One area of therapy that tends to cause me a great deal of emotional struggle
is that of empowering clients. I believe we often confuse our actions as empowering
when in reality, we are enabling them.
Ethics - Fixing
There is a distinct difference between empowering
and enabling. In practice, empowering is the process of assisting
the client to solve their own problem or issue through self action. The therapist
provides an avenue or process that helps the client improve their life situation
through full self participation. Enabling is better described as the therapist
improving the situation by appearing to fix the problem without true
involvement of the client. Effective empowerment relies a great deal on appropriate
and accurate assessment of the entire problem or issue. Enabling often results
due to an inaccurate assessment which leads to the temporary fixing
of a problem that was identified inappropriately. Often times, social workers
fix problems the client never identified.
The following situations
are common to mental health professionals. Read each scenario and think about
your response as if you were the therapist.
Washing Machine: Enable or Empower?
A group of professionals have gathered
at a case conference for a young boy who is receiving multiple services in a community.
Participants in the meetings include: several special education staff persons,
a mental health therapist, a mental health case manager, an elementary principal,
two school psychologists, a social and rehabilitation social worker, and a school
social worker. The mother and step-father were invited but were not present at
the meeting. The young boy was also absent from the meeting. The meeting was to
focus on transitioning the young boy from a special needs school into a regular
Indentifying problems and issues. The meeting progressed
quickly. Many of the participants began identifying problems and issues.
Parent participation, medication, attendance, and hygiene were the major identified
areas. The one issue that seemed to be a focus for several of the participants
was the young boys hygiene. It seems he had come to school without bathing
and his clothes were quite dirty. Someone noted that he wore the same clothes
several days in a row. Another added that the boy had told her, they were washing
clothing in the bathtub. Before too long, the plan began to include buying a washing
machine for the family. After discussion, someone directed a question to the social
and rehabilitation social worker. The question went something like this, Cant
SRS try to find a way to purchase a washing machine for them? The workers
response was one filled with frustration. She pointed out that the family had
already received assistance in paying the deposit for a house rental, monthly
rent, had received financial aid in paying back energy bills, and finally that
she didnt think the washing machine was an option. She also pointed out
that there was a laundromat a few miles away and that a relative had offered the
family access to their washing machine. Some in the group heard the workers
response but others continued to argue the importance of a washing machine. If
its right there, theyll be more likely to use it, was a comment
overheard several times in the discussion.
With continued disagreement,
the meeting ended with no commitment to pursue the washing machine. Several left
the meeting upset and believing the family was not receiving adequate service.
Set by Values: In this first scenario, it was believed the washer would somehow
change the boy and his familys perspective on cleanliness. The reality is
that the family did not value clean clothes or maintaining clean bodies. Plus,
the familys absence from the meeting truly stated the amount of investment
the family had in the interventions. Their absence should have halted any decisions
on intervention. Many services and interventions were provided, but it appears
there is little to no investment from the family.
A second scenario describes another meeting
in progress. Present at this meeting was a middle school principal, two middle
school teachers, a school nurse, a school social worker, and a school psychologist.
The issue at hand was the habitual tardiness and truancy of a 14-year-old female.
Historically, the team had sent a social worker to the girls home to bring
her to school. Some days, this process would occupy two to three hours of the
social workers day. Attendance during the past three semesters had not improved.
This particular meeting had been scheduled to discuss attendance and the current
intervention plan. In this meeting, the social worker stated she didnt feel
she should continue going to the students home and bringing her to school
as the intervention was not effective. The group was not in favor of addressing
the truancy issue through the legal system and verbalized that the social worker
needed to continue picking up the student if her attendance was dependant upon
this service. The social worker left the meeting with no new plan of intervention.
Boundary of Responsibility: In this second example, the team failed
to accept that the current plan of intervention was not resulting in success,
and the team was unwilling to reassess the situation to create a new intervention.
Unfortunately, the girl continued to miss school and rely on the social worker
to pick her up and bring her to school. Neither the teenage girl, nor her parents,
ever assumed responsibility for getting her to school. No improvement was noted.
C. Get a Job!
scenario involves a family of four that lives in a small community of about 500.
Both parents live in the home but are not employed. There are two teenage boys
ages 14 and 16. The family was referred as the boys were not attending school,
and local law enforcement observed both boys out past curfew. During an initial
intake, income was addressed and the mother shared that the family survived off
a social security disability check received for the youngest boy. He was diagnosed
with ADHD and depression and had received disability moneys for three years. Historically,
neither parent qualified for disability moneys. The mother had been diagnosed
with depression but was not involved in treatment. Their house was inherited from
a relative, and they paid no rent. They were behind in taxes, owed the local convenience
store several hundred dollars, and were being threatened by the power company
to have their power shut off. The family did have a prepaid cellular phone and
appeared to keep this service paid. The family also owned two working vehicles.
During an intake with the parents, the worker asked what changes the
parents would like to see in the boys. The response focused on behavior and on
the boys getting a job to help with expenses. The parents felt the
boys were old enough to take on jobs, and the income would allow the boys to buy
their own clothes and contribute some toward family expenses. A plan for improving
school attendance and improving behavior was briefly addressed, but the worker
said they would discuss these issues with the boys during a follow-up meeting.
Prior to the next meeting, the worker took the parents ideas and quickly
began identifying job options for the boys. Prior to the follow-up meeting, the
boys were provided job experiences. No explanation was provided for the boys,
other than their parents had suggested they get a job. Within a few days, both
had quit their jobs and negative behaviors had escalated. The boys were threatening
their parents with physical violence and were not coming home at night. School
attendance had decreased even more.
Boundaries: This next example focused on parents assessment of their children.
The interventions put in place failed to involve the young boys in the planning
phase. The result was a lack of empowerment for the boys to assume responsibility
for their actions and personal changes. Their feelings were expressed clearly
in a follow-up meeting. They expressed frustration that the parents contributed
no income and wondered why they, the boys, should pay for bills accrued by their
parents. They also asked why the parents hadnt been included in the goal
of employment. The boys had responded to the situation by defying their parents
with more extreme behaviors. The initial assessment did not include the appropriate
people or an accurate account of the total perceived needs in the home.
D. Willful Disobedience
One last scenario involves a middle school boy who has struggled a great deal
with attendance issues and also academic failure. He has only one identified friend,
has been the target of peer harassment, has a history of legal involvement, and
has few advocates in the school system. Several meetings had been held with the
young man and his parents. Meetings included teachers, the principal, the school
nurse, the school social worker, probation officer, and the area social services
social worker. The young man was offered new clothing, the opportunity to shower
at school, the opportunity to participate in a peer advocacy program and many
opportunities for after school tutoring. However, even with interventions throughout
the year, the boy was suspended several times for various reasons. Finally, the
young man was expelled from school for the final quarter due to an act of willful
disobedience. On this occasion, he refused to change his shirt that featured a
marijuana leaf on it. The staff of the school deemed this shirt inappropriate,
and a decision was made that he could not remain in school without changing the
shirt. The young man appeared nonresponsive to the expulsion. A 14-year-old boy
was out of school with no options for acquiring an education.
of Investment: In the final example, an accurate assessment was never
made to determine the boys investment in school and what might help him
invest in school. An accurate assessment should have included a discussion about
what the boy wanted to gain from school and what it would take to make school
a better place. The team assumed all the interventions listed would help, but
the boy never invested in any of them.
All four situations have one very important concept in
common. All four lead to an intervention process that enables the client to continue
in a situation without making any personal investment in change.
The service providers assume responsibility for fixing the problems, and the result
is that the problems continue even after the interventions.
assessments never occurred.
3. The assessments were made without including
the clients in the process of intervention or change.
assessments prohibit empowerment from occurring, and this leads to the enabling
of clients by the service provider.
I continue to struggle in many situations
as I attempt to make accurate assessments of needed interventions. Through my
own mistakes, observations of my co-workers successes and failures, and
through reevaluation of many cases, I make fewer mistakes now than I used to.
It is still very hard to admit failure when youve spent many hours, many
dollars, and devoted a great deal of emotional energy to a plan that was based
on an inaccurate assessment.
Therapists who are new to practice have
a great deal of energy and often fall easy prey to this whole phenomena of enabling.
I would encourage any mental health professional, old or new, to ask the question
and set a boundary, Is the client I serve invested in this intervention
enough to carry it through in my absence? If the answer is, No,
please proceed with caution. I would encourage the practitioner to reassess the
situation and make sure the problem is accurately defined from the clients
perspective. It will improve the likelihood of success for the client as they
will feel empowered, and the worker will not carry the load. Empowerment is perhaps
one of the most powerful practicing concepts in being effective as a social worker.
Good luck in assessing for opportunities to empower.
- Daniels, Jill L. (2005). Employed by Healthcare Training Institute to research and write the article Setting the Boundary between Empowerment and Enabling.
Bio - Jill Daniels, LSCSW, Salina, Kansas, Jill has experience in residential youth care, community mental health, special education, general public education, and a group worker in a wilderness treatment program.
Assessment of Patient Empowerment - A Systematic Review of Measures
- Barr, P. J., Scholi, I., Bravo, P., Faber, M. J., Elwyn, G., & McAllister, M. (2015). Assessment of Patient Empowerment - A Systematic Review of Measures. PLoS ONE, 10(5). doi: 10.1371/journal.pone.0126553
Reflection Exercise Explanation
Goal of this Home Study Course is to create a learning experience that enhances
your clinical skills. We encourage you to discuss the Personal Reflection
Journaling Activities, found at the end of each Section, with your colleagues.
Thus, you are provided with an opportunity for a Group Discussion experience.
Case Study examples might include: family background, socio-economic status, education,
occupation, social/emotional issues, legal/financial issues, death/dying/health,
home management, parenting, etc. as you deem appropriate. A Case Study is to be
approximately 300 words in length. However, since the content of these Personal
Reflection Journaling Exercises is intended for your future reference, they
may contain confidential information and are to be applied as a work in
progress. You will not
be required to provide us with these Journaling Activities. The article above contains foundational information. Articles below contain optional updates.
Reflection Exercise #1
The preceding section contained information on
setting boundaries between empowerment and enabling. Write three case study examples
regarding how you might use the content of this section of the Manual in your
NOTE: sentences and phrases are in bold type, in each Section
of this Manual, for the purpose of highlighting key ideas for easy reference.