’s perspective. 2. When improvements are reported: a. Ask for the client’s theory How do you explain this b. compliment and credit the client How did you make it happen c. Explore exceptions What was different this week d. Empower progress How is life different for you now. 3. When no change or slips are reported: a. Ask for the client’s theory What do you make of that Should we try something different or hang in there and see what happens next week b. Normalize and validate Sometimes it takes a while to get some traction Sometimes things get worse before they get better c. Ask coping questions Where do you find the strength to keep trying d. Explore exceptions and other resources As bad as it was was there any small thing that went well this week How did you keep things from getting worse. 4. Can Interventions Be Built from Exceptions or Other Resources If yes collaborate to develop interventions based on exceptions or other resources. If no move to the next step. 5. Change the Viewing or Doing of the Problem: Viewing Invite client to consider a different view/explanation/interpretation Doing Invite client to “do something different” 6. Compliment Review Session Rating Scale Wrap-Up: Compliment the client on positive attributes coping persistence and other assets Review/refine intervention plans and responsibilities Address closing questions or comments from the client Administer/discuss rating scales 7. Thank client for cooperation and input 8. Schedule next meeting or terminate services based on client progress and input How will we know when to quit. 124

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Chapter 4: The Crisis Intervention Process 1. What is involved in the crisis intervention process 1. TAASA outlines nine steps for effective crisis intervention: 1. Establish Rapport 2. Active Listening 3. Define the Problem 4. Assess the Situation 5. Explore Options 6. Discuss Acceptable Alternatives 7. Referral 8. Closing 9. Follow-up 1. The first step establishing rapport is intuitive. No successful transaction occurs when there is a lack of comfort and trust. Both librarians and crisis counselors should work hard to make that good first impression. 2. The most striking similarity is that regarding the concept of active listening. According to Bopp “Active listening involves reflecting back to the user the librarian’s understanding of the question to verify that it is being properly understood.” TAASA advises a crisis coach to “check out what you understand them to be saying to see if you are on the same wavelength.” Active listening can serve much the same purpose in both situations: clarifying the problem or question making sure that it is being understood completely rephrasing it to cast it in a different light and using this broadened understanding to form an action plan. 3. The third step recommended by TAASA is defining the problem. This is necessary in all reference interviews. Hoskisson stated that the first question asked seldom addresses the true need. Eidson recommended that librarians should be able to adjust to a question that changes as the conversation continues. In crisis coaching defining the problem might involve isolating the survivor’s true emotions and needs. In a reference interview the patron’s emotions might play a lesser role but the patron’s needs are still paramount. 4. The fourth step assessing the situation is crucial to conducting a successful interview. The librarian should take stock of the patron’s appearance and behavior. Is she nervous or agitated Are her questions clearly articulated or frantic Such an assessment might help the librarian learn the immediacy of the patron’s needs. 5. Exploring options and 6. Discuss acceptable alternatives are an effective way to help a survivor in her decision-making process. TAASA recommended avoiding advice and presenting all of the available options to the survivor. A survivor who has options from which to choose is taking back power over her own life from the assailant who took it away. Librarians should be interested in giving complete information including options for finding help but a survivor might not be interested in all of the options. A librarian should understand that this does not mean that the interview has been unsuccessful. 7. If a referral is necessary it is a good idea to give more than one. If a patron is given several different sources of assistance this increases the options and gives back a small part 125

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of that power over her life that an abuser took away. Nolan advised that an unsuccessful interview should be ended with a referral. In the case of a possible survivor even a successful interview should be ended with a referral. It may not be possible to recognize a survivor so a referral to a rape crisis center “for more information” might be very useful for a survivor or even for a researcher. Many larger hould be aware of all campus resources. 8. The closing of a crisis coaching encounter is ideally initiated by the survivor. Nolan pointed out that a reference interview may be closed by either the reference librarian or the patron or both simultaneously. He recommended that a librarian encourage the patron to come back for more help if necessary. It may appear that in this situation the librarian is closing the interview but in actuality he or she is leaving it open to continue at a time of the patron’s choosing. TAASA also recommends that the crisis coach let the survivor know that calling the hotline was the right thing to do and that it is the first step in the healing process. Eidson recommended a similar approach but at the beginning of the reference interview. He suggested affirming that the patron has come to the right place and the librarian is open available and ready to help. This approach is well-placed at either end of the interview with a survivor. At the beginning of the interview it may encourage the survivor to relax and be more willing to ask questions openly knowing that she will be heard and respected. At the end of the interview such an approach may make the survivor feel comfortable returning to the library and working with its staff. It may also make her feel that if the librarian is kind encouraging and affirming there may be others who are the same way. This might encourage her to seek the assistance of counseling professionals. 9. Follow-up is defined as summarizing the encounter encouraging the survivor to call the crisis center anytime and saying goodbye. This leaves the decision of whether to have any more contact with the crisis couach in the survivor’s hands. Nolan takes much the same position. In a crisis intervention situation it might be helpful to offer to call the survivor a few days later in order to offer additional help. A follow-up call of course should only be made with the survivor’s permission. This is an excellent practice for librarians too. A reference librarian may need to contact a patron to offer additional information found after the patron has left or for related purposes. If the patron is currently in an abusive relationship or does not want the people in her household to know that she has been assaulted a call from a librarian may raise suspicions. If a patron does not give permission it is best to wait for the patron to come back or call. 2. Alan A. Roberts identifies seven stages of working through a crisis situation with someone: Source: Crisis Intervention and Time Limited Cognitive Treatment. 1. Assessing lethality potential for harm to self or others and safety needs 2. Establishing rapport and communication 3. Identifying the major problems 4. Dealing with feelings and providing support 5. Exploring possible alternatives 6. Formulating an action plan and 7. Follow up measures 126

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1. A brief assessment of lethality and safety needs An assessment of lethality and safety needs should be done in any telephone screening or face to face assessment and should hold an important place in any intervention. Is the person safe Is the person alone Does the person intend harm to self or others Does the person have means to carry out his or her intentions These screenings must be done with sensitivity. Some callers are offended if asked questions about suicidal or homicidal intent before they are allowed to identify the issues that they are calling about. Assessment of danger to self or others should continue throughout any crisis assessment crisis intervention and crisis stabilization process. Lethality and safety needs are however not the only elements of a telephone screening or face to face assessment. What is the first step in interviewing in a personal crisis "In the midst of a crisis or most other times for that matter people want to be heard understood validated and valued as a human being. Instead we are likely to get advice "I told you so" or "you think you have it bad." A person in crisis needs to be empowered given choices options resources encouragement and hope. A responder needs to establish rapport and communication with the person. One of the best tools in building rapport and communicating clearly is active listening. 2. Active Listening “Active Listening provides empowerment. As a listener you dont have to „do anything „fix anything or „change anything. When people are „heard they will „do „fix and/or „change things for themselves.” Listening is an art. A lot of people stop talking and in their mind theyre already trying to think of what theyre going to say next. That is not really listening. If you are preoccupied with your own thoughts then there is no room for the other anymore. Not really. And even if you are listening and not busy with your own thoughts on the matter listening is so much more than just hearing the words and being able to repeat them. To get the essence of whats being said -the words behind the words is just as important if not more so. While the other person is telling his story try to also listen for things like a slip of the tongue jokes omissions recurring themes metaphors and contradictions. They can speak volumes. Apart from the intonations you can pick out the different emotions in the individuals voice. Body language and other signals can strengthen or weaken the story. Contradictions are called incongruence and you can either keep these in mind or ask about them. Make sure you do this carefully so the other wont feel caught out. In active listening the personal crisis intervention provider has an open and alert attitude hes completely there for the other and is peeling his ears so to speak. To listen empathically means that the service provider shows a lot of understanding for what the other is experiencing and in a way he manages to convey this warm understanding to them who can appreciate it. Before asking questions we must learn to listen attentively and effectively. Active listening is a major part of communicating well. It is extremely important and necessary. 127

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By actively listening to a persons story the responder will hopefully accomplish the following with the individual:  Find out what their real needs are  Understand their reality and emotions  Know what is motivating them and what is keeping them back  Help them make sense of what happened  Validate their concerns emotions and reactions  Offer perspective from your objective viewpoint  Provide hope and a sense of direction  Point out resources they may have forgotten  Give them power to make choices and take action.  Set correct and smart goals  Concentrate on one goal at the time  Plan good action steps  Proceed towards their goal with enhanced commitment and accountability  Deal with setbacks and celebrate successes To the individual the personal crisis intervention services provider listening actively to them proves that they are taken seriously as a person and that the other is making efforts to understand their situation. Active listening sounds easy but it requires skill and practice. Active listening skills are essential for a crisis services provider. Good communication is a solid foundation for any relationship. Communicating well sounds easy but it is really quite complex in practice. Typical expressions related to active listening are: - If I understand correctly you think that … - So what you are saying is … - If you think … then I can see why this situation makes you upset - I understand why you are so …. - Wow I want to acknowledge the courage / maturity / persistence / … you have shown in speaking up to … / in taking this initiative … / in working so long … - In reply to a statement ask : how do you know - In reply to “I must”: what would happen if you don’t - In reply to “I cannot”: what is stopping you - In reply to “nothing all always never …”: ask to think of exceptions - If you don’t know what to answer ask: ask: Why do you say that Active Listening Skills Contrary to what some think active listening does not stop at listening and creating rapport by nodding and humming but involves a wide range of different skills. Each skill is used concurrently with the others while attempting to remain objective empathic and human.  Paying attention to body language  Minimal encouragements  Asking questions 128

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 Repeating and summarizing the message  Acknowledging the feelings expressed and the reasons for these feelings  Acknowledging the qualities shown that is: who they have to be to accomplish …  Probing for background information  Checking the quality of the communication  Paraphrasing  Reflecting  Summarizing  Emotional labeling  Validating  Reassurance  Encouraging and  Waiting. Paying attengion to Body language Body language is important. Excessive eye-contact may be felt as threatening. Not maintaining enough eye-contact on the other hand might be interpreted as a lack of interest e.g. when listener is repeatedly looking at their watch or documents on their desk or as an indication that the listener is hiding information or is not sufficiently open or honest. Body language includes affirmative head nodding and the use of silence which are powerful tools in any conversation. Gerard Egan describes the correct position for listening as follows : SOLER : Sit squarely face interlocutor O: keep an Open posture L: Lean forward when appropriate E: maintain regular Eye contact don’t stare R: Relaxed body language Show individuals that you are interested in the situations experiences and feelings that they are communicating and that you care not only about what they are saying but also about how this affects them. Using Minimal Encouragements Non verbal encouragement such as making eye contact nodding orienting your body toward the person and leaning slightly forward humming and short expressions like “Yes” ”I see" “go on” “what happened next” … are used to confirm the other person that you are listening to him keenly. These expressions also help them to understand which part of their message is being appreciated and to elaborate on that particular topic. Asking questions Asking questions is another way of showing your interest and making people feel understood valued respected and listened to. Well chosen powerful questions facilitate a person in finding his own answers. Life-coaching for dummies – Jeni Mumford 129

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Clarifying and reflective questions often are a very good idea: Clarifying brings unclear or vague subjects into sharper focus. It is useful to confirm what was said to get supplementary information to present fresh points of view or add details or to shed light on new elements. 1. Restate what you heard the trainee say 2. Listen for confirmation that what you are saying is correct 3. Encourage trainees to tell you if you are right or wrong Examples of clarifying questions: - Tell me more about … - Go on … - I am interested to hear more about … - What did you do then - You say … why is this so - Is this always the case - Let me see if I’ve got it all … - Let me try to state what I think you said … Examples of reflective questions: - How was this different from … - What would it look like if … - What would happen if … - What do you wish … - What did you want him to do instead - How would this impact / change … Repeating words content meaning and feelings Often enough it is also very useful to repeat in some way what they have said. This forces people to concentrate on what you are saying thus helping them to take some distance from their own story and obtain an improved general view of the whole situation. By repeating their messages you also stimulate their thought process without introducing new subjects. Different options to repeat a message are available: 1. Parroting : literally echo their exact words. Often only the last words are repeated mirror-questions in an invitation to amplify on them. The use of parroting should however be limited since hearing your own words echoed repeatedly soon becomes very annoying. 2. Repeating Content: This technique goes beyond parroting: The individual’s exact words are repeated inviting them to elaborate on their story or to continue it. 3. Repeating Conflict: Repeat both sides of a conflict situation opposing pros and cons stimulate them to make a considered choice. 4. Paraphrasing or Reflecting Meaning: Repeating the individual’s message in your own words that is: reflecting the facts or ideas but not the emotions and without getting 130

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emotionally involved may open new perspectives. Often an element of acknowledgement or positive feedback will be part of the paraphrasing thus motivating the other to continue sharing. Paraphrasing Paraphrasing expresses interest and focuses on the individual and his/her problem. By actively seeking clarity you achieve a shared meaning avoid misunderstanding and gain the trust of the person with whom you are speaking. Paraphrasing includes several elements. Repeating the intent or content of what the person has stated is very helpful in making sure that the responder understands the meaning of the words the person is using. Most people do this when communicating on a regular basis. Take this brief example: - A woman walks into her house after being at work all day. "Boy what a rough one" she says. - Her daughter asks "You had a bad day" - The woman responds by saying "No not the whole day just the drive home. The traffic was horrible." In this example the daughter stated what she thought her mother meant and the mother clarified. The daughter however does not use the same words to "paraphrase" her mothers statement. Crisis service providers must be very careful about parroting phrases that the person uses. Unless done thoughtfully this can come across as not hearing or mimicking the person. Clarifying can be done in a number of ways. The crisis service provider can simply say "I am not clear about what you mean when you say ..." or "Tell me more about that." Simple paraphrasing also opens the door for the person to restate his or her intent in a different way. In order to ensure a shared understanding of the situation the crisis service provider may want to summarize the information to be sure that he or she has understood correctly and has the whole picture. Simultaneously paraphrasing is - either a request for verification of your perceptions feedback - or a confirmation that you have correctly understood the message. Good openings for paraphrasing are: - So you think …. - You don’t believe that … - You don’t understand why … - So what you are saying is … - Sounds to me like you …. - The way you see things … - To you this means … - So you are saying that … - I guess it is your opinion that … - If I understand correctly … - You’ve always thought … but now you found out that … 131

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Some manuals use the term “reflecting” to indicate reflection of meaning thoughts only and use “paraphrasing” for referring to reflecting thoughts AND emotions Reflecting Feelings Reflecting Feelings - or Repeating Feelings - is very similar to paraphrasing but instead of reflecting the meaning the service provider now reflects the emotions that are the basis of other person’s words. Reflecting feelings resorts a much stronger effect because the individual will experience that the service provider is not only understanding him but is also empathizing with his feelings. Reflecting feelings is the basis of emphatic listening and creates rapport. Naming the feeling that you recognize in their story helps people to define and explore their own feelings and become more aware of their seriousness. Reflecting is very useful also when you feel people are rattling information without feeling involved. Reflecting gives the person an idea of what is being interpreted from their information. It can help him/her identify what he or she is feeling and projecting. Tone of voice and pointing out what is being heard or sensing helps make sense of the confusion and adds to rapport. Reflecting means telling the person how they are being seen such as "You look really worried scared etc." or heard such as "You sound very anxious angry etc.". Reflecting is giving feedback on the situation such as "You seem so tense right now what would help you relax while we talk" An objective party is an ideal person to provide this sort of feedback. Feedback is a way to communicate thoughts and reactions to another person. Example of a specific method to present feedback:  Identify what you are thinking feeling etc.  Identify the behavior that you think provoked your response.  Indicate how this might impact the individual. For example "It concerns me when you talk about committing suicide even though youve said that you are not serious it may scare others enough that they dont want to talk to you about it or about your situation." The person has a lot to gain by hearing honest direct feedback in a sensitive way. People who are too closely related to the problem may hesitate for fear of hurting someone fear of a reprisal or they may just feel inadequate in handling a sensitive situation. Unfortunately if the person is not aware of how his or her behaviour affects others he or she cant change. This type of feedback should always be given in a very thoughtful way or else the person may shut down and not discuss their thoughts or feelings with anyone. Good introductions for reflecting are: - You feel doubly hurt because … - The situation is worrying you … - You are disappointed … - You feel it’s a shame … - You are feeling sad … - You were angry because … 132

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- You don’t dare to … - You are afraid … - You must be very fond of him. - You feel you have failed … - You are worried that you … - You had the strong feeling that … - Yet I notice some doubt in your voice - You don’t sound very convinced though - And yet you sound sad. Maybe you can tell me what happened - I sense you are still angry troubled mixed up confused … maybe that’s why … Summative Reflection Summative Reflection involves summarizing the message in order to provide a structured complete and comprehensive feedback. Aside from organizing and integrating the major aspects of the dialogue summarizing also establishes a basis for further discussion and offers a sense of progress in the conversation. It is required to also plan regular summaries and evaluations during which you - repeat the essence of what has been said or done - provide a clear image of the situation - locate where the other is with respect to the total journey Logical moments for summarizing and evaluating are: - At the start and end of each session - At transiting to a new phase - At any moment that you feel a summary might be helpful to keep track of the situation or to stimulate the individual. Alternatively it is a good idea to ask individuals every now and then to summarize and evaluate things themselves. This will help you to take notice of - Their point of view - Which elements have stuck - What is most important to them now - What they are “forgetting” The most important elements in a summary are: - Accurate summary of core material - Clarity and structure - Reflection of content - Reflection of feelings - Deeper empathy 133

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Possible opening lines for summarizing: A. X let’s see how far you got until now: - You came to me X weeks ago because … and because …. - We determined that … because …. - Is there something you would like to add at this point B. So to summarize you say that … is that correct C. At that moment you set yourself the target of …. Because …. - To this end we composed an action plan - Now the question is when to start with the execution of this plan. D. Summarizing your story you reported that … but … and … - Can you agree with this presentation E. This seems a good moment to summarize what we have done during this session. - Is there something you want to add - How did you experience the conversation - By the next session I would like you to consider / go through today’s points again / to start the actions we agreed upon - Which would allow us to proceed next time with …. F. Is there anything you want to add Examples:  I dont understand why my wife is getting worked up I for instance never get mad  Still I hear a bit of anger in your voice. Your wife might perceive this as you being angry.  If you think it helps Im quite willing to do it you know  You dont sound convinced what might be holding you back  I actually wanted to stop coming here as I think Im doing much better now.  Im glad youre feeling a lot better and of course youre free to stop whenever you want. However Ive noticed there are still some things that seem to trouble you...  I havent touched a drink in weeks its clear Im not an alcoholic... hiccup  Being an alcoholic might be too strong a word but something tells me you still do have a drink regularly.  I dont know whats wrong with me or where to start.  We can take our time. You sound very sad maybe you could tell me what has happened 134

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Emotional Labeling During a crisis situation feelings are often confusing and hard to define. Helping the person label the emotions that he or she is feeling helps him or her to make sense and gain some control of these emotions. Labeling the emotions also gives the person a chance to clarify and correct the perceptions of the crisis service provider. Crises happen as a result of some loss real or perceived in a persons life. The pain felt in a crisis is grief over that loss. The loss may be something you can put your hands on like an automobile money or a home. It may also be less tangible like loss of self-esteem power freedom or prestige The resulting grief is the same. There may be a number of losses present in a single event. For instance it is not unusual for a widow to lose financial well-being because of her husbands death thereby she loses security power prestige and quite possibly friends and social contact. Two key elements in any crisis are grief/loss and anxiety. No one can predict exactly what a grieving person will feel like. However there are stages identified by Elizabeth Kubler-Ross which are seen in most people experiencing grief. The five stages of grief are: 1 Denial 2 Anger 3 Sadness/depression 4 Bargaining and 5 Acceptance These stages provide a road map of sorts that point out where someone may be in the process of his or her grief. Grief doesnt progress through the stages and end there. Rather it seems like a series of loops traversing the same ground over and over. We may be at different stages with each aspect of our grief at any given time. The following responses may or may not occur as a grief reaction. This is not meant to be a complete list other reactions may occur that are quite normal. Emotional reactions and their somatic or physical counterparts often occur in "waves" lasting a varied period of time. Emotional responses Sadness/Abandonment/Despair Anger/Rage/Resentment - Irritability/Vengefulness Relief Fear/Panic/Anxiety/Worry Guilt Feeling Lost/Numbness Hopelessness/Helplessness/ Somatic physical responses Tightness in the throat Shortness of breath Empty feeling in the stomach Nausea / Headaches / Dry mouth Weakness overall lack of physical strength 135

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Behavioral responses Crying at unexpected times Hostile reactions to those offering help or solace Restlessness Lack of initiative or desire to engage in activities Difficulty sleeping Constantly talking about the loved one and his death Isolation or withdrawal Increased smoking/alcohol use Cognitive responses Delusions/Hallucinations Nightmares Poor attention span/Indecision/Slowed thinking Disorientation/Memory problems/Blanking out Anxiety is an emotional response that can be expected to manifest in any crisis situation because there are no answers and seemingly no resolution. People may become afraid of the unknown or what they fear might happen. This projecting into an unsure future is a normal natural response to crisis situation. Anxiety also acts as a motivator to find options solace and resolution to problems. Sometimes anxiety can be experienced as free-floating fear or panic. Bereaved by Suicide Losing someone close to you brings about intense grief and mourning. The loss of someone through suicide often results in different responses and emotions. Bereavement by suicide is prolonged. Shock social isolation and guilt are often greater and the element of choice raises painful questions. You may experience some or all of the following: Intense Shock The sense of shock and disbelief following a death of this kind may be very intense. A common aspect of grief is recurring images of the death even if this was not witnessed. Finding the body may be another traumatic and indelible event. It is a natural need to go over and over the very frightening and painful images of the death and the feelings these create. Questioning - Why Bereavement through suicide often involves a prolonged search for an explanation of the tragedy. Many people eventually come to accept that will never really know why. During the search for explanations different members of the same family may have very different ideas as to why a death happened. This can be a strain on family relationships particularly where an element of blame is involved. Questioning - Could it have been prevented It is common to go over and over how the death might have been prevented and how the loved one could have been saved. Everything can seem painfully obvious in retrospect. The what-ifs may seem endless. Rewinding events is a natural and necessary way of coping with what has happened. Research suggests that some people bereaved by suicide feel more guilt self-blame and self-questioning than those bereaved in some other way. Abandonment / rejection You may experience a sense of rejection. It is common to feel abandoned by someone who chooses to die. 136

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"I was upset that he hadnt come to talk to us. I think we all went through anger at some point. You think: How could you do this to us ". A sister whose brother took his life. Suicidal fears and feelings Despair is a natural part of the grieving process but after the suicide of a loved one hopelessness may be combined with fear for ones own safety. Identification with someone who has taken their life can be deeply threatening to ones own sense of security. You may suffer more anxiety than those bereaved in other ways and be more vulnerable to suicidal feelings. Media Attention When someone dies by suicide or other unexpected causes it may attract public interest. The inquest that may be demanded by law draws attention to the person who has died and to close relatives and friends. Attention from the media can be very stressful for bereaved relatives and friends particularly where a death is reported in an insensitive or inaccurate manner. Stigma and Isolation Social attitudes to suicide are changing but they may still limit the support that is available. The silence of others may reinforce feelings of stigma shame and being different. If others are embarrassed uneasy or evasive about suicide you may be left feeling intensely isolated. Opportunities to talk remember and celebrate all aspects of a loved ones life and personality may be denied. A strong need to protect a loved one and oneself from the judgement of others may also be felt. A mother writing about her sons death pointed out that we have never been told what to say to someone who has had a suicide in the family. She needed to hear the same thing that might be said to anyone else who had experienced the death of someone close: "Im truly sorry for your pain and is there anything I can do If you need to talk about it I am a good listener. Ive got a shoulder to cry on." Needs: A group of Canadians bereaved by suicide were consulted and felt that they needed help and support to:  get the suicide in perspective  deal with family problems caused by the suicide  feel better about themselves  talk about the suicide  obtain factual information about suicide and its effects  have a safe place to express their feelings  understand and deal with other peoples reactions to suicide  get advice on practical/social concerns How to give support to a grieving person  Be available.  Remember that the individual is in a very different place emotionally.  If youre not sure what to say or do just ask. Say "Do you feel like talking about this right now" If they do be there for them.  Dont tell them you know how they feel unless youve really been there. You dont have to know exactly what they are going through to offer support.  If they dont want to discuss their heartache dont press the issue. Let them know that you are there for them regardless.  Dont treat the individual like an invalid. Encourage him or her to get out and get busy doing 137

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day-to-day activities.  Be supportive but not smothering.  Recognize that you may need your own support system. Sometimes you can give support and other times youll need to receive it. Dont expect yourself to always be the leader.  Watch out for a shift into depression. If you see the individual withdrawing into an emotion fetal position its time to intervene. Validation Perhaps the most important support to give to a person in crisis is validation. Validation is conveying that it is okay to feel whatever it is the client is feeling and that he or she is not alone in that given the same circumstances others might feel the same way. Affirm their worth and their efforts to cope with the situation. Crises spawn feelings of inadequacy. Reassure them that they can get through this crisis and that they deserve help when things seem intolerable. The most important thing is to somehow convey the idea that the feelings the person is having are normal. Some examples of validation are listed below: - "You dont sound crazy to me." - "Id be angry too if that happened to me." - "With so many things going on of course you feel overwhelmed I think anyone would in your situation." Affirmations Affirmations are simple direct statements that go a long way toward instilling confidence hope and reassurance. For example: - "Im glad you decided to talk to me." - "You sound like a very strong caring sensitive person." - "Im glad youve decided to get help you deserve it." - "You have a good sense of humor thats a great way to cope sometimes." It is very important not to make a statement that is not true. If you say that the person sounds like a sensitive person but do not believe that the person may sense that you are being less than truthful. False statements ruin rapport and trust. 3. Identifying a major problem A number of questions need to be answered to identify the nature of the crisis situation: 1 What happened to prompt the call 2 What led up to the precipitating event 3 Who is involved in the situation 4 What does the person feel 5 What do they fear Many of these questions will be answered as the person tells his/her story and rapport is built. The basic information needed is the answer to "Where does it hurt" and "How can I help" 138

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4. Dealing with feelings and providing support Responding to specific symptoms of behavior How can a person who is experiencing specific symptoms or behaviors be assisted Review the symptom behavior below with suggested actions. Symptom Behavior- Anxiety or Agitation - Decrease stimuli that might increase agitation - Identify the agitating stimulus and remove it if possible - Remain calm - Ask the person to slow down - Reassure the person that there is plenty of time to sort the situation out - Give the person enough personal space. You may wish to ask about what is "enough" as personal space varies. People who experience paranoia generally need more personal space. - Dont demand answers - Help the person find a safe quiet space as needed Symptom Behavior- Low self-esteem - Assist person in pointing out his or her own strengths but if he or she is unable then the crisis services provider can point out strengths - Do not discuss past failure or weaknesses unless brought up by the person - Discuss any weaknesses or past failure the person brings up in a tactful manner - Help the person problem-solve ways to deal with these perceived weaknesses Symptom Behavior- Oppression frustration loneliness feelings of guilt - Allow the person to vent his/her feelings - Listen and accept his/her feelings as stated - Allow the person to cry - Beware of trying to cheer someone up because the person may perceive this as minimizing the pain - Help in problem solving and making changes in behavior that will have an impact on the feelings Symptom Behavior- Hallucinations and/ or delusions or disorganized or illogical thinking - Do NOT dispute the persons reality of experiencing delusions or hallucinations - Accept that this is what the person truly believes or perceives - Do not encourage the person to express accelerated or illogical thoughts - Encourage the use of a quiet place - Stay calm - Word sentences in simple terms - Ask one question at a time - Be clear practical and concrete - Allow time for the person to decode your communication and form an answer/response - Act as a buffer between the person and outside stimuli or other people if needed Symptom Behavior- Slow response time - Be patient - Allow the person time to formulate a response 139

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Symptom Behavior Loss of contact with reality-based personal boundaries - Support reality-based statements - Do not encourage out of touch with reality statements - Be careful with the use of touch Symptom Behavior Difficulty with establishing self-initiated goal directed activity - Make expectations clear and realistic - Help the person identify meaningful tasks and break these down into "doable" pieces Symptom Behavior Difficulty making decisions - Decrease stimuli - Limit number of decisions to be made if possible - Take a directive stance about issues that relate to the persons safety Symptom Behavior Bizarre behaviour - Set firm limits - Identify bizarre or inappropriate behavior specifically. It is better to say "Wrapping your fingers with aluminum foil to block thought transmissions might seem strange to many people" rather than "You have some habits that other people would find strange." Symptom Behavior- Withdrawn behaviour - People with schizophrenia need a quiet place to withdraw and may wish to be alone more often than others - Allow the person some quiet time as a way to cope with chaos - Do not take withdrawal as rejection - Be available at the persons request Symptom Behavior- Exaggerated response to stimuli - Reduce exciting stimuli - Assist the person to find a quiet space - Use clear concise questions or statements Symptom Behavior- Aggressive behaviour - Set limits on behaviour - Be aware of threatening statements and take them seriously Symptom Behavior Lethargy loss of interest - Help the person set realistic doable goals Symptom Behavior- Sleep disturbances - Encourage adequate physical activities during the day - Encourage reduction of caffeine and other stimulants - Encourage a regular bedtime and wake-up time - Help the person identify a calming pre-sleep routine 140

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5. Exploring possible alternative solutions How does a crisis services provider help the person go about exploring possible alternative solutions Several questions are pertinent to exploring alternatives: 1. What does the person believe is the most important issue that he/she is dealing with 2. What is the person hoping for 3. What does the person think he/she needs 4. What has he/she already tried 5. What has worked in the past 6. What personal and community resources does this person have to draw on Many people in crisis tend to see their world in black and white. They feel that they have limited options. Offer alternatives that the person may not have thought of. 6. Formulating an Action Plan In a supportive conversation you will not want to stop at listening. Towards the end of the conversation you will want the other to take a next step start changing things commit to action. Examples: - So where does this leave us - What will you do next - How will this help you to proceed towards your goal - What will be your first step now Formulating an action or crisis plan If someone has an active mental health provider it is possible they may have an existing crisis plan they have developed with their mental health provider. If this is the case it is necessary to try to access the persons current crisis plan. If a plan has not been developed then the person may find it useful to develop a plan. The plan that is developed should be short-term clear doable and developed as much as possible by the person experiencing the crisis situation. Specific activities that will give the person the feeling of control over his/her life should be included. Alternatives to harmful or unproductive behavior should be included. For instance instead of going for a drive when feeling upset the person might decide to call a friend or play with the dog. Including resources identified by the individual is also useful. The person may be able to think of these resources when he/she is working with the crisis services provider but may not be able to identify them when alone or in the midst of an escalating situation. Writing the plan down and making a copy for both the person and the crisis services provider is important. The crisis services provider may also find it appropriate to make referrals to other services in the community. They may serve an "introductory role" to ensure that a person who has experienced a crisis makes connections with services that he/she needs to prevent further crises. 141

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7. Evaluation Agreeing on Follow-up measures The follow up service is a very important part of the crisis intervention services. These services can range from a telephone call or a face-to-face contact the next day depending on the need of the person. Follow-up measures should be written into the crisis plan and agreed to by both the person and the crisis service provider. Contractual time frames and/or standards for follow-up must be followed. DO’s and DON’Ts in De-Escalating Crisis Situations DO approach clients in a calm non-threatening manner. DO be assertive not aggressive. DO allow clients to resolve a situation themselves if possible. DO remove any bystanders from the area. DO remove any dangerous articles from the area. DO encourage clients to use more appropriate behavior to get what they want. DO work with other staff or significant others available as appropriate in defusing a crisis. DO give an agitated client time and space to calm down. DO make use of PRN medication when appropriate based on a consultation with a physician nurse practitioner or physician assistant. DO negotiate temporary solutions to buy time. DO be respectful toward the client. DO leave a physical escape route for both yourself and the client. DONT get into an argument or power struggle with the client. DONT be authoritarian or demanding. DONT tell clients you are frightened even if you are. DONT argue with clients over the reality of hallucinations or delusions. DONT "humor" clients regarding hallucinations or delusions. DONT overreact to the situation. DONT insist that a client discuss a situation if he or she doesnt want to. DONT confront a client under the influence of substances. 142

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Chapter 5: Critical Incident Stress Management CISM 1. Introduction The Critical Incident Stress Management process includes education and awareness. CISM is a comprehensive range of integrated services procedures and intervention strategies designed to mitigate the effects of exposure to a critical incident. The core components of CISM are: 1. Pre-Crisis Preparation 2. Mobilization/Demobilization and Crisis Management Briefing CMB 3. Defusing 4. Critical Incident Stress Debriefing CISD 5. Individual One-On-One Crisis Intervention 6. Family Crisis Intervention 7. Follow-up Services. 2. Mobilization/Demobilization Mobilization and Demobilization are group processes that are generally reserved for crisis interventions by trained crisis intervention staff operating in the wake of deeply distressing events that have the potential for widespread effect on a particular group of people. This includes events that are prolonged or have high media visibility. Support is provided by way of factual information about the incident stress education information and rest/refreshment as necessary. This is often delivered in conjunction with start of shift or end of shift staff meetings provided by management. Specially trained employee peers usually conduct Mobilization / Demobilization on a rotating basis for the first few days post- incident. Crisis Management Briefing CMB CMB is a large group crisis intervention ideally suited to business and industrial applications for up to 300 persons. It is used after large-scale events disasters major crisis etc.. A CMB may be thought of as a form of “town meeting” for the expressed purpose of crisis intervention and is led by CISM Team members – it should NOT be considered an “operational debriefing”. A CMB may include a panel of CISM peer support personnel mental health professionals management and union representatives and operational experts from within the organization or suitable outside agencies as required. A CMB consists of four distinct phases Assembly Information Reactions and Coping Strategies/Resources and may be used to triage individuals for more intense and appropriate intervention at a later time. It is primarily used to assist tertiary groups who may be less directly affected by a crisis. This is sometimes used when emergency operations impact a community. A CMB assists community members cope/cooperate with an increased operational presence. 3. Defusing Defusing is the front-line response to a critical incident or potential critical incident. It is provided within a few hours of a crisis event to minimize the effect of acute critical incident stress. Its goal is to reduce intense reactions to the event to normalize the experience to provide practical/useful information stress education to develop expectancies about recovery and to assess the need for follow up with a Critical Incident Stress Debriefing CISD. This process is used primarily to assist small groups of individuals who were directly exposed to and most seriously affected by a critical event. A Defusing is led by a trained peer team member without the aid of a mental health professional. It is less structured and less time consuming approximately 30 to 60 minutes than a Debriefing. A Defusing may eliminate the need for but 143

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should NOT substitute for a formal Debriefing if one is obviously required. After a Defusing follow up is essential. Defusings are highly flexible in how they are delivered and are of low visibility. This combines to make them one of the most effective CISM tools. 4.Critical Incident Stress Debriefing CISD CISD is a structured seven-phase group process utilized in the normalization of critical incident stress or traumatic stress and integrates crisis intervention strategies with educational techniques. It is best conducted in the short-term aftermath of a critical incident approximately 24 hours post-incident but usually within the first 72 hours later if circumstances require. A CISD is called for after obvious deeply disturbing events that may overwhelm the coping skills of those involved. Typically a 2-3 hour confidential group intervention led by a specially trained mental health professional and assisted by trained employee peers after delivery follow up is essential. Two main goals of a Critical Incident Stress Debriefing 1. Mitigate the impact of the Critical Incident on those who were victims of the event. Victims are defined as: a Primary victims i.e. those directly traumatized by the event. b Secondary victims i.e. those individuals who are in some way observers of the immediate traumatic effects that have been experienced by the primary victims. Co-workers peripheral to the scene would be an example. c Tertiary victims i.e. those affected indirectly by the trauma via later exposure to the scene of the disaster/trauma or by a later exposure to primary or secondary victims. Typically tertiary victims are those not exposed to the immediate “first-hand” aspects of the traumatization thus not impacted by the “shocking immediacy”. Staff from other departments family members co- worker friends of victims or rescuers might be examples of tertiary victims. 2. Accelerate recovery process in people who are experiencing stress reactions to abnormal traumatic events. 5. Individual Intervention One-On-One This is an individual intervention provided by a Peer Team Member after a critical incident or potential critical incident. Individual Intervention is used to support stabilize and provide stress education and to help assess the need for a formal Debriefing in a group setting if other individuals were involved. It is best provided within 24 to 72 hours of an incident later if circumstances require and may be conducted by specially trained peers in person or by telephone. An Individual Intervention should NOT substitute for a formal Debriefing if one is obviously required for a group of individuals. After delivery follow up is essential and a referrals may be required. 6. Family Crisis Intervention Support is not complete unless it also includes special support services for spouses and significant others who may be indirectly and negatively impacted by the same traumatic events. Support for the families may include providing educational information Debriefings One-on-One interventions and Crisis Management Briefings CMB. 144

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7. Follow-up Services Every time a CISM intervention is provided Defusing Debriefing Mobilization/ Demobilization Crisis Management Briefing One-on-One it is necessary to ensure that follow up services are provided. Follow Up Services are generally provided by Peer team volunteers and may include telephone calls chaplain contacts small group meetings peer visits one-on-one services family contacts referrals for professional contact or any other helpful outreach programs. 2. CISM Assessment Criteria – Emergency Triage • Nature of incident and complications • Location date time of incident • Present location of persons affected • Any injuries or fatalities • Number of people involved • Personal information of people involvement in incident Full Name Gender Age Address Gsm or cell phone number Landline telephone number Fysical situation: general health / injuries Mental condition Contact Data of spouse / relatives • Are individuals asking for CISM intervention • Any stress reactions/ symptoms noticed in any of the individuals • Source of incident reports 3. Assessing the Need for a Critical Incident Stress Debriefing CISD Debriefings are to be conducted only when it is necessary. The following questions and comments should be helpful in determining if a Debriefing is necessary: Additional Information:  How long ago did the incident occur Is the event ongoing Is it getting worse / more complicated  Does the event fit within the definition of a Critical Incident Is the event of sufficient magnitude to cause significant emotional distress among those involved “Defusing” within initial few hours may allow for assessment of involved personnel.  How many individuals are involved in the incident If more than three think CISD If less perhaps individual intervention would be more appropriate.  Are there several distinct groups of people involved or is there only one Are there witnesses Does everyone belong to the same community Organisation Team or work group Are they staff or management Are they related married partners etc. Do they have the same incident perspective Etc… Depending on criteria more than one CISD may be required. 145

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 What is the status of the involved individuals Where are they and how are they reacting  What signs and symptoms of distress are being displayed  Are any of the following key indicators present:  Behavioural change  Regression  Continued symptoms  Intensifying symptoms  New symptoms arising  Group symptoms o How long have the reactions or signs and symptoms of distress been going on Significant symptoms that continue past a few days indicate a Debriefing may be necessary. If symptoms of distress continue longer than one week after the incident a Debriefing is definitely necessary. o Are the symptoms growing worse as time passes Worsening symptoms may indicate a need for Debriefing. o Are individuals simply requesting information on stress stress management operational details etc A formal Debriefing may be unnecessary if these requests are not accompanied by significant stress reactions. o Are they willing to come to a Debriefing o What other stressors or influences are complicating Are there any other issues that might inhibit or otherwise derail a successful Debriefing Automatic CISM Debriefings The incidents listed below will mandate that a Critical Incident Stress Debriefing be automatically offered to affected individuals. In the interim whenever possible a Defusing should be conducted within 12 hours of the incident and prior to the individuals return to home. If a Defusing is not possible and/or a formal Debriefing is not practical then a Peer Team member can provide individual interventions in-person or by telephone to those involved. Incidents that will result in automatic CISM Debriefing: • line of duty death • suicide or homicide • armed / violent assault • hostage-taking • disaster • client / traveler fatality Potential CISM Debriefings The incidents listed below have a potential to result in a Critical Incident Stress Debriefing and will depend on Defusing held within a number of hours of the incident prior to the affected people’s return to home. This provides an opportunity to assess the impact of the incident on them. If a Defusing is not possible then a Peer Team member can provide individual intervention in-person or by telephone to those involved. 146

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Incidents that have the potential to result in a CISM Debriefing: • serious injury or death of a relative friend or co-worker especially when under unusual circumstances • perceived threat to personal safety • medical emergency 4. Critical Incident Stress Signs and Symptoms: Critical Incident Stress is a normal reaction by normal people to an abnormal situation. It may affect individuals at varying degrees and for different lengths of time. It is significantly more intense than everyday stress and is tied to a specific event. CIS reactions may include emotional physical and cognitive reactions that are beyond a persons control listed below. After a Critical Incident individuals are likely to experience one or more of the following... Physical reactions Cognitive reactions 1. Exhaustion 2. Nausea/vomiting 3. Weakness 4. Difficulty breathing 5. Chest pains 6. Rapid heart rate 7. Headaches 8. Dry mouth/always thirsty 9. Elevated blood pressure 10. Fainting/dizziness 11. Exacerbation of allergy problems 12. Symptoms of shock 1. Blaming attitude 2. Confusion 3. Reduced attention span 4. Flashbacks 5. Poor concentration/loss of confidence 6. Negative self-talk/loss of confidence 7. Decreased awareness 8. Troubled thoughts 9. Nightmares 10. Easily distracted 11. Short-term memory disturbance 12. Time/place/person distortion Emotional reactions Behavioural reactions 1. Frustration 2. Strong need for recognition of what they experienced 3. Anxiety 4. Guilt/feeling strongly for victims 5. Sense of loss 6. Anger 7. Denial 8. Fear of loss of control 9. Irritability/agitation 10. Depression 11. Feeling overwhelmed 12. Feeling isolated 13. Loss of emotional control 1. Emotional outbursts 2. Change in activity level 3. Disturbed sleep 4. Increase in smoking 5. Easily startled/ hyper-vigilance 6. Antisocial behaviour 7. Withdrawal 8. Change in eating habits increase or decrease in food consumption 9. Difficulty relaxing 10. Fidgety/restless 11. Increased use of alcohol and other drugs 12. Change in sex drive 147

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definite indication of the need for medical evaluation Individuals experiencing cumulative stress or delayed stress reactions should seek out help from an EAP practitioner. 5. Moving Past a Moment of Crisis If you have recently had a traumatic experience you may be having feelings that are new to you. Dr. Phil explains that some of these emotions and fears are normal under the circumstances and offers suggestions on how to move past the moment of crisis: If you fear that something traumatic might happen again you are experiencing rational regression. Understand that this is a natural reaction to a traumatic event. Be patient with yourself and realize there is rational fear and irrational fear. With rational fear we react to a real threat and protect ourselves. When we have irrational fear we are scared even though there is no threat to us. If you were injured during your traumatic event its normal to have fears that may seem irrational until your body heals. Understand that it will not be like this for the rest of your life. You will heal. Stop asking "What if something happens again" Remember that something traumatic happened and you got through it. If something else happens you will get through that too. When you do survive a moment of crisis know that there is a reason. Dont have survivors guilt. Decide that theres a purpose find it and live it. Dont be afraid to reach out and ask for help from friends family or a mental health professional. The American Counseling Association recommends Five Ways to help with coping AFTER a crisis situation. 1. Recognize your own feelings about the situation and talk to others about your fears. Know that these feelings are a normal response to an abnormal situation. 2. Be willing to listen to family and friends who have been affected and encourage them to seek counseling if necessary. 3. Be patient with people fuses are short when dealing with crises and others may be feeling as much stress as you. 4. Recognize normal crises reactions such as sleep disturbances and nightmares withdrawal reverting to childhood behaviors and trouble focusing on work or school. 5. Take time with your children spouse life partner friends and co-workers to do something you enjoy. 6. Post-Traumatic Stress Disorder: The Symptoms Post-Traumatic Stress Disorder PTSD is a complex anxiety disorder that may develop after exposure to an extremely stressful or life-threatening event — involving death the threat of death or serious injury — with resulting intense fear helplessness or horror. If you experience these symptoms for a duration of more than a month you could be suffering from PTSD. "This is not meant to be used to diagnose yourself but rather raise your awareness of when you might need to reach out" Dr. Phil says. Persistently Re-Experiencing the Event Having recurring dreams about the event or having persistent and distressing recollections of the event. Feeling and acting as if the trauma was reoccurring — hallucinations or flashbacks — and 148

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experiencing distress when exposed to cues. For example Dr. Phils guest Shelita was attacked at gunpoint in her house so when she is at home she often replays the event in her mind. Avoiding Stimuli Associated with the Trauma Making efforts to avoid thoughts conversations people places and activities associated with the trauma and avoiding activities places or people that arouse recollections of the trauma. Shelita makes every effort to avoid being inside her house. She often spends long periods of time at the mall and sits in her car outside her home so she doesnt have to go inside. Numbing of General Responsiveness Pulling back and having a diminished interest in activities that are significant and suffering low energy. Feeling detached or estranged from others. Displaying a restricted range of affect — unable to have loving feelings or dont want to become excited and happy or let scared emotions out. Increased Arousal Symptoms Not Present before the Trauma Being easily startled having difficulty sleeping or concentrating. Developing a heightened irritability and/or having angry outbursts. Becoming hypervigilant — behaviors you did not experience before the event. Disturbance Impairs other Areas of Functioning Experiencing significant impairment in social or occupational activities or any other important areas of functioning. Shelita has a difficult time working because loud noises easily startle her. Other Possible Symptoms  Inability to recall important aspects of the trauma  Sleep difficulty  Irritability or anger  Feeling hopeless  Sense of foreshortened future  Excessive drug and/or alcohol use If you find yourself experiencing these symptoms dont let it drain your life energy. Seek help from a medical professional. Post Traumatic Stress Disorder may come on silently. It is a very progressive illness that becomes more severe year after year if left untreated. It will eventually consume those victims who have experienced trauma beyond what their minds are able to comprehend or deal with at one time. 149

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Common Signs and symptoms of Post Traumatic Stress Disorder Physical Behavioral Emotional Fatigue Withdrawal Anxiety or Panic Vomiting or Nausea Pacing and restlessness Fear Chest Pain Anti social acts Denial Twitches Suspicion and Paranoia Irritability Thirst Inability to rest Depression Weakness Loss of interest in hobbies Intense Anger Insomnia or Nightmares Increased Alcohol Consumption Agitation Breathing Difficulty Other substance abuse Muscle Tremors Grinding of Teeth Profuse Sweating Pounding Heart Diarrhea or Intestinal Upsets Headaches 7. Apprehension Am I Stressed Out... If you experience the symptoms below Post Traumatic Stress Disorder may be starting to show its early signs. Please see a doctor as well as a qualified Police Stress Therapist to discourage the disorder from getting worse. Headaches – Fatigue - Pounding Heart - Digestive Upsets - Teeth Grinding - Light Headedness - Lowered Sex Drive - Irritability - Short-temper - Backaches - Muscle Aches - Loss or Gain in Weight - Insomnia - Restlessness - Muscle Tics - Drinking too Much - How to Cope With Emotional Pain 1. Dont try to cure what is normal. Temporary emotional pain is caused by any number of events: death of a loved one a breakup thoughtlessness or cruelty on the part of others. When youre hurting because of any of the above accept that its normal to feel hurt or angry for a short time. Lets face it: if a loved one dies only a very cold person would be unaffected by it. If you love someone and that person dumps you its natural to feel hurt. These things are normal. Trying to cure what is normal is pointless. Expect to feel pain for a while - its normal. 2. Theres a statement that goes something like If you get enter mad hurt insulted offended etc. here its your fault. Thats just not true. That suggests that people dont love or bond or trust or invest emotions. If you have emotional pain theres a reason for it. 3. Dont pretend you dont feel it. The pain is real. You have to address it or you will never get beyond it. Dont try to rush through this season of pain. Even though all you can really think about is ending the pain the truth is that just allowing yourself the feelings is important. Masking your pain when youre trying to work or just get through each day may be necessary to a point but make sure to allow yourself some "me-time" - some time to allow yourself to really feel all of the feelings you are having rather than just suppressing and denying them. 150

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4. Identify all of your feelings. Are you just heartbroken Or are you angry too Maybe just the tiniest bit relieved - which is also making you feel guilty Do you feel betrayed Insecure Afraid Giving some thought to exactly how you are feeling can be very helpful in processing all of your emotions in the wake of a traumatic or life-changing event. 5. Endure it. Things that cannot be cured must be endured. It sounds obvious but sometimes thinking of emotional pain as if it were physical pain can be very helpful. Think of your broken heart just as if it were your arm that is broken instead. A broken arm takes time to heal and it hurts like crazy just after its broken even after its been set and casted. A few days later it doesnt hurt so much. But weeks or even months later if you bump or jar it that pain can come roaring back to life with a vengeance. You baby it a little take care not to aggravate it and eventually its stronger where it was broken than it was before. You have no choice - you cant cut off the arm. That wont make it hurt any less. You just have to endure it while it heals. 6. Talk to someone. There are times when it seems that the hurt you feel inside is just too deep to talk about. You feel like no one could understand. Or maybe you worry because your loved ones didnt share your feelings about whatever it is thats hurting you. Maybe they didnt care for your boyfriend whom you just broke up with or they didnt know your friend who passed away. You may be right - they may not totally understand. But right now it isnt being understood that you need. Its compassion. Your family and friends love you. They see you hurting and want to help. Sometimes if you will just try to talk out your feelings say something about what hurts it can help start your healing. Letting someone put his or her arm around you and hearing them say "Its going to be okay" may not seem that helpful but it really is because it helps you feel youre not totally alone. Realizing that someone wants to be there for you will help. 7. Dont let anyone tell you that your feelings arent real. They are real significant and important. And theyre your feelings. Feeling alone doesnt mean there is no one around. Feeling sad doesnt mean youll never be happy. Feel your feelings think your thoughts but realize theyre just feelings and thoughts. 8. Get your mind off yourself and how bad you feel. You have the right to feel sorry for yourself - for 10 minutes. Then move on. No exceptions. Go out with friends. Tell yourself that you will not talk about your pain for more than a few minutes - you will not bring down the activity by wallowing in it. Dont let your friends walk on egg shells around you just because youve been traumatized. You still need to live. Distract yourself by just forgetting it for a little while. If youre grieving a death or heartbroken over a breakup especially giving yourself a little time to just be without obsessing on the event that hurts will help you to heal and move past it. Thats not to say that you just forget about it and move on - no. Its only to say that even grief needs to take a breather. Give your weary heart a little respite and let it mend with the love and lightness of heart that comes from being with friends or doing something that brings you pleasure. There will be time to cry again but not just now. 9. Allow time to heal. This is part of just enduring. You will need to muster up the patience to allow healing to commence. There isnt any substitute for just ... waiting. Time requires one thing: that you allow it to pass. Getting past emotional pain requires a grieving process which takes time. 10. Dont let your pain define you. Remember you are greater than this hard time you have a past and a future. You have awareness and creativity. This was a single episode which will soon pass. 11. Write a letter. Writing down your feelings can help you to sort them out. It can help more if you use positive "I messages" instead of negative ones. If you dont write talk about your feelings with someone close or a therapist. Dont justify them just talk about them get them out and listen to what you say. 151

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12. Stay away from statements that blame you or others. Take responsibility for your actions and your part of whatever went wrong but do not indulge in blaming. The question of "And whose fault is/was that" does not apply. 13. Develop a learning orientation. Life hands you difficulties so you can learn from them. People who have really easy lives fall apart when bad things happen because they have never learned how to cope or let things roll off their backs. Everything even very painful times can be used to learn better coping skills and to develop wisdom and perspective about life that will help you deal with many difficulties in the future. Whatever doesnt destroy you can serve to make you stronger. 14. Make a Thankfulness List. Write down what you are thankful for even basic things like having clothes and a warm place to sleep then moving to people who care for you and good things in your life. Being thankful is naturally healing and will balance out any trauma over time. 15. If the pain is lasting more than a week or so or youve lost hope or youre thinking of suicide youre either suppressing your pain or you have deeper unresolved issues that you need to complete. The strategies above are healthy ways to deal with emotional pain. Often as kids we didnt use these strategies and instead incorporate the pain into our character our subconscious. Said another way when were young its easy to let emotional pain define you. Often this needs to be undone teased apart and handled in a healthy manner for us to be free. If a current incident upsets you too much or for too long or your whole life is colored by a negative outlook consider getting some help to unearth re-examine and complete a prior incident. 8. CISM Follow Up Protocol CISM Debriefing Follow Up All participants in formal CISM Debriefing sessions will receive at least TWO follow up telephone calls or visits no later than: • 48 hours after conclusion of Debriefing session and • Three weeks after conclusion of Debriefing session A second Debriefing session may be held for the same participants if: • There is an expressed need from the participants and/or • Two or more groups wish to be debriefed together and/or • Multiple events necessitate Anniversary follow up should be planned for one year later. Note: The same Peer Team Members who participated in Debriefing should provide follow up services whenever practicable. CISM Defusing Follow Up All participants in CISM Defusing will receive a follow up telephone call no later than 48 hours after conclusion of defusing session or within 24 hours if circumstances warrant priority attention. CISM Individual Intervention One-On-One Follow Up All participants in One-On-One Intervention will receive a follow-up telephone call no later than 48 hours after conclusion of Intervention or within 24 hours if circumstances warrant priority attention. 152

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Note: The same Peer Team Members who provided One-On-One should provide follow up services whenever practicable. CISM Mobilization/Demobilization Follow Up Follow up telephone calls should be made within 24 hours to any staff member who may be assessed to require additional and/or priority attention. CISM Crisis Management Briefing CMB Follow Up Follow up may be provided immediately after conclusion of CMB. Peers Team Members in attendance may provide this service as informal “walk and talk” conversations with audience members who request it or who may exhibit stress reactions. Refreshments The provision of refreshments is strongly advised to help facilitate certain CISM intervention techniques specifically Debriefing and Mobilization/Demobilization. Care must be taken to ensure that the refreshments are appropriate for the intervention. DO NOT over-cater – the refreshments are intended as an incentive toward the goal of stress-reduction through healthy eating and as an encouragement to participate in a particular CISM activity. Use the following as a guide:  Refreshments situated opposite entrance to room across room if possible.  Healthy snacks sandwiches simple fillings fruit juice bottled water decaffeinated coffee do not indicate milk/sugar.  No red food no grilled food no bone-in food rare beef Italian barbeque fried chicken etc..  Avoid strongly-spiced messy or “ethnic” foods whenever possible. 9. Critical Incident Stress Management CISM : “How do I know when I’m in over my head” Prepared by: Gregory Janelle Janelle Associates Consulting Ltd. 1997. Revised 2001 Peer support training does not fully equip the average layperson for the occasionally overwhelming circumstances that may be encountered after a critical incident. This is especially true during Defusing and One-On-One intervention when the Peer is often the first to respond and assessment of a survivor’s emotional state is difficult at best. No matter how experienced and confident one may feel going into a situation there may inevitably come a point when it would be harmful even dangerous to try to handle a survivor without professional mental health intervention. A responsible Peer will always enter a dialogue cautiously and follow established guidelines with due care. It is very important that the Peer remain constantly vigilant to “danger signals” that may alert them to the moment when they feel they are beyond their limits as a caregiver and no longer capable of providing proper support to the traumatized individual. To err on the side of caution is always the best route to take. 153

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As a helpful guide consider the following BEFORE speaking to a person in crisis: Excerpt with permission from “Coping With Survival” by Margaret A. Kilpatrick 1981 Alertness and Awareness You can probably handle if the survivor:  is aware of who he/she is and what happened  is only slightly confused or dazed or shows slight difficulty in thinking clearly or concentrating on a subject Consider referral if the survivor:  is unable to give own name or names of people he/she is living with  cannot give date state where he/she is tell what he/she does  cannot recall events of past 24 hours  complains of memory gaps Actions You can probably handle if the survivor:  wrings his/her hands appears still and rigid clenches his/her fists  is restless mildly agitated and excited  has sleep difficulty  has rapid or halting speech Consider referral if the survivor:  is depressed and shows agitation restlessness and pacing  is apathetic immobile unable to rouse self to movement  is incontinent  mutilates self  excessively uses alcohol or drugs  is unable to care for self eg. doesn’t eat drink bathe or change clothes  repeats ritualistic acts Speech / Mental Functioning You can probably handle if the survivor:  has appropriate feelings of depression despair discouragement  has doubts of his/her ability to recover  is overly concerned with small things neglecting more pressing problems  denies problems states he/she can take care of everything him/herself  blames problems on others is vague in planning bitter in feelings of anger that he/she is a victim Consider referral if the survivor:  hallucinates – hears voices sees visions or has unverified bodily sensations  states his/her body feels unreal and fears losing his/her mind  is excessively preoccupied with one idea or thought  has delusion that someone or something is out to get him/her and family members  is afraid of killing self or another 154

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 is unable to make simple decisions or carry out everyday functions  shows extreme pressure of speech talk overflows Emotions You can probably handle if the survivor:  is crying weeping with continuous retelling of the disaster  has blunted emotions little reaction to what is going on around him/her  shows excessive laughter high spirits  is easily irritated and angered over trifles Consider referral if the survivor:  is excessively flat unable to be aroused completely withdrawn  is excessively emotional shows inappropriate emotional reactions 10. Critical Incident Stress: Tips on How to Recover from a Critical Incident Critical Incident Stress traumatic stress tests your coping mechanisms to the limit. Because of the impact on your psychological system a variety of coping mechanisms appear – some healthy some not so healthy. Research has shown that the way in which a person takes care of him or herself during the first few days following a traumatic event will help to minimize the development of future psychological reactions to the event. Here are some tips on how to cope in the aftermath of an incident: 1. Do not use alcohol or other drugs to cope. Drugs in particular alcohol are powerful symptom suppressors. Ethanol the active ingredient in alcohol saturates the brain creating an artificial feeling of euphoria. As more ethanol is absorbed into the system more and more areas of the brain are numbed or shut down creating a distance from emotional issues. No psychic healing takes place because of the alcohol in the system. Consequently once the alcohol leaves the body not only is the original problem still there but your body is now struggling with the depression and nausea from the alcohol. Similarly drugs also prevent any psychological resolution at the subconscious level. 2. Do not isolate yourself from family friends and co-workers. People react to psychological trauma by keeping it inside. Often the trauma may seem so great that life seems meaningless. By withdrawing you isolate yourself running the risk of allowing the incident to become larger than life. By remaining involved with others: • You prevent yourself from becoming obsessed with the incident • You are more likely to appreciate that though this incident was traumatic life goes on • You may end up talking out the incident contributing to your working it through. 3. Eat well and maintain a physical outlet. Diet is an important factor in reducing the negative effects of stress. Even though you may not feel hungry eat something and make sure it’s healthy food. Exercise is critical to cleansing the body of the negative consequences of stress. It is recommended to get good exercise within 24 hours of the incident. But don’t stop with that. Keep up regular activity whether it’s a tennis game a run or a swift walk. 155

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4. Assess your situation carefully. If you are very traumatized by an incident it may be necessary to take time off work. Working while being emotionally vulnerable puts us more at a risk for an acute stress reaction. On the other hand you may be someone who finds that being back on the job is just what you need. Assess your situation carefully. If you feel vulnerable request time off or arrange to have a reduced workload. 5. Watch your fixation on the incident. Some individuals become obsessed with finding reasons for the event. Shocked by what has happened they feel a need to regain meaning or a sense of fair play in life. Whether they are looking for simple or complex answers the solution doesn’t come immediately. Allow time to pass. Only over time will the real meaning of what has happened become apparent. 6. Give yourself time to heal. Traumatic stress can seriously affect you. Accept that it takes time to heal. Beware of having unrealistic expectations for hasty recovery. 7. Expect the incident to bother you. Take comfort in knowing that the incident won’t bother you forever. Though you may never completely forget the incident recalling it doesn’t have to cause emotional distress. Your goal shouldn’t be to totally forget the incident rather it should be to heal. You know you are healed when you think you are able to think of or talk about the incident without profound emotion. 8. Learn or review your facts about critical incident stress C.I.S. You need facts about what you are going through. By reading up on C.I.S. and it’s associated reactions you will see that however unusual they may seem your reactions are normal. 9. Take time for fun. You must take care of yourself – that includes doing what you enjoy. Take time for leisure activities. 10. Get help if necessary. If you find the incident is staying with you longer than it should seek individual counselling. Through talking with a trained professional any unresolved issues can be faced and resolved. If you don’t get help you run the risk of remaining distressed or of seeing this incident affect you more intensely in the future when facing other events. 156

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11. Critical Incident Stress – Tips to Colleagues and Family If a friend or mate has experienced a traumatic event your behaviour may help the recovery process. Here are some suggestions: Learn about Critical Incident Stress C.I.S. so you can begin to understand what the person is experiencing. Encourage the individuals to talk about the incident but don’t be overly demanding. They may feel that others don’t want to hear about their feelings or that you expect them to be able to “handle” the situation. You need to challenge these beliefs by indicating your willingness to listen. Ask “How are you doing” or “How are you feeling” If people want to talk they will if not they won’t. By your questions you have at least sent the message that a listening ear is available. Don’t be afraid of deep emotion. Many of us have not experienced profound grief or anguish. Seeing someone cry uncontrollably can be somewhat distressing. Traumatized individuals need to vent their emotions and if they are in your presence they need your support. Simply be there to listen and let them talk. Afterwards suggest a walk to help them further reduce their level of stress. Share your feelings about the situation. Don’t say “I know how you feel” because you don’t. You may have gone through a similar experience but no two experiences are the same or perceived as being the same. You can however say things like “I can imagine this must hurt a lot” or “I feel sorry for what has happened.” Don’t make false promises such as “everything will be okay. No one knows the future. Your role is that of a support person not a miracle worker. If you don’t know what to say say nothing. In most cases all people need is someone to “hear them out” not necessarily to solve their problems. Say “it’s okay for you to feel the way you do.” Affirm that there has been a terrible tragedy and that it is normal to feel pain confusion etc. Such a statement is particularly reassuring if you are a peer. It is helpful to have co-workers legitimize your feelings. Do not explain away anything. At this stage your explanation is not needed emotional release is. Your explanation may be interpreted as minimizing rather than supporting the individual’s feelings. Encourage a subsequent debriefing or counselling session if the pain persists. Guidelines are difficult to provide. However the situation should improve one week to next. Indications of progress include hearing comments such as “Yeah I’m feeling better today” seeing less stress and strain on the individual or seeing the individual become more like his/her former self. Take care of yourself you are a co-survivor. Though not involved in the incident you are a victim of the by-product of the incident. Make sure there is someone with whom you can talk things out. 157

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Chapter 6: Harm Assessment Suicide Homicide Injury to self or others 1. What should a responder knew about suicide People become suicidal because of a crisis or series of crises in their lives. Sometimes people see suicide as a resolution to the pain they are experiencing in the midst of a crisis. What they may not see is that there are always other options. Suicide is rare but devastating when it does occur. The information below shows a few relevant statistics: In 2001 suicide took the lives of 30622 people in the US. In 2001 there were twice as many deaths due to suicide than due to HIV/AIDS 14175 In 2004 suicide took the lives of 32439 people in the United States.  25566 were males 6873 were females : : 80 male vs 20 female  29251 were white 3188 were non-white : Non-whites more than 25 of the population account for only 10 of the suicides  4316 were 15-24 years 5198 were 65+ years : From 1999 to 2010 the suicide rate for men in their fifties rose 494  Average suicide rate is 12/100000 – but for white men over 85 it is 65.3/100.000  Males are four times more likely to die of suicide than are females. However females are more likely to attempt suicide than are males In 2004 suicide was the 11th leading cause of death in the US. In 2010 38.364 Americans killed themselves No official data was compiled on the number of attempts but it is estimated to be 25 attempts for every death by suicide. Suicide attempts are expressions of extreme distress that need to be addressed and not just a harmless bid for attention. A suicidal person should not be left alone and needs immediate mental health treatment. Suicide is a complex behavior usually caused by a combination of factors. Research shows that almost all people who kill themselves have a diagnosable mental or substance abuse disorder or both and that the majority has a depressive illness. Studies indicate that the most promising way to prevent suicide and suicidal behavior is through the early recognition and treatment of depression and other psychiatric illnesses. How should a crisis service provider deal with someone who may be considering suicide The statistics are nice as guidelines but offer little help when dealing with an individual. Each individual has his/her own history and reasons for thinking of suicide. If someone is suspected to be thinking of suicide the best thing to do is ask directly "Are you thinking of killing yourself" By asking directly you are actually giving the person permission to talk about it. Talking it through is the best way to prevent a suicide. You will not be putting the idea into someones head. Ask open- ended questions. Let the person talk about what happened who else is involved how long has he/she been thinking of suicide what would happen if he/she went on living how others would react etc. 158

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What do people who feel suicidal want Someone to listen. Someone who will take time to really listen to them. Someone who wont judge or give advice or opinions but will give their undivided attention. Someone to trust. Someone who will respect them and wont try to take charge. Someone who will treat everything in complete confidence. Someone to care. Someone who will make themselves available put the person at ease and speak calmly. Someone who will reassure accept and believe. Someone who will say "I care." What do people who feel suicidal not want To be alone. Rejection can make the problem seem ten times worse. Having someone to turn to makes all the difference. Just listen. To be advised. Lectures dont help. Nor does a suggestion to "cheer up" or an easy assurance that "everything will be okay." Dont analyze compare categorize or criticize. Just listen. To be interrogated. Dont change the subject dont pity or patronize. Talking about feelings is difficult. People who feel suicidal dont want to be rushed or put on the defensive. Just listen in a caring and non-judgmental way and you will be an invaluable resource to people who feel they have nowhere else to turn. Who knows - Talking to you may help someone save their life. Being listened to If someone is feeling depressed or suicidal our first response is to try to help. We offer advice share our own experiences try to find solutions. Wed do better to be quiet and listen. People who feel suicidal dont want answers or solutions. They want a safe place to express their fears and anxieties to be themselves. Listening - really listening - is not easy. We must control the urge to say something - to make a comment add to a story or offer advice. We need to listen not just to the facts that the person is telling us but to the feelings that lie behind them. We need to understand things from their perspective not ours. It is important for people to have the opportunity to explore difficult feelings. Being listened to in confidence and accepted without prejudice can alleviate general distress despair and suicidal feelings. Often being listened to is enough to help someone through a time of distress. Even just showing that you are there for them and that you know they are going through a distressing time can in itself be a comfort. Important elements of active listening when listening to a person who is feeling depressed or suicidal:  Always try to give people your undivided attention  Let them sit in silence and collect their thoughts if they need to  Question them gently tactfully and without intruding  Encourage them to tell their story in their own words and in their own time  Refrain from offering advice based on your own experience  Always try and see their point of view even though you may not agree with it 159

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People who feel suicidal should not try to cope alone. They should seek help NOW. For people who are lonely despairing and considering suicide the most important step is to talk to someone they can talk to in complete confidence about their deepest fears and darkest secrets.  Talk to family or friends. Just talking to a family member or a friend or a colleague can bring huge relief.  Call a hotline search a support group on the internet call a befriender. Some people cannot talk to family or friends. Some find it easier to talk to a stranger. There are befriending centers all over the world with volunteers who have been trained to listen. If calling is too difficult the person can send an email.  Talk to a doctor. If someone is going through a longer period of feeling low or suicidal he or she may be suffering from clinical depression. This is a medical condition caused by a chemical imbalance and can usually be treated by a doctor through the prescription of drugs and/or a referral to therapy. Time is an important factor in ‘moving on but what happens in that time also matters. When someone is feeling suicidal they should talk about their feelings immediately. What other things might a crisis service provider need to keep in mind Suicide is rarely a spur of the moment decision. In the days and hours before people kill themselves there are usually clues and warning signs. The strongest and most disturbing signs are verbal - "I cant go on" "Nothing matters any more" or even "Im thinking of ending it all." Such remarks should always be taken seriously. Other common warning signs include: Behaviors  Crying  Fighting  Breaking the law  Impulsiveness  Self-mutilation  Writing about death and suicide  Previous suicidal behavior  Extremes of behavior  Changes in behaviour  Becoming depressed or withdrawn  Behaving recklessly  Getting affairs in order and giving away valued possessions  Showing a marked change in behavior attitudes or appearance  Abusing drugs or alcohol A persons history may actually make him or her more susceptible to completing a suicide. Predisposing Factors  Chaotic or disjointed life style  Mental illness especially depression  Adoption  Isolation  Physical health/weight concerns 160

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 Family history of suicide or violence  Sexual or physical abuse  Suffering a major loss or life change  Death of a close friend or family member  Divorce or separation ending a relationship  Failing academic performance impending exams exam results  Job loss problems at work  Impending legal action  Recent imprisonment or upcoming release There are also certain perpetuating factors to take into account. If a person is in the midst of a crisis these things may prevent him or her from getting assistance. Perpetuating Factors  Negative coping patterns i.e. hostile no sense of humor thinking everything is meant negatively toward them  Overly controlled rigid personality  Overachiever  Poor communication skills  overly sensitive  Low self-esteem  Anti-social behaviour  Drug/alcohol abuse or addiction or gambling addiction  Depression: Low mood that persists  Change in eating or sleeping habits  An inability to enjoy anything  Irritability  A hopeless helpless outlook  Feeling guilty for no apparent reason  Crying or weeping with little or no provocation Physical Changes  Lack of energy  Disturbed sleep patterns - sleeping too much or too little  Loss of appetite  Sudden weight gain or loss  Increase in minor illnesses  Change of sexual interest  Sudden change in appearance  Lack of interest in appearance Thoughts and Emotions  Thoughts of suicide  Loneliness - lack of support from family and friends  Rejection feeling marginalized  Deep sadness or guilt  Unable to see beyond a narrow focus  Daydreaming  Anxiety and stress  Helplessness  Loss of self-worth 161

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Additionally the Surgeon Generals Call to Action on Suicide identifies the following risk factors:  Previous suicide attempt  Mental disorders - particularly mood disorders such as depression and bipolar disorder  Co-occurring mental and alcohol and substance abuse disorders  Family history of suicide  Personal history of abuse-physical sexual emotional victimization  Hopelessness  Impulsive and/or aggressive tendencies  Barriers to accessing mental health treatment  Relational social work or financial loss  Physical illness  Easy access to lethal methods especially guns  Unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts  Influence of significant people - family members celebrities peers who have died by suicide - both through direct personal contact or media representations  Cultural and religious beliefs - for instance the belief that suicide is a noble resolution of a personal dilemma  Local epidemics of suicide that have a contagious influence  Isolation a felling of being cut off from other people  Of course in most cases these situations do not lead to suicide. But generally the more signs a person displays the higher the risk of suicide. Risk Factors for Jail Setting Individuals who are psychotic in a jail setting are also at increased risk for self injurious behaviors and suicide attempts. The psychotic individual is also at increased risk of being harmed by other inmates due to the perception of the individual with mental illness as vulnerable or bizarre. Just as there are factors that create a higher risk for suicide there are factors that lessen the probability of suicide. Protective Factors  Effective and appropriate clinical care for mental physical and substance abuse disorders  Easy access to a variety of clinical interventions and support for help seeking  Restricted access to highly lethal methods of suicide  Family and community support  Support from ongoing medical and mental health care relationships  Learned skills in problem solving conflict resolution and nonviolent handling of disputes  Affective coping techniques  Cultural and religious beliefs that discourage suicide and support self-preservation instincts  All of the perpetuating risk and protective factors listed are important considerations in assessing a persons ability to cope and gain assistance during periods of crisis. 162

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2. There are two however that deserve special consideration: Depression and alcohol/ drug use. What makes depression and alcohol/drug abuse important Studies have shown that roughly 90 of those who complete suicide have a diagnosable behavioral health disorder commonly a depressive disorder or a substance abuse disorder.18 Most of us can relate to depression because we have felt a bit of the low mood listlessness restlessness helplessness and hopelessness that accompanies depression. However true depression is far more intense than a blue mood. The Diagnostic and Statistical Manual of Mental Disorder 4th Edition Text Rev/sad DSM-IV-TR identifies criteria for a Major Depressive Episode. A condensed version of these criteria follows. Five or more of the following symptoms have been present nearly every day during the same 2- week period and represent a change from previous functioning:  Depressed mood most of the day  Markedly diminished interest in all or almost all activities most of the day  Significant weight loss or significant weight gain without attempting to either lose or gain weight or a decrease or increase in appetite  Insomnia inability to sleep or stay asleep or hypersomnia need for more sleep than usual  Psychomotor agitation or retardation as noted by observation by others  Fatigue or loss of energy  Feelings of worthlessness or excessive or inappropriate guilt  Diminished ability to think or concentrate or indecisiveness  Recurrent thoughts of death suicidal ideation or a suicide attempt These symptoms must cause significant distress or impairment in functioning. One depression sufferer described the effects of depression as having so little energy that lifting a pencil became an overwhelming task. For many people alcohol and other drug abuse is both a risk factor and a symptom. Alcoholism is a primary diagnosis in 25 of people who complete suicide. Self-medication to relieve symptoms of depression or other mental illnesses is not uncommon. It is estimated that approximately 50 of people who have a serious and persistent mental illness SPMI also abuse substances. When providing crisis services it important to remember that the use of alcohol and drugs may increase impulsiveness and reduce judgment. Additionally drug intoxication or withdrawal from drugs both licit and illicit drugs may cause symptoms that are similar to symptoms of a mental illness. Responders should ask about psychotropic medications as well as illicit drug use. Antidepressants may allow the reason to regain physical energy before mood improves. Persons may be at higher risk of suicide at this point. At the time someone completes suicide there is often some identifiable event that precedes the act a conflict or loss that pushes a person to believe that the pain is no longer tolerable and even death is preferable to living through this misery. The event is what most people think of as the why of suicide. Suicide is almost always much more complicated than simply being the result of one event in a persons life. History concurrent stressors and coping ability are all part of the equation. There are many facts of the circumstances that add up to the whole story. When in the depths of despair people are most likely to focus only on the negative leaving out any positive aspects of their situation. The positives usually become obvious to anyone listening 163

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and it is important to point them out. Pointing out positive aspects "there are people who care you do have value" will create ambivalence. The goal of course is to create enough ambivalence to tip the scale in favor of living rather than dying. Always start with the precipitator what happened today or in the recent past that made the difference. Precipitating Factors Usually an accumulation of life stressors conflict or loss  A conflict with family member or love relationship  Failure to get a job get a promotion achieve something  Loss of money income material goods  Legal problems DUI etc.  Injury or illness  Pregnancy  The number and seriousness of previous attempts  The level of stress and number of concurrent stressors  The intensity and duration of depression  The normal ability to cope with lifes ups and downs  The persons physical health  Active symptoms of psychosis especially command hallucinations  The level of external support available to the individual  Impulsivity/absence of protective factors  Alcohol and/or drugs and  Any prescribed or over the counter medication Command hallucinations: Hallucinations that tell the hearer to act or behave in a particular way. In a true command hallucination the hearer feels that he/she MUST behave in the way indicated by the hallucinatory voice. Intuition or "gut sense" of the seriousness of this particular persons presentation is a very valuable tool in assessing suicide risk. From the beginning of the interaction with the person begin to ask for contracts or little agreements. For example: "I know you feel lousy right now but would you agree to sit and talk with me just for half an hour" Take every threat of suicide seriously. Consult others as necessary and never promise anything that you cannot do. Do not say that you care if you do not really care. “It is very hard to make decisions when you are feeling this bad. Can you let us help you with decisions until you are feeling better" Develop a strategy Help the person make a decision on a specific short-term plan. You wont resolve all the problems stick to one issue that is doable. 164

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There are three wishes identifiable prior to a person attempting suicide: 1. The wish to die or be dead 2. The wish to be killed 3. The wish to commit murder Any one of these wishes may create ambivalence. The work of the crisis services provider is to identify the ambivalence point it out and create more time. The more time between the impulse to commit suicide and the act the more likely it is the person will choose life. Certain steps should be followed when intervening with someone who feels suicidal. 3. Suggested guidelines for assessment and prevention CAUTION NO ONE CAN PREDICT A SUICIDE Assess lethality The following factors are important in determining if the person is likely to actually attempt suicide and how lethal the attempt may be:  What resources does he/she have  What resources can you offer  What has this person already tried  The level of detail to which the person has planned the act  The dangerousness and availability of the method  The level of isolation OFFER OPTIONS -- NOT SOLUTIONS Choices empower a person to make decisions and create a plan that is specific doable and short- term. What is the difference between para-suicide and suicide Parasuicide is a word used to describe behavior in which a person hurts himself or herself by cutting burning etc. but does not intend to carry out the suicide. These behaviors are also referred to as SIS self-injuries SIBs self-injurious behavior or self-mutilation. People who engage in parasuicidal behavior often indicate that their self-injury is a mechanism to cope with overwhelming emotion that they do not know how to regulate or express effectively. These individuals are sometimes diagnosed as having borderline personality disorder. What if a suicide occurs despite your best efforts In the event that a suicide occurs even after you have tried to help get some support for yourself. Suicide is a very personal decision and no one else can ever take responsibility for anothers suicide. In a like manner each staff person will respond differently due to his or her individual history and relationship with the person who completes suicide. Take some time to support yourself and your colleagues. "Debriefing" "case review" or "psychological first aid" are terms used by mental health professionals to describe interventions that should be available when a crisis service provider experiences a completed suicide or traumatic event that involves a service recipient. The goal of these interventions is to allow a crisis service provider to express their personal reactions to the event and to identify steps that might relieve stress symptoms related to their exposure to the event. In some cases emergency mental health interventions may include staff members outside of the crisis service provider. Any of these interventions should be conducted by or in consultation with a trained mental health professional in the area of emergency mental health services. 165

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4. Assessing dangerousness to others How does a crisis service provider work with a person who may become violent Assessing for dangerousness to others is similar in many ways to assessing for suicidal intent. Many of the items considered and the process of developing a plan is similar. Risk assessment for dangerousness is a very in-exact science. Studies have shown that even trained professionals can accurately predict only one out of three episodes of violent behaviour. The following are some basic guidelines for interacting with a person who is potentially violent:  Get as much information from records on file or other sources before going into any crisis situation.  Triage staff should ask about presence of weapons before dispatching crisis service provider when applicable.  If you believe that a person may have a potential for violence do not intervene alone.  Partner with another crisis responder or involve law enforcement personnel.  Do not conduct an interview in a room with weapons present.  If the person is armed you may wish to ask the person why he or she feels a need to carry a weapon. The persons response to this question may help the responder to formulate a way to request the weapon be put aside with which the person may be willing to cooperate. If a potentially dangerous person refuses to give up the weapon the crisis services provider should excuse him or herself and seek assistance from law enforcement officials.  Do not interview potentially violent people in cramped rooms especially if they are agitated and need to pace. Kitchen bedrooms and bathrooms are usually poor intervention sites due to the potential presence of items that may be used as weapons.  Be aware of exit routes for yourself and for the person in crisis. A paranoid or agitated person must not feel that they are trapped and a crisis service provider must have an avenue of escape if the person does become violent.  Pay attention to the persons speech and behavior. Clues to impending violence include:  speech that is loud threatening or profane  increased muscle tension such as sitting on the edge of the chair or gripping the arms  hyperactivity pacing etc.  slamming doors knocking over furniture or other property destruction. Do not stay in a dangerous situation 166

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What factors should be considered when assessing a person for potential of harm to others The following factors are important in determining if the person is likely to actually attempt to harm someone else:  Previous episodes of violent or assaultive behavior This is perhaps the best indicator of potential for violent behavior. o Under what circumstances was the person violent in the past o What is the frequency of violence o How does the person behave in between episodes o What is the most violent thing that the person has ever done o What was the intent  Clarity of the plan for violence.  Has the person identified a victim  Do they have means or access to a means to harm the potential victim  Does the person have or could he or she gain access to the potential victim  The level of isolation agitation paranoia or belief that another is planning to or is hurting or harming them in some way.  Command hallucinations ordering violence.  Intoxication from alcohol or other drug use especially cocaine amphetamines or other stimulants or withdrawal from alcohol drugs or medications.  Psychotic symptoms/lack of contact with reality  The level of stress and number of concurrent stressors.  The intensity and duration of homicidal or assaultive ideation.  The normal ability to cope with lifes ups and downs - coping skills and mechanisms.  The persons physical health  Any history of mental illness especially command hallucinations.  The level of internal ability to control impulses.  Does the person wish to control him or herself o And if so can she or he o Is the person overly controlled  Does the person have a brain injury or other cognitive impairment that makes control difficult  The level of external support or external constraints available to the individual.  If a persons mental state is so agitated that a full evaluation or assessment cannot be completed the crisis responder should consider the person as potentially violent.  Collateral information from family friends and medical records is very important in intervening appropriately with potentially violent individuals. Your own intuition or "gut sense" of the seriousness of this particular persons presentation is a very valuable tool in assessing risk. 167

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How can a crisis services provider best intervene with a potentially violent person Establishing Rapport and Communication 1. Show concern for the person. Be respectful and offer some choices even if they are small. Where to sit whether to have a snack or beverage. 2. Attempt to speak with the person at eye level. 3. Sit in a manner with feet solidly on the floor with heels and toes touching the floor hands unfolded in your lap and your body leaning slightly forward toward the person. This position gives the person the feeling that you are attentive to what he or she is saying and it permits you to respond immediately if threatened 4. Stand in a manner with feet placed shoulder width apart one foot slightly behind the other weight on the rear leg knees slightly bent hands folded but not interlocked on the upper abdomen or lower chest arms unfolded. This stance allows instant response to physical threat. Do not place hands in pockets. This slows response and may add to paranoia of the person. Folded arms also slow response and can be interpreted as threatening. Maintaining weight on rear leg with knees slightly bent also allows quick movement and response to any threat. Practice this stance to become comfortable in it before using it in a crisis situation. If the stance is unfamiliar to you your discomfort will only add to the stress of the situation. TAKE EVERY THREAT SERIOUSLY CONSULT OTHERS AS NEEDED. DO NOT STAY IN A DANGEROUS SITUATION. 1. Develop some rapport with the person before asking questions about history or intent of violence. 2. Assure the person that you will do what you can to help them stay in control of violent impulses. Set firm limits but do not threaten or display anger. 3. a person is experiencing paranoia it is best to conduct the intervention as if the person and the intervener are facing the problem together. A crisis situation is not the time to tell the person that he or she is experiencing delusional thinking. 4. Give the person adequate physical space. 5. Develop a strategy. Help the person make a decision on a specific short-term plan. You wont resolve all the problems stick to one issue that is doable. 168

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5. Legal implications of working with suicidal people If a person completes suicide after a crisis services provider intervenes it is possible that the family or friends of the individual may hold the crisis services provider responsible for the suicide. Three sorts of suicides are most prone to this sort of blaming and/or legal suits: 1 Outpatient suicides should the clinician have hospitalized the individual 2 Inpatient suicides Did the institution provide a safe environment and 3 Suicide following discharge or escape. In determining malpractice/liability four elements must be present: 1.A therapist-patient relationship must exist which creates a duty of care to be present. 2.A deviation from the standard of care must have occurred. 3.Damage to the patient must have occurred. 4.The damage must have occurred directly as a result of deviation from that standard of Care. Risk management guidelines:  Documentation - always document what is not documented did not happen per most entities opinion.  Information on previous treatment  Involvement of family and significant others  Consultation on present clinical circumstances  Sensitivity to medical issues  Knowledge of community resources  Consideration of the effect on self and others  Preventive preparation. DOS and DON’TS in suicide prevention  Remove opportunities  Receive and accept suicidal communication  Do intrude  Prevent isolation and involve significant others  Transfer rather than refer  Follow-up Always obtain consultation when unsure  Do know your own value system about suicide  Get precipitant Identify the issues concerns and events that led up to the current crisis.  Use self as instrument of prevention  Do not worry about saying the wrong thing  Do not consider suicidal persons as special  Do not assume ability to solve problems  Do not try to talk the person out of committing suicide  Do not engage in abstract discussion about suicide death  Do not be too accepting of suicide  Do not delegitimatize  Do not give cheap general reassurance  Do not lose confidence may need more limited goals 169

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The following are examples of forms that can be utilized for crisis evaluations: Maureen Malloy R.N. Behavioral Emergency Outreach Program. Common single predictors of suicide listed in order 1 Depressive illness mental disorder 2 Alcoholism drug abuse 3 Suicide ideation talk religion 4 Prior suicide attempts 5 Lethal means 6 Isolation living alone loss of support 7 Hopelessness cognitive rigidity 8 Older white males 9 Modeling suicide in family genetics 10 Work problems occupation economics 11 Marital problems family pathology 12 Stress life events 13 Anger aggression irritability 14 Physical illness 170

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LETHALITY ASSESSMENT WORK SHEET 171 LOW LETHALITY HIGH LETHALITY. PLAN Vague indeterminate plan Clear thoughts philosophical Some specifics Note or will thought out written Note written time place method chosen METHOD Method undecided Method: pills cutting Method: CO oven gas car Method: Hanging Jumping Method: Gun AVAILABILITY Method unavailable Can acquire easily Some effort required to Plan Complete today Plan in progress TIME No time specified Specified vaguely within weeks Day and time chosen within a week Plan to complete today Plan in progress PREVIOUS ATTEMPT No Previous attempts 1 or 2 gestures Hx of many threats attempts Hx of highly lethal attempt Over 2 serious attempts DEPRESSION Feeling low or blue Mild depression Chronic depression Major depression Major depression hopeless RECENT LOSSES No specific stress 1 minor conflict or loss Several concurrent stressors Major loss or conflict Several significant losses/changes HEALTH Physically healthy Transitory illness Disability or chronic health problems Severe illness or injury Recent Dx Terminal illness Recent Dx ISOLATION Others present and supportive Roommates/SO there Others close by Alone at home no help nearby Alone rented room or car isolated COMORBIDITY No presence jf 0 predictors listed below 1 predictor present More than 1 factor present Long term existence of several factors Suicidal careers

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Critical Item Suicide Potential Assessment This tool should be used in assessing the risk of suicide for clients. I. PRIMARY RISK FACTORS: If any one of the following is present the client should be considered a high risk for potential suicide which should be given serious consideration in placement decisions. A. Attempt:  Suicide attempt with lethal method firearm hanging/strangulation jumping from heights etc.  Suicide attempt resulting in moderate to severe lesions/toxicity.  Suicide attempt with low rescuability no communication prior to attempt discovery unlikely because of chosen location or time no one nearby active prevention of discovery etc.  Suicide attempt with subsequent expressed regret that it was not successful and continued expression of intent or unwilling to accept treatment. B. Intent: as expressed directly by client or by another based on their observations  Intent to commit suicide immediately.  Intent with lethal method selected and readily available.  Intent with post-mortem preparations disposal of personal property writing a will writing a suicide note making business and insurance arrangements etc..  Intent with planned time place and opportunity.  Intent without ambivalence or inability to see alternatives.  Command hallucinations to kill self regardless of expressed suicidal intent.  Intent with active psychotic symptoms especially affective disorder or schizophrenia.  Intent or behavior indicates intent but client unwilling to cooperate in adequate assessment. II. SECONDARY RISK FACTORS: An individuals risk increases with the presence of the following factors. If over half of the following factors are present consider the person a high risk for potential suicide in making placement decisions.  Expressed hopelessness.  Recent death of significant other.  Recent loss of job or severe financial setback.  Significant loss/stress/change event victimization threat of prosecution pregnancy illness etc..  Social isolation.  Current or past major mental illness.  Current or past chemical dependence/abuse.  History of suicide attempts.  History of family suicide including recent suicide by close friend.  Current or past difficulties with impulse control or antisocial behavior.  Significant depression clinical or not especially with feelings of guilt worthlessness or helplessness.  Recent separation or divorce.  Rigidity in adapting to change Adapted from the CISPA form used at the Hennepin County Crisis Intervention Center Minneapolis MN. 172

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What professional crisis services are currently available in …. Every crisis service provider should at all times have an updated database of available crisis services centers at hand. Crisis services include 24 hour seven days a week 24/7 toll free telephone lines answered in real time by a trained crisis specialist with face-to-face crisis service capabilities including but not limited to: triage intervention evaluation referral tele-health capabilities walk-in services crisis respite services and/or crisis stabilization units for additional services/treatment and follow-up services. Many individuals and families access crisis services directly but several of the high volume crisis calls are from emergency departments law enforcement agencies community providers advocates etc. 173

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Chapter 7: Empowerment and Community Planning - Dr. Elisheva Sadan The present chapter is taken from Dr. Elisheva Sadans book "Empowerment and Community Planning" and published with permission from the author "Sadan E. 1997 - Empowerment and Community Planning: Theory and Practice of People- Focused Social Solutions. " Translated from Hebrew by Richard Flantz. Copyright © 2004 by Elisheva Sadan. The full original text of the book is available for free download at: The complete text of the present publication is available for free download at: PART ONE Theoretical Development of the Concept of Empowerment 1. connection between empowerment as a personal process and community processes and their influence on powerless people 1.1. Introduction Dr Sadan develops in her book a theoretical development of the concept of empowerment including the three interconnecting dimensions of empowerment: individual empowerment which is the personal intimate change process community empowerment which is the social change and empowering professional practice which is the organizational and functional change that encourages the realization of both the above. A successful planned change process oriented to increasing people’s control over their lives has to achieve outcomes in all three dimensions of empowerment. This background information about empowerment is important because we must at all times be aware that the concept of empowerment is an attempt to break the circle of vicious social problems which are difficult to resolve. People suffer and are harmed not only because of neglect and apathy but also because of the attention of bad social services. Groups suffer from powerlessness not only because of indifference cruelty and a shortage of resources in the impoverished parts of the world but also because of humanly degrading social solutions in the ostensibly enlightened portions of democratic society. The existential approach says that people need freedom and choice despite and perhaps really because of the certain knowledge that they are fated to die. The meaning of the temporary and partial character of life is that truths are relative and must not be received as dogma. People’s commitment to and responsibility for the world comes into being as a consequence of their development of their abilities and not vice versa. These abilities are 174

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more than technical skills they are a quest for meaning which stems from an awareness of our own needs and a sensitivity to the needs of others. Empowerment aspires to a legitimate position in the center of the social consensus from where it is possible to influence the society’s character policy and goals. This is an endeavor to create an ethos of empowerment. Such an ethos is important and essential because it is so lacking in the social reality we live in. Societies are saturated with disempowerment—with discrimination with prejudices with the casting of stigmas with blaming the victim. It is permeated with ideals which isolate and exclude individuals inside their private space and place them in confrontation with one another—the individual’s success is measured by her/his capacity to compete in a weak market to be a winner among losers. Social practices which encourage solidarity social integration support of the vulnerable compassion and empathy are rare and the outcome is a society of lonely individuals in the crowd. The community provides its members with important needs in ways which people who live without a sense of community are not aware of. Alienation can become an existential condition unless a person feels that s/he belongs to a body in which there exist mutual trust and commitment to shared goals. The creation of a community is both a personal and a social solution—what it means is working as a group to grapple with problems that the individual cannot cope with alone. True there is no guarantee that the collective effort will succeed where the individuals have failed but the very process of collaboration of involvement of people’s commitment to attain a shared goal to influence the making of decisions that affect their lives to improve the quality of their lives and their environment creates a new feeling and new capabilities among the participants—and this is an important outcome in itself. Empowered action means coming out of the alienation marginality and sense of irrelevance that are the lot of those who have no influence over what influences them. Since the local community is the focal location through which people develop an inclusive social responsibility community building and community development need to become a national interest a part of the social charter between the State and its citizens. It is important to make it possible for people to feel a sense of belonging and being at home in a particular place for only through this can one belong to a more abstract entity such as the State or the world. Without a place of my own where I can be myself I cannot understand or be concerned with the universal nor with the welfare of others. Empowerment is important to every human being. There are people who live in a community and for them the community is a basic fact of life. Others live without a community and don’t need one at all—perhaps they have attained a feeling of being at home in the world or in their professional or ideological communities. As opposed to these there are people among us who need a community in order to actualize themselves as involved citizens—at work or in voluntary organizations. But there are also people who need a community to ensure their very existence. People who do not find a social solution appropriate to the problem that bothers them create communities in order to improve their quality of life and the future of their children or in order to provide an answer to a physical limitation or to create a space for a different way of life. These if you like are different degrees of the need for empowerment. The critical lack of control over their lives is that of people living in despair poverty discrimination dependence. They need empowerment and the creation of a community in order to survive. The need for belonging and meaning is felt by a decisive majority of human beings even if it hides behind the screen of isolation cynicism and disbelief in one’s own ability to make a change. There can and should be many shades and diverse expressions to people’s need to belong to a 175

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supportive and egalitarian social group. The need for empowerment at every level of intensity is manifested in the call to bring to life the active community that participates in the political arena as a civil right and expresses its unique voice in order to achieve its special objectives. In the world at large the concept of empowerment is widespread. As a term it contributes to the discourse on social problems since it exposes the extent of oppression discrimination and stigma in the lives of vulnerable populations especially in a society with an egalitarian democratic vision. In conversations about empowerment reservations are expressed as well. Some people refuse to accept powerlessness as a starting-point for empowerment. For example leaders of neighborhoods and community organizations who are people with power are not prepared to identify with a stigmatic description of poverty marginality social alienation and indifference. They explain that since they are not poor or weak themselves the transition from powerlessness to more control over life is not relevant to their lives. It is important to emphasize here that empowerment is important to every human being because the danger of deterioration to a constant and systemic powerlessness lurks in wait for any citizen in the society. The danger is social not personal because disempowerment is entailed in social practices that can injure the life of any person: during illness and hospitalization as a patient who needs treatment and nursing during an absorption crisis as a new immigrant who needs the support of the social services during the loss of a spouse as a widow who needs financial support from the social security services. In every need for social services there exists a potential loss of power and a danger of deterioration to a permanent and destructive powerless dependence. In every intervention in a problematic social situation there potentially exist all the possibilities of professional intervention—one can disempower people and bring them down to powerlessness or one can encourage empowerment and develop personal and communitarian abilities. People who have control over their own lives and are not interested in recognizing the dangers of disempowerment may unconsciously and not because of bad intentions disempower others. Organizations that were built through processes of empowerment may after becoming established disempower those who need their services. There are people who oppose empowerment because it is too critical and radical an approach. Empowerment deals with the citizen’s rights to self-definition with people’s critical awareness of their social situation with people organizing in order to achieve important goals with the creation of a community. There are people who interpret such social change as civic revolt. To them it is important to make it clear that social changes will take place around us anyway and will influence our lives. The question is only: Will we participate in what is going on in our lives and try to influence the course of the change or will we look on at what is happening and accept every intervention as a force majeure The goal of empowerment is to create a civic culture which recognizes the rights of people to influence that which influences their lives. Empowerment then supplies a legitimation for social change efforts on the local level. The awakening of local initiatives of change has not received much academic attention since the sixties†. Then people spoke of resistance and of civic revolt. Although today the formulations are more moderate more sober the demands for equality and dignity remains as it was. The struggle for people’s rights to more control over their lives and in decisions affecting their future and their environment promises gains for which it is worth risking the status quo. 176

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While empowerment calls for an avoidance of a uniform worldview that imposes itself on others it is liable to impose itself and thus to create a dissonance so sharp that it may turn everything empowerment calls for into a farce. Another paradox connected to empowerment has to do with the right to choose. When someone proposes a certain fundamental approach there is a need for an alertness to the danger of the negation of the right to oppose this approach. The beauty of empowerment is in its consciousness of the wealth and diversity that human society has been blessed with and in its giving a legitimation to differences among people and to people’s right to be faithful to their way of life to their thinking and their preferences and their right to be proud of this even when they are a minority. We must at all time be attentive to influences which would make people who are different in any way powerless and to the condemnation of the victim. Empowerment should enable someone who is not accepted by the community because s/he is special and different to establish a community of his/her own together with others in her/his condition. 1.2. Empowerment: Definitions and Meanings The theory of empowerment draws its inspiration from an integration of two domains: from an understanding of theories of power and the use of insights drawn from these for the purposes of developing a theory of empowerment and from an analysis of processes of empowerment. 1.2.1. Verbal Definition Empowerment is related to the word power. In English the concept leans on its original meaning of investment with legal power—permission to act for some specific goal or purpose Rappaport 1987. The new meaning of the concept includes mainly references to power that develops and is acquired. People are managing to gain more control over their lives either by themselves or with the help of others. The form to be empowered relates to what is both a process and an outcome—to the effort to obtain a relative degree of ability to influence the world Staples 1990. 1.2.2. Initial Meanings of Empowerment Three of the first writers to relate systematically to the concept have had a most fundamental influence on the development of its use. Barbara Solomon 1976 1985 Peter Berger and Richard Neuhaus 1977 and Julian Rappaport emphasized the important connection between individuals and community and encouraged a contextual ecological approach to the treatment of social situations. They discussed the failure of social programs to provide social solutions and the destructive by- product of these programs—the creation of powerlessness among those in need of the programs. The root of the evil they claimed is that local knowledge and resources are ignored in the course of corrective intervention and that the missing resources are provided insensitively without consideration for what is already there. Since the eighties four ideological approaches have provided the framework of ideas for the discussion of empowerment. The first is an ethnocentric approach which seeks a solution for difficult social problems of ethnic and other minorities Solomon 1976 Gutierrez Ortega 1991. The second is a conservative liberal approach that seeks to revive the community as a social unit which among other things has to care for its weak citizens as well Berger Neuhaus 1977. 177

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The third is a socialist approach which demands of equity and social responsibility in the treatment of social problems Boyte 1984. The fourth approach wants to see empowerment as a profound and professional implementation of democracy—one that will contain every legitimate social ideological current in the democratic society. This is a progressive democratic world-view which resolves to live in harmony with the other approaches and attempts to create an integration of them. Its distinctive spokesman is Julian Rappaport 1981 1985 1987. The present publication is a continuation of this approach. 1.3 Individual Empowerment The personality structure as we know is significantly influenced by environmental conditions. A person is not formed only by heredity and conditions of growth and care but also by opportunities and experiences in the world around him. Among these especially important to us is the ability to make decisions and to act in order to attain goals. This ability or its absence shapes the person’s character and influences the degree to which she will be the effective actor in her life Pinderhughes 1983. Empowerment is an interactive process which occurs between the individual and his environment in the course of which the sense of the self as worthless changes into an acceptance of the self as an assertive citizen with sociopolitical ability. The outcome of the process is skills based on insights and abilities the essential features of which are a critical political consciousness an ability to participate with others a capacity to cope with frustrations and to struggle for influence over the environment Kieffer 1984. The process of empowerment is an active process. Its form is determined by the circumstances and the events but its essence is human activity in the direction of change from a passive state to an active one. The process brings about an integration of self-acceptance and self-confidence social and political understanding and a personal ability to take a significant part in decision-making and in control over resources in the environment. The sense of personal ability connects with civic commitment. Individual empowerment is an expression on the individual level of a multi-leveled process which may be applied to organizations communities and social policy Zimmerman Rappaport 1988. 1.3.1. Empowerment is a process of internal and external change. The internal process is the person’s sense or belief in her ability to make decisions and to solve her own problems. The external change finds expression in the ability to act and to implement the practical knowledge the information the skills the capabilities and the other new resources acquired in the course of the process Parsons 1988. Some writers call the internal change psychological empowerment and the external change political empowerment. According to this distinction psychological empowerment occurs on the level of a person’s consciousness and sensations while political empowerment is a real change which enables a person to take part in the making of decisions that affect his life. To achieve psychological empowerment a person requires only internal strengths while to realize his political personal empowerment a person requires environmental conditions mainly organizational ones which will enable him to exercise new abilities Gruber Trickett 1987. In this discussion I do not intend to deal with the practical and the psychological processes of empowerment and the differences between them rather I want to emphasize the need for an integration of both. While the traditional approach sees political power as the possession of sufficient influence or authority to bring about a change or even to 178

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impose it the idea of empowerment adopts a different approach to power one that does not attribute possession of power to anyone. When power is not conceived as a resource or a concrete position in any particular site then it is in any case both political and psychological. Indeed people have testified that in their empowerment process they did not necessarily acquire more social influence or political control but they did become more able participants in the political process and in local decision making. They estimated that they did not possess more absolute power to dictate the character of their environment but they believed that they were beginning to be more effective in the dynamics of social and political negotiations Kieffer 1984. 1.3.2. Psychological Constructs and Empowerment Several attempts have been made to define individual empowerment by means of psychological constructs. Especially conspicuous is the desire to connect empowerment to two groups of psychological constructs. The first group is that of personality constructs which are called locus of control Rotter 1966 the second group is that of cognitive constructs which focus on self-efficacy i.e. the belief in one’s efficacy to alter aspects of life over which one can exercise some control Bandura 1989. Locus of control is a concept with an internal-external continuum which in general terms determines that someone whose locus of control is inside him is internal—he expects reinforcement from himself possesses inner motivation and therefore his achievements will be more under his control as opposed to someone whose locus of control is external. The external person perceives reinforcements as beyond control and due to chance fate or powerful others Rotter 1966 Levenson 1981. Several studies have attempted to define individual empowerment by means of the locus of control construct. Here an internal locus of control indicates the realization of the empowerment process while an external locus of control means the continued existence of powerlessness Chavis 1984 Zimmerman Rappaport 1988 Hoffman 1978 Gruber Trickett 1987 Sue 1981 in Hegar Hunzekar 1988. However studies on the locus of control construct indicate that there is no unequivocal connection between important factors connected with the concept of empowerment and this construct. For example no significant connection has been found between the locus of control and political social activity. Likewise especially in extreme states of powerlessness no indication has been found of the advantage of internality over externality particularly not among women. In many studies the locus of control has been revealed as a situation- contingent quality which may appear or disappear according to the circumstances with no clear connection to the personality Levenson 1981 Sendler et al. 1983 Parsons 1988. The critique of locus of control sees it as a culture-dependent concept which discriminates against those who are in a social and cultural state of powerlessness and lack of control. The locus of control research in fact presupposes that the researchers themselves have an internal locus and attributes an external locus of control to certain especially weak population groups. If so it is preferable to see this construct as an indicator of the social situation of those population groups instead of using it to measure the personality of individuals Antonovsky 1979. Self-efficacy Bandura 1989 is a central and ongoing individual mechanism which operates by means of cognitive motivational and affective processes which is comprised of a person’s perceived belief in her capability to exercise control over events. Studies indicate that a person’s belief in her ability to achieve outcomes is among other things connected to her 179

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thinking patterns—to what extent they help or hinder her to realize goals. This belief determines how a person will judge her situation and influences the degree of motivation that people mobilize and sustain in given tasks their degree of endurance in situations of stress and their vulnerability to depression and the activities and the environmental frameworks that people choose. The social influences operating in the selected environments can contribute to personal development by the interests and competencies they cultivate and the social opportunities they provide which subsequently shape their possibilities of development Bandura 1989 1997. The connection between the self-efficacy mechanism and the empowerment process is so clear that there can be no doubt about the value of an integration between them. The psychological constructs are not the subject of this book for if we assume that every powerless person needs empowerment and that potential empowerment exists in every person then personality qualities are not essential for an understanding of the various levels of the empowerment process or its outcomes. Beyond this the hidden message in the personality constructs is that an empowered person has changed psychologically in ways that only professionals can understand and measure. Such a message contradicts empowerment language which calls for equal and transparent relations between professionals including researchers and the people in whose lives they intervene Rappaport 1985. I recommend that as part of adopting an empowering professional practice we should avoid using concepts which brand people in advance. Since empowerment is not a particular quality of a person but an important condition for his existence its realization must correspond to the most diverse theoretically at least the infinite number of human variations. Paradoxically this very complexity is what enables the process to harmoniously absorb a vast quantity of psychological constructs Zimmerman 1995. Although we cannot dismiss the attempt to make connections between psychological theories and the concept of empowerment my preference is to develop empowerment in a less psychological and more social direction. 1.3.3. Individual Empowerment as a Political Concept The advantage of the concept of empowerment lies in its integration of the level of individual analysis with the level of social and political meaning. This conjunction appears in feminist thinking which connects the personal with the political: what happens in the life of an individual woman is not only her private affair it is also an expression of her social situation Lengermann Niebrugge-Brentley 1988. If we acknowledge that politics is the everyday activities of ordinary people who are attempting to change social and economic institutions individual empowerment cannot consist only of personal assertiveness mobility and a psychological experience of power Morgen Bookman 1988. Feminist thinking presents the personal and the political as two sides of one coin in remonstration against a common social tendency to divide what is considered worthy of public discussion and is openly and publicly discussed from what is not such and belongs inside the private sphere Ackelsberg 1988. This division defined women’s problems as private prevented public recognition of their importance excluded them and separated them from one another and thus prevented them having a community life which would strengthen their perceptions establishing a vicious circle that augmented their exclusion and institutionalized their disconnection from politics. In this way too the private space and the public space were divided: the home and the residential environment as one entity and public life and work as another. Men are connected with the public domain—the world at large women with the private domain—the home. This division has been harmful not only to women. 180

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Any division that contributes to isolation and separation between domains in the individual’s life brings it about that people do not comprehend the connection between what goes on in their work situation and what happens in their home and community just as they do not understand the connection between political decisions or non-decisions and personal economic outcomes. The severance between the private and the public has reinforced the view that citizens as individuals or as residents in a community are not capable of effecting a change in politics or the economy: they are busy realizing personal goals and are involved in conflicts with one another for the sake of their own interests. Self-interest is natural Perloff 1987 and this implies that for people to cooperate and contribute to the general interest there needs to be a great change in behavior attitudes and human nature. Empowerment is a political concept because it comes out against these views and connects the individual with a public a community and with politics. Individual empowerment is a political demand by women – and men – not to stop them at the door of their residences Ackelsberg 1988. Empowerment promotes involvement in politics because it broadens a person’s social understanding and connects her with others in the same situation empowerment broadens a person’s horizons imbues him with faith in social change and accords him the ability to change. 1.4. Group Empowerment 1.4.1. The Group as a Means of Empowerment Anyone who has gone through the experience of joining a self-help group in order to get help and has discovered that she can also help others knows how someone who begins the journey towards empowerment feels Rappaport 1985. The group is the perfect environment for consciousness-raising for mutual help for developing social skills for exercising problem- solving and for experiencing inter-personal influence. Empowerment means coming out from the limited boundaries of the I into the expanse of possibilities of the we. It was only natural that the professionals who in the seventies developed the concept of the self-help group would add the concept of empowerment to it in the eighties Reismann 1983 1985 Kahn Bender 1985. When the empowerment process is undergone by the individual in a group it also includes the enabling influence of a peer group within a collective-organizational structure and also relations with a mentor that enrich the experience Kieffer 1983. The conjunction of empowerment with mutuality – mutual empowerment – broadens people’s possibilities of controlling their lives. It has been found that people in selfhelp groups who have both provided and received help have gained more satisfaction from their participation in the group and more self-esteem than people who only received help or only provided help Zimmerman Rappaport 1988 Maton Rappaport 1984. Participation in a self-help group is considered an ideal though not exclusive means of encouraging individual empowerment for such a group produces empowerment beyond the individual as well: people receive emotional and social support in the course of a change process in which they provide concrete help to others and acquire new skills including development of ability for future public action Dodd Gutierrez 1990 Chesler Chesney 1995. 1.4.2 Critical Consciousness and Individual Empowerment The development of critical consciousness is without doubt. The most significant personal experience in the empowerment process. Critical consciousness is the process by means of which people acquire an increasingly greater understanding of the cultural-social conditions 181

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that shape their lives and of the extent of their ability to change these conditions. A person lives not only in the present but also in history and is capable not only of interpreting but also of interpreting interpretations—hence a critical consciousness is essential and basic to all human learning Freire 1970. Critical self-consciousness includes people’s recognition of their right to give their experiences a name. People learn to speak in their own language and to give names to the elements of their world Van Den Bergh Cooper 1986. Critical consciousness is people’s better understanding of their powerlessness and of the systematic forces that oppress them. The success or failure of a particular struggle or activity are only one aspect of empowerment. The change in people’s outlook on themselves and in their ability to understand the world in which they live is more important. The empowerment of a woman who is poor belongs to an ethnic minority and is at the bottom of the social status and income levels expresses itself in her understanding and her consciousness of the dynamics of her oppressed condition and not in her success to liberate herself from it. Her power expresses itself in a translation of her consciousness into action with others in her situation in order to withstand the heavy burden of their lack of resources Gilkes 1988 Bookman 1988. We may distinguish two main approaches to the significance of critical consciousness in the empowerment process: those who see empowerment as essentially an internal process see the development of critical consciousness as the main realization of empowerment. On this view critical consciousness is the outcome of empowerment Luttrell 1988 Morgen 1988. Those who claim that the goal of empowerment is actual achievements see the development of critical consciousness as an important stage but only an initial one in the process Kieffer 1984 Gruber Trickett 1987. Consciousness is formed by means of praxis in the course of action Morgen 1988. Hence one may also join in collective action without such consciousness and through actual experience and learning about such experience one may achieve consciousness and empowerment. Action alone does not deepen critical consciousness just as learning with no experience at all does not achieve this. Theories of learning and education have long since recognized the importance of experiential learning. The empowerment process makes manifest the importance of the application of this approach to the social domain Rivera 1990 Freire 1970 Lane Sawaia 1991. Empowerment then is a pro-active concept that encourages an active and initiative-taking approach to life on the individual level as well. The individual process entails the will to influence the environment on all levels: it begins with a sense of faith in one’s own strength advances to activity in inter-personal domains and continues from there to activity for social change. An elderly woman may feel empowered from the very fact that she is still independent and controls her own private affairs but she can feel much greater control over her life when she is involved in neighborhood activity for herself and for other citizens in her situation. Action and consciousness are bound up with one another and vary from one person to another. They together with the other constituents of the process contribute to the vast variety of forms and contents of the empowerment process. 1.4.3. Individual empowerment is a process of personal development. The process involves both a development of skills and abilities and a more positive self- definition. People testify to a better feeling about themselves a sense of more self-respect and self-esteem. A new self-confidence and a feeling of self efficacy are connected with a redefinition of the self and the latter is closely linked with a real improvement in personal knowledge abilities skills resources and life opportunities. A higher level of personal activity makes possible more effective inter-personal relations. Since self-perception is based on achievements in the real world there is a clear positive interaction between development of 182

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self-confidence and reinforcement of personal ability. The ability to redefine yourself and to act efficiently for yourself is the essence of individual empowerment. But individual empowerment cannot be an exclusive or principal component of the concept of empowerment because powerlessness is not only an individual problem but also a social and structural condition. People generally are not powerless because of lacks in their private lives or their personalities but because they belong to a powerless group. Of course in each such group there will always be those who thanks to exceptional talent or luck will attain to personal success and power the converse situation also exists: in a group that possesses power there will always be some powerless individuals. Nonetheless although these are known and accepted truths psychological and individual explanations of success and failure are still prevalent and the conservative social policy that reinforces them is still in vogue. These explanations remain in force because they cast the responsibility for the situation and the onus of change on the individual victims of inequality and oppression instead of on the social structure which is the root of these problems. Empowerment is the opposite approach and that is why its social dimensions are so important. Individual empowerment is only one constituent of the process which as a whole connects the personal and the individual with the collective and the social in people’s lives. 1.5. Community Empowerment Community empowerment is the increased control of people as a collective over outcomes important to their lives. Before discussing community empowerment we need to clarify the concept community in the sense used in the present book. 1.5.1. The Community and the Common Critical Characteristic Community has a meaning of a life that is more egalitarian participatory and intimate than life in society at large which demands the objectification of man and anonymous obedience to authority and law. There are several approaches to community. One is a social approach which redefines community and departs from the traditional community as it used to be Warren 1975. The new community is a social collective entity and the image appropriate to it is one of people with common problems and generally a common dependence on service providers. This is a community which does not include all the aspects of existence but responds to those needs in people’s lives for the sake of which it was created Reinharz 1984. Parents of children with Down’s Syndrome can create a community for themselves to deal with all aspects of their lives as parents of these children: the care the raising and the development of the child. However they may also have life interests which they do not share with this community Handler 1990. I will be referring mostly to this kind of partial and changing community. It has advantages for analysis on both the macro and the micro levels. On the macro level—the partial community which changes according to circumstances constitutes a recognition of the fact that not all the social needs can or have to find a response in a community setting. Community is not the supreme end but a supportive and complementary means for human existence Handler 1990. On the micro level—this community softens the friction between the individual’s needs for autonomy and the demand for loyalty to the collective and the imposition of group values implicit in the idea of the community. The individual can choose and can create a community he is free to leave a community and join a new one at his discretion. The concept common critical characteristic Sadan and Peri 1990 too supports the conceptualization of the partial community. For example a geographical place is at times a common critical characteristic of many of the people living in a certain deprived neighborhood. 183

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When the basis for solidarity with others is not geographical it is necessary to seek the common critical characteristic which causes people or others in their environment to define themselves in a similar way and apart from the environment. The common critical characteristic is what defines and distinguishes people and cannot be ignored. Hence it has a potential for the creation of a community. For example people suffering from hemophilia do not usually live in one geographical community but they have a potential to create a community around their common critical characteristic: they need special services some of which are provided and some of which are lacking partial or defective. Their everyday lives and the problems that preoccupy them are similar and they share a common fate. All these are a common basis for connection. The connection may be partial unstable and changing or permanent and requiring more commitment but it exists and a community may be built upon it. It is important to remember not to define all people who share the same common critical characteristic as a community: not everyone who carries the critical characteristic has to belong to a community even if it exists—joining a community is a conscious and voluntary act. Nonetheless these two concepts – community and common critical characteristic – complement and reinforce one another in very important ways. One of these perhaps the most important one is that the creation of the community helps the surrounding society to understand the critical characteristic as a social problem instead of seeing it as an individual problem. While an individual view isolates those who suffer from a problem and casts the responsibility for their situation and for changing it upon them as individuals the creation of a community around a critical characteristic is an expression of an improvement of the human ability to cope with a social problem: there is an improvement both in the ability of those suffering from the problem to ease their suffering and in the society’s ability to understand their distress and to seek a social solution for it. The definition of community empowerment contains processes that have diverse collective bases. As already noted community empowerment on a basis of geographical boundaries as in residential neighborhoods is only one of the possibilities. Also important is community empowerment of people whose common characteristic is ethnic origin gender women age the elderly or a difficult and limiting life problem such as deaf or paraplegic people. Further on we will discuss these various categories and also some issues that are common to community empowerment of all kinds. 1.5.2. Community Empowerment on a Geographical Basis The first thing that the idea of community empowerment brings to mind is a neighborhood or any other defined residential area. It should be made clear that since human existence as such is anchored in a locale in a specific space the discussion of community empowerment on a non-geographical basis may also take place within the bounds of a geographical neighborhood. In such a case however the common critical characteristic of the people involved may be their origin and not their place of residence e.g. Greeks in Arcadia New York or Armenians in Jerusalem. The discussion of community empowerment on a geographical basis is conducted almost separately in a number of professional disciplines e.g.: community psychology Wandersman Florin 1988 community work Rubin Rubin 1992 urban studies and planning Friedmann 1992 Brower Taylor 1998 social action Boyte 1984 and social policy Page-Adams Sherraden 1997. I have chosen to present the essentials without relating to each domain separately. Techniques of resident participation in the affairs of their neighborhood are considered as encouraging individual empowerment: participation encourages perceived selfefficacy 184

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expectations of successful group solutions and increased civic commitment Wandersman Florin 1988. Community empowerment is manifested in the increasing actual power of neighborhood groups especially when the participation produces a change in decision making in the neighborhood and leads to residents’ organizations having more control over their affairs Biegel 1984. Only when residents’ participation in their neighborhood’s agenda becomes an accepted procedure where poor neighborhoods are concerned this is in most cases an achievement that entails considerable efforts can community empowerment be defined as collective knowledge of problems and alternative solutions and skills in the presentation of issues in groups leadership and in implementation of tactics Fawcett et al. 1984. Community work builds the individual’s ability to act together with others and to create a community. It teaches people to cooperate—to make group decisions to solve common problems and to mobilize resources for the general good. The belief in an active democracy in maximal participation of residents in the life of their community in the realization of people’s right to influence important decisions in their lives are the basis of thought about empowerment and undoubtedly originate in the values of community work. However in community work as in any professional practice the values do not attest to the actual practice. Hence it is possible to measure the degree of empowerment that is encouraged by community work in the process of professional intervention by means of the DARE criteria: 1. Who Determines the goals 2. Who Acts to achievement the goals 3. Who Receives the actions 4. Who Evaluates the actions Rubin Rubin 1992. The test of community empowerment then is the active participation of the people themselves in processes of decision making that affect the community starting from the stage of formulating the goals through to the stage of evaluating the outcomes of the effort. The more the DARE criteria point in the direction of resident groups and organizations and less in the direction of formal services and/or factors external to the community the more community empowerment there is in that area of intervention. Some writers believe that community empowerment is expressed in the community’s ability to create new human existential economic social and political values for its residents as an alternative to dysfunctional values that penetrate into the community from the capitalist economy such as intensive consumption separated from daily life isolated individualism. Community empowerment therefore depends on a de-linking from the system at large and on greater local self-reliance based on resources that the community households can produce Friedmann 1987. The outcome may be making change: the recovery of the political community. The goal is not community empowerment but the reactivation of political life—a society whose residents are active in the processes of civil governance. This is an ideal way of life that includes: cooperative production of consumer goods democracy at home and outside the home and active participation in political and community life. Household economy the society and the world economy are integrated together in the framework of a moral economy that is based on social justice in the division of resources and the care of people Friedmann 1989. In the domain of urban planning models that declare goals of empowerment are occasionally presented Bradbury et al. 1987 these models accord people more choice proclaim a 185

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message of more equality recommend that people should not be labeled nor isolated in services of their own. The danger in these models is disempowerment resulting from inattention to the importance of the empowerment process. For example the establishment of a city-wide pilot project means most significant changes in the lives of people who will not be participants in the planning or the implementation of the change. The deterministic premise that the outcomes of such a plan will lead to empowerment of people has no connection with the empowerment approach as it is presented here. A social plan which makes use of the word empowerment to describe final outcomes only and does not deal with processes of community development or mobilization of participants from the area of intervention is not empowering. Following Berger and Neuhaus’ classical article 1977 the idea of turning the community into an exclusive provider of welfare services to its members has also been called community empowerment. The critique of this trend stems from concern about the erosion of the idea of the welfare state by means of such solutions. Although not all the present institutions are efficient as service providers or promoters of public participation neighborhood organizations too can be “institutionalized rigid inaccessible insensitive and undemocratic just like professional bureaucracies” Kramer 1988. Exaggerated enthusiasm about voluntary activity in the community mutual help and social networks may cause harm because the replacement of bureaucratic state services by community services is problematic for three reasons: 1. The social networks on which they rely do not always exist or are not always acceptable to those in need. It also happens that the most needy are not wanted by the geographical community or by the community services Borkman 1984. 2. The resources of the community service may be inadequate to provide efficient service. 3. The accountability of community organizations is still particularly problematic. We often tend to forget that the present formal and bureaucratic form of service provision developed in the wake of the failure of the mediating institutions – the community the family the church and the voluntary organization – to provide a response to complex needs. John Friedmann 1992 claims that community empowerment is the creation of access to social and economic resources. Poverty then results from lack of access to essential resources not only economic but also political and social resources. This being so some writers claim that politics not planning is the major process by means of which needs should be identified and responses for them should be located Marris 1987 Hajer 1989. The term community empowerment hints at the at least theoretical possibility that in a certain sense it is the community itself and not only the individuals who belong to groups or organizations that comprise it that undergoes an empowerment process. The question that precedes such a possibility is whether the geographical community can act collectively. Urban neighborhoods lack the primal connections of kinship emotional connection and economic inter-relations that in the past created a community and enabled community activity. The typical urban neighborhood of today is in most cases a place where individuals and families are separate entities which by chance or intentionally have chosen to live in a particular place. Such a divided and thin foundation cannot serve as a basis for solidarity Davis 1991. But solidarity can emerge in a residential area when the interests on which it is based stem from non-geographic sources such as relations of race religion ethnicity and class that are 186

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expressed in residential neighborhoods. In other words neighborhoods may serve as arenas in which races religions nations or classes are separated spatially and concentrated socially. People who live in the same locale can act collectively on the basis of political and material interests which are not local in origin Harvey 1973. However experience shows that people act collectively on the basis of interests and out of a solidarity that are created in the place itself. Neighborhoods act as a community in order to improve security services or quality of life at times in order to protect the value of local property and at times because inaction means participating in the destruction of the community through silent agreement Davis 1991. Beside the organization of groups which manage to pool their resources into a common effort there are also groups that act apart from one another. There are situations in which one neighborhood organizes itself for action against the establishment there are cases when these neighborhood groups initiate separate efforts for interests of their own and there is activity of neighborhood groups against one another and against the establishment Atzmon 1988. The relevant question is: what is the connection between all these kinds of community activity and community empowerment. Some writers describe an empowered community as a place in which the residents have the skills the will and the resources to act in order to regulate the quality of life in their community and where there exist a structure and relations between the organizations and the agencies: the empowered community responds to threats to its quality of life or initiates efforts for the improvement of the quality of life by means of a network of community organizations. In addition in an empowered community the following conditions exist: 1. Political openness which is manifested in serious consideration of the residents’ criticism and claims. 2. A strong leadership which seeks the residents’ advice and knows when to confront external forces and when to receive help from the outside. 3. Strong connections between the community’s formal and informal leadership. 4. Access to the mass media such as radio television the press which reflect all sectors of the community Zimmerman n.d.. In my estimation the conditions posited in these descriptions of the perfect community and the perfect environment are not attainable in most community empowerment processes. They may be aspired to but positing too high a target for the realization of empowerment disregards the importance of primary stages in the process which involve development in the direction of control over the environment and the creation of a community. Situations in which the community struggles for its survival connect well with community empowerment. In such situations organized community activity to prevent external intervention that threatens its very existence is essential. If the community does not act or does not act in time or does not act efficiently it does not survive. Those neighborhoods which lack consciousness of the danger they are in and/or the organizational tools to prepare against it before it happens are annihilated Levine 1982 Gans 1982 Erikson 1994. Community empowerment stems from the immense sense of achievement that comes from safeguarding the community’s continued existence and from the assurance of the well-being of its residents but also from the struggle itself Couto 1989 O’Sullivan et al. 1984. 187

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1.5.3. Community Empowerment on the Basis of a Common Critical Characteristic The common critical characteristic makes it possible to reveal further aspects of community empowerment and especially to reinforce the non-geographical aspect. Ethnic minorities Belonging to an ethnic minority is a common critical characteristic such as origin language at times religion or a difference in outward appearance and life in a different and a more or less hostile environment—all or some of these signs. The dilemma in ethnic community empowerment even if it is not always articulated explicitly stems from the tension between the negative and the positive aspects of the barrier between the ethnic community and the environment in which it lives. While isolation by coercion and rejection leads to powerlessness alienation and backwardness voluntary segregation facilitates safeguarding of values uniqueness and authenticity. Community empowerment of ethnic minorities then involves two sets of needs: needs for control required by people who live in conditions of permanent marginality Gutierrez Ortega 1991 Solomon 1976 and need for autonomy especially cultural. Autonomy is important to the ethnic minority in order to restore its lost dignity and to enable the community to continue living in frameworks of its own—including the retention of their language and customs O’Sullivan 1984 Rivera Erlich 1984. Consequently two approaches to ethnic community empowerment may be identified: a corrective approach and a preserving approach. The corrective approach sees empowerment as a method of treatment which will ease problems created as a result of prolonged deprivation and discrimination and will help a group overcome obstacles on the path to social equality. This approach affirms that it does not cast blame on the victim but it still contains a strong emphasis on the adaptation and adjustment of the minority itself to the society around it Weaver 1982 Solomon 1976 1985 Luttrell 1988. The preserving approach also wants to overcome discrimination and deprivation but to preserve the ethnic group’s special qualities as well. This approach also demands from the society at large a degree of adjustment to the existence of an ethnic minority in its midst. The ethnic community as a deprived and discriminated- against minority needs empowerment in order to be able to contribute to the society within which it lives from the resources innate in it – original knowledge values and life-style – and all these are not considered valuable as long as the community is powerless. Hence preserving community empowerment emphasizes the benefit the society at large may obtain from the ethnic community’s valuable resources: the community values the moral economy the protection of ecological values and new sources of knowledge Rivera 1990 Friedmann 1989 1990. Instead of seeing the provision of services to ethnic minorities as an organizational problem ethnicity should be seen as a permanent component in the deployment of the social services. The society at large needs to make an adjustment to the minorities living in its midst and to provide them with services in the appropriate language and in a style appropriate to the social values that are important to them Morales 1984. We must beware however of a one-dimensional approach to the ethnic minority—to remain content with a sensitivity to the ethnic culture and non-intervention in the minority’s norms and the cultural expectations cannot present a full picture of the ethnic group’s situation. This 188

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is to attribute too much value to the cultural common denominator within the group while ignoring the low and powerless status which informs the principal experiences that shape the life of the individual who belongs to this minority. Lack of self-esteem and a sense of self- blame are a part of the ethnic experience no less than the culture Horton Freire 1990. Attention should also be devoted to those ethnic minorities whose absorption difficulties are not temporary. They live in separate communities in a society which is not interested in them. Their main goal is survival in a hostile environment. The more skilled these communities are in survival the more distinctive in character they become. In contrast to the description of the open and partial community referred to above communities which live in a deterministic life- reality of racial segregation and economic exploitation tend to be relatively closed and permanent. The points of entrance and exit into and out of them are sharply defined and are based on the cultural socio-political and economic situation of the people Rivera Erlich 1984. Community empowerment of an ethnic minority has to do with overcoming the direct and indirect obstacles of power which are responsible for the ongoing disempowerment of this minority Solomon 1976. Some writers see self-help groups as method for empowerment of ethnic minorities Gutierrez et al. 1990 Neighbors 1991 Gutierrez Ortega 1991. Others side with organization and social action as main vehicles for solving difficult social problems of minorities and attack the individual and group approach to solutions as unsuitable and hindering Russel-Erlich Rivera 1986. Insistence on diverse means which will always also include community methods is the key to adapting empowering social solutions to the many and contradictory needs of these groups Rappaport 1987. People with special needs such as disabled people are beginning to interpret their special situation in society as analogous to that of an ethnic minority Finkelstein 1993 Dolnick 1993 Deegan 1998. Hence the path to community empowerment of people with disabilities may be similar in some aspects to that of ethnic minorities Morris 1997. Women Being marginal and powerless does not indicate a population’s numerical weight in the society. Although women constitute half of the world’s population they are discussed in the present context because like the elderly children and disabled people many women are powerless. At times it seems that the only population in the Western world that does not need empowerment is that of healthy white male members of the upper classes. This is also a superficial but quite comprehensive description of the decision and policy makers in Western democratic society who shape the social and physical environment and allocate resources leaving the majority feeling worthless and marginal. The significant connection between women and community empowerment is their high numerical participation in efforts to create community. The question of how it is that women are more active than men in the residential environment has occupied many researchers Reinharz 1984. Some writers explain this by the women’s responsibility for social reproduction an activity which is not acknowledged and is thus rendered valueless by the economic system. The kind of community action that women are generally involved in at least at the outset of their empowerment process is close to their social reproduction functions like organizing a club for children or running a neighborhood laundromat. In this way women create community as an extension of home Markusen 1982 Feldman Stall 1992. 189

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The greater participation of women in creating community among poor and weak populations is also explained by the fact that women can adopt alternative criteria for the definition of social success. While men of the same social class accept the definition of success that is accepted in society at large – that a successful man is rich and fulfills a valuable social role – society defines a successful woman as married a mother mature responsible and caring. As a result of this difference women do not experience the powerlessness that stems from their social situation with the same intensity that men do Luttrell 1988. These interpretations suggest that the community empowerment process of women converts the sources of their powerlessness which are their traditional roles as housewives and mothers into a power base. From this starting point they become stronger and continue to extend their activities to additional domains with a political character. The Elderly Another special population which also constitutes a considerable part of human society are the elderly. Especially powerless among these are the poor elderly. Elderly people suffer from lack of economic security more than other populations do. Elderly people suffer from physical and emotional stress which stems from physical deterioration and from the loss of a marriage partner and of friends of the same age. Elderly people generally lack political influence. Western society has a negative attitude to old age and aging and in this way increases the powerlessness of the elderly as well as the social and psychological pressures upon them. The social services for elderly people encourage dependence and helplessness. They do not enable clients’ involvement and that is why the alienation of the elderly from the inappropriate services given to them is increasing Cox 1988. The needs of the elderly are universal and are connected with their age and not with special problems. That is why their powerlessness must be understood as stemming from a social policy of deprivation and from discriminatory social values. Hence their conspicuous need for an empowering environment. Since they are very dependent on public services encouragement of empowerment among the elderly depends on the creation of a service system based on empowering principles Gallant et al. 1985. People with Disabilities I refer here to the empowerment of people with severe physical or mental disabilities including people who are released from mental health institutions into life in the community. In addition to empowerment these groups need advocacy Rose Black 1985 Wolff 1987. Advocacy/empowerment is an approach to empowerment which sees representation of the powerless as an essential preliminary stage in the empowerment of the most vulnerable people. This approach emphasizes the important role of the change agent who among other things serves as an advocate of the people who need empowerment. In contrast to the strong emphasis on self-help and the diminished role of professional assistance so common in empowerment practice the advocacy/empowerment approach emphasizes the need for an external agent. The reason for this is simple. Very weak people will not succeed in embarking on an empowerment process without help in creating the minimal conditions for managing the environment. The goal of advocacy then is the creation of environmental conditions that will enable even the weakest people access to empowerment processes. The environment relates to the mentally and physically disabled with hostility and rejection. These people need empowerment as part of a survival plan: they have to learn how to survive by their own strength and how to conduct independent lives. They need community 190

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empowerment because life isolation from others endangers their existence. For them the residential area in which they have to learn to live is an object of social change rather than a community to become integrated in and the advocacy process is oriented primarily towards achieving this goal. To enable vulnerable people a basic existence and their rightful access to the various services they need advocates who will pave a path for them to walk on so as to begin processes that will gain them some control over their lives Rose Black 1985. 1.5.4. Community Empowerment as Political Concept Some writers argue that community empowerment is a political concept mainly because it does not content itself with local change and individual achievements and openly aspires to social transformation. Empowerment means liberation of people from the oppression and deprivation they are subject to and is oriented to populations which do not obtain social justice. Hence someone who sees community empowerment as only a means of delivering public community services is manipulating the concept of community in order to exclude the local community and to prevent its members from developing a social consciousness Russel- Erlich Rivera 1986 Boyte et al. 1986 Friedmann 1987. People’s discovery that they have the right and the ability to control their destiny their lives and their environment is the basis for political change. In spite of this many people choose to ignore the political meaning implicit in the concept of empowerment. On the other hand there are people who relate literally to the power component of empowerment and interpret it as partisan intervention Messinger 1982. Politicians frequently make use of the word empowerment and have made it a common political slogan and hence a cliché. This state of affairs has only an indirect connection to the present subject — it is a further proof of the reception and broad acceptance of the concept but does not suffice to clarify its political meaning. Political community empowerment opposes the conservative approach which is also heavily represented in the empowerment literature. The conservative-liberal writing is not less political than the radical writing but the consensus ideology has the ability and the talent to put on the form of a neutral apolitical and rational paradigm while writers on the left wing of the political spectrum appear more political in their outlook Goodwin 1980. In determining that people come to politics as individuals and equals conservative liberalism denies the roots that people have in communities it denies the creation of communities around class race or ethnic origin and ignores the influence of economic inequality on participation in politics. In the name of protection of individualism the liberal viewpoint isolates people and at the same time turns them into a homogeneous mass. A community whose members share interests only is a reduction of the ideas of the human community into an instrumental arbitrary and unstable alliance Ackelsberg 1988. Much evidence exists that people in the lower classes and in minority groups are not isolated in terms of community. Women as noted are especially known as community builders Reinharz 1984 and hence creating a community is probably not the difficult part of their empowerment. The political problem encountered by the poor and vulnerable is their inability to connect their problems desires and outlooks and those of their peers with the political establishment which is detached from them yet controls their lives. Politics is not a narrow framework of activities in which only a few people are involved with the aim of influencing structures of governmental power. Politics is a range of activities which people are involved in out of a concern for everyday problems of caring for the life of the home the community and work. The basis for political activity and the source of community empowerment is therefore the need for social relations and for human contact which is as universal as the need for profits 191

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and for representation of interests Ackelsberg 1988. The political approach to community empowerment is part of the critique of conservative liberalism and its abandoning of the welfare state. The background for this is the hard social conditions in the United States not only among the poor but also among the lower middle class Ehrenreich 1992 Philips 1993. Added to this is the perpetual lack of social security of elderly people women and ethnic minorities these past two decades Edelman 1997. The radicals accuse the conservatives of creating insoluble social problems as a consequence of a Darwinist social policy that supports only slight reforms and ameliorative steps. The conservatives’ use of an identical concept – empowerment – creates a new arena where an argument can take place between the various approaches. Moreover the use of the same concept serves other interests of both sides as well For example each side can go on camouflaging its real intentions for tactical purposes. The liberals are interested in appearing more innovative and the radicals are interested in sounding more reasonable than they actually are. The creation of a social consensus is on the face of it an interest of conservative liberalism. Hence the liberal approach prefers to pour its own contents into new concepts rather than to come out against them. This may be seen as a linguistic imperialism. The most important common interest is that the entire range of participants in the political discourse has a real need to reach new audiences by means of new messages—and empowerment is one of these messages. 1.6. Organizational Empowerment 1.6.1. The Organization as a Means of Community Empowerment Participation in organizations and groups in the community is part of the definition of the empowerment of the individual and of his community as well. This combination leads to the question of how much empowerment the individuals bring to the organization and how much empowerment they receive from the organization. In other words are organizations empowering because powerful people have joined them or is empowerment what the people gain by means of their participation in the organization Zimmerman Rappaport 1988 Maton Rappaport 1984. Since empowerment can be realized only in connection with others in groups organizations and communities of people who feel and act together the small local organization that is managed democratically is a dual vehicle of empowerment both for social change and for individual empowerment Crowfoot et al. 1983. On the theoretical level I think that organizational empowerment as a separate category of empowerment leads to a dead end because the concept is defined by identical means to those of community empowerment Zimmerman n.d.. Beyond the tautology this produces concern with organizational empowerment also entails an ethical flaw. Just as concentration of individual empowerment alone ignores the context of the individual as part of a collective with a history of powerlessness so too emphasis on the organization as the goal of empowerment subordinates the goals of social change to organizational reforms a knowledge-packed subject in itself which in any case makes use of the concept of empowerment for its own purposes Crowfoot et. al. 1983. These organizations then are means of empowering individuals and communities and not goals of empowerment in themselves. The creation of community organizations and their extension to as many as possible of the life domains that are important to the community are an indication of community empowerment Couto 1989. 192

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The sophistication of the community organization and the degree of cohesion of its members are expressions of community empowerment. A number of studies indicate that organizations that were created in a community by the community members as distinct from organizations for the sake of the community created by outsider volunteers have been responsible for a number of improvements: for physical improvements in the neighborhood for more stability in the neighborhood for the creation of a sense of community for coping with social problems by setting up new services for the growth and development of the people who are members of the organizations Florin 1989. Since empowerment is a process which can be set in motion only by the people concerned themselves community organizations can provide the climate the relations the resources and the administrative means that enable people to achieve more control of their lives in other words community organizations create empowering environments. While the environment that promotes individual empowerment is more intimate involving interpersonal relations in a group framework in an environment that promotes community empowerment the organizational aspect is conspicuous in two dimensions: 1. The organization itself: the climate the relations the resources and the procedures of the organization and their influence on members of the organization. 2. The community: the climate the relations the resources and the procedures that are established between the organization and its environment which includes the community other organizations in the community and outside it and other factors that the organization decides to exert its influence on in order to achieve its goals Simon 1990. If so it is not only the organization’s success that signifies the community empowerment process the very existence of community organizations is an indication of the process. In this context it is important to remember the warning against the use of success criteria as signs of empowerment for success can be defined in more than one way and an attempt to define it objectively and professionally may have disempowering effects Rappaport 1984. Community empowerment is realized through organizations and may be defined and identified by them. Community organizations exist at all levels of organization starting from support and task groups through to volunteer organizations and social protest movements. The level and the sophistication of the organizations certainly have an important role in empowerment but the very existence of community organizations their number and their deployment over the various life domains point to the realization of community empowerment. 1.7. Some Issues of Community Empowerment 1.7.1. Resistance Activity organization and creation of a community originate in resistance. People protest against injustice deprivation lack of resources and opportunities. Resistance is a catalyst for activism and empowerment Kieffer 1984 Feldman Stall 1994. Community empowerment develops in conditions of injustice by protest against the harsh conditions the indifference and the lack of cooperation on the part of the bureaucratic institutions that are responsible for providing services to the neighborhood. When the injustice is overt and glaring it can be paralyzing Gaventa 1980. It is important to recall the vulnerability and the fragility of powerless people beside the very same people’s powers and the abilities to withstand failure and conditions of pressure Erikson 1994. 193

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Some writers combine the establishment’s hostility and indifference into a single thesis if disempowerment. In my view in order to understand resistance that develops into empowerment it is particularly important to differentiate between the two Schuman 1987. Indifference and lack of interest in what happens in the community on the part of the establishment make possible a certain level of organization and empowering activity within the community while under a hostile regime the attempt to develop the empowerment process is difficult and even dangerous for it arouses the regime to brutal activity against the community and its residents Sanchez et al. 1988. In a particular combination of circumstances and factors an empowerment process that will strengthen the community for further action may develop despite establishment hostility. But there are places and circumstances in which the hostility of the public mechanism or of the regime itself manages to effect disempowerment. The practice of empowerment perhaps the art of it is the search for the right combination which arouses resistance without defeating the people’s spirit. 1.7.2. Conflict Part of the community experience is the division between the people who feel they are members of the community and the people who do not belong to it. Hence the community may be a very stormy framework. Conflict is part of the reality in which the very idea of community is formed and it is very possible that dealing with disputes and success in resolving them is an essential experience for the creation of people’s social consciousness Ackelsberg 1988 Davis 1991. The literature is not rich in examples of actual implementation but projects in which empowerment practice has been implemented Rose Black 1985 Couto 1989 Schuman 1987 Heskin 1991 show to what extent conflict is inevitable. Implementation of empowerment principles in the organization in the community and anywhere else exposes the disempowering practices of existing services and creates a confrontation with the accepted procedures and methods of these services. The ability to survive in a situation of inevitable conflict depends on the allocation of resources to train activists and practitioners for life in conditions of conflict and uncertainty Delgado 1986. The indirect but systematic violence that the establishment exerts against weak people is a principal pretext for the rise of conflicts in the first stages of the empowerment process. Establishment violence manifests itself in the various ways in which people are barred from access to resources knowledge and information that are essential for their existence and for their ability to control their lives. Like for example the delaying of material resources by means of budgetary policy or control over information and data services in order to leave people in ignorance with regard to their rights and to possible options of change in their situation Crawfoot et al. 1983 Solomon 1976. The literature on empowerment sometimes emphasizes harmony and social integration but since conflict is an inseparable part of political life in a democracy it should not be feared it certainly is inevitable in conditions of social injustice and cannot be skipped over into realms of tranquillity which originate in quiescence and in lack of social consciousness. 1.7.3. Community Awareness Couto 1989 defines community awareness as the important part of the empowerment process as a process of the community’s rediscovery of its powerlessness. This is a recognition by people who have just achieved a degree of control over their lives and their future that there are limitations to their new ability. Empowerment is not merely action says Couto it is also reflection. 194

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Especially important is the community’s understanding of the constraints on improving their situation in domains where the sources of the problems lie outside the community—the social political and economical limits to their empowerment. Awareness is also the community’s evaluation of its strengths and advantages and of how to exploit these usefully. For example recognition of the ecological values of the physical environment or understanding the economic worth of the land on which it is built. The question of community awareness is interesting because of the surprising use of the terms awareness and consciousness in the community context. After all these are in a very basic sense cognitive processes experienced by the individual. Yet here in the context of community empowerment we find writers presenting the ability to arrive at a collective consciousness without preparing a basis in theory or by research for understanding such a phenomenon. The main questions requiring clarification are: How does collective consciousness manifest itself Is it synergetic Katz 1984. Can it be subjected to empirical investigation If so with what means Who are the people in the community who represent this consciousness—activists professionals members of the community a combination of all these Is it possible to point to distinct manifestations that are characteristic of community-collective awareness 1.8. Organizing and Creating a Community The basis of community empowerment is people organizing themselves around a common critical characteristic. Since the meaning of empowerment is among other things the overcoming of difficult experiences of isolation and alienation it can be realized only in a stable and ongoing connection with others. Organizing turns a collective into a community while collectives are comprised of people who have a common characteristic of age race gender occupation income and the like. Where there is no organization this common characteristic is a burden and a limitation that narrows the individuals’ possibilities and their perception of reality. Community organizing is a step towards appropriation of the physical space the people live in. A residential neighborhood can become a community through the organized effort of the people living in it to appropriate their home place—an effort which brings about social change in this place and a personal change in the activists themselves Feldman Stall 1994. 1.8.1. Outcome and Product Another question that remains open for discussion is whether community empowerment produces an outcome and if so what this outcome is. For the empowerment process as already mentioned is a creative process which transforms a powerless community into one that is capable of action for its interests and its environment. There is a synergy in the creation of a community an abundance that stems from co-operation Katz 1984. People who have a common goal or who have shared a common experience become a community with new and expanded abilities the influences of which spread beyond the place where they began. Empowerment is a dynamic process and therefore has no final or absolute outcome. Just as there exists no final state of synthesis so too there is no final state of empowerment. Empowerment is a continuing process which strengthens the capacity to act successfully in changing circumstances. 195

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Some writers distinguish between the empowerment process which involves a feeling of control and of ability to act successfully and its outcome which is the real ability to act effectively Staples 1990. In empowerment there is a close connection between the process and the outcome for both the feeling of ability and real ability are parts of a single positive and self-reinforcing whole. Yet it is possible to gauge the success of empowerment at a given point in time from a number of what may be called process outcomes such as the existence of community activity the quality of its decision-making the degree of its purposiveness the standard of organization of community activity and the usefulness of the latter to the community’s interests see also the dimensions Rubin and Rubin 1992 each of which may be seen as a community outcome. One could claim that the final product of empowerment is power but power is not a legitimate goal and hence must not be allowed to be more than a means for the attainment of moral goals. It is always essential to ask: Power for what—as well as the Foucaultian question: What are the positive and negative by-products of the power that has been attained and how do they find expression in the community the society and the environment The process through which a residential area or a collective possessing a common critical characteristic becomes transformed into a community is a complex one. Community empowerment is dependent on context environment behaviors and circumstances—some overt and some covert. The present study aims to identify at least some of these: personal motivations and qualities of the participants in the process professional practices and the organizational means which give expression to the aspirations and efforts of all the participants. The particular contents of the process may vary but they have to include activity which on the one hand contributes to the growth and learning of individuals and groups and on the other hand has a beneficial influence on the environment Hegar Hunzeker 1988. The connection between individuals and their environment is important not only for mutual improvement and development as implied by what has been said so far but also for human existence itself for man’s survival in the world Bateson 1979. The need to survive demands adaptation to changes in the environment while the need for a degree of control of one’s life motivates the will to influence the direction of these changes and not just to adapt to them. Community empowerment is an organized effort by people who from a starting-point poor in resources and social advantages attempt to influence the human environment to achieve more control of their situation in order to improve their lives. 1.9. Empowerment as a Professional Practice The concept of empowerment was born in the context of the professional discourse on social problems. To a large extent it expresses the disappointment of professionals with the existing social solutions which not only do not provide an effective response to distress but also in themselves constitute an obstacle in the lives of weak populations Swift 1984. Although empowerment may also be realized without the intervention of practitioners the theoretical discussion of empowerment is by its nature professional and academic. From this discussion arises the need for the development of professional tools that will encourage the spontaneous empowerment process. Not for those exceptional individuals who by virtue of their talents or their good fortune will manage to fulfill their potential for 196

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empowerment without any help but for the many people who need external support in order to liberate themselves from the powerlessness they are subject to. A systematic understanding of the process and a translation of it into policy and principles of action will advance the realization of empowerment from an esoteric phenomenon occurring in the lives of a few to a social and political solution. In this section we will deal with values and beliefs held by the professional who uses empowering methods with principles that guide empowerment practice and influence professional goals and the design of social programs with the roles of the professional who encourages empowerment with a selection of recommended methods of intervention and finally with empowerment as a need of the practitioners themselves. 1.9.1. Values Guiding Empowerment Practice Empowerment is based on the assumption that the environment has to be adapted to people and not the other way around as is commonly perceived. In contrast to radical and Marxist approaches which focus on social change this is an approach that focuses on the individual. Empowerment is indeed an idealistic approach but this is a practical and rational idealism which can be implemented. Empowerment represents an alternative ideology of intervention that differs from traditional approaches in that it provides a different experience to the person who needs help and to the professional as well: without dependence on the expertise of the professional and without any attempt to create such dependence Payne 1991. Empowerment wants to create a practical and metapractical whole which includes language ideology and action principles. It may be seen not as the intervention itself but as a meta- practice—thought about intervention Russel-Erlich Rivera 1986. Meta-practical thinking is essential in all the human service professions because the professional’s thinking about the way he performs his role is one of the principal expressions of his professionalism. The empowerment approach recognizes the paradoxical nature of social problems. Social problems do not belong to the kind of logical problems that have one correct solution social problems may have a number of solutions which are all logical. Social problems are dialectical in character—they pull in different and contradictory directions. The main paradox that empowerment practice has to deal with is that the person most lacking in aptitudes most lacking in ability to function the person in the greatest distress is the one who needs more not less control in his life Rappaport 1981. Is empowerment a special method of treatment for defined – oppressed and deprived – groups or is it a professional practice suitable for the entire human population On the face of it the answer to this question looks simple: just as empowerment is a potential innate in every person so too empowering practice is suitable to general application. However the equitable deployment of empowerment has a moral meaning. Indeed the vision should be implementation of empowering social policy on the macro level—in the society at large. Until this is realized however the equitable distribution of empowerment is liable to create inequality because those people who will know how to exploit professional resources better will enjoy more empowerment and they in most cases will not be the powerless. Liberal thought demands social equality of opportunities in the belief that all the actors in the social game begin competing for all the social resources from an equal starting-point and that those who win probably deserve it more than others. Empowerment wants to grapple with difficult and complex social problems that have arisen as a consequence of this way of thinking. 197

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Empowerment is based on the recognition that a potential exists in every person but that it is the social context and circumstances that determine who realizes this potential and who finds it difficult or almost impossible to realize it. This being the social reality empowering professional practice needs to aspire to become a comprehensive social policy while focusing principally on programs for those who live in the most difficult social circumstances. An empowerment approach is in many senses a translation of Paulo Freire’s educational theory into the social domain Handler 1990 Parsons et al. 1994 Rose Black 1985. According to Freire 1985 the need for change is an inseparable part of social life. The conditions also oppress the ability to change i.e. they distort the social development of the oppressed people. Hence the professional has to believe in people’s ability to learn and to change and at the same time to recognize that oppressed people are liable to possess a distorted consciousness due to their life circumstances. The consciousness of a person submerged in an oppressive reality may become distorted to the point of actual reconciliation with the oppression itself. Dialogue is the core of the empowering change process. It is part of the ideology and also of the principles of action and the methods of intervention. Dialogue is the true speech with mutual trust that takes place between the practitioner and the people she is helping. In the course of the dialogue both the practitioners and their clients change. Its important components are trust and mutuality each side relating to the other with attentiveness and equal worth. Without understanding cooperation and trust there can be no mutuality and no real dialogue. The human condition is complex fluid and constantly changing. The individual does not live for or by himself. He is part of a context and is defined by his situation. Since the right solution for relations between weak people and the public services they depend on is not known the creation of partial communities which will respond to selected aspects of life is the answer Handler 1990. In the framework of these communities real dialogue and trust are fragile and delicate but between practitioners and powerless people there is no substitute for them. Empowerment is based on the belief that people have skills and abilities but need circumstances and opportunities in order to express them. Belief in empowerment claims that new abilities are best learned by means of activity in the life context itself and not in artificial training programs controlled by professional experts. The sense of control the empowerment process develops is the converse of the sense of dependence. It fills people with energy and it is self-nourishing. Empowerment is always a political process because it creates social change. Its political relevance stems from its tendency to spread to further aspects of life. Empowerment is ecological and contextual in character. In the empowerment approach the environment is always part of the picture. An ecological outlook on human behavior claims that behavior is a function of the interaction between the organism and the environment. Hence problematic functioning may in certain cases indicate problems in the personality but when it exists in the lives of entire populations it is a consequence of a defective social structure and of lack of resources Rappaport 1987. 1.9.2. Principles Guiding Empowerment Practice The principles of action that stem from the values of empowerment are not rules which determine specifically what the professional should do but guidelines for selecting suitable practices. 198

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1. Empowerment has to be a permanent component in any problem-solving process irrespective of the theoretical approach that shapes this process. As a meta-practice it can and must be integrated into every kind of professional thinking irrespective of the sort of program or the methods exercised. Rose Black 1985. 2. Giving help. Those who receive help need to be able to give help as well. Hence as already noted self-help groups are considered as distinctive promoters of empowerment. Active participation in programs is an empowering principle and to achieve this it is worth causing a deliberate under-manning of social frameworks Rappaport 1985. This means the implementation of programs without sufficient salaried manning of various functions a situation that mobilizes participants in the program to perform these functions. Frameworks which operate in this way foster empowerment efficiently because it is essential for the people to help not only as consumers but as people who care for the organization’s operation. They enter naturally into a position of worth and concurrently receive professional and social support with their problems while they perform their valuable role as helpers. Manning of important functions in a program by those using it emphasizes a corollary principle one that is accepted in community work and essential to the empowerment process: the professional must see his role as temporary. As he encourages empowerment he also works towards a diminution of his professional presence. He trains leaders local functionaries to take their positions as soon as possible so that they can take responsibility and be less in need of outside help. 3. Lack of power cannot be compensated for by means which increase lack of power. Economic dependence which is one of the forms of powerlessness cannot be improved by means of a program that humiliates and oppresses those in need of it. Hence an empowering professional ascribes the same importance to the means of activating social programs as to their objectives at the same time it is necessary to be cautious and to avoid programs where the means are strongly emphasized but the goals are unimportant. 4. Think big and act small. An important principle in empowerment is to analyze phenomena on the macro level but to intervene with attention to the micro level. Empowerment demands simultaneous concern for the environment the collective its organization and the individuals who organize. This is the distinctiveness of the integration of the personal change as part of the organizing for social justice Friedmann 1992. 5. The collective is a central principle of the empowerment process. Even when the objective is individual the means are collective. Collectivity provides a true rationale for empowerment Staples 1990 if the empowerment process were solely individual it would have no social significance. Collectivity is the source of the synergy in the process because it grows in power and extends the boundaries of its influence. 6. Empowerment is a multi-leveled concept. It integrates individuals groups organizations communities and states as well as contexts—the environmental cultural and historical contexts. The influence that each of the levels of empowerment radiates upon all the other levels is of much importance. The principle of levels leads to the conclusion that we should aspire to a policy of empowerment and to the conjecture that professionals need empowerment in order to be able to empower people who need their help Rappaport 1987. 199

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1.9.3. Principles Guiding the Relationship Between Practitioners and the People Who Need Their Help Empowerment requires a re-examination of the whole of social public policy and demands of the practitioner a re-examination of the professional relationship. 1. Different people require different solutions for the same problems. In order to arrive at a variety of solutions we must emphasize the strengths of those in need of help and to use a mixture of resources: of the practitioners and of those who come for help Solomon 1985. 2. Cooperation between the helpers and the helped is essential to the empowerment process. The helped bring a distinctive knowledge about their lives and their own point of view about their problems and the helpers bring specialized knowledge that stems from formal training and work experience with people suffering from the same problems. In this connection the helped are not seen as responsible for the problems but as responsible for the solutions. This cooperation also changes the research not only the practice. The researcher has to make the people he studies participants in his research and to reward them according to the circumstances: if they contribute to the research they should gain from it Tyler et al. 1983 Sohng 1998. 3. Respect for people is the basis for professional relationships. Respect is expressed in treating the request for help not as a sign of weakness or dependence but as an expression of a need to receive professional service. Respect expresses itself in accepting people’s interpretation of reality. Respect for a person and recognition of his strengths confirm his very existence and give it a validity. Powerless people tend to cast doubt on the existence of reality as they perceive it. The low self-image of vulnerable people which involves doubt and self-denial serves the existing order. People are willing to accept the problems they suffer from as justified thus reinforcing the negative opinions prevalent about them Mullender Ward 1985 Rose Black 1991. 4. Empowerment has a language of its own that influences immediate communication and the meta-communication level. It prefers clarity and simplicity of expression and is very wary of using professional jargon. For example practitioners who use and think in terms of concepts such as the placebo effect and spontaneous remission contradict messages of empowerment because they express a lack of faith in people’s ability to help themselves outside the professional context Rappaport 1985 1987. 1.9.4. Principles Guiding the Design of Social Programs The quality of social programs is critical in determining people’s destiny. In the connection between people in need of help and the services that provide help an oppressive dependence may develop or an opportunity may grow to develop independent social skills. The welfare service system has to change from an obstacle route to a system of opportunities Solomon 1985. All that has been said so far does not imply dilettantism. In order to encourage empowerment the social service system has to be professional. Outcomes are not produced by policy statements. There has to be training of professionals in the field so that they will understand and respect community norms and work with an open approach to people. On the face of it this demand for professionalism contradicts the messages of participation and equity that were presented earlier as part of the principles guiding the relations of the professional with those in need of his help. 200

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However I see no contradiction here because in practice one needs considerable professional confidence and knowledge to work in an equitable and empowering manner Handler 1990 1. Social programs need a structure and a design which serve dialogue and openness to the other. A dispersed organizational structure a free and informal climate and professional autonomy for the professionals are suitable for the achievement of the objectives of empowerment. A centralized structure rigid rules and hierarchical supervision disempower participants in the program Handler 1990 2. Small-scale local projects are preferable to a large central solution. Social projects have to be small enough to provide participant with socially valuable roles and large enough to assure themselves of resources from various sources. Some writers believe that in any case a program with an empowerment ideology will succeed better in obtaining resources and developing them than a program dominated by professionals and professional treatment methods irrespective of its size Rappaport 1987. 3. Empowerment needs to express itself on three levels of a social program: on the personal level between the professional and the person who needs his help empowerment expresses itself in the increase of the person’s resources so that he may control his life better on the organizational level people in need of the program have to become an important interest and influence group in the program. On the policy level greater control of the program participants in the program’s resources has to be facilitated as well as an improvement in their access to alternative services Handler 1990. 4. For a social program to be empowering it should preferably be open to outcomes. It should be built on a principle of an open-ended process rather than on planning that aspires to one particular outcome as is generally the case Adams 1990. 1.9.5. The Professional’s Roles Empowerment demands that professionals have a different set of expectations than what is customary: instead of relying on their professional training and on their socialization into a structured role they must dare to open up to situations as involved human beings who have taken it upon themselves to fill a role and to survive in it Rose Black 1985. Empowerment also sets up criteria for criticism of professional models. A professional approach which is contradictory to empowerment requires a change of approach or has to be totally rejected and this is not simple at all. For example some writers note the contradiction between the empowerment approach and the psychodynamic medical model which focuses on the person as the source of the problems blames the victim for them and mostly ignores the direct and indirect influence that social circumstances have on these problems Solomon 1985. The crisis theory is attacked in a similar way. This theory relates to social problems as transient and extraordinary phenomena focuses on the symptoms of the crisis and on changing the victims of the crisis and ignores the structural conditions that caused it as well as the need to change people and institutions that create or sustain the crisis. The crisis theory is a soporific for policy makers: they get used to thinking in crisis terms and expect the crisis situation to pass and thus encourage the seeing of problems as extraordinary and unrelated to one another. The crisis theory has a bad influence on practitioners because it guides them to deal with immediate problems only and to neglect work on processes of social change Crowfoot et al 1983. 201

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The mainstream of social work earns similar criticism for its conservative social approach for basing itself on liberal principles and for its recoiling from politics. The institutional submissiveness of the social services and their agreement to serve as social shock absorbers impede their ability to encourage empowerment of people who receive services and prevent professionals employed in them from developing a critical consciousness and empowering themselves RusselErlich Rivera 1986. In contrast the role of the professional engaged in empowerment is to help people who live with a continuous and systematic stigma to perceive themselves as capable of exerting influence on their world and on other people. In contrast to conventional professional approaches in the empowerment approach the emphasis on the individual does not mean looking for the problem in the individual himself but moving away from the traditional professional models and emphasizing that the individual is a motivating force who creates change and solves problems. Empowerment is a professional role by means of which the professional involves the individual or collective client in a series of activities aimed at reducing the powerlessness that has been created as a consequence of a negative evaluation towards their belonging to a stigmatized group. This series of activities involves identifying the power blocks that contribute to the problem and specific strategies intended to reduce the influence of direct and indirect power obstacles Solomon 1976. In the literature on empowerment a number of professional roles are emphasized: Resource consultant. More than anything poor people need provision of resources such as housing money health care homemaker services. The resource consultant is a role which connects people with resources in a way which enhances their self-esteem as well as their problem-solving capacities. The consultant makes his knowledge about resource systems and his expertise in using them available to the client. He has to create an intensive partnership with the people involving them in each step of the process from the identifying stage through to the locating and activating of resources Solomon 1976. Sensitizer. People require self-knowledge in order to be able to act upon their problems. The role of sensitizer is performed in a variety of methods of intervention with the objective of providing people with the maximal opportunities of understanding themselves and their environment Solomon 1976. Teacher/trainer. Many people have difficulties learning because of experiences of failure and boredom in formal educational settings during their childhood. The professional’s role is to find suitable ways of helping people to acquire information knowledge and skills. Teaching is a major professional role of empowering professionals Rose Black 1985. Mutuality is emphasized in the empowering teaching process: the professional learns from the people themselves what their preferred social solutions are and what they need to know. Likewise from settings in which empowerment is realized the professional also learns how to plan and activate empowerment enhancing programs. Service planner. Since the structure of the welfare services contributes to the sense of powerlessness and worthlessness of the people who receive the services it is important to re-plan this system so 202

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that it may operate on different organizational principles through which the services will be able to provide new opportunities to people instead of disempowering them. Coordinator and networker. It is the professional’s role to shape the environment by coordinating and networking the various services that are connected with the people in whose lives she intervenes. The emphasis in this role is on re-planning of services by way of creating mutual connections among them and an atmosphere of community consensus while avoiding conflict Biegel 1984 Wolff 1987. Advocate. The advocate represents her clients herself knowing that in the particular situation which requires advocacy this is the only possible way to stand up for the client’s rights. The advocacy aims at a change of environmental conditions that have a bad influence on the immediate situation of people in need of the service. The use of the dual strategy of advocacy/empowerment obliges the professional to watch out for a dual stumbling-block: she must not neglect her responsibility as a leader and she must not incline in the opposite direction of excessive directing and taking control of people. The role of advocate complements all the other professional roles because while encouragement of empowerment is a role performed towards the clients advocacy is the role towards the environment and in many cases it precedes empowerment especially when it is the environmental conditions that create the problems and contribute to their becoming more severe. Advocacy is a role that involves certain professional risks which need to be prepared for well Rose Black 1985 Parsons et al. 1994 Beresford Croft 1993. The advocate is often in conflict with the establishment with other services and even with colleagues. He is liable to be very isolated he may not infrequently be considered a crank fighting with windmills and may even get fired. To contend with all these organizations dealing with advocacy have been founded in recent years and people working in them act as a team and have the protection of their organization. 1.9.6. Methods of Intervention The literature on empowerment is full of recommendations to professionals about methods of intervention that encourage empowerment. The methods of intervention that appear below are a selection from the literature which illustrates how it is possible to implement empowerment in professional practice. The problem in presenting the various methods of intervention was the great lack of uniformity in their levels and in the content that they represent. I have chosen to classify them in two groups: 1. Strategies which are methods of intervention that also contain principles a rationale and a special role. 2. Tactics which are more specific ways of action focused on achieving a defined objective and/or a particular outcome which the professional is interested in as part of a strategy she has developed to achieve her goals. Strategies Participation is a basic method of intervention for empowerment which is much emphasized in the literature as encouraging empowerment Wandersman Florin 1988 Beresford Croft 1993 Rubin Rubin 1992. 203

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Participation reinforces a sense of personal and political ability creates expectations for a successful solution of problems and encourages civic commitment. People’s participation in group and organizational frameworks promotes community empowerment as well as individual empowerment. This method of intervention has aged and become rigid and needs to be used not in its old form but as a basis for improvements Arenstein 1969 Hanna Robinson 1994 Condeluci 1995. 1. Organization. Organization is the collective voice of those whose voice would otherwise not be heard. By organizing people learn alternatives to a life of quiet despair. They learn that what looks like a private grievance is part of a broad pattern which influences many people. They translate their general dissatisfaction with life into a set of practical objectives of changing the physical and social environment. Organizing teaches people to administer to plan to write to speak to conduct negotiations and to activate projects and large budgets Boyte et al. 1986. Integration of Levels of Intervention. Empowerment practice integrates clinical group and community intervention methods into a single intervention system in order to respond to people’s diverse needs and to encourage empowerment Cox Parsons 1994 Gutierrez Ortega 1991 Lee 1994. Empowerment is opposed to the traditional medical model which tends to sever the interactional connection between the concrete reality the environment and its influence and the subjective reality self-perception and emotional life and to emphasize only one side in every field of specialization. An empowerment strategy integrates these two and focuses on an integration that emphasizes the interpretative dialectical character which stems from the mutual connection between social reality and human activity. The professional working with an empowerment approach needs to recognize the existence of a vicious circle in the form of a downward spiral: oppressive conditions create alienation which leads to powerlessness and lack of self-esteem which reinforce the oppressive conditions. Praxis—integration of learning and action. A strategy of empowerment is not interested in a separation between theory and practice. The desirable combination for both the professionals and their clients is constant practice and thought about this practice. Thought about practice develops critical consciousness among the community and among the professionals. In the empowerment process the professional too undergoes a change as a person and as a worker. An integration is created between the professional person’s fate and the fate of the people in whose life she intervenes. Tactics Enabling. People have resources but are not always aware of possibilities of implementing and using them to achieve what they require. Enabling involves actions carried out by practitioners in order to guide people to information or connections with the help of which they will be able to activate their resources more effectively. Linking. Professional activity which stems from the need to strengthen people by creating connections among them. Linking aims at providing people with more power in confrontations with 204

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external systems. The professional connects among people and creates groups and networks that can strengthen individuals and families by providing them with collective support. Catalyzing. Although people have resources of their own they need additional resources in order to be able to activate their own resources fully. The professional seeks complementary resources to accelerate processes and to reinforce the activity. Priming. The assumption behind this professional activity is that part of the problem of powerlessness is caused or reinforced by people’s unsatisfactory encounters with services that are important to their existence. These systems respond more positively when the conditions are not threatening to them. For example if an action is not perceived as an infringement of policy or as submission to external pressure there is a better chance that the system will perform it. The professional who deals with priming prepares the systems and the clients for a positive connection between them even before problems requiring solutions arise Solomon 1985. Providing information and knowledge. Professionals provide people with information in areas that they have identified together as important: for example the socioeconomic conditions of the country past endeavors in community development and the platforms of political parties. The information is transmitted in various ways in written summaries in talks and informal meetings Couto 1989 Serrano-Garcia 1984. The difficulty that people without a formal education have in understanding professional knowledge and in processing information obliges professionals to be better teachers—to improve the ways of imparting knowledge and information. The principle is that there is no subject that cannot be learned or spoken about. There must be no withholding of information or knowledge from people because of their difficulties of understanding. Each difficulty of comprehension that people have is the professional’s responsibility. Developing Skills. Planning organizational and evaluative skills are generally developed in a group framework. The professional works in the following ways: she facilitates the participation of as many people as possible in the groups identifies the community’s resources guides the people on how to pool these resources makes sure activities are planned in advance outlines a clear process of decision making that emphasizes problem definition assessment and choice of alternatives allocation of tasks and monitoring of their execution she refuses to perform tasks that the people themselves have refused to perform promotes group norms that reward the completion of tasks devotes structured time at each meeting and after each activity to evaluation and promotes a non-hierarchical organizational structure in which decisions are made in a consensus and tasks are divided as equally as possible Serrano-Garcia 1984. Modeling. The practitioner serves as a model of collaborative behavior and dialogue. In this method important interpersonal skills are demonstrated by showing not by telling and these are thus reinforced in the course of action. Modeling involves performing various tasks such as cooking cleaning preparing collection tins for donations hauling and the like. Within the organizational framework the professional does everything that the people do and while doing so reinforces values important to empowerment. For example women conduct most of the meetings the participants have a more active role than the professionals and decisions are presented as decisions of the entire team. Precise formulation of values. 205

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The practitioners give verbal expression to values that are important to the group and the community such as: the residents’ ability to perform tasks by themselves the people’s abilities to identify their needs and problems cultural diversity and individual differences that leadership potential exists in every man and woman the importance of effective organization the need to express together with others the sense of pride and of belonging to the community the importance of collective responsibility. The use of doubt. In the professional’s vocabulary why is an important word. He has to teach the people to doubt and to investigate each situation. Why can this not be done Why must this be done in the regular way and not otherwise Why is it always done this way Why doesn’t everyone think this way The questions are more important than the answers because the goal is to encourage a critical approach to the social situation Serrano-Garcia 1984. Informality in the professional intervention. An informal structure of activity is important because courses or workshops reinforce the specialists emphasize the learners’ lack of skill and create a distance between the professional and the other people and this may lead to resistance to the acquisition of skills. Some writers prefer intervention methods which focus on observation team thinking trial and error feedback and critical analysis Serrano-Garcia 1984. Developing social technologies. Designing professional tools as a set of procedures which can be duplicated with the aim of reinforcing abilities and skills in the social domain. A social technology has to be simple inexpensive effective decentralized flexible and adapted to local values beliefs and customs. The technologies are particularly important in order to diminish – by means of an accessible set of procedures and briefings – the hegemony of experts in the social domain over certain techniques and to reduce dependence on these experts and their opinions Fawcett et al. 1984. Technical assistance. Many professionals can be engaged in empowerment enhancing technical assistance. They can: teach people how to create connections between the community and other communities with similar needs help people understand the reasons for local problems help with research which harnesses local knowledge to planning a better future for the locale provide specialized help in domains important to community life such as marketing economics pricing and planning of transport Couto 1989. 1.9.7. Empowerment of Professionals In the past decade new approaches to organizational development connect the empowerment of employees at all levels of the organization with ideas of progressive management and team development Tjosvold 1990 Plunkett Fournier 1991 Peters 1992. Empowerment is presented as an essential means for the business advancement of organizations which are in need of innovative ideas and are facing competition. Here the CEO is seen as the empowering professional and the employees in the organization as the people in need of empowerment. 206

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The principal claim of these organizational approaches is that a humiliated and submissive worker will not initiate innovations and will not take responsibility for solving problems at his work place. An active worker who is confident of his own strengths will also act beyond the defined limits of his job will take initiatives invent and contribute to the success of the firm and his own success as well. Education for empowerment means the opening up of possibilities: to take risks to struggle for a place in the decision-making process to acquire knowledge in a critical manner beyond one’s immediate personal experience and to imagine versions of the future world. All these have to be imparted to the professionals themselves. Through the empowerment process people become strong enough to take part in events to participate in institutions which influence their lives and to attempt to influence them. A person’s empowerment involves her ability to acquire knowledge and skills in order to influence and control her life and to be an active partner in the lives of others for whom she cares. The need for empowerment of professionals stems from the apprehension that they will not succeed in encouraging empowerment of others from a position of submission and humiliation. The claim is that a person who does not implement empowerment in her own life will not be able to encourage this process in others. Teachers for example have to be intellectuals who use knowledge and information to guide pupils to think not technicians who transmit knowledge. Today the education system isolates teachers limits them with regulations and instructions and does not enable them to use their knowledge in the selection and disposition of study material. A teacher who is treated as a person who is incapable of making a mature decision cannot prepare others for maturity if she is closely supervised and is not trusted she will not be able to teach others what autonomy and trust are. Teachers are expected to teach how to take risks to consider alternatives and to form alliances while they themselves are limited to technical and mechanical aspects of their profession Giroux 1987. For professionals to be able to teach clients how to form alliances set up coalitions overcome organizational obstacles and act in a political way they must first experience all these themselves Pinderhughes 1983. Practitioners implement empowerment in their relations with clients but are captive within a conception of equality that denies the existence of power relations and of inequality in their connection with their clients Hasenfeld 1987 Hopps et al. 1994. Besides this contradiction the organization greatly limits their power as autonomous professionals. The responses of powerless employees are characterized by various forms of withdrawal ineffectiveness burnout and leaving the service. The empowering solution proposed is a mutual support group as a means of self-empowerment. We may learn from this recommendation how essential the group is for any kind of empowerment: professionals will not succeed in attaining to individual empowerment on their own. The mutual support group creates for the professional employees a sub-culture of their own in the organization and weakens the influence of the disempowering processes that the organizational culture produces Sherman Wenocur 1983. Beyond the peer group in order to develop an empowerment policy and practice within the welfare services professionals need more autonomy and more discretion as well as a different organizational structure —one that is less hierarchical and more decentralized Handler 1990. In my opinion focus on empowerment of the professionals themselves is a marginal concern which must not become the major issue in the discussion of empowering professional practice. 207

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The question of whether empowerment of practitioners will lead to their becoming empowering practitioners has a different meaning for the individual professional and for the professional organization as a whole. On the personal level empowerment is a value based ideological choice and involvement in empowerment demands a moral and a professional decision. A professional choice such as this is not dependent only or mainly on the professional’s position and status in the organizational power relations but on his commitment to the profession and on his professional world-view. On the organizational level the empowerment of employees as a method of organizational development is an efficient method of advancing empowering professional practice because it proposes empowerment as a comprehensive change both in relation to clients and in relation to organizational personnel and presents it as effective and profitable for the organization itself thus facilitating the dissemination of an empowerment approach both towards the employees and among them. Even when the change process is organizational the same rules of choice and discretion mentioned above apply to the individual employee. However in this situation the organizational context changes completely. The choice is no longer a moral one because the empowering practitioner active in an empowering organization is free from dilemmas of conscience and from conflicts of loyalty connected with the choice of empowerment as a professional path. Empowerment has to be a mutual process. In the relations between the professional and the people in whose lives she intervenes each side encourages and actively contributes to the empowerment of the other. At the same time the focus of attention must be on the empowerment of the people not of the professionals Adams 1990. At the conclusion of the discussion it is important to recall that powerful professionals physicians lawyers and other specialists who come to mind in this context are not famous for encouraging empowerment of their clients. Hence there is no certainty that increasing the power of powerless professionals will lead them to this. It is possible that particularly those professionals who experience or have experienced powerlessness in their private or professional lives are more capable of identification and of understanding the harm in this situation and of sustaining more equitable relations of help and dialogue in order to change it. This however is in the nature of a speculation and its realization depends on many complex circumstances. To sum up empowerment is a source of inspiration and innovation in the domains of practice of professionals who are interested in social change and in the personal change that it entails. It may be assumed that adoption of an empowering professional practice will not limit itself to the professional’s working hours but will influence her as a person on various levels of her views and beliefs. A theory of empowerment is a theory that is conscious that it is a world-view. The professional who adopts it does so because she agrees with a number of premises about professionalism about subjectivity and about the origin of social problems and these correspond to her beliefs values goals and intentions. 1.9.8. Summary Individual empowerment is a process of personal development in a social framework: a transition from a feeling of powerlessness and from a life in the shadow of this feeling to an active life of real ability to act and to take initiatives in relation to the environment and the future. Community empowerment also includes a definition of a community as a partial temporary and dynamic unit that originates in the human need for a sense of togetherness and identification with others. Community empowerment can be realized in geographically 208

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defined areas that constitute the common critical characteristic of their residents or it can develop in groups with other common critical characteristics such as origin age gender or physical disability. The discussion of individual and community empowerment has also touched upon the political meaning of empowerment. The perception of the empowerment process on all its levels as a political process is important to the present study and is influenced by feminist thought which accords a new meaning to social change. The group and the community organization are the main means of activating environmental processes. These are the settings which actively connect the individual with his environment and make possible a change which includes the individual the group and the environment in the one process. The professionalism of empowering professional practice is expressed in the professional’s critical approach to himself and his practice. Empowering professionalism means placing the profession at the service of processes that empower people. Empowering professionals choose from their professional repertoire those strategies and ways of action that encourage empowerment. In the framework of the discussion on professional practice a discussion generally also takes place on empowerment of the professionals themselves The need for empowerment of professionals such as teachers and social workers employed by complex organizations is emphasized beyond the universal need for empowerment that every person has. The claim is made that empowered professionals will be more empowering professionals this claim still needs to find support in a reality in which a majority of powerful professionals such as physicians and lawyers have no interest in the discourse on empowerment. 209

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2. Developing a Theory of Empowerment 2.1. In Search of a Meta-theory Empowerment theory wants to make a place for itself among those new social theories that are attempting to connect the personal and the social the individual and society the micro and the macro. Connecting the individual and the collective in a way which is not organic- biological or systemic-mechanical is not unique to the present study: this is the great challenge of sociology in recent years Ritzer 1988. In our case the search is for a connection between the micro level and the macro level. For the individual – the micro level – the empowerment process is a process of increasing control and transition from a state of powerlessness. Community empowerment – the macro level – is a collective social process of creating a community achieving better control over the environment and decision making in which groups organizations or communities participate. Beside these two we have to develop the theoretical meaning of empowering professional practice through which an abstract theory is translated into a practical tool of intervention. An empowerment theory requires a convincing integration of the micro and macro levels in order to make clear the interrelations among individual community and professional empowerment. In the search for this integration I will present three theories which have taken on the challenge of connecting the individual and his behavior with the society and its processes. Drawing on these I will go on to propose a theory of empowerment processes. 2.2. Integration of Micro and Macro Levels in Feminist Thought The declaration that the personal is political is the feminist rationale for removing the separating fence between the micro as a personal domain and the macro as a public domain. The split between the personal and the public domains is essentially a social means of isolating women and separating them from communities which could validate their views about life and society Ackelsberg 1988. The recognition of the existence of mutual influence between private activity and social structures demands a connection between the personal world and what happens in political and public life. The change in the values and beliefs of the individual woman in the goals that she sets herself in the life-style she chooses and in the understanding of her existential problems is a political declaration that is aimed at a change of the social structures that influence her life Van Den Bergh Cooper 1986. The concept social individuality Griscom 1992 makes the feminist dialectics explicit. The woman is an individual within the social reality in which she grows up and develops with the contradictions between her and society. According to this holistic view the separation between self others and community is artificial because these three create one another within a single complex whole. The powerlessness of one woman which changes by means of her activism in collaboration with others in her situation is a process that empowers the entire community of women. Feminist thought attacks the illusion of objectivity. Since knowledge about the social world is always created from a social position no comprehensive and uniform social outlook really exists. People positioned in different places 210

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in the social structure know different things about the world. Hence when a social view is presented as objective and exclusively valid it is only an expression of the excessive rights that a certain group has appropriated for itself in the social order Lengermann Neibrugge- Brantley 1988. 2.3. Developing a Theory of Empowerment Several important ideas follows from this thinking: The work of production and maintenance in society is done by subordinates whose work is in most cases invisible and because of a dominant social ideology is not appreciated either by the society or by those who actually do the work. As a consequence the understanding of the real components of production in society is distorted Markusen 1980. A senior manager in a large company can devote all his time to his job thanks to his wife who takes care of him their children his elderly parents and their home. For the firm and for the society as well the invisible work of this woman is of no economic value. It is women irrespective of their status who do most of this invisible work not only in the domestic domain cleaning cooking maintenance and providing emotional and sexual services. In paid work too they do most of the activities of coordinating such as waiting arranging meetings mediating being interrupted which are also considered unimportant. Another part of women’s work which is more obvious in its contribution to social production – motherhood – receives social glorification and idealization which convert it into an unrealistic experience. As a consequence of this women walk on a line of fault that separates the dominant ideology about their role in social life from their actual experience as they understand it. The incompatibility between the private reality and the social generalizations creates a constant dissonance with reality and women navigate their lives according to this sense of separation between them and the society. On this line of fault women navigate in different ways: some by repression some by acquiescence some by rebellion and some by an attempt to organize social change Lengermann Neibrugge-Brantley 1988. All that has been said here about women may be applied analogously although not in a totally identical form to all powerless people who are subordinate to others. These people cannot express themselves as individuals and silently accept other people’s interpretations of their actions and failures. This is the source of the culture of silence that characterizes life in conditions of inequality Gaventa 1980. The conclusion of feminist theory is to question accepted categorizations that were developed by disciplines that are basically dominated by men such as sociology for example. The aim is to create alternative concepts which can help to explain the world as it appears to its invisible and disadvantaged subordinate subjects Lengermann Neibrugge-Brantley. Theorists must engage in dialectical analysis of the knowledge process and be conscious of the constant tension that exists between the subject and the object—each affecting and changing the other. The knower the subject the theorist has to admit his interaction with the knowledge the object for knowledge about the social world is always created from a social position. The connection between the personal and the political which characterizes the feminist approach has been warmly adopted into the theory of empowerment as has the premise that feminism is valid not only for women but also for everyone whose world is characterized by 211

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oppression and marginality. Empowerment wants to turn public attention to the distress of groups that are in need of social change. 2.4. The Transactional Approach in Environmental Psychology The transactional theory in environmental psychology Altmann Rogoff 1987 proposes a bridge between the micro level – the person – and the macro level—the environment. In the transactional approach which is influenced by both phenomenology and ethnomethodology Berger Luckmann 1967 Mehan Wood 1975 the unit of analysis is a holistic entity – an event generally – in which people psychological processes and environments are involved. The transactional whole is not composed of separate parts like the whole in systems theory but is a compound of inseparable factors that are dependent upon one another for their very meaning and definition. The whole – person-environment – is a happening that is changing all the time. Various aspects of the event accord mutual meaning to one another for in a different setting or with different actors a particular person would have acted differently. The observer the researcher too is part of the event since she defines the event and its boundaries and her approach and behavior dictate part of the phenomenon. Understanding the observer during the event her point of view her role and her position is part of the interpretation of the event. The transactional theory is pragmatic eclectic and relativistic. Despite its ambition to be able to predict it recognizes that the events are liable to be idiosyncratic and non-recurrent. Several principles stem from this theory: 1. Change is a property of the whole entity—of the event itself. Change is expected since processes are temporary by their very definition. An understanding of the change – of how it comes about and of its form – is required in order to understand the phenomenon and not as in other approaches in order to understand the change and its reasons. The description and analysis of the event focus on the study of process and change. 2. Since the basic research unit is an event involving psychological temporal environmental and social aspects any focus of the research on one of these aspects turns the others into a context. For example if the focus of the study is the psychological aspects of an event then the physical environment is its context. 3. The perceptions and perspectives of the participants in an event are important for an understanding of the event. The analysis is not done solely from the perspective of the researcher who as already noted is one aspect of the event. The transactional approach studies the ways different observers interpret the same event. 4. Methodological eclecticism: Resaerch methods are produced out of the event not imposed upon it. The theory and the structure of assumptions are constants while the strategies of study may vary. A study is designed according to the problem and the question being studied. Hence even when it is not possible to do the research empirically it is important to report and acknowledge this so that even without empirical research it will be possible to understand the entire picture theoretically. From transactional theory empowerment theory has taken the place of the professional as an inseparable part of the social situation itself the emphasis on the process and the freedom to move between focus and context that this theory permits the researcher. 212

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2.5. Structuration Theory: Giddens’ Duality of Structure Giddens’ structuration theory 1982 1984 – which is also called the theory of duality of structure after its central principle – is the most developed among those sociological theories that integrate micro and macro levels of analysis Ritzer 1988. On this theory the social structure has neither primacy nor preference over the human agency and vice versa. Social structure is the outcome of human action and this action is made possible within the boundaries of the social structure in which it takes place. Giddens makes use of the term “system” to describe the overt pattern of social structures. The social outcomes – both the intentional and the unexpected – are an embodiment of the actions of human agencies. Social systems are reproduced social practices that are embedded in time and space. Rules and resources are drawn upon in the production and reproduction of social action. At the same time they are the means of system reproduction the duality of structure. Human agency is enabled by means of social rules and resources. The rules guide and inform the action and the resources provide it with energy: purpose power and efficacy. The three concepts that are central to an understanding of human agency and the social structure are communication power and sanction. These represent human actions as well as structures of meaning communication systems of rule and authority power and systems of morality and legitimation sanctions. Giddens breaks the mechanical character of social structure in that he sees it as a cluster of rules and resources and hence a fundamental part of human activity and not as an obstacle to activity. Structure is always both constraining and enabling Ritzer 1988. Communication. In order to communicate people draw interpretative schemes from symbolic structures of signification. Power. A system of domination is made possible due to the existence of social structures of rule and authority. Sanctions. In order to impose sanctions people rely on norms which are part of a social structure of morality and of a system of legitimation. The concepts of structure and action are produced and reproduced on the human agency level and exist as concepts of meaning on the social structure level. I have chosen the structuration theory as a basis for empowerment theory because it is critical self-critical holistic relates directly to the concept of power and binds micro and macro phenomena in the one explanation. The principle of duality of structure is suitable as an explanation for the various levels of empowerment as it is for analysis of any social process. Individual empowerment is human agency whose structural outcomes are not intentional it may have structural consequences but these are not the essence of the process. Community empowerment is human activity that has structural and organizational aspects which are aimed at changing social systems and creating structural alternatives. Professional practice is another form of human agency one that is made possible through existing social systems. When its outcomes are oriented to producing the two kinds of empowerment it is called empowering. 213

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2.6. A Definition of Empowerment In my search for a suitable meta-theory I wanted to establish the idea that the development of a theory of empowerment needs to draw its inspiration from interdisciplinary and multidimensional theories. From here on I will present a contextual interdisciplinary and multidimensional theory of empowerment. Empowerment is a process of transition from a state of powerlessness to a state of relative control over one’s life destiny and environment. This transition can manifest itself in an improvement in the perceived ability to control as well as in an improvement in the actual ability to control. Disempowering social processes are responsible for creating a sense of powerlessness among people who belong to groups that suffer from stigma and discrimination. A sense of powerlessness leads to a lack of self-worth to self-blame to indifference towards and alienation from the environment beside inability to act for oneself and growing dependence on social services and specialists for the solution of problems in one’s life. Empowerment is a transition from this passive situation to a more active situation of control. The need for it is part of the realization of one’s very humanity so much so that one could say that a person who is powerless with regard to his life and his environment is not realizing his innate human potential. Since the sources of powerlessness are rooted in social processes that disempower entire populations the empowerment process aims to influence the oppressed human agency and the social structure within the limitations and possibilities in which this human agency exists and reacts. We may therefore conceptualize empowerment processes as three interwoven processes which complement and contribute to one another: The process of individual empowerment which actually can occur in an immense variety of circumstances and conditions without any connection to the other two processes but when it occurs in the course of active participation in social change processes in groups and organizations it has a special value for both the individual and the environment. The process of community empowerment is a social change process which involves organizing and creating a community. A collective with a common critical characteristic that suffers from social stigmas and discrimination acquires ability to control its relevant environment better and to influence its future. Community empowerment processes develop a sense of responsibility commitment and ability to care for collective survival as wells as skills in problem solving and political efficacy to influence changes in environments relevant to their quality of life. Empowering professional practice is methodical intervention aimed at encouraging processes of individual and community empowerment. Empowering professional practice is professional activity that stems from social systems with the aim of encouraging processes of increased control of those individuals and communities in whose lives these systems intervene. 214

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2.7. Individual Empowerment or the Importance of the Human Agency The potential for empowerment like one’s very humanity exists in everyone and the ability to make a difference is a component of human existence. Systematic and permanent limitation of one’s ability to exert power is a negation of one’s very humanity. A human agency ceases to be such if it loses the ability to influence the world in some way Giddens 1984. To be a human being in the full sense of the word then means to carry out intentional acts in order to achieve defined goals that is to say to influence the environment to be able to bring about change. Circumstances exist in which people’s humanity in this sense is not realized. At times so many limitations are placed upon a person’s ability to exert power that he is unable to act at all. Nonetheless there is a fundamental difference between inability to act because one has no choice and lack of ability to act. Not every case of inactivity may be seen as lack of ability to act Mann 1986. The contextual theory of empowerment confirms the connection between the private and the political. It analyzes individual issues in social life politically. The individual interprets the politics of her life on the basis of the knowledge available to her about political achievements in the social domain. In the Western democracies people are conscious of certain social values. They know that there exists a fundamental demand for autonomy and free independent functioning and also that freedom and responsibility co-exist socially in a certain balance. Although people are not free in any absolute sense of the word they are supposed to be free from limitations and conditions of exploitation inequality and oppression. On the individual level a private political response to these ideas develops Giddens calls this life politics 1991. On the collective level life politics focuses on what happens to people who have achieved a degree of consciousness and initial ability to act and are in need of community empowerment processes in order to realize their aspirations for personal autonomy. 2.8. Community Empowerment or the Social Structure’s Shaping Influence The individual then in seeking his personal political interpretation – a quest which is a result of the individual empowerment process – creates expectations for change on the social structure level. Community empowerment takes place when expectations for change which have accumulated in the social structure in the form of abstract structures begin to materialize. In other words one could say that individual empowerment creates a reservoir of community potential. Beyond this potential community empowerment requires resources of its own in order to be realized. It draws these resources from two sources which must be available with a certain coordination between them: 1. Individuals who have come to recognize that they are interested in acting not only to realize their own personal desires although still in the framework of improving their quality of life. 2. External change agent – professionals and others who are involved in a planned change process and contribute rules and resources to it – meaning legitimation and power—which support the creation of a community and its growing ability to influence the environment. The concept of life politics emphasizes the democratic context of the concept of empowerment. 215

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The empowerment process is conditioned by what already exists—by the social structure that enables or limits it. Regimes that do not recognize the individual’s right to act and to change and emphasize the duty of obedience as the essence of man shape social processes in a very different way than the democratic regime which at least on the expectations level permits and encourages the individual’s participation in public decisions. This is how the duality of structure principle operates. Beside the social activity the extent to which there exists a social structure that provides legitimation to civic participation – political regime policy resources – influences the character and the route of the empowerment process and is a critical factor for the chances of initiating it. However human agency has a variety of ways and means available to it in order to exert control on life even in conditions of severe structural limitations. Hence social relations even when they are asymmetrical are always mutual and a person is never without resources to the point of absolute lack of ability to exert influence on others even if they have privileged access and control over ability and resources Davis 1988. Empowering professional practice encourages and facilitates processes of increased control of individuals and collectives over their lives and environments. It develops intervention methods through which people can effect changes in their lives. In the empowerment process people learn to take on socially valuable roles to exercise social skills to exert interpersonal influence to develop commitment to take responsibility and to acquire political efficacy. The acquired abilities contribute to the joint goals of empowering themselves as individuals and as a community. Resources of the individual kind exist in every environment and may also be discovered there spontaneously. Few communities have developed from situations of powerlessness to belief in themselves and ability to make independent decisions through their own inner resources alone by boot straps processes. The encounter between the community and practitioners who use empowering professional methods is not spontaneous it is generally a synthetic occurrence embedded in a social system. It can stem from planned policy Couto 1989 Feldman Stall 1994 or from the professional’s individual moral decision Schuman 1987. The empowerment process produces a synergy that encourages the preservation and reproduction of the process Katz 1984. As the empowerment process progresses the empowering professional practice is reinforced and from the outcomes of the process and from the process itself it receives proofs of its effectiveness and in certain cases also legitimation from the system. On the action level the practitioner accumulates experience and professional confidence as well as new knowledge. On the structure level a potential for creating new social systems based on empowerment-enhancing communications norms and forms of authority is created. The empowerment process also limits the professional practice because at its peak it eliminates the need for its services. The more the empowerment process progresses the weaker becomes the dependence on professionals principally on the empowering professionals who deliberately avoid developing dependence and they become less essential for the continuation of the process. When a community achieves empowerment it no longer needs the professional services that were essential in the stages of transition from powerlessness. Social knowledge is neither objective nor neutral it either contributes to social liberation or it encourages exploitation and social domination. By the same principle empowerment practice cannot be neutral either: a professional who does not advance empowerment almost certainly hinders it. The rules of empowering practice also apply to an interpretative social theory which must therefore be a critical theory too because it is not only the social scientist who produces and 216

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interprets knowledge but also the people who are the objects of the research participate in its creation through their activities that produce and reproduce it Giddens 1982. Such double hermeneutics is called for in order to give validity to the knowledge created both by the people living in the society and by the social sciences. 2.9. Duality of Structure Dynamics in Empowerment Processes Empowerment Processes. Duality of structure emphasizes an important dynamic aspect of the empowerment process: empowerment potential exists not only in terms of people’s personal resources and abilities but also in terms of the rules and regulations of the social structure. The connection made by Giddens 1984 between social structure and human agency reinforces the theoretical explanation of the way community empowerment contributes to individual empowerment. Hence empowerment may be compared to a circular process of social change and activation of abilities and resources in which human agents in need of empowerment act together with empowering human agents. The social structure that is produced by means of this activity includes preservation and reproduction of elements from the existing social structure and a moral process of critical social analysis. In the communications domain empowered people learn to understand their situation differently and thus create a symbolic structure that they share one which gives them a new social meaning of their situation and their relations with others. In the normative domain people learn to appreciate anew certain social norms that affect them. They start taking an active part in the moral discourse and change it by the very fact of their joining it. Through this new social participation they can impose sanctions against social systems with which they had previously acquiesced to their own detriment. Empowerment may be described in terms of individuals’ ability to effect change but one cannot understand the power of a particular person which is expressed in his own specific activity without relating to the existing structures of control that this person reinforces interprets and changes through his behavior. Personal efficacy draws its strength from structural forms of control that are embedded in social systems Clegg 1989. Hence the empowerment process depends on what already exists in the society but the success of the process is defined by what and how much changes on the personal level the community level and the social systems connected with the process. Community empowerment depends on the acquisition of ability and on access to essential resources which can be divided into two kinds: allocative resources and authoritative resources. Allocative resources are material resources such as raw materials technologies and products produced through the combination of these. Authoritative resources are organizational resources which can be divided into three kinds: 1. Organization of social time-space i.e. the creation of paths of daily life. 2. Organization of human beings in mutual association. 3. Organization of life chances: the constitution of chances of self-development and self- expression Giddens 1984. The degree of access to necessary resources of both these kinds is what determines the degree of ability to act and to influence. The less accessible these resources are to a person the further she is from the ability to influence the social structure or to influence the creation 217

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of rules and laws which also determine the degree of people’s distance from resources. Empowerment creates a change in human behavior and in the social structure. The potential for community empowerment exists in every environment just as the potential for individual empowerment exists in every person. In every process of individual empowerment there also exists a potential for community empowerment and every process of community empowerment creates an environment that facilitates individual empowerment and at the same time also shapes and determines its form Maton Rappaport 1984. 2.10. What are the intended outcomes of this process Since we are speaking about a theoretical process it is open to an infinite number of variations but we may note a number of outcomes in the course of it: 1. The empowerment process in most cases begins from a sense of frustration: people’s sense that there exists an unbridgeable gap between their aspirations and their possibilities of realizing them. People discover that the realization of their aspirations depends on abilities and resources that are beyond their reach Kieffer 1984. 2. For the empowerment process to be able to develop this sense needs to be accompanied by a minimal level of ability and resources to enable organized activity as well a minimum of social legitimation to permit such activity. 3. Empowerment begins then with people’s will to obtain resources and means to develop ability in order to achieve something in their lives. The mobilization of resolve and will is a first outcome in the process. 4. People’s recognition of their right to express aspirations and their ability to define them is an outcome of developing a critical consciousness of the existing situation Freire 1985. 5. People’s belief in their own ability to achieve outcomes is an achievement in terms of a sense of individual ability to control one’s life Bandura 1997. Self-efficacy may become collective efficacy if it gets translated into the community’s practical ability to organize itself for a collective effort to achieve outcomes in the environment. 6. Success in mobilizing resources to continue the process including resources of knowledge about organizing and setting up community organizations are outcomes that indicate that the empowerment process has established itself Mann 1986. This is a proof that the people have secured for themselves an ongoing ability to achieve outcomes: to control their lives to participate in decision making and to influence the environment. The entire sequence of stages may be any hypothetical empowerment process and each one of the stages is an end in itself and may also be a starting point for a different empowerment process. The point of departure for change depends on the opening conditions of the particular empowerment process. 218

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2.11. Powerlessness. It is the social systems which are intended to solve social problems that produce the powerlessness of the people in need of their services generally not out of bad intentions but as a by-product of the flawed way that social policy is executed and that public services are given to people in distress Berger Neuhaus 1977 Rappaport 1981. Hence empowerment theory diagnoses powerlessness as a social problem and not an individual problem and criticizes the conservative tendency to diagnose manifestations of powerlessness dependence despair and self-blame as the personal at times cultural problems of individuals. What all situations of powerlessness have in common is the personal psychological experience of loss of control which every human being can identify with emotionally. Since there is nobody who has not experienced moments of helplessness and powerlessness there exists an intuitive understanding of the injuries caused by constant and ongoing powerlessness and this validates the universality of the need for empowerment. Disempowerment of people who belong to a particular population group produces powerlessness that influences the lives and futures of the individuals and the fate of the entire community. Powerless people as already noted expect a lack of connection between their behavior and desirable outcomes and defend themselves by means of extreme fatalism self contempt and indifference to their deplorable situation. As a consequence of the negative valuation that is part of the disempowering processes directed towards a social group this group is systematically denied identities and roles possessing social value and important resources Solomon 1976 1985. These two – roles and resources – are the basis for the exertion of interpersonal influence and for effective social functioning. Hence inability to exert interpersonal influence and inability to function effectively in society which various theories identify as personal problems are structural manifestations of powerlessness. Duration is what differentiates between states of constant and ongoing powerlessness and situations of powerlessness that originate in a crisis or in stress and can happen to any person or any group. In crisis situations too there are manifestations of powerlessness but without systematic and structured disempowerment. Nonetheless there may be a subtle difference between the two situations of powerlessness the temporary and the chronic. We can learn something about this from the vulnerable situation of new immigrants who in the first stages of their absorption into the society should be regarded as a population in crisis. The transition from the country of origin to Israel creates a rupture that is accompanied by feelings and manifestations of powerlessness. The expectations of both the immigrants and of the established society are that this is a temporary situation which will pass when they become part of the local society. However beside groups of immigrants who experience a temporary crisis and then do become part of the society other groups of immigrants are exposed to systematic and ongoing disempowerment that includes discrimination and stigma and leads to powerlessness with all its difficult manifestations. The conclusion is that in society a tendency exists to selectively disempower certain groups of immigrants. To identify the victims is a relatively simple matter. They are always the poorest the weakest both physically and psychologically or those who are most conspicuously different in cultural or ethnic terms. The combination of economic/organizational weakness and cultural difference creates an especially high risk of powerlessness. 219

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From this example we can learn that in every case where a crisis event occurs in the life of a social group even if this crisis is planned expected and temporary there needs to be criticism of the practices activated by the social systems that treat the event in order to identify disempowering policies and practices to prevent these and thus to prevent the constant and perpetual powerlessness of an entire social group. Powerlessness like any social situation produces adaptive mechanisms in those subject to it and it is important to identify the principal mechanisms. Powerless people internalize their impossible situation and the blame it entails. They identify with the negative social opinions and accept the society’s judgment of their worthlessness. As a means of escaping from their hopelessness and their knowledge that there is no way out of this situation they tend to internalize the society’s values beliefs and game rules including those that are directed against themselves. People who are prevented from participating in action that defines them and from expressing thoughts about their actions develop a passivity and give up on the idea of controlling their destiny and their future Gaventa 1980. Even when the passive quiescence breaks it does not totally vanish its remnants make it difficult for people who have become accustomed to quiescence to express themselves in a clear and stable way. The new consciousness in the stage of emerging from powerlessness is a source of instability and that can easily be manipulated Freire 1970. The quiescence of the powerless endangers their future for it enables the society to speak for them and tacitly endorses the development of a victim-blaming rationale of powerlessness and a legitimation of its continued existence. An example of such a rationale is the prevalent conservative position which claims that a developed political consciousness is the reason for participation in political processes. According to this position someone who does not participate chooses this course because she lacks political consciousness and therefore prefers to be represented by others. This is a way of explaining non-participation and also of giving legitimation to the existing situation. However research has shown that people’s participation in political processes augmented their political consciousness Pateman 1970. In other words participation itself creates consciousness no less than consciousness leads to participation and hence someone who does not receive an opportunity to participate is prevented from developing political consciousness and becoming involved in public matters. In empowerment theory terms what we have here is not the human agency’s choice not to act but a structural duality which creates a deliberate social outcome: the social structure systematically by means of structures of sanctions communications and domination limits the human agency of particular groups. This limitation is manifested in limited allocation of resources resulting in the human agency’s inability to develop abilities which condemns them to playing a passive subordinate role in society’s production. 2.12. Power Barriers. How does the allocation of meager and powerlessness-producing resources come about The society has direct and indirect ways of effecting disempowerment. The indirect power barriers are the ones that are incorporated into a person’s growth and developments stages and are transmitted to the child and the adolescent by means of significant others in his life Solomon 1976. These are the authoritative resources that the society provides by its organization of social relations and life opportunities in ways which although covert have a most profound influence Giddens 1984. 220

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The direct power barriers that originate in the allocative resources are implemented against the individual directly through the practices of social systems. The authoritative and allocative resources integrate the direct and indirect power barriers into a single structure of rationalization and legitimation: the liberal approach which encourages the non-participation of the poor in political life gets internalized in the child by means of his parents who have accepted their negative social valuation and when he grows up it is transmitted to him directly by means of the meager allocation of the allocative resources from the education system through to old-age pensions. Due to the penetrating thoroughness of the integrated power barriers as long as the consciousness of the powerless does not change in a stable and fundamental manner no significant change in their situation may be expected Gaventa 1980. Their emergence from a situation of powerlessness then demands a great effort in contrast to the relatively small steps that need to be taken to maintain their existing situation. To overcome the power barriers is much harder than to preserve them. However when a change process begins it is self-reinforcing. When a barrier collapses this means a change in the rules and structures of meaning and legitimation. These lead first to changes in the allocation of the allocative resources the material resources and with much more difficulty also to changes in the authoritative resources the organizational resources Clegg 1989. Hence the breaking-down of one power barrier accelerates and facilitates further progress. This is an example of the synergy involved in the empowerment process and of the motivating power of success which brings about an improvement of self-image in the course of acquiring abilities and obtaining resources which originate in the empowering professional practice. The question of whether these processes fundamentally influence the field of power relations will be discussed further on Gaventa 1980 Clegg 1989. 2.13. Organizational Outflanking. Organizational outflanking is yet another conceptualization sophisticated in its simplicity of the power barriers Mann 1986. Its claim is that powerlessness is nothing but a submission to power’s organizational advantage. Because of this concept’s strategic importance to empowering practice it is worthwhile to become acquainted with the two categories of response to organizational outflanking. Conscious Submission to Organizational Outflanking In certain social conditions the knowledge and consciousness of the outflanked is of no practical value. Their inactivity stems from knowing the price they would have to pay for struggling with the organizational outflanking. Such submission covertly undermines the conception that development of critical consciousness is the beginning of a practical change process. This gives further support to the claim that individual empowerment does not necessarily lead to community empowerment. The conscious submission to organizational outflanking makes perceptible the affinity of the concept of empowerment on all its levels with the democratic context. An event which occurred in a different context describes the regime’s brutal response to a community empowerment process in a town in Venezuela where the residents built homes for themselves by themselves assisted by professional practice of people from the nearby university. The regime’s response made it clear to anyone who needed clarifications that a dictatorial regime sees even personal empowerment as a threat that has to be eliminated. Although they were conscious of their situation and possessed not-inconsiderable abilities the local residents did not manage to advance in their community empowerment process because the 221

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social structure they live in entails dangers to the lives and property of any human agency focused on change Sanchez et al. 1988. In Israel the occupation regime in the territories provides daily examples of frustration of attempts to organize and of independent community expression. An example of conscious submission to organizational outflanking in a democratic society is an event in which a group of parents participated in the running of an open school but was pushed to the margins as a consequence of the teachers’ taking control of all the school’s organizational frameworks. The parents who lacked organizational means of their own remained outside the decision making process and ceased having an influence. The researchers Gruber Trickett 1987 analyzed the process by dividing the concept of empowerment into psychological empowerment and political empowerment. Psychological empowerment was described as a personal process that is not dependent on organizational means and this was achieved by the parents. Political empowerment was defined as actual participation in decision making this was not achieved by the parents. Had the researchers analyzed the situation with the assistance of the organizational outflanking theory they would have reached the conclusion that the parents despite their consciousness of their situation had difficulties in realizing empowerment because they were organizationally outflanked by the school. Unconscious Submission to Organizational Outflanking The unconscious response to organizational outflanking is attributed to three factors: the ignorance the isolation and the exclusion of the outflanked Mann 1986. Ignorance is considered the major cause of powerlessness mainly because of the absence of tools and abilities that accompanies lack of knowledge. People are unable to describe and conceptualize their situation and their powerlessness deepens because of the quiescence that accompanies ignorance. This connects with the two other factors – exclusion and isolation – which are responsible for preserving the status quo of the ignorance of the outflanked Gaventa 1980. Isolation of groups from one another so that they will not be able or interested to organize themselves is an old and tested strategy in the service of power. The advantage of strategies of isolation and exclusion is that they are commonplace to the point of banality and at the same time are easy to camouflage. An example that demonstrates how common is the use of methods of exclusion for purposes of organizational outflanking are the procedures for the participation of residents in the Israeli Urban Renewal project which began in 1978 and has actually not been completed to this day. From 1980 on the authorities engaged in the project instituted neighborhood elections as a condition for participation of residents in the formal decision making processes. In this way a separation was effected between the elected representatives of the residents who received appointments to participate in the committees and other representatives of the residents who were not given right of entry into the official decision making process. Further separations were also instituted in the same project. For example: between owners and rent payers in public housing and between the more established residents of the neighborhood and people in need of welfare services Alterman and Churchman 1991. 222

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2.14. Empowerment as Social Transformation Does empowerment create a fundamental change in the power field that it occurs in This is a Foucaultian question which therefore has no simple answers for an answer which is not complex and dialectical which generalizes and simplifies serves the existing power relations. If we see empowerment as a local resistance to power then its occurrence does not transform the field of power relations itself very much. This analysis is correct for individual empowerment in particular. Through his own empowerment a person gains a higher level of consciousness about his place in the power relations but his achievements are not felt in the existing power fields although they do add to the potential for social change as Giddens 1984 presumes. Michel Foucault claimed that there are human actions and phenomena that have managed to elude the net of power and to preserve their freedom and then institutionalization is the major danger to their existence. In his view the very endeavor to develop new knowledge around empowerment and to organize it in an institutionalized way as the present book is attempting to do is liable to turn a phenomenon that means more control by the individual over her life and her fate into yet another domain under the supervision and surveillance of power. Conceptualization of empowerment may be interpreted as yet another attempt by power/knowledge to take control of the field of humane social phenomena. This is one of the problems in a Foucaultian analysis. Any attempt to organize knowledge in an ordered way is suspect as an attempt at normalization—at judgment and domination. Nonetheless there is truth in this extreme position: a phenomenon that is adopted by the scientific establishment and is disseminated under its auspices to social institutions is liable to lose its authenticity as a substantiation of the validity of Foucault’s claim we may cite the mechanical use of the concept of creativity since it was adopted by educational and therapeutic institutions and became distorted while being activated in their framework. Foucault justified his refraining from creating a theory in the domain of power as a refusal to cause harm to any social subject that is condemned to scientific generalization. Anyone who agrees with him can go on developing a theory only within this contradiction in the hope that Foucault’s evaluation of the extent of the interconnections between the technologies of power and social knowledge was an exaggerated one. Although insufficient evidence exists about the fundamental social change that empowerment will bring about if and when it is adopted as a policy and a professional practice Foucault himself demonstrated how a written idea may serve power relations and provide a direction for development of technologies 1979. Any new idea any linguistic innovation then has this opportunity of bringing some fresh innovation to the accepted perspectives and conceptions in the domain in which it appears. Likewise any such innovation may be implemented in different and contradictory directions. Empowerment emphasizes the ability to control that is innate in every person the importance of context for an understanding of this ability the special place of human solidarity and of community in this context and the roles of professional people in changing the disempowerment produced by social systems. It is thus different from the ideas about achievement competition and selfish individualism that according to Foucault as well characterize the knowledge that acts in the service of technologies of power. 223

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A Foucaultian interpretation will also claim that empowerment promises too few outcomes in the field and places too much emphasis on the consciousness and feelings of individuals and groups without changing their actual situation. In this way empowering practice is liable to turn into a technology in the service of power which helps deprived groups to be more contented in their deprivation. This is not a totally groundless possibility especially if we agree with Foucault’s evaluation that power in the Western world is characterized by the sophistication with which it conceals itself. Any focus on individual empowerment arouses a Foucaultian interpreter’s suspicion and in the writing on empowerment in social work such an orientation exists Lee 1994 Miley et al. 1998. When the professional practice focuses on the individual question of who is empowered and who is not this question becomes yet another criterion for judging people and separating between them as is common in typical power technologies. Hence empowerment as knowledge cannot limit itself to developing an individualistic therapeutic approach. Despite its originality and importance such an approach will limit itself to implementing knowledge in the service of veteran social institutions the welfare services for example. Empowerment is valid as a new approach and a new idea only when it is implemented on the social level. 2.15. Politics of Empowerment When a chance for social change exists the next question that follows is what will be the character of the process of social change or what kind of politics characterizes empowerment. One could answer that generally it seeks social legitimation and consensus and the use of the concept of life politics attests to this see above. Empowerment is not interested in appearing as a revolution but as a new social agreement— a social contract. Empowerment is a demand in the name of shared social values for recognition of the harm caused to certain populations as a consequence of manipulation of some of these values against them. Empowerment is a hope that on the basis of a platform of shared values it will be possible to reach conclusions and to change policies and practices that are prevalent in social systems. From a Foucaultian perspective at least three remarks are called for on this subject. 1. Since there are no possessors of power there is in fact no-one to approach. However it is necessary to ensure the development of a new professional consciousness. In too many cases people ask technical questions – such as How is it possible to improve the welfare system – and do not ask essential ones—such as What does the welfare system do to the people in need of it Empowerment poses such questions Rappaport 1985. 2. Since there is no-one who stands outside power and everyone is activated by the same technologies then as already stated even someone who feels he has power is manipulated and entrapped by it. If only for this reason it is worth abandoning the prevalent belief that power relations are a zero sum game. This belief results in a refusal to share resources of power with others thus perpetuating isolation and separation among people even in opposition to their interests. 3. In a democratic regime we can relate to empowerment as a kind of legitimate resistance that serves as a brake and a substitute for much more dangerous alternatives Minson 1986. Empowerment is an idea that is compatible with liberal democratic ideas and hence Western democratic society is capable of digesting it without shocks and even to gain some advantages through it. Power is prepared for tactical losses in order to gain a strategic advantage and empowerment may be a tactical loss of this kind. 224

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2.16. “What Does Empowerment Do” Foucault and Giddens after him would have wanted to investigate the unintentional outcomes of the empowerment processes. At first glance this would be a superfluous investigation because empowerment was born out of the critique of harmful by-products of social programs that have not asked What does the program do Swift 1984. In fact however it is important to investigate the connection between the discourse on empowerment and the empowering professional practice and also to analyze technologies that declare themselves as empowering in order to understand what does empowerment do or how it influences people beyond its overt messages Rojek 1986. Like any new concept empowerment too can lead intentionally or unintentionally to the establishment of new social structures and the preservation of existing structures that contradict its principal goals. If we believe Foucault power penetrates more and more into our lives as individuals but at the same time it increasingly camouflages itself behind knowledge and practices that have goals aims and a logic of their own. The question is whether empowerment teaches us something new about the existing power relations. Does it expose these relations and increase our consciousness about them or conversely does it contribute to the concealment of the mechanisms of power Empowerment’s test of authenticity then lies in its contribution to the creation of a critical social consciousness by means of speaking the truth and exposing unilluminated levels of oppression and discrimination Habermas 1975 Forester 1989. 2.17. Does Empowerment Stand a Chance In order to realize empowerment processes reinforcing systems of meaning power and legitimation are necessary on the level of the social structure. A democratic regime and democratic values provide these better than other regimes. However the theories of power as well as everyday human experience make it clear that in democracy there is no guarantee of fairer or more equitable power relations in every case. The democratic system provides a mechanism a legitimation and a moral endorsement for extreme and structured powerlessness. Empowerment theory then is a product of a democratic climate and its goal is to deal explicitly with problems of powerlessness created by structures and systems of meaning operating in democratic society. The advantage of the structuration theory as a meta-theory of empowerment lies not only in the integrated explanations that it provides for phenomena that a contextual theory of empowerment is interested in understanding but also in the sense of optimism that this theory contributes to the empowerment process itself. Exercise of power is primarily an action oriented to achieving strategic advantages in social relations. The right strategy is more important than the quantity and the possession of power resources. Instead of asking who has power and who doesn’t and how much power a more challenging and more optimistic question is redefined from the viewpoint of weak and poor people: how to activate what exists in order to influence the power field in a way that will make possible more control in their lives. The perception of the power relations as mutual and as a non-zero sum provides a way out of the catch involved in the lack of material resources and turns the realization of empowerment into a more realistic challenge. The centrality of strategic thought reinforces the rationale which says that development of abilities is the main means of emerging from situations of powerlessness despite the fact that powerless populations suffer also and perhaps mainly from a lack of resources. 225

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2.18 Summary of Part One The first part of this study dealt with a theoretical development of the concept of empowerment: the first chapter presented the connection between empowerment as a personal process and community processes and their influence on powerless people and also emphasized the role of professional practices as an essential component in the definition of empowerment. In the second chapter I looked for a meta-theory suitable to empowerment theory. In the course of my search I found out that not a few theorists look for an integrated explanation for social macro-micro phenomena. I examined three such endeavors and from these I chose Giddens’ structuration theory to serve as a meta-theory for empowerment. Giddens is suitable for this role not only because of the quality of his theory but also for his values. I appreciated the way he discusses the various theoretical influences that guide him his sources of inspiration and his values are revealed in the course of his theoretical discussion and are suitable to a theory of empowerment no less than his theory itself is. The way in which Giddens exposes the sources of his professional method made my choice of him easier for me on the metapractical level of my work as well and has enriched my approach to the development of a theory in many significant ways. The contextual theory of empowerment presents the transition from powerlessness to more control in life as a change in both human activity and the social structure. Powerlessness is a social phenomenon that has structural aspects which are rooted in the power relations and the disempowering practices that originate in the social systems. In the second part I will focus on the empowerment process in the context of community planning. The discussion of the professional practice will illuminate and illustrate various issues of the three empowerment processes the individual process the community process and the professional process. 226

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Part Two: Community Planning 3. Developing Empowerment Practice in the Context of Community Planning 3.1. Introduction The second part of the book applies the theory that was developed in the first part to a particular professional activity—community planning. Community planning as a context makes it possible to examine the mutual influences of empowerment processes and professional intervention upon one another without limiting the discussion to the bounds of a single discipline. In this way it is possible to make connections among several disciplines and to develop shared knowledge about empowerment for them. This part of the book will point to problems common to professional disciplines that are engaged in the planning of social solutions without creating the false impression that empowerment or disempowerment are connected to a single discipline exclusively. Having decided to choose community planning for the contextual discussion I had to grapple with a number of difficulties. I had to redefine community planning in order to connect it with the various professions each of which engages in it separately. I also discovered that community planning had gone out of favor—mainly because urban planners who had engaged in it had wearied of the participation of residents which had been forced upon them in the framework of this method. On the other hand I enjoyed a personal advantage for I was able to feel at home inside a practice that is connected with my own profession which is community work. Beyond that in Israel in contrast to Holland and the United States there is no feeling of burnout in the sphere of residents’ participation in planning. Community planning has proved itself in a holistic planning of neighborhoods and in the encouraging of residents to act for themselves in nationwide projects such as the Urban Renewal Project and it is definitely likely to make achievements in contemporary programs such as regional development of the Negev and the Galilee for example. Community planning in Israel constitutes a kind of check and balance mechanism for the national and municipal planning system by dint of its focus on the local arena. Community planning then has a potential to influence individuals and communities. It is practiced by professionals from a variety of disciplines and through it it is possible develop an understanding of empowerment and to promote empowering practice among those involved in social processes. Although the empowering change is meant to have a favorable effect on individuals as well this book focuses not on the personal change but on the community change. It is important to remember that exclusive focus on individual change almost always entails some blaming of the individual for his situation and a placing of the onus of the change on him alone. Hence empowering practice uses individual change methods together with community interventions and never separately from the latter. In this part of the book special emphasis will be placed on the need for a change in professionals’ attitudes and methods of working for social change. Since the conditions and 227

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the circumstances which produce powerlessness are social and disempowerment occurs by means of social solutions and the practices customary in the frameworks of these solutions the target for change is these practices and not the people who suffer from them. Our assumption is that in this way the situation of powerless men and women will be improved in the fairest and most thorough way. In principle the empowerment process need not begin in local planning processes. It may also stem from social policy and from the decision making level in social institutions. However the reality proves that for the time being such a development route is no more than a wish. Social policy in most of its manifestations is still a source of disempowering practices. This book deals with how people overcome the disempowering influence of social policy. The experienced route of empowerment processes is an encounter with a disempowering solution and a resolute and somewhat subversive effort by local activists to solve social problems that stem from it Boyte 1984 Feldman Stall 1994. I am interested in pointing to the important even critical role played by empowering professionals in these change efforts. It is they who know how to systematically link community empowerment with individual empowerment and thus to facilitate both processes and also to mediate between local structures and social policy and institutions and thus to enable the empowerment process to continue. The fourth chapter – Community Planning – deals with practice in this field and redefines it both through an analysis of the approaches of a number of disciplines that engage in planning and in the community and through a presentation of various styles of community planning. The fifth chapter – Individual Empowerment Processes in the Context of Community Planning – begins with a presentation of the group context in which individual empowerment processes occur it goes on to analyze the mutual empowering connection created between the individual and the environment and then analyzes the signs of the realization of empowerment in the individuals involved in community planning processes. The sixth chapter – Community Empowerment Processes in the Context of Community Planning – presents the stages of the community empowerment process. This chapter discusses organization as a central tool in the creation of a community and in the encouragement of community empowerment. After this several issues are discussed: the issue of conflict and its inevitable place in the empowerment and planning processes in the community the issue of outcomes—how can we evaluate what is a product of community empowerment the community empowerment of minorities and of women two populations whose needs in the domain of community planning are great yet not enough attention is devoted to them in the urban planning context Churchman 1990b. The seventh chapter – Community Empowerment as an Empowering Professional Practice – discusses the planers themselves as promoters of the empowerment of individuals and communities and as a population which itself is in need of empowerment. On the basis of the stages of empowerment that were developed in the previous chapter this chapter presents a conceptual model of stages of empowerment enhancing professional intervention. The purpose of the model is to answer some methodical questions on the many subjects included in this complex chapter. The discussion of each of the intervention stages focuses on the intervention methods and the questions specific to that stage in the practice of encouraging empowerment. 228

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3.2. Community Planning Community planning is a practice that is engaged in by numerous disciplines: community work urban planning macro social work architecture urban geography community psychology environmental psychology community psychiatry. A study of the practice of community planning in the various disciplines leads to the conclusion that despite their similar means and the fact that they are influenced by the same social processes almost no dialogue exists among the various professions engaged in community planning. The diversified activity rather than contributing to an enrichment of this occupation has led to a dispersal of the knowledge has made it difficult to create a significant mass and has interfered with efficient learning of lessons from experience. In the domain of urban planning since the early eighties it has been rare to find explicit reference to community planning except where the issue is to shake free of it Hague 1982. In the United States in the sixties community planning represented a reform in planning methods but the political and professional expectations this aroused were frustrated. The planning was supposed to consider local needs and to involve the public but large projects of urban renewal and war against poverty which used community planning methods failed. Furthermore politicians did not achieve social quiet and a more efficient problem solving process by means of community planning Needleman Needleman 1974. The Republican administration from the time of Reagan on curtailed public resources and dealt a fatal blow to the social legitimation of investing in the weak Boyte et al. 1986 Phillips 1990. However despite the absence of community planning from the mainstream of planning in the United States in recent years the documentation of the practice of planning indicates that during all these years there has been significant – if also modest in resources and extent – community planning activity Rubin Rubin 1992 Feldman Stall 1994. In Israel the situation is different mainly because the largest community planning project ever conducted – the Urban Renewal Project for the rehabilitation of poor neighborhoods – has had much more impressive results than in the United States. In Israel however community planning is almost never related to as a defined field of practice and was never thought of this way in the past either. Traditionally community workers and city planners who have participated together in this project define themselves as being engaged in community planning. My choice of community planning as a context for empowerment processes stems as I have said from a desire not to impose disciplinary boundaries upon thought on empowerment. The interdisciplinary approach is more suitable for coping with the diversified knowledge and many conflicting wants which constitute the stormy reality that characterizes community intervention. I have chosen community empowerment as a context for two more reasons: firstly because the principles of empowerment practice recommend small planning Shumacher 1973 as close as possible to the people who are living in the planned space and are influenced by the outcomes of the planning and secondly because of my personal preference to stay close to community work. Community planning is a suitable context for a theoretical development of the concept of empowerment because it is an interdisciplinary professional practice that declares its intent to work small to create a community and its interest in solving community problems. In principle though it is possible to analyze empowerment processes in completely different professional contexts as well. However the context is not only a framework. One of its properties is that it can become an important part of the phenomenon itself. The ecological approach presumes that it is impossible to investigate a social situation in isolation from the texture in which it occurs Altman Rogoff 1987. The context includes the environmental conditions which are the cause of the characteristic situations that define the phenomenon. A change in these conditions influences the entire social situation as well as private lives Stokols 1987 Saegert 1987. Community planning then is an inseparable part of the social situations in which it intervenes. It is almost 229

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certain that a choice of a different practice would have led to a different discussion of empowerment and its meaning. 3.2.1. Community Planning in Community Work In community work planning is often discussed under several names: community planning social planning and neighborhood planning. In the literature these sometimes appear as synonyms Lauffer 1979 but it is also common to differentiate among them: community planning is planning in and with the community social planning deals with more institutional change—allocation of resources and setting up services for the solution of general social problems Rothman Zald 1985 neighborhood planning is an attempt to escape the vagueness of community to a concrete neighborhood Checkoway 1984 Rohe Gates 1985. The plurality of names attests to dispersion and confusion. Attempts to define a special planning for community work have created divisions between planning and three other kinds of requisite skills—of participation organization and action. Planning received a technical meaning of information collecting program planning and evaluation Rothman 1979. Despite the importance of planning some writers stress that it is not as natural for community workers as their other tasks and that there exists a tension between community development and community organization on the one hand and community planning on the other hand Morris 1979. Community planning is considered to be less sensitive to process than other fields of practice in community work Tropman 1984a. While the processes of community development and community organization demand that community workers possess skills in interpersonal communication and creation of dialogue planning is perceived as an essentially intellectual skill Gilbert Specht 1979. As a consequence many community workers traditionally avoid engaging in community planning mainly on grounds of alienation and lack of technical skill—sentiments which originate in the central texts of the profession. This is a mistake that neglects a whole spectrum of solutions and means which it indeed leaves in the hands of professional planners most of whom though not all are not trained or interested in contending with social problems. 3.2.2. Community Planning in the Theories of Planning In the domain of planning community planning was a disputed issue even at the peak of its flourishing. Needleman Needleman 1974 chose to call their book on community planning Guerrillas in the Bureaucracy and defined it as the source of problematic relations with the employing organizations as possessing disputed methods of action and as impossible to implement because of its abrasive intensity and its tendency to arouse conflicts. A prevalent approach in planning is to present community planning at times as a method in the framework of rational overall planning and at times as a separate approach to planning. Theoretically it is a type of comprehensive rational planning Friedmann 1987 but practically the claim is that it opposes rational planning models. Some writers interpret this as an advantage and others see this as a flaw Burke 1979 Mayer 1986 Hague 1982. The argument in theories of planning between those who negate community planning and those who affirm it centers around its effectiveness as a means of achieving support for the planning and for quiescence in the planned environment. The writers in favor of community planning refer to the good influence of residents’ participation in the planning and to the atmosphere of the planning and its effectiveness in the solution of problems in the field. Those who oppose it claim that the chaotic reality and the paucity of achievements overwhelm these advantages. This argument implicitly contains the explanation for the disappointment in community planning evident in the theories of planning. If the main issue is the success of the planning then only achievement of support for the planning and for quiescence in the relevant environment can justify the planner’s work in cooperation with the community. From this approach derive procedures and rituals of participation aimed not at bringing about social change and creating a community but at achieving social agreement and consent. In 230

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this way community planning becomes a manipulation a double message and a game within a game Hasson 1988 Atzmon 1988. Apart from several exceptionally sensitive planners Davidoff 1973 Friedmann 1973 1987 Krumholz Forester 1990 this is generally the approach to community planning in theories of planning. 3.2.3. Community Planning Orientations in Urban Planning While community planning under this name has been pushed to the margins of planning theories something which may be called a community planning orientation has been emerging in urban planning. A number of writers emphasize that urban planning needs to be more political more social and more community-oriented. Politics social problems and interpersonal skills need to become more central in planning practice Benveniste 1972 Baum 1980 1986. Phillips 1990 predicted that the nineties heralded a new political period in the United States. In his view after years of benevolent neglect p. 219 that had led to impoverishment of the middle class homeless families and people with mental disabilities. After the excessive individualism the glorification of Mammon and the disregard of community a desire for a new social and political approach that will divide wealth and power differently has emerged. Signs of this may also be found in the planning literature e.g. Marris 1987 Krumholz Forester 1990 where a trend to change urban planning itself are discernible. The planning process is described less as a technical economic and design activity and more as political social and personal intervention. The direction is to see the planner’s role as one of creating relationships and mutual understanding dissolving uncertainty and assisting self-empowerment. Urban planning is not only a technique but also a worldview with distinctive social goals of achieving better quality of life for the city’s residents. Hence planning is always a social political activity and as such it always entails a tension between the mechanical the efficient and the standard on the one hand and the cultural the social and the historical on the other. The question is not whether planning should or should not be rational for there exists no single rationality but many kinds of rationality and these find expression in political world-views. It is important to understand that according to one – the conservative – world-view social phenomena such as crime unstable families and unorganized communities are the cause of poverty while according to another – the progressive – world-view they are the outcome of poverty. The implications for planning are critical: in the conservative approach means and technologies are allocated in order to supervise the internal order in poor communities. For example conservative researchers prefer to focus on the poor people’s motivation to work instead of acknowledging the humiliation involved in degrading work and miserable wages Galbraith 1992 and the existence of deep unemployment where the poor live. According to the progressive approach it is necessary to relate to the causes of poverty and to seek more environmental more equitable and less individual solutions Since ideologies influence the strategies of intervention in social issues it is important to understand what sort of rationality a particular theory of planning employs. One conclusion is that even adoption of the most rational approach cannot prevent the planner from relating to a social problem from a bias in one direction or another or from accepting the unexamined axioms of others and from planning unsuitable solutions on the basis of these. Logic always has a clearly political context. Since poverty is a political issue the questions that have to be asked about it as about any political issue are: Who are the people who are included in the division of resources and who remains outside Who receives what and what does this do to the people Poverty is not an unfortunate accident which has befallen some individuals entangled in the mechanism of social mobility. On the contrary poverty is an inevitable outcome of a political set of priorities and of economic activity. Hence both the allocation of resources and the methods of contending with poverty are politicaleconomic issues. Planning then is political activity and the planner is only one of the participants in it Katz 1989 Mueller 1990. The planners and they only are committed to the planning process and the production of a comprehensive plan. 231

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The rest of the participants see the planning activity as only one of the options for political activity. Hence they will make use of planning only if it helps them control situations of uncertainty better Marris 1987. Planning is one component in a complex social system in which the dominant processes are the political processes. The practice of planning when it is at its best may make a contribution of its own to the process. For example planning can help relatively weak groups that participate in the planning process to achieve goals of their own Hajer 1989. Planning can provide an alternative rationale which can illuminate processes of social change and social action in a more positive and hope-inspiring light Marris 1987. Another orientation in planning thought shifts the focus of planning from thought about form and design to thought about practice and meta-practice. Even if the planner has to possess analytical skills interpersonal skills are an important part of her professional practice—she also has to be able to hug somebody to work with people who are different from her and not to be arrogant Forester 1989. The planner’s ethics honesty reliability and the clarity of her communication require a humane and participatory approach. Supreme importance is accorded to processes of communication language and creation of reliable and shared meaning. The planning style recommended is democratic based on broad participation and engages simultaneously in design and negotiation. It emphasizes the empowerment of the participants in the planning as one of the goals of the planning process. An explicit communitarian orientation has also emerged from planning theories and gained an important ideological status of its own. This orientation aims at the creation of an active democratic community. Writers in this vein express a longing for a community and speak of the isolation and the exclusion that Foucault expresses in his writings as one of the most destructive by-products of urban planning and of modern life in general Handler 1990 Etzioni 1992 Etzioni 1995. A community has both a local and a national importance. It supports social networks and facilitates relations between individuals and groups but it is also a significant unit of analysis and action in the domains of social policy and economic development. It is a large enough unit to become a political force and small enough to relate to the individual and to be accountable to him. On the basis of the connections between people as individuals and as groups and between them and systems of rule and administration services are founded and social and cultural life develops. The opportunities for more skillful participation in politics created in the community help people acquire organizational skills and political understanding and consolidate a sense of common purpose in their lives. The actual meaning of the recovery of the political community Friedmann 1987 is severance of the household from disempowering service systems and concentration on community values The positive aspects of the community are presented as decolonization—severance of the household from exaggerated consumption democratization— creation of equality within the household itself and collective self- empowerment produced by means of interaction among the households themselves. By means of these processes and with the assistance of planners who understand them people – at least according to Friedmann – can create an organized political community. These approaches when they support active and socially involved planning in the advancement of weak groups like Friedmann’s and unlike the communitarians’ Etzioni 1995 come very close to the original meaning of community planning. The introduction of community planning principles in this way has contributed to an improvement of urban planning at those points where it is too standardized total inclusive supervisory and based on scientific technical specialization. 3.2.4. Definitions of Community Planning So far I have deliberately avoided defining community planning both because a single agreed definition does not exist and because it was important firstly to present the current situation in the planning theories in the framework of which both local planning and the concept of 232

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community undergo a metamorphosis the meaning and orientations of which must be understood first of all. A dichotomous discussion is generally employed to contend with issues that do not have an agreed solution and that entail a moral dilemma. This is also the case with the series of dichotomies to be discussed here. The questions are: Which is preferable and why: planning from above or planning from below Lauffer 1979 Regional planning or neighborhood planning Checkoway 1984 Professional intervention focused on services or professional intervention focused on people Briscoe 1976 Directed professional intervention or undirected professional intervention York 1984 An expert planner who is distant from his client or a reflective planner who is socially and emotionally involved in his practice Schon 1983 3.2.5. Planning from Above or Planning from Below Planners who see planning as stemming from below are more interested in advocacy for people who are deprived of their rights and believe more in participation than in the achievement of pre-defined goals. On the other hand planners who see planning as management from above emphasize the achievement of specific goals and prefer a central planning which in their view is more objective. These two approaches represent two levels of planning: local planning initiatives and supra-local initiatives that come from outside the community. Despite the differences between them both kinds of planning are task-oriented efficient and adhere to a planned schedule and are likely to transmit the same impatience with the process that characterizes most kinds of planning Lauffer 1979. 3.2.6. Decentralized Neighborhood Planning and Centralized Sub-Regional Planning According to Checkoway 1984 we may distinguish between two kinds of planning in the community that originate in two different planning schools: planning that originates in community work is oriented towards neighborhood planning and planning which originates in urban planning is oriented towards sub-regional planning. Neighborhood planning is directed from below and sub-regional planning is directed from above. This presentation seeks to remain neutral on the question of decentralization-centralization but some writers explicitly prefer decentralized planning to centralized planning Handler 1990. The planner’s independent judgment and autonomy in the course of his activity in the community are an essential component of a professional practice that is interested in developing a community. Organizational centralization and the planner’s lack of authority frustrate his effectiveness in these domains. 3.2.7. Project-Focused Planning and People-Focused Planning Community planning may be divided into planning that focuses on service and projects and planning that focuses on people. People-focused community planning activates people in the planning process to develop a project by themselves and is compatible with decentralized neighborhood planning from below. Briscoe 1976 maintains that both kinds of practice – the service-focused and the people-focused – are necessary and complement one another. They represent more of a duality than a polarity. The two extremes are likely to represent different situations different conditions and different organizational structures that dictate a different diversity of work methods. However we must not ignore the fact that they may also represent an ethical dilemma when the planner has to choose whether to plan a project that has been dictated by the service that employs him even if he knows that the people it is meant for are interested in a different solution. 233

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3.2.8. Directive and Non-directive Professional Intervention At one end of the scale we find directive intervention where the initiative for the planning is in the hands of the planner the planning system and other professionals from the beginning of the process until its conclusion at the other end is non-directive intervention—here the planner serves as a counselor and a companion in a planning process in which people are enabled to decide plan and carry out the project by themselves York 1984 1990. The assumption is that the more people do for themselves with the assistance of professionals the greater will be their chances of achieving a solution to social problems that is more suitable to their needs and their life-style Mullender Ward 1990. This is an important therapeutic principle which is relevant to all the professional practices involved in human change. The key question is to what extent this principle is applied in practice for on the level of declarations its importance has been known for decades. In order to examine this we again ask the DARE questions: Who Determines the planning goals Who Acts in order to achieve the planning goals Who Receives benefits from the planning activity And who Evaluates the activity The more the citizens and their organizations determine the goals act to achieve them enjoy the outcomes of the planning and evaluate to what extent the action was worthwhile the more they direct themselves rather than being directed by others Rubin Rubin 1992. 3.2.9. The Community as an Object or a Subject The degree to which the professional intervention is directed has a further meaning. Directive community planning relates to the community as an object of the planning—a planned community. Non-directive community planning sees the community as a subject—the planning community Freire 1985. From the planner’s viewpoint the question of directiveness is a professional one a question of style and perhaps also of ethics. From the community’s viewpoint the important question is not professional or technical but rather a question of control: “How much do others control the processes occurring among us and how much do we influence the making of decisions that affect our future and the plans that determine our quality of life” Thus when you change your viewpoint and shift from the professionals to the local people the important questions change from professional questions into political questions Marris 1987. The message that non-directive intervention conveys to people is one of transition from existing as an object to existing as a subject Freire 1985. As we will recall people who are objects remain silent and their interpretation of reality is not taken into account. People who are subjects are conscious of their situation they participate actively in creating the reality by means of their experiences in the world and their subjective interpretation of life in this world. 3.2.10. The Expert Planner and the Reflective Planner Donald Schon 1983 conceptualized the difference between the two ends of this scale as stemming from different sources of satisfaction that professionals obtain from their practice and their connections with people. He differentiated between the expert and the reflective professional. The expert presents a total knowledge in planning and solutions despite his own uncertainty while the reflective practitioner sees his uncertainty as a source of learning for himself and for others possessing relevant knowledge on the situation. While the expert keeps a professional distance and transmits warmth and sympathy in what he considers the requisite dosage the reflective planner seeks an emotional and intellectual connection with people. The different styles influence people differently. The people who are in contact with the expert planner feel both the solace and the danger involved in the dependence and the unlimited trust that is required of them while the people who are in contact with the 234

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reflective planner feel both the satisfaction and the anxiety resulting from the demand that they participate actively in a shared process of investigation. The dichotomous discussion supports the conjecture that says that the planning style – be it service-focused or peoplefocused directive or non-directive centralized or decentralized – is an essential component for understanding empowering community planning while the content of the planning is merely marginal from this perspective. In other words even if the substance of the planning is important for the solution of problems in the community and is based on the community’s needs the planning style – the way the planning is carried out – will have a greater influence on the degree of empowerment that will be made possible through it. The substance of the planning alone however important it may be to the community does not ensure the suitable solution. The language that the professional uses her attitude to people and the amount of responsibility and authority that she delegates are principal variables in the question of professional empowerment while the formal contents of the planning are only secondary. The project may engage in the renovation of residential buildings or in the development of health services in taking care of single-parent families or the mentally disabled as positive and necessary as it may be it still needs to be carried out through certain processes and in a certain style if it is to achieve empowerment. 3.2.11. A Definition of Community Planning Community planning then is activity directed to effecting a social change that creates a community or reinforces an existing community. Community planning operates in a defined and limited environment and activates a process that emphasizes participation and mutual relations between the planner and the community and among the people in it. There are various styles of community planning—it ranges on a scale between directive and non- directive planning there is community planning which sees the community as a planned object and that which sees the community as a planning subject community planning may be based on centralized organization or it may be decentralized community planning may give the planner defined authority to develop a certain solution in the community or it may grant the planner autonomy to initiate a plan with the community. However only certain styles of community planning encourage empowerment. The positive connection between the non- directive decentralized subjective people-focused end of the scale of community planning and empowerment processes is almost self-evident analogously we may assume that the directive centralized objective end of the scale is disempowering. That is to say community planning like any professional practice is not neutral towards empowerment. Community planners operate along a scale of empowerment disempowerment and it is impossible to engage in this domain without influencing for better or for worse the empowerment potential of the people and their community. In this chapter we have reinforced in one more way the claim that community empowerment cannot come about of itself—systematic strategies must be implemented in order to encourage it. 235

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4. Individual Empowerment Processes in the Context of Community Planning This chapter discusses the personal experiences of people in the course of community planning processes. In the interactive process that takes place among them and between them and the environment they experience a transition to a situation of more control over their lives and environment discover new insights and abilities and contribute some of their knowledge energy and talent to society. 4.1. The Importance of the Group in Individual Empowerment When the individual empowerment process occurs in a man’s or a woman’s life they begin to believe that they are capable of having better control over their lives they understand their situation and begin to act to improve their lives and their environment. All this and much more can be enabled in group frameworks. In a group people are accepted as equals they express feelings and aspirations learn about themselves and their environment plan solutions and act for their own good and for the good of the environment. The social and political skills that are learned in the group are the ability to collaborate with others to exercise interpersonal influence to act politically to fill a responsible role to become committed to a cause to make decisions and solve problems to organize and perform complex organizational tasks to develop a democratic leadership. Development of many skills reinforces people’s belief in their ability and improves their self- confidence and in this way the individual empowerment process is reinforced in the group as well as receiving a meaning of doing for others and changing the environment which is what motivates the community empowerment process. The group is a mediating agency among the various levels of empowerment: it connects between the individual and the community empowerment processes it connects among the individuals who participate in it and between them and the environment that is relevant to their lives. The attempts to conceptualize individual empowerment by means of various psychological criteria see Chapter 2 have led me to the conclusion that the activity in a group no less than the personality determines whether the empowerment process will or will not take place in the person’s life. A person whose circumstances and conditions have led her to participate in an empowerment-encouraging group has a better chance of becoming empowered than someone who has not participated in such a group. It may be claimed that the very fact of being willing to join a particular group is likely to be a function of a special kind of personality as may the ability to persevere and to remain a part of the process. However experience teaches that coincidence and fate also play a part in people’s joining an empowering group and in the way the opportunity for empowerment is created. I was sitting on the balcony and I saw some people I knew walking with someone in the street. I asked “What’s up” and they called out “Come come” so I left my paper went downstairs and went with them from a movie about community work. 236

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Cooperation develops the personality. The individual who is a member of a group which helps to develop his political and social abilities becomes better equipped for action. A person’s belief in his own ability to control his life and his environment becomes part of the active character that Carol Pateman calls the democratic character 1970. The same person who testified that he had joined a group by chance also testified about how much the activity in the group had influenced him: I would not have been the person I am today if I hadn’t gone through what I went through in the group. Empowering community planning relates to all the people in the planning environment as candidates for empowerment in the organizational and group process that is developing in the locality. Some of the people will derive more from it than others. The conditions of empowerment depend on integration of environmental components with the individual’s personality. However group activity in the course of the planning is a necessary condition for empowerment. The next condition already depends on the individual himself: the greater the individual’s investment in the group the more successful is his empowerment process. That is to say the criterion for the realization of individual empowerment is the level of the individual’s activity in the group and not the level of the assistance that the group provides him Churchman 1990a. Giving to others responsibility for the task and commitment to the group and the community are important components in the individual empowerment process that occurs in a group Maton Rappaport 1984. 4.2. Individual Empowerment and Concern for the Environment A theory which integrates micro and macro levels in one explanation makes it possible to extend the perspective of time and space and to integrate micro-psychological with macro- ecological processes. The global ecological problems facing humanity highlight the urgent need to create in people a sense of personal commitment and responsibility to concern themselves with a much broader environment than the one they are aware of. One of the claims made by ecologists is that people do not understand the connection between the solution of problems in their immediate environment and potentially disastrous by- products in the broader environment. This implies that there is a global need to increase people’s ability to care for an increasingly expanding environment. I claim that processes of empowerment and disempowerment influence the way that people understand their environment and their degree of commitment to take responsibility for this environment. Disempowerment processes make people feel small and imbue them with a sense of marginality and worthlessness to the point of alienation and indifference. People therefore feel that there is no connection between themselves and society and they certainly have neither the will nor the ability to work for its well-being. Empowerment processes create the opposite effect—people feel that they can influence they are willing to commit themselves and to take responsibility and to play an active role in the world because they know that their efforts are important and valuable. The question that arises here is: What are the boundaries of a person’s relevant environment For what environment will a person be willing to take responsibility 237

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The assumption that has guided me so far has been that the relevant environment of people at the beginning of their empowerment process is relatively narrow. The word community and community planning designate this narrow realm to the local and the familiar. But for the purpose of the present claim I want to burst through this assumption and to say that we professionals do not know enough about people’s potential for concern commitment and responsibility because we are more concerned with the limits of our own intervention than with the extent of the environment that is important to them. We consider the boundaries objective while we gather data and information about people that of course also includes their subjective data. Disempowering planning does not consider subjective boundaries at all precisely because they are subjective Stokols 1987. Empowering planning avoids the use of the terms objective and subjective as distinguishing between true and false. The empowering planner also relates to herself as a subjective person. She knows that the limits of planning intervention are in most cases determined by technical considerations when the researcher decides that she possesses sufficient data to describe the situation in a credible and convincing way or when the economic considerations dictate where and to what extent the intervention may be performed. The balance between the practitioner’s interpretation and that of the local people does not represent a negotiation between equals who have arrived at an agreement on the limits of the environment that is relevant to both sides rather it is the practitioner’s or researcher’s own inner intellectual process which is not necessarily more objective. For these reasons the empowering community planner knows that the limits of the environment that is relevant to the individual depend on what that individual perceives as influencing his life Churchman Ginsberg 1984. This perception is dynamic and changing and will change further as a result of the empowerment processes the person experiences. It may be said that a narrow perception of the environment attests not only to the limits of the environment that is perceived as relevant to life but also to the person’s social and personal situation. The more powerless people are the narrower their world and the more empowered they become the more their world expands. My claim is that for the sake of survival in the world and not only for the sake of the quality of our lives as a society and a community we must aspire to the empowerment of as many people and communities as possible because the more empowered people are the more capable they are of caring for a broader environment. Bateson 1979 claims that mind and nature which are our thinking about the environment and the real environment in which we think are interwoven. We understand the environment as an extension of ourselves and we act within it according to our perception of ourselves and of what we have chosen to do. In other words we act in relation to the environment by means of the definition that we have given this environment. That is to say there is a close connection between how a person thinks about the environment and her ability to act within this environment. “By survival I mean ... in negative terms ... the avoidance of the death of the largest system about which we can care ... We cannot care much about the inevitable survival of systems larger than our own ecology” Bateson 1979 pp. 243-244. 238

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4.3. Individual Empowerment Broadens Awareness of the Environment It may be assumed that empowerment of the individual broadens the environment she is aware of. Development of a critical self-consciousness broadens the individual’s sense of responsibility for the environment’s survival. The added knowledge information and ability that the empowerment process provides also lead to responsibility for the survival of a much broader environment than before the empowerment process. I feel that I walk more erect now and so the distance I can see to has grown and broadened an activist on the founding of a service for children with developmental disabilities. At first I knew only my street I hardly knew what there was in the city. Today I know the entire city including the industrial zone an activist on the founding of a service for children with developmental disabilities. At first only my own and my friends’ problems interested me today I understand problems connected with the entire city the difference between different parts of the city and how important the school is for all the kids in the neighborhoods around here” an activist on the struggle against a decision to close down a high school. The empowerment process gives the local environmental knowledge a new context—an intellectual understanding of the social situation which encourages a sense of greater control of the environment and an ability to feel at home in the world Howard 1993. The importance of the process is that it awakens a sense of responsibility towards what is included in the home. People have testified that they are aware of a more comprehensive and complex environment and at the same time have a better understanding of their place in it and of its importance in their lives. They are therefore also willing to care for its survival. Activists in neighborhoods I have worked in and one of the boys in the struggle over the school as well have told me that they feel wiser. Wisdom is the integration of environmental knowledge with a social understanding and an inner sense of ability. Heskin 1991 speaks about organic intellectuals local leaders who have the ability to narrate and to theorize the empowerment experience for others. These people are important for the community empowerment processes because they give the community a reflection of the process it has gone through. Heskin believes that the presence of organic intellectuals in a community is a coincidence. I see the process of environmental broadening and individual empowerment as the source from which the organic intellectual grows. The understanding of the social world and the ability to explain it to others and to conduct the continuation of the empowerment process at a higher level is an outcome of integrated individual and community empowerment processes. The developing sense of responsibility for the environment and of feeling at home in the world which leads people to take responsibility for an increasingly broader environment leads some of the participants in the process to discover abilities of intellectual learning and leadership. The way from here to concern for the well-being of the world as a global ecological system depends on the circumstances that will shape the continued development of people as leaders of environments that are relevant to their lives. 239

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4.4. Awareness of Environment Encourages Individual Empowerment One could also formulate an assumption which says that awareness of a broader environment advances individual empowerment processes. That is to say the environment is a means of encouraging empowerment. The creation of a spiral of mutual influence between individual empowerment and the environment is a professional task—it is possible to develop a learning style and a way of getting to know the environment that will enhance people’s sense of control and their real ability to influence the environment. The knowledge itself empowers but what is fundamentally empowering is the ability to absorb knowledge in an active and critical manner. Getting to know an environment which on the face of it is already familiar to us often means a deepening and not only a broadening of the knowledge of the environment. The most empowering materials are those that are taken from the immediate environment for the purpose of critical and analytical observation. People who have learned for the first time how to make a geographical map of their area have been astounded by the new knowledge that they have acquired about the place where they have lived all their lives. This is an active understanding of the individual’s world which signifies the beginnings of the empowerment process Freire 1970 Marcus 1995. The boys and girls who participated in the struggle for the survival of their high school got to know the political environment relevant to their struggle – the local authorities the national institutions and the legislative authority – in the very course of their struggle. They met with people on all administrative and political levels and learned to understand the roles of officials in the education system members of the Israeli parliament’s Education Committee and the teachers’ trade union. No Civics class could have let them absorb this knowledge and arrive at an active and critical acquaintance with it as much as the action they initiated and conducted did. The parents who founded a service for their disabled children testified that in order for them to be able to survive they need to continue to develop connections with institutions and organizations in their city and in the relevant national institutions. The process of actively getting to know the environment nourished their empowerment as well as the frustrations and the difficulties they grapple with. It is the organization that they set up and not their children’s problem that has made them experts on the subject of their children’s special problems. They testify that before the organization was set up they only knew about the problems through the individual child. Today they know much more about it through the shared knowledge that has accumulated in their community organization. Every social entity an individual a community or an organization organizes its social environment in the same way that it organizes its internal actions Morgan 1986. This is yet another interpretation of the connection between the inner process and the environment this time implying the real ability to care for the environment’s survival by means of organizing. The ability to shape the environment according to the inner interpretation is evidence of considerable power because other factors wanting to do the same are also active in the environment. Although it is customary to assume that a social environment is created through a mutual interpretation by the bodies participating in it I claim that mutual interpretation is indeed such only when all the participants have an equal ability to contribute to it. When we acknowledge that there are individuals and groups in the society whose powerlessness 240

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prevents their participation in the mutual interpretation which creates their society we must also acknowledge our social obligation to enable them to become more involved in the environment so that it will also include their interpretation that is to say that it will suit them as well. The mutual interpretation then has a rich potential of conflict and of organizational outflanking which promises an advantage to the interpretations of participants possessing organizational and strategic advantages. In the most general sense then we may say that the broadening of the environment in which the person is interested is an expression of her progress in the empowerment process. The limitation that defines the environment as the one in which the person is interested is necessary on the assumption of the difference among people. People are different in their preferences of substance and value and in the point of departure from which they start out on the empowerment process. Hence the broadening of a person’s attitude to the environment means a broadening of the attitude to the environment which is important to that person. It seems appropriate to conclude this section with a personal interpretation by Clare Cooper Marcus who integrates the psychological with the ecological in words that are both beautiful and powerful: Part of a deep sadness we carry with us as a species is the barely conscious loss of a loving relationship with the world around us. While we may be quite aware of a lack of community in our lives we are less conscious of how much we grieve at some deep level for that close connection with nature we once experienced in an earlier period of our history or perhaps in our own personal childhoods 1995 p. 287. 4.5. Further Signs of Individual Empowerment Signs of individual empowerment are proofs of the realization of the empowerment process in the context of community planning. These signs are based on overt criteria testimonies about which may be obtained from people who have been participants in processes of individual empowerment. Individual empowerment processes that occur in the context of community planning are part of a shared experience and it is important that they meet the shared evaluation of all the participants in the process. I therefore quote people’s stories about these process in their own words so as to accord more authenticity to the processed knowledge. I wish to discuss a number of further signs of individual empowerment that have been revealed at community planning processes. There is nothing final or exhaustive in this list: the individual empowerment process certainly becomes realized in many other ways. However for planners to be able to understand their significance and to encourage their occurrence it is important to analyze several distinctive signs of the process. Apart from feelings of anger and dissonance which are a distinctive sign of the beginnings of the path and the critical consciousness which is one of the peaks of the individual empowerment process we must not seek a fixed pattern or a developmental sequence which can order the signs. It is important only to acknowledge that in the individual empowerment process several sub-processes occur some of them more personal and some more social. Some are common to all the participants and others are idiosyncratic. 241

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4.6. Feelings of Anger and Dissonance Testimonies about dissonance between a person’s inner feelings and the accepted social interpretation of his situation are commonplace among people who have experienced empowerment. The feelings of dissonance are a kind of emotional prelude that heralds the beginning of the process. They include: constructive internal dialogue that people report having conducted with themselves for years Kieffer 1983 a vague sense of dissonance which some writers call navigating a line of fault Lengerman Niebrugge-Brentley 1988 and others call lack of fit Germain 1979 or the problem that does not have a name Friedan 1963. In some of the people these feelings crystallize into a more defined consciousness. Generally the change occurs in the wake of an event that makes perceptible the sense of injustice that the people had felt until then as a feeling of vague pain that has accompanied their lives. In the struggle for the school the students tell about how they felt when they heard about the decision to close the school about how amazed they were that they had been able to develop ideas which they hadn’t been aware they had. One of them recalled feelings which he had been conscious of but which had not been formulated or expressed aloud because they did not have a goal: I told them why should they suddenly close this school. Our neighborhoods deserve a high school like any other district in the city. On top of all the other problems here in the neighborhood if there isn’t a high school here that children can go to after primary school what will be done with them They’ll end up in the street in crime. Anger is a sign of inner consciousness that begins crystallizing around a sense of dissonance. For some of the people the anger appears in the wake of a feeling of dissonance and after prolonged inner soul-searching. Other people describe joining a group spontaneously and tell about how in the course of their participation in it anger awakened in them together with a new social awareness. 4.7. Mutual Help and a Sense of Self-Worth Anyone who has experienced joining a group with the aim of receiving assistance and has discovered that she was also capable of offering help knows what people feel at the beginning of the path to empowerment Rappaport 1985. Likewise anyone who has experienced joining a group for other reasons and in the course of participation has discovered the ability to fill a useful role also comes out gaining personally. This lesson is the essence of self-help groups but is also learned in other groups and organizations in which participation accords the participant an opportunity to accept responsibility and to take part in a planned change effort. The mutual group experience is the essence of the attraction of task groups and social action groups of all kinds because it operates against the sense of marginality and worthlessness that are the root of powerlessness. People who participated in community planning processes testify to the sense of self-worth that accompanies the group effort: I feel that I’m helping and am willing to help in any way because the feeling is that something important is happening and that I’m a part of it a girl student who participated in the struggle against the closing of the school. I have a reason to get up in the morning. I’m useful to myself and to others I don’t have as much time for housework as I used to but my day is devoted to an important cause one of 242

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the women activists involved in creating a service for children with developmental disabilities. 4.8. Filling a Socially Valuable Role and Leadership Active participation in a group creates an opportunity to take part in an equitable process in which people experience different social relations and ways of decision making to those they were accustomed to until then. The kind of group and the nature of its tasks are less relevant to this change than the opportunity to act together and solve common problems which are important political skills. The transition from helplessness to self-efficacy is a political one even when it is personal. Filling a socially valuable role constitutes an important means of emerging from the sense of marginality and lack of self-esteem because it prepares a person for much more than an improvement in one’s inner feelings. Participation in a supportive framework enables people to break the vicious circle of marginality and low self-image by means of the confirmation and the sense of worth that stem from filling a responsible position and from helping others. It is important to make clear what a socially valuable role is and to distinguish between this and leadership. A socially valuable role is any role that is accompanied by authority and responsibility. Groups interested in empowerment need to ensure that rank-and-file members fill important roles in the group. If this is not done the group the conventional concepts of power patronage and social status and ceases to I encourage the empowerment of its members. Heskin 1991 describes two different periods in the life of a community organization one in which the organization’s leadership was open and provided opportunities of participation and influence to all its members and a period of a different leadership which closed itself in and played the role of a patron who functions as a middleperson between the organization’s members and influential people outside it. In the second period the organization became disempowering. He claims that this cycle is characteristic of community organizations—they create and lose community through the character of their leadership. The group’s leadership then is an outcome of individual empowerment and also has an important role in the encouragement of individual empowerment. An open I leadership can delegate authority in the group and allocate additional socially valuable roles. The more open the group is the more motivation grows among its members to take responsibility for group tasks and the more roles there will be which members I can take upon themselves. One Important leadership role is that of the network center While the role of the spokesman leader is generally given to men the role of the network center in the organization is generally filled by women. Centerwomen play a key role in network formation and consciousness shaping in the establishment of social relationships and of the members’ confidence in the leadership and the organization’s aims Sacks 1988. In several studies it has been observed that women created an organization caused members to feel they were part of the common effort did the routine work that the organization’s existence depended upon while the men represented the organization—were public speakers representatives and confrontational negotiators Sacks 1988 Stoecker 1989 Markusen 1989. “Women are organizers and men are leaders” Reinharz 1984. In the struggle for the school students describe how at a demonstration of the entire school outside City Hall they were called inside to conduct negotiations. Since they feared that the demonstration would disperse because the students who remained outside would start leaving if they remained without their leadership one of the girl leaders took it upon herself to remain with the students and to try to keep them there for several hours. She remembered 243

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this role as especially difficult and important and was proud that she had filled it successfully. Is it a coincidence that the same gender division that is described in the literature on empowerment also appears here at the school between girls and boys Here are the words of another girl who filled positions of maintenance and organization with great enthusiasm because she felt that her help was appreciated and important for the effort: I came home and said to my mother: Mother they want to close our school you have to come to the Parents’ Committee. We need you. My mother’s a busy woman she manages a wedding parlor but I persuaded her and she joined the committee. I was willing to do whatever was needed. I’m not good at speaking or making speeches in front of people. I’m not such a good student. But I did a lot of things that needed doing I brought benches I collected money from students for transportation everything that was needed. The main thing is for us to succeed and that they don’t close the school. The brief life-span of community groups teaches that positions of organization maintenance are critical for its survival. Then the entire leadership potential of the members is not exploited groups cannot perform complex tasks that require perseverance such as resource mobilization for example. It is actually tasks like these that offer empowering activity and allocation of valuable roles to many of the group’s members. Hence it is also important for groups that engage in short-term tasks not to disintegrate after a single task. The success of the task itself however important is not more important than the benefits that the group can provide to its members if it continues to exist. This is a different approach to leadership and to group organization than the one which differentiates between a formal and an informal leadership. We have here two kinds of organizational leadership that are essential to the building and the survival of the organization. The role of the network center is an intra-organizational role and the role of the spokesperson is a more external representative role. Jane Baker Miller 1983 explains that beside the conception of power as the exercise of control over others there exists a feminine definition of power which sees it as the ability to change to move something from one point to another a change which can be effected together with others and not at the expense of others. According to her view the conception of power as producing a change together with others encourages empowerment and the conception of personal power as taking control over others is disempowering. 4.9. Learning and Practicing Social Skills Women who fill roles of network centers and men who fill roles of spokesmen use different social skills. It may be noticed how at the beginning of their participation in groups there are members who have difficulties in speaking in front of an audience in thinking on their feet in formulating their thoughts and expressing them in public. The skill of public speaking is one of the especially impressive abilities that people testify to having acquired in an empowering group. At the start I didn’t say a word. I only sat and listened. All pantomime. After a lot of time I started speaking in the group and now I have no problem I participate like all the others from the film Encounters of the Community Kind about a group of activists in Yehud. The ability to speak in front of an audience is considered a quality of leadership. In the individual empowerment process that takes place in a community framework all the participants acquire this ability at first by watching others and afterwards by active practice of their own. In this way the group provides an opportunity to learn a skill to which society attributes a very high social value. 244

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According to Freire powerless people are in effect voiceless they lack the ability to express themselves and their world in a creative way and by choice. From this perspective the value of speaking in public is important and demonstrates the personal as political—to learn to speak for yourself is to make your imprint on the environment and to see yourself as a leader. 4.10. Development of a Critical Consciousness A critical consciousness is the ability to think and to criticize that comes together with the permission to express yourself. The transition from having no voice to speaking in front of an audience is both a physical and a mental change. Whereas isolation is paralysis and silence social belonging connects with upright bearing and action. The person begins being busy much more busy than she was in the past and at the same time much more free. The development of consciousness has a connection with self-realization which people expressed in terms of a feeling that their lives were fuller than they had been previously before their participation in the group. In the individual empowerment process a person increasingly feels that he understands his life from a social perspective that it is his right to give a name to this understanding. This is the process of self-definition that is contained in the development of consciousness Van der Berg Cooper 1986. It is the change from a situation in which others are the possessors of the language and the definitions while the person is an object that they explain and define as they see fit. In certain senses the connection between powerlessness and illiteracy Freire 1970 is similar to that between power and knowledge Foucault 1980. Development of consciousness then is a process of learning—of emergence from illiteracy. The critical consciousness which is created in the empowerment process is an interpretation of the person’s situation and of the situation of the world he lives in. People feel that they think more and understand more than they did before they joined the community activity. Empowerment then is a process of expressing criticism. A person evaluates the society he lives in and acts to change what he considers requires improvement. The principal tool for the achievement of consciousness is learning through dialogue how to think how to express thoughts aloud how to formulate them and to influence the world through them. A boy recounts how he assembled all the students in the school hall and spoke to them about the decision to close the school and about the need to oppose it. He describes his amazement about himself in this situation. His first feeling was an instinctive opposition to the decision which he and his schoolmates saw as an injustice Afterwards in talks they held to plan the continuation of the struggle and while giving explanations to the students they continued developing their claim and crystallized their position: I don’t know a lot about integration but if the school has to close because we don’t have social integration that means that integration has to happen when they bring students from stronger districts in the city to our school and not the other way around. That is to say he and his friends started objecting to the reasons for closing the school that had been put forward by City Hall officials and in this way they crystallized their social world- view while developing a rationale for why their school should remain open. Empowerment is a transition from a situation of passivity to a situation of activity and initiative. Critical consciousness develops side-by-side with learning and with the ability to speak. The ability to think to understand and to be critical develops together with the right that a person receives or takes to express herself. 245

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4.11. Praxis Praxis is a way of learning that integrates activity and thinking about activity. In this method the critical conscious is integrated into the social activity and is not separated from it. “From the perspective of planning the separation from political practice is not permissible. ... Critique unrelated to action is a respectable bourgeois practice that is tolerated precisely because it is irrlevant Friedmann 1987 p. 268. The empowerment process is a process of learning while doing which is shared by all the learners including the community planner who in this context is simultaneously a teacher and a learner. The professionals are partners in the praxis process and also change in the course of it but they should be warned not to expect that all the people in the group will undergo a change process and a raising of consciousness of the kind that they do. Dialogue means mutuality and acceptance of diversity. On the other hand they should not set the standard too low and be content with preaching consciousness raising. The feminists for example had a tendency for years to be content with consciousness-raising groups. There were writers who said that empowerment means a better understanding by women of their powerlessness and of the systematic forces that oppress them and that neither success nor failure in the struggle were the important aspect of empowerment Bookman 1988. Paulo Freire too admitted that he had thought this way for years but changed his mind since change processes cannot be realized only on the basis of consciousness raising with no actual doing 1985. In my experience people have undergone a significant change in their lives when they have actually participated and been supported by others in their new participatory ability. Foucault’s claim that disciplinary power influences people’s body – physique – is corroborated here. In order to emerge from a physical sensation of lack of control to a situation of control something real has to happen to a person something that is not limited to mental processes alone. Action that is accompanied by knowledge is what nourishes the new consciousness and creates the commitment to go on with the process. Community planning as a method does not sufficiently emphasize the role of the teacher. Despite the great amount of time that the planner devotes to education there is no investment in his skills in this domain. Because the learning occurs through dialogue and because there is no insistence on distance as there is between the traditional teacher and the student at school and because the group of learners is also an action group this kind of teaching requires special training Friedmann 1973. 4.12. Restoration of Respect Individual empowerment is a process of restoring people’s lost dignity. Two concepts of equality are accepted in a democracy: equality of respect and equality of rights. Some writers claim that the struggle for equal rights became more bitter when people despaired of achieving the right for respect Heskin 1991. Other writers point out that in the course of their struggle powerless and dependent groups emphasize gaining respect and autonomy more than justice Jordan 1993. People with mental disabilities who have been released from closed institutions are an especially humiliated and oppressed group and in their empowerment process advocacy is integrated with empowerment with the aim of ensuring a minimum of respect towards them in their new environment Rose Black 1985. With the development of the empowerment 246

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process respect is already self-respect which has been acquired with the commitment to take responsibility and to continue bearing it even in difficult conditions of struggle: The Chairman of the Parents’ committee claimed that he was making time for activism at the school because he felt responsible for the fate of the school and the future of the community which needed a school with an acceptable standard. He is aware of the fact that his role wins him respect and responsibility which are not his lot as an ordinary citizen the struggle against the closing of the school. Students at the school reported a sense of pride and selfconfidence which were reinforced by the respect and appreciation they received from various systems outside the school: reporters public representatives and decision makers on the local and the national levels. These students were particularly gratified by the appreciation they have received since the struggle from students of other schools who in the past used to look down on their school because of its low scholastic level. They feel that their struggle against the closing of the school had brought them city-wide respect among their peers and among adults. People repeatedly testify to a sense of self-respect and of respect from those around them that they have gained in the course of empowering social action Boyte 1984. Activists admit that their commitment to continue acting stems from a moral obligation that they owe the community. In slump periods in the community planning process time and energy resources diminish and stress is created due to the failure to achieve goals in time. In such periods part of the motivation to keep going and to preserve what has already been achieved is the will to ensure that the respect that has been restored will not be lost again. 4.13. Commitment to Devote Time to the Process and Access to Resources of Time The individual empowerment process demands a great investment of time from the individual. Generally it is customary to calculate time in a planning project only as the costs to the investors and the professionals and to ignore the investment of time by other participants in the process Churchman 1990a. We will discuss this aspect here. Poor men and women who display a will a motivation and an ability to participate in a community process invest a very important resource because many of them have very little spare time. Access to surplus time over subsistence requirements is an important source of social power Friedmann 1992. Without spare time one cannot get involved in group activity participate in setting up an organization or struggle for rights in any other way. Community planners often report low attendance by people in planning processes and ascribe this to apathy and lack of awareness. Beside these simplistic explanations we should remember that even people who do have spare time are selective in their use of it and will not invest efforts in processes that are not relevant to them. The goals of community planning then should appear worthwhile to people if they are to be willing to devote the necessary time to the process. But even in order to take the first step to take interest in the planning there needs to be a minimal access to time resources which at times are very difficult to obtain. The poorer that people are the more they work in jobs that demand more time and the more difficult it is for them to control their spare time. This situation is one of the social barriers to their empowerment Heskin 1991. A situation that is familiar to anyone who works among poor people is that people cannot commit themselves to making an appointment in the middle of the week. People require a certain control of their work days and their lives even in order to participate in an evening meeting and certainly in order to activate and run an organization. Another important 247

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domain of access to time is a certain degree of autonomy in the work place which for example allows for access to the telephone during working hours or a possibility of taking a few hours off in the course of work for the purpose of community activism without endangering one’s job. Many of the institutions City Hall schools government offices with which groups in a community negotiate and have other contacts with are open for business only during the day that is during the activists’ working hours. Women as a group have much less access to surplus time than men do and this is more true for poor ethnic traditional minority groups in Western society Green 1996. For women whose husbands forbid them to leave the house involvement in community activity means real physical danger just as in oppressive regimes. The discussion of time resources highlights a problem of the weakest groups living in weak environments. The severe shortage in all resources blocks their chances of empowerment. Empowering community planning demands special deployment in order to act among groups that are unable to obtain even a minimum of resources Cohen 1994. 248

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5. Community Empowerment Processes in the Context of Community Planning 5.1. Introduction Community planning has problematic scientific social and political contexts. Firstly the scientific knowledge about social problems often lacks relevance to planning secondly society allocates less and less resources to social objectives thirdly the connection between the decision to allocate and its execution is most shaky. The planner is given a broad mandate a budget and regulations in the framework of which he activates a delicate diversified and complex process which involves personal skill judgment and discretion communication and interpersonal commitment. Between these two levels of activity one general and contextual and the other specific and detailed there is almost no connection and thus community planning lacks a sufficiently stable legitimation. The community planner’s employers can always claim as has happened not infrequently that they actually do not know what his real actions are. When the situation in the field becomes politically or economically awkward or difficult the financing institution can renounce the solution which has been developed and claim that the original intention was completely different Elmore 1983. Even when community planning operates from below with local people participating in all the decisions in most of the cases the decision on the planning itself is still not a local one. Only a powerful community can make decisions on the allocation of professional community planning. In most cases the decision on the allocation of community planning to a particular locality is made outside the local context and does not necessarily stem from considerations of local needs. When the residents themselves are interested in community planning there is no guarantee that they will be able to benefit from it. For example the residents of a neighborhood listed for renewal wanted to employ an independent community planner because of their mistrust of the local planning process. This initiative was frustrated by means of organizational outflanking: the planner who had been chosen by the residents was asked by the local authority not to respond to the invitation. Since he was a free-lance professional whose livelihood depended on local authorities he acceded to the authority’s request and did not counsel the residents. This example can help us understand that the connection between the theoretical basis of planning and the professional activity in the field is quite shaky. The field requires very different interventions to those learned about in the formal professional training frameworks. A consequence of this is a lack of professional self-confidence among some of the community planners who instead of relying on their personal experience and on local knowledge as their principal sources of action may in fact cling to routine and to common solutions that have already been tried in the past generally without discernible success. Lack of professional confidence together with lack of social legitimation are not a suitable climate for originality and innovation. A community planner also cannot rely on the allocation of resources for his project because the decisions that are made on the policy level including the budget level are not sensitive to their impact on the creation of social problems in the field. In a situation of uncertainty – of uncertain values as well as economic and professional uncertainty – the planner’s outcomes depend on his skills and on the product he creates in the planning arena. He himself depends on the local people for the latter. He expects them to devote time to participate to display commitment to the planning process and solidarity among themselves. However solidarity 249

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among people which is the basis for building a community is also influenced by the broader social context. Although the origin of racial ethnic gender and class relations is general-social not local they find expression in the places where people live—in the residential neighborhoods themselves Davis 1991. Nonetheless even people who are divided among themselves are in need of community and at times the very existence of weak people depends on their ability to organize and rise above what divides them. Life demands organization for the purpose of improving personal security assuring a roof over one’s head obtaining additional social services. Inactivity may result in physical destruction of the environment and the people Heskin 1991 Erikson 1993. In other words survival is a strong motivation for creation of solidarity among people. In less acute situations community planning assists in the creation of a community a micro society which is an alternative to the separating isolating social context which emphasizes the supremacy of self-interest and competition as opposed to group solidarity and the sense of togetherness. Community planners and community leaders frequently find themselves proudly reminding people that their community is a source of different norms and a different morality than those of society at large. Community planning may become an experiment in decolonization in distancing people from the disempowering social influences in the context of which the empowerment process is taking place Boyte 1984 Friedmann 1987. Since society still disempowers people and reinforces powerlessness and marginality on a sweeping scale it is important to foster local processes of social change. Such change has at least a theoretical chance of being realized due to the interrelations that exist between phenomenon and context. Although the phenomenon community empowerment is influenced by the context a disempowering society the context too is influenced by the phenomenon and consequently might change as well. The human activity and the social structure as we remember are parts of a single duality. 5.2. Stages in the Community Empowerment Process 5.2.1. The Discovery Stage People discover that they are not alone in their situation and their needs. They discover the critical characteristic as a source of connection with others and not only as a source of suffering and isolation. The discovery stage has individual personal aspects but since it takes place in a group it has a significance beyond the personal. In the group a consciousness of abilities and potentials that exist among people with a common critical characteristic awakens. The potential for everything that is yet to occur is already present in the discovery that other people feel as I do and suffer as I do and I am not alone. The discovery of the critical characteristic as a source of individual empowerment also operates as a catalyst of community empowerment. Parents in a group for children with developmental disabilities described this discovery as a great sense of relief. Mothers who before joining the effort to set up an organization had been completely alone in their struggle to cope with the diagnosis and treatment of their child with their feelings about themselves and the inadequate standard of services discovered that there are other parents who think and feel as they do. This discovery strengthened them personally and at the same time increased their will to work together. 250

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5.2.2. The Partnership-Creating Stage People begin relating to the critical characteristic as a source of partnership between themselves and others. This is a new way of relating to people in a similar situation to your own: instead of feeling contempt for them and blaming them and yourself for the situation you start seeing the other people who suffer from the same problems as partners. Residents in the same street in a poor neighborhood used to feel contempt for one another and for the neighborhood. People testified that when they were asked about where they lived they did not mention the name of the neighborhood but only the name of the city and hoped that their acquaintances at work or in the army would think that they lived in the more affluent nearby neighborhood. Their common approach to themselves and their neighbors was that nothing good could be expected to happen in their neighborhood. The participation of these people in the community planning program changed their attitude to the neighborhood and to themselves. When they began acting together they also understood the damage done to them and to the neighborhood by their mutual isolation and alienation. In the case above the partnership stage developed gradually in the course of progress in the community empowerment and planning processes. The new consciousness is formed gradually too and in the first stage it is very fragile and not without regressions. Proofs of progress in the process and real outcomes reinforce this consciousness. People need proofs and reinforcements in order to feel and think differently about themselves. At the start of the process any difficulty can arouse a wave of mutual recriminations despair and regression among the participants Freire 1970. 5.2.3. The Self-Definition Stage People seek an authentic definition of their situation. This too is a stage of discovery. After the discovery of other people as partners in distress and as potential partners for change comes the stage of the discovery of the right rhetoric to describe the group and its situation. At the start of the process people use vague terms to describe their situation. They live with a disparity between their own feelings and the definitions that others give them. When people are called underachievers they cannot identify with this term which does not express them as people but it still exists in the background of their self-identity and casts its shadow upon it. The lack of ability to oppose negative social diagnoses is a symptom of inability to cope socially with the stigma and the result is a quiescence in the domain of the self that increasingly dims self-perception and social consciousness Deegan 1995. People’s new ability to express themselves and to define themselves decreases their dependence on experts on their situation. When we are less dependent on other people’s definitions we cease being dependent on them for other needs as well. This stage demonstrates the extent to which independence of consciousness is important for the creation of practical independence. For example when people define their high blood pressure as a life-style problem and not as a disease they still need a doctor for specific aspects of observation and medication but they learn to control their blood pressure by means of group support mutual learning of control methods and changes in life-style. Or for example when people perceive a school as an educational social and community service they depend less on education experts for the solution of all of the problems at the school. Then the social knowledge of the students and their parents receives greater weight in the search for organizational solutions. Where a community perception of the place of the 251

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school in local life is lacking many of the parents students and residents in the area live with the sense that the school is not what it should be but appeals for improvement of the situation are addressed only to education experts. 5.2.4. The Self-Representation Stage People discover that they can represent themselves instead of being dependent on professionals and experts. The ability to represent yourself becomes reinforced as you acquire practical skills in this domain. The more the empowerment process unifies people increases their self-confidence and sharpens their understanding of their situation the more confident they feel about representing themselves. The advantages of self-representation point to the need to transfer as many issues as possible in the community planning process to the shared control of the planner and the local people. Advocacy is suitable only as preparation towards empowerment when it is necessary to mobilize a minimum of resources to enable weak people to begin the process because it contradicts one of the most basic rules of empowerment: never do for others what they are capable of doing for themselves. Hence in every case it is important to make sure that people will learn to become their own advocates in a reasonable span of time Zirpoli et al. 1989. In the self-representation stage people discover their political ability and develop self- management skills. A person who can speak for herself before others knows that with the help of appropriate skills which can be acquired she will be able to manage her affairs herself. The Urban Renewal Project carried out in Israel in the eighties is an example of a community planning project with a centralized style. The form and style of self-representation were directed from above and in most cases were not an outcome of local considerations. It is possible that for this reason representation was defined as a democratic right and not as a community task. Both the style and the manner of representation were included in directives that came from outside the neighborhoods. During the evaluation of the project it was found that only a few residents had participated actively in the self-representation frameworks. In most of the neighborhoods most of the residents felt that they were not represented on the neighborhood steering committees likewise many of the government representatives who sat on these committees did not see the residents who participated in the committees as representatives of the other residents Churchman 1990a. Self-representation then like the other stages before it is realized essentially by means of local praxis processes: integrated learning and action. Policy from above even when it is aimed at this goal does not provide the appropriate tools for its realization and does not enhance empowerment processes. 5.2.5. The Stage of Resistance to Existing Policy The previous stages in the empowerment process too are accompanied by a certain level of resistance. As already mentioned in the discussion of individual empowerment without a degree of resistance to an existing situation there is no leverage for a beginning of the empowerment process. People resist other people’s definitions and learn to define themselves. They resist being represented by others and start representing themselves. At this stage the resistance is already based on experience progress in achieving goals and knowledge: the activists have learned what the existing policy is on their concerns and what plans have been derived from this policy and they reject these and in effect engage in planning by themselves. People either reject the existing policy as a whole if it does not suit them or plan changes in particular programs only. The struggle over the school was conducted around a rejection of a plan to close the school. The struggle was intense because of the pressure of time and the threat to close the school that very year and escalated because the students and the parents threatened to strike and shut down the school until an alternative solution was found. 252

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The struggle of the residents in Los Angeles against the plan to evict them from their homes Heskin 1991 and the struggle of the women in the Wentworth neighborhood in Chicago against the building of a sports stadium in the neighborhood Feldman Stall 1994 also involved resistance to an external plan and a public struggle against it. When community planning is involved in a process there is a chance which is not always actualized that the resistance will be more organized and orderly in character and less chaotic and violent. This resistance does not begin with a traumatic discovery but with a methodical learning of policy. At times the undesirable policy is covert and a certain sophistication is required in order to learn it and to find ways to resist it effectively. For example members of a community who discovered that the solutions of experts were not effective and were liable to cause further environmental disasters Couto 1989. The rejection of the proposed solution in this case was accompanied by the astounding discovery that through their terrible experience the residents of this small community had become national experts on technical solutions for the removal of coal waste tips. In Chicago the community coalition for public housing discovered that the city’s policy of encouraging investors was being carried out at the expense of development budgets for their neighborhoods. They organized public resistance to the policy of unbalanced city planning that neglects the poor communities CAHC—Chicago Affordable Housing Coalition 1993. 5.2.6. The Stage of Presenting an Independent Alternative At this stage people who can represent themselves and can resist a policy they don’t agree with present an alternative of their own to the existing proposals affecting their community. In this situation people reach the conclusion that “Either you plan or they plan for you” Boyte 1984 p. 97. Most communities do not reach the point of presenting a proposal of their own. In the Urban Renewal Project for example this stage was in effect blocked by the central authorities. Residents’ representatives sat on the project’s steering committee and participated in meetings of forums that were supposed to make decisions but in fact they responded to plans which in most cases were presented to the activists for the first time at that meeting. They engaged in discussions and did not make decisions. As I see it self-representation in most of the neighborhoods degenerated as a consequence of participation in these ineffective forums. Only in one neighborhood did the residents plan an alternative proposal of their own but there too the local proposal was outflanked and frustrated by the project’s central authorities. This struggle for the realization of an independent alternative was so exceptional that the evaluators of the project called this neighborhood the shrew As in the Shakespearian Taming the shrew Alterman Churchman 1991. In the struggle over the school the group of students and parents did not propose an alternative of their own for how to run the school. The parents’ committee continued responding as well as it could to existing proposals. This situation designates the limits of empowerment of this group. The level of organization and self-management necessary to design an alternative proposal was not achieved by the parents and students at the school and did not receive encouragement from outside agencies. The creation of the community service of parents of children with disabilities is an example of a local alternative. The parents organized in order to provide for a need of their own which was receiving no public recognition or response. Their proposal met with some resistance but since their initiative was the only one available at this time and place and since the group organized for self- management of the plan it succeeded in implementing it. 253

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The Affordable Housing Coalition in Chicago prepared a proposal of its own for a balanced urban development that would also allocate money for development of housing in the neighborhoods. The organization lobbied among members of the city council in order to ensure that its proposal would obtain the necessary majority in the council. The organization’s proposal was not the most desirable proposal for the residents but a compromise that was achieved in the course of negotiations with some of the councilors in order to gain their support. The preparation of the proposal required considerable organizational effort: legal assistance academic assistance planning of a lobbying campaign and monitoring of municipal legislation in order to promote the proposal and bring it to the voting stage CAHC 1993. 5.2.7. The Evaluation Stage In this stage the people evaluate their achievements and rediscover the limits of their empowerment Couto 1989. The evaluation stage involves the community’s thinking about its ability to achieve social change. The rediscovery of powerlessness now stems from a position of active consciousness and empowerment. In my view this is the climax of the empowerment process and the most important sign of its success. When this stage of the empowerment process is not achieved there is a danger that the process will deteriorate into a distorted consciousness. A community which is not conscious of the limits of its power and of its powerlessness in certain areas will have difficulties continuing to produce empowerment for its members. Experience teaches that an unrealistic perception of power endangers continued development of the process while the community’s consciousness of its own limits is a constructive factor for such development. People understand that there are goals they will not be able to achieve by themselves. These realizations lead to the setting up of roof-organizations coalitions between communities and contractual employment of experts to obtain assistance with technical matters. In the cases that I investigated the groups did not arrive at this stage. The parents shifted back to the form of representation customary for school parents’ committees. The students’ council too operated in the usual school framework and separately from the parents’ committee. The two groups ceased cooperating with one another and ceased participating in the management of the school. The parents’ committee was still a very involved body committed to the school’s continued existence but it operated without any organized community basis. In my estimation the sense of community that was created around the school could have mobilized activists to confront a crisis again. For example the struggle over the school was renewed several years later when a teacher was dismissed because of his different approach to the students and his criticism of the school’s educational policy. Students struggled against his dismissal and he himself exploited the dismissal to express his opinion on education and on social discrimination. In this case the specific struggle was of no avail. The teacher was dismissed and became part of a group which founded a school in the spirit of alternative educational values. The evaluation stage is the last but not final stage in the circular process of social change that is characterized by rises and falls. We must distinguish between this stage which may indicate the success of the empowerment process and the completion of the community project itself which was the program that the community planning produced one of the outcomes of which was community empowerment. At times the processes are parallel but it is possible that from this point on community planning and empowerment go different ways. Some writers believe that success or failure of the plan itself are not critical to the success of empowerment. 254

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Experience in community work shows that successful outcomes are very important. Participation in community activity is a way of acquiring ability within a framework that can and does succeed. Success is an important dimension of learning especially for people for whom failure has been a constant life experience. Participation in a project that has failed is like repeating a prior history of powerlessness and self-fulfilling prophecy. Hence an important goal of empowering community planning has to be the development of a feasible plan with reasonable chances of success in order to provide the participants with a positive initial experience. Later on after one success people acquire organizational experience and self-confidence and can also learn from failures especially because of the sense of control of the situation and the confidence in their ability that they have already gained through the process. 5.3. Organizing and Organization: The Basis for the Community Empowerment Process Community empowerment is a process of creating a community and of much greater control over its environment. The process demands organizational means in order to develop. The organization enables the people in the community to manage their lives by themselves Simon 1990. The effectiveness of this process is expressed in its ability to produce empowerment: on one level to produce individual empowerment for the people active in it on another level to find social solutions for the community. A particularly strong and efficient community organization such as COPS Communities for Organized Public Services in San Antonio for example can achieve a social change and also create a real cultural alternative. COPS provided community – including civic values and norms of behavior constituted a source of identification and of social criticism and thinking enabled community members to control their rage and direct it to a constructive route and symbolized sustainability – hope for a better future for the next generation Boyte 1984. While the traditional communities – the village the tribe – have almost completely vanished their place is being taken by a new unit of social integration—the organization. Whereas belonging to the traditional community was fate membership in an organization is a free choice. The traditional community demanded the entire person while the organization is a means for achieving personal goals Drucker 1995. Community empowerment is realized by means of organizations and it may be identified and evaluated through them. The evaluation of the extent to which the community planning process is actually succeeding to enhance empowerment processes is based on the level of independent organization the community planning enables in the course of its activity and on the community organization’s efficacy and degree of sophistication. The importance of organizing as a principal means of community empowerment is made perceptible in the mechanism of organizational outflanking. The organization is a strategic creation. A community can struggle for control of its environment and its future only by the organizational means that it develops. A community organization can serve as an alternative to external bases of decision-making and of expertise because it can involve community members in processes which develop the skills and knowledge necessary for self-management. 255

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Lessons learned from practice and theory indicate that community development and planning processes which also build a community organization achieve more stable solutions to social problems. The Urban Renewal Project did not set goals in the domain of organizing and organization. On the contrary its centralized structure prevented the establishment of community organizations in the various neighborhoods sabotaged independent decision making on the neighborhood level and in a considerable number of the neighborhoods actually even prevented the creation of a community. As already mentioned the struggle to keep the school open was characterized by organizing but what was set up was a weak organizational basis. The parent’s committee did set up a non-profit association of its own which enabled it to mobilize resources and produce plans independently but this was an administrative arrangement more than a community organization. Because of its organizational weakness the parents’ committee actually had to wage repeated struggles to maintain its achievements. The struggle for the school’s survival therefore continued from one year to the next. When the parents’ committee and the students found out that the new director who had been appointed had no intentions of allowing them to continue participating on the level they had become accustomed to they had to initiate a public struggle to have her replaced. It is possible that a better based organization could have participated more actively in the management of the school and would have prevented the appointment of an uncooperative headmistress. An example of a different process is the way parents organized around the establishment of services for children with disabilities. At first they organized together in order to find a local solution for the families involved. The organization they set up engaged in mobilizing resources from the entire town in order to provide several missing services. This goal shaped the organizational form. This group attached special importance to the organizational structure because it was conscious of the need to ensure the survival of the new services. Hence a lot of work was devoted to networking the new organization within the local and the national organizational system in order to ensure its future survival. A community planner accompanied the process of setting up the organization but at the stage when the various services that the organization provided became established she was already much less involved. Because of the great differences in civic culture governmental structure and the organization of the public services it is almost impossible to make comparisons between the Israeli and the American societies. In the United States due to a strong democratic tradition of participatory community there exists a legitimation for creating community and for communitarian initiatives of various ideological persuasions Delgado 1986 Boyte 1986 Simon 1994 Walzer 1995. In Israel in the fifty years since the establishment of the State the authorities and large public institutions have concentrated organizational and community functions of mutual help and social services in their own hands though with ever decreasing success. This centralism is one of the reasons though not the only one for the fact that local organizing self-management and participation of residents have not yet taken their rightful place in public consciousness and in the social discourse in Israel. 256

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5.4. Community Planning as Context for Empowerment of Populations with Special Needs The aim of this discussion of issues connected with community planning and empowerment of two groups – minorities and women – is to stress once again the importance of the community in the lives of special population groups. I am not claiming that minorities and women are groups that are more deserving of community empowerment than any other population groups. The idea I am interested in reinforcing is that every population group experiences its empowerment process in a different and unique way and requires a community definition of its own. Likewise I wish to emphasize once more that community planning is a practice which requires a critical consciousness—in every planning of a social solution it is necessary to re- examine professional concepts and how well they fit the groups at the focus of the planning process. 5.4.1. Empowerment of Minorities A minority is a group of people whose existence in the midst of other people is marked by being different and conspicuous. The definition of a minority on a basis of ethnic origin race or religious belief is for the purposes of the present discussion not different in principle from the definition of a minority on the basis of physical or mental disability. Any given minority because of its distinctive characteristics faces dangers of stigma prejudice and marginality. At times minorities need assistance in order to survive in a hostile environment. Hence everything that has been said so far about community empowerment and the need for organization is equally true for minorities but their distinctive needs must be acknowledged as well. The community framework of a minority group has a special significance for the more successful the minority is in its efforts to survive the more distinctive in its character it becomes. Unlike the image of an open partial and unstable community I adopted for the purpose of developing the concept of community in this book a community created by a minority group tends to be relatively closed and permanent. This tendency stems from a combination of internal needs and external conditions: as a consequence of living in a deterministic reality of racism rejection and economic exploitation the minority community creates an alternative system of values that enables people to preserve a sense of self-worth and self-respect that are not possible outside the community Liebow 1967. Minority communities tend to be relatively closed because the points of entry and exit into and out of them are rigidly defined at times beyond any possibility of change: only someone who bears the minority’s common critical characteristic may belong to the community. The community empowerment of minorities therefore creates a community within a community in which community planning can operate on two levels the macro and the micro. On the macro level the community planning has to relate to the environment that surrounds the minority. A change is required in this environment in order to change discrimination rejection isolation prejudice and economic exploitation of the minority concerned. The planning approach to such environmental change is generally dubbed a radical approach Friedmann 1987 Rose Black 1985. On the micro level the community planning has to encourage individual and community empowerment among the minority people with the aim of creating solidarity and mutual help to halt powerlessness and to encourage the creation of a community Gutierrez et al. 1990 DeLois 1998 Okazawa-Rey 1998. The planning runs into the tension that exists between on the one hand the minority’s aspiration to preserve its own authenticity and distinctiveness and to be in a supportive 257

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environment with people like themselves and on the other hand the will of this minority to emerge from the isolation and separation imposed upon it because of its difference and to become integrated with the majority it lives among. The key to community empowerment of minorities lies in raising their consciousness of these legitimate and contradictory needs: on the one hand support and acknowledgment of the group’s difference and hence of its distinctive social and existential needs on the other hand support of the group’s need to become integrated into the surrounding community. The individual empowerment of as many of the minority people as possible brings confidence and hope to the entire group and also enriches its leadership potential and its capacities for self-management. An example of this is the development of organizations of disabled people from being organizations for these people that were administered by people who were not disabled into organizations of these people which provide mutual self-help. It is important to note that this change may give confidence and a sense of control to all those belonging to the minority and not only to members of the organization or its activists Renz-Beaulaurier 1988 Hasler 1993. Empowering community planning broadens the minority’s possibilities of choice and adapts existing social solutions to its needs and its life-style. As I have said the key to empowerment is acknowledgment of the group’s difference and distinctiveness. What this acknowledgment calls for is community planning of diversified and non-stereotyped solutions for minorities. Here in particular a policy of avoiding arrogance and patronizing – a characteristic of all empowering community planning – is imperative. I make no pretension to claim that empowering community planning provides a perfect social solution for the empowerment of minorities. The disempowering processes directed at minorities are massive. They can involve fear hatred prejudice and social exclusion that have been going on for generations enclosing the minority within discriminatory laws procedures and policies. A minor local tool such as community planning may have a most limited effect from the outset when the powerlessness is an outcome of systematic discrimination and is anchored in laws which support the existing local social relations and culture. However every empowerment process is a change in the status quo and is thus important in itself. 5.4.2. Empowerment of Women Community empowerment in community planning processes takes on a special meaning among women because of the paradoxical manner of their participation in community activity. According to reports from all over the world women constitute a majority among the activists in any community and a minority among the leadership in the community Reinharz 1984 Andersen Larsen 1998 We have to discuss the special way in which women are involved in the community and the difference in the empowerment process of women in contrast to men in the same social situation. Likewise it is important to try to understand why women are active in all aspects of setting up a community but tend to retreat and vacate the arena when there is a need for leadership and formal representation of the community. Some writers claim that women who are active in a community do so out of their traditional roles: they maintain structure and activity obtain resources and in general function in the community as an extension of their activities in the home and the family. For example women were the majority in the process of setting up a community service for children with disabilities. Women were a majority among the tenants in the effort to cope 258

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with landlord abandonment of a low income neighborhood in New York Leavitt Saegert 1988 and women were the activists in Wentworth Chicago and struggled for the community’s existence Feldman Stall 1994. Some writers explain that activity in the community is indeed a process that empowers and advances women but in part it represents a perpetuation of the traditional feminine roles. The women open community laundromats day-care centers for children playgrounds babysitting services and the like all of which are only an extension of their activities inside the home. The criticism implied here is that women are exploited in the community as well and not only in the home and do not progress in an equitable way while realizing their potential. I would like to illuminate this subject in a different way. I claim that women experience individual and community empowerment from a better starting position than men in the same community because they sense their social situation in a different less destructive way than men do. Because of their gender they have had to reconcile themselves with powerlessness and marginality since childhood and for this reason they develop an alternative culture out of which they draw power Liebow 1967. Because of their social roles which are limited to the bounds of the home women are not perceived and do not perceive themselves as responsible for the social situation of the group to which they belong. Hence they do not bear the same amount of guilt and do not experience personal and social failure in the paralyzing way that men with the same critical characteristic experience it. A woman who succeeds in filling her traditional roles is likely to draw self-confidence and a sense of self-efficacy from this. In this way an alternative feminine culture is created which includes values of mature femininity responsibility for the home and the family and a sense of mastery. From this compensating starting point women can identify with the social powerlessness of their group and at the same time can be less harmed on the personal level Andersen Larsen 1998. Hence it is easier for them than for the men in their environment to overcome inner barriers to make a commitment to community social action and to fill socially valuable roles in this domain. Women who since their youth have held on to values of maturity responsibility and independence begin the community empowerment process from a higher point of individual empowerment relative to men. They derive pride and a sense of self-worth from the very fact of their skills and mastery in filling feminine roles which is not dependent on economic success on a level of formal education or on social class. This protects them from the despair and marginality that men in the same situation feel and makes them a catalyzing force and a stabilizing factor at the beginning of community empowerment processes. Another important aspect of the difference presented here is who the women who turn to community social action are. My impression is that women do not escape to valuable roles in the community due to unwillingness or inability to fill their traditional roles in the home. On the contrary the women active in community building are generally successful housewives and mothers. Poor women who do not successfully fill their traditional roles in the home belong to a very weak and deprived group which also lacks the strength to contribute to the community. It is important to understand that in very poor families a woman who does not function at a very high level is often the cause for a diagnosis of the entire family as a multi- problem one. In order to survive in conditions of poverty and deprivation a woman has to have organizational and economic talents excellent physical fitness and needs to excel in human relations in the exercise of influence and in negotiating. The modest status of the role of wife and mother is entirely disproportionate to the standard of personal skills that are required in order to function properly in this framework. For this reason indeed analogously to their status in the home when the community process 259

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develops most women abstain from overt leadership roles especially when their organization enters the stage where more public representation and political visibility are required. At the beginning of the struggle against the closing of the school the parents’ committee was headed by a woman. When the parents’ committee actively joined the struggle she was replaced by a man and from that time on the leadership roles in the school parents’ committee were taken by men. Among the students there was a majority of girls and after the struggle the students’ council was headed by a girl although during the struggle itself the leader was a boy. A similar phenomenon may be found in neighborhood committees and community organizations: many women generally participate in neighborhood activities itself yet it is rare to find a woman at the head of a neighborhood committee Churchman 1985. When leadership in an organization is evaluated not only for charisma or other superfluous reasons but is rewarded for results women can fill formal leadership roles more securely. A woman activist in San Antonio explained that in the COPS organization this is what made the difference: “Women have community ties. We knew that to make things happen in the community you have to talk to people. It was a matter of tapping our networks” Boyte 1984. Community planning frequently relies on the activity of women in networking and maintenance roles and it turns out that when leadership roles are developed on the basis of tasks and not of representation equal opportunity is given to development of leadership among both women and men. 5.5. Conflict and Community Appropriation Are resistance and conflict an inseparable part of the empowerment process As I see it conflict like all expressions of anger and resistance is a sign of emergence from a state of powerlessness. It is important to remember that social powerlessness is characterized by social quiescence and not by overt resistance and conflict. Resistance to an existing situation is in many cases expressed in claims for space appropriation Feldman Stall 1994. In the course of the struggle against the evacuation of a poor neighborhood in Los Angeles people obtained ownership of their homes either as individuals or through shares in cooperatives. Since the housing authorities in Los Angeles prevented the residents from managing the cooperatives by themselves they were not given the opportunity to appropriate their community. This is an example of organizational outflanking that had a disempowering influence on the development of community among the members of the cooperatives. Heskin has described these processes of disempowerment and destruction of community as cycles of gaining and losing community Heskin 1991. In the struggle against the closing of the school teachers and other school employees noted that members of the school’s parents’ committee were “behaving as if they owned the school”. They said this in a critical tone which cast doubt on the parents’ right to behave in this way. During the struggle students and parents took control of the school’s daily schedule: they determined a time-table for demonstrations and meetings outside the school during school hours. After the struggle they felt as if they owned the school because it was they who had ensured its continued existence. The issue of space appropriation not infrequently arose in the Urban Renewal Project. In one neighborhood the neighborhood committee decided to dismiss the project director after the authorities had refused to dismiss him despite the residents’ dissatisfaction with how he was doing his job. 260

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The dismissal notice drew harsh criticism from the project and town authorities who saw it as a radical declaration of appropriation of the project by the neighborhood activists. Despite the criticism and the formal resistance of the authorities to this move it was impossible to ignore the dismissal and the project director was forced to resign. Apart from this step which was in essence a political declaration this neighborhood failed to create an organization efficient enough to realize the claim for space appropriation. The neighborhood committee absorbed the harsh criticism of their step and did not make any more claims of executive responsibility in this project. The appropriation of space then is a conflict. It cannot be expected that the such a powerful claim will not run into opposition on the part of authorities and institutions which perceive themselves as owners of the space or as rulers of the process. Community appropriation is a process which originates in people’s inner needs. The struggle for a community proves how artificial the separation between individual and community empowerment is. A successful outcome of such a claim is a commitment to take care of the environment. On the individual level the struggle answers the need to feel at home in the world Howard 1993 a deep need that is repressed by processes of disempowerment and powerlessness. In the empowerment process it surfaces and demands realization. The sense of being betrayed by society and the man-made environment in disasters such as the coal slide in Aberfan or the chemical pollution of an entire town in Love Canal Couto 1989 Levine 1982 leaves the people dispossessed of any control in their world. The residents of Aberfan set up group processes of empowerment in order to express and give meaning to their loss. The residents of Love Canal remained injured and uprooted. They had lost their homes and their basic sense of security at home with no possibility of erecting a memorial for their loss. After the process Lois Gibbs the woman who headed the Love Canal residents organization became chairperson of a federal organization of citizens against chemical pollution. Creating this organization was her way of structuring a social meaning from the disaster that had occurred in her life. It is worth noticing that the struggle for ownership does not always involve the appropriation of a physical space. It may also be a claim of proprietorship of the definition of a problem. For example in the town of Love Canal people struggled for years to have their definition of the disaster that had occurred in their life accepted. The neighborhood had been built beside a chemical plant which employed many of the town’s residents and caused the pollution of the entire town. During the years when chemicals seeped through the ground into the residents’ homes they caused chronic and malignant diseases children born with deformities and miscarriages. The conflict between the state and federal health authorities and the residents of Love Canal arose on the background of the authorities’ unwillingness to recognize a definition that would expose them to long-term responsibility and to immense damages suits including precedents throughout the entire country. At its height the struggle between the residents and the authorities and their experts centered on the definition of the problem and on knowledge about the problem Levine 1982. When the conflict subsided it turned out that in this case as in other cases too it was the residents and not the experts appointed by the authorities who possessed the most relevant and most precise knowledge about their problem. It is interesting that in the examples above and in others as well apart from the experts appointed by the authorities yet another professional agency appeared of great importance to processes of community planning: external professional experts whose services are recruited by the community at times on a voluntary basis. These experts may be as the case may call for community planners 261

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psychologists chemists educators. These experts provide the community with knowledge about the problem and reinforce the people’s ability to deal with expert claims that are directed against them in the course of the conflict. These external consultants are important for giving the community confidence in their knowledge as opposed to the “authorized” knowledge they are struggling against. Their involvement in the process is sometimes subversive and may endanger their professional career in the future Levine 1982. In Chicago the CAHC organization set up a formal partnership with the city’s universities which research disputed issues for them. In this way the organization strengthened its claim to appropriate the problem definition and its ability to fight for its solution and also neutralized the system of pressure and sanctions almost always activated against experts who participate in public struggles on the side of community organizations. Conflict is an aspect of the empowerment process. The struggle for the community and the struggle for self-definition express a blocked need to act in the world. Conflict is not only an expression of anger but also a proof of a will to act and to create something new even in the face of opposition. The great danger lies not in conflict but on the contrary in quiescence and indifference which enable planners to create an environment that is foreign to and alienated from the people who live in it 5.6. Outcomes of Community Empowerment Is it possible to define community empowerment outcomes that community planning is interested in In general terms a social change involving community activity and community organization and action that continue encouraging empowerment even after the conclusion of the planning task is an important outcome of the planning. The need to achieve a concrete outcome stems from the instability of community achievements that are based mainly on good will and activism. It not infrequently happens that an especially empowering leadership contents itself with widespread community activity and deliberately avoids investing in organization building. When such a leadership is replaced an organizational vacuum may come about where leadership that will lose the community may position itself Heskin 1991. A community organization has to be stable and needs to produce efficient empowerment. Efficiency is the ability to mobilize resources to set up a structure suitable to the community’s purposes to achieve goals even in difficult conditions of organizational outflanking Mann 1986. Another important outcome is the creation of a community culture. Distinctive values and rules of behavior are a basis for the community’s existence. The community that was formed around COPS in San Antonio based itself on a set of values and norms that not only obligate the organization’s leadership and major activists but also reinforce the pride the mutual responsibility and the self-respect of the local residents. People in this community are conscious of the fact that the community norms they have adopted are an alternative to the discrimination and the injustice that characterize the society outside their community. They are aware of this contradiction and of the vulnerability of their situation and hence see themselves as responsible both personally and collectively for safeguarding the organization’s existence and values Boyte 1984 COPS. 1994. In especially successful cases the outcomes of the empowerment process also have an influence beyond the community itself. For example over the years the town of Aberfan developed knowledge of its own on a national problem – safety treatment of coal waste tips – and in this way contributed to the quality of life in the entire region. Likewise this community decided to devote compensation money they had received from the government after the catastrophe to setting up a joint community center with a neighboring 262

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village that had been not been harmed and in this way the compensation money was used to foster an additional community Couto 1989. In Israel the successful struggle of several poor neighborhoods to be treated as partners in the decision making processes affecting their renewal led to the creation of rules for the participation of residents in the Urban Renewal Project throughout the country. Senior functionaries in the local education authority testified that as a result of the struggle against closing the high school they had changed their attitude towards the participation of parents and students in educational decision making and had enlarged the resources for fostering participation of parents and students in the schools. After the struggle the education authorities also understood the importance of community planning as a suitable approach in their domain. It is important to highlight the Foucaultian aspect of these achievements one expression of which is greater attention on the part of the authorities. Constitutions allowing residents to participate in the renewal of their neighborhood or parents and students to participate in the life of their school also represent an attempt by the authorities to take control of a local field of resistance institutionalization of the relations makes possible closer surveillance of phenomena which were relatively free of the supervisory gaze of the authorities. Since we are speaking about a successful organized struggle of ordinary citizens some of them children poor citizens residents of low income neighborhood against governmental authorities it is worth taking into account the following interpretation as well. The institutionalization of local processes by the authorities always entails a potential for cooptation and domination. Beside the official recognition of an additional active factor in the power relations arena there exists the desire to position it in such a way that it will not threaten the status quo. Empowerment processes always involve a process and an outcome—a process of organizing and outcomes of organization. The organization is the main means of encouraging community empowerment and also the major outcome of the process and the proof of its realization. However the processes of organizing have to continue even after the setting up of one organization efficient as it may be because encouraging empowerment by means of the organization is a no less important outcome than the organization itself. We may therefore identify several integrated outcomes of community planning and community empowerment: 1. The establishment of an empowering community organization 2. Widespread community activity 3. Active community consciousness 4. The appropriation of space and responsibility for it 5. Improvement of the quality of life and the attitude to citizens in the society. These are different levels of outcomes which indicate once more that empowerment is a process that occurs simultaneously on the levels of human agency and social structure. For community empowerment to become stable it has to be preserved on the level of the individual consciousness of many members of the community as well as to be enabled by the norms and values of the social structure. A social change is established by means of actions of individuals who produce new values through their everyday behavior and their discourse. The new social process becomes meaningful through the new community frameworks that enable people to make a difference and to reinforce social change. 263

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6. Community Planing as an Empowering Professional Practice 6.1. Introduction In the two previous chapters I outlined individual and community empowerment processes made possible in the course of empowering community planning practice. The present chapter deals with community planning itself and with the adaptation of it to encourage these processes. Social problems are not the kind of problems that have only one logical solution. Because of the paradoxical and dialectical character of these problems several solutions all of them logical may be suitable for the one problem and each of them will lead to different and even contradictory outcomes. Out of the range of possible solutions the empowerment approach prefers those solutions which in the course of their planning and execution lead to the creation of as much real and perceptible control as possible by people over their lives their future and their environment Rappaport 1987. In the domain of city planning a trenchant discussion is being conducted about the negative by-products of social solutions including those caused by the planning process itself Harvey 1973. Some writers prefer to think that the harmful effects are inevitable Moore 1978. You can’t make an omelet without breaking eggs is an example of a cliche used by people who claim that in the course of changes for the good there will always be victims. Although it’s a pity that there are victims it is inevitable. This claim ignores the fact that in city planning processes these victims are not randomly chosen—they are generally the weakest the poorest those without knowledge while those who gain are generally the people who possess power resources. Empowerment theory wants to make professionals aware not only of what they do and why they do it but also in Foucault’s words of “what they do does” Dreyfus Rabinow 1982. A professional solution also has to provide an empowering process that will act against the negative by-products of plans and planning on people and their environment. 6.2. Community Planners and the Organizations that Employ Them Community planners work in social political professional and organizational contexts that have much influence on their ability to encourage empowerment as part of their professional activity. We have discussed the first three contexts in previous chapters in this chapter we will consider the organizational context. Although significant differences exist among planners from different professional disciplines we will not deal with this here rather we will focus on organizational questions that are common to the various professions that engage in community planning. Experience teaches that most planners find it difficult to act with social responsibility if they have not received backing for this from the agency that employs them. In both my practice and my research experience I have found that very few planners acted to encourage empowerment without backing from the organization that employed them. Those who did do so in most cases had considerable seniority in the profession and a high level of professional 264

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commitment and in all cases they received alternative legitimation and backing from activists in the community organization that they set up in the course of the planning. As I see it when the employing organization opposes a process of community planning a combination of professional confidence commitment to the process and backing from the field are required for the completion of the process and only few professionals will risk this. Likewise a research on city planners found that very few of them are socially and politically committed. Most of the planners functioned as technicians defined themselves as possessing quantitative and analytical problem-solving skills and deliberately avoided social activity Baum 1986. Agencies engaged in community planning may be divided into those that see planning as engagement in decision making on policy and environmental design and those that see the solution of social problems as their mission. Organizations which see their role as technical and the plan as the major component of the planning are outside the context of my discussion. Two community planning agencies that I investigated acknowledged their social responsibility but tried very hard to avoid conflicts and to establish themselves within an inter-organizational network of cooperation and complementary relations. The situation in both agencies teaches that it is impossible to understand the activity of the community planner without understanding the organization that employs her. The organization’s policy determines the approach of the community planners in the field even when on the face of it they are given relative autonomy and freedom of judgment which are essential to ensure empowering practice. Organizations can direct their employees by means of rewards given to practices favored by the organization or by hierarchical departmentalization of the discussion of new ideas. This directing can even contradict principles declared as important and essential by the organization. We must however make a reservation here and stress that there are community planners who will act with an empowering approach in any organizational context. As a minimum they will content themselves with preventing disempowerment like for example the community planner who built a professional training program and asked the participants to take part in the evaluation of the program and in thinking about the continuation of their professional advancement. The planning was conducted with an equitable approach to the participants and a shared interest – the planner’s and their own – in the advancement of their professional level in domains they had defined for themselves. There always exists a minority of community planners who will encourage empowerment from a personal professional and ideological commitment and will struggle against the negative messages and evaluations of their superiors in the organization even at the critical stages of the process. When the organization that employs such a community planner begins to benefit from his activity his position in the organization changes for the better and he receives the positive appreciation and the rewards that he had been forced to give up in the earlier stages of the process. For example the establishment of the local organization of parents of children with developmental disabilities was accompanied by pressure on the community planner. The employing agency found it difficult to accept as partners people it perceived as weak who in the past had been dependent on the agency. As the group grew stronger the agency too learned to benefit from its empowerment. Then the attempts to disempower and to weaken the community planner’s involvement in the process lessened. Appreciation of her work increased in the organization and she was promoted to a more senior position. 265

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6.3. Empowerment of Community Planners Another aspect of the organizational context is the popular issue of the empowerment of the professionals themselves. The main claims of those who believe that empowerment of professionals is essential for the empowerment process of their clients may be divided into two: the most widespread claim is that professionals cannot engage in empowerment from a position of weakness e.g. Giroux 1987. Some writers claim that the power of professionals has a good influence on the results of their work with powerless people and that what is involved is parallel processes of empowerment Guterman Bargal 1996. All agree that professionals have to understand the way that power relations shape their professional intervention on all levels: their connection with the organization that employs them their attitudes to their clients the attitudes to themselves as professionals and their world-view Hasenfeld 1987. An additional aspect of the subject deals with the ineffectiveness of the professional who does not understand the politics of his practice Benveniste 1989. This lack of understanding facilitates the creation of the dangerous power/knowledge connection: due to a lack of tools and a lack of consciousness the knowledge serves the power relations existing in the place and time in which it is produced Foucault 1980. I adopt the conclusion that lack of political sophistication on the part of professionals and their unwillingness to take full responsibility on all levels – from the consciousness level to the execution level – for the power aspects of their professional status also casts doubt on their ability to encourage empowerment. People who are not conscious of the disempowerment that is structured into their professional activity may be unable to abandon it for a more empowering practice. I am interested in discussing the need to empower professionals but not in line with the over- simplified claim that a powerful professional will encourage empowerment of others better there are too many powerful professionals who empower no-one but themselves. Agencies that employ community planners will allow empowerment of their employees if and when the empowerment approach is adopted as an efficient management principle and as a basis for business success. Indeed the empowerment approach has recently been gaining a reputation as a successful management method as well. The more respect and independence the employees receive the more creative they become and the more willing they are to invest their energy and strength in their workplace see e.g. the books by Plunkett Fournier 1991 Peters 1992 Well ins et al. 1991 Tjosvold 1991. This phenomenon is increasing the legitimation of the concept of empowerment in the organizational context. Following the adoption of the empowerment approach by the business and management world there is a chance that the public sector too which is known as being less sensitive to its own survival and also as slower in its initiatives will join this trend. 266

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6.4. The Empowering Community Planning Process The community planner’s efforts to encourage empowerment are meant to achieve outcomes in the domain of community empowerment. In the previous chapter I presented the stages of community empowerment here I will outline parallel stages of empowerment enhancement. At the same time it is important to remember that a division into stages is not a method of analyzing a process. It is possible that certain stages will indeed be realized concurrently but it is equally possible that they will not occur at all. There are various ways of entering the process and staying with it. Table 1 p. 262 presents community planning as a professional method that engages in planning and enhancement of community empowerment concurrently. The stages of community empowerment that were presented in the previous chapter appear here beside the practical steps that support and enable them. Human activities and social structures are intertwined in empowerment theory and there is therefore no point in asking what comes first the community process or the professional intervention. However what is important is a proper orchestration of time and space. It is particularly important to intervene at the right time and the right place in order to support and reinforce both processes—the planning process and the empowerment process. 6.4.1. Stages of Rational Comprehensive Planning The steps of rational comprehensive planning appear on the left side of the table. Although this is not the only possible kind of professional planning process I have chosen to present it as a representative planning orientation because of the universality of its use. Rational comprehensive planning has served as a basis for most of the subsequent planning methods as well as for models of problem solving. Here because of these advantages and despite its many disadvantages it represents community planning Alexander 1984. I will briefly explain each of the stages of a rational comprehensive community planning process Meyerson Banfield 1955. Identifying the Problem and Collecting the Data In this stage the community planner becomes acquainted with the reason for the planning and with its site. If for example the planning calls for housing solutions in a particular neighborhood the planner identifies the housing situation and methodically collects data about the neighborhood as a whole and the housing conditions there. Defining the Target Population In this stage the planner becomes acquainted with the various populations in the arena of intervention. She locates the people who particularly suffer from housing problems and decides on how to describe them. She may content herself with defining them by their housing situation only e.g. – renters owners non-owners – or she may add data according to other criteria such as age size of family seniority in the neighborhood and the like. At this stage she engages in determining criteria for identifying and classifying various populations their size and the intensity of their problems. Defining the Problems and Outlining the Goals At this stage the goals of the project are presented. Defining the problems also means outlining the domains in which the planning will engage. Articulating the goals defines the expectations for the project’s achievements. The project’s goal may be a solution to the housing problems of young couples living in the neighborhood. 267

slide 268: Presenting the Alternatives The community planner activates a planning process in the course of which a number of ways of achieving the goals are proposed. Each of the proposed ways deals differently with the target populations and with the goals of the planning. Hence different alternatives provide different solutions to the same problem. One alternative may propose the construction of public housing for young couples in a different part of the city which young couples from the neighborhood in question will also be directed to. Another alternative may propose allocation of land in the neighborhood for a Build Your Own Home program for young couples born in the neighborhood only. A third alternative may be a change of land use regulations that will allow neighborhood residents to build housing for their children in the yards of their own homes. Choosing the Preferred Alternative The task in this stage is to consider the advantages and disadvantages of each of the alternatives developed in the previous stage and to decide which alternative is the best. In practice the planners do not make this decision. However they help the decision makers to make it by presenting their professional opinions and their estimates of the advantages and disadvantages of each alternative in economic social environmental psychological and other terms. They can thus have a considerable influence on the decision making. For this reason the various criteria the planners provide are very important since they determine the extent to which they have facilitated a responsible and informed choice. Designing the Plan At the conclusion of the decision making stage and after the preferred alternative has been chosen the community planner designs a plan which will facilitate implementation of the chosen program. If the chosen alternative is the allocation of land in the neighborhood to build homes for young couples it is necessary to set up an executive team to start the necessary changes in the land use regulations and in the infrastructure blueprints and to outline the stages of implementation of the project. Implementing the Plan In the classical planning process implementation of the plan is not part of the planning and the planner is not a participant in it. If we come back to our example the executive team may be a firm of architects and planners who have been hired to implement the project and the project manager will be a building engineer from the municipal engineering department. Today it is customary for planners to be part of the implementation team itself but there are also cases in which the planner continues only in monitoring roles—to gauge the real success or failure of the implementation. Evaluation This stage is supposed to be implemented at the conclusion of the project and it examines whether and to what extent the community planning project has achieved its goals. This is a stage which is frequently not implemented at times because of the non-allocation of resources for the concluding stages and the evaluation of the project most often because most projects in which comprehensive planning is involved are not implemented according to the original plan that was designed in the sixth stage due to adaptations to a changing reality. Eric Erickson 1963 outlined stages in people’s combined biological social and psychological development. Although many different developmental phenomena occur in each of these stages he chose to characterize each stage by a single task completion of which was critical for the advancement of the process. 268

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Likewise each stage in the process of enhancing community empowerment will bear the name of one critical task that the planner has to activate at that stage beyond this analogy there is no similarity between empowerment processes and Erickson’s psycho-social development processes. 6.4.2. The Beginning of the Planning Intervention Process The presented model describes a complete hypothetical process where the planner begins at the first stage of empowerment and brings an empowering intervention in the lives of a powerless population to its successful conclusion. The reality as usual is more complicated and interesting. For example community planners frequently arrive at a community which is in the fifth empowerment stage i.e. that of resisting an existing outside plan. In certain cases the planner enters the scene in the fourth stage—as one of the achievements of the local negotiations over allocation of additional resources to the community. At each stage the community planner has to adapt herself to the time and place of her entry into the process. She has to integrate herself into the local empowerment process to act in accordance with the community’s norms and values and to intervene in a manner that will reinforce local organization and patterns of cooperation that have been developed there before she arrived. In many senses these situations are more complicated than the situation in which the planner begins a planning process with a powerless group that is itself at the beginnings of its path. More than a few planners prefer the difficulties that accompany a process which begins at an initial stage such as this to the difficulties they may expect from having to adapt their efforts to local empowerment processes. Some of the difficulties that are characteristic of a late entry into a community empowerment process are: 1. The difficulty of creating relations of dialogue and trust when the community already has experience in creating connections of this kind with practitioners while for the community planner relations on an equal basis are new and unfamiliar. Misunderstandings and friction between the community planner and the local leadership are liable to thwart the connection between them and consequently to sabotage the entire process. 2. The difficulty of understanding community values and local forms of action when the stormy dynamics of the process are already in progress. A new professional requires a period of learning and adaptation in order to become part of the process. When the process demands quick decisions the planner is liable to act without a strategic understanding of the situation and without understanding his role and his place in the process. 3. Groups which are in the midst of empowerment processes are still also in the midst of processes of developing their critical consciousness. One of the signs of this is the instability of this consciousness. Not infrequently the community lacks sufficient confidence to understand the limitations of its empowerment. Manifestations of this may be a leadership which presents an arrogant and omnipotent stance or that the people find it difficult to define the kind of connection and the nature of the assistance they need from professionals. At times they think that they no longer need the services of community planning in other cases they decide by themselves on the definition of the community planner’s role without allowing her to participate in the decision. Power struggles and conflict characterize advanced stages of the community empowerment process. Community planners who are not experienced in empowerment processes and most are not have to beware of several characteristic mistaken responses: they may receive the impression that they are not needed by the community at all they may get offended by the 269

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lack of trust towards them and sever the connection with the community and its leaders they may forget that that in this situation the responsibility for a large part of the building of a relationship and a dialogue is still theirs and depends on their understanding of the process. The planner has to conduct negotiations with the community about her role and the kind of connection she is to have with it she must try as far as possible to avoid conflict over respect and must strive to create a work contract with the community most importantly she must take care not to submit to attempts to position her in a marginal role that will prevent her from being effective in the process. There thus exists a great potential for friction and even conflict in relations with the community when the community planner enters the planning in advanced stages of the community empowerment process. The more advanced the community is in the empowerment process and the later the planner enters the process the greater the potential for conflict. When the empowerment process stabilizes the community is more experienced in working with professionals and is relatively organized. At this stage entry into the planning process is different more like a contract with any powerful client who is aware of his needs. Likewise entry into a place of powerlessness entails many stumbling blocks for the planner. The quiescence and alienation that characterize community powerlessness are indeed accompanied by suspicion and mistrust but on a superficial view they create the illusion of agreement with the planning. Interpreting community quiescence as a kind of acquiescence is a common mistake made by planners. Many of them understand the alienation as indifference and as proof that the people are not interested in active cooperation. From the point of view of the planners entering into planning in a powerless environment may be relatively tranquil and orderly. The planner senses the silence the alienation the suspicion and the indifference towards himself but since he is not involved in a confrontational situation or under political pressure and is not obliged to make changes in his role he is not personally threatened. True an important side is absent from the planning but because of this the actual task becomes more simple. The danger is that a planner who is not willing to pay the price of stormy planning and uncertainty may have to pay the price of disempowering and ineffective planning. When a community planner enters a community that has already achieved the ability to represent itself she has to time and to coordinate the planning process and the critical tasks from her point of view not that of the community with many people. Since the planner is not directly or exclusively responsible for the enhancing of community empowerment she is liable to think that her role as an empowering practitioner is not important at all. The planner’s entry stage therefore also requires evaluation of the extent of community empowerment that exists in this place: the extent of ability and control the sense of community standards of participation and organization present in the planning environment. In the community planning process with the group of parents of children with disabilities the community planner and the group began working together almost from the first stage. There was a need for certain adjustments because three of the parents had been active on behalf of their children very intensively although not effectively for many years. The community planner respected their activism and recognized its value for their individual empowerment. This small group became integrated in the new organization. Although the planner’s attitude may seem obvious experience teaches that not a few community planners would choose to 270

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ignore the senior activists and their history and even to confront them as ineffective and as obstacles to organizational change thus missing out on the entire empowerment process. Stage 1: Developing Relations of Trust and Dialogue In the first stage of the rational planning process the planner engages in understanding the context—in identifying problems and collecting data. To a large extent the stage of entering upon a new planning task begins with a widening of the original project’s concrete context. This is a spatial activity which includes people services and environment. This stage involves quite a number of personal decisions about the style suitable for the dialogue with the people. In many cases the professional begins working without knowing at this early stage who the dialogue is going to be with. In this stage the community planner develops a sensitivity towards the place by means of regular presence and becoming personally acquainted with as many people as possible. The emphasis is on opening up good and numerous channels of communication as a basis for establishing relations of mutual trust. In this stage there is no substitute for the practitioner’s personal acquaintance and personal connections with people in the arena of the intended planning. Not a few planners content themselves at this stage with collecting statistical data or holding interviews using questionnaires in order to identify problems and collect data. Limiting oneself to such technical means at this stage may harm the process. If trust is not established between the planner and the people they will remain outside the process that she initiates and she will lack feedback on the meaning of the information she has collected. The dialogue created at this stage also contributes to mutual interpretation of the information that has been collected including the people’s knowledge about the place and about themselves. The interpretation that is produced in the course of this interaction facilitates feedback and filtering of partial impressions and of one-sided views that are characteristic of the initial stages of becoming acquainted with one another. At this stage the planner begins the praxis – learning through action – and gathers new insights as he learns. It is important for the professional to be conscious of the language that he uses and of the verbal and non-verbal messages that he transmits to the people around him. Since hidden messages have great empowering and disempowering potential everything that transpires in the domain of language and messages requires streamlining and consciousness raising. In community planning agencies I have researched I did not find an awareness of the importance and the power of messages or of the importance of dialogue in the opening stage of the planning process. In this stage first agreements for collaboration are drawn up. The practitioner’s initial attitude towards the place and the people is much more important than the objective data collection Reid Aguilar 1991. Hence there is no substitute for the practitioner’s consistent presence in the place and his personal contacts with the people. The place has to be learned through its history its culture and its everyday life in order to understand the past evaluate the present and collaborate on producing alternatives towards the future. Getting acquainted and establishing trust are processes that take time and this time has to be devoted if one wants to achieve outcomes. The community planner’s commitment to devoting time to the process is the basis for the trust that is created between him and the local people from the first stage on. His consistent and continuous presence proves his commitment. Further on in the process he will be able to base participation in the planning process upon this commitment. 271

slide 272: Stage 2: Creating a Participatory Infrastructure In the second stage of the comprehensive planning process the focus is on the target population for which the planning is intended. Planning is an intervention in the human environment and hence it is very important to define this environment from as early a stage as possible. I am aware that in the classical rational comprehensive planning process there is no real obligation towards the real target population of the planning beyond a formal one. The client is the one who commissions the work—he pays for the planning has to be satisfied and his interests must be acknowledged by the planners. Community planning in contrast has to declare its obligation to a particular community even when it is not facilitating empowerment. This obligation ensures that the community planner will be concerned from the outset not only with the interests of the people who contract for the planning and of her employers but also with those of the people who will be influenced by the planning. In this stage it is important to develop the sense of togetherness that will characterize the continuation of the empowerment process. This is the stage in which a community begins to be created. The sense of a common fate a common interest and the subsequent common struggle are what create it. Participation is the critical task of this stage—the outcome which is to be encouraged is partnership. This is the appropriate time for preparing the infrastructures and for creating the possibilities for people sharing a critical characteristic to manage their own affairs. Although we are speaking about new partners who are perhaps not yet committed to the planning it is preferable to invest in encouraging a partnership around a common general vision or issue it is wasteful to invest in particular plans which will later change entirely. Planners who want to implement a ready-made model of participation risk initiating a technical procedure which even if it does not become disempowering misses out on the essential creativity and the empowerment potential of a process that is created by the people themselves. In Holland for example a technical procedure of public participation in each planning stage was developed. Even if we assume that the procedure was appropriate to all the people it was applied to it was the professionals who wearied of it as I was told by Andreas Faludy in a conversation in 1992. In the Urban Renewal Project in Israel the regulations determining residents’ representation in the project’s steering committees caused similar damage. In a large portion of the neighborhoods the implementation of this participation procedure did not correspond with the processes of participation that developed locally and frequently was more injurious than useful to the process. Although the project’s evaluators praised the fact that there was participation and the institutional recognition of the need for it they estimated that the level of participation in the project was not high Alterman Churchman 1991. Community planners I have interviewed were convinced of the importance of participation as a major strategy and as a goal in itself in their work. At the same time there was a predominant sense that participation as a concept was identical with empowerment. Hence it is important to recognize that a formal procedure of participation is no more than a framework for various approaches. Participation is not more empowering than democracy. Formal structures of participation and democracy are indeed necessary conditions which provide a basis and a context for the development of empowerment but they are not sufficient for enhancing empowerment. In order to understand what advances empowerment 272

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and what is disempowering in the participation process we have to devote thought to rules of caution which are recommendations on how to avoid disempowerment. These are principles of social hygiene the fulfillment of which creates the necessary though not sufficient conditions for the facilitation of empowerment by means of participation. Likewise we must analyze the active practice: by accepting these recommendations the professional ensures the sufficient conditions for enhancement of empowerment in the course of her professional practice. The list of rules of caution and rules of practice may not exhaust all the possibilities of empowerment and disempowerment that exist in situations of participation but it helps to clarify the differences between participation and empowerment. Rules of Caution Caution in professional practice means sensitivity and openness towards the local people. In this way the community planner proves that he is avoiding any arbitrary activity that may harm the social tissues and social networks especially those whose existence he is unaware of. A. The empowerment paradox has been stated thus: “that even the people most incompetent in need and apparently unable to function require just as you and I do more rather than less control over their lives” Rappaport 1987 p. 15. It is especially the alienated weak and dependent people who need to obtain more control over their lives and environments. The paradox warns against the tendency to develop a patronizing attitude towards weak people to act for them and thus to preserve their inactivity while letting them go through rites of participation. B. The bias in needs identification originates in seeing participation principally as a reliable way of collecting information about the participants’ needs. The focus on participation for the purpose of identifying needs creates a disempowering division of roles. In this division the local people are the experts on the needs while the professionals are experts on the fulfillments. Or in other words the people bring the problem and the professionals bring the solution. Despite its prevalence there are no firm proofs of the effectiveness of this division. To date it has not been proved that the experts on solving social problems are exclusively or especially the professionals Borkrnan 1990. Empowering participation means accepting the participants as complete people with wants and aspirations knowledge and skills and not only as people with needs. The very willingness of professionals to relate to people’s hopes and to use their knowledge in the framework of a common project is in itself a very powerful message in the direction of empowerment. Empowerment is realized when people begin to believe in themselves as thinking people with abilities and hopes for the future and do not see themselves only as a source of problems in the present. C. Avoidance of external intervention in local participation processes. External dictates of conditions for participation may be disempowering. A common example of such external intervention is a one-sided demand on the part of professionals that the local partners in the participation process hold elections to choose their own representatives. Since the empowerment process on the community level means more control by the local people in their affairs such intervention is a disempowering message. It is preferable for professionals to try to collaborate with the local people and together with them to formulate rules for local participation. To trample down a local process and dictate the manner of participation from the outside are disempowering actions. All that it achieves is yet another affirmation of the superiority of experts – this time experts on resident participation – over the local knowledge and initiatives. 273

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D. Developing a leadership is not the only vision. Some professionals tend to content themselves with developing leaders or encouraging an existing leadership and involving them in the planning process. Empowerment is a process intended for all the people not only for potential leaders. Although a local leadership is an important means of advancing community empowerment as a strategy of cooperation it is important to remember that empowerment wants to mobilize and activate as many people as possible to extend the basis of participation and to provide a diversity of opportunities and subjects for participation Churchman 1987. Empowerment is to a large extent an extension of the idea of leadership into the idea of active citizenship. E. The fallacy of representative or typical representation. There is no such thing as a typical resident who by her very presence represents all the other local people. Some experts assume that the participants from the community have to represent all the other residents in their way of life and their way of thinking. This is a misleading and discriminatory assumption. Such representatives when chosen do not live up to these expectations and when it becomes evident that they represent only themselves it is the professionals who are most disappointed in them and in the idea of participation altogether. This disappointment leads to a decline in the motivation to encourage participation and the process generally degenerates until it stops. F. Participation may isolate and exclude. A danger exists in the seemingly equal treatment of all the participants in the participation procedures. If the non-professional participants do not receive special attention in the course of the process they will not be able to follow the contents and the expert language or to understand the various ramifications of the plan and will lack information sources of their own and an organization to support them. Instead of participation a frustrating situation arises where the local participants cannot act effectively for their own interests because they lack the tools. When despite these limitations they do act they are subjected to paralyzing criticism for their inappropriate behavior in the formal forums. Rules of Practice Rules of practice are what advances empowerment and creation of a community. The participation process is an opportunity to demonstrate to people that they can work for the good of the community and it provides them with practical tools and diverse opportunities to do so. It develops people’s organizational ability through involvement in making important decisions in their community. A. Thinking and action. Participation has a chance of empowering the community if it provides opportunities for active involvement of as many participants as possible and for thinking about this action. Likewise it is important that the recruiting of participants be done by the practitioner himself as part of his dialogue with the community. It is important to ensure that the local people do not get a feeling that an external system is interfering arbitrarily in their lives as a condition for allocation of resources. Participation has to be an expression of an opportunity for change a will to take on a new challenge and a learning of new abilities not a bureaucratic dictate Breton 1994. B. A process of developing skills and abilities. Participation processes should be accompanied by appropriate training of both the participants and the professionals. This participation is a mutual process of learning and development from which the task should stem. The recommended learning method is that of praxis learning that integrates theory and action into a commonly shared understanding. The professional is both a teacher who guides the process and a learner herself. The process leads to the personal growth of all the participants as well as to their ecological ability to act for the good of the environment Breton 1994. The critical consciousness that the professional has acquired as a tool for her own use now serves 274

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her in the empowerment process and helps her to teach people to understand their situation to criticize it and to act for change Freire 1970. C. An opportunity for people to fill socially valuable roles. The opportunity to fill a role that is of value to the community is an important element of the empowerment process. Some writers believe that it is even worthwhile to underman new programs in order to give participants in them an opportunity to organize manage and run services by themselves Rappaport 1987. D. Taking responsibility. Powerlessness causes people to feel that the responsibility for their fate and that of their families is in other people’s hands. A person who depends on others and does not believe in her ability to change things also does not see herself as responsible for her life. Hence experience in responsibility is an important corrective experience. Taking responsibility has a dramatic effect on the community level. Participation enables communities to take responsibility for their own existence again or for the first time in their history. This is one of the distinctive signs of the realization of community empowerment. E. Integration of task and process. The empowerment process demands that community planners devote time effort and resources to two domains concurrently: to the managing of the planning task and to the empowerment process. The investment in facilitation of empowerment concurrently with achieving the concrete tasks is not a simple matter. However without investment in the processes any social project will suffer from superficiality and will miss out on its main goals. Although the process consumes resources of its own it leads to an outcome that is qualitatively different from that which is achieved by task-oriented means only. At the same time it is important to remember that the converse is also true: when there are no real achievements the empowerment process loses vitality. All the participants in the process invest effort and resources in it and want to achieve practical outcomes efficiently and in a reasonable time Churchman 1990a. There is no point in participation if it does not yield practical achievements. Stage 3: Defining The Planner’s Roles At this stage relations of trust between the planner and the people in the planning environment have already been established a feeling of community has begun to form and a basis exists for partnership in the planning. A diagnosis of the problems the inclusive planning has to focus on has already been made through an integration of the local people’s experiential knowledge with the planner’s professional knowledge. Now as the community’s self-definition develops a definition of the role of the community planner who makes his professional knowledge and previous experience available to the current process develops as well. Since projects differ considerably in the circumstances and the subjects of the planning and in the stage the community has reached in the process in each case the planner’s various roles will carry a different weight. In the first part of the book I surveyed a variety of roles that the planner may fill. Here I will pause over two roles that are especially important for the community’s ability to define itself—the role of teacher and the role of activator. The Role of the Teacher and Mentor The planner’s role as a teacher and mentor stems from the constant need to develop the knowledge skills and abilities of the community. People who can help in the self-definition and building of the community’s norms are essential to the empowerment process and it is the community planner’s task to cultivate them. As long as there exists no local leadership 275

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that can take responsibility for the community and its affairs the professional has to ensure representation of the community before various agencies in the planning process. In this domain she functions both as a source of knowledge and as a consultant for the decision makers and the other participants in the planning process. Development of the participants’ knowledge accords them an ability to formulate issues and goals of change. The community’s self-definition is at once an emotional experience a political declaration and an intellectual process Boyte 1984. On the intellectual level the self-definition stage demands an ability to formulate goals of change. Even though this sounds absurd people can have the gravest problems and can feel them without being able to formulate or define them as issues Alinsky 1972. Empowerment attributes great importance to learning—from critical and strategic thinking to organizational skills of management and maintenance. Freire’s thinking about literacy and his methods too can thus complement the professional practice of encouraging empowerment in important ways. Just as power and knowledge are integrated in Foucault’s thought so illiteracy and powerlessness are integrated in Freire’s approach 1970. The ability to think and to be critical develops when people are enabled to express themselves and to know themselves. A person is not a tabula rasa but possesses many abilities—to know to create texts to express his world view and his thoughts. Every person comes to the process with what he has and the teacher’s role is to help him discover and develop himself. Since people convey the message that they experience rather than the message they understand rationally the planner has to take responsibility for forming the particular synthesis of systematic and professional knowledge and experiential knowledge appropriate to her style and her personality. In this way she commits to learning how to be self-critical. The adoption of Freire’s approach involves choosing a number of components in the planning environment which are most significant in the participant’s lives. In the same way that Freire creates a text book with his learners the planner can create a planning log with the participants which can help them identify the subjects important to them develop them into an action plan and understand their world through it. In Freire’s method familiar words are used as codified representations of the learners’ existential situations. Each word is positioned inside a scene from the learners’ lives. The learners describe the familiar situation and discuss it in a discussion group with the teachers. This is the learning of the code—the superficial structure of the situation. The second stage is that of “decoding”—developing an understanding of the relations between the word and the situation within the scene. After the people engage in dialogue about the reality as they experience it they continue analyzing the words in order to understand them in different contexts as well. Instead of receiving external information about one fact or another from the teacher the learners analyze various aspects of their existential experience. Codes of the existing reality may also be decoded by means of community planning. The planner can begin with a log of the local planning which the people prepare together with him and can go on using Freire’s method to decipher the deeper meaning of the described reality. This analysis leads to new insights about change which can serve as a basis for constructing an alternative community plan. In order to work this way full cooperation between the teacher and the learners is essential. According to Freire the learner is at the center of the learning process. Freire rejects methods in which the learner is a passive object who cooperates in a task that has no connection with the sociocultural reality he lives in. Likewise empowering community planning places the people at the center of the planning process and together with them shapes the goals that are relevant to the reality of their lives. 276

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Routine plans of community planning are an example of a converse method. For example in the Urban Renewal Project it used to be customary to divide a community planning project into two—a physical project and a social project. In my estimation this division symbolized the alienation between the local people and the project which did not reflect their world and their way of thinking. The result after ten years of intensive activity in the neighborhoods each numbering a few thousand residents is that most of the residents in these neighborhoods were not acquainted with the project that operated in their neighborhood and did not make use of the various services that were planned for them Alterman Churchman 1991. The Role of the Activator The empowering planner is sometimes called a radical planner Schuman 1987 Friedmann 1987. What this means is not quite clear for radicalism in the sense of extremism is a relative matter. The literature that deals with planners indicates that most of them are not interested in radical practice of any kind Baum 1986. We will define the radical planner as an activating planner who is actively involved in creating a community and in encouraging people’s control over their environment. The main radical characteristics in the planner’s role are a critical approach to the existing situation and an oppositionary attitude as a planning strategy. Although the radical planner has confrontations with the establishment in most cases these conclude in full cooperation Friedmann 1987. Hence one may say that swimming against the stream mobilizing people into action and struggling against barriers are characteristics of any planner who is ready to struggle for something she believes in Faludi1990. It is my impression that disempowering planners are those who tend to see the opposite end of the scale – the undirected people-focused approach that operates from below – as extreme radical activity. These planners who perceive their role as essentially technical and consultative feel there is a conflict of interests between an obligation towards empowerment and their other tasks. For example the opposition between empowering the weak people in the planning arena and an obligation towards stronger groups in the same environment. Or the community planner’s obligation towards the planning process itself as prior to his obligation towards certain groups taking part in the process. Some planners believe that the professional’s objective stance is undermined by the empowering role and oppose it vigorously. I have found that the more that planners see themselves committed to the planning project itself the more they see empowerment as a practice that does not correspond with their aims and roles. It is important to note that most community projects are not conflictual. Their aim generally is integrative: community development and integration of the community in the society around it. The social struggle takes place if at all in the initial stages of the change processes and after this the community is built with the establishment’s cooperation of and financing Boyte 1984 Rose Black 1985. Cases in which the radical strategy is the core of the project are most rare Schuman 1987. We may therefore define an activating planner as someone who does not recoil from conflict and struggle is willingly involved in the planning and understands the necessity of politics. However in those cases where such planners have both struggled and managed to achieve their goals and to survive in their positions the role appears much less radical than in cases where there were failures e.g. Krumholz Forester 1990 Schuman 1987. As we will recall the belief in the need to solve social problems in a way that accords people a better control over their lives may also be viable in the framework of a moderate liberal democratic framework. It seems to me that what we call radicalism is a declaration of the 277

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community planner’s anti-conservative and anti-liberal world view. In practice community planners who are moderate in their views and empowering in their professional approach may also employ means of struggle and resistance if there is a need for it. For our understanding of the community planners’ role it seems to me more useful to define them as community activators than to think of them as radical or moderate. Stage 4: Developing Organization In the self-representation stage of the community empowerment process considerable knowledge and an adequate level of participation to propose various alternatives for achievements of goals already exist. This is therefore the time to start establishing an organization. The organization is necessary to make it possible to confront situations of resistance and organizational outflanking and to achieve complex goals which are the tasks of the next stage. The critical task in the present stage is to help the community develop appropriate organizational tools for achieving its goals. Power theories have contributed a great deal to our understanding of the importance of organization for community empowerment. The concept of organizational outflanking Mann 1986 emphasizes the importance of developing empowerment methods that are specific to the organizational domain: development of alternative organizational resources control of existing organizational resources and experience in activating organizational resources. Encouragement of community empowerment in this stage involves firstly establishment of an organization and secondly improvement of the community’s ability to control its affairs by using this organization efficiently and enduringly. While the need to fit the structure of the organization to the patterns of activity is a source of tension and change in organizations Clegg 1989 the lack of fit between institutional solutions and human needs is a cause of the powerlessness of the weakest and most needy people. Hence we may conceptualize an organization that advances empowerment as a proper fit of an organizational form to a social environment. The danger lies in the organizational tendency to duplicate structures of power—to adapt an organization to the organizational environment. The empowering organization which is generally different and unique in its surroundings is liable once it is established to follow socially accepted organizational principles and to neglect empowerment principles. Organization and the individual. Individual empowerment means a person’s liberation from an undesirable situation in the power relations. The individual’s consciousness of the harm that institutions and organizations have caused him creates a resistance in him towards them and he recoils from them even when he needs them for his own purposes. A very common expression of this resistance is people’s sweeping and fundamental repugnance for bureaucracy of any kind. However the organization also constitutes a means for individuals to become involved in social frameworks which they previously did not even know about. For example: joining a social club or membership in a branch of a political party. Because the entire process of individual empowerment may take on a unique form the reasons and motivations for organizing too are unique to the conditions and circumstances in which each individual finds herself. The activity that mediates between the individual and the organization takes place in the group. 278

slide 279: Organization and group. In a group tension arises between two wants: the want to improve a personal position in the power relations field and the want to realize social goals beyond the personal goals of the group’s members. When the group exists primarily for purposes of social support and consciousness-raising no contradiction will arise in this domain. A shortage of community goals does not frustrate the group’s ability to function it only limits its roles. In contrast a group which has political aspirations and goals of social change which is interested in outcomes that can be achieved only through action in the field of power relations has to set up an organization. In the group then processes of organizational institutionalization meet with the members’ needs for support spontaneity and self- definition. Hence groups have to seek organizational solutions which will both ensure the group’s ability to grapple with political tasks and encourage the members’ individual empowerment. Experience also teaches that an organization which is formed in the course of empowerment processes is liable to turn into a disempowering organization. Community organizations which have become rigid bodies that are inaccessible to other groups in the community are a common social phenomenon. Organization and community. If from a group point of view the organization is an option from a community point of view setting up an organization is the process itself. Hence it is important to check to what extent the organizational model itself advances or frustrates empowerment. Empowering community planning is tested by its ability to integrate an empowering social solution with an empowering organizational solution. Michel Foucault Dreyfus Rabinow 1982 contributes important insights for the construction of an empowering community organization. Organizing is essential in his view too because the answer to power mechanisms is to develop methods of dealing with their harmful consequences. I propose the adoption of the following conclusions selected from his writings: 1. A community organization must avoid the supervisory gaze that characterizes disempowering organizations. The working methods in such an organization will unequivocally avoid reaching conclusions without the community’s participation and will shun work methods based on observation and supervision. It is important to plan a space which cannot be encompassed by a supervisory gaze to create a structure and an atmosphere that respect people’s privacy as well as their right to assemble without a hierarchical gaze over both these behaviors. This should be strengthened by corresponding physical planning of the organizational setting as specified in 5 below. 2. A community organization will not impose rules and regulations upon its participants rather it will draw the rules and regulations for its operation from the principles upon which it is built. 3. The organization will behave with sensitivity towards each person’s body and privacy. According to Foucault a person’s body is an especially crowded intersection of power relations because too many institutions take an interest in the person’s body and psyche. This point is self-evident when homosexuals protest against discrimination and exclusion on the grounds of their sexual preferences or when dark-skinned people complain about discrimination in a white society. However it also touches much more ordinary populations— for example those people who are considered bad human material this is a literal translation 279

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from Hebrew of professional parlance in certain circles in Israel according to the criteria of one institution or another school the army etc.. Their failure is not grasped by the institution as its own failure but as the failure of the individuals. An empowering organization must exercise an opposite approach: it has to seek within itself for the causes of failure. 4. A community organization must diminish the importance of common formal tests such as entrance and eligibility tests. On the other hand it must attribute greater importance to messages and symbols especially to indirect messages. For example a community organization which is developing a program for parents will recognize that a name like School for Parents may transmit a disempowering message to parents who experienced failure as children at school. If these are the people it wants to involve such a name and framework will not be suitable Freire Horton 1990. 5. A community organization will take care to transmit an empowering message in the planning of the physical space in which it is located as well. Foucault analyzed the similarities among jails factories schools and hospitals and showed how the idea of disciplinary power found its physical expression in the majority of social institutions. Hence attention should be paid to potentially disempowering meanings and messages that the organization’s structure and design are liable to convey to people. Symbols of hierarchy and rule should be abandoned and a more equitable message should be created through the architectural design of the physical space as well Peters 1987. Principles of an Empowering Community Organization 1. The organization is a means of achieving change and not an end in itself. Hence its importance lies in its continuous activity and its advantage lies in its simple structure. In order to be able to act it must be based on clear communications and on as flat a structure as possible and it must be committed to constant learning and innovation. When developing a new plan it is preferable to create a new structure and thus to split the activity into small units which increase the number of opportunities for people in the community to participate in the organizational effort. 2. The organization is committed to its aims and to providing for the community’s needs and wants. Hence each new service that is set up has to undergo maximal adaptation to its users. In no case is a standard service to be set up. 3. Since the organization’s major resource is its activists and clients – the people of the community – it must be built to preserve a constant contact with them. The community is the source of the organization’s inspiration and its members fill valuable roles in its frameworks. 4. A community organization may not content itself with routine activity it has to be an enthusiastic partner of the community in attaining its objectives. The organization’s role is to continue creating a community through a vision of its mission identification with local culture and pride in its own existence. 5. In order to ensure preservation of its uniqueness and its relevance the organization – in its structure its objectives and its style of action – has to be based on local knowledge. As I have already said several times in this book most of the valid knowledge in the social domain is based on experiential knowledge so that an organization which operates in this way will be built on a solid basis of knowledge. 6. In order for the organization to become an empowering factor in the community it has to operate on a high level of commitment and morality and to insist on norms of organizational behavior that create respect and appreciation towards it and towards the community it represents. In this sphere it is necessary to safeguard a high degree of firmness for otherwise the organization is liable to lose acceleration and uniqueness and become just another institution. On the other hand in order to ensure continued relevance the community 280

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organization needs to be flexible and prepared to respond to new initiatives. This synthesis – of insisting firmly on values while letting diversified initiatives guide the organization’s activities – characterizes successful community organizations Peters Waterman 1982. Like participation organization and organizing are not in themselves empowering processes. Community organizations may be as rigid hierarchical and disempowering as any other organization. Hence there is always the danger that an empowering organizing process may be followed by the setting up of a disempowering organization. Awareness of this danger does not ensure immunity against it but it does promote the creation of important preventive mechanisms in the form of the empowering principles presented here. Stage 5: Strategy Development In this stage the community is already capable of expressing its opinion about its problematic situation and even of actively resisting a plan it finds undesirable. The ability to resist existing policy or plans we will recall is an important condition for ensuring the community’s survival. In the comprehensive rational planning process the preferred alternative is chosen at this stage. If the planning is neither participatory nor empowering and is conducted with no regard for the community this is a choice that the community is liable to organize against. In this stage an empowerment enhancing community planner engages in developing the community’s strategic ability. Among other things she may teach them how to resist effectively and to initiate their own alternative. When the community planning process cooperates with the community empowerment processes the community can move on to the next stage—to develop an independent plan on the basis of alternatives that were developed in the earlier stages. This stage then is designed for strategic confrontation against a solution a situation or a policy that the community does not agree with. The community planner’s main task in this stage is to help the community develop a winning strategy. The community planner’s dilemma about political involvement. The community planner’s difficult dilemma stems from the potential for tension and conflict that exists in this stage. Although resistance is an expression of active participation in the power relations and a test of the efficiency of the community’s organizational and tactical power the community planner’s commitment to the empowerment process is also put to the test here. In a situation of resistance and active struggle around the planning itself the community planner cannot not take a position. And yet quite unrealistically at this very stage his employers expect him to be neutral which means only one thing—that they expect him to support them and at least not to act openly on the community’s side. This happens even if until this point he has been involved in all the stages and his positions on the disputed subject are known. For example in the process of setting up the service for children with disabilities when a dispute arose between the new parents’ community organization and the local authority the community planner’s superiors said that she had to decide where she belonged and claimed that she was behaving disloyally when she went on working with the organization. The local service for community planning that I investigated prevented its planners from getting involved in any resistance against City Hall from the outset. The service forbade community planners to take actions that might be interpreted as political involvement as part of a policy not to antagonize agencies providing finance and legitimation against the service. The time of this policy was a stormy political period in local government but the message was understood by the planners and it has guided them ever since in calmer times as well. We may sum up and say that in this stage planners are expected to be politically involved in a way which may make them recoil from encouraging community empowerment. In some of the 281

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personal interviews and in the group discussions a few of those interviewed expressed the feeling that there exists a conflict of interests between the idea of empowerment and loyalty to the employer. None of them claimed that their job or their advancement in the service were endangered by being politically involved against their own employer but experience teaches that such a danger indeed exists. Developing Strategies of Coping with Power Theories of power as we have seen reveal methods of ensuring obedience and discipline that are exercised upon the weak in the power relations. It is to those theories that we must go to draw ideas for strategies of coping with these methods. Empowering community planning in this stage engages in several tasks at once: the technical task of choosing among alternatives becomes a process of development of capabilities: the community has to learn how to present its opinion about those alternatives it objects to in a substantiated manner based on facts and findings as well Churchman 1979. On the more dynamic and political level the community planner has to engage in two processes: to help the people understand the means and methods of disempowerment that are liable to be used against them in a political struggle and to help them develop an active strategy of dealing with the difficulties of the confrontation they are involved in. The very act of setting up a community organization is the most efficient strategy of coping with a hostile environment. However with or without an organization it is necessary to learn how to cope with the overt covert and latent dimensions of power Gaventa 1980 and this is what we will discuss now. Developing a strategy for coping with the overt dimension of power relations. Resistance to an existing plan takes place in the overt dimension of power relations. The ability to appear in the decision making arena is an important sign of the realization of the empowerment process and of emergence from a passive stance towards what goes on in the relevant environment. At the same time it is important to recall that appearing in the arena does not attest to an ability to join and participate in it permanently. Entering the arena without tools or unsystematically may conclude in a major effort that may bring about a particular change yet without fundamentally influencing the way decisions are made in the community. For example the struggle over the school: the struggle of the students who came out against a municipal decision was itself a proof of the empowerment of the participants in the process. But the struggle over the school was also conducted in more sophisticated decision making arenas and here manipulations that the students and parents did not have the tools to cope with were already exercised. Firstly when the students held a demonstration at the beginning of the struggle the local authority announced that they were minors and therefore no negotiations would be held with them. This was a tactic of division based on a calculation that the parents would be an easier partner to negotiate with. The students however managed to get the parents involved and to get them to identify with their struggle and their way of conducting it. After this the parents demanded that representatives of the students council also participate in all the discussions. When the Knesset Education committee decided on a common forum that would make decisions about the school’s future a situation arose in which the students and their parents were a minority among professionals from several organizations. Thus from the outset there was no chance that their proposal might get accepted and indeed it was not accepted. In that 282

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forum it was decided to open the registration zones from which students came to this school to registration for two more schools in the city. The students and their parents were not pleased with this decision but they were forced to accept it because they had agreed in advance to the negotiation rules. After several years of observing the occurrences at and around the school nothing definite may be said about the change effected in the school by the struggle. The extensive sympathy of public opinion for the students’ struggle and the local and national press coverage influenced the decision makers’ attitude towards the school. The struggle affected the way the local authority relates to the participation of students and parents in the education system and the allocation of resources to the school. There has been an improvement in the level of achievement of the students at the school but not to the extent of closing the gap between it and other schools in the city. Since that time there has been no further attempt to close the school but there have been efforts to give it new contents and a different character. Furthermore since the struggle over the school the local authority has been working to change the character of social integration in the education system see discussion below. Generally local resistance is not a publicized event as in the example above. In an especially severe case in a particular neighborhood in the Urban Renewal Project people who resisted the plan were subjected to intimidation and humiliation on the part of the local authority. The situation there changed for the better after advocacy on behalf of the neighborhood by independent professionals and journalists who exposed the oppression and protested against it. Generally however resistance is a local matter and the activists are subjected to pressures of cooption. They are invited to join the authorities and to receive benefits that will cause them to moderate their attitudes or to give them up entirely. For this reason the leaders of COPS in San Antonio for example rejected attempts to bring them closer and avoided any contact with politicians in order to prevent temptations and attempts to co-opt them Boyte 1984. It is important to provide support and guidance to new participants in the power relations who are taking part in the overt stage of discovery of decision making. They need to be trained to cope with circumstances that may arise in the decision making arena. At this stage a community planner who is not a community worker by profession may recommend that the community bring in consultants who are experts in negotiations and political struggle. However if she is the only professional in the planning environment she has to be alert to this need from the outset and to diagnose the extent to which she herself can be of assistance in this sphere. Developing a strategy for coping with the covert dimension of power relations. The covert dimension contains mechanisms that are aimed to limit the ability of resistance to power as much as possible. Empowerment strategies in this dimension concentrate on exposing these mechanisms and developing a critical awareness towards them. A. Developing a strategy for situations in which a consensus exists about one position and no legitimation exists for the positions that the community represents. This kind of situation may indicate a mobilization of prejudice in order to preserve the existing situation. An empowering strategy will seek to open up public discussion on this subject in order to bring in a diversity of positions and opinions. For example in the struggle over the school the discussion on the character of the integration process in that city was reopened. For many years there had been an acceptance of the 283

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situation of one-way bussing of students from the lower social class in the city to upper class areas in the city. Since the school is situated in a lower class area it lost out from this form of integration because students from the upper class were not brought there while students from the area itself were bussed to schools in more established areas of the city. In fact because of the character of these arrangements the integration program was never really implemented at the school. The leaders of the struggle for the school claimed that if this was the reason for closing the school then a grave social situation was being perpetuated here: no hope for educational institutions of a high standard in the poor areas of the city. When a policy of changing the education structure in the city was announced on the face of it there seemed to be no direct connection with the struggle over this school. The new program proposed that parents could choose a school for their children already at Junior High level before this free choice was allowed only at High School level. In this way attention was diverted from the past to the future and this too is a tactic of power. The proposed change in education structure in the city obscured the main issues that interest many of the city’s residents the students of this particular school and their parents included. The new program is complex it has various sections and these are not presented in full detail. For this reason among others it cannot be understood by someone who is not an expert on education another tactic of power. In this way the new program is sold to various groups as the product that they want despite the completely contradictory wants of these groups. Because of their developed critical awareness the activists from this particular school both students and parents understood at once that the new program would harm them. However due to a lack of a suitable organization they did not have the tools to oppose it. This was a city- wide program and their strength was sufficient only for action within the boundaries of their school. B. Developing a strategy for an ongoing situation of non-participation of certain groups in the decision making process. Here there is a need to examine the direct and indirect obstacles that have been set up to prevent participation. Exposing the obstacles is an achievement in the domain of critical consciousness and a basis for preparations for social change. The great difficulty lies in overcoming them. We may understand this better if we take as an example the findings of the evaluation team of the Israeli Urban Renewal Project who found that in the end the project did not work for an improvement of the situation of especially weak populations and improved the situation of relatively strong groups in the neighborhoods where it was deployed. In the course of the project which operated in certain neighborhoods for ten years and more this strategy was justified by the need to strengthen strong residents in weak neighborhoods so that they would not leave the place and in this way to achieve a general improvement in the neighborhood situation. In other words what happened was not only that the weaker residents were not represented in the project and hardly even benefited from its resources but that a rationale was also developed to justify this phenomenon in the spirit of conservative trickle down economy. The idea was that the most worthwhile economic investment was to encourage the strongest residents because they would invest and develop the economy and this would eventually also lead to an improvement in the situation of the weak this should happen in a natural way in the spirit of laissez faire not by direct intervention. In this way improvement in the situation of the weaker residents will trickle down without a need to invest in them directly and thus waste the project’s resources. 284

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The outcome – in the Urban Renewal Project in Israel as in conservative economies all over the world – is a benevolent neglect of the weak accompanied by an accelerated increase of the social gaps because the stronger residents benefit not only from their own power but also from the public resources intended for the weaker residents Phillips 1990. In such conditions when the rationale for the absence of a weak group is justified by and anchored in social values a community planner cannot content himself with exposing the obstacles to participation. If he is interested in ensuring the participation of weaker populations such as the physically disabled the chronically ill people with developmental disabilities people released from mental hospitals in the policy considerations that affect them he will probably have to function as an advocate i.e. to represent these groups himself in order to advance their cause in the community. The community planner who worked with the group of parents of children with disabilities employed a combined strategy of advocacy/empowerment. At the beginning of the process she had to work on her own opposite the decision makers in the city in order to ensure the participation of this group in the municipal forums that were important for its interests. She had to absorb the criticism of colleagues and superiors for the fact that she was acting as the representative of the parents instead of looking after her organization’s interests. This strategy even when it is essential must be very brief in cases where the people have the ability to represent themselves. In cases where people totally lack the ability to represent themselves – children very sick or very weak people – the professionals are permanent advocates and the representing organization’s main role is advocacy. C. Developing a strategy for coping with non-events. This is an especially difficult dimension to identify because it is difficult to build a consciousness around something that does not happen. Here it is necessary to develop knowledge and understanding of what does not exist of what has to happen and is not happening. For example: The evaluation team of the Urban Renewal Project found that in the steering committees that were set up in the project in which half of the participants were residents’ representatives there existed a procedure of not voting in order to decide on disputed issues Alterman Churchman 1991. The evaluation does not mention how such a procedure came to be accepted in all the steering committees throughout the country. This is the essence of a non-event: it is not a phenomenon that occurs but a phenomenon that does not occur. If we pause over this example we have to ask where the decisions were made and what actually did happen when there was a need to decide on disputed issues. In order to answer we need to ask and investigate: who profited from the non-event In our example it was not the residents. In order to understand who profited it was necessary to analyze a phenomenon that was prevalent in the project—the budgetary flight of project funds. The meaning of this term is that the project’s money and resources were used to finance the ongoing public services in the neighborhood and at times also in the entire local authority. The investigation found that it was the Education Ministry that profited most. The education system financed many of its regular programs and many of the renovations that would have had to be done in schools in any case at the expense of the urban renewal of distress neighborhoods Alterman Churchman 1991. This phenomenon eluded supervision and continued even after it was exposed despite the fact that residents and professionals had called attention to it during most of the years the project was operative. This same non-event – the non-participation of residents’ representatives in the decision making – was what made possible the uninterrupted continuation of the budgetary flight of the project’s funds. 285

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The possibility of exploiting the Urban Renewal Project’s budgets for ongoing operations explains why it was not in the interest of the existing power relations to allow the neighborhood steering committees to make the real decisions in the project. The continuation of this non-event to this very day in more than a few local authorities proves that to date no efficient strategy of coping with this phenomenon has been developed. The question that arises here is: What purposes did the steering committees serve They were a school for residents’ participation they taught negotiation they made the rules of democracy perceptible. In other words they had a ceremonial value and an educational value but they were also arenas of non-decision. D. Developing strategies of coping with the latent dimension of power relations. Mechanisms of power in the third latent dimension of power relations make use of social myths prejudices symbols language communications processes information and social legitimation in order to achieve a strategic advantage. In this dimension of the power relations the indirect blocks take form: mothers convey to their children a message of social inferiority and failure which they have internalized as members of a minority group that is discriminated against Solomon 1976. This is Foucault’s bodiless power: the expectations of powerlessness accumulate into oppressive social structures which accord a legitimation to disempowerment by means of practices and ideology. The strategic lesson learned from the latent dimension is that it is necessary to make use of the power of symbols and the power of language in the shaping of social myths and symbols in the opposite direction as well. The community needs to understand how myths symbols and messages are used against it and to learn how to harness these for its own ends. A community planner has to help the community to shake off stigmas and prejudices that have been attached to people and/or the environment. He can help the community shape an alternative value message of its own and to consolidate it so that it will support the community’s goals and create identification with it and with how it sees its future. The message of COPS is a suitable example: the community organization in San Antonio has a name that is a message. The initials stand for the full name Communities Organized for Public Services but the word cops means policemen. The community is transmitting the message that it has power and is for law and order and that for its members it is an alternative to law and order. The full name symbolizes the organization’s mission and goals the initials transmit a calming message with regard to the organization’s aims towards the outside society it is worth noting the contrast between cops and Black Panthers a name that was chosen in a different period by people in a similar social situation in order to transmit a message of power within but a threat to the society outside. The conclusion to be drawn from the discussion of the dimensions of power is that exposing the covert and latent dimensions of the power relations is an important part of developing the strategy. The victories in the first overt dimension – in the decision making arena – are the realization of the work and the effort in the second and third dimensions. Mechanisms of disempowerment work deeply on the covert and latent levels and only by exposing these and by developing a consciousness of them is it possible to cope successfully in the overt arenas of decision making. The community planner’s role as a developer of strategy begins with the development of a critical awareness of the situation. This stage demands special energies and resources of the community planner. At the same time to avoid creating the impression that we are speaking about an exceptional process it is worth recalling that resistance is an everyday human activity. Resistance has an energy of its 286

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own that can surprise the other side Clegg 1989. As the struggle over the school shows every opposition creates an effect of its own in the power field in which it acts and hence it is impossible to precisely calculate what the strategy’s outcome will be. Some writers believe that the power of each factor is actually less than the abilities it mobilizes when it attempts to achieve a specific outcome ibid.. Community planners may draw encouragement from this and occasionally may also see evidence of the truth of this opinion. For the community and the community planner to be able to submit a joint proposal they need to go through a long and far-from-simple process of creating a community and of preparing patterns of participation organization and political involvement. It is important to note that the transition to the next stage is difficult to achieve not only because it is an advanced stage in the community empowerment process but mainly because many communities stop and even get stuck in the present stage that of resistance. The political problems and the immense energy required for successful opposition cause many of the participants to see this as the principal goal of the community effort. Some believe that the struggle is the principal achievement but there also exist rivalry and personal hatred that were aroused in the course of the struggle and it is difficult to get free of these. The main criticism expressed about conflict as a legitimate professional practice has to do with the fact that it is difficult to control it and difficult to ensure that it will be possible to manage it and resolve it and then go on advancing towards the achievement of the goals. At times the conflict consumes too many energies and takes too high a price. One of the advantages of entering into a systematic planning process is the organizing of the resistance into a structured framework of negotiations. In this way there is better control of contacts and emotions and it is possible to have some more control over the conflict. It is important to recall that resistance is not always a stage in the community’s development. At times it is a desperate struggle for the community’s survival. A group of women in Chicago who objected to a plan to build a stadium that would divide their community Feldman Stall 1994 residents of public housing in St. Louis who resisted a plan to evict them Boyte 1984 students in Israel who resisted the plan to close their school are examples of struggles for actual survival not attempts to obtain an advantage in the power arena. Stage 6: Presenting an Alternative Plan In this stage the central product of the planning – the plan – is presented. I have chosen to call the product of the empowering planning process an alternative plan so as to differentiate it from ordinary plans which are not based on partnership and on local knowledge Friedmann 1992. The alternative plan is a product of the struggles of the previous stage: people have become persuaded that they have to prepare a suitable plan by themselves and have accumulated the ability and confidence to carry out the task. The empowering community planner has a unique opportunity to design a proposal that is based on professional knowledge and is at the same time original and well fitted to the community. This is a singular situation and I want to present its advantages here both as a social solution and as a professional planning method. The agency that employs the planner receives a product which meets its professional standards and is suitable to the place where it is about to be implemented. The community receives a professional product as a consequence of a joint effort with professionals and not out of dependence upon or blind faith in them. In an ordinary comprehensive planning process the presentation of the plan is generally the final stage of the planner’s work. In community planning in general and empowerment-enhancing planning in 287

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particular continuity is very important. Implementing the alternative plan is a process of adjustment to the community. The implementation stage too is a process of mutual learning listening and constructive evaluation of what has been achieved and what needs correction and change. Hence it is very important that the community planner’s work should not cease at this stage. It is worth emphasizing several advantages of a local plan over a conventional plan: Firstly the plan is relatively cheap because it is generally based on local resources and local knowledge. Imported plans are always more expensive because they are not aware of available local resources of knowledge work volunteering and improvisation. Secondly the local problem is human-intensive. It involves more face-to-face interaction among the planners and the implementers. An external plan in contrast will try to replace human interaction with capital and for this reason too it is more expensive. Thirdly the technology of the local plan is familiar locally and generally builds on local technologies even when it is more advanced than they are. The plan is sensitive to local conditions. In contrast external plans are designed to replace local knowledge and local practice with advanced technology and therefore require the adaptation of the place and the people to the plan. Fourthly the management of the local plan is flexible and flat in its structure is generally based on the knowledge that changes may occur during the implementation and emphasizes mutual learning among implementers from the outside and the local people. The management of an external plan is generally bureaucratic and for this reason the plan’s formal aspects are hard to change. The external method emphasizes technocracy: teaching is from above to below and there is almost no mutual learning in the course of the implementation. Fifthly the local plan is built in such a way that it itself can watch over negative by-products easily and quickly while with the external plan it is hard to control undesirable by-products. Sixthly the local plan has an advantage in the speed of transition from planning to implementation while in external projects prolonged preparation is necessary. I remember local community plans where the implementation began a day after the plan was completed. In contrast long months of preparation and adaptations passed in the same community until it became possible to begin implementation of the first plan in the Urban Renewal Project. The six points are based on Friedmann 1992. The setting up of the service for children with disabilities is an alternative project of this kind. Nonetheless it is important to note that no solutions of the type which may be called an ordinary plan exist for children with developmental disabilities. So it is actually the only plan that exists in this domain. The fundamental difference in terms of planning is in the way it is implemented and in the plan’s quality. For those parents of deviant children no other possibility existed other than to initiate a program by themselves because as we will recall the reason for their organizing together was the severe lack of social services for people in their situation. Since the time they set them up the services are available to them. The process of individual and community empowerment undergone by this community in the course of organizing together and setting up the services is a most important accompanying achievement. Necessity then is often the main motivation for developing local programs as distinct from cases where the local plan is preferred in principle over other plans. Actually for the community the division into planning and implementation does not exist. The people continue living their lives and acting in the community. Hence it is desirable that the 288

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implementation processes – which are processes of adapting the plan to the actual conditions – continue in the spirit of the planning stages. Stage 7: Evaluation Evaluating the degree of empowerment produced by the planning process is the stage that completes the empowering planning process. The evaluation establishes the knowledge and experience that have been acquired in the process and distills and prepares them for further use. This is a concluding stage of one process and a starting point for new processes in the community and for new and different planning roles for the planner. Stability is not a characteristic of community processes. In each cycle of community activity there are opportunities for and dangers to empowerment and a particularly successful stage of empowerment may be followed by a regression to a stage of disempowerment. The community organization is one of the means for ensuring relative stability in the empowerment process but it is not a guarantee of such stability. High stability in a community organization may be a sign of institutionalization of procedures which preferably should be kept flexible an indication that the organization has become disempowering. In the evaluation stage several important issues are summed up. The first and at times the only issue dealt with in this stage is the degree of effectiveness and efficiency of the planning and the program. Since this book focuses on empowerment processes we will not devote space to this issue anyone interested in evaluation of outcomes of social programs will find excellent books on the subject e.g. Rossi Freeman 1989. The second issue is the degree of empowerment that the program which is the product of the planning has produced in the course of its implementation and the third issue is the degree of empowerment that was made possible and was encouraged by the empowering professional practice. I will now discuss these two issues. Evaluating the Degree of Empowerment Provided by the Program This is evaluation of the solution – the program – in terms of empowerment. It is an attempt to estimate to what extent the program has enabled the people involved in setting it up to have more actual and perceptible control over their lives and their environment. The principal questions for evaluation are: A. Does the program serve the populations for which it was initially intended If so what services does it provide At times it turns out that the service is not being given to the population which especially needed it but to others. If this is indeed the case and the plan serves other or additional populations it is important to know this and to analyze the causes. This point connects with a known organizational phenomenon: human services tend to prefer certain clients over others and to select those who receive the services according to undeclared criteria Hasenfeld 1984. This happens for example when a marriage counseling service intended for a particular distressed neighborhood and financed from its budget is set up in the center of the city and not in the neighborhood itself. The distant location has actually been designed to ensure secrecy to those who visit the service and to spare them the possible stigma. However an evaluation after some time may reveal that the program is being used by married couples from all over the city and that in fact the majority of those receiving the service were economically established residents while people from the neighborhood itself were making almost no use of the service. B. Has the program encouraged community participation in the environment in which it was implemented Who are the people who participated It should be recalled that the 289

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empowering goal is to reach population groups that have not participated before. What is the level of participation What is the number of volunteer participants relative to the number of salaried workers in the program What are the actual roles being filled by the new participants To what extent are these roles socially valuable in the views of the various participants The aim of these questions is to understand whether the program contents itself with a small nucleus of participants in a particular domain or by means of organizational structure and agendas creates diverse opportunities for involving volunteers in its ranks. It is also important to know what roles the participants fill for as we have said it is important that as many people as possible obtain the opportunity to fill socially valuable roles. There are programs which produce a hierarchy of importance between people in salaried positions who fill important roles and unsalaried volunteers who fill marginal roles. When the program puts people in maintenance roles identical to those they fill in their private lives these people may miss out on an important opportunity in their lives I refer mainly to repairs cleaning cooking which even if they involve responsibility may not involve learning of new skills. C. What influence has the program had on the local environment Has anything changed in the local people’s ability to influence the physical environment since the program was implemented What has changed in the lives of particular groups as a consequence of the program Can one say that a community has been created in the program’s environment What community and whose community is this see further in par. E D. To what extent has the program helped to organize a community This question examines what remains on the organizational level after the planning. Has a group of equals been formed Is there a group of activists who are committed to continuing the program Are people who were active in the plan initiating or participating in new projects following their experience in this one Has a roof-organization been set up following the planning If so what is its character How closed and hierarchical or open and equitable is it E. Has the program contributed to the creation of a community Besides its other achievements a local program in order to be empowering has to contribute to a sense of community. Some questions which can discover signs of such a contribution are for example: Has a new community organization created by a group which was previously not actively involved in the community been set up around the project To what extent does the project contribute to social control to the community’s ability to cope with its principal problems Holahan Wandersman 1987 Has the program contributed a service which the community needs access to It has to be recognized that for the community it is preferable that certain services such as a drug rehabilitation center be not too accessible so not every affirmative answer to the previous question will be relevant. What has the project contributed to social networking To what extent does it provide opportunities for new acquaintanceships and new connections in the community To what extent does the project provide opportunities to create connections with agencies outside the community in a significant new way F. The creation of new and surprising social networks is an indication that the program has contributed to social integration in the community and its surroundings. Hence it is important to ask to what extent the program encourages and enables the integration of the community into its social organizational and political environment without its losing any of its authenticity. G. To what extent does the program encourage a new leadership Who How many In what domains Questions of revitalizing the leadership are directly connected with questions of power. Empowerment is a process which develops leadership among people in the community and the proof of the plan’s success in encouraging individual empowerment may 290

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express itself among other things in the development of new leaders as a consequence of the plan. H. To what extent has the program had a good influence on the image of its users and the community it serves as perceived by others in the environment The reference is to a change in the prejudices and the stigma that exist against the people who need the service. There are different ways of estimating the inputs of the program in this context: 1 To what extent has the program been publicized in the community itself in the town or city among groups of populations which should have an interest in it What kind of publicity has the program received outside the community and what direction has this publicity taken Has it created appreciation of the community and interest in joining it or has it strengthened the stigma and the isolation of the community 2 Have there been expressions of satisfaction with the program By whom Have there been criticisms of the program By whom It is possible to examine the kinds of statements that have appeared in the various communications media about the program and about the community before and after the implementation of the program and to analyze expressions of satisfaction with it and criticisms of it in terms of two aspects: their content and their source. The populations whose response it is important to receive if we want to understand the extent of empowerment fostered by the program are: users of the program people who live in the vicinity of the program it is important that the program also contribute to its neighboring environment in aesthetic values in prevention of noise and pollution people responsible for the program professionals politicians. 3 It is possible to draw upon evaluation methods used by urban planners and to develop a method that will attempt to present the uses and the costs of the program and to evaluate its success from the points of view of various populations e.g. Hill 1968 Lichfield 1975. It is difficult to assume that a single program will have a significant influence on the social image or on stigma and prejudices. Nonetheless every social program generally invests a great deal of effort in this domain and it is important to evaluate its outcomes both as a contribution in the right direction that has had an accumulating influence and as inspiration for subsequent programs in this environment. Hence it is important to try to evaluate the extent of the program’s influence on improvement of the community image. Evaluating the Extent of Community Empowerment Facilitated by the Planning Process Here we engage in evaluating the extent of individual and community empowerment encouraged by the community planner herself. Some questions about the enhancement of the community empowerment process are: To what extent did the planner develop dialogue and praxis in the course of her intervention To what extent did she make possible a process of collaboration and develop tools to ensure participation To what extent did she define her various roles and adapt them to the needs of the community empowerment process To what extent did she assist in setting up a community organization already during the planning stages To what extent did she help in developing an appropriate community strategy To what extent was local knowledge also used in the planning process Did the planners also help in developing an ordered evaluation process for their plan Evaluating the Extent of Individual Empowerment Encouraged by the Planning Process It is important that the planner ask himself a number of questions about the extent of individual empowerment that his intervention has provided. 291

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1. To what extent has the planning intervention assisted in extending the local participants’ knowledge about and responsibility for the environment What tools were used to bring this about What were the outcomes 2. To what extent did the planners cope with negative feelings such as anger and contempt on the part of people in the planning environment and to what extent did they manage to channel these and use them to produce a critical consciousness and a positive energy of inspiring people to act for themselves This question requires the creation of operational categories of critical consciousness and positive energy and this in itself is research of great value. 3. Did the planners manage to encourage mutual help among the groups participating in the planning 4. Did they exploit every opportunity to create socially valuable roles for people in the planning environment and in the planning intervention process 5. Did they develop the roles of the teacher and the guide And as a corollary has the planning process also been a process of learning and of exercising social skills 6. Has the planning process assisted in enabling people to develop a critical consciousness towards their own situation and has the planner himself arrived at new insights with regard to his work his life his own social situation 7. Did the planners accord sufficient importance to the self-respect of the participants in the process Did they contribute to feelings of self-worth among the people they worked with 8. Finally in the light of the outcomes do they think that they have devoted sufficient time and resources to encouraging the empowerment process These three sets of questions – evaluating the extent of empowerment achieved by the plan evaluating the extent of community empowerment in the professional planning intervention and evaluating the extent of individual empowerment encouraged by the community planner – represent the possible achievements of processes that encourage individual community and professional empowerment in the community planning process. 6.5. Conclusion Whereas the introduction to this book dealt with empowerment as a new concept the conclusion will be devoted to the meaning of empowering professional practice. Community planning has been redefined according to the principles of the contextual theory of empowerment that was developed in the first part of the book. Community planning methods have been adapted to processes of individual and community empowerment of the people in the planning arena. We have discussed the abilities and skills required of the professional who is interested in achieving the joint goals of empowerment and planning. Likewise we have proposed a theory of practice that encourages empowerment of others and persists in critical thinking and constant re-evaluation. In contrast to pure theoretical approaches which prefer to focus on theory and leave the practical aspects as recommendations and conclusions for further work this book has proposed the principles of empowerment and the professional activities that encourage them as a single whole. The connection between reflection and action has been preserved in the structure of the book itself. 292

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The situation in the field and the little that is being done to encourage empowerment lead to the almost self-evident conclusion that in order to deal thoroughly with powerlessness what is needed is an empowering social policy that will create a supporting basis for empowering social plans and practice. This requires a fundamental change by policy makers and the management of the public social services because public services that are not aware of their practices and especially of the undesirable by-products of their daily activities are responsible for the chronic powerlessness and the disempowering practices that reinforce it. In contrast to the prevalent view we have learned that the quiescence of powerless people is not evidence of agreement. Injured people are silent because of despair because they are resigned to their hopeless existence. A democratic society with a social contract of mutual human responsibility must refuse to resign itself to the existence of powerlessness among sections of its population. The practical expression of this refusal is the creation of a partnership with the people in whose lives society intervenes. Such a partnership is not a harmonious idyll. It is a stormy reality which begins with a quest for mutual understanding and a common language and the creation of an ongoing dialogue. Its next stage is a common quest for suitable solutions which respect the people who need them. The purpose of the partnership is the creation of a society that has a sense of community and encourages greater control by local people over their lives and environment. The book has outlined several methods of empowering professional practice. In concluding it is important to stress that all these methods have a single common principle—an empowering practice does not seek for easy solutions. The cause of people’s distress is not to be sought in the victims. When the problem we have to deal with encompasses entire populations we have to improve our understanding of an entire social situation. We must not go on contenting ourselves with out-of-context diagnoses of individuals who come to us with their suffering or continue blaming them for their situation. This book wants to encourage professionals to shift from the passivity and the objective professionalism of therapeutic intervention in the lives of people with multiple problems to an active involvement of collaborative work with people who need more control over their lives and environments. The aim is to learn how to improve the situation and the quality of life of all the people living in the planned environment. The book has also dealt extensively with the limits of power. Its aim has been to convey a message of hope to all those people who do not believe in their ability to change their lives and to have an influence on their world. However it also contains an explicit warning against the power intoxication. We are all weak and transient. Anyone who for the sake of the power advantages his role or position affords him dares to dominate the lives of others will have to face the inevitable by-products of his actions. The alternative lies in the understanding that the feeling of being at home in the world is acquired through creativity and action. Devoting effort to creating a community participating in processes of social change partnership in making decisions that affect our fate accord us a sense of ownership of and responsibility for the place we live in. In the course of this process we discover that the right to realize ourselves as active citizens and equal partners is in fact also an amazing grace for it rehabilitates injured souls provides self-respect adds knowledge ability and power. The synergy produced by the addition of self-respect 293

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knowledge ability and power enriches the individuals creates a community strengthens the society and adds most valuable resources to the world: human initiative social responsibility and care for others. 294

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Policymaking: Empowering People. JASH –. Zola I.K. . The Politization of the Self-help Movement. Social Policy –. Additional References on Empowerment and Community Adams R. . Social Work and Empowerment. Third edition. Houndmills: Palgrave Macmillan. Barnes M. Warren L. Eds. . Paths to Empowerment. Bristol: The Policy Press. Bauman Z. . Community: Seeking Safety in an Insecure World. Cambridge: Polity. Bauman Z. . Society Under Siege. Cambridge: Polity. Beresford P. . Towards an Empowering Social Work Practice: Learning from Service Users and Their Movements. In W. Shera L.M. Wells Eds. Empowerment Practice in Social Work: Developing Reacher Conceptual Foundations. Toronto: Canadian Scholar’s Press Inc. Pp. –. Bereseford P. Evans C. . Research Note: Research and Empowerment. British Journal of Social Work –. Breton M. . An Empowerment Perspective. In C.D. Garvin L.M. Gutierrez M.J. Galinsky Eds. Handbook of Social Work with Groups. NY: The Guilford Press –. Brown P. . Empowerment Theory and Social Work Practice. Presentation in Conference on The Professionalization of Social Work Bodo Norway June . Busch N.B. Valentine D. . Empowerment Practice: A Focus on Battered Women. Affilia –. Clark H. Spafford J. . Adapting to the Culture of User Control Social Work Education -. Cocks E. Cockram J. . Empowerment and the Limitations of Formal Human Services and Legislation. In P. Ramcharan G. Roberts G. Grant J. Borland Eds.. Empowerment in Everyday Life: Learning Disability. London: Jessica Kingsley –. Cohen B.J. Austin M. J. . Transforming Human Services Organizations Through Empowerment of Staff. Journal of Community Practice –. Collins D. . Towards a More Challenging “Vision” of Empowerment. Business Research Yearbook –. Couto R.A. . Making Democracy Work Better. Chapel Hill: The University of North Carolina Press. Cox E.O. . Empowerment-oriented Practice Applied to Long-term Care. Journal of Social Work in Long- Term Care –. Cox E.O. Joseph B.H.R. . Social Service Delivery and Empowerment. The Administrator’s Role. In Gutierrez L.M. Parsons R.J. Cox E.O. Empowerment in Social Work Practice: A Sourcebook. Pacific Grove: Brooks/Cole –. Dalton J.H. Elias M.J. Wandersman A. . Community Psychology: Linking Individuals and Communities. Australia Wadsworth Thomson Learning. Davis K. . The Disabled People’s Movement: Putting the Power in Empowerment. In M. Barnes L. Warren Eds. Paths to Empowerment. Bristol: The Policy Press –. Dowson S. . Empowerment Within Services: A Comfortable Delusion. In P. Ramcharan G. Roberts G. Grant J. Borland Eds.. Empowerment in Everyday Life: Learning Disability. London: Jessica Kingsley –East J.F. . An Empowerment Practice Model for Low- income Women. In W. Shera L.M. Wells Eds. Empowerment Practice in Social Work: Developing Reacher Conceptual Foundations. Toronto: Canadian Scholar’s Press Inc. -. Elms M. Smith C. . Moved by the Spirit: Contextualizing Workplace Empowerment in American Spiritual Ideals. The Journal of Applied Behavioral Science –. Fleming J. Ward D. . Research as Empowerment: The Social Action Approach. In W. Shera L.M. Wells Eds.. Empowerment Practice in Social Work: Developing Richer Conceptual Foundations. Toronto: Canadian Scholar’s Press Inc. –. Fung A. Wright E.O. . Deepening Democracy: Institutional Innovations in Empowered Participatory Governance. London: Verso. Gilchrist A. . The Well-connected Community: A Networking Approach to Community Development. Bristol: The Policy Press. Gladwell M. . The Tipping Point: How Little Things Can Make a Big Difference. Boston: Little Brown. Gutierrez L.M. Parsons R.J. Cox E.O. . A Model for Empowerment Practice. –. In Gutierrez L.M. Parsons R.J. Cox E.O Eds. Empowerment in Social Work Practice: A Sourcebook. Pacific Grove: Brooks/ Cole. Hermann P. . Empowerment: Discussion paper submitted to the European Network on Indicators of Social Quality. Amsterdam: European Foundation on Social Quality. Hodges V.G. Empowering Families. In Gutierrez L.M. Parsons R.J. Cox E.O Eds. Empowerment in Social Work Practice: A Sourcebook. Pacific Grove: Brooks/ Cole –. Jonson-Reid M. . Evaluating Empowerment in a 304

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Community-based Child Abuse Prevention Program: Lessons Learned. Journal of Community Practice –. Klein K.J. Ralls R.S. Smith-Major V. Douglas C. . Power and Participation in the Workplace: Implications for Empowerment Theory Research and Practice. In J. Rappaport E. Seidman Eds. Handbook of Community Psychology. NY: Kluwer Academic/Plenum Publishers –. Kretzmann J.P. McKnight J.L. . Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Communiy’s Assets. Chicago: ACTA Publications. Manning S.S. . Building an Empowerment Model of Practice Through the Voices of People with Serious Psychiatric Disability. In W. Shera L.M. Wells Eds. Empowerment Practice in Social Work: Developing Reacher Conceptual Foundations. Toronto: Canadian Scholar’s Press Inc. –. Morris J. . Community Care: Working in Partnership with Service Users. Birmingham: Venture Press. Mullender A. . From the Local to the Global: Groups at the Heart of the Community. In H. Bertcher L.F. Kurtz A. Lamont Eds. Rebuilding Communities: Challenges for Group Work. NY: Haworth Press. –. O’Connor E.S. . Back on the Way to Empowerment: The Example of Ordway Tead and Industrial Democracy. The Journal of Applied Behavioral Science –. Prasad A. . Understanding Workplace Empowerment as Inclusion: A Historical Investigation of the Discourse of Difference in the United States. The Journal of Applied Behavioral Science –. Putnam R.D. . Bowling Alone: The Collapse and Revival of American Community. NY: Simon Schuster. Rose S.M. . Reflections on Empowerment-based Practice. Social Work –. Rubin H.J. Rubin I.S. . Community Organizing and Development. Third edition. NY: Macmillan. Rubin H.J. . Being a Conscience and a Carpenter: Interpretations of the Community-based Development Model. Journal of Community Practice –. Sadan E. Churchman A. Process-focused and Product-focused Community Planning: Two Variations of Empowering Professional Practice. Community Development Journal –. Sandercock L. Towards Cosmopolis. Wiley London. Schwartz D.B. . Who Cares Rediscovering Society. Boulder CO: Westview Press. Sewell G. . What Goes Around Comes Around: Inventing a Mythology of Teamwork and Empowerment. The Journal of Applied Behavioral Science –. Sirianni Carmen Friedland Lewis . Civic Innovation in America: Community Empowerment Public Policy and the Movement for Civic Renewal. Berkeley: University of California Press. Smock K. . Democracy in Action: Community Organizing and Urban Change. NY: Columbia University Press. Speer P.W. Andrew Peterson N. . Psychometric Properties of an Empowerment Scale: Testing Cognitive Emotional and Behavioral Domains. Social Work Research –. Swift C.F. Bond M. A. and Serrano-Garcia I. . Women’s Empowerment. A Review of Community Psychology’s First years. In J. Rappaport E. Seidman Handbook of Community Psychology. NY: Kluwer Academic/ Plenum Publishers –. Taylor Marilyn . Public Policy in the Community. Houndsmills: Palgrave MacMillan Watkins Murphy P. Cunningham J.V. . Organizing for Community Controlled Development: Renewing Civil Society. Thousand Oaks CA: Sage Publications. Zimmerman M. A. . Empowerment Theory: Psychological Organizational and Community Levels of Analysis. In J. Rappaport E. Seidman Handbook of Community Psychology. NY: Kluwer Academic/ Plenum Publishers –. 305

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Annex 1: Screening Screening Tools The most important domains to screen include: 1. Substance abuse 2. Immediate risks for self-harm suicide and violence 3. Pregnancy considerations 4. Immediate risks related to serious intoxication or withdrawal 5. Past and present mental disorders including posttraumatic stress disorder PTSD and other anxiety disorders mood disorders and eating disorders 6. Past and present history of violence and trauma including sexual victimization and interpersonal violence 7. Health screenings including HIV/AIDS hepatitis tuberculosis and STDs 1. Substance Abuse Screening The goal of substance abuse screening is to identify individuals who have or are developing alcohol- or drug-related problems. Routinely women are less likely than men to be identified as having substance abuse problems Buchsbaum et al. 1993 yet they are more likely to exhibit significant health problems after consuming fewer substances in a shorter period of time. Substance abuse screening and assessment tools in general are not as sensitive in identifying women as having substance abuse problems. Screening for substance use disorders is conducted by an interview or by giving a short written questionnaire. While selection of the instrument may be based on various factors including cost and administration time Thornberry et al. 2002 the decision to use an interview versus a self- administered screening tool should also be based upon the comfort level of the counselor or healthcare professional Arborelius and Thakker 1995 Duszynski et al. 1995 Gale et al. 1998 Thornberry et al. 2002. If the healthcare staff communicates discomfort individuals may become wary of disclosing their full use of substances Aquilino 1994 see also Center for Substance Abuse Prevention CSAP 1993. How Much Is Too Much Men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. SOURCE: National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide. NIH Pub No. 05–3769. Bethesda MD: the Institute 2005. A standard drink is defined as one 12-ounce bottle of beer one 5-ounce glass of wine or 1.5 ounces of distilled spirits. 306

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General Alcohol and Drug Screening AUDIT The Alcohol Use Disorder Identification Test AUDIT Babor and Grant 1989 is a widely used screening tool that is reproduced with guidelines and scoring instructions in TIP 26 Substance Abuse Among Older Adults CSAT 1998d. The AUDIT is effective in identifying heavy drinking among nonpregnant women Bradley et al. 1998c. It consists of 10 questions that were highly correlated with hazardous or harmful alcohol consumption. This instrument can be given as a self-administered test or the questions can be read aloud. The AUDIT takes about 2 minutes to administer. The Alcohol Use Disorders Identification Test: Interview Version Read questions as written. Record answers carefully. Begin the AUDIT by saying “Now I am going to ask you some questions about your use of alcoholic beverages during this past year.” Explain what is meant by “alcoholic beverages” by using local examples of beer wine vodka etc. Code answers in terms of “standard drinks”. 1. How often do you have a drink containing alcohol 0 Never Skip to Qs 9-10 1 Monthly or less 2 2 to 4 times a month 3 2 to 3 times a week 4 4 or more times a week 2. How many drinks containing alcohol do you have on a typical day when you are drinking 0 1 or 2 1 3 or 4 2 5 or 6 3 7 8 or 9 4 10 or more 3. How often do you have four women / six men or more drinks on one occasion 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily Skip to Questions 9 and 10 if Total Score for Questions 2 and 3 0 4. How often during the last year have you found that you were not able to stop drinking once you had started 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily 5. How often during the last year have you failed to do what was normally expected from you because of drinking 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily 307

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6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily 7. How often during the last year have you had a feeling of guilt or remorse after drinking 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily 8. How often during the last year have you been unable to remember what happened the night before because you had been drinking 0 Never 1 Less than monthly 2 Monthly 3 Weekly 4 Daily or almost daily 9. Have you or someone else been injured as a result of your drinking 0 No 2 Yes but not in the last year 4 Yes during the last year 10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down 0 No 2 Yes but not in the last year 4 Yes during the last year Record total of specific items here - If total is greater than recommended cut-off consult User’s Manual 308

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The Alcohol Use Disorders Identification Test: Self-Report Version PATIENT: Because alcohol use can affect your health and can interfere with certain medications and treatments it is important that we ask some questions about your use of alcohol. Your answers will remain confidential so please be honest. Place an X in one box that best describes your answer to each question. Questions 0 1 2 3 4 1. How often do you have Never Monthly 2-4 times 2-3 times 4 or + t. a drink containing alcohol or less a month a week a week 2. How many drinks containing 1 or 2 3 or 4 5 or 6 7 to 9 10 or alcohol do you have on a typical more day when you are drinking 3. How often do you have six or Never Less than Monthly Weekly Daily / more drinks on one occasion monthly almost for women: four or more daily 4. How often during the last Never Less than Monthly Weekly Daily / year have you found that you monthly almost were not able to stop drinking daily once you had started 5. How often during the last Never Less than Monthly Weekly Daily / year have you failed to do monthly almost what was normally expected of daily you because of drinking 6. How often during the last year Never Less than Monthly Weekly Daily / have you needed a first drink monthly almost in the morning to get yourself daily going after a heavy drinking session 7. How often during the last year Never Less than Monthly Weekly Daily / have you had a feeling of guilt monthly almost or remorse after drinking daily 8. How often during the last year Never Less than Monthly Weekly Daily/ have you been unable to remember what monthly almost happened the night daily before because of your drinking 9. Have you or someone else No Yes but Yes been injured because of not in the during the your drinking last year last year 10.Has a relative friend doctor or No Yes but Yes other health care worker been not in the during the concerned about your drinking last year last year or suggested you cut down Total Skip to questions 9 and 10 if total for question 1 or total for questions 2+3 0 309

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Risk Level Intervention AUDIT score Zone I Alcohol Education 0-7 Zone II Simple Advice 8-15 Zone III Simple Advice plus Brief Counseling and Continued Monitoring 16-19 Zone IV Referral to Specialist for Diagnostic 20-40 Evaluation and Treatment The AUDIT cut-off score may vary slightly depending on the country’s drinking patterns the alcohol content of standard drinks and the nature of the screening program. Clinical judgment should be exercised in cases where the patient’s score is not consistent with other evidence or if the patient has a prior history of alcohol dependence. It may also be instructive to review the patient’s responses to individual questions dealing with dependence symptoms Questions 4 5 6 and alcohol-related problems Questions 9 10 Provide the next highest level of intervention to patients who score 2 or more on Questions 4 5 and 6 or 4 on Questions 9 or 10. Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use as well as possible alcohol dependence. A cut-off score of 10 will provide greater specificity but at the expense of sensitivity. Since the effects of alcohol vary with average body weight and differences in metabolism establishing the cut off point for all women and men over age 65 one point lower at a score of 7 will increase sensitivity for these population groups. Selection of the cut-off point should be influenced by national and cultural standards and by clinician judgment which also determine recommended maximum consumption allowances. Technically speaking higher scores simply indicate greater likelihood of hazardous and harmful drinking. However such scores may also reflect greater severity of alcohol problems and dependence as well as a greater need for more intensive treatment. The AUDIT questionnaire: choosing a cut-off score. Conigrave KM Hall WD Saunders JB. Source Centre for Drug and Alcohol Studies Royal Prince Alfred Hospital New South Wales Australia. Abstract Three hundred and thirty ambulatory care patients were interviewed using a detailed assessment schedule which included the AUDIT questions. After 2-3 years subjects were reviewed and their experience of alcohol-related medical and social harm assessed by interview and perusal of medical records. AUDIT was a good predictor of both alcohol-related social and medical problems. Cut-off points of 7-8 maximized discrimination in the prediction of trauma and hypertension. Higher cut-offs 12 and 22 provided better discrimination in the prediction of alcohol-related social problems and of liver disease or gastrointestinal bleeding but high specificity was offset by reduced sensitivity. We conclude that the recommended cut-off score of eight is a reasonable approximation to the optimal for a variety of endpoints. 310

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More detailed interpretation of a patient’s total score may be obtained by determining on which questions points were scored. In general a score of 1 or more on Question 2 or Question 3 indicates consumption at a hazardous level. Points scored above 0 on questions 4-6 especially weekly or daily symptoms imply the presence or incipience of alcohol dependence. Points scored on questions 7-10 indicate that alcohol-related harm is already being experienced. The total score consumption level signs of dependence and present harm all should play a role in determining how to manage a patient. The final two questions should also be reviewed to determine whether patients give evidence of a past problem i.e. “yes but not in the past year”. Even in the absence of current hazardous drinking positive responses on these items should be used to discuss the need for vigilance by the patient. In most cases the total AUDIT score will reflect the patient’s level of risk related to alcohol. In general health care settings and in community surveys most patients will score under the cut- offs and may be considered to have low risk of alcohol related problems. A smaller but still significant portion of the population is likely to score above the cut-offs but record most of their points on the first three questions. A much smaller proportion can be expected to score very high with points recorded on the dependence-related questions as well as exhibiting alcohol-related problems. As yet there has been insufficient research to establish precisely a cut-off point to distinguish hazardous and harmful drinkers who would benefit from a brief intervention from alcohol dependent drinkers who should be referred for diagnostic evaluation and more intensive treatment. This is an important question because screening programmes designed to identify cases of alcohol dependence are likely to find a large number of hazardous and harmful drinkers if the cut-off of 8 is used. These patients need to be managed with less intensive interventions. In general the higher the total score on the AUDIT the greater the sensitivity in finding persons with alcohol dependence. Based on experience gained in a study of treatment matching with persons who had a wide range of alcohol problem severity AUDIT scores were compared with diagnostic data reflecting low medium and high degrees of alcohol dependence. It was found that AUDIT scores in the range of 8-15 represented a medium level of alcohol problems whereas scores of 16 and above represented a high level of alcohol problems. On the basis of experience gained from the use of the AUDIT in this and other research it is suggested that the following interpretation be given to AUDIT scores: Scores between 8 and 15 are most appropriate for simple advice focused on the reduction of hazardous drinking. Scores between 16 and 19 suggest brief counseling and continued monitoring. Scores of 20 or above clearly warrant further diagnostic evaluation for alcohol dependence. In the absence of better research these guidelines should be considered tentative subject to clinical judgment that takes into account the patient’s medical condition family history of alcohol problems and perceived honesty in responding to the AUDIT questions. While use of the 10-question AUDIT questionnaire will be sufficient for the vast majority of patients special circumstances may require a clinical screening procedure. For example a patient may be resistant uncooperative or unable to respond to the AUDIT questions. If further confirmation of possible dependence is warranted a physical examination procedure and laboratory tests may be used. 311

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Other Screening tools: TCUDS II The Texas Christian University Drug Screen II TCUDS II is a 15-item self-administered substance abuse screening tool that requires 5–10 minutes to complete. It is based in part on Diagnostic Interview Schedule and refers toDiagnostic and Statistical Manual of Mental Disorders 4 th Edition Text Revision DSM-IV-TR American Psychiatric Association APA 2000a criteria for substance abuse and dependence. TCUDS II is used widely in criminal justice settings. It has good reliability. Knight 2002 Knight et al. 2002. This screen along with related instruments is available at CAGE CAGE Ewing 1984 asks about lifetime alcohol or drug consumption. Each “yes” response receives 1 point and the cutoff point the score that makes the test results positive is either 1 or 2. Two “yes” answers results in a very small false-positive rate and the clinician will be less likely to identify clients as potentially having a substance use disorder when they do not. However the higher cutoff of 2 points decreases the sensitivity of CAGE for women—that is increases the likelihood that some women who are at risk for a substance problem will receive a negative screening score i.e. it increases the false-negative rate. Note: It is recommended that a cutoff score of 1 be employed in screening for women. This measure has also been translated and tested for Hispanic/Latina populations. A common criticism of the CAGE is that it is not gender-sensitive—that is women who have problems associated with alcohol use are less likely than male counterparts to screen positive when this instrument is used. One study of more than 1000 women found that asking simple questions about frequency and quantity of drinking coupled with a question about binge drinking was better than the CAGE in detecting alcohol problems among women Waterson and Murray-Lyon 1988. The CAGE is “relatively insensitive” with Caucasian females yet Bradley and colleagues report that it “has performed adequately in predominantly black populations of women” 1998c p. 170. Johnson and Hughes 2005 conclude that CAGE has similar reliability and concurrent validity among women of different sexual orientations. The CAGE-AID CAGE Adapted to Include Drugs modifies the CAGE questions for use in screening for drugs other than alcohol. This version of the CAGE shows promise in identifying pregnant low-income women at risk for heavier drug use Midanik et al. 1998. Substance Abuse Screening and Assessment Among Women  How screenings and assessments are conducted is as important as the information gathered. Screening and assessment are often the initial contact between a woman and the treatment system. They can either help build a trusting relationship or create a deterrent to engaging in further services. 312

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 Self-administered tools may be more likely to elicit honest answers this is especially true regarding questions related to drug and alcohol use.  Face-to-face screening interviews have not always been successful in detecting alcohol and drug use in women especially if the counselor is uncomfortable with the questions.  Substance abuse screening and assessment tools in general are not as sensitive in identifying women as having substance abuse problems. 2. Screening Instruments for Pregnant Women Considering the devastating impact of substances on the developing foetus routine screening for drug alcohol and tobacco use among pregnant women is imperative. Face-to-face screening interviews are not always successful in detecting alcohol and drug use especially in pregnant women. However self-administered screening tools have been found to be more likely to elicit honest answers Lessler and O’Reilly 1997 Russell et al. 1996 Tourangeau and Smith 1996. Three screening instruments for use with pregnant women are TWEAK T-ACE and 5Ps Plus CSAP 1993 Morse et al. 1997. Women who smoked in the month before pregnancy are nine times more likely to be currently using either drugs or alcohol or both while pregnant Chasnoff et al. 2001. TWEAK TWEAK Russell et al. 1991 identifies pregnant women who are at risk for alcohol use. It consists of five items and uses a 7-point scoring system. Two points are given for positive responses to either of the first two questions tolerance and worry and positive responses to the other three questions score 1 point. A cutoff score of 2 indicates the likelihood of risk drinking. In a study of more than 3000 women at a prenatal clinic the TWEAK was found to be more sensitive than the CAGE and Michigan Alcohol Screening Test MAST and more specific than the T-ACE Russell et al. 1996. The tolerance question scores 2 points for an answer of three or more drinks. However if the criterion for the tolerance question is reduced to two drinks for women the sensitivity of TWEAK increases and the specificity and predictive ability decrease somewhat Chang et al. 1999. In comparison with T-ACE TWEAK had higher sensitivity and slightly lower specificity Russell et al. 1994 1996. It can also be used to screen for harmful drinking in the general population Chan et al. 1993. 313

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T-ACE The T-ACE is a 4-item instrument appropriate for detecting heavy alcohol use in pregnant women Sokol et al. 1989. T-ACE uses the A C and E questions from CAGE and adds one on tolerance for alcohol. The first question assesses tolerance by asking if it takes more than it used to to get high. A response of two or more drinks is scored as 2 points and the remaining questions are assigned 1 point for a “yes” response. Scores range from 0 to 5 points. A total of 2 or more points indicates risk drinking Chang et al. 1999. T-ACE has sensitivity equal to the longer MAST and greater than CAGE Bradley et al. 1998c. It has been validated only for screening pregnant women with risky drinking Russell et al. 1994. In a study with a culturally diverse population of pregnant women Chang and colleagues 1998 compared T-ACE with the MAST short version and the AUDIT. The study found T-ACE to be the most sensitive of the three tools in identifying current alcohol consumption risky drinking or lifetime alcohol diagnoses Chang et al. 1998. Although T-ACE had the lowest specificity of the three tests it is argued that false positives are of less concern than false negatives among pregnant women.. Prenatal substance abuse screen 5Ps This screening approach has been used to identify women who are at risk for substance abuse in prenatal health settings. A “yes” response to any item indicates that the woman should be referred for assessment Morse et al. 1997. Originally four questions regarding present and past use partner with problem and parent history of alcohol or drug problems were used Ewing 1990. However several adaptations have been made and recently a question about tobacco use in the month before the client knew she was pregnant was added Chasnoff 2001. Chasnoff and colleagues 2001 reported that women who smoked in the month before pregnancy were 11 times more likely to be currently using drugs and 9 times more likely to be currently using either drugs or alcohol or both while pregnant. In a study evaluating prevalence of substance use among pregnant women utilizing this screening tool the authors suggest that it not only identified pregnant women with high levels 314

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of alcohol and drug use but also a larger group of women whose pregnancies were at risk from smaller amounts of substance use Chasnoff et al. 2005. For a review on how to improve screening for pregnant women and motivate healthcare professions to screen for risk refer to the Alcohol Use During Pregnancy Project. At-Risk Screening for Drug and Alcohol Use During Pregnancy  In screening women who are pregnant face-to-face screening interviews have not always been successful in detecting alcohol and drug use.  Self-administered tools may be more likely to elicit honest answers this is especially true regarding questions related to drug and alcohol use during pregnancy.  While questions regarding past alcohol and drug use or problems associated with self partner and parents will help to identify pregnant women who need further assessment counselors should not underestimate the importance of inquiring about previous nicotine use in order to identify women who are at risk for substance abuse during pregnancy.  There are other factors that are associated with at-risk substance abuse among women who are pregnant including moderate to severe depression living alone or with young children and living with someone who uses alcohol or drugs for review see Chasnoff et al. 2001. Not all drugs produce physiological withdrawal counselors should not assume that withdrawal from any drug of abuse requires medical intervention. Only in the case of opioids sedative- hypnotics or benzodiazepines and in some cases of alcohol is medical intervention likely