Is it a problem for the caring professions that responsibility is inseparable from knowledge?
It seems easy to understand that we could equally contribute to an outcome. We know that many people can be involved in a project and have equally vital contributions.
And yet… It seems difficult to maintain. The different allocation of responsibility to different jobs is very common. This is especially the case with the division between management and — what do we call them…’underlings’, ‘workers’, ‘plebs’? Management is presumed to be the decision makers, directing the less intelligent in how to apply their work well. This is the division into the controlling brain directing the brute body writ large — but that is the subject for another post. Curiously, this division only applies when things are going well. It is usually the underlings who are laid off first in a recession. This too had best be the subject of another post.
The problem as I see it is that responsibility is inseparable from knowledge. Managers are presumed to have an overview of the whole system and to be in touch with the wider situation as well. This is the reason for their privileged position.
This connection of knowledge and responsibility is particularly acute in the caring professions. Doctors, lawyers, counsellors, accountants and others are presumed to possess expertise. This brings with it a particular kind of responsibility, known in legal jargon as ‘duty of care’. It is presumed that the professions’ clientele are not competent to handle their affairs in this particular domain.
This is a very uncomfortable position for a professional to be in. Somebody else’s legal, financial or emotional life is a big responsibility. So, naturally, the professional tries to get out of it. How could they be responsible for somebody else? They cannot control the world, and so how could they be responsible for outcomes? This usually means that their responsibility is to follow established procedures — the rules and standards of professional practice.
What is the responsibility of the client in this situation? In some sense it is to do as they are told (intelligent mind and brute body again). This often amounts to answering questions asked and following instructions given. Think of your last visit to the doctor — who asked most of the questions?
There are (at least) a couple of problems with this profession/client scenario:
- the professional is not responsible for the outcome, and,
- the client is robbed of agency.
If the professional is not responsible for the outcome, how can they be held to account? Is the patient who endures a botched operation (when the doctor followed established procedures) to be left with sole responsibility for their situation? This seems problematic (at the least).
The client is left passive. They are unable to control or change their situation. (It is beyond their competence in this domain. The professional’s competence is guaranteed by their certification — yet another subject for another post.)
This passivity is especially a problem for counsellors. People usually come to counselling because they are in pain and want it to go away. Other than dispensing drugs, the counsellor cannot do something directly about this — which means that the client is the active agent. They are the one who knows most about their life, after all (aren’t they?). But then, does the counsellor have any responsibility at all? The professional’s responsibility is based on a claim to technical competence and a particular domain of knowledge. What happens when it is the client who has this special knowledge?
Outrageous though it may seem, I do think that sometimes someone else may know us better than we do. I have told people on occasion that I think they are having themselves on — that their behaviour does not match their beliefs or intentions. So, in some situations, I do think someone else can know us better than we know ourselves.
The counsellor’s special knowledge is what they have learned from hundreds of other clients with problems analogous to — though far from identical to — those of this particular client. Our thoughts and feelings and behaviour do have regularities and reasonably reliable relationships. This is the special knowledge of the counsellor.
If it is the job of the counsellor to assist their client to make changes in their life then some kind of education seems to be in order. (I don’t mean abstract and academic knowledge — although a client reading books about their issue or therapy may be an excellent thing in my view.) In this situation, it is the counsellor’s responsibility to give away some of their special knowledge. The caring professions seem to have a duty to work themselves out of a job. (I note in passing that very few professional associations have classes open to the general public to educate people in their domain.)
I think the counsellor and the client do share a common task, as well as responsibility. This is something like the following: being willing to share their thoughts and feelings (although not necessarily the biographical details that go with them) and to reflect on their behaviour. I also think there should be a mutual willingness to be questioned.
The time when this connection between knowledge and responsibility occurs most acutely in counselling I think is when the client asks the counsellor, “What should I do?”
Often the counsellor will refuse to answer. This can be a good idea. Especially in the early stages of a relationship, when people don’t know each other, it could be very silly to answer this question. Later in the relationship, I think it can be an evasion of responsibility by the counsellor. In one sense, the counsellor is being paid to answer this question.
I think this also means that expectations need to be clarified. I think a contractual approach, where the client says what they want and the counsellor states what they can provide, can be very beneficial.
I’d like to hear your thoughts on tasks and responsibilities. Have you found this easy with counsellors (or other professionals)? Have you found a way that responsibility fits easily into a happy and productive relationship? If you would like to share your experiences about this — good, bad or mixed — please tell me in the comments.
All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by Dr Greg Mulhauser, Managing Editor on .on and was last reviewed or updated by