Stepping Up to the Plate

By Kathryn (Seng) Gurland, LCSW

I recently used the expression “I’ll go to bat for you” as I consulted with a young woman, Aida, whose primary language is not English. I was trying to convey that I would advocate for her in a particularly tough situation, but I quickly realized she had never heard that expression before, and she was confused. She was familiar with the game of baseball, however, so when I explained the origin of the phrase, she immediately got it—and then responded with, “Thank you, but I’d prefer to bat for myself if you will coach me.”

Without even realizing it, Aida had just demonstrated the initial steps required when practicing self-advocacy. First, she knew what she didn’t want—for me to lobby for her; second, she knew what she did want—to obtain the skills needed to defend her own position; and, third, she communicated those needs effectively without alienating me, her trusted clinician. It was clear she wasn’t going to need much coaching.

What Is Self-Advocacy?

The term self-advocacy, though initially associated with a movement for individuals with disabilities, is more commonly defined today as a person’s ability to communicate effectively and to negotiate or assert his or her own interests, desires, needs, and rights. Becoming a skilled self-advocate entails learning how to obtain pertinent information and self-assess strengths, weaknesses, needs, and goals and then ascertain the best way to communicate so that others really hear you and respect your position. Regardless of whether you have loved ones or professionals who can advocate for you regarding health or legal matters, learning to be your own advocate can prove invaluable in so many other life situations.

On the surface self-advocacy doesn’t appear too formidable a task to undertake, especially for those already equipped with a fair amount of confidence. Many people today feel more empowered when they access expansive information via the Internet and other sources; and self-assessment has become a familiar tactic as more people avail themselves of individual therapy and support groups, both of which foster increased self-awareness, healthier interpersonal relationships, and overall personal growth.

Three Key Barriers to Self-Advocating Behaviors

So why do so many of us find ourselves in situations where we wind up thinking, I should have asked this or I wish I had said that or, even worse, This doesn’t feel right to me or I feel like I have no choice? What gets in the way of our being good self-advocates when we have developed so many of the requisite abilities, feel confidently informed, and possess good communication skills?

I use “we” because I too lost sight of my well-honed advocacy skills when, as a patient, I met with a specialist a few months back. Since then I’ve discovered three key barriers that repeatedly prevent people from executing self-advocating behaviors.

Perceived Power Differential

There is no doubt that trained medical experts come to the table with expertise and knowledge that those of us without medical training do not have. And when initially diagnosed with any illness, it’s natural to relinquish control and look to the specialist to “save” us.

Because clinicians see multiple patients with the same disease, however, they often forget to view their patients as individuals. Your first and foremost responsibility as a self-advocate is to identify right from the start your distinctive situation and your individual needs and convey them to your clinicians. You may well be the five-hundred-forty-seventh patient that the expert has met, but it is your unique life experience, and your expertise is about you. You have power via your personal information that can contribute to an effective game plan, one that could yield more-beneficial results because the strategy is more in sync with who you are and what goals you have.

I once had a lovely young patient who was diagnosed with a Stage IV cancer; she asked the oncologist what her “odds” were for a certain treatment protocol. When he somberly cited the discouraging statistics, she replied, “Okay, so only 8 percent of patients have gone into remission, but I want to be the one who raises the number to 9 percent.” She knew she had no power over the diagnosis, but she regained much control by letting her oncologist know that she would be dealing with the disease in her way, with optimism and humor. At future appointments the doctor would greet her with a smile and ask, “So how’re you doing, Ms. 9 Percent?” To him she was now an individual with specific goals and a unique outlook.

Assumed Negative Outcomes

Think about the last time you didn’t speak up, ask a question, or negotiate for what you really wanted. If you reflect on what stopped you, you’ll discover that you were afraid of something. Whether the fear was about rejection, refusal, or retaliation, your hesitancy to express your needs was the result of your fear of a negative outcome.

The thing about negative outcomes is that they initially have no greater certainty than positive outcomes. Yet because our fears tend to lead us to worst-case scenarios, we allow our assumed negative consequences to override our true desires. Instead of attributing credence to negative outcomes, try remembering the simple adage It doesn’t hurt to ask. In most cases, asking doesn’t hurt the situation, and you just might be surprised at the answer you get. Then ask yourself, What’s the worst that can happen? Too often the consequences of not asking or not negotiating for what you want are more disappointing and more detrimental to your overall well-being than if you took the risk and went to bat for yourself.

Emotional Entrapment and Self-Coaching

How often do you find yourself fearless when it comes to defending those you love but not nearly so brave when it comes to yourself? The two most common traps people fall into are worrying about how we will be perceived and not valuing our own needs as much as we value those of others. We become captives of the notion that we will appear confrontational, aggressive, bothersome, or complaining. We convince ourselves that it’s better to just stay quiet than to cause a fuss. If you find yourself stuck in either of these obstructive cycles, stop and think about what you would tell your best friend: if you know what you would coach your loved one to say or do, then you know what you need to do for yourself.

Use Self-Advocacy to Become a Home-Run Hitter

Thanks to my client Aida, the baseball analogy continues to resonate with me as I advocate for my clients and for myself. Here are some additional pointers from one self-coach to another:

  • In the game of life, be the best player that you can possibly be, not just a spectator.
  • Know your game from both an informational and an emotional viewpoint.
  • Learn to be your own coach and how to pump yourself up before each inning.
  • Strive for your personal best; don’t compare yourself with other players.
  • Learn to play both offensively and defensively.
  • Know the strengths and the weaknesses in yourself, in your team members, and in your opponent.
  • If you’re not getting the results you want, change up your game strategy.
  • Don’t let your fear of losing prevent you from getting off the sidelines and into the game.
  • Go to bat as often as you can, play as well as you can, and remember that, if need be, you can always call on your designated hitter.

Kathryn (Seng) Gurland, LCSW, is a Licensed Clinical Social Worker and Cancer Navigation Consultant™ in New York City. Her many years as a medical social worker and private psychotherapist, specializing in psycho-oncology, pain and palliative care, and end-of-life care, exposed her to the intricacies of cancer and its effect on everyone involved. After losing sisters Judi and Peggy to cancer, Kathy conceived and developed PEG’S Group, a private consulting group of cancer navigators. PEG’S Group has been Kathy’s personal and professional endeavor to provide the individualized services that our healthcare system is unable to deliver at this time. For more information, visit pegsgroup.com. Kathy holds affiliations with National Association of Social Workers and Association of Oncology Social Workers, is on the Advisory Board of the NASW’s Communication Network Committee, and is a regular contributor to SocialWorkersSpeak.org.