Social Justice Theory and Lukes Three-Dimensional Power Model - Case Study Example

Theory Generated from Practice Abstract Although the social worker in this case was not as judicious as to play the pivotal role of proposing egalitarian solutions that would have boosted the chances of having better clinical results for a sexually abused 15-year old girl during an encounter at a paediatric unit, s/he has applied retrospect to generate theory from the incident. This paper has applied the social justice theory and Lukes’ three-dimensional power model in context, and argues that the social worker could have applied social justice theory to ensure that the girl - who was disadvantaged by her age, and hence considered unable to make decisions - would have her interests prioritised over other issues arising in the case. Additionally, the paper argues that the social worker was in a position to tilt the power balance between the 15-year old girl and the adults handling her case in a manner that would best serve the interests of the girl. The incident The following incident stands out among the many experiences I have had as a social worker due to the innocence of the child involved, and the fact that upon reflection, I believe I could have acted differently in order to ensure the child had access to justice. In other words, I still shoulder some sense of guilt that although my intentions were well-meaning, they were misguided by the belief that I had to abide by the family wishes, hence denying a young girl the chance to access justice. Working in the paediatric unit in a hospital can be one of the most fulfilling experiences in a social worker’s life. Unlike adults, children are often transparent with their feelings, and are always honest about their likes and dislikes; Yet, working in the paediatric unit can also be a heart wrenching experience especially when a social worker encounters incidences where adults have ‘violently robbed’ a child off her innocence. The case of Beatrice*1 - a 15 year old who had been sexually molested by her step-father was one such heart wrenching experience that I have had to witnessed in my line of duty. When Cathy*2 – Beatrice’s mother brought her to the hospital, she made it very clear that though the step father (Cathy’s husband) was liable for the offence, they had resolved to settle the matter without involving the criminal justice system. As such, Cathy was seeking treatment for her daughter in the hope that the hospital personnel would be discreet enough to respect her (and her husband’s) decision to solve the matter without involving the authorities. Cathy also revealed that she had already contacted a counsellor who would guide Beatrice on her journey to recovery following the sexual molestation incident. As a social worker, it was arranged that I would be among the health team working on Beatrice’s case. As such, I had to be present during her medical examination. Throughout the medical procedure however, I noticed that Beatrice was less than willing to cooperate with the medical personnel. Understandably, the intrusive medical examination procedures caused her great anxiety, and not even the assurances that Cathy and I gave her could wipe away the worried look from her face. Determined to get her through the treatment, Cathy and I used different means to encourage Beatrice to cooperate with the medical personnel. In the end, the examination was done albeit with a lot of resistance from Beatrice. Additionally, she could not stop crying thereafter, perhaps because of the discomfort brought about by the examination, or perhaps because the situation had reminded her of the unfortunate experience she had had in the hands of her step father. Analysis and theory development –social justice theory Beatrice’s case raises several issues; first, whether the medical team had a right to proceed with the medical examination even though Beatrice was obviously not comfortable with the procedure; second, whether Cathy and I had the right to persuade Beatrice to undergo the medical tests even though she was not willing to do so voluntarily; and third, whether as a social worker I could have pursued justice for Beatrice by disregarding her family’s position of settling the sexual abuse case without involving the relevant authorities. As I reflect on Beatrice’s case, I realise that her rights as a child were ignored and she was at a disadvantage owing to the power relationships between her and the parents; and between her and the medical team that was her examining her. As such, the social justice theory is applicable in the case. According to Furman and Shields (2004, p. 12), social justice is the “deliberate intervention that challenges fundamental inequities that arise, in large part, due to the inappropriate use of power by one group over another”. Notably, it has been recognised that children are vulnerable to exploitation, and that adults have relatively high decision-making power when compared to children (Schneider & Bramley, 2008). As such, adults can misuse their power to disadvantage children; in the same manner, adults can make deliberate choices to empower children by allowing them some sense of control. In retrospect, I now recognise that the adults handling Beatrice’s case did what they thought was good for her (and her family), without considering the effect that their decisions were having on her. For example, by deciding to settle the sexual abuse case out of court, Cathy may have been interested in keeping her family together without considering Beatrice’s feelings and needs, and even the risk that such an arrangement would pose on her daughter. In the paediatric unit, the medical examination, though well-meaning, was done without Beatrice’s consent. If anything, her mother signed the consent forms hence giving the medical team the approval needed to carry out the examination procedure. Overall, it seems that the adults in the case assumed that they had all the power over her, thus denying her any chance to decide what she wanted done. Social workers who attend medical appointments have a responsibility to ensure that the psychosocial needs of the patient and that of his/her family are considered and addressed (Pockett & Giles, 2008). However, the patient’s needs should always be regarded supreme especially if she is in a disadvantaged position as was the case with Beatrice. As Guthrie, Kaufman and Rose (2006) found out in a research carried out among sexually molested girls in the US, most families do not consider the emotional development stage and state of the abused girls when making decisions on their behalf. This then means that the child agrees to the decisions made by their parents or guardians, but they rarely get through the sexual abuse experience emotionally. Instead, they perceive the experience as a “risk factor” indicating that something in them or around them is wrong (Guthrie, Kaufman and Rose, 2006, p. 11). In other words, as parent and other adults in the child’s life move on and overcome the sexual abuse incident, the real culprit i.e. the child still bears the burden of the experience. Ideally, and as stated by the Australian Association of Social Workers (2008), Social workers should pursue social justice by challenging the status quo, questioning prevailing social assumptions, and challenging barriers or views that contribute to oppression. Additionally, social workers are in a position to oppose the exploitation of power relations that exist between the oppressors and the oppressed as they advocate for the latter and any other people whose voices have been silenced by prevailing societal norms (Australian Association of Social Workers, 2008). As indicated by Faller (1993, p. 7), social workers need to consider “what is in the victim’s best interest”, and the “potential iatrogenic effects of intervention”. As was witnessed in Beatrice’s case, investigation can be traumatic. As such, and given a chance to reconsider, I would have opted to reschedule Beatrice’s medical examination until she was less upset, or as suggested by Wyatt and Powell (1988), the same can be done under anaesthesia but only in situations where it is considered critical for medical purposes. To apply social justice theory in the described scenario, one would need to do several things as described by Swenson (1998). First, the social worker (in this case I), would need to understand the clients (Beatrice, and to some extent Cathy) in the context of their social positions, power relationships and strengths. Secondly, the social worker would need to develop techniques that will enable the client to understand the same social positions and strengths in a manner that will help them become liberated from any oppression that may exist. Additionally, the social worker could have worked with both Beatrice and Cathy for purposes of ensuring that they reassess their positions and forge a better relationship going forward. As Swenson (1998, p. 527) indicates, social workers can “develop new structures in agencies to counter oppressive beliefs and practices and work to develop programs that will offer social, economic, spiritual, political, and psychological resources”. In my case, I believed that Beatrice deserved justice against his step father and that deciding to resolve the matter without involving the authorities was placing her at a risk that the same offence would be meted on her in future. In retrospect, and as indicated elsewhere, I also believe that the power-relationship in the paediatric unit where she was subjected to the medical examination exulted the dominance of the adults against her wishes. As such, I now believe that the fair thing to have done at the time was inform her of the necessity of the medical exam, and allow her to make an independent choice regarding the medical examination without coercing her. The child’s best interest According to Faller (1993), whenever a child is sexually abused, professionals attending to her must ensure that her basic needs of safety and rehabilitation are well addressed. In Beatrice’s case, this would translate into rehabilitating her both physically and emotionally, and keeping her away from further risk. Given that Beatrice’s case is similar to an incest offence owing to the fact that the sexual abuse took place in the family setup, the well-being of Beatrice lies in prosecuting the offender. Although a social worker may be caught between respecting the family’s decision to settle the case without involving the authorities, the need to attain justice for Beatrice may call for the same social worker to inquire just how the family is seeking to handle the case. Ideally, the well-being of Beatrice should be upheld at all times, and this means that she and her step father cannot continue living in the same house. As Faller (1993, p. 8) notes, questions such as “does the family remain intact, does the offender leave, or is the child removed?” are pertinent, and hence a social worker who is intent on pursuing the social justice system should consider them. Theories of power in social work (Lukes’ three-dimension model of power) The three-dimension model of power is based on Steven Lukes’ “three faces of power”, which he identifies as: decision-making; non-decision-making; and shaping desires. In decision-making, Lukes argues that a person has the power to make decisions and implement the same. In non-decision making, Lukes argues that a person has the power to set the agenda, but usually, such ability is stopped by the person’s inability to make decisions. In Beatrice’s case for example, her objection to the intrusive medical examination was ignored by her mother, the social worker and the medical personnel present owing to the fact that they were relatively powerful compared to her. Following the same thought in regard to the offence committed by the step-father, Beatrice’s mother chose to avoid the issue perhaps because it would have led to further inquiries and investigations that could have culminated in the imprisonment of her husband. The third dimension of power according to Lukes is shaping desires through ideological power. Here, those in power manipulate their subjects into consenting into something which does not actually serve their interest. In Beatrice’s case for example, the mother, the social worker and the medical team coerced her into going through with the medical examination even though it was clear that she was not psychologically prepared for the same. According to Lukes (2005) those in power exert their influence on the ‘powerless’ through ideological institutions. For example, by taking Beatrice to the paediatric unit, Cathy was exerting her ideological power over her daughter by assuming that the medical examination was the right thing to do. The fact that Beatrice objected to the actual process however raises questions into the quiescence thought since it would be assumed that no resistance would emerge if Beatrice had indeed resigned herself to the fact that the medical process was a ‘necessary evil’, and that those in power (i.e. Cathy, the social worker, and the medical team) were right in carrying it out. According to Dowding (2006), Lukes has revelled domination in the three-dimensional model of power. This is especially the case in the third dimension (i.e. shaping desires), where it is argued that ideological power takes effect where there is domination, and where the “dominated acquiesce in their domination” (Dowding, 2006, p. 137). Such acquiescence may occur where people actively believe that the values oppressing them are right, or where they are resigned to the fact that the situation cannot get any better (Jupp, 2005; Sadan, 1997). In Beatrice’s case, the fact that they had decided to handle the sexual assault case without involving authorities may have been a sign of the latter, while her willingness to come with Cathy to the paediatric unit may have been a sign of the former. In other words, Beatrice perhaps knew that getting medical treatment was the right thing to do, although she probably knew the invasive nature of the examination procedure. Given that Beatrice was a minor who had gone through sexual abuse, one cannot rule out the likelihood that symptoms such as “fear, posttraumatic disorder, behaviour problems, sexualised behaviours, and poor self-esteem” as defined by Guthrie, Kaufman and Rose (2006, p. 6) could have affected her behaviour. Analysis Having noted that the social justice theory is applicable in Beatrice’s case, and having stated that her disadvantaged position was as a result of the imbalance of power between her and the adults handling her case, this section will address how the social worker could have gone ahead to empower Beatrice. In this regard, finding out Beatrice’s views regarding her step-father’s actions towards her; Cathy’s decision to settle the matter without involving the police and the subsequent search for treatment would probably have been a good starting point for the empowerment process. As Hasenfeld (1987) notes, social work practice should have client empowerment as a core strategy towards attaining good results in a clinical setting. As a member of the team that attended to Beatrice in the paediatric unit, I, as the social worker should have tried to form a relationship that was “voluntary, mutual, reciprocal, and trusting” as suggested by Hasenfeld (1987, p. 469) in a bid to empower the underage girl. According to Fook (2002, p. 104), empowerment has four stages that make up the deconstructive/reconstructive process. They include deconstruction; resistance; challenge; and reconstructions. Deconstruction According to Fook (2002, p. 106), “the deconstructing power and power relations” is the first and extremely essential stage in understanding a situation. In this stage, the social worker is able to conceptualise and understand the situation by analysing the themes, communication patterns, sources of power, different players in the situation and how their perspectives are represented, assumptions and biases among other things. In the deconstruction stage, the social worker is also able to determine what power he or she can exercise in the situation. In Beatrice’s case, the deconstruction stage would have revealed that the 15-year old girl did not have much decision-making power either at home or in the paediatric unit. However, and owing to the fact that she had been defiled by her step-father, the social worker had relative powers to seek social justice for her, either by insisting that the father should be held accountable for his actions against the minor, or by Beatrice’s removal from the family. Ideally, and depending on Beatrice’s feelings towards her step-father, the social worker would be in a position to make a decision based on the girl’s best interest. Resistance In this stage, Fook (2002, p. 106) states that the social worker should identify the “types of power and the ways it is exercised which may need to be changed or resisted in order to change the situation in more empowering ways”. Ideally, and having identified Beatrice as the disadvantaged party in the power relations between her and Cathy, and between her and the medical staff at the paediatric unit, the social worker should have identified the adult-dominance over Beatrice as the aspect that needed changing in order to give her more power to decide what needed to be done in her case. As a 15-year old, it is comprehensible that the adults handling her case probably thought that she did not possess the capabilities to know what is best for her; however, such assumptions should not be held as facts, unless it has been established that the minor was indeed not capable of deciding her own fate. Questions such as “what do you think of what Daddy did to you?” can be quite revealing. By allowing Beatrice to express her feeling without the fear of being reprimanded, the social worker could have empowered Beatrice as has been suggested by Fook (2002). Challenge According to Fook (2002, p. 106), this stage should involve making specific changes to the way “we conceptualise power, and thus the way in which we construct the situation and the power relations within it”. In other words, the challenge stage should involve questioning the power dynamics in a situation, and gauging the different effects that a change in the same dynamics would cause. For example, what would have happened if Beatrice was allowed to decide whether or not to undertake the medical exam without being coerced? i.e. shouldn’t the adults involved in handling her case respect her decisions? Reconstruction Following Fook (2002, p. 107), reconstruction marks the final stage of the empowerment process, and here, the social worker enacts the “series of changes indicated” in earlier stages namely deconstruction, resistance and challenge. Applying the reconstruction stage in Beatrice’s case would involve “negotiating a changed system of power relations and structures which is experienced as empowering for all parties” as suggested by Fook (2002, p. 107). In other words, Beatrice’s position in the power arrangement would need to change in a manner that enables her to make decisions, and also enable the adults handling her case to respect the same decisions, or negotiate a middle ground that upholds her best interests. In the paediatric unit for example, the adults present could have respected her decision not to undertake the intrusive medical procedures by postponing the same, or informing her about the necessity of the procedure towards contributing to her physical well-being and thus empowering her towards making an informed decision. To numb her discomfort, and the perception of the medical staff invading her ‘personal space’ as her step-father had done during the sexual assault, Beatrice could even have been given the option of having the medical examination carried out under anaesthesia. As indicated by Fook (2002), the reconstruction stage is usually empowering for the formerly disempowered party, and disempowering for the previously powerful party. In other words, the entire process seeks to shift the power balance from the dominant party to the disadvantaged party, hence attaining a balance, or enabling the previously disadvantaged party to have more decision-making powers in regard to their situations. The social justice theory and theories of power in social work seem to be correlated in Beatrice’s case owing to the fact that her apparent powerlessness calls for the social worker to either seek some form of social justice for her or empower her in a manner that will ease her disadvantaged position. As indicated by Smith (2010) social workers are now increasingly questioning their claims to “professional authority and expertise” (at 6.2). As indicated in this case, I as the social worker, have reflected on the events surrounding Beatrice’s case and have concluded that the outcomes of the clinical experience would have been better if I had acted differently, and perhaps convinced the rest of the team to allow Beatrice some decision-making powers. In hindsight, it appears that the team attending to the 15-year old girl assumed that the natural order of things was to subject her to a medical examination, whether or not she consented to it. Though well-meaning, the clinical team ignored the possibility that the intrusive procedures were equally as demeaning to Beatrice as her step-father’s sexual assault. Unlike other professionals, Folgheraiter (2004) holds the opinion that social workers should not just use professional and legal authority as granted by their profession when engaging with clients; rather, they should seek to gain the authority to work on a case through establishing a mutual, collaborative and empowering relationship. Essentially, this means that instead of agreeing with Cathy and the rest of the clinical team about the steps taken towards conducting the medical procedure, I, as the social worker could have tried to forge a mutual, collaborative and empowering relationship with Beatrice. Overall, Beatrice’s case reflects the powerful role that a social worker has in a society where power relations are often problematic, usually pitting the powerless against the powerful. 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