Communication, Relationships and Care

A Reader

Sheila Barrett, Carol Komaromy, Martin Robb, Anita Rogers

• Publisher: Routledge
• Year: 2004
• Topic: Social Sciences
• eBook ISBN:
  9781134358229
• Subtopic: Health Care Delivery
• Index: Social Sciences

Communication and relationships have become an increasing focus of attention in debates about the future of health and social care. People working in care services are being encouraged to improve communication processes, to develop more participatory relationships with service users, and to work more closely in partnership with other professionals. This Reader provides a comprehensive collection of literature that aims to enable those involved in care services, as workers, carers or service users, to reflect on their everyday interactions and to situate them in wider contexts. Including new material from the frontline of research and practice, as well as some classic readings, this wide-ranging volume emphasises the need to see interpersonal communication as embedded in relationships, and to take account of issues of power and diversity, as well as the emotional dimension of care work. Covering both health and social care, the Reader is divided into four sections, focusing on: * concepts and contexts * analysing aspects of communication * the person in the process * communication and relationships in organisations. Communication, Relationships and Care will be an essential resource for students of social work, nursing, health and social policy, and for all involved in health and social care services, whether as professionals, carers or service users. It is a set book for the Open University's second level undergraduate course Communication and Relationships in Health and Social Care (K205).

PART I
CONCEPTS AND CONTEXTS

INTRODUCTION

Martin Robb

The chapters included in Part I introduce some of the key concepts, or ways of thinking about communication and relationships, that are developed in different ways throughout the Reader. They also place interpersonal communication in care settings in the personal, institutional and social contexts that help to shape them.

The first two chapters engage with the question of what is meant by ‘communication’ and ‘relationships’ in the context of health and social care. Although Chapter 1, ‘Communicating humans . . . but what does that mean?’ by social anthropologist Ruth Finnegan, does not make specific reference to care, its approach has important implications for thinking about interactions in care settings. Finnegan argues that communication is a basic human process, rather than a separate or specialist activity, and one that embraces a wide range of activities and uses a multitude of resources. In this view, communication is also an interactive process, in which those involved jointly construct the meaning of their interactions. In Chapter 2, ‘Relationship-based social policy: personal and policy constructions of “care”’, researchers Jeanette Hen-derson and Liz Forbat use examples from their own and others’ research in the area of informal care to present a view of care as fundamentally relational. Like Finnegan, they emphasise the active involvement of all participants in the process, at the same time challenging fixed views of the roles played by ‘carers’ and ‘cared for’. Instead, they pursue the idea that the roles played by people in caring relationships are many-sided and complex, with an important emotional dimension.

The second pair of readings builds on these introductory chapters by focusing on communication in two different contexts, while also exploring the ways in which contexts shape communication. In Chapter 3, ‘Giving voice to the lifeworld’, by Barry et al., the authors, who are all involved in different ways in medical education, discuss communication between doctors and patients in general practice. The research reported on here uses the work of the medical sociologist Mischler, who called the voice of the doctor the ‘voice of medicine’ and that of the patient the ‘voice of the life-world’. The study reveals the complex use of these two voices and discusses different communication strategies used by doctors and patients. Chapter 4, ‘Life choices: making antenatal screening decisions’ by writers and researchers Carol Komaromy and Angela Russell, is based on a study of the way that pregnant women and their supporters make decisions about screening. It explores the ways in which different elements of context, both personal and institutional, frame the decision-making process.

The next three readings engage with some of the ways in which the context of interpersonal relations in care services is changing. One of the main developments in health and social care in recent years has been a move away from relationships based on paternalism and towards a degree of service user participation. In Chapter 5, ‘Experience and meaning of user involvement: some explorations from a community mental health project’, researchers Carole Truman and Pamela Raine make use of their own study of a community mental health project to explore the meanings of user involvement for those taking part, as well as some of the barriers to meaningful participation. A key element of changing practice in interpersonal communication in care services, and in society more generally, has been the growing influence of counselling as a model. In Chapter 6, ‘Cultural and historical origins of counselling’ John McLeod, an established writer and teacher in this field, situates the growth of counselling in its cultural and historical context. Viewing counselling as bound up with developments in western societies in the last century, McLeod argues for regarding it as one approach among many, rather than as a universal panacea. Following on from this discussion, Chapter 7, ‘Communication culture: issues for health and social care’ by Deborah Cameron, an academic and writer on language and social issues, takes a critical look at the increasing emphasis on ‘communication skills’ in care services.

Another important area of change is in ideas about communication and relationships. Elsewhere in this Reader, a range of theoretical perspectives on interpersonal relations is represented, including humanist approaches (see Chapter 19, by Carl Rogers) and psychodynamic perspectives (see Chapters 30, by William Halton and 32, by Jon Stokes). In Chapter 8, ‘Postmodernism and the teaching and practice of interpersonal skills’, Helen Jessup and Steve Rogerson draw on their experience of teaching interpersonal skills to social work students as they challenge these largely psychological approaches. Basing their critique on the theoretical work of Michel Foucault and the radical educational practice of Paolo Freire, Jessup and Rogerson advocate what they describe as a postmodern approach to teaching interpersonal skills – one that is oriented to radical social change. The final reading in this part of the book explores the implications for practice of adopting this kind of critical theoretical approach. In Chapter 9, ‘Practising reflexivity’, Carolyn Taylor and Susan White, who are also involved in social work education, argue that a truly reflective approach to practice involves being critically aware of the values and assumptions that we bring to our interactions and relationships.

CHAPTER 1
COMMUNICATING HUMANS . . . BUT WHAT DOES THAT MEAN?

Ruth Finnegan

Like other living creatures human beings interconnect with each other. When you come to think about it, this is actually something remarkable – that individual organisms are not isolated but have active and organised ways of connecting with others outside themselves; that we can reach out to others beyond the covering envelopes of our own skins.

How do we do it? And what resources do humans have at their disposal for achieving this? The answer is in a way simple: we work through the resources of our bodies and of our environment. Unpacking that short statement is less easy, however. It leads into a vast and wonderful field of the complex resources that human beings draw on to interconnect with each other . . .

Rather than plunging at once into definitional issues let us start with four short examples. [. . .]

COMMUNICATION AND HUMAN INTERCONNECTEDNESS

Three people are standing around discussing a recent event they all feel strongly about. They are interchanging spoken comments, partly taking turns, partly interrupting, capping and overlapping each other, and formulating their annoyance and surprise through gesture and body positions as well as words. One shows round a memo, pointing to specific bits of it, additionally inflaming their anger. They gasp, tut-tut or ‘hm’ from time to time in acknowledgement or agreement (partial at least) with each other’s comments and actions, or as a way of expressing ironic or mock-incredulous reactions. One is more lukewarm, but all three show their active involvement through mutually recognised actions like eye contact, direction of their gaze, body movements, facial expressions, postures, and occasional touches. They move in to stand closer, and increasingly formulate and build up a shared sense of indignation about what had happened.

Face-to-face interaction among a small number of people is one obvious instance but not of course the only context for communicating. Take another example. Among the highlights of the year among the Limba rice farmers of northern Sierra Leone in the 1960s were the rites surrounding boys’ initiation into manhood. The night before the boys were taken off to be secluded in the bush there was a grand and public ritual thronged with hundreds of people from throughout the chiefdom. The boys wore the special garb traditional for these rituals, an obligatory mark of the occasion. All through the night they displayed their prowess in special dances, incredibly vigorous and demanding with powerful gymnastic gyrations and hand-springs. Expert drummers sounded out the emotive patterned beats appropriate for the occasion, engaging both dancers and spectators over the long hours with their body-stirring rhythms. Whistles were blown, songs sung, and the crowds, above all the principals in the rite, contributed their shouts and movements. Every now and then friends or relatives rushed up to touch one of the dancers or give a gift in token of their support and admiration. Speeches of welcome and admonition were made by local dignitaries. Fires and lamps lightened the gloom, itself part of the atmosphere. So too was the olfactory ambience from the aromas of food, palm wine, closely touching crowds and perspiring dancers. Through these colourful performances people marked the public validation of the boys’ approaching status-change, a major occasion for the community, enacted through these highly specific and recognised multisensory processes. Individuals signalled their personal allegiances and involvement, the boys demonstrated their fitness for elevation to manhood, and through their speeches the elders conveyed both their own leading positions and what they presented as the age-old values of malimba ma, ‘the Limba way’. All these multiple communicative processes were mediated not through publication in writing but through publicly shared and multifaceted enactment.

Humans also interconnect at greater distances – not so easy perhaps but made possible through our ingenious uses of material objects and technologies. So as a third example consider a personal letter and photograph sent through the post. Simple at first sight, this again has multiple dimensions, though in different ways from the other two cases. The visual marks on the material page – written words, format, punctuation, handwriting – are one obvious dimension. But others matter too. Even before the letter is opened up, the envelope and its handwritten address visibly declare its specific character not only to the named addressee but also to others in the household where it is delivered. The appearance and feel of the paper and the layout on the page are relevant too, accepted conventions which in this case clearly indicate personal intimacy not officialese. So are the handwriting, the nonverbal visual signs (a squiggle of a diagram, x’s at the end (for kisses), exclamation marks), the crackle of paper and envelope, and, not least, the enclosed photograph, a human-made artefact which also plays its part. The communicating is experienced in the context of (more, or less) shared understandings and associations between the various participants – participants who include not only letter writer and addressee but in this case a number of other people involved in different ways and at various removes, including others in the recipient’s household among whom the letter is mentioned or read aloud, the photograph circulated, or the interpretations formulated – some more interested or more directly involved than others. And if time passes and the letter and photograph are looked at again, other forms of interconnecting may come into play for those later users. The specific ways in which people engage in ‘mediated’ communicating of this kind vary with different individuals, contexts and conventions. But the communicative process is always likely to be more complex than just a chunk of information transmitted once-and-for-all by fixed marks on a sheet of paper.

The final short example is one where the enactors were involved in yet further temporal and spatial dimensions beyond the momentary occasion: the memorial service for the British Poet Laureate Ted Hughes in May 1999, a large-scale ritual in Westminster Abbey drawing on the multiple resources conventionally deployed on such occasions. There were jointly sung hymns; choir anthems; a visually colourful procession; organ, piano and guitar playing; the olfactory and spatial ambience of the building; the closely-pressed throng; spoken and read words; and a ringingly declaimed oration. And then came the dead poet’s unseen voice reciting ‘Fear no more the heat of the sun’, with all its resonating associations for an English-speaking gathering.

One by one, line by line, the looking stopped and the listening went on: ‘The sceptre, learning, physic must, all follow this and come to dust’ . . . And now for a few moments, he was back with us. It was as though he was moving from the pews of the living into the poets’ corner of the dead . . . The crowd that flowed away out of the Abbey was both different from and the same as the one which arrived.

(Stothard 1999: 24)

The occasion drew not only on written and remembered words, first formulated centuries ago and long handed-down through people’s creative chains of experience, but also on recent auditory technology for storing and transmitting recorded sounds, all set within a multidimensional process with its plurality of participants.

These four short cases . . . assume a view of ‘communicating’ that is not confined to linguistic or cognitive messages but also includes experience, emotion and the unspoken. Communicating is envisaged as creative human process rather than transport of data or meeting of ‘minds’, and goes beyond the preoccupation with ‘information’ and ‘the information revolution’ typical of much current discussion. It encompasses the many modes of human interacting and living, both near and distant – through smells, sounds, touches, sights, movements, embodied engagements and material objects.

These interconnecting processes are necessary ones for collective human life. We humans are notably social animals. We live in interacting groups, larger or smaller depending on the context and purpose. Through these we bring up our children, order our affairs, make decisions (the disputed and disastrous...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• INTRODUCTION
• PART I: CONCEPTS AND CONTEXTS
• PART II: ANALYSING ASPECTS OF COMMUNICATION
• PART III: THE PERSON IN THE PROCESS
• PART IV: COMMUNICATION AND RELATIONSHIPS IN ORGANISATIONS