Therapy is power whether it is delivered in a hospital or in a group home.

In response to my previous blog, Barbara made the comment that she didn't quite understand the comment that "Therapy is power whether it is delivered in a hospital or in a group home."  Let me expand a bit on this.

When people are in need, those who provide services have power over them. They have power in defining them according to their need, in the provision or withholding of services, and determining whether someone is or is not in need of services. This is particularly true in the lives of persons with intellectual disabilities, however, it also applies more broadly.

People with intellectual disabilities are placed in group homes, for example, and research shows that this placement has the effect of largely placing them out of community consciousness. In the rare case they enjoy the presence of advocates, or just people who care, and their lives are radically changed. Otherwise, they experience a life managed by people who are working in this area as a profession. Now I honestly hope that people who run group homes are in that business because they care for their clients, but I am just not that naive. There is money to be made in disability programs. But putting that aside, people managers will manage people in ways that make the management easier for themselves. To offer people enriched lives costs time and money. It takes effort. It implies that I will have to go out of my way to do things for my clients which are not required by the agencies that monitor the services that I provide. As a result, too many group homes shoot for minimal standards because that is all that is required for them to stay in business. Can you see how the end result is that people lives are subjected to the power of those who manage them? Now power doesn't necessarily imply evil, or a bad use of power, however, there is power nonetheless. A goal of therapy (whether it be counseling, or hospital care, or managing a group home) should be to empower people which implies messiness in the delivering of services because the managed will express their freedom. They will not want the regimented life that is easier for those who are managers. In a group; home setting, they will go to bed at different times, want a shower at at a different time, want to take a walk, want to do a variety of things that require more staff or greater costs. The result, then, is that freedom is restricted because it is administratively convenient to do so. But there are also limitations based upon those who fund therapy. Those providing therapy have power over the lives of people because of the way they choose to spend the money they are given to provide services.  

I believe I have stated in this blog how a local school district provides "state of the art" services to children with autism, only if there is the likelihood that the parents will get a lawyer and go to fair hearing. So those providing therapy will limit best educational practices for children with autism on the basis of trying to save money. This once again is power and without an advocate, you get less services.

I could provide more examples positively and negatively. I mean I have power over people with intellectual disabilities simply in the ability I have to enrich their lives by the things that I do. If I show up once a month with a box of candy bars, I have the ability to insist on certain behaviors in the people in order to get a candy bar. I have resources that I have the ability to offer to the people that they have no concept of. The way that I wield those resources gives me power over the people. So the point is not to vilify or praise the fact of power, but just to describe it so that those who are in the position of power understand what they bring to a situation in terms of impacting the lives of others.

McNair