AACP Newsletter, Volume 13,
Number 4, Autumn 1999
Moving Toward Provider-Consumer Partnerships:
A New Concept of Professionalism
The profession of psychiatry has not been distinct with regard to these concepts of professionalism, and for many years it was served fairly well by them, even if its clients did not always feel similarly well served. Much has changed in recent years, however, and as the knowledge base of the profession has expanded to encompass the role of autonomy and self-determination into its concepts of recovery, it has also become clear to many in the psychiatric community that traditional concepts of professionalism and the professional-client relationship are no longer adequate. A new concept of professionalism must emerge which can meet the demands of a recovery-oriented model for change.
We should not discard all elements of traditional professionalism, as there are many which may continue to serve us well. Clearly, the profession's sense of mission, the commitment to providing service will continue to be an important aspect of professional conduct, but a reconceptualization of what that service is will be required. Similarly, a facility or expertise in translating a body of knowledge in psychiatry to serving a population in need will continue to be of import, but the nature and inclusivity of that body of knowledge requires deconstruction and reformulation. Certain aspects of the professional relationship will need to be transformed into more useful paradigms. Paternalism, power, independence and exclusivity must give way to mutuality, participation, interdependence and empowerment. An honest interchange between professional and client incorporating mutual respect and trust is essential. An understanding that the ability of knowledge to confer power will not be potentiated by guarding it greedily must be part of the new professionalism. Increasing the client's access to information regarding the professional's dilemmas and difficulties will strengthen this relationship just as expanding the professional’s access to information regarding the client's experience of the relationship and their illness will enable greater sensitivity to treatment needs. Participation and self-direction in developing the recovery plan will not only fortify the client's autonomy but will increase the professional's effectiveness.
This newer concept of professionalism should transform the knowledge base of psychiatry to include concepts related to fostering autonomy, problem solving, living skills and self-determination. The concept of service will then necessarily be transformed as well to one that is not delivered, but rather one that is developed. The service will not be one that follows the traditional paradigm of an active agent prescribing or doing for a passive agent, but rather one of facilitating a client's solution to their own understanding of their problems. There should be no controversy over how we refer to one another, as this will be dictated by mutual respect.
A shift to the new concept of professionalism will be a slow process, and it has so far significantly affected relatively few of the psychiatric profession's current members. The challenge for the future will be to integrate this conceptualization into the training programs for developing psychiatrists and to incorporate then into the quality standards by which treatment and recovery are measured. One paradigm for this training process has been called Pioneer Dialogues, a process by which providers and consumers join together in a nontraditional setting to discuss issues related to their experiences in relating to each other. This process was described in an earlier edition of Community Psychiatrist (13:1 p4). Innovative opportunities for communication between mental health professionals and behavioral health consumers like Pioneer Dialogues will hopefully allow us to move toward greater mutuality and understanding in the recovery process and move away from the sometimes adversarial processes of relating to one another that has obstructed recovery in the past.
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