do no harm
A precautionary principle.
harmlessness
The first and most useful principle (for me anyway) came early by way of advice given to us at the beginning of our Social Work course and almost anxiously I thought at the end as we were about to be let loose on the world. “Whatever you do don't make things any worse”.
I use this to screen my reactions especially in complex situations with no-one at hand to consult. This check encourages me not to react too hastily or interfere, but rather just step back, be there and see what arises.
Using the least necessary effort or force minimises the chance of causing damage and leaves more options open and room to move. Less bridges are burnt. More strategic time, energy, intellectual and emotional resources are left uncommitted and still in play.
There are strong temptations for a therapist to justify their wage and prove their expertise by taking control and doing things. This can get in the way. Doing nothing has a long and honourable history in therapy (backed by research) as a comparatively effective form of treatment in many if not most of the kinds of situations psychotherapists find themselves in. If doing nothing works best then do that.
intervene just in case?
In liability driven workplaces this precautionary principle can be difficult to implement particularly when governmentswant the health and welfare agencies they fund to keep them out of the headlines. Nowadays agencies especially in child protection, mental health and indigenous affairs are increasingly pressured to intervene (for instance by taking children from their parents or taking over someone's affairs) just in case a problem develops. This is an inversion of the principle.
In this environment agencies spend a lot of their energy staying on the right side of their paymasters. If they do something that's sanctioned or fashionable they are not going to lose points if anything goes wrong. They did their best and followed best practice.
This displaces personal responsibility and clinical decision-making onto legislation or protocols and avoids legal liability to ourselves and our agency. We look as if we are doing something.
Rather than being there for clients we end up being there to protect and promote ourselves and our agencies. Extensions of the agencies that fund us rather than healers. We are in effect managing risks to ourselves like loss of face or loss of funding.
By avoiding powers of discretion and responsibility, power is centralised rather than devolved to individuals and families where it is needed.
Lack of power and self esteem is the root of most of the problems we are asked to solve. If we merely administer laws and regulations and let formulas and protocols make decisions we are not empowered ourselves. We are not demonstrating decision-making and empowerment. Not encouraging or mobilising.
When the top priority is control of risk to self, others or property, we almost always end up trying to control our clients. And we incidentally dis-empower them.
Punishments or imposed solutions, forced treatment and removal adds to the already overwhelming burden of loss and trauma of children, indigenous peoples and those diagnosed with a mental illness. Official violence in any of its forms like threatening loss of family, freedom or possessions parades fear, weakness and incompetence. It demonstrates violence and spreads violence through the community.
Incidents are controlled in the short term but the society and the social contract are damaged over the long term as these messages pass down the generations. Extreme risk aversion in individual situations increases long term overall risks. The gains are immediate and fleeting, the damage is long term. Not surprisingly many indicators of well-being deteriorate as more workers are put into the field.
We encourage compliance rather than initiative when we tell clients how to live their lives instead of listening and helping them discover ways to live the lives they want. We become part of the problem, rather than part of the solution and inevitably make things worse. Living their lives for them instead of providing a hand up to enable them to learn to live their own lives. This is similar to handing out food instead of enabling self sufficiency.
Struggling against clients instead of listening makes life difficult for everyone. Many (maybe most) new recruits put onto the front lines in this way burn out within a few years. If we damage our clients we are damaging ourselves. Workers who are put on rails and micromanaged don't get the chance to enjoy helping others improve their lives and develop their instinctive skills especially if they are made to parrot the instructions and interpretations of absent out of touch managers. These dysfunctions are obvious to clients and outsiders but invisible to inhabitants of an organisation who have absorbed its culture.
making things worse
The interests of clients do not always line up with those of welfare agencies, funding authorities or the wider community. Under pressure to punish or change people or make money out of them, the espoused aims of agencies and legislators to increase well-being may not be an operational priority. Self preservation is often the core aim.
Many health and welfare industries seek ever more money from governments and donors to cope with problems that expand because of the damage they are doing. Following advice and spending money is about the limit of the power of first world governments. It does not necessarily get anywhere.
If something makes things worse, doing even more of the same might not work. Doubling the medication or reiterating therapeutic rituals over and over may dig the hole deeper.
Just ask the question. Is this working? Where is it taking us?
copyright (C) John Brasted 2008
updated 06/11/11
