Reconciling Paternalism and Empowerment in Clinical Practice: An Intersubjective Perspective (Report‪)‬

American social work has characteristically embraced at least two differing streams of practice. One has emphasized a paternalistic approach akin to the medical model. In these approaches, a client's right to self-determination may be superseded by what the social worker determines is in the client's best interest (Reamer, 1983). Thus, in these approaches, the worker is in an overtly superior hierarchical role to the client or patient and is viewed as the expert. The second model has originated from the "empowerment" approach. In this model, social workers view clients as possessing inherent strengths, resources, and knowledge, which the social worker, by dint of her or his authorized role, may be in a position to help foster (Simon, 1994). In empowerment approaches, the client or patient is viewed as the expert. Although there is considerable overlap between these two divergent streams of social work practice, they do, nonetheless, represent two distinct helping paradigms. The focus of this article is based on the assumption that the dichotomy between these two streams of social work practice is artificial and that social workers should, therefore, consider how best to integrate these approaches to support client development. An intersubjective perspective is considered for the ways it provides a basis for better understanding the importance of integrating a focus on both client strengths and client vulnerabilities.