My work in homeless hostels has brought me into contact with a very interesting guy whom I shall refer to as Eddie. My contact with Eddie has led me to reflect on the therapeutic role which institutions play in today's welfare state...
Eddie is suffering from some very deep emotional, psychological and social wounds. In order to attend to these wounds "the system" has devised a therapeutic process for Eddie which involves a myriad of professional-client relationships. He's got a couple of drugs workers, a hostel key worker, a probation officer, social worker, housing adviser, lawyer, GP plus other doctors, including specialists, and nurses. All of these are very likely good people doing their best to help Eddie deal with his various issues.
And very likely they will help. They will ease his way through the criminal justice system; they will help him with his housing needs and his benefits needs; his physical health will be attended to; even his drug problem will be addressed. Over a period of time Eddie will no doubt make some progress and will develop new skills to help him cope with what life has thrown, and will throw, at him.
It is important to note that, typically, these professionals (and I was one) are not naive. They have a good sense of what their limitations are and they will try and empower Eddie, in so far as they are able, to take responsibility for himself so that ultimately he can survive without professional help.
But they can only take him so far. The limitations of the professional-client relationship (or we could call it the "institutional relationship") constitute an impermeable boundary, beyond which Eddie can not be accompanied. Unfortunately it is outside this boundary that nearly all of "functioning" society find their most important coping mechanisms. For outside this boundary are relationships of friendship and community, relationships that are most people's primary resource in times of crisis.
Eddie, a man whose life is in almost perpetual crisis, has very few such resources. His primary friendships are with fellow drug users; friendships that, for obvious reasons, provide him only a very limited solace. He is also without close family.
More than any professional, Eddie needs a friend. He needs a community, by which I mean some kind of family-structure. He needs structures of human-ness to help him cope when he feels wobbly. Why do I say this? Simply because I know that these are the structures in my own life on which I lean most heavily.
And not only when I am feeling wobbly. Friends and communities also provide a purpose and a meaning which can get me through the day when nothing else seems worth doing. By their nature, friendships are permeable - there is a two way stream along which gifts of time, thought, care and love flow. It is their two way nature that distinguish them so entirely from professional relationships. Eddie needs the opportunity to give to someone else. For what other opportunity can provide such a feeling of self worth as the opportunity to help someone in need?
Institutions in which professional boundaries are inviolable will never provide this most vital human privilege. Eddie will need to look elsewhere and, if he is lucky, he will find friendship and community for himself. If he is unlucky - and Eddie has had a lot of bad luck - he will fail in this search. And this failure may well undermine all of the tender ministrations of those concerned professionals. For, when the shit hits the fan and with no friends to turn to, will Eddie phone his social worker or his dealer?
ADDENDUM: I’ve considered here the effect of the institutional relationship on the client. But what about the professional? The limitations and particular dynamics of the institutional relationship also greatly affect the professional. The primary factor seems to be that the professional is seen to have power over the client and, to quote a phrase, power corrupts!
In an institutional relationship it is too easy for the client to become object, while the professional is subject. While the aim is (or should be) always to empower the client to function autonomously, in reality this is frequently not the case. Rather, the professional has control over the client in a way that can be fundamentally destructive for both parties. Too often I hear stories of people working in the social sector who have come under investigation because the relationships that they have established with clients are abusive or manipulative. The professionals in question are not necessarily abusive by nature; rather, the dynamics of an unequal relationship seem to prove too much for them. The corrupting influence of power is often an irresistible force.
The irony in all this is that the professional boundary, which is the cause of the limitations discussed above, is also intended to be the structure which prevents abuse. With a dissolution of the professional boundaries real concerns over possible abuse immediately arise. While these concerns are of course valid, my contention is that friendships, by their (more) horizontal nature, are inherently more robust than institutional relationships when it comes to matters of abuse. And it is friendship which ultimately offers a far greater therapeutic reward for both of the people involved.