Updated: Nov 9, 2021
Rebecca, the team leader of a local psychosocial support service, took a deep breath as she stepped into the meeting room for the weekly team meeting. She wondered how the meeting would go, there were often competing views and practices to work through and today she had a practice issue she wanted to explore with the team.
Yesterday she had overheard Rita and Maree, both community support workers, discussing Rose, a client of the service. They were discussing a new twelve-week coaching program at the local PCYC a mix of fitness and group discussions.
“I just don’t think she’s ready” Maree said.
“Oh, but it’s such a good program”, replied Rita enthusiastically.
“I agree the program is great, but Rose is just not ready”. Maree had said. “There is no way she could stick the twelve weeks out; it would be a waste of a space. Plus, it’s a lot of paper work to do the referral and I don’t want to make a failed referral. Rose needs to get her life stable and her medication sorted before I would make that referral.”
Rebecca always felt uneasy when discussions took place without the person being present but that wasn’t what pricked her attention this time. It was the “not ready” comment that made Rebecca uneasy. She knew she should have addressed it at the time – but the office was so busy. Rebecca also took a guess that this was not isolated to Maree and she wanted to know what other team members thought about the concept of readiness. As Team Leader it was rightfully her place, she opened the discussion with her own reflection and unease before she posed some of her best curious questions.
“I want to ask about the concept of readiness”, she started. She had caught their attention. “I understand that sometimes we make decisions that someone is not ready for something. I have been reflecting how uneasy I feel when I hear this. I wonder in what situations do we get to decide if a person is ready or not? I think we might be gatekeeping and getting in the way of someone’s ability to test something new or difficult.
People shifted uneasily in their seats. Team members shared their various views and practices. Rebecca understood that workers saw it was their role to determine what was right for a person at the right time, and this gave them a sense of pride. Also, she heard how vulnerable they felt about what would happen if the person failed and this would also reflect badly on them as workers. Other workers said that they did not know how to introduce something new and therefore it was easier to stay doing the same things with people.
Rebecca’s story illustrates the tension of the question, ‘who gets to decide when another adult is “ready” or not’? This is a pervasive and persuasive stance within our health and community services industry.
“Not job ready”,
“Not ready for coaching”,
” Not ready for a relationship”,
“Not ready to study”,
“Not ready to live independently”
Let me say at the outset, I don’t agree. I learnt many years ago reading and listening to Patricia Deegan in her “Beyond the Coke and Smoke” program that people are always motivated, and that our task is to listen to and understand what it is that motivates them, resisting making judgements that they are not ready. In accepting this concept – is it not our craft then, to work with people to harness their motivation so they can live well.? In a paid capacity, we are professionally obligated, as part of our duty of care not to protect people from failure but to offer every skill development opportunity that fosters increased capacity and confidence.
As an example, employment consultants will often decide that a person is not “job ready” – based on their own assumptions, experiences, and determination. This is no different to any of the other ‘not ready’ determinations made on behalf of people. This is not done out of any desire to harm or exclude – but frequently based on a range of personal and professional assumptions. More contemporary job networks no longer use the term “not job ready”, they instead consider that it may be “risky to place” the person in a certain position at this time leading them to consider more deeply the range of skills, needs and situations in matching the right job to the right person. It does not “write the person off” or limit their rightful search for work. It marks a shift in thinking and practice.
Readiness is not a binary state; it is constantly fluid, iterative and non-linear. We all exist somewhere in the context of readiness. The Stages of Change Theory (DiClemente & Prochaska, 1988) can lure us to the idea that people are either ready or not yet ready. This popular theory promotes readiness for change through 4 stages: precontemplation, contemplation, preparation, action, and maintenance. These are not static nor should they relegate us to one category alone for all our endeavours. Whilst I may be contemplating change in one area of my life I may be very active making change in another. If a person is not deemed ready then as workers we could be tempted to just wait for readiness to emerge. Instead of attempting to activate a person we might consider they are already active. Even in the quiet moments of pre-contemplation there is action and movement, it just may not be visible to ourselves or to others. As workers, our role is not to determine readiness for change but explore these concepts with people.
What are the risks if WE make readiness decisions for someone about what they can or cannot do or what type of services they may or may not access? These are all acts of holding power in people’s lives.
There is a risk that we will perpetually keep some people in a dependent child like state which is life limiting, and costly to society. Our service system is designed for workers to assess and make decisions about what will treat or help distress. We have been invited to adopt a parent child relationship, or a replica of the doctor-patient relationship. In these false relationship states it becomes easier to believe in our right or even duty to prescribe what is right for another adult.
These are the concerns that fed Rebecca’s unease. To go back to Rebecca and her team. After a robust discussion she invited the team to develop some deeper questions together to safeguard people’s right to determine their own readiness. This is what they came up with:
Who has determined readiness? The worker or the client? Who is not ready in this situation? The worker or the client? How have I determined readiness? What am I basing readiness on? Have I shut the gate to opportunities based on what I think is in the person’s best interest? Have I shut the gate to opportunities that serves my best interest? Is my concept of readiness different from the person I am working with? Have I invited the person to step into the new initiative or have I already rejected the invitation on their behalf? What opportunities have I offered that enables them to ‘be ready’ (worker’s perception)? Have I created a pathway so they can successfully ‘have a go’? Have I really heard their need and desire about what is important? What skills do I need to have to do this well? Is there something else I need to learn?
I wonder have you ever made a decision, that someone is not ready? Has anyone ever told you that you are not ready? In my view and experience – if a person is alive and breathing there is always hope for renewal and change. Readiness is always present in some state- we just have to find it.
These questions contribute to the exploration of Mind-Life’s main assumption that:
An inability to live and lead a full life is not necessarily or simply because of the symptoms of mental illness, but much more from the reduced opportunities to exercise our human rights and live extraordinary lives.
Whilst our health and community models of service assist people to manage their symptoms better; these models can inadvertently disable a person’s identity, autonomy, and ability to live outside of the illness experience.
Mind-Life boldly disrupts the construct of “psychiatric disability” as we have known it - not by trying to change the person, but by challenging the narrative, creating resources and hosting events that build opportunities to LIVE different, THINK different and ultimately BE different.
I invite you to post your reflections and comments and be part of the exploration of this theme.
Patricia Deegan PhD, Beyond the Coke and Smoke Syndrome: working with people who appear unmotivated. National Empowerment Center Inc www.power2u.org
DiClemente, C. C., & Prochaska, J. O. (1998). Toward a co
mprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In W. R. Miller & N. Heather (Eds.), Applied clinical psychology. Treating addictive behaviors (p. 3–24). Plenum Press. https://doi.org/10.1007/978-1-4899-1934-2_1