One of the primary values of Social Work is self-determination. We provide clients with information, resources and pathways, but the final choices are theirs. We are, we proudly say, about empowerment, not paternalism.
As an American, I whole-heartedly agree with this policy. After all, I am an independent adult and therefore expect the full right to make my own choices the way I think is best. In fact, I react viscerally to the idea of anyone making decisions about my life for me. As a result, it only seems fair that I would give my clients the same rights and respect I desire. And yet, the more I think about it, the more self-determination seems far from a simple concept. After all, as adult human beings, do we really always know and choose what is best for us? Without the strong intervention of loved ones, there are times I would have plunged down some very problematic paths. This question becomes even more complicated, however, when placed in the picture of the addictions and mental illnesses with which many of our clients suffer, forces often directly opposed to wise decision-making.
Today was the first day of my internship. I shadowed a mobile therapist for a mental health agency that works with people who have been homeless, but now live in apartments partially paid for by the government. Many of these people have drug and alcohol addictions, mental illnesses, or both. The first man we went to see was drinking, although it was only 10:00 in the morning. His whole apartment reeked of alcohol. He was watching tv, and made comments about spending most of his time in front of the tube. Nonetheless, he complained vociferously against his landlord for not cleaning up the black mold in his kitchen, for giving him a terrible fridge in desperate need of defrosting, for the bad condition of the wooden steps leading down to his front door, and the list went on. Some of these things were certainly problems on the landlord's end. Others seemed fixable with a little bit of concentrated effort on his part. Reasonable or not, right or not, I confess to a desire to shake the man. This was probably partly due to the fact that I am currently in school full-time, working part-time and doing a two-day internship, so time to sit and watch a favorite tv show is at a premium for me. The good news is, no shaking occurred. Instead I listened politely, nodding and agreeing when necessary and eventually followed the mobile therapist out the door. She explained to me that this man had not yet recognized that his alcohol addiction was a problem. He was in the first of four stages through which they hoped to guide their clients, something along the lines of approach, persuasion, gaining health and preventing relapse.
With a little bit of time to calm down, I was able to see that shaking the man would not have been a good idea. It makes sense that building a trust relationship is an essential first step, before anything else. The therapist could not simply say, "make different choices," and expect the problems to disappear: addictions do not work that way. Until the man recognizes the destruction caused in his own life by his own alcoholism, the therapist's hands are tied, except for in helping him with practical things essential to physical survival. Throughout the day I met other people much further along in the process, many of whom were, frankly, delightful. I came away admitting to myself that self-determination is not as simple as it initially seemed, but newly committed to trying to practice it. People do need to be respected, and need as much of a voice as possible in their own choices.
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