Experience Of Powerlessness Research Articles

Racism in inpatient settings in Germany: professionals’ perspectives

Abstract Background Experiences of racial discrimination during healthcare encounters have increasingly been recognised as a source of health inequity. Narrative accounts by racialised healthcare users have dominated research in the field but it is equally important to capture the perceptions and practices of professionals to understand how racism operates in healthcare provisioning. This presentation asks: how does racism manifest in the German inpatient healthcare system (hospitals, rehabilitation facilities), and are there areas or phases of healthcare provisioning where racism is observed more frequently? Methods Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002). Results Racism occurs widely in German inpatient settings. It manifests both structurally, e.g. in the absence of professional translators for healthcare users with limited German skills, and interpersonally, e.g. in the form of microaggressions and stereotyping but also the witholding of treatment and verbal abuse. Targets of racism are both patients and staff, especially internationally recruited healthcare workers. Respondents thereby identify night shifts, psychiatric settings and the emergency ward as contexts where racism is more likely to occur. The hierarchical nature of and pervasive power asymmetries in hospitals thereby prevent effective interventions against racial discrimination. Conclusions Racism in German healthcare institutions requires multiscalar public health interventions, particularly at the level of the institutions themselves. These include the establishment of a robust and low-threshold complaints structure, spaces for self-reflection for professionals, and mandatory anti-racism training rather than a focus on diversity-sensitive competence. Key messages • In future research approaches, structurally determined reproductions of racism should be investigated using a multi-method approach. • Experiences of powerlessness are reported by both those affected by racism and those professionals who observe racism and should be addressed by the institutions.

Latent sibling violence

This article analyses latent violence to highlight important aspects of our empirical data: qualitative interviews with women who have been subjected to violence by their siblings. The concept points to the fear experienced by victims in close relationships, and the adaptations they make to avoid violence. Although the concept has been applied to family and intimate partner violence, it is also useful to describe sibling violence. Latent violence occurs when violence is not openly acknowledged; indeed, sibling violence often goes unnoticed. This invisibility can be associated with experiences of powerlessness and unpredictability for victims, who may have difficulty defining their experiences. While we emphasize the vulnerability described in the interviews, we also highlight and explore the interviewees’ strategies of resistance. Our interviewees describe how they created alternative safe spaces in spite of the violent context in which they lived, including the use of hideouts and secret refuges, outdoor places as well as fantasy spaces or escape plans. Their strategies show that children subject to latent sibling violence should be understood not as passive victims, but as actively strategizing to cope with situations that many cannot escape due to their age and lack of parental understanding.

‘If you wanna have an easy life in secure, you have to bite your tongue’: Children’s narratives of power, voice and resistance in the children & young people secure estate

Locking up and detaining children and young people is and should be a human rights issue per se (Aymer et al., 1991). The United Nations Convention on the Rights of the Child provides that ‘no child shall be deprived of his or her liberty unlawfully…the restriction of liberty shall be used only as a measure of last resort and for the shortest appropriate period of time’ (United Nations General Assembly, 1989). It follows on to state that legal safeguards should be put in place to protect children’s human rights in settings where their rights and liberties are restricted. Despite this there is overwhelming evidence that in the Children and Young People Secure Estate (CYPSE) in the United Kingdom, children’s rights are inconsistently and excessively restricted, suggesting insufficient protection of their human rights (Goldson, 2006). Although the CYPSE is a highly restrictive setting in which children and young people are deprived of their rights and liberties for welfare or criminal justice reasons, there has been very little focus on power, voice, participation and human rights within these settings. In this article the authors outline the narratives of nine children and young people detained in the CYPSE through semi structured narrative interviews. Analysis of the interviews produced themes around experiences of powerlessness, control and restriction, voice & participation and resistance. This paper presents a detailed focus on the narratives around voice and resistance. The authors offer critical insights into how the lived experiences of children and young people in these settings strengthens the need for practice and policy to be informed by children’s rights, power and participation. Implications for how clinical psychology is enacted in these settings is also explored and interrogated, with a deconstruction of the role of a Clinical Psychologist.

Measuring needs-based quality of life and self-perceived health inequity in patients with multimorbidity: investigating psychometric measurement properties of the MultiMorbidity Questionnaire (MMQ) using primarily Rasch models

BackgroundMultimorbidity is a burden for the individual and to the healthcare sector worldwide, leading to a rising number of intervention studies towards this patient group. To measure a possible effect of such interventions, an adequate patient-reported outcome measure (PROM) is essential. The aim of this study was to assess the draft MultiMorbidity Questionnaire (MMQ), a PROM measuring needs-based quality of life and self-perceived inequity in patients with multimorbidity, for its psychometric properties and to adjust it accordingly to create a content- and construct valid measure.MethodsThe draft MMQ was sent to 1198 eligible respondents with multimorbidity. Modern test theory and classical test theory were used to analyse data. Dimensionality of the suggested domains and invariance of the items were assessed through item analysis, examining the fit to a psychometric model.ResultsThe psychometric analyses were based on responses from 390 patients with multimorbidity. In the MMQ1, measuring needs-based QoL, evidence of six unidimensional scales was confirmed: physical ability (6 items), worries (6 items), limitations in everyday life (10 items), my social life (6 items), self-image (6 items), and personal finances (3 items). The psychometric analyses of the MMQ2 outlined four unidimensional scales measuring the feeling of Self-perceived inequity in patients with multimorbidity: experiences of being stigmatised (4–5 items), Experiences of insufficient understanding of the burden of disease (3 items), Experiences of not being seen and heard (4 items), Experience of powerlessness (5 items). These scales are relevant for patients’ with multimorbidity encounters with (1) their general pratitioner, (2) staff at their general practitioner’s surgery, (3) healthcare professionals, (4) staff at the local authorities and (5) friends, family, and others.ConclusionThe MMQ, a QoL measure for patients living with multimorbidity has been validated: the MMQ1 is a condition-specific PROM with adequate psychometric properties designed to measure needs-based QoL. The MMQ2 measuring Self-perceived inequity, has also been found to possess adequate measurement properties; however due to the risk of type 2 error a revalidation of MMQ2 is suggested.

Parole hustle: a preliminary study on the lived experiences of females serving parole in Nelson Mandela Bay

PurposeThis paper aims to shift from the male offender perspective in attempts to explore the stories and lived experiences of five females on parole in Nelson Mandela Bay, as most correctional research in South Africa focuses on the male offender experience. The experiences of females are largely ignored both in terms of reform and in research, and while only a few South African studies on female criminality have emerged, little is known about the impact of incarceration and reintegration on their livelihoods.Design/methodology/approachThis paper makes use of an ethnographic approach as the narrative follows the complex realities of females on parole to include their voice, depth and experience in the debate within the parole experiences measure framework. This study made use of five individual interviews and observations, which were complemented by existing literature.FindingsThis paper provides insights on the experiences, vulnerabilities, challenges, fears and concerns of females on parole and the relative social costs of their incarceration. The experiences allow for a deeper understanding of the shades of their experiences of powerlessness, gender-specific sexualisation and exploitation, economic vulnerability and destitution and social alienation and exclusion which uniquely influences behavioural and emotional deficits.Research limitations/implicationsBecause the number of females on parole in Nelson Mandela Bay is few, this study could only interview five female offenders. Yet, as this study is ethnographic in nature, it offers a deep understanding of these five female offenders.Practical implicationsThis research offers an insight into the social ills faced by female on parole. This work highlights the effects of incarceration are often felt by females long after their release since their experience of imprisonment affects their future prospects, damaging and debilitating. This paper suggests self-reclamation that could lead to positive reactions towards rehabilitative and reintegration. This research opens up the larger debate and does not offer tangible recommendations.Originality/valueThis paper fulfils an identified need to study parole amongst female offenders.

Public coping discourse in response to government health crisis communication

PurposeThis study aims to explore public coping strategies with government-imposed lockdown restrictions (i.e. forced compliance) due to a health crisis (i.e. COVID-19). This directly impacts the public's power, as they may feel alienated from their environment and from others. Consequently, this study explores the relationships between the public's power, quality of life and crisis-coping strategies. This is important to help governments understand public discourse surrounding perceived government health crisis communication, which aids effective policy development.Design/methodology/approachAn online questionnaire distributed via Qualtrics received 371 responses from the South African public and structural equation modelling was used to test the hypotheses.FindingsThe results indicate the public's experience of powerlessness and resulting information-sharing, negative word-of-mouth and support-seeking as crisis coping strategies in response to government-imposed lockdown restrictions.Originality/valueThe public's perspective on health crisis communication used in this study sheds light on adaptive and maladaptive coping strategies that the public employs due to the alienation they feel during a health crisis with government-forced compliance. The findings add to the sparse research on crisis communication from the public perspective in a developing country context and provide insights for governments in developing health crisis communication strategies. The results give insight into developing policies related to community engagement and citizen participation during a pandemic.

Family inclusion in child protection: Knowledge, power and resistance

The inclusion of families throughout the child protection process can improve lifelong outcomes for children who have been removed from their parents’ care. However, child protection authorities have struggled to prioritize principles of family inclusion within systems that position families as risky. While parents’ experiences of powerlessness within child protection systems have been well documented, little is known about parents’ perspectives on family inclusion specifically. We engaged six parents who had experienced removal of children from their care in interviews and focus groups as part of a larger study that examined practitioners’, carers’, lawyers’ and parents’ views on family inclusion in Australia. In this article we report on parents’ experiences and recommendations for improving family inclusion. Through the analytical framework of Foucauldian concepts of power, knowledge and acts of resistance we highlight the complexities of parents’ lives and intersections in their experiences of systemic and social exclusion. In identifying the importance of collaboration, decision making and parental identity these findings suggest that the advocacy of parents for inclusion in the lives of their children is an underutilized asset in child protection systems.

Experiences of powerlessness and the limits of control in healthcare

ABSTRACT To what extent are experiences of powerlessness explained as involving a loss of control, and to what extent are attempts to increase patients’ control suitable as means of addressing these experiences? In this paper, I present some findings from a recent project in the phenomenology of powerlessness to argue that in response to experiences of powerlessness, the ideal of control has limited use in either a diagnostic or therapeutic function.

Health professionals' reflections on existential concerns among people with obesity.

This study aimed to describe health professionals' reflections on existential concerns among people with obesity when attempting to support them in their lifestyle change processes. For many of those affected by obesity, the condition becomes lifelong and causes existential concerns. The health professionals' reflections on existential concerns among people with obesity may influence central aspects of their practice and their patients' well-being. Eighteen health professionals with relevant health education working in three different treatment programmes for people with obesity were recruited for three focus group interviews. The interviews were analysed and interpreted using a model for interpretation of meaning at three levels with a phenomenological-hermeneutical approach. The analysis identified three themes. The health professionals reflected on existential concerns among people with obesity in terms of patients' repressed emotional difficulties and lack of self-respect. In addition, they reflected on their own experiences of powerlessness when presented with people with obesity's existential concerns. The present study provides valuable insights into reflections on existential concerns among people with obesity, based on health professionals' descriptions. We believe that these insights add to the existing literature and have consequences for how people with obesity are met and cared for.

Policy Alienation in Frontline Social Work – A Study of Social Workers’ Responses to a Major Anticipated Social and Health Care Reform in Finland

ABSTRACT Change in the policy and ideology governing social and health care has been much debated in the Western welfare states, including in Finland, where the public sector has witnessed a shift towards a market and managerial ideology in a climate of austerity. These changes affect organisations as well as individual workers. Social workers implement social policies in their daily work, and are thus positioned in between policies and clients. This may expose them to feelings of unease in the implementation of certain policies. In this study, we apply the policy alienation framework of Tummers and colleagues (2009. “Policy Alienation of Public Professionals: Application in a new Public Management Context.” Public Management Review 11 (5): 685–706) in analysing the responses of social workers to a major social and health care reform prepared in Finland in 2015–2019. By applying problem-driven content analysis to interview data, we study how social workers responded to the proposals for reform, and how the two dimensions of policy alienation, i.e. experiences of meaninglessness and powerlessness, were manifested. The findings suggest that policy alienation is widespread among social workers and that experiences of powerlessness and meaninglessness are common. The social workers experienced powerlessness in relation to specific policies and practices. They also viewed the reform as meaningless, as it lacked socially relevant goals.

Prospect Theory in Times of a Pandemic: The Effects of Gain versus Loss Framing on Risky Choices and Emotional Responses during the 2020 Coronavirus Outbreak – Evidence from the US and the Netherlands

ABSTRACT During the 2020 coronavirus pandemic, governments across the globe relied heavily on the legacy media, not only to inform citizens about fast-paced developments in the midst of a crisis, but also to stimulate compliance with strict interventions. Prospect theory postulates that gain versus loss framing may affect preferences for different interventions. In a conceptual replication of Tversky and Kahneman’s seminal prospect theory, findings from surveys in the US and the Netherlands (N = 1,121) demonstrate that gain frames of the coronavirus promote support for risk-aversive interventions, whereas loss frames result in relatively more support for risk-seeking alternatives. Loss frames elicit stronger negative emotions, such as frustration and powerlessness. The experience of powerlessness, in turn, mediates the effects of loss versus gain frames on support for stricter interventions. Together, these findings indicate that framing the pandemic in terms of gains may be most effective in promoting support for risk-aversive treatments of the pandemic.

Living to Die, Dying to Live: Another Look at Suicidality

Using a clinical example, I explore the dynamics and the analyst’s response to suicidal fantasies, particularly when the patient’s grief and loss resonate with her own. This paper pushes beyond the accepted complex dynamic meanings of suicidal preoccupation by suggesting that along with the wish to end one’s life may paradoxically lie a wish to re-imagine it. While the threat of suicide can foreclose and narrow the interpersonal field, it also, at times, has the power to reframe it and bring new life to stale narratives. Standing in contrast to its destructive potential, the desire to suicide may be a call to give birth to a self that has, heretofore, eluded expression and recognition. Examining these aspects, while also parsing out degrees of risk, brings new awareness and acceptance to shared experiences of powerlessness and the possibility for change.

"Beyond the Boundaries of Care Dependence": A Phenomenological Study of the Experiences of Palliative Care Nurses.

Dependence is a common life experience and innate condition for human beings due to their bodily and relational essence, but in contemporary society, it has become a stressful condition. Care dependence is central to nursing, and patients with advanced cancer are often dependent on care. Understanding nurses' perceptions of care dependence can contribute to awareness of the impact it has on nurses. The aim of this study was to explore palliative care nurses' experiences and perceptions regarding patient dependence. Sixteen nurses taking care of dependent patients in a palliative care center in Rome were interviewed. Giorgi's descriptive phenomenological method was used. Nurses caring for dependent patients transcend the boundaries of dependence. Care dependence is an experience of powerlessness and regression. A patient's life in dependence is precarious, as they have to overcome the daily limits of life. Taking care of dependent patients requires nurses to manage the unmanageable and to know and to embrace change from within in order to build positive relations of personal closeness and reciprocal self-giving. Nurses should be aware that self-transcendence and the consequent positive relations could make the difference in the experience of care dependence and promote personal growth for both patient and nurse. Positive and transcending relationships can transform care dependence into the opportunity to find meaning and purpose in life. The study highlights what nurses feel in caring for dependent patients. Understanding nurses' perceptions is important to delineate a proper caring for dependent patients.

Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood: A case study exploring the role of social determinants of health

BackgroundPregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women’s experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors.MethodsIn this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material.Results21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child’s father. Social support and personal coping styles provided relief for some participants.ConclusionsThis study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women’s health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process.

The Powerless Therapist and the Helpless Borderline: Acceptance, Aloneness, and Dyadic Joining

ABSTRACTThe encounter between therapist and borderline patient brings with it a humbling experience of powerlessness. The therapist or helping agent must confront her or his own feelings of inability to change anything in the patient's mental or material life. With this comes a corresponding reality that the locus of therapeutic action remains very circumscribed indeed. Many therapists, particularly new ones to the field, may feel overwhelmed by anxiety, grief, guilt, and fear, tempting them to jump precipitously into interpretations or thinly veiled advice-giving—or, alternatively, to deflect emotion with hollow “empathic” mirroring. By actively getting in touch with and using his or her experience of powerlessness, however, the therapist can find a way forward that relies on dyadic joining and a more useful conception of the therapist/patient system (whose dynamics, as we will see, are also increasingly clarified thanks to emergent neuroscience findings). Central aspects of this approach have been present since borderline first appeared in the literature, continuing through more recent contributions, notably those of Marsha Linehan and the Dialectical Behavior Therapy (DBT) school.

Social work undergraduates and service users as co-learners and researchers

The article presents an analysis of the process and content of an undergraduate social work research seminar conducted with service users in Israel. The seminar focused on human rights and the experiences of service users as they attempted to access their rights. Analysis of the seminar process revealed three classroom phases, similar to normative group stages of development. Discourse content analysis revealed two major themes. The first focused on role relationships between the students, the service users and the institutions responsible for provision of rights and entitlements. The analysis exposed power imbalances as experienced by the service users in their relationships with social work professionals and the institutions responsible for rights provisions. Moreover, students’ experiences of powerlessness in their roles within those institutions were articulated. The second theme addressed the significance of the joint service user and student platform and the importance of meeting within the academic context. Students and service users expressed their sense that the seminar partnership was a meaningful experience. The analysis sheds light on the process of engaging students and service users in partnership work and on those areas that may contribute to advancing our understanding of the role of service users in social work education.

Harassment at the Workplace, Powerlessness and Identity: Experiences of Women Civil Servants in India

Women civil servants have to put up an incessant fight to assert and defend their ‘identity’ in Indian workplaces. The article discusses the perception of women civil servants based on semi-structured interviews that were audio-taped and transcribed. The discussion is situated within Indian culture that elevates woman’s status to that of a deity (Basham, 1954) but practises rampant discrimination through dowry harassment, violence within the family and harassment at workplaces. The role of women civil servants produces sharp tensions between perception and reality; as civil servants, the women attempt to reconcile men’s perceptions of women with their true identity and capabilities. The purpose of the study is to examine how this affects women’s life and work. The methodology adopted is the case study with narrative inquiry supplemented by the Listening Guide (Gilligan et al., 2003) and voice poems (Gilligan, 1993) to comprehend the views of the respondents. The analysis and findings highlight the cognitive, emotional and behavioural defences used by women civil servants. They attempt to reconcile their experience of powerlessness at the workplace with the sense of power that accrues to their socially ascribed position.

Dismantling Powerlessness in Addiction: Empowering Recovery through Rehabilitating Behavioral Learning

Addiction is characterized by a subjective experience of powerlessness over one's behavior. Those who wrestle with addiction affirm their experience of powerlessness, and therapists trained in 12-Step models validate that experience—making powerlessness a core phenomenological, theoretical, and clinical tenet commonly applied to addiction. In a previous, companion paper (Butler, Call, Meloy, & Zitzman, 2014), we presented a straightforward model of behavioral learning processes capable of producing overpowering habituation and ritualization of behavior, comprising a significant yet often overlooked dimension of powerlessness in addiction. In this article, we apply the learning model to the task of overcoming powerlessness in addiction through rehabilitating learning. A learning model can capture and convey the neurobiological processes underlying addiction and recovery in a way that is readily accessible to clients—both in terms of understanding and intervention. Understanding learning processes not only illuminates mechanisms of powerlessness, but can also empower recovery, showing how behavioral learning can be rehabilitated for recovery. First, we describe the rehabilitation of addictive learning and the dismantling of powerlessness for recovery in academic terms. Then we describe the model as we would to a client—in terms of ordinary, everyday experience and metaphors. The intent is to provide therapists a way to explain and demystify powerlessness for their clients, using a model and language that are accessible, meaningful, and resonant with everyday understanding, thereby empowering clients for self-help intervention for recovery.

Deconstructing Mechanisms of Powerlessness for Clients Seeking Recovery: Learning to Be Powerless Over Addiction

Addiction is characterized by a subjective experience of powerlessness over one's behavior, yet articulation of precise mechanisms of powerlessness is essential to inform recovery. We assert that straightforward behavioral learning processes produce powerful habituation of behavior and comprise a significant but overlooked dimension of powerlessness. A behavioral learning model captures this neurobiological mechanism of habituation and addiction, while informing intervention in everyday terms. After presenting the model, we then describe it in more accessible instructional language that might be used with clients. A second paper (Butler, Meloy, & Call, 2014) articulates how a learning model informs rehabilitation of learned powerlessness, for recovery. The model can be presented psychoeducationally or clinically.

The Power of Man in Fromm’s Humanistic Ethics

Erich Fromm analyzed how man is divided in his sense of true self. This division within forces him to cling to abstract and concrete entities outside of himself and Fromm calls this which he, after all, borrowed from Freud. This transferring of man's individuality to outside forces brings temporary relief to his experience of powerlessness and loneliness. The transference makes man acquire a masochistic character wherein he submits himself to outside irrational forces that perpetually dehumanize him. This is the reason why his ethics is a struggle to bring back the power of man within, nursing his potentialities to change himself and transform his world. Ethics, for Fromm, is a form of normativity which leads man into freedom to fully actualize his own sense of self.