Communication in social care is about power

The Royal College of Speech and Language Therapists has just issued ‘Five good communication standards .. Reasonable adjustments to communication that individuals with learning disability and/or autism should expect in specialist hospital and residential settings’. It is a helpful document that has relevance beyond hospital and residential settings. Standard 4 is about services creating “opportunities, relationships and environments that make individuals want to communicate”. Here they recognise that ‘communication problems’ derive not just from individual characteristics but also from how people relate to each other: “Good communication needs to be considered broadly. It is about social interactions – greetings, sharing stories and fun. It is the quality of interaction that contributes to overall emotional and mental wellbeing; providing a sense of belonging, involvement and inclusion.” One of the ways in which services will know they have achieved Standard 4 is when “Staff are observed spending time with an individual for no purpose other than interaction and communication.”

This is especially important when we think about the many people in care situations who have to make do with the scraps of social contact that come their way. (Many disabled people, young and old, are almost totally deprived of that essential social activity: conversation.)

There is a dimension of communication which the Royal College does not cover: power. Our communication with another person is shaped by our power relationship with them. You talk differently to your colleague than to your boss; you talk differently to your cellmate than your gaoler. Where power is exercised in a relationship the less powerful person is often inhibited: think of the authoritarian parent and the timid child. Social care staff have power. In the terminology of French and Raven, they have ‘reward power’ (power to confer rewards), ‘coercive power’ (power to withhold rewards), and ‘expert power’ (knowledge and skills that others need). In learning disability and other ‘care’ services staff frequently have significant discretion over how their power is exercised.

In the worst cases staff will dominate, not just with the power they have to define a person’s needs and control their actions, but with their use of language, their demeaning expressions, their failure to acknowledge the other person’s contribution or significance, the superficiality of their contact and, at times, their intimidating physical presence .. “You might need me to help you, but I have no interest in what you have to offer me.” (The Winterbourne View court reports illustrate all these features in the language and demeanour of the defendants.)

Where power is exercised in an arbitrary way by staff communication by the person who needs support is disabled and distorted: “I’m communicating just to show I’m complying .. or seeking to humour you .. or trying to minimise my contact with you.” People who are consistently at the wrong end of power in relationships may retreat from the world, getting further and further away from the prospect of good communication with anyone.

Good staff will recognise the problems caused by the misuse of the power and authority conferred on them. This doesn’t stop them being authoritative or assertive when required.

So, when we teach good communication, regardless of a person’s vocalisation and articulation skills, their ability to use signs or symbols or their grasp of world around them, we need to teach about the exercise of power in relationships.

The best conversations are always between equals.

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