Perceptions of power in client/worker relationships

Cohen, Marcia B

ABSTRACT

Recent literature on empowerment-oriented social work practice raises intriguing questions about the nature of power in client/worker relationships. This qualitative study explores client and worker perceptions of power in their relationships with each other. Individual and focus group interviews were conducted in residential settings serving men and women with histories of homelessness and psychiatric hospitalization. Staff and residents' experiences with helping relationships were probed, with particular attention to characteristics of mutuality, equality, and power. Client and worker preferences were conceptualized as ranging from partnership-oriented relationships to mentorship-oriented relationships. The author draws on empowerment and feminist theory in analyzing the study/simplications for social work practice.The question is posed as to whether social work practice can fully realize the goals of shared power, mutuality, and collaboration associated with feminist and empowerment-oriented practice models when client/worker relationships are embedded in a hierarchical power structure.

The burgeoning literature on empowerment-oriented social work practice (Breton, 1994; Cohen, 1994; Gutierrez, 1990; Gutierrez, Delois, & GlenMaye, 1995; Miley, O'Melia, & DeBois, 1997; Mullender & Ward, 1991; Parsons, 1991; Rose, 1990; and Saleeby, 1997) has made significant contributions to our practice wisdom by exploring methods and techniques for working with client strengths, increasing client control over the environmental resources, and developing collaborative client/worker partnerships. This literature has not, for the most part, examined the perceptions of power on the part of the participants in the helping relationship. As Hasenfeld (1987) points out, ". . . although social work practice theory recognizes that the worker typically exercises considerable power over the client, the impact of power on the clinical relationship remains understated (p. 470)." Some questions that have largely gone unanswered include: (1) How do social workers who identify with empowerment-oriented practice models perceive and address power imbalances in their relationships with clients? (2) How do clients perceive and address power imbalances in their relationships with workers? (3) Do clients state a preference for equal partnerships in their relationships with social workers?

This article will examine these questions in light of findings from a qualitative study of client/worker relationships, conducted in residential settings serving men and women with histories of homelessness and psychiatric hospitalization. Worker and client perceptions of the dynamic of power in their relationships with each other were explored. It is hoped that this inquiry will begin to fill this identified gap in the literature and spark further research on the dynamics of power in client/ worker relationships.

Theoretical Underpinnings

The conceptual framework informing this study incorporates feminist theory and empowerment theory. Although they share many of the same values and assumptions, feminist practice and empowerment practice evolved from different theoretical traditions and bodies of research.

Feminist theory places a strong emphasis on the centrality of the helping relationship. The ground - breaking work of Miller (1976) and Gilligan (1982) has transformed the way in which human development is understood. Feminist social work is strongly influenced by the relational model of women's development pioneered by the Stone Center at Wellesley College (Jordan, Kaplan, Miller, Striver, & Surrey, 1991). The relational model emphasizes affiliation, connection, and mutual empathy in the development of women's sense of self. Within a relational social work practice framework, efforts are made to ensure that client/worker relationships are open, nonhierarchical, egalitarian, and characterized by mutuality and reciprocity (Bricker-Jenkins, 1991; Jordan, 1991). Power is understood as taking different forms in helping relationships with profoundly different implications.

Miller (1991) defines power as "the capacity to produce a change" and sees the power to empower others as a particularly potent force (p. 198). Feminist theorists distinguish between power that is shared with another individual and power that is wielded over someone (Surrey, 1991). Brown (1994) speaks to the important role of the therapeutic contract in promoting client equality and confirming clients' power over the goals of the helping relationship. Bricker-Jenkins (1991) builds on these conceptualizations of power in her discussion of feminist social work practice:

Perhaps the biggest challenges faced by practitioners . . . are resisting -doing for" and supporting the choices made by the people with whom they are working. Refraining from "doing for" is a challenge to one's ego and . . . involves yielding some conventional practice techniques and much of the formal power derived from one's status in hierarchically structured professional relationships. Getting out of the way of other people's growth means creating opportunities for choice and supporting those that people make (p. 296).

Empowerment theory was inspired by the radical pedagogy of Brazilian educator Paulo Freire (Breton, 1994; Freire, 1970; Lee, 1994; Rose & Black; 1985; Rose, 1990). Although different interpretations of the term empowerment abound (Breton, 1994), most include as a central concept the need to be an effective and creative participant in one's environment. This understanding of empowerment implies "having the choice to participate in the decisions that affect one's life, and the life of one's society and community" (Breton, 1994, p. 27).

Empowerment theory in social work emphasizes a view of social problems as stemming directly from oppression and powerlessness. Centrality is given to the role of social work in addressing the problems of oppressed populations and mediating the impact of powerlessness (Gutierrez, 1990; Gutierrez, DeLois, & GlenMaye, 1995; Pinderhughes, 1989; Solomon, 1976). The social work relationship is seen as a vehicle for increasing client control over self-definition, validity of meaning, and the surrounding social environment (Breton, 1994; Cohen, 1989; Rose and Black, 1985; Rose, 1990). Empowerment in direct social work practice is "a process of dialogue through which the client is continuously supported to produce the range of possibilities that s/he sees as appropriate to his/her needs" (Rose, 1990, p. 49).

Empowerment-oriented social work focuses directly on the mobilization of power. Its goal has been described as increasing "personal, interpersonal, or political power so that individuals, families, or communities can take action to improve their situations" (Guitierrez, DeLois; & GlenMaye, 1995, p. 535). Within the client/worker relationship there is an emphasis on clientdefined problems and goals, collaboration, shared power, and resource mobilization (Cohen, 1989; Guitierrez, DeLois, & GlenMaye, 1995; Miley, O'Melia & DeBois, 1995). Clients are the center of all decisions that affect them (Rose, 1990). Power disparities within the relationship are identified, acknowledged, and reduced (Miley, O'Melia & DeBois, 1995). The social worker is the facilitator of client goal achievement, rather than the architect.

In one of the few studies that have been done on perceptions of empowerment-oriented practice, Gutierrez, DeLois, and GlenMaye (1995) obtained definitions and descriptions of empowerment practice from human service workers in six agencies identified with this practice approach. Respondents primarily focused on individual and psychological aspects of empowerment, rather than political or societal dimensions. Respondents saw gaining personal power as central to empowerment, in terms of identifying existing sources of power and developing power to influence one's situation. Developing access to consumer-driven choices and promoting autonomy were also highlighted as critical aspects of empowerment practice. The Gutierrez, DeLois, and GlenMaye study makes an important contribution to the empowerment literature in its use of practitioner-based knowledge to inform theory building. It suggests a need for further research on the experiences of participants in empowerment-oriented practice.

The present study explores worker and client perceptions of power in client/worker relationships. It attempts to fill some of the gaps in the literature by probing potential contradictions between empowerment ideology, feminist practice, and professional role.

Methodology

Research on social work practice with homeless, psychiatrically labeled people suggests that clientcentered, strengths-oriented practice is most effective with this population (Berman-Rossi & Cohen, 1988; Brown & Ziefert; 1990; Cohen, 1989; Pollio, 1994; Sheridan, 1993). The present study was conducted at a nonprofit agency serving homeless, psychiatric survivors and promoting a practice philosophy consistent with feminist and empowerment models. Study participants were drawn from the agency's five residential programs that provide services to men and women with extensive mental health, substance abuse, and homelessness histories. As survivors of the streets and the mental health system, these clients have experienced numerous relationships with social workers and other mental health professionals.

Structured, open-ended individual and focus group interviews were conducted with residents and staff in five residential settings. The interviews focused on staff and resident experiences of client/worker relationships. Questions directly explored client and worker perspectives on power dynamics, experiences with goal setting and treatment planning, and the saliency of concepts such as mutuality, equality, and shared power.

Following the collaborative principles of participatory research (Sohng, 1992), an effort was made to involve staff and residents in the final study design. The researcher held informational meetings in each residence in which the proposed study was described, questions about the research process and objectives were clarified, participation in the research project was invited, and client and worker input into the research plan was solicited. Residents and staff were queried as to what questions would be important to ask in view of the researcher's interest in client/worker relationships. Suggestions on the content of interview questions were incorporated into an intentionally flexible research design. Individuals volunteering to participate in the research were offered several interview options. Interviews were conducted individually, in dyads, and in focus groups, depending on the preference of respondents.

Participants

The study participants were self-selected. All forty clients and twenty-four workers (including four student interns) in the five residences during a three-month period were invited to participate in the study. Involvement on the part of workers was high; all but one employee and two student interns participated. Among the residents, twenty-four individuals participated. Differential levels of participation between staff and residents may partially reflect different levels of pressure experienced by the two groups. Staff understood that while their involvement was voluntary, the agency actively supported the research project and strongly encouraged their participation. Residents were also encouraged to participate, but they were explicitly informed that their involvement was completely voluntary. Consistent with the principles of client empowerment, efforts were made to minimize any pressure or coercion residents might feel about becoming involved with the project. An unintended consequence is that the staff may have been more likely to feel pressured to participate in the research than the residents.

There were few demographic differences evident between sample members and non-members. Differences between worker participants and nonparticipants appeared to be a function of work schedule and availability for interviewing. The staff sample was predominantly Caucasian, reflecting the demographics of the region. Most were in their twenties or thirties, with social work education and/or licensure.

The client sample consisted mostly of individuals in their twenties, thirties, and forties. Nonparticipants fell into the same age groups as participants, in similar numbers. Both groups were characterized by extensive psychiatric histories, both inpatient and outpatient. Many members of both groups had also received substance abuse treatment. Client participants and nonparticipants were both predominantly Caucasian. Men slightly outnumbered women in both client groups. There was some difference between client participants and nonparticipants with regard to educational background; participants were more highly educated (high school graduates, many with some college education) than were the nonparticipants.

Treatment Planning and Goal Setting: Whose Goals Are They Anyway?

As a means of exploring perceptions of power in client/worker relationships, respondents were asked about their experiences with the treatment planning process. State Medicaid funding of the residential programs mandated the completion of quarterly treatment plans for all of the residents. These plans included a template of required categories into which the residents' goals had to be fit. In addition to discussing the process of goal setting and the experience of negotiating different points of view, respondents were asked whose goals they felt were reflected in the plans: clients, worker, and/or agency. Six of the twentyfour clients and four of the twentytwo workers experienced treatment plans as client goal driven.

The following interview excerpts reflect this perspective:

It has always been stressed here that the treatment plan is my plan. / just tell my worker what I want; so far that has worked just fine. The plan reflects my goals for myself . . If I had a problem with something on the plan, I would say so, and we would talk it over and if I still didn't agree, they would change it. The goals and the decisions are ultimately mine.

(Cathi, a female resident in her twenties)

Treatment planning has been a big challenge. I used to find it hard to separate my goals from the residents'. I have really worked on this - on not imposing my goals. I just keep reminding myself that it's about what they want.

(Don, a BSW student)

Nine of the twenty-four clients and eleven of the twenty-two workers described the treatment plans as reflecting a combination of client and worker goals. These respondents described treatment planning as a collaborative process between the client and the worker. Donna, a female resident in her thirties, is one of the clients who expressed this view:

With the worker I have now, I have a say in what happens to me. We set the goals together. The goals reflect my ideas about what I want for myself and also her ideas. It's a combination; we do it together. This is much better than what I had in the past It's easier now because I have some say in what the goals are.

Some clients, such as the two quoted below, described a goal setting process that went beyond collaboration. They voiced a preference for relying on their workers' expertise:

We do the plans together, but my worker comes up with most of the goals. I trust her judgement, so I don't mind her coming up with goals for me.

(Craig, a male resident in his forties) I would say that for the most part, the treatment plans are based on the residents' goals but the workers have a lot of influence on them. I think that is a good thing because the workers usually know what's best for us.

(Serena, a female resident in her forties)

Only a small number of residents and staff described the plans as reflecting a combination of client goals, workers goals, and agency goals. Theresa, a female client in her twenties, saw all three as playing a role but identified stronger, external forces influencing the goal setting process:

I guess the goals are ultimately mine, but my worker writes them up and doesn't always give me much input. So, I guess it depends on who the agency assigns to be your worker. But the whole treatment plan format comes from the state and Medicaid, not from the agency.... These plans aren't really for our benefit They are for the State, for Medicaid reimbursement The workers have to make up a plan that looks good on paper, that looks good to Medicaid.

Several staff members articulated a similar perception. These workers tended to view their role as mediating between client interests and Medicaid demands:

The residents here are intimidated by treatment plans. It's a real struggle to meet Medicaid requirements and also make the plan a userfriendly tool. The trick is to talk to the residents, find out what they want to be doing and turn that into Medicaid goals, get them on paper, and then show it to the client.. . Almost anything can be turned into a Medicaid goal as long as it fits one of the Medicaid categories.

(Jill, a program director)

I try to make the treatment plans reflect residents' goals and not impose my own but the whole idea of 'goals' is imposed. I think it's too bad that the state always expects people to be working on something. Some people get to a point in their lives where they are happy where they are and don't want to work on anything else. The dtate just doesn't recognize that; they can't just let the person be.. It's frustrating having to finagle and make up these goals because the state can't see that as far as the person is concerned they have lived a full life, done what they wanted, don't want to do anything else.

(Paula, a line worker)

Joe, a house manager in one of the residences, was the only staff member to describe treatment planning as wholly imposed on clients and workers by the agency and the state. He describes a diminished role for workers and clients in the goal setting process:

I have a hard time with treatment planning. I spend a lot of time doing the plan and wording it in a certain way to satisfy the agency, the Bureau of Mental Health, Medicaid... My role in writing the plan is really a technical one. And, nine times out of ten, the client reads it and doesn't understand what it says because I have written it to satisfy the agency or the government. It's not for the client.

A small number of residents shared Joe's perspective that clients had limited, if any, input into goal setting. They did not identify the role of the state in the planning process. These clients described their plans as heavily worker-driven:

My worker came up with the all goals; they were written for me before I ever saw them. I was asked for input before I signed them, and I think my input was taken seriously. Still, it wasn't me coming up with the goals. It wasn't me writing them down.

(Geoff a male client in his thirties) With my most recent worker, the goals on my plan were mostly her goals. She had an idea of what my goals should be because she knew me pretty well, but it would have been much better if she could have listened to me.

(Loretta, a female client in her thirties) There were many subtle variations and nuances among residents and staff in their perspectives on whose goals were reflected in the treatment plans. None of these appeared to be attributable to demographic differences. The majority of residents and staff expressed satisfaction with the goal setting process as practiced in the agency. Most viewed the plans either as clientdriven or as a process shared between clients and workers. Dissatisfaction, where it was expressed, mostly revolved around the state's imposition of requirements for formal treatment plans that established predefined categories into which client goals had to be fit. Workers who commented on this influence described their role as one of buffer between clients and the state. They saw this role as detracting from their collaborative relationship with residents.

The comfort many clients expressed with strong worker influence in the goal-setting process ("they know what's best for us") raises important questions about power and control. Do clients prefer to rely on their worker's expertise in decision making or are they comfortable with more of a collaborative relationship, with shared power? As will be discussed below, client preferences can be depicted as varying along a continuum.

Partnership and Mentorship

The theme of power emerged directly from the discussion of goal setting. Clients and workers were also asked explicitly about their experiences of power in client/ worker relationships. They were asked if they experienced their relationships as characterized by equality or whether one member of the dyad "tended to be more in charge." Clients and workers were then asked about the type of power arrangement they felt most comfortable with.

Client and worker preferences distributed themselves along a continuum ranging from partnership at one end to mentorship at the other. Partnership, in this context, implies an equal distribution or sharing of power. The worker/partner is essentially a facilitator with specific skills and knowledge which are used on behalf of the client, at her/his request, to meet the client's objectives. Mentorship implies a relationship characterized by mutually agreed upon inequality. The client grants the worker authority to make decisions about her/his life, indicating a significant degree of trust in the relationship (Palmer, 1983). The status of mentor conveys knowledge, wisdom, insight. The mentor is a teacher, a guide, a role model. Approximately half the residents expressed a preference for a mentorship relationship with their workers. There were no evident demographic differences between the two groups of clients.

The partnership to mentorship continuum can also be seen as part of a broader spectrum, extending from partnership to authoritarianism, with mentorship as a midpoint. Some of the clients' described authoritarian relationships they had been subjected to in the past. None expressed a desire for this kind of power arrangement. Similarly, staff preferences fell between partnership and mentorship. The following quotations are illustrative of the responses that the researcher categorized as falling at the partnership end of the continuum:

If feel like an equal with my workers. I ask for help when I need it and they give it to me. It feels equal, not like they have power over me. Equality is important to me. I need to be in charge of the decisions in my life. (Johnny, a male client in his late teens)

It needs to be a partnership. These clients give up too much of their power to experts... I'm just not comfortable with an authority role; it's not what clients need.

(Jeremy, a senior social worker)

With my worker here, it has been an equal partnership. I have always felt like I could talk to her about anything and not be judged. She never put herself on a pedestal or acted like she knew what was best for me. We were always on the same level That's the kind of relationship that helps me. The worker I had before had to be in charge; she always had to be right about everything. She did me a lot of harm.

(Donna, a female resident in her thirties

Laura's description of how she comes to terms with power discrepancies in her work with clients captures the spirit of mutuality inherent in partnership relationships: There obviously are power differences, but I try to minimize them. I believe individuals have power; they just need to tap into it and maybe I can help.... I try not look at people as other than me, that is where power over someone comes from. But there are differences in power that come from systems that say I have power. can pick up the phone and say 'this consumer needs a service,' and get it for them. If the person needs something and I know that I can do it then I will, provided that the decision to do that is mutuaL I may have the ability that can help a person open a door, but they decide which door to walk through

(Laura, a graduate student intern)

The distinction between partnership and mentorship can be subtle. These concepts represent points on a continuum rather than distinct and separate categories. One difference between partnership and mentorship relationships is reflected by the terms client-centered and clientdirected. At the partnership end of the continuum, direction and decision making is the province of the client, with the worker providing information, acting as a sounding board, and/or serving as a link to desired resources. Mentorship relationships are client-centered, with workers using their expert knowledge and skills to provide clients with advice and guidance. Mentorship implies a less directive role for clients, with workers acting in what they believe to be in clients' best interests. Mentorship implies client consent to a power imbalance, unlike authoritarian relationships in which worker authority is imposed. The following excerpts describe mentorship relationships:

Staff does have all the power here, that is the dynamic of the house but we can use our power selectively... You don't need to control people's lives just because you have the power to. It doesn't make for good relationships... The whole teaching, showing, role modeling approach is so much better than controlling, telling, and forcing.

(Jill, a program director).

They are the social workers, and I am the client. They are the boss. I don't think it should be equal The roles should be different I prefer for the worker to be in charge, to be the expert . I'm just a wee little thing, but I do feel like I should have my say... They should be in charge - not in charge of my life but in charge of helping me run my life better, like a guide.

(Beatrice, a female resident in her forties)

For the most part I prefer to rely on my workers expertise. They usually know what's best for me. I have found most of my workers to be knowledgeable and affirming of my needs. They were able to uphold the responsibility and trust I was willing to give them.

(Paul, a male resident in his thirties)

Paul's comment underscores the consensual nature of mentorship. He sees himself as having chosen to give his workers some responsibility over his life. A somewhat different perspective was offered by several clients and workers who struggled with the power imbalances and imposed authority they saw as inherent in the residential context:

I think every day of my role and my power. Staf has a lot of power. Residents often have nowhere else to go; we are their last chance. They know if they don't follow the rules, they won't be able to stay. So, we have a great deal of power over them. It is important to acknowledge that we have power, even if it makes us uncomfortable. We need to be very fair in how we use our power. Sometimes you need to step back and take a deep breath and make sure you are using that power in a good direction in terms of the program and the people in it and not use it to intimidate people.

(Marie, a program director)

The staff certainly has more power than you when you are under their roof You have to try and go along with what they think is best otherwise you might be asked to leave... So, all of these house rules are being imposed on me, which I don't like. I'm not that happy about my discharge plan, either. But, I am cooperating. It's not what I really want, but I am trying to believe that they know what is best.

(Kellie, a female resident in her forties)

Kellie went on to say that she basically trusted the expertise of the staff and believed them to have her best interests at heart, but she never sounded fully reconciled, not to the house rules, not to her treatment plan, nor to the profound power imbalance she experienced.

As Kellie and Marie's comments imply, power differentials emanating from unequal control over crucial resources such as housing have the potential to bring elements of authoritarian control into relationships, even when participants prefer collaboration and mutuality. Client participants in one of the focus group interviews described a similar power dynamic. After a lengthy discussion about the friendly and collaborative nature of relationships between residents and staff, the residents clarified the difference between mutually developed treatment plans and worker-developed contracts that were automatically invoked whenever a resident used alcohol or drugs. Residents who "slipped" in this fashion were expected to read these staff imposed contracts daily and follow specific behavioral injunctions such as refraining from drinking and avoiding arguments. The penalties for not adhering to such contracts included eviction. Members of this focus group echoed Kellie's sentiments that the staff had considerable power over them in these situations but reasoned that the staff were the experts and knew what was best. As Theresa stated, "They know what's in our best interest; they must know better than we do, or we wouldn't be here in the first place."

The magnitude of the power to withhold housing resources from people who have been homeless cannot be overstated. Neither can the power to bestow such resources. This may, in part, explain the willingness of many of the residents to give up some of their power in exchange for residential services. Theresa and the other residents in this focus group did not express discomfort with the consequences involved in "slipping." They agreed that the policy was "for our own good." Although Kellie was not quite so convinced about the merits of her discharge plan, she was determined to go along with it. In her words, "When you are under their roof you are better off cooperating."

Discussion

There are several possible explanations for the willingness of clients to enter into relationships in which they relinquished control over personal decision making. Residents were apprised of the rules of the various programs before they decided to move in. Many may have made a conscious decision to give up some control over their lives in exchange for food, housing, and support. Some may have welcomed the opportunity to be mentored, particularly by workers they experienced as respectful and concerned. Clients who believed their workers to be compassionate and competent, found it reassuring to rely on their judgement. The image of a wise and caring guide, devoted to one's best interests, is an appealing one.

In his book, Checkerboard Square, Wagner describes his homeless subjects self- consciously weighing "the combination of physical necessity . . . the loss of independence and freedom, (and) alternative options available for survival" in deciding whether to make use of public shelters and other "institutions of control" (1993, p. 104). He proposes a typology consisting of accommodation to institutional systems, avoidance of institutions, and resistance to these systems, to explain many of the decisions of street persons. In Wagner's framework, the clients of the present study who chose to relinquish some of their freedom in exchange for residential resources would be seen as accommodators. They may have persuaded themselves that they preferred external control (mentorship), or pretended it did not exist (partnership). Both of these categories represent a trade-off between autonomy and independence on the one hand and goods and services on the other.

A somewhat different analysis would interpret clients' willingness to relinquish control as less a function of conscious choice that one of trained passivity. People who have spent years trapped in the mental health system have been socialized to rely on relationships where power is in hands of professionals. The role of psychiatry and the mental health system in enforcing and reinforcing passivity on the part of patients/clients has been discussed in the literature for decades (Chamberlin, 1978; Ferguson, 1984; Foucault, 1965; Rappaport, Reischl, & Zimmerman, 1992; Rose & Black, 1985; Saleebey, 1997; Szasz, 1970). The relationship between doctor/therapist and patient/client is understood by these theorists as characterized by the power and control of the latter at the hands of the former. As Foucault explains, the psychiatric patient learns that there can be no cure . . without obedience and blind submission" (1965, p. 186). Obedience to the authority of psychiatric experts leads to an internalized self-discipline, "an apparent passivity . . . (through which) the patient succeeds in being cured" (1965, p. 192). The psychiatrist wields enormous power over patients whose hope for discharge rests in acceptance of the prevailing power structure. In the words of ex-patient Judi Chamberlain:

The whole experience of mental hospitalization promotes weakness and dependency. Not only are the lives of patients controlled, but patients are constantly told that such control is for their own good. . . Patients become unable to trust their own judgement . . overly submissive to authority.... Patients are seen as sick and untrustworthy, needing constant supervision. Staff members are seen as competent knowledgeable, natural leaders (1978, p. 6).

The belief of many of the residents that "the staff knows best," needs to be examined in this light. All of the clients in the present study had been hospitalized and most had extensive psychiatric histories. They had been trained to doubt their own judgment and depend on the expertise of professionals. Indeed, as survivors of the streets and public social agencies, as well as the mental health system, these residents had numerous opportunities to learn that the path of least resistance often yielded the most material benefits. Lipsky (1980) suggests that client compliance results from:

. . . the superior position of workers, their control over desired benefits, and their capacity to deny benefits or make their pursuit more costly ... Client strategies include passivity, acquiescence, expressions of empathy with workers' problems, and humble acceptance of their own responsibility for the situation (p. 59).

The responses of many of the study's participants suggest that power imbalances can remain, often unexamined, even in the context of practice intended to be empowerment-oriented. Some of the workers acknowledged power disparities and expressed discomfort about them. They sought to minimize power imbalances but rarely discussed the issue of power openly with clients. This uneasy resolution echoes Lipsky's (1980) descriptions of workers who struggle "to resolve the incompatible orientations toward client-centered practice on the one hand and expedient and efficient practice on the other" (p. 51). Even where the workers studied sought to increase client control (over treatment plans, for example), "the structure of choices available to clients limits the range of alternative behaviors that they (workers) consider realistically available. In short, clients' consent is continuously being managed ...." (p. 57).

Some of the clients interviewed expressed displeasure about the power imbalances in their relationships with workers, others deemed it "for the best," while still others disavowed the existence of power differentials. This latter findings might be indicative of "denial" in the service of accommodation or it might be a response to differences in the degree of control. Many of the residents contrasted their current helping relationships with the more authoritarian ones they had experienced in the past, particularly in psychiatric hospitals. Present relationships were viewed as more responsive to their needs, and comparatively more equal. Most of the residents perceived their current workers to be competent, caring, and client-centered.

Conclusion

Despite considerable variation among the clients in their perceptions and preferences, several areas of commonality emerged. These clients cared about their relationships with their workers and had strong opinions about the extent to which power was or was not shared. The clients were aware and appreciative of the client-centered, strengths-oriented practice philosophy articulated and practiced by the staff. Numerous negative references were made to other settings where respect, dignity, and client self-determination were far less valued. They were very clear about their distaste for authoritarian relationships. Clients were clear about their preference for having input into any plans or decisions that have an impact on their lives. In view of the strong socialization towards compliance associated with mental hospitals (Chamberlin, 1978; Foucault, 1965; Szasz, 1970) and the public sector service system (Lipsky, 1980), this attitude of persistent self-determination speaks to the strength of spirit in these resilient men and women.

The interview data also suggest that even an agency that takes pride in its client-centered practice can be coercive in its relationships with clients. Many of the workers and clients identified distinct power imbalances. Due to the residential nature of the program and the homeless status of the residents, the staff's power to withhold resources was a particularly potent force.

Despite the imposition of social control associated with agencybased practice and the demand that workers serve as buffers between client, agency, and the state, the social workers in this study were compassionate, concerned, and client-centered. When other demands did not interfere with the goal of client empowerment, they embraced and practiced it, seeking to maximize client choice with sincerity and dedication. But, as Hasenfeld (1987) points out, the agency exerts considerable power over its workers, controlling their decisionmaking, constraining the type of information they process, limiting the range of alternatives available, and dictating the rules by which they will choose among alternatives.

The question remains as to whether social work practice can fully realize the goals of shared power, mutuality, and collaboration associated with feminist and empowerment-oriented practice models when client/worker relationships are embedded in a hierarchical power structure that simultaneously transcends and impacts on power relationships within the dyad. Practitioners seeking to practice from an empowerment-base would be well advised to examine and confront the sometimes subtle sources of power within their agency contexts and within their relationships with clients. It has been suggested that "social workers do not like to acknowledge having authority and power over clients" and, as a result, don't see that doing what they believe to be in the client's best interest is itself an expression of power" (Gitterman, 1989, p. 167). Social work practice that embodies the principles of empowerment and feminist philosophies must begin by clearly identifying and openly acknowledging all sources of power over clients in a collective effort to struggle against them. It also entails examining and resisting the sources of power over social workers, particularly organizational constraints that limit client/worker mutuality. This approach to practice may mean fighting the power of funding sources, accrediting bodies, agency hierarchies, and our own power as professionals.

Confronting imbalances in client/worker relationships and increasing client power includes helping clients to assert their legitimate claims to entitlement and rights within our agencies, increasing their expertise in manipulating the environment in order to achieve desired outcomes, and linking them to supportive social networks outside agency structures. Empowermentoriented social work practice also includes organizing and allying with client resistance and protest in situations where disruptive tactics are effective in obtaining needed resources (Hasenfeld, 1987). To reduce these power disparities, we will have to confront - and be prepared to give up - our power in relationship to our clients while simultaneously seeking to increase our power, through collective organizing and action, in relationship to our agency bureaucracies.

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Original manuscript received: October 30, 1997 Final revision received: May 14,1998 Accepted: March 29,1998

Marcia B. Cohen is associate professor, University of New England School of Social Work Biddeford, Maine. The author thanks the residents and staff of Ingraham, Inc., for their generous assistance with this project.

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