Practising Reflexivity in Health and Welfare: Making Knowledge

Practising Reflexivity in Health and Welfare: Making Knowledge

Practising Reflexivity in Health and Welfare: Making Knowledge

Practising Reflexivity in Health and Welfare: Making Knowledge

Synopsis

In recent years, professional practice in health and welfare has come under increasing scrutiny. The dominant response to this has been technical and procedural, as epitomized by the evidence based practice movement. This book offers an alternative, and equally rigorous approach to helping professionals to understand and analyze their practice. Drawing on a hitherto under-utilized literature about argument and persuasion, originating in qualitative research, ethnomethodology, conversation analysis and discursive psychology, the book provides a new perspective on the concept of professional reflexivity. It explores, not only how knowledge is used in professional practice, but how it is made and generated in everyday encounters. It should be a valuable resource for practitioners in health and welfare as well as students in social science disciplines.

Excerpt

This is a book about making knowledge. It examines how professionals in various health and welfare settings make sense of and process cases. in the contemporary policy climate, with its emphasis on performance indicators, clinical audit and evidence-based practice, practitioners across the range of health and welfare agencies have become accustomed to evaluating and justifying how they make use of knowledge. We shall argue that these methods of ensuring quality have their place, but that they leave the messy business of categorization or ‘diagnosis’ unexplored. This process of screening and assessment is simply taken as read, or is assumed to follow unproblematically from eligibility criteria, or from procedural or clinical guidelines.

Alongside these policy developments, however, practitioners and academics have sought to try to reflect on decision making in different ways. This has notably been through the development of ideas about reflective practice, or in social work, about anti-oppressive ways of working. Again, these have been important developments, but both have their problems. For example, practitioners may know they should be ‘reflective’ or ‘reflexive’ (our use of these words is explained in due course) in their decision making, but they often have few ideas about how they may accomplish this, or even what it means. Similarly, there is a tendency for anti-oppressive practice to become a rather empty exercise in which practitioners assert their knowledge about various forms of ‘oppression’ or ‘disadvantage’, or simply gloss people into categories as ‘oppressors’ and ‘oppressed’ without understanding or interrogating how ‘oppression’ is brought about by practitioners in their encounters.

We are arguing, then, for a refocusing of ideas about reflexive practice. Instead of providing introspective accounts of inner thoughts and feelings, or ‘structural’ analyses of oppression, we want to emphasize the active processes of meaning making. We are certainly not suggesting that the other domains do not matter, but they are not the business of this book. Here, we . . .

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