Abstract
Reimagining the Human Service Relationship, edited by Jaber F. Gubrium, Tone Alm Andreassen, and Per Koren Solvang, is an excellent collection of essays that explore and rethink the relationship between service professionals and service users. The book is divided into four sections that emphasize, first, the historical development of the human service relationship; second, service users’ shifting participation in human service relationships; third, changes in professionals’ relationships to human service; and fourth, reimagined service relationships in which equity and caring figure prominently.
The chapters range across a variety of professions concerned with service and caring, including service relations with “difficult” users—for example, young children, the homeless, and older people with identified cognitive deficits. As Andreassen notes in Chapter Two, co-morbidity is a feature of illness for service users but is rarely addressed by the professionals responsible for care. Indeed, given the ongoing discussions in the field about the impermeability of human service silos, this collection illustrates the possibilities that exist across service divisions.
The data on which the analyses are based are primarily qualitative. Some authors have been collecting data in the field of human service relationships for twenty or more years. Others are drawing on recent PhD research, at times with teams of researchers. The breadth of the research combined with the historical character of some of the data brings a depth to this volume that is unusual and certainly welcome.
In this review, I will summarize the sections and focus on one chapter that stood out for me. I will explore more fully those chapters that combine qualitative data from users and professionals with the limits imposed by professional dicta and address the administrative and technological boundaries that are propelling the shifts we see in the human caring relationship today.
Gubrium’s chapter “From the Iron Cage toEveryday Life” opens the collection. Heprovides a historical overview of the inside and outside of the service caring relationship.Gubrium proposes that reimagining the service relationship of both the professional and the service user collapses the traditional dichotomy of insider and outsider. The author identifies two trends challenging the traditional power of human service professionals. The first challenges expert knowledge—who knows, and what do they know? The second involves the increased involvement of service users in the human service relationship.The everyday practices of service providers and users are embedded in moment-by-moment decisions in which service policies are coordinated and moderated by front-line workers. Gubrium introduces a theme that runs throughout the volume: what does the human service relationship look like from the life world of both user and professional?
Part Two takes the historically invisible perspective of the service user. This section is perhaps the most ethnographically rich. Recognizing the various strategies and manners through which service users manage this relationship not only shows their active participation but also calls into question professionals’ assertions about what works in the caring process.
E. Summerson Carr’s chapter draws from an outpatient drug treatment program for homeless women entitled “Flipping the Script.” The chapter reveals the ongoing language work of homeless women as they learn and use the talk of the professionals working with them. Their language use is strategic and skilled, particularly in the context of evaluations of progress made by the professionals. Managing to “talk the talk” without necessarily following up with the “walk” is a learned and risky strategy the women use. Carr suggests that the women successful at flipping the therapeutic script were able to command the reason and agency of the professionals involved in the program, undercutting the very basis of the service relationship.Her analysis brings into view the imaginative, ongoing, and often unremarked reworking of the human service relationship by both professionals and service users.
Part Three shifts our attention from service users to the professionals with whom they interact. Topics range from disabled service users to elder-clowning in dementia care to the complex moralities encountered in family welfare. The analyses in this section are strikingly different from those in Part Two, emphasizing the disjunctures common to participation in human service relationships.
Amanda Grenier and Cristi Flood’s chapter takes up the notion of risk and how it shapes the everyday actions of professionals and service users. They note that with the introduction of new public management, the concept of risk has reshaped care settings. Risk is seen as an objective measurement, a concept for standardizing safety and security across care settings. However, their data show that in the context of care, risk is subjective and contradictory. Grenier and Flood point to risk as a contradictory factor (autonomy vs. safety) that restricts service users’ access to social resources and erodes the caring relationship.The authors suggest an alternative perspective: “the relatively uncharted territory of trust and the variable sentiments of enacting care” (p.203). They propose a relational model that balances risk and trust in order to address the organizational responsibilities of the professionals with the autonomy needs of the service user.
Part Four completes the circle promised by the title of the book—reimagined service relationships. The chapters describe a range of programs in which the human service relationship has been deliberately disrupted. All of the programs discussed are focused on strengthening the voice of the service user in relation to the professional voice. Throughout this volume authors have asked, what separates professional from service user? In this final section of the book, a second question appears: What happens when a professional becomes a service user? In other words, what happens when the apparently distinct lines of action become blurred?
Janet Newman’s article “Border Work: Negotiating Shifting Regimes of Power” uses the concept of “border work” to “focus on actors working the borders of contemporary policy and politics” (p.318) and to emphasize the power of reimagination and reflexive practice. In contrast to the other authors, she emphasizes the political character of organizational borders and of the border work done there. Newman uses the term “translation” to discuss the negotiation of contested meanings as they are enacted at the borders. These “spaces of power” are not necessarily organizational. The border work done in these spaces is done on the front lines of service, is often invisible, and is highly gendered. Newman notes that many of the current transformations in human service relationships are occurring during a time of austerity and cutbacks. She suggests that the possibilities for reinvigorating the human service relationship are to be found in the mutable borders of coproduction and participation among service professionals and users.
Reimagining the Human Service Relationship is a positive note in the current human service environment of austerity, cut backs,and top-down control of local care. Each chapter includes some imaginative possibilities for invigorating the care relationship.Taken as a whole, it is a well-balanced read that questions traditional assumptions about human service relationships as well as proposing strategies and describing programs in which transformation is already taking place.