The "responsible" client-facilitator relationship

Birenbaum (1981) suggests that the numerous problems in the health care system are symptoms of a broader issue--the deep tension and conflict in our society. While this may be true, the health care system cannot wait until society resolves these conflicts before striving for solutions to health care questions. The facilitator role for professionals with the active, responsible role for clients is one method of dealing with a current social and health problem. This relationship model adds a fourth model to the three identified by Szasz and Hollander. Philosophically it fits between the guidance-cooperation and the mutual participation models. There is an element of guidance, as facilitators enhance the adaptive abilities of clients. There is also an element of mutual participation, as both persons share in the discussion, each bringing their area of expertise--clients bringing knowledge themselves, and facilitators their knowledge about health. There are significant differences as well. Unlike the guidance-cooperation model the clients are not passive and cooperative, but challenge the suggestions of the facilitators. The health professionals do not tell or direct, but listen carefully to clients and give information as suggestions. Unlike the mutual participation model, facilitators assume responsibility actively to help clients develop to their maximum potential. There is collaboration, but the facilitator assumes the responsibility to foster the client's assumption of responsibility. The strength of resistance of clients and professionals to the roles of responsible clients and facilitators remains to be seen. It is apparent that the roles are already beginning to be used by Americans to meet health needs.