3. My Stance
This has been a difficult section to write. I have tried several times to write it without success. It has been a struggle since August 2018. I tried again in October, hopelessly. I tried twice more, once in December and again on January 15, 2019, in vain. Yesterday, I re-read my notes from my reading and courses I have taken over the past several years, and I realize that I have been making a blunder, which explains this struggle. I have been sitting here trying to explain the medical profession approach to collaboration so I could say what is wrong with it and what is right about my approach. I have been trying to articulate the approach that has been accepted within various mental health facilities and out patient programs, also to explain how they cannot be ‘truly’ supportive of the patient.
I have been taking a ‘they are wrong’ approach to this portion of the paper. Who am I to explain that to the people who use these theories and practices? Am I an arbiter of these models (whatever they are)? Who am I to tell my colleagues that their approach is wrong (even if these approaches are not their approaches)? Why have I placed myself in opposition to my colleagues? Am I really in opposition? What does it mean to be in opposition? Of course, if I believe that ‘they’ (my colleagues) are wrong, does that mean I am right? What have I been doing? This does not support how I want to be with my colleagues. Also, my colleagues are NOT wrong, they have their perspectives – and these are not necessarily in opposition to what I would like to see or the way I want to practice. This is about my practice, and interactions with them based on my approach – so articulating that approach is the purpose of this section – not what I was trying to do before.
Hyde and Bineham (2000) state that the biggest barrier to dialogue is the human impulse to defend one’s identity from a perceived threat. When dialogue breaks down, it is likely due to someone holding to the rightness of some position. These authors discuss ‘being committed’ to authentic inquiry and how this creates space to engage in others’ points of view. If I want to be the change I wish to see in the world – then perhaps this is the approach I need to take in with my colleagues. My stance, therefore, will not be what I do not like or appreciate about other’s way of doing things – but what I like, appreciate and strive for in my own approach. (Hyde & Bineham, 2000)
McNamee (2008) discusses the concept of ‘right’ and ‘wrong’ from a postmodern perspective – by simply wondering whose standards we are using to determine right and wrong. Of course, my response would be ‘my standards’ because I am looking at collaboration from a relational stance. However, if we look at her next point regarding ‘self-reflexive and relationally reflexive inquiry’ (p. 11) it points us in the direction to entertain doubt about our own uncertainties and certainties. We can invoke our inner voice of skepticism about our own strongly held beliefs. (McNamee, 2008)
So, now I will move away from the surety that I am right to ‘this is what I think’ and how I invite and welcome discourse with my colleagues. I will start by describing the ‘three C’s’ that I first encountered while reading Harlene Anderson’s work: connect, collaborate, and construct. Although she discusses these in relation to a supervisor/supervisee relationships, I believe that it is just as applicable to collegial relationships within multidisciplinary teams and therefore, relevant to the position I will describe for myself. She talks about respecting, inviting and valuing each voice as a means of connecting. Collaboration comes about from learning from other’s positions and ideas, then the plans (for whatever situation we are dealing with) are constructed (or co-constructed) from these conversations. (Anderson H. , 2000)
One description of how to practice these ‘three C’s’ comes from McNamee (2009) as she describes dialogue as a responsive activity.
In dialogue, we are steeped in uncertainty, incompleteness, and multiplicity. This may appear to be a very uncomfortable space to occupy. … Privileging uncertainty, incompleteness, and multiplicity highlights how very different dialogue is from our common understandings of communication. Dialogue is not about successfully transmitting our meaning, knowledge, or information to another. It is not about persuasion or self-promotion. On the contrary, dialogue is a process of holding firmly to one’s position while maintaining a curiosity and respect for another’s very different position. This is what Bahtkin refers to as responsivity. McNamee, 2008, p. 9
Maintaining a dialogue with colleagues is an important thing for me to undertake when we move from certainty to uncertainty and multiplicity. Does it matter to me how my colleagues manage this? Perhaps I need to manage it for myself and stay in a reflexive position and to find my own comfort in accepting a multiplicity of ideas and perspectives as the team tries to determine the best course of action in any given situation. How does my comfort impact on others in the room during the sometimes heated discussions around who’s idea we will follow? Can I assist as we come up with workable plans from this uncertainty? This is one of my challenges.
It is apparent that dialogue is an important part of collaboration and anti-oppressive practice. Paulo Freire (1996) one of the first authors to influence me in this area discusses dialogue: “It is not our role to speak to the people about our own view of the world, nor to attempt to impose that view on them, but rather to dialogue with the people about their view and ours.” (p. 77) In another part of his book, he talks about our existence as not being nurtured by falsehoods but only by true words. Naming the world is to change the world. If this naming later reappears as a problem, then it requires new naming. “Human beings are not built in silence, but in word, in work, in action-reflection.” (p. 69) This is the struggle people who are marginalized face. I must keep in mind this process not only threatens those who perpetrate this disenfranchisement but could further disenfranchise those who were initially isolated and abused. I need to not be guilty of that which I stand against. (Freire, 1996)
Gergen and Gergen (2004) mentions Paulo Freire’s work. These authors bring an important caution to his work, to look beyond biases informed by class, gender and race and to include those biases created by religion, and sexual preference. It is important to look at created biases from as many aspects as might exist in a conversation. Looking at this in my workplace, I see that education level, job description (nurse, social worker, psychiatrist etc.), role on the team, (Team Leader, Clinical Manager) all contribute in different ways to the kinds of oppressions discussed by Freire. We do not want to replace one oppressor for another. In order to refrain from doing this, the Gergens suggest supplementing critique with explorations of the positive. “It is when we also acknowledge what is positive in another’s tradition that mutual exploration is likely to yield new forms of life.” (Gergen & Gergen, 2004, p. 62)
I still worry however, that the idea of oppression is not given a strong enough voice when discussing collaboration from a relational perspective. Those who are sitting at the table all come with their own experiences and life stories. Some might be aware of their oppressions and others might not be. Some might know that they have benefited from their privileged position. Others do not think they come from privilege or that ‘it does not matter’. Also, the white male in the room might feel he can contribute nothing because of his privileged position – and frankly, that is not always the case. I believe that we need to know and recognize our privilege and power positions. A manager who says ‘I just want to be a member of the group’ is not really considering her position in relation to the group but to deny it and expect other people to deny it as well. However, an acknowledgement of her position (power relationship) and that she will do her best not to let that interfere with her participation in the group might be a beneficial approach. I believe for those in a position of power (or privilege) it is important to remember:
There are, however, forms of power which have nothing to do with the domination of others. The first is “power within”. This refers to one’s own centeredness, one’s grounding in one’s own beliefs, wisdom, knowledge, skills, culture, and community. The second is “power with”, or power exercised cooperatively among equals. The third is “authority”, that is, the wisdom, creativity, or expression of the group’s energy which is recognized and agreed to by others as right at a certain time. Bishop, 1994, p. 30
Some organizations struggle with the presence of many ‘isms’ embedded in the organization itself. I believe this is where my struggles were coming from when I first attempted this section. I knew it was there – I was trying to fight ‘isms’ without even being able to articulate it. In our hospital we struggle with including the patient and hearing their voice when discussing plans for their recovery. We (the treatment team, or management) believe that everyone should participate in creating treatment plans. At times everyone looks around and says – look we include the patient well here, we do this and this and… to include (insert patient/family/staff) but are we really? Is it a fait accompli or does more need to be done? Again, I bring in some of Anne Bishop’s (2005) thoughts on this matter. She says that the work of anti-oppression is like being in recovery from an addiction. The work is never ‘finished’. We cannot sit back and say: ‘we are no longer oppressive’. She suggests that organizations are ‘always recovering’. If there is foundational injustice and inequality, one individual cannot become ‘non-oppressive’. The same is true for organizations. Individually and institutionally we must all continue to work on our recovery. (Bishop, 2005)
Mullaly (2008) discusses how reflexive knowledge of our location within the social order, of both domination and oppression, impacts on how we exercise power in our lives to either reproduce or resist social features that limit others’ agency. He continues:
I can claim however that I am anti-racist, which means that I am committed not only to fight external forms of racism but also to struggle, through critical self reflection, against the racism that I have internalized. Mullaly, 2002, p. 208
So, as I continue in my position as a social worker who wants to work in an anti-oppressive collaborative way, I need to be reflexive of my own power relationships and to also reflect on how I apply the ‘three c’s’ of connect, collaborate and construct while keeping in mind the challenge that I have noted for myself: staying with the uncertainty that this may create.
I have looked at various forms that this reflection might take, and it seems that an autoenthnographic approach would be the most appropriate. I will be looking at that in the next section and describe the process I will apply.