Caring presence - with Andries Baart and Guus Timmerman
Episode 20 of Careful Thinking
For Episode 20 of the Careful Thinking podcast, I was joined by two distinguished care theorists, Andries Baart and Guus Timmerman, the co-authors of Relational Caring and Presence Theory in Healthcare and Social Work: A Care Ethical Perspective, which was published by Policy Press in December last year .
Andries is extraordinary professor in the field of ageing and generational dynamics at Northwest University in South Africa and an emeritus professor at a number of universities in the Netherlands. He has been a key figure in the development of care ethics in the Netherlands and in 2004 he founded Stichting Presentie, the Presence Foundation. Guus has worked as a care ethicist and qualitative researcher at the Presence Foundation since 2014 and has published widely on relational caring in healthcare and social work and on the methodology of qualitative research.
I continue to be impressed by the richness and dynamism of work on care theory coming out of the Netherlands, of which Andries’ and Guus’ work on relational care and caring presence is an important example. Like the work of other Dutch care theorists that I’ve interviewed for the podcast, such as Carlo Leget and Inge van Nistelrooij, Andries’ and Guus’ research is firmly rooted in care practice but at the same time informed by rigorous philosophical thinking. In a recent post I also noted that the work of many of the care theorists I'd interviewed had theological roots. So I was interested to see that Andries’ and Guus' work on presence theory grows out of research on pastoral care and that religious thinkers are cited a number of times in the book.
In a way, this episode circles back to the very first episode of Careful Thinking, which also featured two guests - my Open University colleagues Mary Larkin and Manik Deepak Gopinath – and also focused on relational care. In talking with Andries and Guus, I was keen to discover what is distinctive about their theory of presence and what it can add to our understanding of relational care.
Andries Baart and Guus Timmerman
I began our conversation by asking Andries and Guus to describe their personal and professional journeys to the work they are doing now. It was interesting to hear about the ways in which, for both of them, their ideas about care had developed through critical reflection on everyday care practice, whether their own or that of others they were observing. I then asked them about the influence of the late Frans Vosman, the dedicatee of their new book, on their thinking, and their answers confirmed his importance in the development of care ethics, particularly in the Netherlands.
Turning to the book, Andries explained the thinking behind it, while Guus outlined some of the key components of the theory of presence, and the ways in which it is illustrated in the book using case studies from care practice. Andries then related how presence theory arose from his research on outreach pastoral care in a socially disadvantaged neighbourhood in the 1990s. Following on from this, Guus acknowledged the original spiritual inspiration of the approach, but also defended its relevance to a wide range of both religious and secular contexts.
Having explored the grounding of presence theory in everyday care practice, we talked about some of the theories, and theorists, that have shaped it. Andries and Guus explained some of the similarities and differences between their approach and other models in care ethics, before responding to questions about the practicality of practising presence for hard-pressed care professionals. This led us into discussing the implications of presence theory for rethinking what we mean by professionalism in care practice, as well as the organisational and political implications of the theory. Finally, Andries and Guus talked about the work of the Presence Foundation and other ways in which they are taking this important work forward.
Like my conversation with Mia Sosa-Provencio in the previous episode, talking with Andries and Guus brought to mind my personal experience as a community educator in the 1980s. Working as a community education organiser on a socially disadvantaged housing estate on the outskirts of Oxford was probably the closest I came to the kind of neighbourhood outreach work with ‘no fixed goals...no fixed methods’ studied by Andries. I’m not sure I was exactly ‘practising presence’, as described by Andries and Guus, though much of my work involved forming relationships with groups of local people and doing my best to respond to their needs, whatever they were. However, as I suggested in my conversation with Andries and Guus, I wonder how many care professionals, most of whom have more or less fixed roles and responsibilities, have the freedom or the capacity to work in this way? In his response, Guus suggested that practising presence is perhaps an ideal to aim for, and that different professionals are able to achieve it to a greater or lesser degree, depending on their circumstances. And Andries’ and Guus’ work at the Presence Foundation suggests that many care practitioners, from a wide range of professional backgrounds, certainly aspire to work in this way, and that many succeed in doing so.
Photos from the 2024 ‘Presentiefestival’, celebrating the 20th anniversary of the Presence Foundation (via ‘Presentie Magazine’)
In the course of our conversation, I wondered aloud whether the kind of ‘exposure’ to others that presence theory requires, though an undeniably beautiful and inspiring ideal, is realistic for busy care professionals. How far should we take Gabriel Marcel’s notion of disponibilité, or availability? Can we ever give ourselves completely to those we care for, or do we always need to hold something back, both in the interests of our own self-care, and for the sake of our own loved ones, who also have a right to something of ourselves? Is complete ‘self-emptying’ really only achievable by those who, like the pastoral workers Andries studied, are celibate priests? I’m sure if we’d had more time on the podcast to explore these questions, Andries and Guus would have had more to say on this, but maybe these are impossible questions to answer, and arguably finding a balance between care for the self and care for the other is an unending struggle in care work.
I found Guus’ answer to my question about the relevance of presence theory to secular contexts interesting. He responded by describing the practice of presence as a kind of spiritual practice (something I explored in an earlier post), one that requires the caregiver to develop the virtues of recognition and attunement, but not one that is necessarily tied to a particular religious tradition. At the same time, he emphasised that the approach is underpinned by a very definite philosophy of the human person. In Guus’ words, ‘the practice of presence is connected to a certain perspective on human beings, a perspective in which every human being is a member of the one human family and therefore deserves relational and social inclusion. You could call that a religious perspective if you want.’
Here are some more quotes by Andries and Guus from the episode:
Guus:
So [Frans Vosman’s] engagement with the world, his openness to what presents itself, his sensitivity to injustice, his meticulousness in the use of words, his criticism of smuggling of morality into seemingly neutral descriptions, his plea to postpone moralising in the service of morality, they were all formative to my thinking about care and care ethics.
Andries:
For me the gap is between care and interventionism...And the gap is that in many cases people experience a kind of failure in care. So care is too...self-referential, busy with itself, it's too tightly bound to general rules, it is epistemically too arrogant. It has a logic that is difficult to connect with the lived life of vulnerable people…It is in a specific way poisoned with the neo-liberal ideals of self-reliance, social engineering, independence, being powerful, making your life a piece of art...You have to manage yourself as if you are an enterprise...And I think that what my theory of presence is offering is a response to that. It could be otherwise. It could be more human.
Andries:
I became a professor in 1991..and I immediately started to follow two chaplains, two pastoral workers in a disadvantaged neighbourhood. And they had the assignment to work on the basis of the Gospel. And then the only thing that was said to them was, support the people living there to live a dignified life...So there were no fixed goals, just a dignified life ...no fixed methods, no fixed target groups, no fixed streets, no fixed whatever. And they started by living with the people in order to find out what was in their life and what...deserves support. So they were forced...to work relationally in order to fill in the work. So I learned this from them....I saw them working in a relational way.
Guus:
You could say that the context of discovery of the presence approach as we describe it, is a religious context...But we found professionals practising presence in all domains of health care and social work. We work with professionals as a Presence Foundation to improve their practice of presence in all domains. And whether they are religious or secular, appointed by a local church or not, working in a religious context or not, our insights into what it means to practise presence are meaningful and useful to them. And we learn from them about how to practise presence in all kinds of different kind of contexts and situations and cases.
Guus:
What we see when we observe good professionals, professionals that are recognised as good professionals, we see that maybe the more the person in need of care has to come forward and show themselves to be cared for, the more the professional comes forward and shows themselves. But up to a certain point, if it's very difficult for the person in need of care to come forward and show themselves, then we see professionals not come forward and show themselves to make the space for the other to come forward. So it's a kind of balance of coming forward yourself and showing yourself, so that the other can show themselves and not seeing you as a professional, as an instrumental thing…It's a balancing, finding out what's helpful to the other to come forward.
Andries:
I believe with many, many others in our field of caring, that care by its nature is political...I would say if you start caring, then you make clear who is worthwhile, who counts...what social order we want, whose suffering is seen, what suffering is not seen, to what extent we want to look for one another...So I always think, even if I just take care of my children or foster children...it is a political deed by which I say, this is the kind of order I want to live in....But I would say, even the smallest act of caring is about that. And I would say...if you start caring in a relational way, as in presence theory, in whatever domain you do, then you will see a totally different emphasis. You are looking in a different way. Your perceiving is in a different way.
You can listen to the whole episode here, or wherever you get your podcasts.
You can download a transcript of the episode here:
The header image is the painting ‘Presence’ by Lyra Morgan. I’m grateful to the artist for permission to use the image. Interestingly, under the name Fi Burke, she has also created art in health and social care settings.
Dear Martin, congratulations on the 20th episode of your podcast! Thank you for inviting us to contribute to your series of interviews with so many socially engaged and thought-provoking scholars! I enjoyed it very much!