Sharing Power

“Power is present in all interpersonal relationships; there is no interaction in which power is not relevant in healthcare” (Nimmon & Stenfors-Hays, 2016). We share power in order to build authentic partnerships.

On Knowing Where Power Lies

Authentic partnerships involve people working cooperatively with joint power. Power differentials undermine partnerships, so it’s critical to be able to identify, name, and interrupt power differences – visible and invisible.

VISIBLE power is explicit, observable, and/or written rules, regulations, and processes that reinforce unshared and unequal power in favor of the provider and/or behavioral health system. Visible power “shows up” in the:

1. Meeting location and time: most in-person meetings involve individuals and families meeting you at your practice location instead of where they want to meet; additionally, families may need to adjust work schedules and coordinate support for other family members
   • NAME IT: “I realize meeting at my office location in the 9am-5pm timeframe may not be convenient or constructive for you. Where and when would you prefer to meet?”

2. Paperwork: forms that we request individuals and families to complete can include questions they’re unable to or feel uncomfortable answering; additionally, forms may be unavailable in families’ native language
   • NAME IT: “I want to acknowledge our current system here asks families to fill out several intake forms. Lots of questions. How is that process going for you?”

3. Intake process: this is the first opportunity for an individual who is seeking behavioral health support to decide whether the relationship with you is a right fit; your attitude while learning about the person’s and/or family’s experiences can influence the outcome
   • NAME IT: “In our first meeting, you are deciding if this partnership feels right for you. If you decide I am not the right fit, I can be available to connect you with providers and options.”

4. Session notes: the notes you take in session are often recorded in a fashion that they are not visible to the individual and family accessing support; explaining to individuals and families why you take notes and making them visible can minimize feelings of insecurity or suspicion
   • NAME IT: “You may notice when we meet that I will record our words and planning. These notes will be visible to you throughout our meeting and available for your review after meetings.”

INVISIBLE Power is the implicit, unacknowledged, and/or undiscussed rules, regulations, and processes that reinforce unshared and unequal power in favor of the provider and/or behavioral health system. Invisible power “shows up” in:

1. Staff diversity: individuals and families may find it helpful or necessary to have the support of a provider who shares a particular identity, experience, or practice; lacking diversity on a behavioral health team reduces how well those families are supported
   • NAME IT: “I want to acknowledge our current team is not staffed with someone who is trained in the traditional practice you’ve expressed is important to you. How does that feel, and would you like to explore area providers who are trained?”

2. Authorized responsibilities: licensed providers hold legal responsibilities to report concerns about the health and safety of individuals with whom they work; individuals and families are not always informed or aware of these procedures
   • NAME IT: “I like to inform all the families I work with about my responsibility to share safety concerns with the Department of Children and Families. We will work with you to self-report. Do you have any questions about this?”

Practice Pause: On Naming The Power

Whether power is visible or invisible, naming the power where it lies informs and encourages autonomy for us, individuals, and their families. When we don’t name the power, we make inaccurate assumptions that can interrupt access to behavioral health support.

On Sharing Power

Maurer et al. (2019) studied how power is shared and shapes relationships across behavioral health settings. They identified three role categories: recipients, consumers, and partners. While you review the definitions of these role categories, consider how the individuals you work with and their families are in the role of:

1. Recipients: hold little/no power and receive support from you with no/little consultation
2. Consumers: hold little/no power and may be consulted about support in this “marketplace” model
3. Partners: hold equal power to you and are authentically involved in decision-making

Practice Pause: Exploring Power Differentials

Your 1-2-3 Summary:

1. Support families by naming and encouraging them to employ their strengths and skills.
2. Show you CARE by Confronting, Acknowledging, and Revisiting difficult topics and Embracing the silence in your interactions.
3. Authentic partners name and share the power.