The International Journal of Psychosocial Rehabilitation
Hegel’s Dialectic and Reflective Practice – A Short Essay

Ethan Grech
Psychiatric Nurse,
Cardiff,UK.


Citation:
Grech, E.  (2004)  
Hegel’s dialectic and reflective practice – a short essay.
 International Journal of Psychosocial Rehabilitation. 8, 71-73.


Abstract
Cotton describes current reflective practice in nursing as an essentially disempowering and devaluing experience. Gilbert draws on a Foucauldian framework to argue that reflective practice imposes a degree of surveillance on healthcare professionals and refers to Johns’ (1995) model of guided reflection as one of the postmodern ‘technologies of power’. This paper will attempt to provide a brief critique of Johns’ model from a broad Hegelian perspective.  Central to Johns’ idea of reflective practice is the goal of accessing, understanding and learning through lived experience. It is this that enables the practitioner to take “congruent action towards developing increased effectiveness within the context of what is understood as desirable practice.” Johns’ model offers, I believe, a robust guide for reflective practice. It enables the practitioner to analyse an experience by promoting the cognition of the contradictory parts that come together to make up that experience.

Introduction
For the postmodern philosophers Michel Foucault, Jean Baudrillard and Jean-François Lyotard, there is little relationship between thought and reality (Rees 1998, p.295-297). Each exists in separate compartments. The recurring danger in human history is that people should come to believe that their ideas can result in a better world (Lyotard 1989, p.8-9). However, within nursing, postmodernism has been celebrated as a liberating philosophy that enables the practitioner to take responsibility for his or her actions (Stevenson 2001).

The ‘hegemonic discourse’ of reflective practice in nursing has been challenged from a postmodern perspective by such writers as Cotton (2001) and Gilbert (2001). Calling for “new conceptualisations” of reflection and whilst citing little empirical evidence, Cotton describes current reflective practice in nursing as an essentially disempowering and devaluing experience. Gilbert draws on a Foucauldian framework to argue that reflective practice imposes a degree of surveillance on healthcare professionals and refers to Johns’ (1995) model of guided reflection as one of the postmodern ‘technologies of power’. This paper will attempt to provide a brief critique of Johns’ model from a broad Hegelian perspective.

The Hegelian dialectic and Johns’ model of reflection
G. W. F. Hegel (1770 – 1831) described how contradiction lies at the root of all change (Miller 1969, online). His theories have been developed and enriched to explain the course of social change throughout history (Marx and Engels 1967, p.79; Marx 1976, p.102-103). This dialectical approach suggests that change and movement are inevitable and inherent in all living things. Whilst a detailed discussion of Hegelian dialectics is beyond the scope of this paper, it should be noted that totality, change and mediation are underlying themes in Hegel’s writings. These themes can provide an antidote to the reductionism of the empirical method so common in contemporary nursing theory. Rees describes how “any two elements in contradiction cannot be dissolved into one another but only overcome by the creation of a synthesis that is not reducible to either of its constituent elements” (Rees 1998, p.7).

In contrast to empiricism, reflective practice suggests that when a structured and analytical methodology is used to reflect on experience, new knowledge and theory can be generated (White, 1997). In the empiricist system, the part is seen as a pre-exiting unit with little relationship to others. Parts may superficially affect each other but not change their fundamental nature. Reality is analysed using static concepts and individuals are held to be the building blocks of social theory. Thus, this methodology lends itself well to the neoliberal economics of present day health service reform. In a dialectical system, the relationship of the parts to each other and thus to the whole is fundamental (Rees 1998, p.5). Not only is the whole more than a sum of its parts, but the part becomes more than it is individually by being part of the whole.
 
Central to Johns’ idea of reflective practice is the goal of accessing, understanding and learning through lived experience. It is this that enables the practitioner to take “congruent action towards developing increased effectiveness within the context of what is understood as desirable practice.” Appendix A provides Johns’ framework for applying Carper’s four patterns of knowing. This enables the practitioner to interpret his or her experience within the empirical, ethical, personal and aesthetic spheres of knowledge (Carper 1978, cited in Johns 1995). Here, the empirical and aesthetic ways of knowing stand in contradistinction to each other. In Hegelian terminology, they form a unity of opposites. Both are discrete whilst simultaneously processing the ability to interpenetrate. The two patterns of knowing exist as parts of a totality, presented as they are as components of Johns’ model. Johns makes the important point that empirical knowledge is transcended by the process of assimilation into the practitioners personal knowledge and thus into practice.
 
When describing the relationship between the four ways of knowing, Johns states that the aesthetic emerges as the dominant sphere and is informed by the empirical, personal and ethical dimensions. In this way, the aesthetic mediates the other areas of knowledge. The result is a synthesis that enables the practitioner to respond to new situations with a changed perspective. The model facilitates the process of self-awareness, description, critical analysis, synthesis and evaluation identified by Atkins and Murphy (1993). Within Johns’ system, the contradictions between the practitioner’s actual and desirable practice are significant as they can provide a powerful motivational force for change. The practitioner may be in a state of “cognitive dissonance” (Festinger 1957, cited in Clark 1999) that can be overcome by the use of Johns’ model.

Criticisms of the model
Heath (1998) points to the complexity and diversity of practice in the real world. She suggests that practitioners need considerable expertise and reflective skill when using Johns’ model so as not to see the examination and categorization of their knowledge as a mere “academic exercise.” Echoing the postmodernists’ concerns, she refers to a degree of controversy surrounding the excessive use of structure in reflection. Similarly, Kitchen (1999) states that any model of reflection should not be over prescriptive. Johns’ model is described as useful in one-to-one supervised reflection but is considered somewhat restrictive, especially for experienced practitioners. In general, practitioners need to guard against the dangers of reducing experiences to a series of questions without any real reflection.

Conclusion
Johns’ model offers, I believe, a robust guide for reflective practice. It enables the practitioner to analyse an experience by promoting the cognition of the contradictory parts that come together to make up that experience. This method bares striking similarities to Hegel’s philosophical approach and is considered to be the very essence of the materialist dialectic (Lenin 1972, p.359). Over time, this process enables the practitioner to avoid the assumptions that might otherwise be made if based on a purely empirical understanding of reality. Given that a reductive process is needed to fit the practitioners experiences into one of Carper’s four categories, some of the criticism above is understandable. However, these concerns entirely miss the point. By treating knowledge as a rich totality, the use of Carper’s four patterns of knowing enables the full examination of practice, theory and assumptions and thus enables the individual to develop as a reflective practitioner.


References

Atkins S. and Murphy K. (1993) Reflection: a review of the literature. Journal of Advanced Nursing, 18(8); 1188-1192

 Clark A. (1999) Changing attitudes through persuasive communication. Nursing Standard, 13(30); 45-47

 Cotton A.H. Private thoughts in public spheres: issues in reflection and reflective practise in nursing. Journal of Advanced Nursing, 36(4); 512-510

 Gilbert T. (2001) Reflective practice and clinical supervision: meticulous rituals of the confessional. Journal of Advanced Nursing, 36(2); 199-205

 Heath H. (1998) Reflection and patterns of knowing in nursing. Journal of Advanced Nursing, 27; 1054-1059

 Johns C. (1995) Framing learning through reflection within Carper’s fundamental ways of knowing in nursing. Journal of Advanced Nursing, 22; 226-234

Kitchen S. (1999) An appraisal of models of reflection and clinical supervision. British Journal of Theatre Nursing, 9(7); 313-317

Lenin V.I. (1972) Collected Works. Vol. 38. Moscow: Progress Publishers

Lyotard J.F. (1989) Defining the Postmodern. In Appignanesi L. (ed) Postmodernism. London: Free Association Books, p.7-10

Marx K. (1976) Capital. A Critique of Political Economy. Volume 1. London: Penguin

Marx K. and Engels F. (1967) The Communist Manifesto. London: Penguin

Miller A.V. (1969) Hegel’s Science of Logic.Available online: http://www.marxists.org/reference/archive/hegel/index.htm (accessed 5 October 2003)

Rees J. (1998) The Algebra of Revolution: the Dialectic and the Classical Marxist Tradition. London: Routledge


Stevenson C. (2001) Paradigms lost, paradigms regained: defending nursing against a single reading of postmodernism. Nursing Philosophy, 2; 143-150

White S.J. (1997) Evidence-based practice and nursing: the new panacea? British Journal of Nursing, 6(3); 175-178



Appendix A  - Johns’ model of guided reflection (10th version): source Johns (1995).

Cue questions
 
Aesthetics                  What was I trying to achieve?
                                    Why did I respond as I did?
                                    What were the consequences of that for:
                                                the patient?
                                                others?
                                                myself?
                                    How was the person feeling? (or these persons?)
                                    How did I know this?
 
Personal                     How did I feel in this situation?
                                    What internal factors were influencing me?
 
Ethics                         How did my actions match with my beliefs?
                                    What factors made me act in incongruent ways?
 
Empirics                    What knowledge did or should have informed me?
 
Reflexivity                  How did this connect with previous experiences?
                                    Could I handle this better in similar situations?
                                    What would be the consequences of alternative action for:
                                                the patient?
                                                others?
                                                myself?
                                    How do I now feel about this situation?
                                    Can I support myself and others better as a consequence?
                                    Has this changed my ways of knowing?


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