Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective

Jan 21, 2011

Through its history as an organized profession, social work has worked under two competing models or philosophies: paternalism and empowerment. But perhaps a third model will provide a more comprehensive view for client care and empowerment.  In “Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective” in the January 2011 issue of Social Work, Cassandra L. Bransford discusses these three models of social work.

Social work originated in the 19th century in a religious context. High-minded reformers sought to ‘lift up’ the poor and indigent, and ‘heal’ their problems and lead them to better lives.  This paternalist vision saw the social worker as an expert and a caregiver, and the client as vulnerable and in need of assistance and guidance. The social work was seen as treating pathology, a mental and social disease afflicting the client.  Social workers viewed themselves as the professional equivalent to doctors. 

In the early 1990’s, social work began to adopt an empowerment model.   Empowerment seeks to increase the power of the individual client (or community) so that the client can take action to change and prevent the problems.  Empowerment proponents saw paternalism as neglecting the client’s natural strengths, and as focusing on the negative (the problem) instead of the positive (the client’s innate abilities).  Empowerment involves collaborative partnerships with clients, an emphasis on capacities rather than incapacities, a dual focus on the individual and the environment, a view of clients as active subjects, and a conscious direction of professional energies toward historically disempowered groups.  In empowerment, rather than the social worker, the client is seen as the ‘expert’, in that he understands the social and physical environment in which he finds himself.  The social worker assists the client in discovering his innate strengths, and how to apply those strengths to increase his power over his life and environment.

However, empowerment ignores two salient weaknesses.  First, there are times when clients actually need paternalistic care. Empowerment, in seeking client-led intervention, ignores a basic human need to occasionally be nurtured and cared for.  Clients do have strengths, but they also have weaknesses that need to be attended to.  Second, often the social worker inadvertently subverts the empowerment model.  While the social worker ostensibly focuses on client ‘expertise’, the social worker can push the client along toward the opinions, ideas and outcomes the social worker deems optimal, rather than what the client really wants or needs.  Empowerment can actually mask a form of parternalism.

Rather than hewing to one or the other of the poles of empowerment or paternalism, Bransford recommends the practice of intersubjectivity.  In an intersubjective model, both paternalistic and empowerment practices and views are incorporated.  Sometimes the social worker will actively nurture and seek to ‘heal’ the client or community, and provide the kind of immediate care required.  At other times, the social worker will allow the client’s expertise about the environment to guide the process toward gaining mastery over the situation, and using and growing the client’s strengths.  Additionally, intersubjectivity reminds the social worker that he, too, is a subject, a person, as well as the client.  The process of doing social work changes both the client and the social worker.  The social worker is called to be open to the client’s actual strengths and expertise, as well as his own strengths and expertise, and working together the two can reach the desire combination of healing and empowerment.