It does not take a rocket scientist to see that the global mood is changing at a frightening pace. Several decades of neoliberalism have left their mark on health and welfare, and it now seems we have given in to populism. Studies do not differ much about what is breeding this: in these times of uncertainty, people do not feel seen or heard – at least not enough, not seriously. Strong relationality, the consequent conception of everything, including persons, as a nexus of relationships, is crucial in understanding and promoting good health and social care. Could this be a remedy for a disconnected world?
Feeling abandoned
People feel that they, their fate, their knowledge and desires do not really matter when it comes to social policy, care, education, the labour market, housing and so on. And, ironically, this feeling has arisen at a time when demand-driven work, service orientation and customer-is-king philosophies reign supreme. Something has gone terribly wrong. We find this feeling of abandonment not only among clients but also among dedicated professionals: their experiences and knowledge are ignored as long as everything revolves around a narrow idea of ‘efficiency’.
Lack of relationality
Following 30 years of research, we have come to the conclusion that one of the causes of this disengagement is a lack of relationality in professional work. The most common form this takes is distancing or detachment. Those who help, care, provide or operate services and promote participation hardly know the lives of the people they are supposed to be serving. All too often, they have the view and appreciation of an outsider. To be successful according to the usual criteria, they rigorously simplify problems, isolate the client from their context and view them individualistically. The priority is to make the problem disappear, and overly complicated clients are easily abandoned because they cost too much money and energy.
This logic of working is frequently at odds with the logic of clients’ lived experience. Professionals may do their work competently, impartially and according to the usual criteria of quality and financial responsibility, but often it turns out to be a mismatch, providing little relevance to those who need help and care. These professionals are not personally to blame; their deeply embedded ways of thinking and doing have simply alienated them from the reality of the citizens they are supposed to be helping. Being critical of practices is not the same thing as being critical of those practising: the latter deserve to be taken much more seriously than they are.
The relational approach
We have found that a relational approach can overcome many of these objections. This method seeks proximity and interaction without prejudice. It is interested in the lives of citizens, learning to understand what concerns them, what could help them and what would do them good. It radically changes our usual way of thinking, perceiving and searching for good care. Relational professionals first relate to people, offering themselves before offering anything from their professional action repertoire. They are humble and interested, genuinely seek connection, and radically attune their practice to the other or others. They make work out of what is depressing and what is good for the other person. They do not carry out their work merely for the purpose of their own professional ambitions, ideals, goals or assignments. The relational approach proves to be successful and beneficial to those involved, even when the problem or need cannot be ‘solved’ – which is more often the case than is generally thought.
An approach that works in multiple fields
This approach may sound idealistic, but it is one we see used by the best professionals in care and welfare when we look very carefully at what they actually do and how they operate. Yet despite its success, it receives little attention. We have found this approach used in healthcare, in social work, with the police, in psychiatry, and in care for people with intellectual disabilities, dementia or addiction; we have also found it in schools, in families and in politics, as well as in many other places. We call it ‘Practising presence’ and see it as the (tacit) core of all human-centred work. It is about connecting and attuning your practice to the other, thinking from the inside out, tailoring your expertise and offering it only when you have really understood what is wrong and what people long for. Regular professionalism is much more about strict methodical compliance, following the (multitude of) rules, executing plans as intended, and achieving measurable results. This typical way of doing things professionally may be necessary and good, but at the same time, it contains a huge blind spot: as a professional, you get caught up in yourself, in your own and your profession’s intentions, logic, interests, systems and ‘rightness’. It seems more cost-efficient, but it often leads to mismatches and even overtreatment and a professional perpetuation of need and neediness.
Deep grounding
For some decades, we have been empirically studying the relational approach of presence in numerous settings. As a result, we can articulate in detail how it is established, what it requires of the professional, and what its returns are. In addition, we have developed our findings conceptually, formulated them in a coherent set of tenets, and incorporated them into a political take on care ethics – theory and practice, in other words. We also took up the challenge – again based on empirical research – of answering additional questions: What is an appropriate form of professionalism and professional training for this method of doing things? What is an appropriate quality system? What forms of management and leadership are helpful? And finally, we have thought about the ethical, political and philosophical implications of all this: How can we make the case for doing ethics contextually, so that all care essentially answers the political question of who matters and what social order we want? What research is appropriate for uncovering this relational way of working? How can we understand this professionally loving and practically wise way of muddling through? What is its deepest underpinning?
The struggle for recognition
A radically relational practice is not only efficient and effective but also gives a basic form of recognition to those who seek care and help. It takes these people and their concerns and aspirations seriously, and this is the beginning of the response to rising populism and widespread societal dissatisfaction. Radical or strong relationality helps to preserve the social fabric of our society at its deepest level.
Andries Baart is Extraordinary Professor of Intergenerational Care at North-West University and was Visiting Professor at the University Medical Center Utrecht.
Guus Timmerman is Senior Research Fellow at the Presence Foundation. He was educated as a physicist, theologian and ethicist and worked as postdoctoral researcher at the Presence Foundation.
Listen to the authors in conversation with Martin Robb on the Careful Thinking podcast, episode 20 (published on 3 March 2025).
Relational Caring and Presence Theory in Health Care and Social Work by Andries Baart and Guus Timmerman is available on Policy Press for £85.00 here.
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