Background: Stable housing is important for overall health and well-being among young people, and poor-quality housing can trigger multiple diseases, including infections, injuries, chronic diseases, and psychological problems. However, many young people in Sweden struggle with an unstable housing situation. It is therefore important to illuminate how health, social, and civic society professionals and volunteers see the overall health situation for young people (16–27 years) in unstable housing situations.

Method: Sixteen health, social, and civic society professionals and volunteers, from both municipal and governmental organizations and civic society, were interviewed during 2024 and were reached through convenience and purposive sampling. The data was analyzed with content analysis.

Results: The results showed that the professionals and volunteers considered that there is a lack of basic necessities, such as food and clothes and often also a place to sleep, among young people in unstable housing situations. They also recounted that the bodies of those young people are weakened as a result of the unstable situation, with its stress and lack of proper care. There are, however, challenges with regard to accessing healthcare and the young people in question are often hesitant to seek care, and inclined to avoid it. Furthermore, the participants mentioned psychosocial challenges, due to loneliness and lack of close contacts with family and friends, and said that people struggling with homelessness tend to suffer from mental illness.

Conclusion: Young people in unstable housing situations need support to stabilize them for the future, and in order to work toward a more stable housing situation for these people in the county of Scania, a holistic approach is necessary. This is crucial in view of their overall health, as well as their well-being and life satisfaction.

This paper aims to show how a phenomenological theory of empathy can be used to achieve a close interpersonal relationship that serves to support shared decision making and recovery from mental health problems. This framework can also be seen as a way to maintain a professional distance in such relationships. This can be learned through training, and that can increase the possibility of developing a deeper interpersonal understanding that will be of value to recovery-oriented practice. A close relationship can be built and maintained with a clear point of departure in the client’s personal world with all its individual presuppositions and possibilities. This does not mean that professionals cannot or should not share their own experiences or express sympathy and compassion. On the contrary, it is important to build reciprocal relationships, a form of balance that can be seen as a “professional friendship”, or a relationship that is constituted by both closeness and distance at the same time (Berggren & Gunnarsson, 2010). This view of empathy should thus be seen as a tool to build relationships with a clear focus on the client’s needs, resources, and possibilities. This makes possible a choice to share those of one’s own emotions and thoughts that are connected to the other’s experience, which can thus enrich the experience and the meaning in that experience without stealing any focus from the other’s first-person experience or the professional relationship. Phenomenological empathy thus fulfills two functions within the framework of this paper: 1. Interpersonal understanding from a second-person perspective 2. A means to build a close relationship that at the same time preserves emotional distance. Against this background, phenomenological empathy can be seen as a tool that can be used to follow the other’s expression of meaning from his or her first-person perspective, while at the same time protecting the professional from emotional contagion or any confusion about the ownership of the experience. A phenomenologically grounded theory of empathy thus constitutes one way of working to build a professional relationship that is personal but not private – a relationship that takes its point of departure in the personal world of the other while maintaining a professional role. Within an empathic attitude we are able to follow expressions of meaning as they are presented by the other and thus appear to us in the empathic encounter – face to face. 

ConclusionFollow the other’s meaning expressions horizons for meaning. Through an empathic attitude, we can also follow the personal world that constitutes the context for meaning. Possibility for individualized methods for support that are grounded in interpersonal understanding with the point of departure where the client is. The empathic attitude can also serve as a means to bridge some of the risks that can come from working within close interpersonal relationships. 

De flesta skulle nog vara överens om att empati är en viktig egenskap för oss människor, kanske i synnerhet för oss som arbetar inom yrken där relationer och omsorg är viktigt; såsom socialarbetare och specialistsjuksköterskor i psykiatrisk vård. Däremot är vi inte alltid överens om vad empati egentligen är. I Psyche nr 1 2022 skrev jag och Andreas Glantz en artikel som delvis diskuterar empati utifrån ett fenomenologiskt perspektiv. Jag kommer nedan att ytterligare utveckla diskussionen och tydliggöra vikten av empatisk förmåga i alla interpersonella yrken men kanske särskilt i återhämtningsinriktat arbete.  Diskussionen om hur empati ska definieras företräds framför allt av det s.k mainstreamperspektivet; simulationsteori. Denna definition innebär att vi simulerar den andres tillstånd eller erfarenheter för att på så sätt nå förståelse. Vi försöker alltså föreställa oss hur det är att vara den andre och att gå i den andres skor. I litteraturen stöter vi ofta på begrepp som affektiv och kognitiv empati. Båda dessa förklaringsmodeller går ut på att känna vad den andre känner eller försöka föreställa sig hur det skulle vara att vara i den andres situation, detta är alltså exempel på simulationsteori. Ett problem med denna definition det inte är säkert att jag förstår den andre utan det som händer är att jag försöker förstå mig själv i en hypotetisk situation. Det blir särskilt problematiskt om vi ska försöka förstå någon som har väldigt annorlunda livserfarenheter än vad jag själv har. Hur skulle det till exempel vara möjligt att förstå någon med psykosupplevelser om jag själv aldrig upplevt en psykos? Simulationsteori kan säga utgöra ett förstapersonsperspektiv, alltså att jag först föreställer mig hur det skulle vara för mig att ha en psykos för att på så sätt närma mig förståelse av den andre. Kritik mot simulationsteorin har kanske främst lyfts från fenomenologiskt håll med början hos Edmund Husserl som allmänt ses som den moderna fenomenologins fader och inte minst genom Edith Steins avhandling On the problem of empathy från 1916. Mer nutida texter hittar vi bland annat hos Dan Zahavi, Shaun Gallagher och Magnus Englander. Fenomenologerna menar att det inte alls är nödvändigt att simulera för att förstå, eller till och med att det kan hindra förståelse eftersom fokus är mer på mig än på den andre. Utgångspunkten är att jag aldrig kan ha direkt tillträde till en annan människas medvetande men det är samtidigt inte dolt för mig. Ett fenomenologiskt perspektiv utgår snarare från en förståelse ur ett andrapersonsperspektiv där jag fokuserar på den andre och dennes erfarenhet oavsett mig själv och mina egna erfarenheter. Eftersom vi är sociala varelser är empatin redan där, poängen här är att stanna i en reflektion kring den förståelse som redan är där utifrån att vi möter en annan människa med erfarenheter, upplevelser, känslo- och meningsmässiga uttryck. Det är alltså en närvaro till ett annat subjekt som föregår eventuell simulering. För att kunna utföra en simulation måste jag först ha varit närvarande till något.  Vad är då poängen med att diskutera definitionen av empati? Jag menar att det blir viktigt i relation till yrkespraktik och dessutom direkt avgörande för återhämtningsinriktat arbete. 

Personal ombudsman (PO) in Sweden is a highly person-centered and recovery-oriented practice that strive to support persons living with serious mental health problems. With the foundation in Case Management (strength model in particular) the practice has since been developed and renamed; people living with mental health problems did not see themselves as “cases in need of being managed” (Berggren & Gunnarsson 2010). Personal ombudsman has, together with a few other practices from around the world, recently been highlighted by WHO as an example of good practice as a community- and rights-based approach to mental health (WHO 2021). This motivates the PO-practice to be discussed and shared with other professionals and interested parties as an example of a social pedagogical practice.What type of professional role is needed to be able to work as a PO? To answer this question, I will turn to the phenomenological interpretation of Empathy as a basic type of interpersonal understanding aimed at the experience of others. The main point is that regardless of our capacity to understand how it is to live with serious mental health problems such as schizophrenia we can understand something of how the person is experiencing this condition (Davidson 2003). As I have argued elsewhere (Stigmar 2022), the discussion is aimed to show how a phenomenologically grounded theory of empathy can be used as a means to achieve a close interpersonal relationship that supports shared decision making and recovery from mental health problems. This framework can also serve as a way to uphold and preserve a professional and emotional distance in that relationship. The aim of PO is to support the person with whatever the persons feel is needed and to strengthen the person’s own capacity to make decisions regarding his or her life. That is; a mobilizing empowerment perspective that takes a holistic point of view with a foundation in the recovery movement. The lived experience of others is of crucial value which makes the connection between recovery-oriented practice and phenomenology both necessary and valuable. By actively training to assume the empathic attitude, within a pedagogical context (Boregren 2022), we can increase the possibilities for a professional “we-relation” and minimize the risk for emotional contagion and too much emotional compassion. 

Carl Rogers (1902–1987) var en framstående amerikansk psykolog som anses vara en av förgrundsgestalterna inom den humanistiska psykologin och grundaren till det som kallas klient- eller personcentrerad psykoterapi. 2022 är det 120 år sedan Carl Rogers föddes. Därmed är det ett lämpligt tillfälle att påminna om hans betydelse för omvårdnad samt hur hans villkor för framgångsrik psykoterapi och hans teorier om självet även kan appliceras på den psykiatriska omvårdnaden. Vi har också försökt anta ett fenomenologiskt perspektiv där det finns beröringspunkter med Rogers teorier. Den fenomenologiska psykologin och den humanistiska utvecklades vid ungefär samma tid och det finns både likheter och skillnader dessa perspektiv emellan. En grundläggande och viktig punkt som gäller för båda är det personcentrerade förhållningssättet med utgångspunkt i den andres förstapersonsperspektiv. En annan är att människan är en intersubjektiv varelse som alltid befinner sig situerad i en värld som delas med andra.  

This paper aims to show how a phenomenological theory of empathy can be used to achieve a close interpersonal relationship that serves to support shared decision making and recovery from mental health problems. This framework can also be seen as a way to maintain a professional distance in such relationships. First, the paper briefly describes the basics of shared decision making and recovery-oriented practice. Second, the paper presents the notion of second-person perspectivity, the “we-relation”, and the phenomenological term epochéas a background to discussing the possibility of performing a specific kind of epoché, which actively brackets taken-for-granted presuppositions and notions and instead facilitates a focus on the meaning of the other’s experience: a special kind of intentionality directed toward the other’s intentionality. Third, the paper notes that the aim of actively assuming an empathic attitude paves the way for a passive ethnographic epoché that allows for an exploration of the other’s personal world, which constitutes the context for meaning. In this way, we can increase the possibilities of developing a professional “we-relation” and minimizing the risk of emotional contagion. This is a skill that can be learned through training, and that can increase the possibility of developing a deeper interpersonal understanding that will be of value to recovery-oriented practice. 

This is not a scientific inquiry as much as it is a glimpse into the life world of people meeting system errors and barriers that is transcending the system itself and forms a sort of relation with errors occurring in other systems. The data consists of reports of problems that individuals actually have experienced in their contact with Swedish support systems. The reports are written and documented by professionals working as personal ombudsmen (PO) in the south of Sweden. So, the problems described is experienced both from the person’s first-person perspective and from the PO’s second-person perspective. This is challenges that we, as people working with social pedagogy (in various forms), face in trying to support people that is dependent on systems that is meant to collaborate and together is supposed to form a holistic view on the person in need of support. The reports from reality states something entirely different; namely that people experience a lack of collaboration and a lack of holistic perspectives. The different systems are supposed to work together but instead it is the system fallacies and structural barriers that is working together and forms a transcendent and translucent gap or barrier that is seriously detrimental for individual and personal recovery processes and empowerment. The picture appearing is a lack of access to support, treatment, economic benefits and even basic human rights for people that does not know how to navigate and manipulate the social welfare system. This could be seen as a movement in society; from a welfare state to a more competitive state. This can be linked to the focus on standardization of support and care systems and to the introduction of New Public Management in psychiatric care and social services. This is not only affecting the person dependent on the systems but also professionals working to support people in their recovery process such as social pedagogues and social workers.  

The background for this paper is in part due to my own experience in participating in phenomenological empathy training, both IRL and in an online setting. I have consequently applied the skills sharpened in that training in professional social psychiatry, both IRL and in online meetings with clients.  This paper aims to show how a phenomenologically grounded theory of empathy can be used as a means to achieve a close interpersonal relationship that supports shared decision making and recovery from mental health problems. This framework can also serve as a way to uphold and preserve a professional and emotional distance in that relationship. First, the basics for shared decision making and recovery-oriented practice is briefly described. Second, the notion of second person perspectivity and the “we-relation”, together with the phenomenological term epoché, serves as a background for the possibility of performing a specific kind of epoché to actively bracket presuppositions and notions taken for granted to instead gain a focus on the meaning of the other’s experience and to show that this is a skill that is possible to train. That is: a special kind of intentionality directed toward the other´s intentionality. This training can take place both in an IRL face-to-face setting and in an online context. Third, the active aim to assume the empathic attitude gives the necessary focus and paves the way for the passive ethnographic epoché that allows for an exploration of the other’s personal world that constitutes the context for meaning. Together with the other and within a Schutzian “we-relation” and in a we-intentionality, it is then possible to explore the personal world of the other to gain a mutual understanding of the possibilities for an individual recovery process that also supports shared decision making, with a clear point of departure in the other’s first-person perspective. Due to the Covid pandemic a lot of the interpersonal relations in which the empathic attitude and ethnographic epoché plays a part has been taking place in an online context and that poses challenges and a change in how the interpersonal relationship is constituted, especially if it’s the first time meeting a certain person. However, by actively training to assume the empathic attitude, we can increase the possibilities for a professional “we-relation” and minimize the risk for emotional contagion and too much emotional compassion, even in an online context. Altogether this is a skill that can be trained, a skill that can increase the possibility of a closer and deeper interpersonal understanding in all interpersonal and professional relationships and thus be of value to all recovery-oriented practices. In this way, the notions of first person perspectivity, subjectivity and intersubjectivity can be restored to its rightful status in the field of social psychiatry.