Why do interactions between professionals and (young) citizens not always lead to trust?

Gerlieke Veltkamp

Introduction

Despite of good intentions, trust in societal institutions is decreasing, alongside concerns about equal treatment. Professionals in healthcare, social work, education, the police or the government serve as access points for citizens to all kinds of services that facilitate participation in society. In their work, these professionals try to tailor general policies and standardized services to individual people. They do so, while they face people with similarities as well as differences, living in very diverse situations. Matching generic services and interventions with varying individuals is not an easy task. In many cases, this requires interactions in which professionals use policy prescriptions and population statistics on the one hand and try to get to know and trust the specific people in front of them on the other hand, in order to assess their situations.^[i] Stereotypical images of groups of people play a role in this assessment. For instance, ideas about mothers, fathers, teenagers and children each having their own ways of doing things, of caring and of participating, whereas inferences are at the same time related to migration backgrounds, cultural backgrounds, educational backgrounds, age, financial situations and/or mental and physical health.

In our previous research^[ii], we saw that the participating professionals in child health care explicitly wanted to build a trust relationship with all parents they encountered, regardless of whether it was a mother or a father, and regardless of the educational background and cultural or ethnic background of the parent. Nevertheless, in practice, trust relationships were more often built with parents who were more similar to the professionals (in terms of gender, educational level, race or ethnic background). With the more similar parents, concrete information about the situation was exchanged, the knowledge of these parents was appreciated more, and stereotypical images were more readily adapted. Hence, (in the terms of philosopher Alfred Schutz^[iii]) 'we' relationships could arise, characteristic of people who 'walk' together and coordinate their thoughts. With the parents who remained more at a distance, on the other hand, we saw more superficial 'they' relationships. The professionals involved did not get to know and trust these parents as well and therefore relied more heavily in their assessments on existing stereotypical images of the groups to which the parents were assigned. In these cases, the professionals were more likely to worry about the child and the family, for example based on the reasoning: this child is growing up in a single-parent family in a neighbourhood where poverty is common; we know little about the child and do not see the family often, so there might be reason for concern.

In our current research project 'Trusting on the Edge?', which is affiliated to - but distinct from - Sarphati Ethnography, we zoom in on these ‘we’ and ‘they’ relationships between professionals and citizens, particularly among citizens in marginalizing circumstances who are more often confronted with stereotypical images that disqualify them, for example linked to their age, mental health, race, ethnicity, gender, financial means or educational background. Why are (disqualifying) stereotypical images not always corrected when professionals and these citizens work together and try to exchange concrete knowledge, and why do ‘we’ relationships not necessarily develop in these contacts? When are stereotypical images confirmed and is mutual distrust formed or strengthened? Our initial results show four directions to better understand these interactional dynamics.

‘We’ and ‘they’ relationships: stereotypical images and distrust

1.     Why do dialogues stop?

First of all, we see that people sometimes act in line with a stereotypical image, after which mutual exchange stops and no further steps are taken to understand the other. There may be a moral desire in a professional (or citizen) to move against a stereotypical image, but this image can initially be confirmed in the contact. For example, two boys at a practical school where our co-creation research project on (dis) trust takes place expressed that it demotivated them when an internship supervisor reacted angrily and disrespectfully when they arrived late at their internship location. In this case, arriving late seemed to confirm for the supervisor the image that a group of young people (who are following practice education, often already stigmatized) are unable to adhere to basic agreements perceived as necessary in a labour market context. The two boys mentioned that the situation and the reasons for arriving late (public transport cancellation) were not listened to, nor to their difficulty with the internship experience and the lack of perspective they perceived in their education. Subsequently, the internship supervisor and the students did not get closer to each other, which could lead to the termination of the internship.

In previous research, we observed a similar dynamic among midwives^[iv] in the German context, who visited families at home for a longer period. In the midwives’ experience, the fathers they encountered often focused on their work and in many cases left the care tasks for the baby to the mother and the midwife. This confirmed a picture of a traditional division of roles in which fathers take little responsibility for care tasks. The midwives subsequently had little in-depth contact with these fathers, even though they did meet them frequently.

In both cases, it is interesting that, after confirming a stereotypical image that disqualified the other, no attempts were made to gain a deeper understanding of the motivations behind it, or getting to know other similarities, or possibilities and forms of involvement. In these cases, the stereotypical image contributed to the fact that the exchange of concrete knowledge and experiences stopped and no ‘we’ relationship developed.

2.     Who has authority?

A second dynamic can be shown by the experiences of a young woman in our study (led by Ariana Rose) who was in the process of being diagnosed with ADHD. She shared her concrete experiences with a psychologist, including her migration history and her upbringing, and that she had experienced physical punishment in her youth. The psychologist immediately linked this to trauma and decided to focus on trauma treatment and not on ADHD. The young woman then indicated that she understood that the psychologist categorized this as traumatic, but that she herself experienced it differently, because many people in her social circle had similar experiences. For her, her lacking diagnosis of ADHD was important (and traumatic). Yet the psychologist continued to hold on to the traumatic aspects linked to migration and upbringing. We see here that an extensive sharing and discussing of personal experiences did not lead to an exchange of knowledge and a mutual understanding of the situation, but that these experiences were moulded into existing stereotypical knowledge about groups of people (migrants) and events that can lead to trauma (physical punishment).

This tells us something about the nature of professional work and how this can complicate ‘we’ relationships. Characteristic of the role of this psychologist - as for professionals in a more general sense - is on the one hand that she had to operate within institutional frameworks ('ADHD cannot be diagnosed before traumas have been treated') and on the other hand that the relationship was not symmetrical. Rather, the psychologist wanted to use her expertise to be able to be of significance, thereby removing the expertise of her patient from the table. Categorisation plays an important role in this, with the risk that this leads to the reproduction of stereotypical images in which the other persons do not recognise themselves. This 'epistemic' inequality, in which someone's knowledge is not or not as much taken seriously, can reinforce distrust and stand in the way of a 'we' relationship.

3.     Why does control promote distrust?

A third pattern that emerged from our research with young people in practical education is that distrust often arose and was reinforced in interactions in which the young people, or people in their environment, had a limited sense of influence whereas the professional was in control. For various professional roles (teachers, police officers, youth care workers and orthodontists) young people in our study mentioned that ‘the power had gotten between their ears’, or that a professional wanted to belittle them because that person wanted to be in control. For example, several young people mentioned that they had no confidence in youth care. One of them explained:

“It appears to be good, but it isn't good. Conversations all day long. They only hear what they want to hear. They don’t care what you say. […] It seems like it’s something good, youth care. That they help you. But in the end… they only screw you over. It’s all used against

you in the end. [In my environment] there have also been many people who went to youth care themselves to ask for help for their child. And in the end, they really regretted it. Children were taken from home. And eventually, they’re simply not allowed to come back. That’s not normal. […]  They just do what they want. And what they want to hear, they hear. They’re not going to listen to you.”

Illustratie by Jellie Heldersen, as a part of the '(Dis)trust on the Edge' project

We can see here that both the institutional context, in which risk management was prominent^[v], and the practice of the professional, who according to this young person did not listen to him, can stand in the way of building trust. The experience that it does not matter what he does (and what others do), and that there are far-reaching consequences, can give groups of citizens reasons to distrust professionals and government agencies, especially if they have to deal with government institutions with a repressive role more than others.

4.     How can one ‘we’ relationship prevent another ‘we’ relationship?

A fourth element that emerged in our current and previous research is that the relationships between professional and citizen are not isolated but must be seen as part of broader contexts and social networks. For example, we saw that relationships between professionals, both in medical and in teacher teams, often had strong characteristics of 'we' relationships. The colleagues (‘we’) discussed the students, parents or children (‘they’) with each other to arrive at a good judgement. In conversations between colleagues, stereotypical images were easily used and confirmed to support the chosen approach. In these interactions with like-minded people, the knowledge and experiences of the citizens involved were therefore given less weight. Here, we can thus see mechanisms that reinforced the hierarchy between professionals and citizens. Knowledge based on science and expertise, often mixed with stereotypical images used in the professional work environment, weighed more heavily than citizens’ experiential knowledge, and the assumption that people outside of the professional expertise were not always in a position to ‘know’ at a comparable level^[vi] was confirmed. We can thus see that one ‘we’ relationship can stand in the way of another ‘we’ relationship.

In a similar sense, parents, children and young people also have ‘we’ relationships with each other, in which different ways of relating to scientific and professional knowledge are shared^[vii]. Our ethnographic study shows how distrust and not being understood, and conversely the disqualification of professionals, was discussed and reinforced within social relationships. Precisely because the relationships between professionals and citizens take place in the midst of these processes, mutual understanding and the emergence of a ‘we’ relationship can be promoted or hampered by other ‘we’ relationships in the social and professional context. It is therefore important to study these interactions and trust dynamics in relation to each other.

Conclusion and discussion

Stereotypical knowledge is important for assessing social situations and they can help professionals and citizens to categorize situations, build knowledge, and deal with the uncertainty and vulnerability of social situations and the professional task. However, there is a serious risk that stereotypical images can prevent professionals and citizens from getting to know and trust each other more concretely, and thus to enable institutional and democratic services to function properly.

Of course, ‘we and ‘they’ relationships come in different forms and these relationships can differ in the degree of proximity, depending on the function and context. Not all interactions need to be personal, reciprocal ‘we’ relationships. In fact, a distant position or refusal of contact can sometimes be necessary, understandable or justified^[viii]. We do argue here however that it is important to consider the reliability of our institutions and social organizations and the role that stereotypes and trust play, through the contact between professionals and citizens who exchange knowledge and experiences with each other. In these contacts, disqualifying stereotypes can be confirmed or resisted, and trust relationships can be enabled, or interactions can strengthen processes of inequality and isolation.

In our co-creation research, we want to collaborate with (young) citizens and professionals to better understand how processes of trust and distrust take place, what this tells us about the reliability (and possibilities/ impossibilities) of our social institutions, and where recognition (of inequality, distrust, different positions) or reform is needed. With our project 'Trusting on the Edge?' we aim to come up with concrete tools and suggestions for professionals and (young) citizens who want to build ‘we’ relationships and come to a mutual understanding, and for situations in which ‘we’ relationships are consciously avoided by citizens.

The project ‘Trusting on the Edge?’ is performed by Gerlieke Veltkamp, Patrick Brown and Ariana Rose at the University of Amsterdam, department of Sociology. We use interviews, co-creation sessions, focus groups and observations. Gerlieke Veltkamp is also involved in Sarphati Ethnography.

^{[i] [i]}Lipsky, M. (2010). Street-level bureaucracy: Dilemmas of the individual in public service. Russell Sage Foundation.

^[ii] Veltkamp, G., & Brown, P. (2017). The everyday risk work of Dutch child‐healthcare professionals: Inferring ‘safe’ and ‘good’ parenting through trust, as mediated by a lens of gender and class. Sociology of Health & Illness, 39(8), 1297-1313.

^[iii] Schutz, A. (1967). The phenomenology of the social world. Northwestern university press.

^[iv] Veltkamp, G. (2019). When do professionals envision and trust fathers as caregivers over the course of giving birth? A comparison of pre-and postnatal healthcare professionals’ assessments of fathers in the Netherlands, Germany, and Poland. Social Politics: International Studies in Gender, State & Society, 26(3), 370-393

^[v] Brown, P., & Calnan, M. (2013). Trust as a means of bridging the management of risk and the meeting of need: a case study in mental health service provision. Social Policy & Administration, 47(3), 242-261.

^[vi] Fricker, M., Peels, R., & Blaauw, M. (2016). Epistemic injustice and the preservation of ignorance (Vol. 1, pp. 144-159). Cambridge: Cambridge University Press.

^[vii] Veltkamp, G., Karasaki, M., & Bröer, C. (2020). Family health competence: Attachment, detachment and health practices in the early years of parenthood. Social Science & Medicine, 266, 113351.

^[viii] Benjamin, R. (2016). Informed refusal: Toward a justice-based bioethics. Science, Technology, & Human Values, 41(6), 967-990.