Preface

This book addresses a deep and globally felt dissatisfaction, among citizens in general but also among professionals. Namely, that in healthcare, the social domain, in education, in the domain of housing, but also in psychiatry, youth care and, for example, public administration, things have too often gone off course. As a result, there is a growing gap between the regime of competent professionals and managers, on the one hand and the lifeworld of patients, clients, pupils and residents with their needs, concerns and longings, on the other. And also a gap between the institutional logic of organisations and their administration and quality systems, on the one hand, and the everyday practice and practical wisdom of front-line professionals, on the other. In these interrelated gaps, disconnected competences, bureaucracy, aloofness, mismatches and distrust are proliferating. In short: ‘Many are busy with you, but few are looking after you.’ The relentless improvements since the 1980s hardly repair these deficits because they are producing more of the same: the same pragmatism and distancing, the same type of thinking, perceiving and knowing, the same rationality and market-driven organisation that are at the root of the difficulties. People, both as citizens and as professionals, hardly feel seen. Their distrust toward fellow citizens, their dissatisfaction with their work and their receptivity to populism are growing.

This book summarises over 30 years of research into the practices of practitioners who are recognised by care receivers and colleagues as good practitioners, to present a realistic and empirically grounded alternative. At its heart is radical relational caring, connecting with and attuning one’s practice to the other person before applying expert knowledge. What relational caring entails and how it works has been practically and theoretically explored in different domains and is described in detail. But the book goes further and shows its payoff. It analyses what kind of professionalism is required for this way of working, and how practitioners can be trained and formed to work in increasingly radical, relational ways. It presents the practice of relational caring in a broad range of domains – the presence approach – but also the underlying theory, ethics and philosophy – the multidisciplinary presence theory. It pays attention to its foundations – in care ethics – and the methodology, qualitative research and politically oriented critiques on which it relies. To this end, it coins its own concepts, which challenge professionals, managers and researchers to stay on track.

Although much of the research was done in the Netherlands, this book is international in scope and actively engages in numerous international discussions. It targets scholars and researchers, but certainly also professionals and change specialists in healthcare and social work, from practitioners to trainers, and from quality officers to managers. In the Netherlands, Belgium, Germany and, for example, South Africa, this kind of presence is practised by social workers, healthcare workers (caregivers, nurses, psychiatrists, doctors), youth care workers, by professionals in the care of people with intellectual disabilities, and at places where people with a serious addiction who avoid any form of care, homeless people or early school leavers need to be reached. The book elaborates the thesis that no form of care, help or support can do without this relational core, with the risk that mismatches arise and seekers of help are abandoned. It is precisely this experience of not being included that fuels discontent worldwide. And not being allowed to practise relational caring is conducive to satisfaction fatigue and burnout of front-line professionals.

The book aims at providing a broad and critical introduction to relational caring in healthcare, social work, education and so forth to interested scholars, professionals, administrators, trainers, quality officers, policy makers and researchers. The book is about professional caring and the required knowledge, attitude, morality, quality frameworks, learning models and so forth. We do not go into the subject of unpaid and family carers, however topical and relevant it certainly is worldwide, especially after the COVID-19 pandemic, criticism of neoliberal efficiency thinking in healthcare and social work, labour market shortages and, for instance, in the light of current thinking on ‘communities’ and civil society. Something for another book.

To give the reader a sense of what we mean by relational caring and practising presence, the book begins with a case description from residential social work and points out a few features which are remarkable, considering the contemporary emphasis on methodical interventionism. The description also introduces some of the terms that will later be explained more fully. In Part I, the concept, practice and theory of presence and relational caring as we understand it are presented, related to other approaches and discussed. We argue that if we are to study complex, dynamic and emergent practices of healthcare and social work, it is necessary to bring about an empirical turn in care-ethical research and a practice turn in theoretical thinking. This results in the theoretical perspective of presence, a complex, rather unusual but fruitful and revealing way of looking at care practices and issues that emerge in these practices and are relevant to its participants.

In Part II, six major topics in relational caring are discussed by looking at it from the presence-theoretical perspective: the political context, perception, relationality and ‘finality’ (that is, the ultimate aim of the practice), practical wisdom, quality and the continuing formation of relationally caring professionals. A note on relational caring and technology is added after the three quintessential aspects of good care are discussed: freely perceiving and imagining, properly attuning one’s practice to the person in need of care and practising practical wisdom. Instead of offering a conclusion, in the final chapter we discuss the meta-theoretical and political background theories of the presence-theoretical perspective.

Andries Baart and Guus Timmerman

Nieuwegein/Amersfoort, The Netherlands

17 May 2024

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