5. Concluding reflections

The various case examples that were explored and discussed during the Intensive Programs in Dublin and Ghent illustrate that a reflexive professionalization is necessary to deal with the intricacies and challenges that participatory approaches in health and social care practice development, research, and education present. A reflexive professionalism embraces the notion that attempts to develop participatory health and social care can be met with resistance, non-participation, exit out of participation or unintentional exploitative or exclusionary consequences including tokenism. In that vein, our collective experiences and considerations led us to link reflexive with democratic approaches to knowledge creation and practice development. Taking democratic professionalism as a normative and guiding orientation to engage with the complexities of participatory ventures aligns with relational approaches to reflexivity that point to the various relationships between professionals, service users, organizations, policy makers and society at large that are at the center of health and social care practice (Dzur, 2008, 2019; Kessl, 2009; Vandertier, 2021). The democratic and reflexive quality of the participative process then lies in the fact that neither professionals ‘as experts’, nor administrators, managers or funders of services nor indeed service users have the monopoly on deciding what counts as good, participatory practice. Instead, the phenomena of contradictions, differences, conflicts, antagonism, non-participation, exit and resistance that inevitably arise in and from user participation are considered as always situated at the center of health and social care practice development. Only from this premise can they be made subject of a democratic dialogue in which the relationship between professionals and service users is shaped in ways that service users are recognized as citizens. In these interactions, the importance of democratic structures and practices can become a lived experience and thereby can trigger both in service users and professionals an engagement with governmental institutions and civil society movements, mediated by but not dependent on professionals (Dzur, 2008, 2019; Vandertier, 2021). We furthermore propose that educational and professional support programs embrace the potential that arises from a more direct involvement of service users in teaching and promoting reflexivity. This potential lies partly in the fact that learners are confronted with the specificity, but also the ‘non-categorizable’ intensity of service users’ lived realities in a relatively protective context in which reactions can be analyzed as to their hypothetical consequences without leading to immediate changes. Equally, such situations are learning experiences for service users as well as it can facilitate reflection on dimensions of their situation that had previously not been accessible to them. This means that both sides become engaged in processes of negotiation over divergent normative assumptions in which ‘the right course of action’ is neither a foregone conclusion on account of the weight of scientific knowledge, nor a matter of ‘pleasing the client’ by settling formally on a consensus. Instead, core principles of democracy are set in motion in such circumstances when conflicting perspectives, interests and normative assumptions surface and call for decisions arrive through a research-driven curiosity and reflexivity to critically interrogate the theories, values, problem constructions and power differentials that are implicit in our endeavors to develop participative approaches to health and social care (Singh & Cowden, 2009).