1. Reflection as transformation Collaboration and reflection across boundaries
Steen Wackerhausen
Dept. of Philosophy and the History of Ideas
Aarhus University, Denmark

2. Content Why inter-professional collaboration?
An ontological perspective
An epistemological perspective
Ethical requirements
Professional identity and boundaries
The anatomy of professional identity
Forms of identity possession
Ways of acquiring professional identity
Reflection and collaboration
1. order reflection
The “immune system” – or the empire strikes back
2. order reflection
Inter-professional reflection
A plea for the future

3. Why inter-professional collaboration?
(a) Ontological perspectives
‘Ontology’ – the study of the basic structures and dynamics of existing phenomena
A solid ontological result:
Every existing phenomenon is the center of a highly complex and dynamic field: a causal field.
Nothing comes of nothing (and only “nothing” causes nothing).
Consequently, every phenomenon owes its existence to something else.
Metaphorical speaking: Every phenomenon is a child with many parents, grandparents, great-great parents, etc.

4. Why inter-professional collaboration?
(a) Ontological perspectives (cont.)
Example: A specific person’s back pain after a football match
What made this phenomenon come into existence?
X = f (a, b, c, d, e, ……)
For causes and explanations:
physiology
physics
psychology
cultural studies
rules of football
etc. X

5. Why inter-professional collaboration?
(a) Ontological perspectives (cont.)
What can make this phenomenon change or disappear?
(q, z, y, w, etc.) X = f (a, b, c, d, e, ……)
Passive
Active X
A phenomenon’s
causal field
.. and only “nothing” causes nothing

6. Why inter-professional collaboration?
(b) An epistemological perspective
The size and complexity of a causal field …
outside the epistemic reach of any given scientific discipline
“The truth, nothing but the truth”, but not the whole truth
epistemic humility – far more to be know
And ..
No profession knows all what are relevant to know
A professional humility is warranted

7. Why inter-professional collaboration?
(C) The ethical demand
The goal
Doing what is best for the patient
The means
Relevant knowledge, skills, and competence
The ontological condition
The complexity and size of a causal field are “infinite”
The epistemic limitations of any profession
No profession has all the knowledge and skills to do what is best for the patient. Collectively, the professions know and can do more.
The ethical demand
For the purpose of the patient’s well-being, inter-professional collaboration is a requirement.

8. Professional identity and boundaries
Inter-professional agreement (in a philosophical moment) ..
on the ontological conditions, the epistemic
limitations, and the ethical demands
but often no genuine collaboration!
Why?
Some of the reasons are to be found in the constitution and roles of the identity of professions (professional identity)

9. Professional identity and boundaries
Macro level of professional identity
not the professions decision alone
acknowledgement and negotiations
other factors: history, economy, political factors, prestige,
technology, scientific progress, etc.
Micro level of professional level
practitioners, communities of practice, etc.
to be “one of our kind”
formal qualifications
explicit knowledge, tacit knowledge, skills, etc.
But more is needed to be a fully acknowledge member
of a profession ..

10. Professional identity and boundaries
(a) The anatomy of a profession
A way of speaking (terms, concepts, etc.)
A way of questioning (relevance)
A way of understanding and explaining
A way of seeing
A way of doing
And acknowledgement of the professions..
symbolic capital, status, metaphors, narratives, conceptions of other professions, etc.
To become, to be, and to stay “one of our kind”
Habitual approach: perspectives and dispositions

11. Professional identity and boundaries
(b) Forms of identity possession
Explicit levels of possession
Embodied levels possession
Embodiment, habituation, and habits
Everyday habits and professional blindness
excursion: A cow named Maren
The habitual/the usual does not thematize itself

12. Professional identity and boundaries
Scholastic learning (secondary)
Informal and tacit learning in communities of practice (primary)
informal learning of:
a way of talking
a way of questioning
a way of explaining
etc.
(c) Ways of acquiring professional identity

13. Professional identity and boundaries
On the micro level of professional identity habitual ways of talking, questioning, explaining, doing, assuming, etc. often embody unwanted boundaries constraining genuinely inter-professional collaboration
On the macro level of professional identity we often witness embodied boundaries of and barriers to inter-professional collaboration too. Survival, symbolic capital, higher salary, etc. plays significant roles.
Often too many unexamined background (embodied) concepts and assumptions are serious obstacles to collaboration. Concepts and assumptions in disharmony with the ontological, epistemic, and ethical arguments for collaboration.
It seems reflection is needed …

14. Reflection and collaboration
Is reflection a solution? It depends!
Reflecting on (theme, topic, etc.)
Reflecting with (concepts, beliefs, etc.
Reflecting from (perspective, interest, etc.)
Reflecting in (context, surroundings, etc.)

15. Reflection and collaboration
1. Order reflection
Reflection as usual: habitual reflection?
1. order reflection
Effective? Maybe! Transformative? Probably not!
Many topics, concepts, perspectives,
contexts, etc.
Background concepts and dogmas of a profession
are often undisturbed

16. 2. order reflection “Becoming a stranger to oneself”
Making the invisible visible
Reflection on our habitual way of reflecting
Reflecting on our 1. order reflections
on something (what and why we thematize)
with something (basic concepts, beliefs, etc.)
from a perspective (tacit interests, values, etc.)
in a context (the motivating/constraining surroundings)
Destabilizing the stabilized
Enough?

17. “The immune system” - The Empire strikes back!
“One of our kind” – rules of conduct and
membership
Attacking the destabilizer
Ignoring
Re-education (rehabilitation)
Marginalization
Isolation or exclusion
Courage and the willingness to be proven wrong
Minimizing “the immune system”
Changing conditions, diversity, and fit

18. Inter-professional reflection
A shared set of goals
Professional humility
Acknowledgment of the ontological, epistemic, and ethical conditions and requirements
Critical and constructive
Non-fundamentalist attitude
A way of being professional
Transformative
Surely, not all reflective activities (reflection) fulfill the normative characterizations.

19. A plea for the future
Reflection as a transformative and collaborative quest
The requirements
1. and 2. order reflection
A quest for what is right and what is true
A willingness to be proven wrong
An epistemic awareness
Intuition, habits and consensus are no guarantee
Humanism (renaissance)
Fighting self-deception
“Raw realism”
Human flourishing (is and ought)

20. A plea for the future Reflection in a humanistic perspective
Reflection as a human obligation
Reflection as a critical and constructive activity
Reflection as an unending journey
Reflection as a productive disharmony
Reflection as a way of being
That is, reflection as a transformative and collaborative quest