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Presence Approach

The theory of presence is developed as a theory of good care for people in extremely marginalised positions, who are considered to be socially redundant, but its basic notions are applicable to all care situations.
The theory has been developed on the basis of an extensive study among pastoral workers in deprived neighbourhoods (Baart, 2001). Baart discovered that the mere presence of these workers in these neighbourhoods already contributed to the well-being of people in a marginalized position. He has been analysing and describing what made the way of working valuable. He found: ‘the most important thing these pastoral ministers bring is the faithful offering of themselves: being there, making themselves available, coming along to visit and listen, drinking coffee together or sharing a meal, completing a small household project, running errands, accompanying another on a doctor visit, going for a walk together, visiting a grave site, sending a birthday card, playing together on the street, being there when a child takes its final swimming test’ (Baart, 2002, p. 1). A substantial emphasis was put on ‘the cultivation of caring relationships’, and not on problem solving. Nevertheless, the relationship proved to provide a fruitful embedding for actions which were conceived by the residents as supportive. The open un-predetermined approach of the pastoral workers, connecting in a natural way to the people they wanted to serve, were leading to an articulation of problems but also of satisfactions, needs and hopes. This logic of providing care is quite different from dominant practices, and can therefore be at daggers drawn with other care logics, for example those which are aimed at fast and efficient interventions. The studies on the presence approach and this study provide however the evidence that this care logic is effective in terms of personal recovery and social participation.
 
Catchwords in the presence approach are patience, unconditional attentiveness and receptivity. Patience is needed to create the space necessary for attaching to the ordinary patterns of daily life in the neighbourhood, adhering to local rhythms and social structures, but also for residents to attaching to the workers. Baart conceives care as an ‘attentive involvement on desires, accepted responsibility, proficient help and receptiveness for the reactions herewith’. The theory of presence is much more comprehensive than described here. It is a care ethical based theory of good care which considers care as concern, which consists of four roots: competent care (doing what should be done), carefulness (not only what is needed is done, but it is also done with attention, dedication and fitting the other), caring (as a characteristic of the care giver which guarantees that what should be done is not only done with attention but also is persevered; good care is faithful care), and compassion (an expression by which the care giver is presenting himself in relationship) (Baart, 2008, p. 52).
The theory is critical because it puts forward other values than the current care system, which is using a market based model aimed at organisational efficiency. The presence theory is advocating (re)humanisation of professional care, which evolves around the person, his dignity, his preciousness and his need for protection.
 
Other notions, appearing in the studies about the Theory of Presence, are being available and reachable for/to the other; being ‘interruptible’; and staying with the other; not abandoning him/her; offering continuity. Being available and reachable for/to the other requires has three dimensions. The first is a physical presence. Someone has to be reachable physically, to be available in person. The second is a psychological disposal. The professional has an open (mind) and a hospitable attitude. He is prepared to be receptive and to be(come) exposed to the presence and (full) representation of the other. Baart uses the notions of inscribility and exposure. The professional declares himself ‘inscribe-able’, meaning that if the person wants, the professional can be part of his life, being of meaning to him. But this is done in a respectful, prudent way. By the term ‘exposure’, Baart means that the professional exposes himself completely to the life world of the other. Exposure is opening up all your senses to a world which is strange to you. This enables the professional to get some insight in the ‘inner world’, the inside perspective. And this can generate both understanding and compassion. Baart considers this to be essential for engagement, really being present for the other. He is emphasising that exposure is a process which requires a great deal of detachment from personal and professional socialisations. [1]
The third dimension is of a social nature. Many respondents state that the presence of this professional in their lives has a social meaning to them. Through this relationship they become part of the world. Often they are considered as a pal or a companion. By this personal engagement, a lot of social support can be offered.
 
From the studies on presence it is shown that professionals play a connecting role between a person and his environment. Social networks are enforced, both qualitatively and quantitatively (Baart, 2001; 2007). The same is demonstrated by other studies about approaches in which establishing close relationships with others is a central asset (Driessens & Van Regenmortel, 2006; Vansevenant, Driessens & Van Regenmortel, 2008).
 
 
This text is taken from Wilken J.P. (2010). Recovering Care. A contribution to a theory and practice of good care. Amsterdam: SWP Publishers, p. 173-174.
 
 
last edited by Jean Pierre Wilken March 2013
 

 

 
[1] In the exposure notion of Baart (2001) he is speaking about four stages. In the first stage, the self has to be oppressed. A quick formation of opinions, or even emotional reactions should de adjourned. So should the inclination to react actively. In the second stage room should be created for the strange, or the other. Baart calls this ‘purification’. In the third stage the person becomes susceptible for the other. This frees the way for what Baart calls ‘a concrete involvement in which responsibility is taken for what is presented, and which is asking for compassion, effort, respect and care’ (p. 214). This is the fourth stage of exposure, which is the devotion towards the other, expressed in engagement, loyalty and support.