Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective

Abstract

The focus of this article is on illustrating how the differences between the paternalistic and empowerment approaches embedded within social work have unnecessarily evolved into competing approaches to practice. Tracing the historical evolution of both paternalistic and empowerment approaches, the article posits that social work is more amenable to an integrated holistic approach to practice than to either a diagnostic or strengths-based approach. Building on G.WE Hegel's notion of recognition and feminist psychoanalystJessica Benjamin's theory of intersubjectivity, the article considers how a simultaneous focus on both strengths and vulnerabilities provides an integrated framework that embraces the joint social work values of personal caring and social justice. Clinical case vignettes are provided to illustrate the limitations of focusing too narrowly on either clients' pathology or clients' strengths. Social workers are encouraged to acknowledge their own vulnerabilities to better appreciate clients' vulnerabilities and strengths.

How would case managers’ practice change in a consumer-directed care environment in Australia?

“…). In support of the literature, we suggest that case managers commit to sharing and achieving the balance of power in a CDC environment (Bransford ).…”

“…This is also supported by the literature. First, for any clients, there are times when case managers need to focus on their lack of independence, at other times their independence and still at other times a combination of both (Bransford ). Second, some clients having complex physical and/or cognitive impairments and lacking social support always need case management support (Kapp ).…”

“…Both theoretical and empirical literature has identified professionals’ micro‐level strategies of empowerment practice. These include: (i) proactively acting as communicators and resource consultants to help clients make effective choices; (ii) educating clients to acquire and maintain relevant knowledge; (iii) engaging clients in the care planning process to increase their control over service‐based decision‐making; and (iv) facilitating clients’ control, autonomy and resilience (Oudshoorn , Bransford , Goodwin , Low et al . , Shearer et al .…”

“…To apply this theory in real practice, professionals need to transfer the control over choices, decisions and directions of services to individuals (Kosciulek ). There are five components of empowerment‐based social work practice, including: (i) directing professional energies in a selective manner towards disempowered groups; (ii) emphasising capacities but not incapacities; (iii) viewing clients as active subjects; (iv) establishing collaborative partnerships with clients; and (v) placing a dual focus on the individual and the physical and social environment (Bransford ).…”

Special Issue on International Group Work and Psychotherapy

“…The social implications of globalization pose a major challenge for the helping professions, both in terms of defining the boundaries of responsibility, and in terms of finding effective interventions that can improve the situation of disadvantaged and excluded traumatized populations that are frequently victims of discrimination, distress, and trauma (Bransford 2011;Dean 2001). A review of the literature indicates that the professional social work establishment attributes importance to professional engagement in this area.…”