THE EMPOWERING RELATIONSHIP

by Sally Clay

There are two ways to relate with someone who is struggling with mental illness. The first way is to regard the person as "sick," as someone whose brain is broken and must be repaired. The second way is to regard the person as unhappy, a human being with inherent dignity experiencing human distress.

The Way of Illness

All too often, in a clinical setting, the "fixit" approach is the one that prevails. Called the "medical model," this approach relies on drugs, behavior modification, and other external means to treat the diagnosed "illness." The goal is the control of symptoms, and success is judged not so much by the satisfaction of the client as by the absence of behavior that is deemed to be "sick." The medical model approach is characterized by judgements and treatments made or implemented for clients by other people.

Our mind is who we are. When we talk about chemical imbalances, what we are really saying is that something is inherently defective in the character or personality of another person. The person is "wrong," and somehow we are "right." We know how to help - whether the person wants our help or not. With the view that mental illness is error and sickness, it is natural to do everything you can to "fix" what is wrong. Unfortunately, this does not always work. Medications will take away delusions, behavior modification will reduce aggression, and restraints will prevent suicide. But the person's pain and confusion are only reflected in these outward "symptoms," and when the symptoms are under control, problems remain. In fact, the kind of treatment that addresses only symptoms often creates problems of its own.

Most mental health consumers complain about the treatment they have received in hospitals or outpatient settings. They complain that they are treated as a non-person; they say that no one listens to them. They deeply resent the locks and restraints and involuntary treatment. Many come away from such treatment with shattered self-esteem and a pervading hopelessness. For many, it is often true that "the treatment was worse than the disease."

The Way of Empowerment

The second way to help someone in mental distress is the way of empowerment. Fundamentally, the medical model is not about relationship at all -- it is about doing something to somebody else. The empowerment model, however, is all about relationship. It is about doing something with somebody else. Whether you are a mental health professional or a family member or a peer advocate, developing an empowering relationship is the first step toward helping someone
recover from mental illness.

As we have seen, the medical model approach is a "half-empty" view of a water glass -- something is defective or missing. The empowerment approach, on the other hand, is the "half-full" view. It does not try to "fix" something that is missing or wrong. Instead, it values the clear water that is already in the glass. An empowering relationship enables a person to work with tools that they already possess and to value who they already are.

These are some of the ways that a mental health worker can establish an empowering relationship with a client:

Cultivate acceptance -- From the start regard your client with unconditional respect, and treat him or her with courtesy. Accept the other person as she is. This means that you do not have a hidden agenda to change her. You do not have to like unpleasant behavior or symptoms -- but your eye is on the person, not the symptoms.

Make friends -- Eastern cultures have a word, maitri, that means both loving kindness and friendliness. Make the happiness of the client your goal. Chances are that, with this attitude, you can establish a friendship with him. The friendship may not extend beyond the clinical setting, but it can nonetheless be rewarding to both you and your client, and a factor for recovery.

Listen, don't talk -- Encourage your client to talk and express opinions. It is less important to give her advice than to hear what she has to say. Here also it is important to be accepting, and not judging. If you listen to what your client says with an open mind, sooner or later you will learn what she values. These values can be the basis for rehabilitation.

Identify skills and interests -- Ask your client what he likes to do and what interests him. With this knowledge, you can encourage him to become involved in activities that really mean something to him and that can be carried over into life in the community. These activities then become tools for long-term recovery.

Express appreciation -- Raising hope is essential to overcoming mental illness. Your attitude of enthusiasm and appreciation can lift the spirits of other people. Be sure to compliment your client when she succeeds at a task or takes a step toward independence and self-respect.

Be a mentor or role model -- When a client learns to trust you, he may come to consider you as his mentor or special helper. Peer advocates in particular often become role models for other peers. You have been given the opportunity to have a positive impact in a person's life, and this is a precious obligation.

Advocate for choice -- Empowerment depends on learning self-sufficiency and independence. Although we value the friendship that we establish with our client, and although we encourage her to find role models, we must be careful also to respect her human and civil rights, and especially the importance of making her own decisions. You can actively work as an advocate for your client,
helping her avoid situations in which treatment is forced or her life is controlled by others.

Appeal to better nature -- We all have a better nature. Recovery from mental illness depends upon acknowledging personal values and respecting the values of others. Most people are genuinely pleased when they can do something to help another person, or when they feel they have done the "right" thing. It is essential to recognize this better nature in your client and encourage her to act upon it by
helping others or doing some kind of compassionate work.

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An empowering relationship between a mental health worker and her client depends on mutual respect and acceptance. A mental health worker has to give up on the idea that she or he can "heal" or change another person. She learns to work with a client just as he is, right now. Remarkably, though, it turns out that unconditional acceptance is the one quality that actually inspires positive growth and change in a client - change and growth that are freely chosen.

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