SOME PREDICTABLE CAUTIONS CONCERNING THE OVER-EMPHASIS AND OVER-RELIANCE ON PERSON-CENTRED PLANNING

by Michael J. Kendrick, Kendrick Consulting International

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Introduction

The broad field of disability has long had available to it various forms of personal-level planning methodologies, though many people may lack a historical appreciation of this fact. It is also been true that a keen and prominent interest in people as individuals is not new. Nor are the values that highlight individualism, autonomy and choice an invention of recent times. Equally, the recognition of the danger of group stereotypes and practices pre-empting individual identity is not at all a new insight. Lastly, this is not the first generation that has seen the value of being open to the crucial role of hopes and dreams, and to the value of ‘imagining better’. Yet one could get the sense from the recent elevation of person-centred planning approaches, by all sorts of jurisdictions, that the use of these ought to always be a ‘given’ or an essential of good practice. It may surprise many people that a more sensible approach to person-centred planning would not be its uncritical adoption, but rather a more historically informed caution and scepticism about what its proper role might be.

This is not intended to be a suggestion that formal person-centred planning systems ought not to play a role, but rather that the best way to do this would be to take into account what their likely limitations are. The following points will help make this clearer.

Effective person-centred practices are profoundly dependent on person-centredness being present in the people involved

The simplistic, bureaucratic and widespread adoption of individualised planning methodologies can frequently be done in such a way that an assumption is made that it is the method(s) and their use that contain the answers for what people need. A closer examination would reveal that none of these methods can work if they are not undertaken by people who have cultivated in themselves the capacity to enable the person to remain at the centre of all thinking. If this is so, then it is important to consider what harm may come to people whose lives and well-being are now officially dependent on such processes. People with an historical understanding of what the absence of the right attitudes and outlooks have meant in earlier versions of personal planning can well appreciate how soulless, distorting and bureaucratic such mandatory processes can become.

Personal planning is deeply dependent on the ability to negotiate its conclusions into existence

Even if various efforts at personal planning were productive and beneficial, it would still leave the person vulnerable to an ongoing necessity to bring the hopes and dreams that are generated into existence. As anyone who has negotiated with agencies and bureaucracies knows, having an idea is not the same as having the authorities agree to its proper implementation. At the same time ‘dreams’, without the practical means to achieve them, can be quite dysfunctional and disappointing if the person is not properly reconciled to this difficulty. Oddly enough, most person-centred planning methodologies are surprisingly mute on this point, and do not usually give direction to adherents as to how such a crucial obstacle is to be overcome. This is because person-centred planning methodologies are acutely limited in this regard, and cannot routinely, or even occasionally, assure successful negotiation outcomes. If one attends carefully to what their proponents offer on this subject, it will quickly become obvious that they typically have no engagement on the question as to how negotiations might proceed and what assures the best outcomes. It is not even necessary that they do so, as long as this limitation is properly factored into expectations.

‘Dreams’ need to be defended and upheld frequently in order to come into being and thrive

As any seasoned advocate knows, today’s services and systems cannot be counted on in any dependable way to implement people’s dreams with a measure of integrity. This is not meant to suggest that they necessarily oppose these dreams, or want to see such dreams thwarted. Rather, it means that keeping a person’s dream alive in today’s very imperfect services can be quite challenging. The cost of such ‘dream advocacy’ for staff, families and supportive administrators can be considerable, as there are any number of forces at work that tend to undermine or deflate the full potential of people’s lives. Needless to say, a few sessions of person-centred planning, even when beneficial, cannot be expected to offset these persistent and often perverse influences. Dreams ought to be encouraged and explored, but with care not to underestimate their vulnerability once taken up by formal services.

The incentive to rely on standardised ‘off-the-shelf’ service models is formidable

Our services and systems make it much easier to select a prearranged service or support model, rather than to create something new ‘from scratch’ around an individual’s unique needs. In fact, both service users and professionals share a common desire to achieve results with the least hassle. The convenience of simply doing what everyone else is doing is simply much easier than generating a ‘model’ or support arrangement that is distinctive and individualised. It should not surprise us that many people will take the easier, less contentious and more ‘authorised’ route of conforming to the system rather than challenging its assumptions. Yet, to properly follow a person’s dream into its practical realisation may necessarily cause a disruption to conventional practices, and bring about the introduction of non-standardised answers to people’s needs and hopes. Most person-centred planning systems do not go all that far in providing the kind of ongoing support and dissidence necessary to bringing into existence something unique and worthy.

Services and service systems do not normally complement person-centred planning with an unambiguous authorisation to negotiate service models

It is quite striking that very few of the services and service systems that adopt, or even require, the normative use of person-centred planning simultaneously offer to the people affected the explicit ability to redesign the service models that they presently use into other approaches that better suit their needs. To some degree, this might occur if monies come to the person unencumbered by an expectation that they are to be spent only on certain models. Yet, the more usual situation is that most services do not explicitly provide the opportunity to ‘un-bundle’ funds, and reuse the resources in new ways. Even where it does occasionally occur, it typically has the status of being an exception or anomaly rather than routine adaptive practice, i.e. ‘the squeaky wheel gets the grease’. Implicit in this is also a refusal to explicitly authorise the service user to contest existing models, and counter-propose these with other more promising possibilities. The use of conventional person-centred planning will normally have no meaningful effect on this, as the issue at hand is one of the system’s operational logic, and it must be resolved at that level.

Formal person-centred planning is not absolutely required to have a better life

It will undoubtedly surprise many people to recognise that countless millions of people will never have a person-centred plan, or participate in such formal processes, and yet will go on to live rich and fulfilling lives. If fact, billions of people have done so down through history. It is also quite possible to plan your life in an entirely private and personal way without using any standardised methodology or process, or involving anyone whatsoever from formal services and systems. Thus, if one were to contemplate the possibility of doing personal planning, it would be useful to know this. Yet, countless thousands, and perhaps even millions, of people are presented with the possibility of participating in formal person-centred planning as an unquestionable and desirable ‘given’. While the prescriptive and coercive nature of this approach is antithetical to the espoused values of most person-centred planning exponents, many well-meaning people do not seem to recognise it for what it is. Oddly enough, given the goal of upholding uniqueness, many person-centred planning methodologies are surprisingly standardised. It is also worth noting that person-centred planning approaches could conceivably harm people and their best interests, if not done within an appropriate ethical framework.

Most systems leave formal person-centred planning processes exclusively under the control of professionals

It is most certainly true that there are many staff and professionals who are quite enlightened and deeply loyal to the people they support. Many may even recognise that their presence and possible dominance can be an issue if not properly subordinated to the higher goal and responsibility of keeping the person’s needs and interests central. Such professionals are an indispensable asset. Yet, it would not be entirely accurate to say that all professionals are enlightened or ethical in this way. Nevertheless, when we examine who actually controls the personal-planning functions in most services and systems, we commonly see that a professional or staff monopoly exists. Even where the facilitators are ‘independent’ of the system, the processes are still largely guided by professionals. This is puzzling when contrasted with the promotion of ‘community’, that so little of these formal processes leave citizens in charge. On the other hand, when one looks at more informal approaches to personal planning that exist outside service system control, i.e. embedded in relationships and networks, we see a much more prominent role for citizens. This ought to make us wonder why we so tacitly cooperate with yet another professional monopoly of control in people’s lives.

Person-centred planning is not a guarantor of needed innovation

It is understandable that for people trapped in standardised and overly prescriptive lifestyles any emphasis on ‘dreaming’ and ‘imagining better’ is much welcome. Naturally, this element is emphasised as a component in many person-centred planning methodologies. Nonetheless, having the opportunity to ‘dream’ does not in itself assure that innovative approaches will automatically emerge. Consequently, it is important to see the role of other supports that may need to be present to people in order for them to not only conceive of possible innovations, but also to test these for their conceivable relevance and validity in their lives. Many people are simply unaware of what is currently possible for their lives, and may have little faith in things they have not seen for themselves. In reality, many well-motivated people will unfortunately use person-centred planning to produce conventional options for people that lack the presence of these needed innovations, and they may not even realise that this is so. Additionally, proceeding with innovative options may prove even more difficult than conventional options, and unless people are well supported, these difficulties may discourage them. Such supports that would properly offset these obstacles would go well beyond the amount of support conventionally offered by most person-centred planning arrangements.

Person-centred planning is not necessarily ‘person-centred’

Person-centred planning methodologies have rightfully arisen because so much of system-sponsored personal planning has acutely distorted what people actually need, in favour of designing options that are either preferable to the system, or better suit the agendas of other parties. While this goal of returning emphasis to the centrality of the person is valid and needed, it is not necessarily the case that person-centred planning will somehow inevitably assure this. It does not automatically displace vested interests, nor does it invariably recognise and challenge their machinations. It may even serve to disguise these as being pertinent factors, simply by making no reference to their presence and operational importance. It may even create the impression that person-centred planning somehow transcends these difficulties simply because its goals are so laudably focused on persons. Nonetheless, goals alone do not ensure a solution, and it is wise to investigate whether the methods used are potent enough to overcome the deep and often unconscious influence of vested interests.

‘Life-building’ is much more than just moments of planning

It is essential to any process of ‘life-building’ that there are instances for critical stocktaking, planning and reflection. This is all the more so when one considers how much of life might be thought of as requiring the rebuilding of one’s life after unanticipated changes or developments. While vision-building cannot be underestimated in its importance, it is also useful to act on that vision, and engage in the struggles and even battles that may be involved in bringing vision into reality. This takes people well beyond the normal activities involved in person-centred planning, into months and years of investment and efforts that can prove to be quite demanding. Person-centred planning methodologies neither undertake the long-term labour of ‘life building’ itself, nor do they assure that others will do what is needed in this regard. It can help encourage such commitments at a point in time, but a stimulus is not a response. Without people willing to live the dream, the dream will wither.

Conclusion

The aim of this paper is not to discourage the use of person-centred planning methods, nor is it intended to convey any sense that people might not derive appreciable benefits from their involvement with such exercises. Rather, it is a brief attempt to surround person-centred practices with some context, as to some of the inherent limits and risks in its use. This might not be so necessary were it not for the fact that person-centred planning is so often uncritically embraced as a panacea. The cultivation by any person or organisation of a mystique that any of its methods or systems somehow easily transcends fundamental issues is misleading, and eventually disillusioning. Unfortunately, despite the sincerity and intentions of many of its founders and practitioners, person-centred planning has now become used by many as one of those ‘magic bullets’ we need to be wary of. The ‘magic’, if any, in person-centred approaches is in the values and ethics it can help uphold about people. These have preceded person-centred planning, and can exist quite well without it.

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