‘Power’ is one of those words that seem to represent a relatively simple concept, just like ‘care’. However, it is more complicated than one might initially think, and its meaning depends on the context in which it is applied. For example, there is electric power and political power, both of which evidently differ from what power means in the context of health and social care. There, power means the ability to influence the behavior of people or the course of events.
Each person has power over something, but the extent of it depends on a number of factors: the situation one is in, society’s perceptions of them, and their personal characteristics. An example of that is society’s expectations of men knowing more about particular topics than women – for instance, car maintenance. This means that a regular woman does not hold enough power to convince a repair shop worker that she knows exactly what is wrong with her car and whether repairs need to be done. However, in this situation, a woman who knows quite a bit about cars may have more power compared to a woman who does not. There are broader patterns when it comes to power dynamics in a given situation, yet sometimes individual differences can make an impact. Power does not always mean forcing people into something, but it could also mean persuading them to behave differently.
Over the years, experts on the topic and researchers have proposed different ways of thinking about power. One of the most influential approaches was developed in 1959 by American psychologists John French and Bertram Raven. According to French and Raven (1959), power can be divided into five types. A coercive type of power is the power to force people to do things by means of physical, psychological, social, or other influences. For example, a parent grounding a child for bad behavior uses coercive power. Reward type of power is influencing people to act a certain way by motivating them socially, financially, or psychologically. This is the type of power my mom had over me when, as a kid, I was promised a treat for enduring the pain of an injection.
Legitimate or positional power is the power of a person holding a specific position or a job role, as in the case of Denny being Michael’s career. Expert power is the power of an expert in a particular field, which is the power Tanya, as a specialist, had in caring for Fiona. Finally, referent power is the power a person holds due to their personal traits or connection to someone: charismatic people use this type of power to persuade.
Power dynamics are not necessarily always about someone having all the power and someone being powerless. For instance, when disabled people like Michael employ personal assistants, they hold coercive, reward, and legitimate power over their employees. Personal assistants, in their turn, possess legitimate or expert power over their employers – and sometimes even have to resort to coercive methods. It shows that power is way more complicated than some think it is.
References
Barry, M.J. and Edgman-Levitan, S. (2012) ‘Shared decision making: The pinnacle of patient-centred care’, New England Journal of Medicine, 366(9), pp. 780–781.
French, J.R.P. and Raven, B. (1959) ‘The bases of social power’, in Cartwright, D. (ed.) Studies in Social Power. Ann Arbor, MI: University of Michigan Press, pp. 259–269.
Gladstone, J., Fitzgerald, K.A. and Brown, R. (2013) ‘Social workers’ use of power in relationships with grandparents in child welfare settings’, British Journal of Social Work, 43(6), p. 1073.
Health Innovation Network (no date) What is person-centred care and why is it important?, London: Health Innovation Network South London. Web.
The Health Foundation (2016) Person-centred care made simple: What everyone should know about person-centred care. London: The Health Foundation. Web.
What Matters To You? (2021) Case studies. Glasgow: What Matters To You? Web.