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The power in dialogue : exploring the experiences of involuntary adolescent clients Doyle, Janet Marie 2003

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THE POWER IN DIALOGUE: EXPLORING TH E EXPERIENCES OF INVOLUNTARY ADOLESCENT CLIENTS by JANET MARIE DOYLE B.S.W., The University College of the Fraser Valley, 1997 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES (School of Social Work and Family Studies) We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August 2003 © Janet Marie Doyle U B C Rare Books and Special Collections - Thesis Authorisation Form Page 1 of 1 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r reference and study. I f u r t h e r agree that permission f o r extensive copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head of my department or by h i s or her r e p r e s e n t a t i v e s . I t i s understood that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n permission. Department of The U n i v e r s i t y of B r i t i s h Columbia Vancouver, Canada http://www.library.ubc.ca/spcoll/thesauth.html 8/12/2003 b ABSTRACT Social Workers providing service to involuntary clients may be challenged with the ethical issues linked to such services. The primary ethical issues in working with involuntary clients are the infringement on self-determination and the use of paternalism and whether either is justified. Work with involuntary clients may also raise the issue of balancing the social worker's responsibilities to both the welfare of the individual and the welfare of the many. Another concern for social work is that the use of paternalistic interventions has the potential to move social work as a profession into a role of solely providing social control. The studies involving involuntary clients have focused on the success or lack of success these clients have achieved through treatment or intervention. The studies may not be helpful for workers struggling with the ethical issues involved in working with involuntary clients. This study explores the experiences of a small number of adolescents who self-identified as involuntary clients. Confidential interviews were conducted with the participants. The interview data was analyzed in a manner consistent with phenomenological study methods. The results indicate that the experience of being an involuntary adolescent client included feeling controlled and labelled. The experience also included feelings of power, acceptance, and validation. The results of this study provide information that social workers might reflect on before making decisions regarding the use of paternalistic interventions or before providing service to involuntary clients. i i TABLE OF CONTENTS Abstract 11 Table of Contents iii List of Tables .. v List of Figures v i Dedication v i i Acknowledgements vjii Introduction 1 CHAPTER I Overview of Self-determination vs. Involuntary Participation in Social Work Practice 5 C H A P T E R n Conceptual Context 20 2.1 Guiding Perspectives 20 2.2 A Br ie f Review of Reactance Theory 28 2.3 Adolescence 31 2.4 Research involving involuntary clients 36 C H A P T E R III Methodology 40 3.1 Sample Design 41 3.2 Data Collection 46 3.3 Data Analysis 53 C H A P T E R IV Results 57 4.1 Questionnaires 57 4.2 Themes 62 4.3 Categories 62 4.4 I Didn' t L ike It 62 4.4.1 They Think I Have a Problem 64 4.4.1 .a The Exception 68 4.4.2 Somewhere A long the Way I was Judged 70 4.4.3 What Could Have Happened 75 4.5 I Can' t Do Too M u c h About It N o w 78 4.5.1 What Do They Expect? 79 4.5.2 Settling Back 81 4.6 Summary 83 i i i C H A P T E R V Conclusion 85 5.1 Limitations 85 5.2 I Didn' t L ike It 87 5.3 I Can't D o Too Much About It N o w 90 5.4 Recommendations 93 5.5 Conclusion 97 References 9 9 Appendix A 1 0 5 iv LIST OF T A B L E S Tablel Results of Adolescents Surveyed re Drug Use for 1995 and 2001 18 v LIST OF F I G U R E S Figure 1 Adolescent Drug Use Survey 1995, 1997-1999 and 2001 17 Figure 2 Program Evaluation Response to Involuntary versus Voluntary 57 Figure 3 Program Evaluation Response to Question Regarding Lose of Freedom 58 Figure 4 Responses to Questions 3-10 on the Recruitment Questionnaire (Total or some loss of freedom of choice) 60 Figure 5 Responses to Questions 3-10 on the Recruitment Questionnaire (Little or no loss of freedom of choice) 61 vi DEDICATION For my daughter, Ceara, you are my sunshine. And in loving memory of my mom, Grace. ACKNOWLEDGEMENTS I would like to express my gratitude to the seven young people who participated in my research. Many thanks go to Frank Tester, my advisor, for never losing patience even while taking on the role of editor. Thanks also to Marg Wright who had to wait years before seeing a final draft. Special thanks to Gloria Wolfson, if not for her I may not have continued on my educational journey and without her straight forward approach I may have gotten lost along the way. Much love and thanks go out to my family and friends for who supported me. I would especially like to thank my dad, George Doyle, for all his love and support, childcare, cooking and encouragement. Tony, Melanie, Selena, Tracey, Joanne and Lianne thanks for letting me try and explain postmodernism again and again in the hopes that I would better understand it even when you didn't. Special thanks to my friend Sherry for graciously sharing her energy with me and re-igniting my passion for this topic. vi i i Introduction For many years, I have worked in the field of alcohol and drugs in a community that was identified by community members as having a 'drug problem'. My professional practice was almost exclusively made up of adolescent clients who were mandated, coerced, manipulated, or pressured to attend programming due to drug related infractions. I used my training in a way that I believed any caring, responsible, and accountable social worker would without any conscious thought to the Tightness or wrongness of working with involuntary clients. Attending to the fact that these clients might have specific thoughts about being involuntary made sense, as I know I have never been one who liked to be told what to do. I was quite amazed when I discovered that there are social workers who believe it is wrong to work with involuntary clients. This infringement on clients' rights to self-determine resulted in an ethical problem directly related to working with involuntary clients. This prompted for me an interest in the ethics that surround working with clients on an involuntary basis and an understanding of what, if anything, this meant to the client. When I started looking at the factors that resulted in a referral to me, I was able to see that often youth were being referred for other underlying factors. These included a) to alleviate parental fears, b) to show the community that something was being done about the 'drug problem', and c) to send youth somewhere when the courts, school, and/or parents did not know what else to do with them. This left me asking myself "How do I apply the practice value of self-determination?" "Moreover, to what degree am I involved in practicing social control, especially with adolescent clients?" I began by seeking out literature on the value of self-determination and its practice, the use of 1 paternalism, and the identified issues of working with involuntary clients. In reviewing the literature, I found information on the value of self-determination in the social work field and on the concerns about working with involuntary clients in relation to client self-determination, social beneficence, and paternalistic practice. I also found information on treatment and intervention outcomes relating to involuntary clients and on recommendations for methodology in working with involuntary clients. In the literature, the primary ethical issues in working with involuntary clients are the infringement on self-determination and the use of paternalism and whether either is justifiable (Atkinson, 1992; Kunkel, 1992; Linzer, 1999; Lo, 1992; Meinert, 1994; Rooney, 1992; Tower, 1994). The literature presents many valid reasons for working with and not working with involuntary clients. It has also provided an almost exhaustive understanding of the value of self-determination in the social work field. What is lacking in the literature is information on people's lived experiences as involuntary clients. This research study sought a better understanding of the experiences of involuntary adolescent clients in the hopes of deepening our understanding of what that means for the youths and to generate a more informed discourse on intervening with involuntary adolescent clients. The studies involving involuntary clients have typically focused on treatment and intervention outcomes. For social workers struggling with the ethics of working with involuntary clients, these studies provide little insight in terms of Tightness or wrongness. Thus, this research gave voice to the involuntary experience of adolescents. The question this research addresses is: How do adolescents describe their experience of being involuntary clients? 2 This research paper used a qualitative design and is influenced primarily by a feminist perspective. I say 'primarily' because in feminist research the participants are generally all female (Reinharz, 1992). In my research, that is not the case. In many ways, youth share some of the issues that are identified as women's issues by feminist research. Youth are generally in a place of less power in society, they lack a voice, and often their experiences are not validated by those with the power and influence in society. These experiences are parallel to experiences identified for women - that is, their experiences and reality have been discounted and they have often not been visible in the research about them (Gottfried, 1996) The purpose of this study was for social workers and other professionals working with youth to gain a deeper understanding of adolescents' experiences as involuntary clients, thereby contributing to appropriate policy development and to the development of direct referral and intervention services. Chapter one examines discussions, both historical and current, regarding the concepts of the individuals' or the clients' right to self-determination versus the practice of providing treatment or service to involuntary clients. This involves an ethical issue or dilemma for social workers with respect to the clients' right or freedom to choose those services that best serve their own interests in opposition to those clients who are required to engage in services although they never actively seek out those services. Chapter two, while presenting a brief overview of postmodernism, feminism or postmodern feminism also includes some modernist theories. Some of these theories address adolescence and one addresses reactions to loss of freedom. Some of the studies done involving involuntary clients and/or the practice of the value of self-3 determination and paternalism have been introduced. I believe it was important to include modern theories because they are widely known. To leave them out might be seen as an omission of other possible ways in which to engage the data. Chapter three discusses the methodology used in carrying out this study including sample design, data collection and data analysis. Chapter four analyzes the results of the research and discusses some of the findings associated with the participants' experiences of being involuntary clients. The last Chapter concludes with some recommendations and implications for social workers and other helping professionals. 4 CHAPTER ONE Overview of Self-Determination versus Involuntary Participation in Social Work Practice It is thought that clients can range along a continuum of voluntary and involuntary participation (Ivanoff, Blythe & Tripodi, 1994; Rooney, 1992; Sheafor, Horejsi & Horejsi, 2000; Trotter, 1999). One end of this continuum can be described as mandated involuntary clients, whereby clients are legally mandated to attend services. This end of the continuum includes institutionalized people such as prisoners, drunk drivers and husbands convicted of domestic assault. The opposite extreme are voluntary clients who actively seek help in problem solving or goal achievement. Mid-range on the continuum are the clients who are not legally mandated, yet are not really voluntary in that they have been manipulated, coerced, or are under an obligation to get help or to receive services (Ivanoff, Blythe, & Tripodi, 1994; Rooney, 1992; Sheafor etal., 2000; Trotter, 1999). Social workers have provided services to involuntary clients throughout history because voluntary clients do not usually make up the balance of social work caseloads (Ivanoff et al., 1994; Kunkel, 1992; Rooney, 1992). The infringement on clients' rights to self-determine is the ethical problem directly related to working with involuntary clients. Social workers were, through history, very sensitive to the values, attitudes, and beliefs reflected by those in positions of socio-economic and political power. Depending on the social, economic, and political climate, the concept of self-determination was seen at times in a social context where each client had the right to self-determine (Biestek, 1951 cited in Freedberg, 1989). At other times, self-determination was seen in an individual 5 context where the right to self-determine was more acceptable for some than for others. At this time, "clients had to be evaluated as to their capacity to make their own decisions and as to their potential for self-direction" (Biestek, cited in Freedberg, 1989, p. 35). Therefore, though the social work profession had values and ethics that endured over time, the meaning and implementation changed as they were impacted by sociopolitical environments (Reamer, 1995). Social work values and ethics were influenced by society and placed on a continuum that encompassed two extremes. The first was the belief that individuals are circumscribed and heavily influenced, if not determined, by political, economic, and institutional patterns within society. The opposite was the belief that individuals had a great deal of leeway in determining their own interpersonal experiences (Reamer, 1995). These beliefs were held in esteem at different times. In the eighteenth and nineteenth centuries, people in need were seen to be in that position because of their own personal failure and much intervention was carried out by the church rather than the state (Turner & Turner, 1981). When the state did intervene, a person's ability to self-determine was not recognized. Servitude rather than relief was most apparent in this government ministration (Turner & Turner, 1981). Workhouses of the 1800s provide an example of this. In the early twentieth century, social workers focused on client capacity so they did not have to link a client's problem with his or her living conditions or the policies of the time (Freedberg, 1989). Social workers linking the potential for clients to self-determine with the political and economic climates were seen as radical (Freedberg, 1989). In the 1960s, social, political and economic climates were in a state of flux. 6 Society's discontent was manifest in a movement that was both cultural and political and included issues of poverty, racism, discrimination, and feminism (Harvey, 1990). In the late twentieth century, the importance of social justice decreased in correlation with the renewal of individualism, traditionalism, and lassez-faire economics (Wilk, 1994). Social workers tend to base their decisions around client self-determination and the use of paternalism on a continuum of deontological to utilitarian. According to Linzer, the deontological approach would see some things as inherently right or wrong regardless of the consequences (1999). A person who will always tell the truth based on the belief that it is 'right' to do this would be an example of this. Social Workers at this end of the continuum may base decisions on the societal norms, professional ethics, and policies of the agency. They may rate the value of their practice on its conformity to professional ethics and/or the policies and procedures of the agency rather than on the consequences of the practice. At the utilitarian end of the continuum, decisions would be based on producing the best possible outcome for the client, reflecting the belief that the ends would justify the means (Holland & Kilpatrick, 1991). Social workers at the utilitarian end of the continuum would see the worth of their practice as being determined by its usefulness to the client rather than by its compliance to rules. The use of paternalism would be directed by whether it would achieve optimum results for the client regardless of infringement on a client's freedom to self-determine. To be an involuntary client is to have one's freedom abrogated. Spicker speaks to the concept of freedom in terms of 'negative freedom', 'positive freedom' and 'psychological freedom'. He says, "...in practice these ideas are inseparable" (1988, p. 7 44). Honderich, (1993) defines freedom as the ability to act in a particular way, or to not act in a particular way, depending on our wishes. Furthermore, the ability to do so is not affected by external forces. In general, authors, when discussing freedom, define it to be a state or condition that encompasses choosing and acting intentionally or choosing and acting intentionally out of reason (Bryden, Davis & Russell, 1994; Feinberg, 1980; Honderich, 1993; Jonas, 1984; Spicker, 1988). Spicker goes on to further define freedom by describing two models, the individual model and the social model. In the individual model of freedom, it would not be considered justifiable to intervene in a person's life without his or her consent because it would challenge a person's sovereignty over self. This would not hold true in the social model, where a person's freedom is seen as being dependent on the structure of society (1988). It would be fair to say that the social model is the model of freedom to which our principles of social welfare subscribe. Hence, these may be seen as paternalistic. In the Canadian Charter of Rights and Freedoms, Canadians are given a guarantee of rights and freedoms (Atkinson, 1992; Beaudoin, 1992), set out in the Charter as "...subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society" (Beaudoin, 1992, p. 217). Chief Justice Dickson said "[The Charter] is intended to constrain governmental action inconsistent with those rights and freedoms; it is not itself an authorization for governmental action" (194, cited in Bryden et al., p. 133). Bryden's discussion on the purpose of the Charter is based on the supposition that the state is to be perceived as the enemy of rights and freedoms, and "it is freedom from the state that we are to be 8 concerned about" (Bryden et al., 1994, p. 133). It seems that, more often than not, people conceive freedom as negative freedom in that they want to be free from interference, rather than to be free to have the ability to choose and act The difference between the two models of freedom can be significant because it seems that freedom in our society is based on the individual model subject to constraints, for social reasons, as defined by the state. On the other hand, the principles of social welfare seem to subscribe to the social model of freedom. These different ways of defining freedom could contribute to the ethical dilemma social workers face in working with involuntary clients. Ewalt and Mokuau (1995), and Pope and Weick (1988), allude to the fact that self-determination is the equivalent of individual freedom. In social work, self-determination has been defined by Weick and Pope as the "clients' right to make their own decisions, their right to actively participate in the helping process, and their right to lead a life of their own choosing" (1988, p. 10). This definition can be seen as reliant on European and American values of individualism where standing alone is equated with strength, and autonomy is equated with health and maturity (Gaylin & Jennings, 1996). Rarely, in European and American cultures is it recognized that self-determination is consistent with contributing to the well being of a group. Yet, in many other cultures value is placed on a definition of self-determination that emphasizes the 'whole' over the individual (Ewalt & Mokuau, 1995). According to the social work code of ethics, social workers are to regard their responsibilities to their clients as their primary obligation. This includes nonmaleficence and applying the value of self-determination (Andrews & Patterson, 1995; Atkinson, 9 1992; Banks, 2001; Compton & Galway, 1979; Ewalt & Mokuau, 1995; Freedberg, 1989; Ivanoff, Blythe & Tripodi, 1994; British Columbia Association of Social Workers [BCASW], 1984; Reamer, 1995; Rooney, 1992; Sullivan & Rapp, 1994; Tower, 1994). At the same time, social workers are expected to be committed to social change (Banks, 2001; BCASW, 1984; Rooney, 1992). These conditions are to be met as long as the right of the community, or others, to protection is not thwarted. Freedberg (1989) points out the contradiction social workers face -- they are to be client advocates and go-between instruments of society. This means that, on the one hand, social workers have a responsibility to promote the welfare of the client while, on the other hand, they have a responsibility to promote the welfare of the many. A social worker may be working in the best interest of his or her client but at the same time may be fulfilling the role of social controller. A probation officer may deal with this situation regularly. In order to demonstrate a commitment to self-determination, a social worker needs, in doctrine and application, to be responsible to both client and society. Still, it is difficult to be equally responsible to both, as the wants and needs of society and the individual may be opposing. This paradox has been a struggle in the social work field throughout history (Freedberg, 1989). "Aristotle argued in his Politics, written in the fourth century BC, that some degree of paternalism is appropriate in a society in which certain elite individuals are clearly more informed and wiser than others" (Reamer, 1995, p. 96). This argument may have influenced the development of paternalistic interventions. I hope that social workers recognize that though they may hold some information that clients do not, they cannot know more about an individual as a whole than that individual can. 10 Paternalism is defined by some, as infringing on a client's right to self-determination for their own good rather than the good/protection of a third party (Reamer, 1995; Rooney, 1992). It has also been seen to include interventions that are for the welfare of others (Linzer, 1999). Paternalism can be justified by social workers through client traits. For example: paternalism can be justified if the worker believes that the client doesn't have the information which would precede consent; the client is not capable of understanding that information; the client has given former consent; or that consent will probably be given (Lo, 1991; Rooney, 1992; Sullivan & Rapp, 1994). Paternalism can also be justified by situational traits. For example: paternalism can be justified if the worker believes either that the consequences of inaction would be harmful and/or irreversible; or that a wider range of freedom would be preserved (Lo, 1991; Rooney, 1992; Sullivan & Rapp, 1994). In practice, paternalism can be overt or covert. If the social worker goes directly against the client's expressed wishes, for that client's own good, it is obvious paternalism. It is not so obvious if information is withheld or the client is manipulated. Rooney discusses three forms of paternalism: a) opposing client wants, b) keeping information from the client, or c) providing deliberate misinformation as a means of manipulation (1992, p. 55). Paternalistic interventions often happen with clients who are not considered capable of sound reasoning. Paternalism is also used with those not considered self-regarding or independent. Youths are often placed in this category (White, 2000). Social workers are to apply the value of self-determination and are expected to be committed to social change for the benefit of all people (BCASW, 1984; Rooney 1992; Sheafor et al., 2000). These sometimes conflicting responsibilities leave social 11 workers looking for clear standards pertaining to the arguments used for intervening or failing to intervene in a client's life (Reamer, 1995). Unfortunately, there is no clear right and wrong to use when social workers are engaging in paternalistic interventions (Eamon, 1994), so it becomes a dilemma for social workers. Ethical dilemmas are situations where there is no black or white response, just a large and sometimes overwhelming block of various shades of grey. Often there seems to be no appropriate response to ethical dilemmas or there are excellent but conflicting ethical reasons to take contradictory and incongruous courses of action (Kitchener, as cited in Hill, Glaser, & Harden, 1995). There is no one right answer to an ethical dilemma and workers are in the position where they need to make the decision that is more right than any other. There are a number of decision-making models available that are based on intuitive and critical-evaluative levels of moral reasoning. These take into account tenets and assumptions of the worker; professional codes of ethics; more general and rudimentary ethical principles such as autonomy, nonmaleficence, beneficence, justice, and fidelity; and laws that govern society (Hill, Glaser, & Harden, 1995). There are limitations to both levels of moral reasoning and, therefore, with these models. Beliefs and assumptions of workers are saturated with cultural values that could be pernicious to the client. Another issue is that professional codes can be incomplete or conflicting. A worker can then refer to the general ethical principles but he or she may be left asking: "Are these valid absolutely, relatively or on face value?" The understanding of these ethical codes and principles can vary depending on where both the client and worker are positioned in the context of power (Hill et al., 1995). The 12 terms used to define these ethical principles are ambiguous and there is an assumption that there is some agreed upon perception of what constitutes each of these principles. For example, if my father fell and had to be hospitalized, the social worker and I may want him to live with me or to have someone come in and care for him to ensure no further accidents. Both the social worker and I would be concerned with my father's safety but does that mean we can really define his best interests? His physical health may be better with added care, but if this is not what he wants, his spiritual, mental, and emotional health may not be improved by receiving care. Different social workers, supervisors, and clients could define the terms 'best interest of the client' differently. How a social worker comes to the decision to work with involuntary clients is impacted by many issues. According to the literature, the value and implementation of self-determination has fluctuated through time and is frequently the first right to be violated in the name of expediency, protection, or cost-containment (Tower, 1994). Now, social workers tend to focus more on individual intervention and less on social justice. This may be due to the failure of past attempts to solve social problems (Wilk, 1994). It may also be a representation of the social, political and economic climates because even if social workers believe it is unethical to work with involuntary clients, the societal norms and policies of the agency may dictate that they do (Holland & Kilpatrick, 1991; Kunkel, 1992). There are a number of concerns addressed by the literature regarding working with involuntary clients and the use of paternalism. In working with involuntary clients, they are denied control of their own destiny and forced to conform to society's ideas of right and wrong (Atkinson, 1992). Some authors claim that once clients have been 13 coerced, there will be no stopping the amount of control our society will engage in (Atkinson, 1992; Rooney, 1992). Atkinson also postulates that working with involuntary clients undermines addressing social problems. She believes that treating the individual can contribute to ignoring the social conditions that may have created the problem. Atkinson (1992) does not see the 'good' of the client as being a legitimate reason to thwart self-determination. Both Atkinson's and Rooney's concerns reflect Mill's position: that interference against a persons will is only right if it is to prevent harm to others (1859, cited in Spiker, 1988). Another concern that comes up in the literature is not as polarized. Eamon (1994), is concerned that self-determination can be thwarted to maintain social control. Self-determination is also stymied when the social worker ends up serving agency interests, such as working with a client in order to keep numbers high to maintain funding. Eamon does not reject the notion of working with involuntary clients or infringing on a client's right to self-determine based on the good of the client. He suggests that practitioners need to be acutely aware of the 'whys' involved in their work with involuntary clients. The literature also provides vindication for the use of paternalism and work with involuntary clients. As individuals, we must function within larger systems and, therefore, individual behaviour affects others (Kunkel, 1992). This is different from Mill's idea of preventing harm to others. It is more general and reflective of individuals as social beings, connected through relationships rather than as beings of total autonomy. The use of paternalism in this sense combines respect for another's right to self-determine with "concerned involvement" (Meyers, 1987, p. 141). If the self is socially 14 defined, the individual will acknowledge a responsibility for others and not always give priority to his or her choices as if he or she were a strictly self-governing, autonomous individual. If there was no paternalism, according to Feinberg, problems in society would escalate because, with their options becoming unlimited, people could become overwhelmed and lose their psychological freedom (1980). This would mean that they would be unable to choose to act, possibly because they couldn't prioritize their wants and would become confused. This would benefit neither client nor society (Kunkel, 1992). If that loss happened, then people would eventually want to be told what to do, how to act, thus having no freedom (Feinberg, 1980). Use of paternalism by social workers can also help a client to follow a path that is life enhancing or to avoid involvement with the criminal justice system (Kunkel, 1992). According to Barber, (1995) expert advice can be sufficient in motivating change. A social worker's use of listening, interpreting, assessing, and confronting skills is more likely to engage the client in looking at change than prison or probation (Meinert, 1994). Through these skills, a worker-client relationship can develop and the involuntary client may become a voluntary client in seeking assistance (Rooney, 1992). Paternalistic benevolence verses self-determination is also a dilemma in the health profession. As stated earlier, paternalism is often used with those clients not thought to be capable of sound reasoning. This is especially true for practitioners working with clients who have been diagnosed as mentally ill, mentally challenged, or incompetent (Abramson, 1989; Eamon, 1995; Manning, 1997; Rooney, 1992; Wilk, 1994). Literature focused on these issues in the health profession was not used for this 15 study. The participants in this study do not have a mental illness and/or a diagnosis that would classify them as incompetent and therefore this literature was not specifically relevant. In my experience, the many youth who receive alcohol and drug services do so, initially, on an involuntary basis. It has also been my experience that some workers see these adolescent clients as 'rabble-rousing' and resistant. This perception appears to be based on the workers' beliefs surrounding 'what it means to be an adolescent'. This may be because adolescence is often described as a time of turmoil and rebellion (Achenbach, 1982; Kimmel & Weiner, 1985) and when the term adolescent is used, people tend to bring up problematic behaviours associated with it (Hersch, 1998). Whatever the reason, it is fair to say that adolescence is seen by many as a phenomenon in and of itself. This is important to this study because the phenomenon under investigation is the experience of being an involuntary client as told by an adolescent population. I make no assumption here that the experiences of these adolescents would be different if they were adults. At the same time, I recognize that at this time in history, adolescence is considered a special period and therefore I need to describe the involuntary experiences in the defining period of adolescence. In the community where I worked in the field of alcohol and drugs, the community service agency in conjunction with the school district administered drug use surveys to 400 adolescents in 1995, 1997, 1998, 1999 and 2001 (see Figure 1). I was provided with information regarding what percentage of youths self -reported as having used a particular drug but I was asked not to name the community or the school district. The information they had accumulated was for evaluation purposes and was not to confirm 16 or deny a drug problem. Figure 1 shows the percentage of youths responding positively to the question, "Have you ever used (name of drug)?" The figure does not reflect number of times the drug had been used by the youths or the quantity of the drug used. Figure 1 Adolescent Drug Use Survey 1995. 1997-1999 and 2001 (%) 0 H . . r H95 H97 H98 H99 H01 The overall trend illustrated by Figure 1, indicates a gradual decrease in the number of youths who have ever used these drugs, from 1995 - 2001, with the exception of crystal methamphetamine which has continued to increase slightly in use overall from 1995-2001. Significant decreases in use have occurred with alcohol, cigarettes, and acid and with cocaine use, although the use of this drug is not all that popular with these adolescents. The use of pot has remained more or less consistent over these years. Table 1 compares the percentage of youths surveyed in 1995 and 2001 to more easily show the change in the percentage of youth who responded to the question "Have you ever tried (name of drug) over the six year period. 17 Table 1 Results of Adolescents Surveyed re Drug Use for 1995 and 2001 (%) Drug type 1995 results 2001 results Cigarettes 67 43 Alcohol 85 68 Pot 55 46 Acid 28 11 Cocaine 13 8 Crystal Methamphetamine 12 13 Youth were referred to the alcohol and drug program for three main reasons: a) the youth had been caught under the influence of an illicit substance, b) the youth committed a crime either under the influence or in possession of an illicit substance, or c) the youth had an infraction or charge and there was some suspicion that the youth had a 'drug problem'. The assumption often made by my colleagues and myself was that the youth were being referred for their own good. We held no expectations that the youth would stop using substances but that they would have access to factual and practical information that might inform their future decisions. This fit well within our mandate as alcohol and drug practitioners. As mentioned elsewhere in this report, it. became apparent to me that the youths I was seeing were being referred for a variety of reasons often in conjunction with other 18 peoples identification of a 'presenting drug problem' rather than the youths' desire to seek out treatment or services on their own. Once again, I was asking myself: "How do I apply the practice value of self-determination and to what degree am I involved in practicing social control, especially with adolescent clients?" For some of the answers to these questions, the focus in my literature review was on the value of self-determination and its practice, the use of paternalism, and the identified issues of working with involuntary clients and resulting ethical dilemmas this created. I discovered in reading some of the research material, that the primary ethical issues in working with involuntary clients revolved around infringement on self-determination and the use of paternalism and whether either is justifiable (Atkinson, 1992; Kunkel, 1992; Linzer, 1999; Lo, 1992; Meinert, 1994; Rooney, 1992 Tower, 1994). 19 CHAPTER TWO Conceptual Context This chapter will lend some understanding to the general concepts that have influenced this research. For 30 years, clinicians have looked for direction in working with involuntary clients (Studt, 1954; and Ohlin, Piven, & Pappenfort, 1956, as cited in Rooney, 1988). There are arguments both for and against working with involuntary clients. This issue encompasses the practice concepts of self-determination, paternalism, and informed consent and how and to what degree they are practiced. These concepts are based on modernist knowledge. This implies that there is some 'core' meaning and method that can be associated with them. Yet, the literature suggests that these concepts, in both practice and meaning, have varied throughout the years (Freedberg, 1989). This can leave social workers grappling with how these concepts fit in the context in which they are practicing. If discourse on the issues of working with involuntary clients is based on modernist knowledge, there is no allowance for either the workers or the clients understanding of these issues. Modern theory is seen to be all encompassing; the idea being there is an absolute truth. These theories are not built upon localized accounts of individuals. They may not account for the individual experiences of people such as clients or workers. Guiding Perspectives Postmodernist thinking has been influenced by the writing of modern theorists such as Kant, Hegel, Marx, and Nietzsche (McGowan, 1991). According to Agger, some postmodern theorists see postmodernity as a complete break with modernity while other postmodernists see it as a unique juncture of modernity (1998). The 20 significance of this is that the latter group of postmodernists would not necessarily completely disregard modern theories but move beyond what these theories had envisioned. "Postmodernity, then, is a phase of modernity in which modernity's most acute contradictions, tensions, and tendencies are magnified, allowing us to recognize that modernity is not a monolith that must be embraced or opposed in total" (Agger, 1998, p. 42). Hare-Mustin and Marece, as well as Hazen identify two intellectual factions within postmodernism, social constructionism and deconstruction (as cited in Ray, 1996, p. 676). Social constructionism is illustrated by the ideas of Berger and Luckman (Payne, 1991). Each individual holds her/his view of reality that in turn influences behaviour. Through different social venues, individuals share their knowledge and develop a shared reality. This socially constructed reality becomes legitimized through social interactions, systems, and organizations. It, in turn, constructs individuals as they are born into a particular shared reality and are taught through that 'how to be in the world'. Therefore, as individuals socially construct reality so too are they socially constructed. . Agger states that deconstruction "is really Derrida's notion that all texts 'deconstruct' themselves by engaging inevitably in literary acts of omission, glossing and suppressing" (1998, p. 60). This means that what is not said in the text, what is partially covered, and what is played down, give alternate meanings to the text. As a text is read, the reader becomes an active participant in constructing the meaning. He or she will attribute meaning to what is said in the text as well as to what is suggested and what is ignored. Deconstruction is generally seen as a method for analyzing text where the reader looks for gaps such as minimizing or ignoring and assumptions in the 21 language and ideas of the writing. For the purposes of this research, I will use the term postmodernism to include both social constructionism and deconstruction. According to Rossiter, Prilleltensky and Walsh-Bowers," feminism has taken up postmodernism in order to disturb the roots of patriarchy in modernism - roots which are the legacy of professional knowledge as well" (2000, p. 84). I will also include some tenets attributed to postmodern feminism because, as stated in the introduction, my worldview is influenced by general tenets shared by the various feminist perspectives. The idea that the personal is political and the belief that social change is directly linked to personal change are examples of those tenets. The purpose is not to provide a comprehensive review of postmodernism, feminism, or postmodern feminism but to provide a brief summary that will lend some understanding of the ideas have influenced this research. Postmodernists, based on the work of Derrida, Foucault, Lyotard, Rorty, and others/are skeptical of any grand or all encompassing theories (Fawcett, 2000; McGowan, 1991; Ray, 1996; Rossiter et al., 2000). They critique positivist notions about "knowledge, power, reason, language, and the self (Ray, 1996, p.676). This includes, but is not limited to, the notion that all real knowledge is based on facts, things that have been or can be experienced. Positivists see language as objectively representing reality and believe that there is a 'self, separate from the social, that can objectively observe the external world. Postmodernists reject the premise that there are any universal truths and they deny our ability to ever achieve a certainty or an objective knowledge. Postmodernists dismiss the idea of an essential self. Experience does not really mirror what is going on but is constructed by each person and impacts 22 what is defined as reality or truth, so there can be various truths and realities (Fawcett, 2000; Ray, 1996). Each person's understanding of reality is one portrayal of reality. These depictions of reality are shared narratives, constructed by and having shared meaning for individuals based on cultural contexts (McGowan, 1991; Ray, 1996). These narratives are not just a retelling of the facts or the breakthrough of an understanding that just materializes from the events; they are made up of individual meanings that have been constructed in social and historical contexts. For example, research conclusions about the experience of being an involuntary client may be more representative of the researcher's prognosis about self, being 'made' to attend a program, and loss of freedom, and these may not point to the actual experiences of involuntary clients. By using a postmodern perspective, researchers will look for the assumptions made in representations and be cognizant of the fact that interpretations are relative to the questions posed (Kvale, 1996; Ray, 1996). Postmodernists see the concept of self as being social, rather than having an inherent core that came before socialization. They do not believe in a 'self that has the ability to observe oneself objectively creating a distinction between 'the social' and 'the individual' (Ray, 1996, Rossiter, 2000). This means that the self and subjectivity are in constant flux and, in terms of involuntary clients, there is no one description to depict an 'involuntary client'. For feminists engaging a postmodern perspective, self and subjectivity are again seen as being socially constructed and situated, but are also seen as capable of construction, of situating and assessment (Fawcett, 2000). Some postmodern feminists hold the idea that there is a 'core' self different from the modernist 'essential' self. The 23 'core' self is seen as created through relationships, so it is socially constructed and interdependent and has the capacity to be 'different' in various contexts (Fawcett et al., 2000). Language and how it relates to thought and reality is central to postmodernists (Ray, 1996). The view that language is a vehicle that gives us access to reality is rejected by postmodernism (Rossiter, 2000). Language impacts what is defined as reality; if something is outside of language, it becomes unknown and then is not accessible as reality. From a postmodern perspective, language is socially constructed (Ray, 1996; Rossiter, 2000; Trinder, 2000). Language is used selectively so a • researcher must not only pay attention to what is being said but also to what has not been said and to the context in which the stories are constructed. This deconstruction can be disconcerting because as the researcher brings to light the ambiguity of the participants' narratives so to can the researcher's text be deconstructed. The researcher's text may not make clear the participants' experiences but confuse them with the researcher's own values, as they are reflected in the language the researcher uses (Agger, 1998). Trinder states that postmodern research is "based on a presumption of local specific constructed realities, with constructions not more or less 'true' in any absolute sense, but simply more or less informed and/or sophisticated" (2000. p. 51). She believes this can prove problematic. One issue, referred to as the representational crisis, relates directly to phenomenological research. This issue is "whether lived experience can be directly captured untainted by social relations" (Ibid, p. 51). Trinder (2000), goes on, not to answer this per se, but to reaffirm the need for the researcher to 24 study the language used by participants, which allows the researcher to not just capture the voice of the participants but to examine the voice the participants use in a particular context. Another issue regarding representation is that if one representation can be as 'true' as any other, there seems to be an acceptance of 'anything goes'. "Cath Wood (1997) suggests that postmodernism ultimately sees all behaviour as acceptable" (Trotter, 1999, p. 13). Power relations are also important to the postmodernist. In regards to the investigation of power, Foucault has had a great impact on postmodern thought (Fawcett & Featherstone, 2000; McGowan, 1991). Foucault, as cited in McGowan (1991), linked power and knowledge - "power produces knowledge... power and knowledge directly imply one another..." (p: 129) - and put forth the notion that "where there is power there is resistance" (p. 129). He viewed power as relational, present in all social interactions, and something that is exercised not possessed (Fawcett et al., 2000; McGowan, 1991). Accordingly, knowledge is a construct of power and is constructed in language. Knowledge brings into being the effects of power (Fawcett et al., 2000). As indicated by Cherryholmes, power can "refer to relations among individuals or groups based on social, political and material asymmetries by which some people are indulged and rewarded and others negatively sanctioned and deprived" (1988, p. 5). This understanding of power makes clearer the notion that there can be power relations operating on every level of interaction. It points to how power can influence how individuals define themselves, how they might think and how they can behave. The power systems involved in cultural, social, and professional affiliations can provide 25 understanding for each individual about what it means to be her or him in that context. This understanding would include gender, age, profession, race, culture and socioeconomic standing. The feedback, both positive and negative, received from the individual's society or community will influence what he or she believes, thinks and how he or she acts. The behaviours that ensue create the society or community to which he or she belongs (Cherryholmes, 1988). These ideas of the power/knowledge relationship may be significant to this research because those who have access to what is considered 'real' knowledge are able to exercise power. Social workers are seen as having legitimate knowledge as ascribed by society and, as such, are in a place of power (Regehr & Antle, 1997) A postmodern feminist perspective allows the researcher to hear marginalized voices. This suggests that the researcher will pay particular attention to the power systems both within the researcher/participant context and the context of the participants' narratives. Attending to the power structures will allow for a deeper understanding of the participant's experience. Postmodern feminist theorists recognize that meanings represented by the researcher or put forth by a participant are in the process of being recreated in language. Each time a meaning is put into language, the meaning changes. Postmodern feminism allows that meanings can be static for a limited time in order to be studied (Fawcett, 2000). Studying the experiences of involuntary adolescent clients from a postmodern feminist perspective acknowledges the validity of a multitude of representations (Kvale, 1996). Research from this perspective is not pinpointing the truth, but portraying meanings that are in a particular context. This approach to understanding includes 26 paying attention to not only language but also the voice, tone, emotion, and strength and the variations in each of these (Fawcett, 2000). Assumptions, contradictions, and paradoxes also need to be attended to by the researcher (Fawcett, 2000; Ray, 1996). Although postmodern theorists see the possibility of understanding global issues by analyzing how they play out in a local context, a criticism of postmodern and feminist theory is that the theorists may be too close to a particular group and local contexts so that the local issues/experiences are not connected to global ones (Agger, 1998). This criticism includes the abandonment of metanarratives. The concern is not that multiple, localized narratives are not useful in understanding social struggles but that the solutions from them may not be lasting or may be more akin to survival strategies (Fotopoulos, 2003). The critique of metanarrativity dooms people to piecemeal solutions formulated within the local discourses and practices of exploited groups, thus failing to locate the source of their exploitation in structures such as capitalism, racism, and male supremacy, which are often quite invisible, especially to those who view the world from the ground up (Agger, 1998, p.163). There is also the concern that the postmodern and postmodern feminist theorists' focus on difference and polyvocality may not allow for different social groups to come together under some unifying element. This may be seen as generalizing and postmodernists are suspicious of any generalizations (McGowan, 1991). Agger state that one characteristic of postmodernity is the numerous new social movements such as feminist, environmentalist, and gay movements (1998). According to Fotopoulos, these movements have brought forward radical critiques against certain hierarchical structures yet they have never advanced any systemic change (2003). 27 According to Agger, the "prefix post- in the word postmodernity" implies a state beyond modernity and that modern theories fall short in handling unique issues arising in this time (1998 p. 35). Based on this, Agger claims postmodern social theory can be seen as utilizing modern theories to speculate and come up with new understandings (1998). Included here, then, are also modern theories that may be relevant to this research but are not intended to provide any overarching, or all encompassing explanation to capture the experiences of the participants in this research. A Brief Review of Reactance Theory In 1966, J.W. Brehm proposed the theory of "psychological reactance" (Reactance to enslavement, 2000). This theory has become a tool in the study of coercion, manipulation, and pressure and the psychological responses related to them. The theory has been assessed in many experiments (Rooney, 1988) and been used by researchers to explain things from restroom graffiti to attraction to the opposite sex (Engs & Hanson, 1989). It has also been applied to various age groups (Engs &, Hanson, 1989). The predicted behaviours of reactance theory have been supported by the outcomes of laboratory experiments (Rooney, 1988) The premise of reactance theory is that if a person perceives an unfair threat to, or a loss of freedom, they will enter a psychological state that includes anxiety, defiance, and struggle. It is then assumed that the subsequent behaviour of the individual is motivated by the individual's desire to eliminate this stressful state ("Reactance to Enslavement", 2000). Reactance theory identifies five different ways that an individual could react to a threat to or loss of freedom (Rooney, 1988). These include: 28 1) seek to restore his or her freedom despite the consequences; (2) show hostility or aggression toward the threatening source, even when such efforts are unlikely to remove the threat; (3) find a loophole or technically comply with regulations while violating other norms that were not expressly prohibited; (4) attempt to incite others to perform a forbidden behaviour; or (5) become increasingly attracted to prohibited behaviour (Rooney, 1988, p. 132). There are also variables that would impact the degree of reactance from the individual! These include the presence of a freedom. For example, youth do not have the freedom to vote until they are eighteen. So if a fifteen year old is imprisoned and told they have no voting rights in prison, it is unlikely to cause a reaction, voting is not a freedom she or he would have or possibly even want outside of prison. How real or fair the threat is and how valuable the freedom is are important, as are how much of the freedom is threatened, and what the likelihood is for further threat (Engs & Hanson, 1986; "Reactance to Enslavement", 2000; Rooney, 1988). The implication of this theory for social work is that it provides an "empirically-based" understanding of possible behaviours of involuntary clients (Rooney, 1988). Typically, behaviours of involuntary clients have been referred to in terms of resistance, non-compliance, passive-aggressiveness, and hostility (Rooney, 1988). These terms label or define the clients in a negative context that is reflective of the practitioner rather than the client. The predicted responses put forth by reactance theory normalize these behaviours and allow for understanding behaviours without labeling the clients (Rooney, 1988). From this theory, approaches for decreasing reactance when working with involuntary clients have been postulated (Rooney, 1988). According to Rooney, (1988) this theory supports and gives credence to social work practice strategies that have previously been based only on practitioners experience and good sense. 29 Social work practices have been founded on modernist sensibilities and have used theories to provide the base from which social workers could loosely define norms of human behaviour that justified interventions (Rossiter, 2000). Over the years, social workers have also sought direction when working with involuntary clients (Rooney, 1988; Sheafor, Horejsi, & Horejsi, 2000). A theory considered empirically based would provide some relief for the profession in regards to working with involuntary clients (Rooney, 1988). From reactance theory, social workers may develop a narrative about engaging involuntary clients. In researching the lived experience of involuntary adolescent clients, reactance theory provides meaningful categories in the form of the 'five ways of reacting' in which to place behaviours that may be represented by the participants, rather than allowing the categories to come from the participants. The foundation of reactance theory can be seen as relative to cultural, social, and historical contexts and as such may not be valid beyond these local contexts. Reactance theory may lend some understanding to possible behaviours of clients who are involuntary but it does not speak to the subjective experience of the clients. It is based on Western ideologies, which encompass particular notions of freedom. The differences that would be inherent in each individual's construction of an involuntary experience may not have been attended to and so behaviour that is ascribed meaning by reactance theory may have little resemblance to the understanding of these behaviours as represented by the client. At the same time it may be possible to draw from this theory, what it includes and what it doesn't include, to compose new understandings. 30 Adolescence As stated in the introduction, adolescence is a time of transition from childhood to adulthood (Cole, 1995: Cote & Allahar, 1994; Kimmer & Weiner, 1985). Adolescence can be described as a time when one is deciding who he/she really is and how he/she fits into the scheme of life (as cited in Kimmer & Weiner, 1985, p. 34). It would appear that this transition period has neither a clear chronological start nor finish (Cole, 1995) It seems the pervasive thinking about adolescents is that they are immature and not able to make 'good' choices and therefore need to be monitored (Cote & Allahar, 1994). According to Piaget (as cited in Achenbach, 1982, p. 43), adolescents have the ability to analyze problems in terms of complicated hypotheses and are able to use abstract logic in their thinking. At the same time, adolescents are not granted full citizenship in our society (Cole, 1995; Cote & Allahar, 1994). It is important to remember that although their goals might be determined to be secondary to their guardians and professionals (Koocher, 1976; as cited in Rooney, 1992), they still have the right to "...informed consent, to refuse treatment..."(Christian, Clark, & Luke, 1981; as cited in Rooney, 1992, p. 50). In Canada, a youth gains legal independence at nineteen years of age. In terms of utilizing social services such as counseling, youth under nineteen have the same right to confidentiality as adults. There are varying explanations as to why adolescence/youth is an important developmental stage. Many of the theories explaining adolescence are based on modern sensibilities. These theories may not appear to fit with research that claims to be influenced by postmodern and feminist perspectives. In fact, any adolescent theory may seem out of place, given the phenomenon being explored is not 'adolescence'. It 31 is possible, however, that readers of this study may hold particular thoughts on adolescence without thought to other possibilities. By including some theories on adolescence, readers may be more inclined to examine their own understanding of adolescence. This may be important because readers' beliefs about adolescence may influence how they regard the thoughts and beliefs of youths. Some views giving meaning to adolescence stem from the biological perspective that claims that there are certain changes that must occur for a person to become an adult (Cote SAIIahar, 1994). These changes are physical, emotional, and mental. The biologically-based perspectives of youth/adolescence place the solutions to any youth issue/problem back on the youth (Cote & Allahar, 1994). The fields of psychology and psychiatry come from this perspective and they acknowledge that the theories tend to focus on the inner workers of individual development in the analysis of youth (Cote & Allahar, 1994). It is important to note that gender and socialization also impact what it means to be an adolescent. For example, Reinharz (1992) points out how Lemer "challenged the gender-neutral definition of adolescence...'As young men pass through adolescence on the way to responsible adulthood, young women have passed through on the way to dependency, giving up the freedom experienced as children ...'" (p. 156). Generally, the theories surrounding adolescence come from a masculine voice and may not portray any significant differences based on gender and socialization, which differs depending on culture, race, and ethnicity. Other views stem from the perspective that adolescence is more of a cultural phenomenon than a biological phase (Cote & Allahar, 1994). This includes the 32 functionalist view that sees youth and adolescence as something that had to develop in affinity with industrialism (Cote & Allahar, 1994). This view lends some understanding to the prolongation of youth. In the mid 1800s, puberty was also the time youth gained independence from parents or guardians (Cote & Allahar, 1994). If youth remained at home, they contributed to the household with either finances or labour. With industrialization came improvements in people's overall heath, which over time decreased the age of puberty. Also, at this time, the view of youth began to change so that they were no longer seen as necessary to the economic welfare of the family (Cote & Allahar, 1994). Children changed from being economic assets of the family to national assets, like raw material, needing nurturance and protection (Goldson, 1997) regardless of sexual maturity and cognitive capacities (Cote & Allahar, 1994). As industrialism advanced, the timeframe constituting youth lengthened. Functionalists explain this further prolongation of youth with the need to have specialized training in order to gain employment that could be described as successful in terms of economic and social standing (Cote & Allahar, 1994). Another view within the cultural perspective is that of the peer group or subculture. This view is that there is a development of a youth culture (which includes behaviours, dress, et cetera) as an attempt by adolescents to find meaning in their lives (Cote & Allahar, 1994). This may be played out with reactivity and defiance as the adolescents define themselves within a peer group and possibly in opposition to their parents and other adults. 33 A third view found under the cultural perspective is the political economy view (Cote & Allahar, 1994). This view seeks to understand the cause behind youth behaviour from a political and economic standpoint. Youth are seen as disenfranchised in all realms and are inculcated into accepting this powerlessness. Adolescence then is seen as a time for indoctrination into the belief and acceptance of "existing power structures as normal, natural, good, and benign" (Cote & Allahar, 1994, p. 25). The State promotes this conditioning of acceptance through various institutions such as the education system. This conditioning is seen as serving the interest of capitalism (Cote & Allahar, 1994). Children and youth are taught that if they work hard and follow the 'rules' they will be rewarded with successful and fulfilling lives. Resistance to this training is generally met with more pressure to acquiesce. This pressure is again applied by the State through teachers, social workers and police, et cetera. (Cote & Allahar, 1994). The political economy view sees youth as also being economically controlled because they lack opportunity in the job market beyond low-paying remedial positions (Cote & Allahar, 1994). This lack of financial independence is seen to contribute to the emotional control of youth and therefore the macro manipulation of their identity and desires (Cote & Allahar, 1994). The systems of industry and media are seen as contributing to this emotional control through marketing and providing images of what it means to be 'in' or 'somebody'. The education system is a contributor because schools become holding places where youth are on the outer edge of society and hungry for identity that can then be provided through consumer items. The political economy view 34 is seen as providing an understanding of the 'how's and why's' of the construction of the social sphere and its changes (Cote & Allahar,' 1994). Postmodernism is the fourth cultural perspective presented by Cote and Allahar (1994). Cote and Allahar state that there is no one agreed upon view in postmodern thinking. They point out how the postmodern views mix components of other models previously put forth by sociologists and may not really contribute to advancing the understanding of youth. However, Moore (1998) sees the condition of postmodernity as having a considerable impact on youth, white middle class youth in particular. In the past, marginalized individuals and groups could reinvest their energies somewhere else. For example, youth of the 1960s engaged in existential subjects, explored alternative philosophies, and held some belief there could be social change (Cote & Allahar, 1994). These youth also maintained trust in progress, renewability, and "the dialectical possibilities presented by the postwar society" (Moore, 1998, p.260). The discourses regarding social issues could be seen as persuasive and logical for these youths. Postmodern youth face deconstruction of the modernist ways to view the world that at one time provided rationality. Progress in postmodernity can be seen as a myth (Agger, 1998). If there are no universal 'truths' then the energy of youth rebellion has nowhere to go. Moore states, "while postmodern subjects may pursue a number of avenues for temporarily locating sources of passion, the fact remains that a fundamental rupture between affect and ideology makes such investment arbitrary at best" (1998, p. 254). If all things are equal and the 'real' and the 'simulated' are so blurred that everything can be seen as counterfeit, youth struggle to identify or decide what matters. The 35 postmodern youth can be seen as, indifferent, disaffected and/or apathetic (Cote & Allahar, 1994; Moore, 1998). The attitude of 'been there, done that' is seen as predominant and the concern is that in turn, the youth will do, say, and feel nothing (Moore, 1998). The state also has expectations of what youth should be engaged in and creates social policy accordingly (Cole, 1995). This means social, political, and economic factors play a part in defining what is meant by youth. When researching the experiences of involuntary adolescent clients, all the former views may be relevant. These theories may lend some understanding to how the adolescents situate themselves in terms of being involuntary. Understanding may also be given to how they represent their experience of being made to attend an alcohol and drug program. For example, their mandatory attendance may have provided them with messages on what it means to be young. Alternatively, the youth's concept of what it means to be an adolescent can affect how he or she defines the experience of being an involuntary client. It is also important to reflect on this developmental stage from a variety of viewpoints because, knowingly or unknowingly, practitioners may subscribe to a particular theory of adolescence. Any thought, feelings or behaviours portrayed by involuntary adolescent clients, can then be attributed to the state of being adolescent rather than the state of being involuntary. Research Involving Involuntary Clients The literature addresses issues of treatment outcome for voluntary and involuntary clients. In terms of treatment, Atkinson, (1992) states that services provided to involuntary clients are often inappropriate or harmful and that the results of such 36 service are dubious. Lerman, (1975) believes those who perceive treatment, as punishment will not be receptive to change. For the general population, Atkinson, (1992) believes that "one of the most important predictors of change while in treatment is the person's desire for change" (p. 162). Brehm and Smith in addition to Videka-Sherman (Kunkel, 1992; Rooney, 1992) reached conclusions that indicated involuntary clients achieved successful outcomes, more often than voluntary clients. Another study by Goldenberg, Smith, and Townes (cited in Rooney, 1992) showed involuntary and voluntary clients to have similar results in terms of outcomes. In fact, they felt that the distinction might not be necessary, as they believed involuntary clients became voluntary through treatment. This seems to infer that if desire for change is measured by volunteering, it may not be a significant indicator of successful results (Rooney, 1992). Clients who are involuntary, yet are not legally mandated, are often classified as voluntary clients and most studies on the effectiveness of treatment do not necessarily look at client variables such as this (Rooney, 1992). O'Hare (1996) states in his study on court-mandated versus voluntary clients that although the referral source might be useful as an indicator of motivation, willingness to change might continually be clouded by ambivalence or reluctance no matter how the client came to be in treatment. In addition, it is suggested that client success, whether voluntary or involuntary, may be more closely related to the client-worker relationship or furtherance of choices and feelings of power in the treatment process than to the client's desire to change (Rooney, 1992). It seems that outcome studies on treatment do not reflect the need for different practice methodologies but other literature on probation and child protection outcome 37 studies that suggest some practice methods are more effective (Trotter, 1999). These studies do not address the ethical issues that workers may have to confront when working with involuntary clients. Although the value of self-determination has been an integral concept in social work, two studies (Proctor, Lott & Morrow-Howell, 1993; Weik, 1994) revealed that practitioners supported the right of self-determination, more as a concept than as an application (as cited in Manning, 1997). Both studies found that if sharing power through decision-making involved too much time and/or effort, the clients' ability to self-determination was compromised (Manning 1997). Although client self-determination was seen as important, expediency was seen as more valuable. Another study by Rothman, Smith, Nakashima, Paterson and Mustan (1996) stated that social workers do use varying levels of paternalistic beneficence in their interventions while holding the belief that this is ethically correct when certain conditions are met. For example, when there is a risk to the health and welfare of the client or others paternalistic interventions may be seen as appropriate. The studies focusing on ethical practice issues for social workers have found client self-determination is often weakened in practice, regardless of worker beliefs. / i Generally speaking, people become social workers out of a real desire to help others and are likely going to work with involuntary clients if it will, in the long run, produce the most good (Reamer, 1995). Meinert (1994) thinks clients engaged in the experience of an intervention will define or form the value position of self-determination, out of the activity itself. The literature about self-determination, paternalism, and work with involuntary clients is extensive. Yet, studies telling the experience of such clients 38 are lacking. Social workers can support the right to self-determine as a theory and believe it is ethically correct to uphold, yet they may be looking for direction when it comes to working with involuntary clients (Rooney, 1988). This speaks to the fact that practitioners do struggle with paternalistic practice and would be better able to provide ethical practice had they an understanding of the actual lived experience of involuntary clients. The following chapter explains the research methodology used in this study of the experiences of involuntary adolescent clients. 39 CHAPTER THREE Methodology Qualitative studies are well suited for five research purposes. These include: a) understanding the meaning of a phenomenon for participants of the study, b) understanding the context of participants actions and the influence the context has on their actions, c) exploring to identify unforeseen phenomena and influences, d) generating new grounded theories about the influences, and e) understanding the manner by which phenomena take place and developing causal explanations (Maxell, 1996). This research is seeking to understand the meaning of a lived event for a small group of people. Phenomenology is one approach used in qualitative studies. According to Creswell (1998), phenomenological enquiry "describes the meaning of the lived experiences for several individuals about a concept or the phenomenon" (p. 51). Doing research from a phenomenological perspective is "to question the way we experience the world" (Van Manen, 1990, p. 5). In this case, it is the lived experience of being an involuntary adolescent client that is being questioned. Accordingly, a qualitative inquiry using a phenomenological approach is the most appropriate method of investigation. Phenomenology is both a philosophy and a methodology (Morse, 1994; Van Mahen, 1990). Anything that is linked to consciousness could be of interest in phenomenology. If something is not connected to consciousness, then it is not connected to possible lived experiences because it is through being conscious that people access or relate to the world (Van Manen, 1990). Phenomenologists look to understand the lived experiences, as they are experienced, to discover the essence of 40 the phenomenon, without explanation as to how the experience came to be or justification for the subjective meaning of the experience (Morse, 1994). This method of study is congruent with focusing my research on the experience of being an involuntary client without any consideration as to why these clients were involuntary. A phenomenological method, as described by Kvale, (1996) includes description, investigation of essences, and phenomenological reduction. Phenomenological reduction involves analyzing and setting aside my own preconceived ideas about the experience so I can arrive at an unprejudiced account of the essence of the phenomenon (Creswell, 1998). Van Manen (1990) defines the essence of a phenomenon as not "some ultimate core or residual of meaning" but something that "may be understood as a linguistic construction, a description of the phenomenon" (p. 39). Investigating the essence involves searching for the common essence of the experience, that which remains constant through the different stories of the experience (Kvale, p. 53). As the intent of this study is to create a full picture of the experiences of a small number of adolescents who received involuntary treatment, phenomenology is the most appropriate approach to inform the study. Sample Design Deciding who will participate in the research is important (Creswell, 1998). As I am researching adolescents' lived experience of being involuntary adolescent clients, it is imperative that the persons who participate in the study have all experienced the phenomenon of being involuntary clients. As shown in the literature, the term involuntary can account for a full range of clientele. Therefore, I wanted research 41 participants who identified as having been involuntary clients. This was done by having the youth respond to the questions: "Were you made to attend (the actual name of the program was used on the questionnaire) and were you expected to complete 12 sessions?" I received approval from the community service agency to access the population of youth who had accessed any alcohol and drug services provided by the agency. I was told that most of these individuals attended the alcohol and drug group for youth even if they were first referred to see a counsellor rather than being referred directly to the group. The alcohol and drug group is a 12-week, alcohol and drug intervention program and is attended by adolescents who were either self-referred or referred by probation, school, parents or the Ministry for Children and Family Development. As such, the group population has been made up of both voluntary and involuntary participants. The community service agency was conducting a program evaluation/client satisfaction survey and I was told I could utilize this to recruit participants. Because the prospective participants were youths, I needed parental approval. For that reason Informed Consent Forms for participating in this research were delivered to the parents of the youth along with the agency consent forms prior to the implementation of the program evaluation. Consent forms for this research were not sent to parents of youth who self-referred to the program as they would already have parental approval on file for the administration of program evaluations and would not be asked to participate in this study. A purposeful criterion sampling strategy was used in order to ensure that the adolescents agreeing to participate in the study defined themselves as having been 42 made to attend the alcohol and drug group. I attached a recruitment questionnaire to a program evaluation that was given out to all adolescents who had attended the alcohol and drug group in the past as well as a letter indicating the reason for the questionnaire and a brief explanation about my research project: The recruitment questionnaire was designed to have the adolescents identify if they were involuntary, to provoke some reflection on their experience, and to elicit interested participants for the study. The program evaluation contained two questions that were also in the attached recruitment questionnaire. The first question as stated earlier, was to identify whether the youths identified as involuntary. The second question was about whether or not the youth experienced any loss of freedom by being made to attend. The group facilitators believed this information might be useful to them for program development purposes. They would compare responses to those questions with the responses to the rest of the questions on the program evaluation. This also allowed all youth participating in the program evaluation to identify as voluntary or involuntary without feeling they had to participate in the research study. Youth who were interested in speaking with me about their experience indicated that on the second page attached to the recruitment questionnaire and included their personal information so that I could get in touch with them. They were able to return the recruitment questionnaires in a separate envelope addressed to me so that they could maintain their anonymity when responding to the program evaluation. This also ensured that the responses to questions on the attached questionnaire, about being involuntary and wanting to talk about the experience, were kept confidential and were not accessed by the community service agency. 43 The community service agency hand delivered the program evaluations to the youths including the recruitment questionnaire, which is a method consistent to what they have done in the past as approved by their'board of directors. This was done after the Informed Consent Forms were received back from the parents. I received ten Informed Consent Forms from parents and 14 questionnaires from youths. After the community service agency analyzed the program evaluation data, they contacted me to indicate that they had 23 youths who identified as involuntary. I had no. way to confirm that the 14 questionnaires I received were not already accounted for in the 23 responses on the program evaluations. I assumed that if the youth filled out the questionnaire to participate in this study then he/she probably completed the program evaluation as well. This meant that another nine youths identified as involuntary and I was provided with graphs depicting the 23 responses to the questions regarding being involuntary and loss of freedom. These graphs are shown in Chapter 4 and are listed as Figure 2 and Figure 3. I matched the parental Informed Consent Forms with the questionnaires and found that I was able to contact 12 youth. Nine had parental consent and three were now 19 years of age and could give their own consent. I contacted the youth and further explained my interest in researching their experiences as people who had been made to attend an intervention and invited them to participate in a group interview that would take about one and one half to two hours. I also let them know that after I had familiarized myself with the transcripts of the interview, I would like to meet with them again for clarification, verification, and further discussion. Six of the 12 agreed to 44 participate in the group interview, while the other six stated they would be willing to be interviewed individually. I was concerned that I had only six participants for the focus group. Seven to ten participants are suitable for a qualitative study because the main point is to "describe the meaning of a small number of individuals who have experienced the phenomenon" (Creswell, 1998, p. 122). It is also a good size for a focus group (Marshall & Rossman, 1995). According to Kvale, the number of interviews for a qualitative study tends to be approximately 15 ± 10 (1996, p. 102). Also, by having only six participants willing to engage in a group interview I could not choose respondents who reflected polarity in their initial feelings about being made to attend an intervention. I believed that I would have a more insightful understanding of the phenomenon if I interviewed youths with different feelings about the experience. I decided to do individual interviews as well as the focus group for these reasons, with the hope that I would gain a variety of insights about the experience of being an involuntary adolescent client. I set up the focus group first because it is harder to schedule a time that works for a number of people than it is for two people. Consequently, I asked permission from the youths who agreed to individual interviews, to contact them again later. They all agreed and I moved forward with setting up the focus group. We agreed to meet and use a group room at the community service agency, which I had suggested as a comfortable place that would provide privacy and a back entrance so the youths had the option of not being seen entering the community agency. I also thought it would be better for me to suggest a meeting place as it may have been 4 5 difficult agreeing on a place if each youth had a different preference. One youth used the back entrance of the agency. In setting up the individual interviews, I again contacted the six youths that had indicated an interest in participating. Of those six, three were interested in participating and willing to commit to a time and a place. Two youths preferred to meet me in a cafe although it was a public location. They believed the noise level would ensure them enough privacy. I agreed but voiced my concerns of missing some of what they had to say. It was decided that if there was anything missing it could be attended to in the following interview. The third youth opted to have me come to school and we conducted the interview in the library. Data Collection The method of collecting the data is an important consideration for the researcher. The process is guided by the research's chosen methodology and theoretical framework. Interviewing is a method of data collection consistent with qualitative research (Kvale, 1996). Interviewing can be used for a variety of purposes in qualitative research. In a phenomenological study, the purpose of the interview is to gather experiential accounts to develop a more insightful understanding of a phenomenon. It can also be used to engage in an informal dialogue with another (a participant) about the gist of an event (Van Manen, 1990). In feminist research, it is suggested that in-depth interviews be unstructured or semi-structured and include the use of open-ended questions (Reinharz, 1992). This type of interviewing allows for a subjective telling of the experience. All the thoughts, feelings, and actions that make up that experience are in the participants' words rather 46 than the researchers (Reinharz, 1992). At the same time, when seeking to understand the 'lived experience of a phenomenon', it is important that the interview stays close to the 'experience as lived' (Van Manen, 1990, p.67). This may include asking very specific questions to help the person walk through the experience. For the focus group, I used a semi-structured format to explore the youths' subjective experiences surrounding being made to attend an intervention. Based on the literature of Hersch, (1997) and my own experiences, I believe that adolescents will already be in a perceived place of less power when being interviewed by an adult, so using a focus group would allow the adolescents more control over the interview situation. Since the interviewer has less control, focus groups have the potential of creating jumbled data (Marshall & Rossman, 1995). My hope was that this would be dealt with by using a semi-structured interview approach recommended for group interviews (Carey, 1994). This means that I had guideline questions and used those to initiate conversation and at times would guide the youths back to the topic if they drifted off, or ask another question if they didn't know where to go next with the topic. A focus group has advantages over the one on one interview when the study is trying to get the thoughts and feelings of the participants rather than behaviours (Carey, 1994). This is because of the interactive nature of groups; a focus group may lead to more unprompted and candid statements about the topic (Marshall & Rossman, 1996). Using a focus group method of data collection assumes "that an individual's attitudes and beliefs do not form in a vacuum..."(Marshall & Rossman, 1995, p. 84). I think this may be particularly true when asking adolescents about a topic upon which they may never have spent any time reflecting. In a group interview, participants will hear others' 47 opinions and begin to form their own and in the right atmosphere they may even do this aloud (Marshall & Rossman, 1995). The aspect of group interviewing that I stayed most aware of was the psychosocial factors that could limit the quality of data (Carey, 1994). These factors include such things as identifying the natural leader in the group, the most talkative, and possible patterns of interaction the youth may have already established with one another. If one participant assumes a leadership role in a focus group, he or she may inadvertently shape how the other participants give voice to their own experiences. When one participant described an experience and others agreed, it was important for me to ask those agreeing: "How was that different for you?" or "Tell me more about your experience." It was also important to be cognizant of the interaction between the youths. I wanted to ensure the youths felt safe and supported in an environment that was free from ridicule from others. I hoped this would encourage the youths to be more candid about their experiences. In the end, I lead a focus group of only four participants. One called me just before the scheduled time for the group and one called minutes after the focus group ended apologizing for forgetting. I did ask this youth to commit to another time but was unsuccessful. The focus group was made up of two female participants, 18 and 15 years old and two male participants 18 and 15 years old. All the participants had been referred and compelled to attend an alcohol and drug intervention program by the high school that they attended. I believe four participants worked well because they did not have to share talk time as much and it may have alleviated some potential cross-talk and interruptions. Adolescents are often seen as a part of a subculture (Cote & Allahar, 48 1994) with their own social constructs so in order to collect rich data I needed to pay attention to the group interaction as well as to what individuals said. Before we began the group interview, we had donuts and refreshments and engaged in 'idle chitchat' to get acquainted. This gave me time to assess who might be leery of speaking and who was more out spoken. Carey (1994) suggests that a person reluctant to speak out be seated across from the leader so they can be encouraged using non-verbal techniques. She suggests that the more verbal participant be seated next to the leader to afford the leader the opportunity to "guide the level of participation of that member" (p. 230). A semi-structured format was also used for the individual interviews. Again, before the actual interview began we, the youth and I, spent time becoming acquainted. This time was used to talk about what the youths could expect as participants in the research. During this time, with both the group participants and the individual participants, I revisited the fact that the information shared would be confidential and invited the youths to sign an Informed Consent Form. I thanked the youth for responding and shared how it was that I chose this topic to research. I explained in some detail the method of research they were participating in and that my research was guided by values found in feminist therapy, where personal experiences reflect and influence the values of society and that people have the right to have equal power in relationships (Larsen & Rave, 1995). These values allow for questions of how women come to think of themselves and to resist or change social constraints. Through these values, women can refuse to be what they are socialized to be. I clarified that the interview process 49 was not intended to be therapeutic but that these values were important to me in any human interaction. I included a brief explanation of feminist research, as I understood it, and qualified it by telling them that I was not doing a gender analysis of the experience of being an involuntary client. I put forth my perspective that youths often have no voice, which I believe to be similar to the experiences of women in our society. In keeping with these feminist values, I sought to ensure non-hierarchical interviews by explaining to the youths that I was not the 'expert' and that I wanted to learn from them. I spoke to the analysis of the data stating that I wanted to stay as true to a phenomenological study as possible in that I wanted to understand what it means to be an involuntary adolescent client; but that at the same time the analysis would be influenced by feminist and postmodern thought. I did not use these terms as much as I discussed my notions about these theories. I did address the thinking that the way we come to understand the world we live in is constructed socially and that there was no one fixed meaning that I was looking for. I also explained my understanding that there are no real 'grand theories' to explain how to be in the world or the 'why' and the 'what-have-you' of different events. We discussed that I may end up with more than one understanding of what it means to be an involuntary client and that each would be as true as the next. I explained I had a few general questions that would guide the process and that my intent was to give them a voice about their thoughts and feelings about being made to attend an alcohol and drug intervention and, therefore, of being an involuntary client. They were informed that they could leave the interview at any time or not answer questions they weren't comfortable with. I explained the purpose of using audio and 50 videotaping, so that I could capture the youths' own words accurately. A request to meet with the youths again was made at this time. Multiple interviews can build bonds and increase trust between the researcher and participants, and provides the opportunity to share the transcripts (Reinharz, 1992). Reinharz also states that multiple interviews will probably be more accurate than single interviews because more questions can be asked and participants have the opportunity to make corrections, additions or deletions from the previous interview. Multiple interviews allow for the establishment of trustworthiness as they prolong engagement with participants and provide for verifying material with the participants (Lincoln & Guba, 1985) When addressing confidentiality, I pointed out that there would be absolutely no consequences for them to face because of anything they may have to say. The raw data would be stored in a locked cabinet in my home so the only person who had access to it was me. I told them confidentiality would be further assured by not using their names in the research paper. We discussed the possibility of using pseudo names to prevent any association of person with the information given. The youth participating in the focus group just started laughing and one stated, "I don't care if my name is used" the others nodded in agreement. The youths participating in the individual interviews did not want to use their names but they all thought it was too humorous to make up names. I suggested for all the youths that they choose a code, a number, a colour or a font style to represent them. They agreed on choosing different colours to represent what they had to say and to differentiate one youth from another. When I asked them if that meant they want to be referred to as that colour they were all quick to laugh and as one youth put it "just use the colour when you're using our words". As will be evident in 51 Chapter 4, the youth are not identified in any way; only their words are in the colour of their choosing. I spoke with the youths about how long they could devote to each interview and how many interviews they would like to participate in. While the youths in the focus group all agreed to a second interview, just three of the four actually participated. Two of the youths from the individual interviews participated in two interviews. The first interview for both the individuals and group was to listen to what they had to say about being an involuntary client. The interviews were recorded and transcribed. Before we began the first interview I gave the youths the general questions that I would be asking so that they would know what to expect from me. 1. What did you think and how did you feel when you were first told you had to attend an alcohol and drug intervention? 2. How did your thoughts and feelings affect the way you responded to the intervention? How did they change or not change during the intervention? 3. Describe how you were treated at the time of the intervention and during the intervention. We began the focus group and, as the youth spoke, I paid attention to the way they interacted and how the responses flowed from one another. Approximately 55 minutes into the interview, a youth looked at the clock, said "shit I have to go", and jumped up to leave. The others also jumped up saying they would get a ride. The focus group reached a hasty conclusion with "call us later" left ringing in the air. I did call the youth after I had transcribed and become familiar with the data. We agreed to again meet at the community service agency but only three of the four youth showed up. The second interview was for the youths to read the transcripts and make any corrections, additions, and/or deletions. This was also a time for me to seek 52 clarification. Before giving the youths the transcripts, I explained that we do not speak the way we write. Since I had transcribed the recordings verbatim, they might be somewhat difficult to read. When the youth from the focus group read the transcripts, they shared some laughs over comments they had made. One youth made a correction. My understanding had been that she had been made to attend the alcohol and drug group when in fact she was made to attend individual alcohol and drug counselling. After attending a number of counselling sessions, she decided to attend the alcohol and drug group. No other corrections were made. The youths who participated in the individual interviews did not make any corrections perse, but one youth did add some information. This youth stated that he had attended the alcohol and drug group three times over the course of two years; the second and third times were voluntary. During the second interview, I asked the each youth to expand on some of their thoughts and we engaged in conversation. I shared some of my experiences working with involuntary clients and information that I had gleaned from the literature. These conversations were taped, with the permission of the youths, and transcribed, though not verbatim, and used in the analysis. Data Analysis As stated earlier I had data from two questionnaires. The first was the program evaluation that had included questions to identify youth who were involuntary and to see if the youths experienced any loss of freedom by being made attend. The second questionnaire was used to engage participants in this study. Upon compiling the results 5 3 from these questionnaires, I found myself wondering how useful they were to the research at hand. The questionnaires may have been limiting because the possible responses were limited by my ideas about being an involuntary client. I asked questions based on my own assumptions about being an involuntary client. The questions were not open ended and only allowed for agreeing, disagreeing, or some extent of agreeing or disagreeing. The youths' responses may not reflect their thoughts and feelings but rather what they thought would be the 'looked for' response. Due to this drawback, the data from the questionnaires is described in Chapter 4 but is not used extensively in the data analysis. In terms of the interview data, the analysis and interpretation was a matter of one step forward, two steps back. I went from the transcripts to contemplation and then from writing back to the transcripts, to doubting, to contemplation, often getting lost in my interpretation or getting lost in the data. The focus group interview was transcribed, read, and listened to until I felt I had a good understanding of the different stories. At that point, I began to work with the data using the five steps involved in phenomenological analysis (Kvale, 1996). The first step is to read the transcript to get a sense of the whole picture without colouring it with my own presupposed ideas about the phenomenon. The second step is to determine the meaning of each unit as expressed by the adolescent. The term 'unit' refers to one or many statements that need to be separated out. The third step is to determine the central theme that dominates each unit. The fourth step is to examine each unit to see what it says about how adolescents describe their experience of having been involuntary clients. In order to examine the units, I asked questions of the units such as "How did it feel to become 54 involuntary?" and "What were the responses to being involuntary?" The fifth step is to pull together the essential, non-redundant themes of the whole interview into a descriptive statement. The intention is to condense the expressed meanings into more essential meanings to better understand the invariant structure of the experience (Kvale, 1996). Going through these steps, I spent time pondering the information from different perspectives and looked for emerging patterns. This involved going through the transcript looking at what was not said, might have been said, as well as what was said. I looked at stories, feelings, and group interaction to analyze the data. The start of the analysis was recognizing that each youth experienced the phenomenon differently and looking to understand how each made sense of it. I then looked for similarities and differences across their experiences. Comparative case studies were done to achieve this. Case studies can be any person, event, or phenomenon where the description and analysis can contribute to our understanding of a particular field of study (Reinharz, 1992), in this case the experience of involuntary adolescent clients. Through comparing and contrasting cases, rules can be formed and categories developed that progressively arrange the facts gained from the individual cases. Individual cases can be combined to allow for the analysis of the relationship between cases and particular social structures and process. Combining cases also enables the researcher to look for specificity, exceptions, and completeness rather than generalizations (Reinharz, 1992). I sought insights and reflections to lead to an understanding of the essence of the experience of being an involuntary adolescent client. I began breaking down the 55 transcripts to descriptive statements, looking for similarities, nuances, and differences, and redescribing them. I paid attention to the context of each statement as well as the tone of voice. I searched for what wasn't said or what could have been said, knowing that as the interviewer I was the co-producer of the interview text and what I asked and how I responded impacted the ensuing dialogue. The interview "is a social production of meanings through linguistic interaction...the interviewer does not uncover some preexisting meanings, but support the interviewees in developing their meanings throughout the course of the interview" (Kvale, 1996, p. 226). The information produced from the follow up interviews was also included and analyzed in this manner. Through this process, statements formed units from which two themes were produced that reflected the participants' experiences of being involuntary clients. I then went through the units, analyzing them further to place them into different categories. At times, if I were unsure of meaning, I would take back the unit to the transcript and listen to the interview for clarification. I realize that had others participated in the analysis or if different methods of analysis used, the themes and categories may have told a different story. An exploration of the themes and categories is contained in the discussion of results in Chapter 4. 56 C H A P T E R F O U R Resul ts Quest ionnaires A s stated in the previous chapter, I w a s given data from the program evaluations. This was the data from the quest ions: "Were you made to attend (program name) and expected to complete 12 sess ions?" and " Do you think your freedom to choose was taken away?" B a s e d on the data from the first question, 23 youths indicated they were made to attend. I had received 14 responses indicating they had been made attend (see Figure 2). Figure 2 Program Evaluat ion R e s p o n s e to Involuntary versus Voluntary 57 What stood out in the responses to the second question (see Figure 3) is that although 23 youths affirmed they were made to attend, 32 responded to the question regarding loss of freedom. It is possible that at there were youths who felt a loss of freedom yet did not identify as involuntary. These results may be due to the fact that the first question only used the term 'made to attend' where as the second question included "yes, somewhat as I was pressured to attend" as a possible response to the question. These youth may have felt they were pressured to attend by family members or by a counselor (if they were seeing one). Another possibility is that the intervention influenced their feelings of having lost freedom. I believe this is important to explore but as none of these youths participated in the interviews I was unable to ascertain their experiences regarding this. Figure 3 Program Evaluation Response to Question Regarding Lose of Freedom o I had no choice No, not really ... Y e s , somewhat No, I had a choice. 58 The recruitment questionnaire also included the questions stated above. Although I received 14 recruitment questionnaires, the data from 12 is used here, as two youths had no corresponding parental consent. All respondents to this questionnaire stated they were made to attend and were expected to complete 12 sessions. In terms of loss of freedom, eight youths believed they lost their freedom to choose either totally or somewhat. The other four youths stated they had freedom to choose. The remaining questions were looking for information on the thoughts, feelings and behaviours thee youths might attribute to being made to attend or attending an intervention. The figure below (Figure 4) shows the number of youths, of eight youths who agreed they had lost freedom, responding positively (strongly agree/agree or yes) to the remaining statements/questions on the recruitment questionnaire. The statements/questions were: #3. I felt angry about being made to attend. #4. I felt disappointed about being made to attend. #5. I reacted with resistance (i.e.: gave attitude) in group because I was made to attend. #6. I used drugs/alcohol more because I was made to attend. #7. Group leaders treated me differently because I was made to attend. #8. My reaction (either positive or negative) to attending the group changed as the group progressed. #9. Do you believe that people who are made to attend a group or service should be treated differently than people who attend on their own? 59 #10. Do you believe that the type of relationship you may have with group leaders effects your attitude about being made to attend? Figure 4 Responses to Questions 3-10 on the Recruitment Questionnaire • Respondents who felt either total or some loss of freedom of choice This figure shows that one youth agreed that people who are made to attend should be treated differently. He included a statement to explain his meaning: "People who attend on their own should be acknowledged for that!" This was not explored further as this youth did not participate in any interviews. The next figure (Figure 5) shows the number of youths, of the four who depicted no loss of freedom, responding positively (strongly agree/agree or yes) to the remaining statements/questions on the questionnaire. 60 Figure 5 Responses to Questions 3-10 on the Recruitment Questionnaire 4.5-1 • Respondents who felt either little or no loss of freedom of choice What is not depicted in either Figure 4 or Figure 5 is that two youth in each grouping stated they were 'not sure' if they 'used more drugs/alcohol in response to being made to attend'. One of these youths did participate in the interviews and said her use did increase. In addition, as stated in the previous chapter, the responses to these questions may not be very useful given they were based on my own assumptions about being an involuntary client. For example, one youth agreed she was angry about being made to attend but in the interviews spoke of feelings of embarrassment and fear, not of anger. The data from the interviews explores the thoughts, feelings, and behaviours the youths associated with being made to attend in more depth. 6 1 Themes The analysis of the transcripts revealed two themes: a) 'I didn't like it' and b) 'I can't do too much about it now'. These seemed to depict the youths' overall experience of having been involuntary clients. The first theme, 'I didn't like it', captured the core of the youths' experience of being made attend an alcohol and drug program. The youth talked about lack of choice and power in the process. They also described the messages they received from friends, family, and teachers regarding being made to attend and intervention. The youths spoke about what could have been different regarding the process of being made to attend. This theme also captured their feelings regarding the experience. The categories 'they think I have a problem', 'somewhere along the way I was judged' and 'what could have happened' form this theme. The second theme, 'I can't do too much about it now', describes the way the youths dealt with being involuntary clients and It encompassed their feelings about the intervention program. The categories 'what do they expect' and 'settling back' form this theme. Categories Each category suggests a set of common experiences shared by the participants in this study. The degree of importance given these experiences differs among the youth. By exploring the categories, the reader will be able to gain some understanding of these adolescents' lived experiences. The descriptions used are quoted from the transcripts but any name of a person or program is replaced by three underscores. 62 I Didn't Like It The first theme, 'I didn't like it', describes the youths' experiences with being made to attend an alcohol and drug intervention. All the youths said they did not like being told to attend an intervention program. The youth used the terms "ripped off', "pissed off', "not fair" and "crappy" to describe their feelings about not having a voice and being sent to a program. There was agreement from the youths about not having a voice and that their position wasn't heard, I didn't have a point of view or didn't get to say nothing they didn't listen (Red). In some cases, not having voice may have been the choice of the youth. If he says to I just do it so then I don't have to go through all the hassle, maybe pissin him off (Blue). There was also a common experience regarding not really having a choice but for different reasons. Youth mandated to attend an alcohol and drug intervention by the school administration faced a minimum two-week suspension if they refused. Youth mandated through the justice system faced a breach of probation for not attending. It is possible a breach could lead to prison, although this was not stated directly by the youths. So the beliefs and feelings surrounding the idea of choice were impacted by the context in which the direction to attend was delivered. What they basically say is you can choose what you are going to do. - Violet Yeah but the outcome is bad if you choose, if you don't do what everybody wants. They want you to do something if you say "no." They say "okay fine you're suspended or whatever." - Navy blue I had to go or I would be back in court. - Pink Their experiences with 'choice' and their thoughts and feeling regarding it are flushed out more in the category 'they think I have a problem'. The youths spoke about messages they received from others about being made attend an alcohol and drug 63 intervention. Their experiences regarding how they interpreted others perceptions are captured more fully in the category 'somewhere along the way I was judged'. The youths also spoke about how they thought the issue of attending an alcohol and drug intervention could have been handled. These thoughts are explored in the category 'what could have happened'. Thev Think I Have A Problem This category describes the youths' thoughts and feelings regarding choice, having a voice or being heard, and power in the process. It also explores their perceptions of the motivation behind the referrals or possible lack of choice. This lack of choice left some of the youth feeling angry or disappointed. I didn't like it at all. My rights were basically taken away. I was ripped off! - Navy blue I should have been able to chose but I wasn't' so, I was kind-a controlled in that little area there. My belief was and still is that you have the right to choose what you want to do and the freedom of speech and your own opinion. But, when people kind-a charge in and kind a try and take that away, its like, your appalled. You don't do that! That's not right! - Red Other youths seemed to be indifferent to their lack of choice. I am not implying they completely agreed with not having a choice, just that they were able to make sense of it. I thought this may reflect some acceptance of being powerless not as a problem so much but as a reality at that time. I didn't think much of it. I just did what he told me to do because I got in trouble. I owed it. I dunno, I didn't think it was fair though, unless what you did was related to alcohol or drugs or somethin'. It wasn't related to the crime I did. If the laws not involved at all I wouldn't go. If I don't do it I breach. -Blue This youth seem to portray that being mandated to attend was just part of the consequence for committing a crime. It did not seem to matter to him that he thought it 64 was unfair because on some level he felt obligated. He did not want to be charged with a breach of probation either. In their experiences, the youths either did not feel listened to by the referral source or believed they would not be listened to. Two youths described how the referral process, with the principal and vice-principal, proceeded for them: I told a totally different story but they just assumed what they thought was right. I was pissed off! - Violet Yeah basically, like yeah it felt kind a crappie. They said," oh there's this thing called and your going!" Its like huh? All right whatever, well no choice there. I dunno about the assumption thing (shrugs). They don't acknowledge us, almost like they don't want to listen to you. Long pause. Its like they don't want to listen to me. ~ Red It would appear that these youth connected the lack of voice with not having any choice. It is as if they believe that they would have been afforded some choice had they been able to explain their situation. This passage also shows how one youth began using terms 'they' (the referral source) and 'us' (youth) and then moved to T. At first, I thought this youth was simply identifying with a collective, which made sense to me given that this youth was a participant in the focus group. However, another reading suggested that the youth was not initially comfortable with personally identifying or owning the statements she made. People can feel powerless when they believe others don't want to listen to them. I tried telling my side of the story and they said "we've heard this already". It was not a good experience. Other youth did not attempt to have a conversation with the referral source. They doubted the usefulness of such an effort, as is depicted here: 65 Why bother talking about it? I was on probation, tells you what to do. Besides he knew I was out of it when I, you know (long pause) broke the law (chuckle). - Pink Here again, the pressure of the legal system had a significant impact. I had a hunch that being made to attend an alcohol and drug intervention made sense to this youth, given his acknowledgment of his alcohol and/or drug use. His response verified that. Yeah, but I wasn't really down with that then. It didn't matter though cause and had to go too. - Pink When the youth explored how they came to be in a situation with no choice they shared beliefs about how they were perceived as needing help. This seemed to exasperate the youth. Their perceptions focused on being seen as having a problem or not being old enough to understand what was good for them. They feel they're wiser -- Violet Older and wiser. They feel they know a certain amount of stuff more that us. - Red Well, just, they think they know everything, they think you're like a little evil person. You really know all the stuff you did, like I know, it's just I don't know how to say it.... (shakes head pauses and is interrupted) - Green They assume you have a bad life. ~ Red The youths seemed to believe that the referral source was judging them because of one incident in their lives. Like sorry. I am a good kid, the reason I chose to smoke dope is not making me bad. Like I smoke it because I smoke it. If you have a problem with that, well then, its your problem, but it's my life so, piss off! ~ Red Its like "oh my god I've made a mistake". Everyone makes mistakes, but if you make one mistake, they frown on you. - Violet 66 Beyond believing that they should have had a choice, the idea that the referral source thought they had a problem seemed to play a significant factor in why they did not like being made to attend" an intervention. One reason I didn't like it was because like everyone was saying like I had a problem and I had to come here (community service agency) and fix it. I didn't think I had a problem. So what am I going to fix if I don't feel like I even have a problem? - Green I got told I had problem, so I got shitfaced, so what, I think they just need to do something with you. -- Pink One youth voiced the issue of having a problem in a way that seemed, in hindsight, that he recognized he might have had a problem. But when I got sent, I just figured I didn't have a problem at the time so I didn't understand why I was being sent at first. I could see it if someone was drinking to extremes. Then there's a problem, you can tell. If someone around, if your friend tells you "you have a problem" then you'll start looking back at yourself and say, "maybe I do". When a teacher or somebody with authority tells you, "You got a problem." You kind a look at it like, "where's the problem, I don't see it". - Navy blue This not listening to authority can be likened to the 'peer group' view of adolescence, where, in an attempt to find meaning, the adolescents may be defiant as they define themselves within a peer group (Cote & Allahar, 1994). According to another youth, the referral source isn't just saying you have a problem with drugs and alcohol, but problems with life that needed to be addressed. If a person would listen, get off probation right away, then that's what helps you see that, you listen. It's just like when you get into trouble, that's their way of putting you in a corner, right there. That's what probation does, controls the situation. - Blue The youth appeared to view this experience with probation as positive. This description and portrayal seems to fit into the political economy view where adolescence is the time 67 for programming youth into accepting the status quo (Cote & Allahar, 1994). Although the youth may just be reframing his reason for compliance because, as he said a number of times, he wanted to avoid any hassles. Even though the youths identified that the referral source believed they had 'a problem' or were in need of help, the youths did not appear to identify any caring involved in the referral. I think it was more a punishment. - Violet Yeah, that's what they were looking for, more of a punishment to keep you in line. - Navy blue Yeah, but when you get there and its not like a punishment. -- Red Its to teach me a lesson - Blue Ultimately, the youths' experiences of being made to attend were ones of being seen as incapable and of feeling ineffective in directing their lives. One youth spoke in a way that showed no real surprise at this treatment. Kids expect to eat shit all the time, but adults expected to be treated equally. As soon as they're not they have this big fit over it. - Navy blue What I heard in this statement was that it would not have been helpful for the youth to complain. The experiences of having no voice or being told what to do were normal for youth so they expect nothing different. In many ways, this statement epitomized the feelings of powerlessness and gave weight to the premise that adolescents are not granted full citizenship (Cole, 1995; Cote & Allahar, 1994). The exception. This sub-category describes one youth's experience of identifying as being made to attend an intervention but still feeling like she had some choice in the matter. 68 I didn't totally have to go. My mom was just like, you should, what do you have to loose? It was just like, if you don't like it you don't have to go. It was recommended I did go though. It makes me wonder if I got favoritism because my mom works here (at the school). I'm sure others got the full nine yards, but if I didn't go I'm pretty sure I would have gotten suspended cause it was highly recommended by Mr. . - Sky blue This youth believed her mom's way of talking with her was useful. When it's like you got to go, it's like you are being nagged. Then you don't want to do it, you don't want to do it at all. I'm wondering if my mom said to go once, cause she knows. It's like sports, practices just go try it once, and when you do, it's really not to bad. It's just getting there.- Sky blue This youth agreed with the other participants in that she did not like being told she had to attend an intervention. Still her feelings about the experience did not focus on lack of choice or not being heard. I remember that day, I walked out of Mr. office, it was like, I ain't goin. (laughs) My friends couldn't stop laughing, because every two second I would say "I'm not going", it didn't matter what they were talking about I would just say "I ain't going". I felt fear though (pauses) the fear that everyone knows. When your out doing that kind of stuff you know, it is a proven fact, that you may even know that you're all messed up, you don't want to admit it, you are in denial of it. - Sky blue It was embarrassing you didn't want the teachers to find out or certain students or it becomes the talk of the whole school. "So and so is into drugs you know". The reason I didn't want to go is because I was embarrassed and scared, because now all of a sudden everyone is going to know. - Sky blue This talk of fear and embarrassment was quite unexpected. These were things I hadn't contemplated, which is evidenced by the results of the questionnaire. I began to wonder if this youth was more able to contemplate her feelings because she wasn't stuck on the issue of choice. She still regarded herself as involuntary but not to the same degree, and framed her involuntariness with emotions none of the other 69 participants spoke to. The other youth may have shared these feelings and maybe I did not flush them out due to my own assumptions about being made to attend an intervention. I asked about these feeling of embarrassment and it seems that the youth was shocked that she would end up being a person who would be sent to an alcohol and drug intervention. I was embarrassed considering that I've always had good grades, into sports, and now I'm seeing a drug counselor for meth. It's like what happened here. - Sky blue This may lend some understanding to why the other youths did not talk about feelings of embarrassment. They all gave the impression that they weren't ashamed about smoking marijuana and spoke openly about it. The youth speaking above was not referring to marijuana and it may have been different for her if her drug choice had been marijuana. Somewhere Along The Way I Was Judged This category describes how the youth interpreted others' perceptions of them being involuntary clients in an alcohol & drug intervention. The youth already felt labelled, as having a problem, by the referral source (school administration, probation). Once the youth began attending the intervention, they received messages from teachers, friends, peers, and parents about what that meant. Messages from friends and peers were generally interpreted as either sympathetic or harmless teasing. My friends just bug me as usual. - Navy blue Friends would say small comments like "you poor kid your stuck in , you poor thing". I would say" its not really that bad" - Red 70 They were kind of being sarcastic trying to get a rise out of me. "So how's counselling?" they would say. - Sky blue Often the youths were made to attend along with their friends. The people I was with that day I was caught ended up going too. -Sky blue It was easier to go 'cause my friends had to go too. - Pink One youth spoke of experiencing putdowns by peers in the way of name-calling such as "skid" and "smoker". The recollection was that this happened a lot. The preppies, now that they know I went to "skid" "smokers" "skid", its like "shut up!" If you look up the word skid in the dictionary it has nothing to do with smoking pot or anything. - Violet This seems to mean that had she not been made to attend the intervention, these other youth wouldn't have had any reason to name call. What was interesting was that she had a name for them as well; preppies. The aforementioned may speak to some history of difference, where these other youth may have been privy to this youth's pot smoking. In describing messages from their parents, there was no indication of any negative consequences. One youth, as indicated in the sub category 'the exception', seems to credit her mom for her compliance in attending the program. The other youth put forth messages ranging from possible disinterest to agreeing their child had a problem. My mom said it was my choice, she didn't care. - Violet My mom knew I was mad at the fact I didn't get a choice. She goes, "Oh well, your fault, you have to deal with it". - Red She (mom) thought it was good for me to be going, for me to be dealing with the problems I had. - Navy blue 71 If I like didn't want to go, if I like even tried to get my parents to, they wouldn't help me at all! They thought that I had really big problems with drugs. - Green Mom wanted me to do what I had to do cause-a probation. -- Pink I interpreted the first youth's statement to mean that her mom might have supported her if she refused to attend the intervention. Because the youth did not avail herself of that possibility, I think her statement may have meant her mom was putting the responsibility back on her daughter. The messages the youths received from their parent(s) seem to suggest that their parent(s) had no reservations regarding their children being made to attend an intervention. In terms of negative messages, the youths seemed to perceive being labelled or judged based on their interaction with some of the teachers. Hey, when I came back, all the teachers were like, 'You missed this when you were at .' Right in the middle of class. It was like, thank you! They show no respect for you afterwards. ~ Violet The teachers got like, "don't bother to talk to me" or "don't bother to ask for help". You're kind a looked down upon. - Sky blue I felt like I couldn't do anything right so I left and went to (an alternate school). They thought it was cool I was going to alcohol and drug counselling. I can't remember if they knew I had to or not. - Pink The youths' experiences seem to convey that they were feeling marginalized. It appears for some this is a result of being made to attend. Had they not been made to attend they may not have had experiences that they would define as being seen as 'less than'. Once the teachers found out, well then I was automatically as bad as everyone else. - Sky blue For others, being made to attend may have exacerbated feeling marginalized. 72 We have the right to choose. ~ Red Yeah its like freedom of speech, it's like the school doesn't even care about that. - Green I see it all the time at school. Its like the teacher says, "You don't have an opinion, so shut your trap and sit down!" Its like, but we do have an opinion! (Her body seems very tense and her face is scrunched up) - Red Based on the tone of voice and the body language of the last person speaking above, I assumed that she was quite passionate about her rights. This may allude to her ongoing issues about how it is to be a student at the school. It may be that being made attend was the tangible element for her construction of what she thought was going on in her world or, more specifically, the school. The youths described being treated with no respect. makes fun of kids to get laughs, at other peoples expense. -Sky blue frowns on the kids, and then has parent meetings and he's all (makes a face to demonstrate, smiling & nodding). It's like whatever. -- Violet acts like the nicest person in the world or tries to when my parents are around but if their not, it's like "see YOU in school". -Green When you're around teachers it's like, "we're better than you". A lot of them do that. "We're better, we're the ones in control". -Navy blue For some of the youth, the messages that were apparently from the teachers were actually passed on or pointed out by classmates. At that time when everyone knew I was doing it. The meth posters were up and all that stuff, we were sitting in class and one of my friends came up to me and said, "Don't you think it's weird how sits there and says meth every two seconds and makes fun of everyone who does meth and all that kind of stuff, while you're in the classroom?" And he always looks at me too. -Sky blue 7 3 In class, when like, all the like, the kids in my class used to talk about me going to , and some kids would ask me if I was going to today, and he would bash me so much when I wasn't in class and everyone would talk about it. I hate him so much, (head down, quiet voice) - Green The following data was chosen because it depicts the experiences of different youth with the same teacher. Oh yeah, , I was like seconds late and he like said " probably just taking care of his crop.' I was like err kill ." (lots of laughter from the other youths but the youth speaking was not laughing, had his eyes down cast.and started hunching forward.) - Green use to razz me very bad about being in , but I would razz him right back, I didn't pay any attention to him. He is completely sarcastic...I have that talent myself so I just took it in order to have a little sarcastic fight. -Red I was curious about whether the latter youth was able to dismiss these potentially humiliating experiences in this class. I wondered it this was a position or affect the youth took on solely for the benefit of the focus group. It was possible that the youth was hurt or embarrassed, which is the meaning I attributed to the other youth's statement based on his body language and tone. The latter youth may not have wanted to share those kinds of feelings in the group or maybe any comments made by the teacher had no impact at all. It is also possible that the youth was not consciously aware of the impact but automatically went on the defensive with sarcasm. I challenged the participant about this to seek clarification. The youth remained firm on the position that any negative or derogatory messages from teachers could be treated lightly. It didn't bother me then and if doesn't bother me now, but somewhere on the way people did judge me. Not so much the students, it was more or less the teachers and what they thought. - Red 74 I still believe that this youth's experiences in this classroom must have been difficult, but that is my interpretation rather than the youth's and I felt compelled to leave that topic. I do feel confident in saying that all the youth thought they were labelled by the referral source and were consequently judged because they attended an alcohol and drug intervention program. The youth were left feeling that they had no power to influence decisions that would directly impact them nor did they have any remedy to deal with perceptions of being put down and judged in the classroom. This same issue may have happened if the youths were voluntary clients. Although the youth spoke of particular people at the school, they also generalized about the school (teachers, counsellors, and administration) as a whole, based on the few. Two participants did point to particular incidents as being 'normal' behaviour for those people but did not infer that they would still be 'made fun of if they had been voluntary. Still my understanding would be that being voluntary would not necessarily have changed how some of the teachers behaved. What Could Have Happened This category explores the youths' perception that the process could be different. All the youth expressed ways they believed the referral sources should conduct mandating youth. For some, this was about the right to choose. For others it was to negate unfairness or feelings depicted as negative. You should have a choice to choose whether you want to do this or that. If it helps you to choose, maybe talk to people who have been through the same thing, to give you an idea of what you possibly are getting into. It might give you a better prospect of what you may wanna choose. - Red Another thing that I think would help is that that perhaps going and trying it out and then make a choice. - Violet 75 A trial day would be really cool, like try this out and if you still feel you'd like to go or whatever it is your choice. - Red Or not even go, but to figure things out yourself. That's when you learn. Make your own choices and plan. Grow up. ~ Violet What seems to be implied here is that the consequence of suspension for not attending is not a valid choice. Rather the youths believe you should be able to choose not to attend without imposed consequences. They did impose limits on who should have this 'real' choice based on age and maturity. Sometimes you're too young to understand. ~ Green If you understand your choices, you should be able to choose. Your choices get a little more complicated from when you were in preschool than in high school, -- Violet Yeah when you're 16 you have the choice if you want to go to school or not. -- Green The youths placed another limit on choice depending on how people are. I know this girl named who's in rehab now because she is totally hooked on crack. I think going there (pause) I hope it helps her. I don't want her to get messed up or anything. - Green If you're doing harsh drugs like HARSH DRUGS and can't get off of it, well then there is a good chance you should be made to do something. - Red To a point yes. I'd say when a person gets so they can't choose. Where they don't know what to do. Where they don't really know the difference. Where they are confused about everything. Then I'd say yeah. - Violet Unless you could help them choose. - Red The youths appear to believe that there are times when people shouldn't have a choice: if they lack understanding; if they are incapable of sorting issues out; with or with out help; and if they have a severe drug problem. The youths did not believe that they could be described by any of those cases. I don't think any of us really have that kind a 7 6 problem (Green). The underlying theme of the youths' discussion seemed to be self-determination and the use of paternalism. Paternalism can be seen as infringing on a person's right to self-determine for his or her own good (Reamer, 1995; Rooney, 1992). The first time they're caught they are given all the choices they want. After that the consequences are their problem. They've been caught, given a warning and been told there are other options. They should be forced to go if they haven't. They haven't learned that you are at school to learn not to screw around. I kind a learned that in grade 12 a little to late unfortunately. Grade 8 to 11 they don't seem to care too much. - Navy blue Again, I heard the practice of paternalism. This youth's statements may be coming from caring. What seems to be unspoken is the acceptance of the belief in the value of education. I was not clear as to whether his use of 'they' referred to only the youths. His last statement could mean that youth don't take school seriously until they are in grade 12. This may depict him taking responsibility for issues he has had. On the other hand, it could mean that the school does not care about the students much until they are in grade 12. It may be the person making this statement was blaming the school for issues he has had at school. I was unable to clarify this with a second interview and I assumed my first interpretation was correct. Another youth seemed to believe a person should learn from her or his mistake. If he or she did not, then he or she deserves whatever happens. If you get caught a second time, you have just brought it on yourself. -Red Other ways were also talked about by the youths. I had to get an assessment done before group.. It was like, covered your whole life. I saw . She's the one who should-a said if I had to go (laughs) she would-a said yes. But I think that's who should-a said not (probation officer), what does he know? -Pink 77 If you weren't using, if it's not part of your crime, you shouldn't be sent. You know like it wasn't with me. -- Blue These youths seemed to be addressing the unfairness they saw in their referrals. came to see me at school. He's the alcohol and drug counselor there was a bunch of paperwork to do, maybe the fact, if students are given a slip from (school counselor) to get out of class instead of . I remember the time showed up. Everyone said, "you're going to counseling." I said, "no I'm not, no I'm not". I was like walking down the hallway, I let him walk meters ahead. He said, "Are you coming?" " yep", I was looking at the floor. Youth don't know me. I'm not walking down the hallway. Don't look at me. - Sky blue This youth had not wanted to be seen with an alcohol and drug counselor. She was embarrassed. She appears to believe that if the school counselor had been the one to come to her class, people would not have known she was going to attend an intervention. She appeared to have been able to hide her drug use because she was an example of a good student. So maybe she is correct and, had it been done differently, she may not have suffered embarrassment. When you see someone come to school stoned, well they're obviously a drug user and someone who gets good grades and is in sports, they aren't. - Sky blue I Can't Do Too Much About It Now This theme captures the youths' descriptions of behaviour changes they attributed to being made to attend an intervention. It also explores their thoughts and feelings about the intervention. The youths believed that they were labelled as having an alcohol and/or drug problem. They associated this labelling and their perception of subsequent judgments with being made to attend an intervention. The youths spoke of behaviours they engaged in that they also attributed to being made to attend an intervention. These behaviours may to be the youths' way of showing that they are still 78 able to exercise some control over their lives, as they weren't able to change the directive to attend. I still should have been able to have the choice whether or not I wanted to go. I definitely should have had that but since I didn't, I can't do too much about it now. - Red The participants also expressed their feelings about the intervention and how they were impacted by it. These feeling were different from the feelings that they shared upon entering the intervention or had when they were mandated to attend. These behaviours, the change in feelings, and impact of the intervention brought about make up this theme and are explored in the categories 'what do they expect?' and 'settling back'. What Do Thev Expect? This category emanated from the youths' descriptions of the behavior they claimed to have engaged in due to being made attend an intervention. It also encompasses how they saw their experience of the intervention as ironic because they thought the mandate to attend was a punishment and they did not feel punished. I think kids are more open to like open to different things if they have a choice, like if somebody tells them to do that or that they rebel. I dunno it's like they expect you to be all happy about it. Do they expect you not to rebel? You're going to anyway, when your forced to do something you don't want to. ~ Violet This statement seems to substantiate the claim that all clients will react negatively if they perceive a loss of freedom (Rooney, 1988; Sheafor et al, 1997). It may also reflect the subcultural view of adolescents where youth define themselves through reactivity (Cote & Allahar, 1994). On the other hand, it may be that this youth saw what she called 'rebelling' as a way to have some power in this situation. 79 When asked what that rebelling looked like for them, some of the youth spoke of changes in their behavior. Some youths agreed that they rebelled at school by not putting any effort into their studies but they did not elaborate beyond their initial agreement with the following statement. I do most of my rebelling at school, like my grades dropped - Violet Interrupts uh-huh (agreeing body language and laughing) - Red Interrupts oh yeah (nodding and laughing) - Green I just didn't care about school anymore. - Violet Nods ... I hate school so much now. - Green These youths may not recognize that their 'rebelling' in school has only a negative impact on them such as lower grades. One youth who seemed to agree that her grades dropped later stated I don't think my work went down (Red). From this, I interpreted her agreement with the other youths as more of an acknowledgement or show of understanding. She did speak to rebelling, but outside of school. She also indicated a behaviour change at school. I don't think my work went down, I just think I used it more out of school. Just got stoned a lot more (laughs looks down at hands). Since they sent me I haven't been doing anything like that at school. - Red An alternate reading of this might be that she used more out of school because she stopped using during school, not because she was made to attend an intervention. Other youth also spoke about behaviour changes although not in terms of rebelling. Myself, I try to like better myself because I could see how it was affecting everyone else. Some people don't care (pauses) the harder you push the harder they are going to push back. - Navy blue 80 This youth may have been admitting to having had a problem or problematic behaviours and then changing them. I assumed 'it' meant 'my behaviour' in his statement. He may believe his freedom to choose is 'fittingly' constrained by how it impacts others and this may be the change due to his experience of being made to attend an intervention. I've smoked pot a couple of times, haven't drank hardly any and I've stopped using meth. I kept going to see like not in a group I mean until I felt I really wouldn't use again. - Sky blue Other youth did speak to changes in their lives but not specifically to their behaviours. I really liked you know trusted her. I went to her if I needed to talk. It kind-a stopped, well helped me, from finding trouble. I still go by and see her sometimes. - Pink As explored earlier, the youths seemed to believe that part of the intent behind being made to attend an intervention was to punish them. It seemed as if they enjoyed describing to me the opportunities to "miss school blocks", to have "coffee" and "to eat pizza". The youths related these as reasons the intervention was not a punishment to them. According to one youth, "pizza is therapy". This appears to have allowed the youth to take back some of the power they lost when they were mandated to attend an intervention. However what I saw as ironic was that no youths wanted to attend, did not like being told to attend, believe they were judged because of it, and yet they seemed to be telling me they liked it. Settling Back This category arose from exploring what the youth thought and felt while attending the intervention. What is of particular interest is how their feelings at the time 81 of the referral seem to have changed while attending the intervention. The youths seemed to value being able to talk about their lives and feelings. I don't like to be forced to do anything I mean if I would have known about the group I would have joined, but when they force me... I knew I wouldn't like it. I'm that kind of person. I hate being forced. When they like first forced me to come here I thought it was like really gonna suck. I didn't know anything about but when I got there, it was like cool. Ya know, talk, spill everything out I dunno it was cool. - Green Soon as I got there I thought okay I'm not really mad about this anymore. I got to talk about what I was doing, stuff form the past or something like that might be linked. You get out your feelings, you know. -- Red You started feeling good and it actually is a good idea that your in there -Navy blue They described what seemed to me a process of feeling comfortable and developing relationships with the counselors. The first couple of times I was quiet, you know, I wouldn't tell the whole nine yards of the story, I would say "I did this but not that much" very typical a lot of people were like me. It might have taken them longer to settle back than me, they did. Eventually I was blah, blah, blah its like this ain't to bad, its like another friend. - Sky blue I had a lot of things happen in my life. My dad died and my brother was killed. I was pretty messed up, understood. I had a hard time dealin with stuff. Drinking and getting high got me on probation. really helped. I went back to group two more times without being made. - Pink I think there is a relationship you have between well, with your counselors, that's what you remember. At you have your own opinion about on anything you want. There is you know you get to say your point of view. Not only that, but you get to learn about things that you didn't know before. - Violet The youths' thoughts surrounding why they were there also appeared to change. They seemed to see some usefulness in attending the intervention. got you to think. You thought one way; they kind of challenged that belief for you to think a different way. Trying to find a medium one where we can reach together blending both to get something better out of it. 82 Whether you were going to go this way or that way, kind of work together, so you still felt respected and heard. You are treated equally. - Navy blue I felt like I was there to learn. I didn't feel like they thought I was all messed up and they were going to fix it or something. - Green It seemed as though the youths may have engaged in some comparisons between their counsellors and the referral sources. The differences they perceived may have contributed to the shift in their feelings. The perception of having received an invitation to learn rather than a directive to change seemed to have been significant for the youth. The sense of having a shared experience and understanding may have allowed the youth to let go of hostility. I know that most of the people there understood what I was going through, they understood my opinion they respected that and I was happy about that, like, I respected their opinion. - Red In a group like at everyone respects everyone, and it's gratifying and everyone listens to everyone. Basically everyone there has been practically through the same thing at one point. - Violet These perceptions spoke to me of the youth having moved from being involuntary to voluntary clients as is suggested might happen in the literature (Rooney, 1992). Two of the youth made statements that may suggest the relationship with the counsellors was significant. "I knew they cared and were trying to help anyway they can" (Green), and "they're just trying to help" (Blue). I am assuming that the youth did not have significant relationships with the referral sources, which may explain why the youths never saw being made to attend an intervention as a caring act. Summary Although the experiences described here appear in a linear fashion, there was a constant flow from one area to another as the youths explored their experiences with 83 me. Each youth's experience was different yet they shared some common elements. All the youths disliked being told they had to attend an alcohol and drug intervention and they did not want to attend. They all believed that they were perceived as having a problem. In addition, they described changes in their behaviors or themselves that they attributed to being made attend. The youths thought the processes involved in getting them to the intervention could have been handled differently. Finally, they appeared to believe that the intervention was a good experience, contrary to what they had anticipated. These common areas could be further explored with other involuntary clients (both adults and youth) in order to create policy for both clinicians and referring agencies. Further exploration might also direct practice in a way that honours and respects the feelings involuntary clients may have and yet not create a barrier to the delivery of services. Chapter Five concludes this study with a discussion of how the results correspond with the literature that formed the conceptual context for this study. The implications for social workers, clinicians, other social service providers and those involved in program and policy development for direct practice will also be discussed. 84 CHAPTER FIVE Conclusions The purpose of this study was to explore the experiences of involuntary adolescent clients. The results indicate that while each youth's experience is unique, there are commonalities among their stories. Other researchers looking at the same data could have achieved different descriptions of the phenomenon by using particular theory to develop categories or by weighing the statements in alternate ways. Limitations Although the data explains how the youths experienced the phenomenon of being involuntary clients, the results must be considered carefully for a number of reasons. The sample size was small, the youth all lived in the same community, and had all been raised in the same culture. In addition, I had my own experiences working with involuntary adolescent clients. I may have slanted the analysis because of my own assumptions about involuntary clients and adolescents. However, the generality of perceptions revealed by these youths may be applied to a wide variety of situations where similar histories exist (Glaser & Strauss, 1967). A possible contentious point in this study could arise from the concern that I have ideas about how to make sense of the experience of being involuntary based on the clientele I have worked with. It could be argued that I come to this research project with preconceived ideas influencing the nature of the questions and the outcome of this research. In much mainstream research, the objectivity of the project is of great concern and the researcher's personal experience is irrelevant (Reinharz, 1992). However, many feminist researchers see this 'objectivity' as pretend and state it 85 contains biases that are not acknowledged (Reinharz, 1992). In feminist research, personal experience is seen as relevant as is the use of the researcher's voice as repairing the pseudo-objectivity of a study (Reinharz, 1992). Feminist researchers may also study a phenomenon that concerns them in their personal life, thereby merging 'the public' and 'the private' (Reinharz, 1992). There is also the concern that the lived experience may have been tainted by the social interaction between myself and the participants (Trinder, 2000). I paid heed to the voice used by the participants and to the context in which it was used in order to more fully understand their lived experiences. In addition, people can change based on how research is carried out, by encouraging self-reflection and facilitating a deeper understanding of their situation in the world (Lather, 1988). A larger sample size with youths from a variety of backgrounds would perhaps have provided more depth and richness to the study. Nonetheless, these results may be generalized through naturalistic or analytical ways (Kvale, 1996). Naturalistic generalizations are based on personal experience; they come from implied knowledge and "leads to expectations rather than formal predictions: it may become verbalized, thus passing from tacit knowledge to explicit prepositional knowledge" (Kvale, 1996, p. 232). Analytical generalizations involve analyzing and comparing two situations and making a "judgment about the extent to which the finding form one study can be used as a guide to what might occur in another situation" (Kvale, 1996, p. 233). While the preliminary findings in this study require further investigation, the present results may hold implications helping professionals could consider when working with involuntary clients. 86 The results of this study gave form to two themes. I may have influenced this construction because the questions I asked, as outlined in Chapter 3, were divided between when the youths were told they had to attend and when they attended the intervention. It is possible however, that it was necessary for the youths to construct an 'us' (youths made to attend) and a 'them' (those who made us attend) in order for them to make sense of their positive feelings surrounding the intervention. The participants in this research were youth who were mandated to attend an alcohol and drug intervention program by either the education system or the criminal justice system. The commonalities of their experiences were captured in two themes, 'I didn't like it' and 'I can't do too much about it now'. I Didn't Like It This theme encompassed the overall sentiment about the experiences of being made to attend. The youths spoke of not having a choice and about not having any input into being made to attend an alcohol and drug intervention. Their perceptions included being seen as having a problem, as needing help, and as being young and ignorant. They believed they were treated unfairly and felt angry. Feelings of embarrassment were also addressed. The participants believed they had 'rights' that were violated. The results also showed that the youths saw themselves as being judged and deprecated, most specifically, by teachers. This seemed to heighten their resentment about being made to attend. The feelings of anger and deprecation may have been heightened by previous experiences of lack of power, of not having a voice, and of injustices in the education system. The participants spoke of 'the school' not caring about their rights. The youths 87 may then have already constructed the reality of attending school as one of being in a 'space' where you are controlled and often treated unfairly. The education system can be seen as the most wide spread form of involuntary service in western culture, with the exception of prisons (Finn, 1997). Being made to attend by the education system may be seen by the participants as one more injustice perpetrated against them. The participants mandated by the criminal justice system also felt angry but were not verbose about it. They seemed, in their dialogue, to be more apathetic. This may indicate that, like those referred by the school, they did not believe their voice would be acknowledged or valued. This theme, "I didn't like it" may be explained in various ways by the different modernist theories on adolescence. For example, from a development perspective, the youths may be described as not mature enough, emotionally and mentally, to be given a choice. The youths' thoughts and feelings could be attributed to this lack of maturity. (Cote & Allahar, 1994). A concern with using a modernist theory to understand the youths' lived experiences is that it suggests all other theories are not true. So youths' thoughts and feelings that cannot be understood within that theory must also be 'untrue' or the youths may be seen as not able to understand their experiences. Alternatively, the researchers could be seen as not being 'objective' in their methodologies and producing 'faulty' findings. The use of postmodern theory provides opportunity to make sense of the lived experience in an individual and localized context. Postmodern theorists reject the idea of any universal truth or metatheory (Fawcett, 2000; McGowan, 1991; Ray, 1996; Rossitier et al., 2000). The relationship between language and thought and reality is central to postmodern thought. Power 88 relations are also important in postmodern theory (Cherryholmes, 1988; McGowan, 1991). Teachers, probation officers, and other professionals hold particular positions in our society. They can be seen a having prestige by virtue of their training. They are also seen as having legitimate knowledge about the individuals and the groups they work with. Their positions then include both power and authority that are legitimized by the functions their positions serve. The youths' experience of being made to attend included feeling judged, labelled, and deprecated. Why would they be forced to attend an intervention if they did not have a 'problem', were not a 'bad' person, or were not able to make 'good' choices? The referring agents can only create knowledge regarding these youths, and this does not necessarily take into account the youths' ability to manage their own images. They create this knowledge by interpreting what they see or think they see based on their training as professionals, their personal frame of reference, and their vantage point. Mandating youths to attend an intervention is seen as behaviour congruent with their professions. This reinforces the value of their professions and thus their knowledge of these youths having a problem or needing help is seen as just and good. It seems then that it is the referring agents' positions of power rather than the behaviours of the youths that make this knowledge 'true'. The youths are not recognized as having legitimate knowledge about their own situations and are left with their feelings of anger and powerlessness. One participant spoke of having some choice about whether or not to attend the intervention. She credits this to her mother's attitude. Her mother spoke to her, not 89 about having a problem, but about being open to the experience. She also supported her daughter in making a choice once her daughter had more information about the intervention. The youth wondered if she received favouritism because her mom worked at the school. It is possible that because of working at the school, her mother did not see the school administrators as having more authority or knowledge regarding the welfare of her daughter. Other parents may have been caught up in the power differentials between themselves and the professionals. They then may have agreed with the judgement that their child had a problem. Alternatively, they may have not known what else to do; after all it was professionals that mandated their children to attend an alcohol and drug intervention. The youths that seemed more indifferent about being made to attend and not having a choice were mandated by probation. It seems that they did not see any value in being visibly upset even though they expressed being angry and disappointed. It j may be that they did not believe their thoughts and feelings on the matter would effect any change and, if not, why bother? The participants in this study did not believe the referring agents held legitimate knowledge about them or their situations. Given this they resented the representation that 'someone' believed he or she could determine what was 'best' for them. They typically viewed the mandate to attend as an act of social control rather than an act derived out of concern for their welfare. I Can't Do Too Much About It Now This theme explored the youths' experiences regarding behavioural changes they associated with being made to attend an intervention. Behaviour changes 90 identified by the youths ranged from rebelling to developing and sustaining support systems. In addition, the youths' thoughts and feelings in relation to attending the intervention were attended to. When exploring behaviours associated with their experiences, one participant stated that the referring agent should expect that the individuals made to attend would in turn rebel. Other youths made motions of agreement both verbally and non-verbally. They made reference to no longer being concerned with school. As stated earlier, there are modernist theories that could be utilized to provide ways to understand the participants' experiences. For example, in terms of behaviour changes, reactance theory claims a prediction can be made about how an individual will behave when he or she has lost or been threatened with the loss of freedom (Rooney, 1988). A cursory reading of the data may appear to support that theory. Modernist theories are seen to provide totalizing explanations for the occurrences of phenomena. There is little room then, for understanding those experiences that fall outside the parameters of a particular theory. In this study, two participants illustrated behaviour changes that might be understood through reactance theory. The remaining participants, who stated they had lost their freedom to choose, also spoke of behaviour changes. These illustrations however do not support reactance theory. The use of this theory would create a conundrum. If the participants' behaviour changes cannot be understood through the theory of reactance, how then can the researcher make sense of the youths' experiences? Postmodernists and postmodern feminist theorists point to the limitations of modernist theories. To gain a deeper understanding of the participants' experience, it is 91 important to attend to the power structures within the context of the participants' narratives. When speaking specifically to rebelling, one youth spoke of not maintaining good grades in school and of not caring about school any longer. Previously she had illustrated that the referral agent negated her voice in the process of being made to attend. Given the power relations operating within an educational setting, not continuing to achieve good grades may have been the only opportunity for this participant to 'show' she had stopped caring about school. Another youth spoke of acquiescence to the school rules by refraining from smoking marijuana at school. She defined rebelling by her increased use of marijuana outside of school. Although the youth described this as rebelling, she did so in the context of another youth normalizing rebelling. It is possible she felt obligated to have a story about rebelling. Others in the group believed rebelling would be normal. Had this person participated in an individual interview the concept of rebelling might not have been explored. She might have spoken of her behaviour changes regarding marijuana use but in other ways. For example, these changes may have been the most practical way for her to fulfill school expectations and still use marijuana. Other participants described changes in thoughts and/or behaviours that were not linked to the concept of rebelling. They described these changes as positive things in their lives. The changes encompassed things that were visible. For example, a youth stopped using crystal methamphetamine completely. Some changes were not so visible, such as the recognition by one participant that his behaviour impacted others and the belief that this was worthy of attention. 92 This theme, 'I can't do too much about it now' also explored the youths' thoughts and feelings about the intervention. The results illustrated that the intervention was a place for learning, for sharing and for self-reflection. The youths described feeling respected and validated. The youths thought their knowledge and opinions were valued by the group leaders and believed that they were seen as contributing to the process. It seems on some level the youths did buy into the intervention program. According to postmodernists, the self and subjectivity are socially constructed (Fawcett, 2000). The atmosphere and social interactions of the intervention can be seen to contribute to the construction of the thoughts and feelings the participants had about the intervention. What seems to be positive about the intervention is that it was done in such a way the young people felt cared about. The youths were given food and drink, which may have facilitated relaxation and relationship building. The intervention program was a group process and the participants spoke of being validated by the other youths attending the program. In addition, the results illustrated the youths' feelings of being equal to the group leaders based on how they were addressed and listened to during the intervention. Recommendations The youths illustrated a number of ways they believed the referral sources could deal with alcohol and drug use by youth. One suggestion was to stop mandating youth to alcohol and drug interventions altogether. This included two exceptions: if a youth was incapable of understanding the issues or making decisions because of his or her alcohol and/or drug use; or if a youth's life was clearly at risk due to his or her involvement with alcohol and/or drug use. If there was no other way to deal with the 93 former situations, then the young people agreed that those individuals should be made to attend. A second recommendation built on the first. The participants suggested that rather than making an individual attend an intervention, the referral agents should provide information about the intervention and trust the youth's ability to make the decision that best fits him or her. The threat of suspension should not be a used as a determining factor regarding whether or not he or she would attend. The participants illustrated ways for the referral agents to provide that information. Youths could be given the opportunity to speak with a peer who had already participated in the intervention. Alternatively, youths could be given the opportunity to attend a trial or introductory session of the intervention program. Either way the participants thought they should have been provided with some understanding of what the intervention was all about and who the 'players' were. The final recommendation was based on the belief that the referral agent did not have the expert knowledge that would legitimize his authority in mandating youths to alcohol and drug interventions. The suggestion was to have the young people participate in individual assessments with an alcohol and drug counsellor to see if there are concerns identified that would warrant attending. This was seen as a joint enterprise between the individual and the counsellor. The first two recommendations were meant to address the education system's referral process. The suggestions were seen by the youths as something to be used for individuals who had been caught for the first time using or under the influence of a substance while attending school. These participants believed that any individuals 94 caught a second time should be made to attend an intervention. The third recommendation was made in reference to a probation officer mandating the youth to attend. The youth may have made the same suggestion had he been made to attend by the education system. The recommendations made by these young people speak about being helpful rather than controlling. These recommendations were made solely in reference to how the participants in this study were made to attend. Still these recommendations and the experiences from which they were developed can be valuable to social workers and other helping professionals. The results of my research support the statement made by Tower. He claims that the way to create less ethical discord around paternalism may be to move social work as a profession back to activism and politics by aligning with the client (1994). Aligning with the client encompasses many issues brought to light by the participants in this research. When working with young people, professionals need to not just be aware of but to critically examine their perceptions of youth. This includes where these perceptions come from. For example, the theoretical framework, personal experience, professional experience, and the expectations from the community regarding how they should perceive adolescents may all influence the workers beliefs regarding youth. Workers beliefs are played out in the client-worker relationship through their use of particular language and posturing. The participants of this study spoke to experiences of having less power than the referral sources. The messages that they lacked power was typically conveyed through the language used by the referral agent but this powerlessness was also expressed as a 'normal' experience for the youths when they spoke of other interactions with these 95 professionals. Social workers and other helping professionals need to be careful in their use of language, even language gleaned from their training, because it puts them in a particular position of power. The power relations between a client and a worker are significant for youths. The worker is already seen in a position of power, which is perpetuated or amplified if the worker uses language that denies or discounts the youth's own expertise regarding his or her life. Although, in some incidents expert advice may be sufficient in encouraging change (Barber, 1995), young people want to be included in a dialogue where their knowledge is seen as valuable and legitimate. The results of my study illustrate that these young people are open to learning more about a particular subject before they make a decision but they do want to be a part of the decision making process. They want to be addressed in manner that is respectful of their ability to self-determine. Workers need to take what youths have to say regarding their situations and life choices seriously. They need to actively engage with the youth. Youths may also use language in particular context so workers may need to ask for clarification rather than nodding and saying, "tell me more about that" in the hopes of really understanding. For example, a youth in this study, when speaking about how workers should posture themselves, said "don't be so much of an adult" (Violet). My understanding of 'being an adult' includes being responsible, caring, and being a role model. The youth meant that the worker should not talk down to youth and should not treat the youth as if he or she was incompetent. Each young person will have his or her own story to tell about how he or she makes sense of the world. This may provide, for the worker, some understanding about what the issues are according to the youth rather than the referral source. 96 Referring agents often define the issue/problem in the process of referring. Because of the positions they hold professionally, the social workers or other service providers may take these definitions as 'true'. By aligning with the client, the worker can gain a deeper understanding of the issues and can validate the client's reality. In social work, the client-worker relationship typically involves valuing the client's individual account of his or her predicaments. This needs to encompass encouraging clients to talk about how they came to be involved in an intervention. This should also include what the clients think and how they feel about being participants in an intervention. The aim of this process is to share knowledge. This process is important to young people and, while involuntary clients might see it as missing in their referral, it should not be missing in the context of the client-worker relationship. By engaging the youths in this way, their experience can be honoured. The workers do not need to be solely agents of social control. Based on the experiences of these youths, social workers could advocate for changes in the referral methods of other professionals. Conclusion For the young people who participated in my research, the experience of being involuntary involved infringement on their ability to self-determine, judgements and deprecation. The feelings associated with these included anger, disappointment, hurt, and embarrassment. The experience also involved acceptance, learning, sharing knowledge, respect, and validation. The youths felt the group leaders treated them as equals. The ethical issue of paternalistic intervention verses client self-determination may not have been clarified in the results of this research and the work with involuntary 97 clients may continually cause controversy. Still, given the results of this research, it makes sense to speak in favour of working with involuntary clients. For these youths, the benefits of their involuntary experience seem to outweigh the costs. They all spoke of positive things stemming from having attended the intervention. These things included: changes in drug use behaviour ranging from abstinence to harm reduction; the establishment of additional support systems; and increased knowledge to further inform their decisions. The experiences shared here speak to carefully weighing out the reasons for making a person attend an intervention and, whenever possible, to engage the individual in a process where ultimately he or she makes the final decision. As this was an exploration of the experiences of involuntary adolescent clients, further studies with involuntary clients (adults and youth) with a focus on their understandings of the ethical issues might provide information to impact ethical discord for practitioners when looking at paternalistic interventions. Studies with involuntary clients may provide a clearer picture regarding the need for referral reform. It would also be useful to engage in research with referral sources in order to gain understanding about the processes they go through that end in making a youth attend an intervention as this too could influence referral policy. What is not clear from the results of the research is whether the experiences of being judged, labelled, and deprecated would have been different if the youths had been voluntary. Further research on this may provide some clarification. 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Yes, Definitely, I Yes, somewhat, No, not really No, definitely, I had no choice because I felt because I could had a choice, pressured to attend choose between because nothing attending and the could make me attend consequences of not attending 3. I felt angry about being made to attend. Strongly Agree Agree Not Sure Disagree Strongly Disagree 4. I felt disappointed about being made to attend. Strongly Agree Agree Not Sure Disagree Strongly Disagree 5. I reacted with resistance (i.e.: gave attitude) in group because I was made to attend. Strongly Agree , Agree Not Sure Disagree Strongly Disagree 6. I used more drugs/alcohol because I was being made to attend. Strongly Agree Agree Not Sure Disagree Strongly Disagree 7. I was treated differently by group leaders because I was made to attend. Strongly Agree Agree Not Sure Disagree Strongly Disagree 8. My reaction (positive or negative) to attending the group changed as the group progressed. Strongly Agree Agree Not Sure Disagree Strongly Disagree 9. Do you believe that people who are made to attend a group or service should be treated differently? Yes No 10. Do you believe that the type of relationship you may have with the group leaders effects your attitude about being made to attend? Yes No 105 


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