Is your work person centred? Really…

My inbox is rammed with emails from various agencies of the State claiming that they are developing person centred approaches to service design, delivery and development.

Most are not.

  • If you have set up a service designed to promote behaviour change because you have been told/asked/contracted to do so by a policy maker – then your work is not person centred – it is policy centred
  • If you have developed a service that only works on predefined agendas, with pre-defined ‘solutions’ and services, then your work is not person centred – it is service centred.
  • If your service works on a  premise that service users are in some way broken, faulty or otherwise in need of your modification (smoking cessation, weight management, more entrepreneurial, better CV and qualifications etc) then your work is NOT person centred.
  • If you push your services on people without being invited, using systems of sticks and carrots, and large marketing budgets, to promote engagement – then your work is not person centred – it is to some degree at least manipulative and coercive.
  • If you make decisions that prioritise achieving targets over the wellbeing of the people that use your service – then your work is not person centred.  It is target centred.

Person centred work is done:

  • At the invitation of the person – they invite you to work with them – primarily based on their perception of your relevance to them and their agendas.  If people are inviting you to work with them and finding the process helpful then word of mouth will soon spread and you do not need to spend vast sums promoting your service.
  • When the person sets out their agenda and accesses the support that they choose (rather than those that your agency is set up to deliver).  They always have choices and person centred work helps them to recognise these and prioritise amongst them.
  • When interventions let the person decided whether they wish to engage with ‘professional service providers’ and/or with their neighbours and peers – they don’t assume that the solution lies with experts and ‘mainstream’ providers.
  • When the ‘whole’ person is acknowledged and accepted – not when we fragment them according to our service design.  If we have a service that is just designed to promote health, crime reduction or entrepreneurship – then we are not person centred.

This matters enormously.

Once we start to take the ideas and ideals of person centred working seriously we can transform the impact of the so called ‘helping services’.  Instead of a Nanny State we can have an enabling and empowering state.  And people can really start to recognise their own responsibility for helping themselves in a context that is out to help rather than to fix.

Carl Rogers in On Becoming a Person had this to say:

It has gradually been driven home to me that I cannot be of help …by any means of any intellectual or training procedure.  No approach which relies upon knowledge, upon training, upon the acceptance of something that is taught, is of any use.  These approaches are so tempting and direct that I have, in the past, tried a great many of them.  It is possible to explain a person to himself, to prescribe steps that should lead him forward, to train him in knowledge about a more satisfying mode of life.  But such methods are, in my experience, futile and inconsequential.  The most they can accomplish is some temporary change, which soon disappears, leaving the individual more than ever convinced of their inadequacy.

The failure of any such approach through the intellect has forced me to recognise that change appears to come about through experience in a relationship.

If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth, and change and personal development will occur.

Carl Rogers – On Becoming a Person

So my plea to you: If your work is not genuinely person centred – please don’t say that it is. You will just be serving to reduce the chances of genuinely person centred approaches ever getting a fair crack at the whip.

And if you you want to explore how you can adopt genuinely ‘person centred’ approaches then please do get in touch!

Comments

  1. With the targets/statistics the government requires to prove they’re not wasting taxpayers’ money, is it ever possible for the public sector to do person-centred work? For that matter, with the increase in 3rd sector contracts and monitoring etc, how much longer will the 3rd sector be able to do it?

    Should we all just get to know our own neighbours better, rather than focusing our person-centred social change efforts on professional practice?

    • Much to be said for developing neighbourliness Tim.

      However there are better and more efficient ways of ensuring that anyone in the community can find a skilled person centred coach/broker who can help them to access the support that they want from their preferred sources on their terms. By developing skilled person centred workers and linking them into ‘social brains’ ie groups of people who know stuff we can indeed develop publicly funded but person centred approaches. Engagement would go through the roof!

      Or of course we can just keep ‘saving’ buildings!

      Thanks for the comment!

  2. Great post, but as the ever-switched on Ben Goldacre might say, “it’s a bit more complicated than that” (http://is.gd/7GXRt)

    Apols for the random stream of consciousness that follows but not much time to respond in and amongst other things

    With the advent of Self Directed Support in Adult Social Care, we’re looking at the development of a model where public funds are freed up to allow people to buy what they think (and which the state agrees) will help them best. But accessing such funds will still require them to display their wounds. And their skilled, person-centred brokers will continue to encourage them to buy dressings, rather than avoid the knives in the first place.

    One is also somewhat restricted by organisational structure and the fact we offer permanent or semi-permanent jobs to people. This is even bigger issue within large state-run orgs but increasingly so in the vol sec too. People are employed to do particular roles, and with a certain skill set. To be radically person-centred may mean a wholescale renegotiation of T&Cs with a workforce. Many orgs are too busy ‘delivering’ to change radically. And attempt to build a shared vision (‘we want to deliver person centred services’) by saying they do something they are only just nibbling at the edges of. You can call hypocrisy the tribute vice pays to virtue, or you can call it aspiration. I tend to assume people need to talk it before they walk it. If they repeatedly fail to make (or attempt) steps in the right direction, then I start to criticize.

    (charities are governed by their Mem & Arts – which – taken to the nth degree – would only allow them to work in person-centred was insofar as the person’s wishes matched those of their M&As. There’s usually lots of flexibility built in to M&As, but the tension is still there.)

    Your solution of a highly mobile associative workforce demonstrates a little too much trust in the free market to deliver what people want, and runs the risk of imposing your map of the world onto others. For a gifted, resourceful and self-confident maven as yourself, this is less of a challenge than it is to a workforce who derive their whole self-esteem from the professional gift model (cf http://is.gd/7H4Qd)

    Glad of the critique though, and the call to honest dealing, rather than re-badging services with the latest modish buzzwords. Keep bustin, Mike. (http://is.gd/7HcSE 1:37)

    • Jon

      I think that you are saying the nature of the beast won’t let us do the work we should be doing. Which is of course true of both public and vol/comm (increasingly arms length organisations of the state). So if we want to do effective work we either change the beast (notoriously difficult but not impossible) or leave it. JDs, M&As of course make change difficult. Nature of the Beast.

      Of course there are risks, when endeavouring to be person centred, that one fails and imposes a personal world view. But that is not the intent. At the moment we impose a world view about what constitutes ‘normal’ in relation to mental health, BMI, educational attainment etc. I suspect that even the clumsiest novice practicing person centred facilitation would manage to avoid these pitfalls.

      I am not sure I am talking about a highly mobile workforce. In fact the opposite – really locally based and extremely well connected to the existing array of provision. The point is that they offer a relationship – not a service. And it is about helping the person to clarify what they want, what they really, really want and then seeking it. Who knows whether the market will provide? As communities start to understand what real people really want perhaps we will craft relevant responsive services?

      In essence it is whether we believe Rogers about the importance of relationship and the insignificance of expertise, in facilitating personal transformation.

      I am definitely not talking about an approach to buying services. How can helping someone chose from a menu of service provision be person centred? I am talking about helping people to clarify self interest and then develop options for how this may be negotiated. I am talking about accessing support. This may be from professional paid services or it maybe from more associative relationships.

      • I agree that we so often fall short of providing the person-centred approach so many of us aspire to.

        In addition to the Rogerian person-centred idea, I would contend we need to consider the influence of attachment theory- which I agree Mike, entails almost neighbourly relationships which can endure.

        We’re all driven to discharge folks these days- statutory and voluntary sectors- but I think that the value of secure attachments for our service users is immense. This is where I predict social media/web 2.0 resources could plug the gap.

        http://claireot.wordpress.com/2009/11/16/thoughts-on-how-were-gonna-use-all-this-new-tech/

        What do you think?

        • I must look some more at attachment theory. My wife, a health visitor, is always saying how attachment theory explains so many of the problems people face later in life. I have never been that clear on what we do with it in our practice with adults. Does it further explain the power of building ties into strong social capital – or am I missing something?

  3. You are pointing out a real issue with the voluntary sector. I as an advisor work to enable people to make things happen. What starts as a seed in their mind turns into something wonderful, they come to me with their idea but dont know how to make it happen. I allow people to use me on an add hock basis and my clients come by word of mouth. My problem is my boss who is a box ticker, she constantly argues with me about the way i do things. She also doesnt like the fact that i work from the heart, apparently it isnt professional, but what she doesnt seem to grasp is that i make her look good with the big boys in council and other infrastucture organisations that she spends her time with. I consider myself to be people centred but the organisation i work for isnt.

    • Watching the voluntary and community sector sell its responsive soul to the bureaucrats and the funders absolutely breaks my heart. Have to maintain positive regard for the box tickers too though. They can usually justify their approach – usually in terms of it ain’t perfect – but it a start.

  4. Hi Mike,
    Is your work person centred really? and your responses to the replies have inspired me immensely. As a drugs worker working within the criminal justice system I struggle to do consistent person centred work in the face of target/service/ideology- various centred policies and procedures. The task can appear impossible when extremely high work loads are taken into account.
    Yet managers and commissioners are people too and as such can be helped to change!
    Thanks

  5. Great article and thanks for sharing, Mike.

    The great thing about Carl Rogers’ person centred approach, to my mind, is its focus on the process as opposed to the product or outcome. It’s what you do and how you do it (the meaningful relationships) that’s important.

    This is totally incompatible with almost all voluntary sector funding streams that I have ever encountered, which insist on prescribed outcomes from the outset. One of the people I work with in the service I run pointed out that when she came to us she could not have specified what outcome she wanted – other than to have a safe and supportive space/place where she could begin the process of finding out. Many more people are like that, too, even if they don’t express it so clearly. For example, people who come to use our service under coercion from their carers. They can spend an awful lot of time half-heartedly looking for work they don’t really want in order to try make somebody else feel better.

    Returning to the space/place idea, I don’t think we should underestimate its importance, especially in mental health. Enfield Clubhouse members have made it quite clear that they really value having the premises we use for a number of reasons in addition to its perceived safety and supportive nature. It’s their ‘workplace’ for starters, where they all have ‘jobs’ and valued roles, whether its cleaning the toilets, fixing the hoover, coming up with ideas and/or complaining, cooking a meal or mowing the lawn. It’s somewhere they can relax, make friends and have fun. All of this leads, almost inevitably, to people having the confidence to try other social, educational and work activities in the community.

    But this is of no interest to local commissioners, especially. I know they have their own government imposed targets to meet and boxes to tick, but they really do not care about any of the above. They do not care what we do (unless it’s an action plan or a CV) or how we do it. All they care about is getting people off benefits and into work.

  6. Mike, I know Carl R Rogers was a major influence on the thinking behind people-centered economic development, as the bibliography from our founding paper indicates:

    http://www.p-ced.com/1/about/history/

    We’re not a State agency offering a service however.

  7. sven desai says:

    Thanks for that.

    Nice to see some clarity amid the self-referential holiness

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    This post was mentioned on Twitter by _jonb: Is your work really person centred? @mikechitty tears it up in another thoughtful blog http://is.gd/7HdAW

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