Health and Social Care in the Community (2015)

doi: 10.1111/hsc.12227

Partnership-based practice with young people: relational dimensions of partnership in a therapeutic setting Shachar Timor-Shlevin 1 3

Mr.

1,2

and Michal Krumer-Nevo

Prof.

3

2

Sociology and Anthropology, Bar Ilan University, Israel, Social Work, Ben Gurion University of the Negev, Israel and Social Work, Ben-Gurion University, Israel

Accepted for publication 11 February 2015

Correspondence Shachar Timor-Shlevin Sociology and Anthropology, Bar Ilan University Ramat Gan 52900, Israel E-mail: [email protected]

What is known about this topic

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A recent growth in interest about direct long-term partnership between professionals and youth. Direct and long-term partnership with youth is highly recommended. However, its practice remains rare and vague; there are few examples in the literature concerning partnership as practice, and of its meanings for the people involved.

What this paper adds

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Partnership between youth workers and marginalised youth in the community youth centre observed exists simultaneously in two interconnected spheres – the structural–technical and contentexperiential spheres. The first sphere contains the settings of shared decision-making; the second contains selfexperiences and interpersonal relationships. For partnership to become meaningful, specific characteristics of shared decision-making should exist. These include atmosphere, duration and content.

© 2015 John Wiley & Sons Ltd

Abstract The recent literature concerning partnership between professionals and young people reveals important developments regarding the nature of partnership: from short-term partnerships with young people’s parents intended to improve decision-making in the context of critical life decisions, to a growing interest in direct partnership between professionals and young people as a core principle of long-term relationships. Although it is widely acknowledged among health and social service professionals that partnerships can have positive outcomes for young people, the concept and implementation of partnership remain vague. This article examines the meanings of partnership for people involved in a community youth centre for marginalised youth. Data were collected during the year 2011 using multiple-methods including focus groups (with eight youth workers), participant observations (in assembly meetings and ‘partnership meetings’) and semi-structured interviews (with 10 principal stakeholders, including youth, youth workers and the Center’s founders). Data were analysed using principles of grounded theory to articulate partnership as an ongoing experience, combining both structural–technical and content-experiential components. Our findings present partnership as existing simultaneously in the practice of decision-making and in the realm of self-experience and interpersonal relationships, and explore the relationship between both spheres. The findings also shed light on the importance of the specific characteristics of shared decision-making (atmosphere, content and duration) in the creation of partnership. We discuss our findings in the light of possibilities for partnership-based practice with marginalised youth. Keywords: decision-making, participation and empowerment, practice, relationships, teenagers

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Introduction

Partnership

Since the 1990s, partnership between professionals and young service users has become a key dimension of social care (Webb 1994, Calder 1995, Morrison 1996) and healthcare (Hook 2006, Wilson 2009). A closer examination, however, reveals two different approaches regarding the nature of partnership and its beneficiaries. Initially, the analysis of partnership was directed mainly at the relationship between professionals and parents, with the child situated as the principal client (Sheppard 2002, Pinkus 2003). In this context, partnership was considered as a short-term process intended to improve decision-making, often in critical circumstances (Sinclair 1998) such as consulting with the parents of children requiring medical treatment (Coyne & Cowley 2007), or decisions concerning custodial arrangements for children (Sinclair & Grimshaw 1997). Over the last decade, however, the concept of partnership has been broadened through a growing interest in direct partnership between professionals and young people (Shemmings 2000, Van Bijleveld et al. 2013, Augsberger 2014). This has prompted calls for the expansion of the existing narrow definition of partnership, employing it as a principle of practice in long-term relationships (Bell 2002, Sinclair 2004, Van Bijleveld et al. 2013). As Sinclair (2004) argued:

As opposed to paternalism – with its emphasis on the hierarchical role division between professionals and service users (Webb 1994, Calder 1995) – partnership emphasises egalitarian and collaborative relationships, framing reciprocity as a tool for empowerment and change (Sinclair 1998, Thompson 2002, Anderson 2007, Li & Julian 2012). Partnership acknowledges the knowledge and expertise that service users bring to social care relationships, and their right to participate in decision-making relevant to their lives (Webb 1994). Shared decision-making, thus, should lead to shared responsibility and ultimately to qualitatively enhanced service user participation in decision-making (Van Bijleveld et al. 2014). However, studies show that partnership in decision-making is conditional upon positive relationships between professionals and service users (Leeson 2007, Winter 2010, Bessell 2011, Jobe & Gorin 2012). Paradoxically, where partnership is needed the most, it seems almost impossible to achieve; children and youth whose relationships with adults were not founded on good-enough attachment do not trust opportunities for partnership in ad hoc decision-making settings (Bell 2002, Horwath 2010). The interconnectedness between partnership and long-term positive relationships changes the emphasis on effectiveness – which inflects partnership with primarily rationalistic characteristics (Karnieli-Miller & Eisikovits 2009) – and highlights the experiential and relational components of partnership (Shemmings 2000, Bell 2002, Sinclair 2004). In this respect, partnership is both the cause and the effect of egalitarian and collaborative relationships (Sinclair 1998, Thompson 2002, Anderson 2007). Professionals differ in their attitudes towards partnership, as manifested by the participation of young people in decision-making. In their state-of-the-art review of the participation of young people within child welfare and protection services, Van Bijleveld et al. (2013) differentiated between case managers who describe participation as obtaining information from children regarding their lives; those who define participation as giving children information about what is decided; and others, who think of it as giving the child the opportunity to express one’s views, but not necessarily the opportunity to exercise any influence over the decision-making process. These kinds of participation will not be considered as partnership at all by other professionals; but even those who critique the superficial application of partnership might allow children to influence minor decisions, but not those that the children considered as important to

The challenge for the next decade will be how to move beyond one-off or isolated consultations to a position where children’s participation is firmly embedded within organisational cultures. (p. 116)

However, recent studies show that while professionals have positive attitudes towards the involvement of children and youth in decision-making processes, partnership, in practice, remains difficult to implement (Archard & Skivenes 2009, Pert et al. 2014). We seek to contribute to this discussion by examining partnership, as perceived and experienced by various participants in a partnership-based Israeli youth centre – service users, youth workers and managers of the Center. The article starts with a brief review of partnership and community youth centres. After describing our methodology, our findings then elaborate on partnership as an ongoing experience, the outcome of the interconnectedness of structural–technical and content-experiential components. The experience of partnership enables growth and development with both service users and youth workers. In the discussion, we highlight the therapeutic potential of partnership, the conditions in which it can develop and the possibilities offered by partnership-based practice with youth. 2

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partnership. This is particularly obvious in health and welfare settings, where disagreements can create lifethreatening outcomes. Thus, partnership is judged according to whether it leads to agreement. In our study, partnership is perceived as a process anchored by the ethos of living together. Differences of opinion or even major rifts are not regarded as obstacles to the routine desired work, but rather as the material of the relationship work itself, an opportunity to be in dialogue, for self-definition, to develop a sense of self and of the other. Thus, partnership should not be judged by its outcomes; rather, it refers to – as David suggested – the process of negotiation and the encounter created by it. It is not a primary goal-directed activity, but a therapeutic experience of being and becoming together (Alexander & Dore 1999). This approach to partnership has implications for professionals working with youth. Contrary to the understanding that partnership is about professionals sharing power and responsibility with service users, partnership, as shown in this study, is the active act of taking professional responsibility. It is the youth worker’s responsibility to build the environment which incorporates youths, to the degree that they are both willing to get involved and feel safe enough to do so. This study has four major limitations. First, it is focused on one specific youth centre setting, and does not seek to represent the work done in other youth centres. Second, it presents the perspectives of service users and youth workers who have had outreach experience with the Center for at least 3 years. It does not represent the perspectives of service users and youth workers at the point of their initial encounter with partnership. Third, the study presents the perspectives of former service users, but not those of service users at the time the research data were collected. Fourth, the ongoing nature of partnership implemented in the Center differs from the one-time meetings established in many social and health services as a medium for partnership. Nevertheless, our study sheds light on the potential for partnership as a therapeutic tool for working with marginalised youth. We hope it will prompt further research into the actual practice of partnership, as well as the conditions and obstacles that facilitate or hinder its development.

References Alexander L.B. & Dore M.M. (1999) Making the parents as partners principle a reality: the role of the alliance. Journal of Child and Family Studies 8 (3), 255–270. Anderson H. (2007) The heart and spirit of collaborative therapy: the philosophical stance – “a way of being” – in relationship and conversation. In: H. Anderson & D. Gehart (Eds) Collaborative Therapy: Relationships and Conversa© 2015 John Wiley & Sons Ltd

tions That Make a Difference, pp. 43–59. Routledge, New York. Apollo A., Golub S.A., Wainberg M.L. & Indyk D. (2006) Patient-provider relationships, HIV, and adherence: requisites for a partnership. Social Work in Health Care 42 (3–4), 209–224. Archard D. & Skivenes M. (2009) Hearing the child. Child & Family Social Work 14 (4), 391–399. Augsberger A. (2014) Strategies for engaging foster care youth in permanency planning family team conferences. Children and Youth Services Review 43, 51–57. Ayme J. (2009) Essai sur l’histoire de la psychotherapie institutionnelle. Institutions 44, 111–153. Barnes V. (2012) Social work and advocacy with young people: rights and care in practice. British Journal of Social Work 42 (7), 1275–1292. Bell M. (2002) Promoting children’s rights through the use of relationship. Child and Family Social Work 7 (1), 1–11. Bessell S. (2011) Participation in decision-making in out-ofhome care in Australia: what do young people say? Children and Youth Services Review 33 (4), 496–501. Bordin E.S. (1994) Theory and research on the therapeutic working alliance: new direction. In: A.O. Horvath & L.S. Greenberg (Eds) The Working Alliance: Theory, Research, and Practice, pp. 13–37. Wiley, New York. Calder M.C. (1995) Child protection: balancing paternalism and partnership. British Journal of Social Work 25 (6), 749–766. Camino L.A. (2005) Pitfalls and promising practices of youth-adult partnerships: an evaluator’s reflections. Journal of Community Psychology 33 (1), 75–85. Cashmore J. (2002) Promoting the participation of children and young people in care. Child Abuse & Neglect 26 (8), 837–847. Coyne I. & Cowley S. (2007) Challenging the philosophy of partnership with parents: a grounded theory study. International Journal of Nursing Studies 44 (6), 893–904. Creswell J.W. (2013) Qualitative Inquiry and Research Design: Choosing among Five Approaches, 3rd edn. Sage, Los Angeles. Dowling B., Powell M. & Glendinning C. (2004) Conceptualizing successful partnership. Health and Social Care in the Community 12 (4), 309–317. Ellis C. (2007) Telling secrets, revealing lives: relational ethics in research with intimate others. Qualitative Inquiry 13 (4), 3–29. Gallagher M., Smith M., Hardy M. & Wilkinson H. (2012) Children and families’ involvement in social work decision making. Children & Society 26 (1), 74–85. Goldberg D. & Comins M. (2001) Struggling with parents: the use of the term “partnership” in practice. Anthropology & Medicine 8 (2–3), 255–264. Halpern R., Barker G. & Molland W. (2000) Youth programs as alternative spaces to be: a study of neighborhood youth programs in Chicago’s west town. Youth and Society 31 (4), 469–506. Hoffman L. (2007) The art of “withness”: a new bright edge. In: H. Anderson & D. Gehart (Eds) Collaborative Therapy: Relationships and Conversations That Make a Difference, pp. 63–79. Routledge, New York. Holland S. (2001) Representing children in child protection assessments. Childhood 8 (3), 322–339. Hook M.L. (2006) Partnering with patients – a concept ready for action. Journal of Advanced Nursing 56 (2), 133–143.

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Participant recruitment In order to derive a rich description of the experiences of partnership within the setting, various stakeholders in the Center – service users, youth workers and managers – were interviewed, using criteria sampling (Patton 1990). Because of the nature of partnership, which needs time to develop, the interviewees selected had all been involved with the Center for at least 3 years. Potential interviewees were contacted directly by the first author and invited to participate in the study. Information was given concerning the aim of the study and its qualitative nature. In addition, ethical considerations were discussed. The interviews The interviews began with an open narrative question, ‘Please tell me your story of the Center’, followed by a set of open-ended questions concerning partnership, memories, relationships and special experiences. Examples included: ‘Tell me about significant experiences you had at the Center’; ‘Tell me about the Center Assembly’; ‘What is partnership for you?’ The interviews all lasted 90 minutes, with the exception of one interview with one of the managers, which lasted 4 hours. The interviews were recorded and transcribed verbatim, producing more than 250 single-spaced pages. Data analysis Data were analysed using principles of grounded theory (Strauss & Corbin 1998). Interviews were analysed during the data collection period, and the interview schedule was amended according to the emergence or non-occurrence of themes. At the initial stage, all statements were categorised into 150 categories (e.g. the Center is a second home, the Center is a safe space for me) (open coding). Categories were then grouped into 38 abstract themes (e.g. partnership as common experiences, belonging, lively relationship) (axial coding). Although the analysis did not provide a full new theory, as analysis progressed focus turned to those categories that appeared to be of greatest relevance to partnership (e.g. partnership as ongoing relationship, partnership in decision-making, ‘dry’ versus ‘warm’ partnership) (selective coding). Data analysis and coding was undertaken by the first author, with ongoing consultations with the second author. Triangulation was achieved by the use of various data collection methods (interviews, observations and memoing), positive feedback 4

received from three presentations of the findings to different audience involved with the Center, and the involvement of two researchers at the analysis (Patton 1999). Ethical considerations The study was approved by the University’s Ethics Committee. All participants signed informed consent forms at the beginning of the encounter in which data were collected (focus groups, Partnership Meetings and interviews). All names were changed to ensure anonymity, with pseudonyms chosen by the participants. Some of the interviewees were known to the interviewer from his past experience as a youth worker; this prior relationship had the potential to create incompatible expectations regarding either the research or the friendship (Ellis 2007). To overcome this, the issues were explicitly discussed during the preliminary focus groups, and again when inviting participation in the study. Ongoing reflexivity concerning the research process was developed in discussions between the two authors.

Findings Participants Participants represented three groups of different position and experience at the Center. Service users Four former service users (two male and two female), average age 23, were interviewed in face-to-face interviews. Interviewing former service users distanced the authors from the difficulties related to interviewing vulnerable minors. However, the variance in the intensity of the interviewees’ connections with the Centre – some were closely connected to the Center, while some were more detached – allowed us to draw from a variety of experiences. Youth workers Four youth workers were interviewed in personal interviews (three male and one female). Their average age was 37, and they had between 6 and 12 years working experience at the Center. One of the youth workers presented a unique perspective, being also a former service user at the Center. Managers Two of the five founders of the Center (male and female), with more than 30 years working experience at the Center, were interviewed. © 2015 John Wiley & Sons Ltd

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The two spheres of partnership Given the Center’s focus on partnership as a core principle, it was interesting to discover that all the interviewees described partnership as existing not just in the forums for shared decision-making – such as the Assembly or the Partnership Meetings – but also as a holistic experience that ran through everyday encounters at the Center. Thus, this study locates partnership as existing in two interconnected spheres: the structural–technical, which includes the operational practice of partnership in decision-making, and the content-experiential, which includes two levels of experience – partnership as a medium for new experience of the self and partnership as a medium for new experiences of the other. This interconnectedness mirrors current research, which broadens partnership to include experiential components (Bell 2002, McLeod 2010, Augsberger 2014). It also adds to the exploration of partnership as an ongoing practice, and to the understanding of the circumstances needed for its development. Partnership in decision-making According to the managers, the main formal setting for shared decision-making in the Center is the Assembly. This claim was corroborated by youth workers and service users. Decisions reached in the Assembly include everyday matters such as selecting pictures for decorative purposes, how to celebrate birthdays, summer vacation preparations and planning special activities. Additionally, the meetings are the forum for discussing general behavioural norms and specific conflicts such as cleaning (which, intentionally, is the responsibility of service users), loud music, alcohol use and issues connected to violence. As mentioned earlier, the assembly is open to everyone involved with the Center, staff and youth alike, and is central to the daily operation of the Center: . . .I can’t remember making a decision by myself in the Center, not even once. . . (1M – Nicole, manager)

The assembly is also described as an opportunity to express oneself fully: . . .wherever we go, they’d say, ‘what a delinquent, he can’t have an opinion’, because we are inferior, shitty children, looked down upon by the whole world. But at least in one place they treated us like human beings, like we are on the same level as normative people, not just a stigma. They let show that we are human beings, that we have opinions that are important and that our opinions are also accepted . . . and that’ s what lifted us up. It let us under-

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stand we are worth something. . . (3SU – Moshe, former service user. Emphases are his)

This description contrasts with descriptions of similar forums in the literature, in which youth describe themselves as feeling restricted (Holland 2001, Pert et al. 2014, Van Bijleveld et al. 2014). However, the descriptions also prompt the question as to whether partnership is a process or an outcome. Dowling et al. (2004) argued that in defining partnership, professionals and scholars confuse processes and outcomes. Thus, while some will consider progress made in terms of shared principles, knowledge and understanding as a key outcome of partnership, others will consider this as a successful process. Moshe’s words could contribute to this confusion as in his experience, partnership in decision-making is not a pragmatic tool but rather the therapeutic experience that ‘lifted him up’ from being ‘a delinquent’ to being acknowledged as ‘a human being’. There are three steps in this process: the recognition by others that he holds an opinion; their acknowledgement of his opinion as valid; and the acceptance of his opinion. The therapeutic aspect of partnership in decisionmaking is dependent upon the specific form decisionmaking takes: . . .in those meetings, no matter what you’ve said, they’ll respond. They’ll talk to you. Even if you just made a joke. Even if you were interrupting. You’re part of this place, not outside or something, you’re really an integral piece. . . (1SU – A-17, former service user)

Moshe and ‘A-17’ locate partnership as existing in two interconnected spheres, the structural–technical (the assembly meetings) and the content-experiential. This interconnectedness is further illustrated in the next quote: . . .in all the forums I’ve sat in, there were debates and disagreements, but how come in the end we reach a decision? . . . Because in the end, decisions are always reached, right? It comes from negotiation. Who will convince whom? This becomes possible through speaking, and through experience with persuasion. . . (2YW – David, youth worker)

David points to the existence of the dialogue or encounter as more important than the issues discussed or the decisions taken. As will be shown, the specific structure of shared decision-making implemented in the Center enables youths to learn new skills, experience new ways of being a part of the world and to connect with others: . . .partnership can’t just be a dry thing. By ‘dry’, I mean that one can say that in partnership we need the forums, we need this and that. But it doesn’t mean anything if after

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the meetings, there’s no place for support, to be partners. . . (1M – Nicole, manager)

The ‘forums’, i.e. the formal structural vessels created in order to carry out partnership, are described as being ‘dry’ if they are not accompanied by the ‘warm’ experiences of partnership, which incorporate a sense of belonging and mutual support. An example of this ‘warm’ component of partnership was observed in a big music festival organised and performed by the Center’s youth and staff together – an activity which gave the youth the status of experts, and where disagreements concerning the music and performances were handled in an egalitarian manner. Another, more everyday example was observed in a Partnership Meeting: towards the end, a youth worker took out a drill and a ladder and started to fix a broken bookshelf. Nicole went to help him, while everybody else continued with their work as usual. The youth worker was surprised when the researcher asked whether he was asked to do it, replying he did it simply ‘because the bookshelf was broken’. The ordinary basic manner of sharing collective works was later interpreted by the participants as an expression of their experience of being involved at and committed to the Center, and as examples of the ‘warm’ way of being together. Partnership as a medium for new experience of the self What does it mean to describe partnership as an experience, rather than a pragmatic tool for decisionmaking? ‘A17’, 25-year-old former service user, explains that ‘being partners’ is an experience of equality and self-worth, being an important member of a group:

The comparison between the natural speech patterns of the Center and the formalism of discourse with a psychologist, burdened with diagnoses and labels, sheds light on the ongoing experience of partnership as possessing strong therapeutic value. Similarly, ‘speaking freely’ is described to illustrate an experience of intimacy between service users and youth workers: . . .the funniest thing, we always say to the youth workers, ‘Hey, ya son of a bitch, son of a whore’. A normal person would die from the curses . . . But they’d reply, ‘I love you, too’. When social workers ask them about this, they try to explain that these are the words we use to say ‘I love you, I can’t do without you’, because we don’t know how to say it directly. . . (3SU – Moshe, former service user)

Analysing the use of profanity and derogatory nicknames among male Israeli friends, Kaplan (2006) argued that this is public–private talk, a communication system employed in public while still retaining a sense of exclusivity. This twisted coding system, contradictory messages that conceal positive feelings behind offensive language but are understood by all members of the group, expresses a shared language and serves to create an inclusive experience contradicting former experiences of exclusion. That the youth workers understand this language as disguised words of love contributes to the intimacy between them and the youth, and to the latter’s feelings of belonging and connectedness. Partnership as a medium for new experiences of the other How do feelings of belonging and connectedness develop? And how do these feelings relate to partnership? Nicole, manager, sees the development of these feelings as the responsibility of the youth workers:

. . .at this place you can say whatever, but they listen, react, understand, internalise, even implement . . . and no one talks down to you. Even if you’re a 14-year-old boy or a 15year-old girl, or who-knows-how-old youth worker, everyone treats you like an equal. . . (1SU – A-17, former service user)

. . .we aren’t a regular service; there has to be something within us that is a bit. . . welcoming. How can a person understand who he or she is, if we don’t know how to welcome, as a preliminary encounter?. . . (1M – Nicole, manager)

Renana, a 24-year-old former service user, compares the experience of partnership to her experience of classic-setting therapy:

In order for the youth to develop a sense of belonging, the youth workers should be ‘welcoming’, and make the Center lively and ‘warm’:

. . .being able to talk freely permits a lot. When a psychologist listens to you, he’s thinking: ‘What’s wrong with her head?’ But when you really sit with a person, it feels like the most natural thing in the world, and you talk to him about whatever you want, there are none of those defence mechanisms, and he’s not thinking ‘She’s screwed up’. He doesn’t see you as defective, and doesn’t think he’s trying to fix you. . . (4SU – Renana, former service user)

. . .we try to make a living place, one that life can find a home in. A warm place. Because ‘warm’ is an element of having regard for others, that is, allowing a person to feel recognised, loved, a living human being. . . (2M – Louis, manager)

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This ‘warm’ partnership is the opposite of Nicole’s previous description of a ‘dry’ partnership, one that © 2015 John Wiley & Sons Ltd

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occurs in the formal setting of decision-making. Similarly, Naama, youth worker, uses metaphors of ‘home’ and ‘family’ to describe the relationship: . . .the Center is, first of all, a home. One big family . . . A place where you feel important. Where people pay attention to you. . . (1YW – Naama, youth worker)

She goes on to explain what ‘being partners’ means for her: . . .I believe it’s a process we go through together, over time; crises, happy events, it’s something that binds, it isn’t one specific thing. What’s meaningful is the moment when each of the parties influences the other. It was something very, very mutual, very, very strong, a real connection. . . (1YW – Naama, youth worker. Emphases are hers)

Naama describes the experience of connectedness as a mutual experience, enveloping the youth workers with as much intensity as it does with the youth. Nicole similarly describes the experiences of partnership, connectedness and belonging as having an impact not just on the youth but also on her: . . .in partnership, I experience something like togetherness; it soothes me, makes me better. . . (1M – Nicole, manager)

The youth service users describe experiences of connectedness and belonging as derived from the ongoing presence of the Center and its youth workers in their lives, and how it accepted them. For example, Dan describes his connection with one of his youth workers as: . . .very, very strong. Very close . . . The kind of person who’s always there for you to talk. I remember her as someone who was there. She was always there. . . (2YW – Dan, a youth worker and a former service user. Emphases are his)

Renana concurs, describing the Center as a safe refuge where she can be herself: . . .it’s a kind of shelter you can always go to, and there’ll always be a place for you, no matter what. . . (4SU – Renana, former service user)

Moshe describes the relationship with a youth worker as the only caring relationship that survived his difficulties: . . .I was a very troubled kid. I messed up with lots of stuff. The only one who came to take me from prison, the only one who dared to meet with me, to visit me in those places was Lior. Even my family wasn’t there. I felt alone, and he was there. . . (3SU – Moshe, former service user)

The essence of partnership as an experience of connection and belonging recalls Anderson’s (2007) notion of ‘with-ness’: ‘A form of reflective interaction that involves coming into living contact with another © 2015 John Wiley & Sons Ltd

living being . . . they touch and are touched’ (pp. 44– 45). This is in contrast to mono-logic encounters, where professionals talk at patients, not with them. Honesty and transparency are the essential components of partnership-based relationships, alongside shared learning and mutual changing in the process (Anderson 2007, Hoffman 2007). Li and Julian (2012) defined the key factor in educational and therapeutic success with youth as what they call ‘developmental relationships’ (p. 158), which combines affective components – such as attachment – with the progressive complexity of joint activity and a growing balance of power distribution. Describing the relationship between youth and adults as merely welcoming and nurturing is incomplete, particularly when discussing helping relationships based on unequal power positions. Partnership, in this context, is a process through which each individual acknowledges, works through and finds one’s footing in an asymmetric power relationship: . . .within this house we offer youth the chance to encounter the other, where you’ll discover two things: you’ll get to know yourself better, and second, that there are rules in this house, and you must also learn to live with boundaries. This internal balance has a therapeutic meaning. . . (2M – Louis, manager) . . .we were terribly, terribly close with one another . . . It’s true that I’m a youth worker and (s)he’s a teenager, quite a few years between us, but it was a feeling of togetherness. Not a hierarchy, but kind of differences, differences in status, things like that. . . (2YW – Dan, a youth worker and a former service user, talking about his relationships with service users as a youth worker)

In the framework of partnership-based relationships, ‘hierarchy’ is replaced with ‘difference’. Connection and mutuality are described as occurring in encounters between individuals who differ from one another in age, socioeconomic status, education, personal histories and characteristics, as well as in their formal status at the Center. Nicole focuses on the difference between partnership and equality: . . .partnership expresses the desire of the adult to invite the adolescent to take a stand, to express what he thinks and feels. The adult is responsible for the adolescent. This way the partnership cannot, of course, be the same as equality. . . (1M – Nicole, manager)

The asymmetric power relations are not an obstacle for partnership; they are the reasons for its establishment, as partnership is the repair of domination, submission and violence: . . .we talk about repair from within a system of domination, of one dominating the other, so that partnership is itself the

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reparation. How do we actually give these two people or two groups the opportunity to connect from a more egalitarian position of mutuality, where each can contribute to the other, not just the more senior, but . . . each one can contribute something. Something different, but something. . . (1M – Nicole, manager)

Consequently, repair is not a fantasy of consolidation blurring the differences between the parties, but an encounter between dissimilar individuals who, despite their differences, find a non-destructive way to live and grow together.

Discussion This study examined the meaning of partnership for service users, youth workers and managers of a community youth centre for marginalised youth. The Center is influenced by the approach of Institutional Psychotherapy, which regards partnership as a central principle of practice. The findings of this study reveal a specific kind of partnership that pulls together the two main spheres of partnership literature: the structural–technical sphere, which includes the operational practice of decision-making, and the content-experiential sphere (Goldberg & Comins 2001, Bell 2002, Sinclair 2004, McLeod 2010, Van Bijleveld et al. 2013). The use of partnership as a mere technical tool to improve decision-making has been criticised in the literature (Alexander & Dore 1999, Karnieli-Miller & Eisikovits 2009). Our findings revealed the specific nature of the formal settings of decision-making that contribute to partnership as a therapeutic medium. The practice of decision-making employed in the Center is unique in three respects – the atmosphere, the topics discussed and the frequency. First, it is conducted as a regular principle of operation in an everyday atmosphere, and thus differs significantly from the acute decision-making that dominates partnership literature (Sinclair 1998, Cashmore 2002). Second, at the Center’s Assembly, everyday decisions are discussed by staff and service users. In contrast to other decisions that focus solely on the future of the patient, these topics are relevant to everyone involved in the discussion, giving the youth an opportunity to express their opinions without being identified as ‘a problem’. The experience of dealing with issues and everyday problems of life, together with an engaged adult in a close and meaningful relationship, is a valuable and important experience for youth development in general and for marginalised youth especially. Third, the Assembly of the Center meets regularly, and is not a one-time activity. This means that everyone involved has the opportunity to 8

develop the skills of discussing, influencing and negotiating, and shared decision-making becomes the norm. These characteristics of the Center’s Assembly portray the setting of shared decision-making not as a limited forum, but as a powerful mechanism for change. The specific characteristics of shared decision-making settings – such as atmosphere, content and frequency – are hardly mentioned in partnership literature. Our findings point to the need to incorporate these in future research, and to assess their impact on partnership. Characteristics such as the role given to service users in these settings, the time set aside for them to express their opinions, the topics they are allowed to discuss and the status attained to their knowledge should also be investigated. Understanding the change achieved through partnership requires consideration of its affective dimensions. In our study, youth workers and service users alike describe partnership in terms of a deep experience, of being in the world and being connected to others. Community youth centres are important venues for marginalised youth, connecting them to mainstream institutions (Halpern et al. 2000) and contributing to their self-perception and educational expectations for the future (Zeldin 2004, Camino 2005). Successful community youth centres bridge the gap between youth and adult worlds, creating a new and hybrid space that serves as a third space (Wong 2010, p. 710). Similar to the characteristics of potential space (Winnicott 1971), relationships between adults and youth in these unique spaces are reciprocal, described as ‘authentic caring’ (Wong 2010, p. 711) and sometimes as ‘youth–adult partnership’ (Zeldin et al. 2008, p. 263). They indicate strong and close connections, trust and a caring environment. All the interviewees in this study describe the unique relationship created under the notion of partnership as including experiences of care, acceptance, belonging, safety and refuge. These affective components of partnership are similar to Alexander and Dore’s (1999) concept of alliance, which includes bonding and affective mutuality (Bordin 1994, Horvath 2001). Wilson (2009) argued that ‘it is the embodied experience of relationship that is the real instrument of healing and transformation’ (p. 621). Contrary to participation – which refers to the extent to which a person is involved in a process concerning one’s life or surroundings, but led by someone else – partnership refers to a reciprocal relationship between two or more parties making a meaningful journey together (Apollo et al. 2006, Hook 2006, Vis et al. 2011). The issue of power imbalance between the parties involved is a central challenge for © 2015 John Wiley & Sons Ltd

Partnership-based practice with young people

partnership. This is particularly obvious in health and welfare settings, where disagreements can create lifethreatening outcomes. Thus, partnership is judged according to whether it leads to agreement. In our study, partnership is perceived as a process anchored by the ethos of living together. Differences of opinion or even major rifts are not regarded as obstacles to the routine desired work, but rather as the material of the relationship work itself, an opportunity to be in dialogue, for self-definition, to develop a sense of self and of the other. Thus, partnership should not be judged by its outcomes; rather, it refers to – as David suggested – the process of negotiation and the encounter created by it. It is not a primary goal-directed activity, but a therapeutic experience of being and becoming together (Alexander & Dore 1999). This approach to partnership has implications for professionals working with youth. Contrary to the understanding that partnership is about professionals sharing power and responsibility with service users, partnership, as shown in this study, is the active act of taking professional responsibility. It is the youth worker’s responsibility to build the environment which incorporates youths, to the degree that they are both willing to get involved and feel safe enough to do so. This study has four major limitations. First, it is focused on one specific youth centre setting, and does not seek to represent the work done in other youth centres. Second, it presents the perspectives of service users and youth workers who have had outreach experience with the Center for at least 3 years. It does not represent the perspectives of service users and youth workers at the point of their initial encounter with partnership. Third, the study presents the perspectives of former service users, but not those of service users at the time the research data were collected. Fourth, the ongoing nature of partnership implemented in the Center differs from the one-time meetings established in many social and health services as a medium for partnership. Nevertheless, our study sheds light on the potential for partnership as a therapeutic tool for working with marginalised youth. We hope it will prompt further research into the actual practice of partnership, as well as the conditions and obstacles that facilitate or hinder its development.

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