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Theories and Approaches

A Quick Guide For Social Work Students

THEORIES TO HELP US UNDERSTAND THE INDIVIDUAL OR SITUATION Attachment Psychodynamic Systems Humanistic Cognitive MaslowHierarchy Needs Erikssons 7 stages Social Learning Theory - Grief and Loss Diclemente cycle of change Social learning Communication i.e. Egan Personal, cultural, social -(Thompson) Structural understandings Multi disciplinary work Bronfenbrenners ecological PERSON CENTRED Confidentiality not secrecy Partnership working

THEORIES OF ASSESSMENT Models of assessment: Questioning, exchange, procedural

AD P AO P

Motivational interviewing technique Skilled helper (Egan) Psychoanalytical Risk assessments Therapeutic relationship Listening 4 tier system model Empathy Multi disciplinary working partnership INTERVENE Reflection Evaluation Person Centred Attachment Behavioural i.e. conditioning Crisis intervention Task Centred Psychodynamic Social Learning Cognitive Behavioural Counselling Group work Advocacy EVALUATE Evaluation takes place throughout the whole process Consider: Empowerment Advocacy User involvement Supervision and Development Working in partnership Reflective practice

THE PRACTICE PYRAMID

A model for integrating Social work values, Theory and practice

Maureen Ross, Aberdeen City Council

The Practice Pyramid is a model which helps to show how professional practice is built up. The top of the pyramid symbolises the worker which is all that is normally seen of professional practice. But why is that worker practising in that particular way? This is a question that students have to be able to answer about themselves in order that they can be assessed effectively. It is also a question practice teachers have to be able to answer for themselves in order that they can successfully guide students through the welter of theories and models of practice that exist. When looking at practice it is important to realise that values drive everything a professional worker does. Therefore, it is vital t make sure that the student learns how to operate from a professional value base and not from his/her own value base. The student should be able to show, at each level of this pyramid, that his/her practice is still congruent with professional social work values. The model can also be used to help the student reflect, at every level, on what values, theories and models of intervention underpin the conduct of others. Clients, their families and friends all have values and theories about why they behave the way they do and what should be done in certain circumstances. So do other professionals members of communities and the public at large. The student will need to be aware of this so that they can both understand the conduct of others while maintaining their own professional boundaries.

Pyramid
Level 1 Level 2 Level 3 Level 4 Level 5 Values Base Theories Specific Theories (Specialised Knowledge) Models and approaches Reflective practice

REFLECTIVE PRACTICE APPROACHES AND MODELS

SPECIFIC THEORIES

BASE THEORIES VALUES PERSONAL PROFESSIONAL

MODELS AND APPROACHES


Help in guiding interventions which will: Redress Alleviate Compensate

For pain and suffering caused when development and behaviour are considered to be outside accepted norms.

REFLECTIVE PRACTICE Guides awareness of: Practitioner strengths and weaknesses The values and theories informing the action of others The need to maintain an appropriate knowledge base The need to check that practice is in line with professional values

VALUES
PERSONAL Acquired from: Primary carers Community PROFESSIONAL Acquired from: Social work training Professional peers

Upheld by: Custom Belief systems Legislation

Upheld by: Codes of practice Codes of ethics Legislation

BASE THEORIES
Help us to: Describe Predict

Patterns of development and behaviour considered to be within the parameters of normality for human beings and Assess the need for intervention

SPECIFIC THEORIES
Help us to: Describe Explain

What has happened when development and behaviour are considered to be outwith accepted parameters of normality and Plan

For appropriate intervention

APPROACHES TO SOCIAL WORK


ADVOCACY AND EMPOWERMENT Links to Theory Advocacy is central to the tradition in British social work of focusing on the needs of the individual, particularly the individual on the margins of society. It is influenced by ideas of social and individual justice, and by humanism. Empowerment is related to radical and Marxist theories about social change, particularly with respect to class, and latterly to feminism and anti-racism. Although based to some extend on revolutionary ideas, empowerment assumes that it is possible to change society to help the service user, rather than seeking to bring about the overthrow of society in order to transform current, oppressive social relations. Its use in Social Work Advocacy has been central to the movement to give people who have been institutionalised (notably those in psychiatric hospitals and institutions for disable people and people with learning difficulties) rights within such systems, and rights to leave and become established in the community. It has moved from advocacy by committed professionals and organisations to self-advocacy, where groups of people seek to take control of the processes and resources which affect their lives. For example, there are groups of disabled people who are advocating their right to control their own lives by gaining equal access to resources, such as transport, housing and employment and by controlling their own forms of personal assistance. Rather than have services controlled by others, these groups argue that money for personal support and assistance should go directly to disabled individuals to use as they see fit. Advocacy is aimed at helping people to more from being passive consumers of carer (or caring) services to becoming active participants in their own lives. The extent to which social workers can act as independent advocates is limited by the fact that they are often state officials. Nevertheless, social workers can encourage people to find a voice and ensure that users have acc3ss to independent advocates where necessary. To practice empowerment, social workers must focus on power and the realities of powerlessness, including the power issues in their own relationships with service users. All the social workers efforts should be directed towards removing the obstacles which prevent the service user from taking control of their own life. The relationship has to become a peer one, and obstacles inherent in the relationship (for example, white social workers working with black people, men working with women, non-disabled people working with disabled) have to become a focus for transforming power relationships.

The social workers role is to work with the service user to overcome blocks to solving problems, whether located in the attitudes and beliefs of the serve user about their own powerlessness, or in societal institutions (education, social services, health, housing, employment, etc). Blocks which are located in the services users beliefs about themselves are seen as largely caused by oppression, rather than personality as such, and can be overcome by changing beliefs and encouraging and supporting the efforts of the service users. A crucial role for social workers in these approaches is the use of their knowledge of services, systems and law, and how they make this knowledge available to service users. Empowerment implies that those with knowledge pass on bother the knowledge itself and the means and skills needed to acquire the knowledge. Further reading
Adams,R.(1996) Social Work and Empowerment,2nd edn.Basingstoke,Macmillan. Jack,R.(ed)(1995) Empowerment in Community Care, London, Chapman and Hall Phillipson,C.(1993) Approaches to advocacy, in J.Johnson and R.Slater (eds) Aging and Later Life, London, Sage Ramcharan,R.Roberts,G.Grant,G. and Borland,J. (eds)(1997) Empowerment in Everyday Life, London, Jessica Kingsley Stevenson,O. and Parsloe,P. (1993) Community Care and Empowerment, York, Joseph Rowntree Foundation Craig,Y.J.(ed)(1998) Advocacy, Counselling and Mediation in Casework, London, Jessica Kinglsey.

Attachment Theory
Attachment theory is meant to describe and explain peoples enduring patterns of relationships from birth to death. This domain overlaps considerably with that of interpersonal theory. Because attachment is thought to have an evolutionary basis, attachment theory is also related to evolutionary psychology. Model of Self (Dependence) Positive Negative (Low) (High) Positive (Low) MODEL OF OTHER (Avoidance) Negative (High) Attachment Styles: An Evolving Taxonomy of Evolutionarily Adaptive And Maladaptive Affectional Bonds The above model (taken from Bartholomew, 1990) is one representation of attachment styles, or ways of dealing with attachment, separation, and loss in close personal relationships. Attachment was first studied in non-human animals, then in human infants, and later in human adults. Basic research on animal behaviour, if it is to apply to humans, must assume that there is homology between the animal and human processes. Homology means that anatomical or behavioural structures in different species share a common function and common underlying mechanisms due to the fact that the species evolved from a common ancestor. Ethological studies on imprinting might appear relevant to human attachment research, since imprinting appears to be a variety of parent-offspring attachment. But as one author says, The charming tales of geese and cranes that court their keepers (to whom they were imprinted as hatchlings) have beguiled us all (Klopfer, 1984,p.157). while imprinting may appear similar to human parent-offspring bonding, imprinting in geese, cranes, ducks, etc. probably does not meet the homology requirement, since birds and mammals both evolved from lizards, and present-day lizards show no evidence of parent-offspring bonding (Crnic, Reite, & Shucard, 1982). Secure Preoccupied

Dismissing

Fearful

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Research shows that attachment occurs in dogs and monkeys (Crnic et al., 1982; Gacsi, Topal, Miklosi, Doka, & Csanyi, 2001; Topal Miklosi, Csanyi, & Doka, 1998). A line of animal research that might be relevant to human attachment is Harlows experiments showing that infant monkeys prefer a soft terry cloth mother surrogate to a wire one, even when only the wire one dispenses milk. Also, severely derived infant monkeys often come to behave differently from their normally reared peers (Novak & Harlow, 1975). When human or non-human primate infant is separated from its parent, the infant goes though a series of three stages of emotional reactions. First is protest, in which the infant cries and refuses to be consoled by others. Second is despair, in which the infant is sad and passive. Third is detachment, in which the infant actively disregards and avoids the parent if the parent returns (Hazan & Shaver, 1987). The fundamental assumption in attachment research on human infants is that sensitive responding by the parent to the infants needs results in an infant who demonstrates secure attachment, while lack of such sensitive responding results in insecure attachment (Lamb, Thompson, Gardner, Charnov, & Estes, 1984). Theorists have postulated several varieties of insecure attachment. Ainsworth originally proposed two: avoidant, and resistant (also called ambivalent; Ainsworth, Blehar, Waters, & Wall, 1978). This triarchic taxonomy of secure, avoidant, and resistant attachment was developed as a way of classifying infant behaviour in the strange situation. Secure infants either seek proximity or contact or else greet the parent at a distance with a smile or wave. Avoidant infants avoid the parent. Resistant / ambivalent infants either passively or actively show hostility toward the parent. Attachment theory provides not only a framework for understanding emotional reactions in infants, but also a framework for understanding love, loneliness, and grief in adults. Attachment styles in adults are thought to stem directly from the working models (or mental models) of oneself and others that were developed during infancy and childhood. Ainsworths three-fold taxonomy of attachment styles has been translated into terms of adult romantic relationships as follows (Hazan & Shaver, 1987). Secure adults find it relatively easy to get close to others and are comfortable depending on others and having others depend on them. Secure adults dont often worry about being abandoned or about someone getting too close to them. Avoidant adults are somewhat uncomfortable being close to others; they find it difficult to trust others completely, difficult to allow themselves to depend on others. Avoidant adults are nervous when anyone gets too close, and often, lover partners want them to be more intimate than they feel comfortable being. Anxious / ambivalent adults find that others are reluctant to get as close as they would like. Anxious / ambivalent adults often worry that

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their partner doesnt really love them or wont want to stay with them. Anxious / ambivalent adults want to merge completely with another person, and this desire sometimes scares people away.

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Assessment
Assessment has always been at the centre of social work practice although there has been a lack of consensus about the true nature of assessment and what constitutes a good assessment. Historically, the process of assessment has not been well defined in social work literature and despite the common usage of the term there has been a lack of clarity about the true nature of assessment which, in turn, has led to an equal lack of clarity about the skills required. Due to this, many social work texts have concentrated on explaining methods of intervention rather than examining models of assessment. Approaches to assessment prior to the NHS and Community Care Act and associated guidance, often borrowed knowledge from psychiatry and psychology. This can be criticised for introducing a medical model into the process, and for individualising problems via the examination of internal factors. Sinclair et al (1995) stated that: However it is defined, assessment was commonly associated with identifying a problem, the purpose of which was to find an appropriate resource or solution. Conventionally however, assessment is the first key stage in a process that leads to intervention and improving the circumstances of an individual. The NHS and Community Care Act and associated guidance sets out that, where an assessment is required, it should: Be needs led not resource led Comprehensive Holistic Include user and carer participation The legislation defined assessment as a separate activity from intervention. However, effective social work intervention must be underpinned by accurate assessment which should aim to: Define and clarify the problem Understand the problems and their meaning and the importance to service users Identify the strengths of the service user and / or situation Form an opinion about the potential effects of intervening or not intervening Make decisions about possible statutory intervention Assessment is a dynamic process, and the quality and accuracy of its outcome are influenced by the manner in which it is carried out and the elements it contains.
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Assessment relies heavily on understanding, listening, observing and relating to what is said and to the feeling with which the information is given. Relationships are also key to an assessment, between the worker and the service user / carer and other professionals, the wider family and the community. The process of assessment (which may not be a linear progression) involves Initial referral / identification Preparation Collecting information Summarising and formulation Hypothesising Planning and setting objectives It utilises Factual detail Theory and knowledge Skills Professional judgement Attitudes and values Finally, the process should lead to intervention and evaluation Factual detail should be informed by Hard data such as income, diagnosis Opinion, such as is the income enough/ What is the impact of the illness? Selective enquiry (ensuring that all relevant information is explored). Theory and knowledge is essential for making sense of factual information Skills are wide ranging and include Interpersonal skills Observational Communication Negotiation Analytical Writing Professional judgement is imperative as the process is complex and involves human beings Attitudes and values, both of the worker and all others involved, cannot be excluded and must be recognised. There are various types of assessment, which include Assessments that enable social workers to respond appropriately to referrals, and to plan their work with service users Self assessment, in which social workers assist service users to explore and analyse their own problems

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Assessments for a third party that form the basis of joint professional decision making outside the court system Assessments undertaken on behalf of the judicial / legal system The Department of Health Managers Guide to Care Management and Assessment (1991), identified the possibility of 6 levels of assessment although, in practice, most local authorities have established three (occasionally four), which are Screening (Routine or simple) assessment Complex assessment The Department of Health Guide to Assessment Systems and Community Care (1991), identifies the key elements of the assessment process as Wide ranging publicity Needs led Taking account of the wishes of service users / carers Collaboration Cost effectiveness Outcomes related to stated objectives Social work assessments have a variety of characteristics in that they involve An interactive process (not a one-off, on way process) Initiating relationships (involving respect, openness, honesty, challenge, persistence and caring) ` Shared activity (establishing and clarifying boundaries, focus on ethical issues and values an investigatory process Clearly definable skills Interviewing skills (sensitive, fact finding, facilitative, active listening, clarification, feedback, focusing, summarising) Observations skills (presentation of service user, home and neighbourhood, discrepancies / inconsistencies in work or action) Relationship skills (empathy / interest, encouragement, challenging without being persecuting) Skills in using assessment tools Analytical skills (prioritising information, discarding irrelevant material, hypothesising) Recoding skills (should be shared with the service user, have clarity of thinking / understanding / process / outcome) It is important to recognise that assessment is not just an event. It is a way of continuously collecting and synthesising available date. It is both a process and a product.

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Smale et al (1993), identified three distinct models of assessment, described as THE QUESTIONING MODEL THE EXCHANGE MODEL THE PROCEDURAL MODEL They cited the key difference between the models as being how poser is used, and its impact on the service user. Features of the Questioning Model are The professional is assumed to be the expert in identifying need Workers behaviour is dominated by asking questions, listening to and processing the answers There may be an assessment form to be filled in which guides the worker The questions reflect the workers agenda, not other peoples It assumes that questions can be answered in a straight forward manner or that the professional is able to accurately interpret what is said and not said Complexities of communication across cultural and other boundaries (eg ethnicity, gender, class, disability, sexuality) tend to be underestimated or even ignored. The questioning model may be sufficient to identify need, but not if the goals include increasing choice, maintaining independence and maximising potential. The questioning model is most likely to be used when risk factors provide the main emphasis of the assessment. The social worker holds the expertise and follows a format of questions, listening to and processing the answers. This process reflects the social workers agenda and corresponds to the assessment style noted by Sheldon (1995) in which the data are shaped to fit the social workers theories about the nature of people. These theories are most likely to be psychodynamic in nature. (See Milner and OByrne, 1998). Features of the PROCEDURAL MODEL o It assumes that the assessors judgements and actions are relatively independent of their agency o Behaviour is informed by professional knowledge o Many workers will operate within given agency guidelines and criteria for the allocation of scarce resources, and will be expected to gather specific information as a basis for judgement o The goal of the assessment is to gather information to see if the service user fits or meets certain criteria that will make them eligible for services o The criteria pre-define what sort of person should get what resources o The worker will complete the form with or without the service user

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o Questions are asked and what is or is not a relevant question will be determined by those setting the criteria for resource allocation The agenda is set not by the worker or the service user, but by those who develop the forms The process is service driven THE PROCEDURAL MODEL is most likely to be used when assessments are subject to resource constraints. The social worker fulfils agency function by gathering information to see whether the subject fits the criteria for services. Little judgement is required, and it is likely that checklists will be used. (See Milner and OByrne, 1998). Features of the EXCHANGE MODEL are o The professional concentrates on an exchange of information between themselves and the service user o The question and answer pattern will be avoided o The worker seeks to engage the service user o The behaviour of the professional is crucial in establishing the respect and trust of the others, and will vary over time o Definitions of the problems and their resolution are arrived at through the initiative of the service user o The professional follows of track the service user leading assumes that the professional knows where to go? o Communication has to be checked out carefully responding to the meaning that each person understands the language used o People are empowered by professionals who assume an l encompassing expert role o The model is supported by consumer studies o People are and always will be, expert on themselves THE EXCHANGE MODEL comes nearest to meeting the criteria for a true needs-led assessment. All people are viewed as expert on their own problems, with the emphasis on exchanging information. The social worker will follow or track what other people are saying, rather than interpreting what they think is meant, seek to identify internal resources and potential and consider how best to help service users mobilise their internal and external resources in order to reach goals defined by them and on their terms. (See Milner and OByrne, 1998). Assessment has also been defined in other ways For example Stevenson (1989) identified three types of assessment FUNCTIONAL SELECTIVE AFFIRMATIVE

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Features of FUNCTIONAL ASSESSMENT are That it moves away from personal judgements towards objective description of present capacity to perform physical, psychological and social tasks It takes as a central stance that a person can function as an ordinary person without extra help It identifies need without asking or understanding why this came about Its main areas of assessment concern activities of daily living, physical and mental health, social life and economic status It tends to involve tick boxes and checklists Features of SELECTIVE ASSESSMENT are Services are provided on the basis of the principle of selectivity and not universality More complex assessments are required They are orientated to the requirements of the organisation from which the assessment originates Relationships are ones of unequal power The needs that are identified and assessed for fall within the area of activity of the organisation fro whom the assessment is being undertaken. Features of AFFIRMATIVE ASSESSMENTS are They focus on the perspective of the service user They identify past and current situations, strengths and difficulties and future potential, all from the point of view of the person being assessed They are developed from the professional knowledge, value base and experience of the practitioner rather than from the policies and constraints of the organisation Information is used to affirm a unique individual from which an individualised plan can be developed through a more equal relationship Needs are distinguished between objective requirements and subjective desires. Other models look more specifically at the assessment process TASK CENTRED practice features An intervention approach as well as an assessment model Identifies 8 problem areas of Interpersonal conflict Dissatisfaction with social relationships Problems with formal organisations Difficulties in role performance Problems in social transition Reactive emotional distress Inadequate resources Behavioural problems

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Identifies 5 phases Problem exploration in which service user views are elicited, clarified, defined in explicit behavioural terms and ranked in order of importance Agreement on the targets for change which are classified under the 8 problem areas Formulating objectives decided upon jointly Achieving the task with no prescription of method or technique Termination built in from the beginning Phillips, in Parton (1996), expresses concerns that formulaic and mechanistic assessment processes may lead to the development of an administrative model rather than a user centred model of assessment, and social work in general. Milner and OByrne (1998) warn that . Social psychology tells us that we are pretty ineffective at making accurate assessments in any social situation. And the human tendency to make attributions, develop stereotypes and increase risk-taking in groups is such a robust behaviour that exhortations to keep an open mind are quite worthless. They propose a way forward that would involve Social workers taking responsibility for their own judgements Being aware of the importance of the first assessment Continually checking hypotheses against outcomes in partnership with the person being assessed Checking case files for use of language that pathologies rather than individualises Report in a logical manner See Milner and OByrne (1998), Chapter 11, for an in-depth discussion of these issues IMPORTANT When reading these notes and doing further research, pay particular attention to issues of risk and the identification / understanding of need. Both are crucial to the assessment process and cannot be considered in isolation. USEFUL READING Specific Consideration of Assessment Issues Dairymple,J and Burke,B.(1995) Anti-Oppressive Practice Social Care and the Law. Buckingham. Open University Press pp 114-125 Milner,J and OByrne,P (1998) Assessment in Social Work Basingstoke Macmillan

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Orme,J (2001) Gender and Community Care Social Work and Social Carer Perspectives Basingstoke. Palgrave pp131-143. Sheppard,M (1995) Care Management and the New Social Work, London. Whitting and Birch Ltd pp11-16 Smale,G. Tuson,G. with Brhehal, N and March, P (1993) Empowerment, Assessment, Care Management and the Skilled Worker, London. National Institute of Social Work FOR VIEWS ON THE WIDER DEBATE Hugman,R.(1991) Power in Caring Professions Basingstoke. Macmillan Lewis,J.(1996) Implementing the New Community Care Open University Press Means,R. Smith.R. (1994) Community Care: Policy and Practice. Mcmillan Milner,J. OByrne,P.(1998) Assessment in Social Work. Mcmillan Payne,M.(1997) 2nd ed. Modern Social Work Theory. Macmillan Payne,M.(1995) Social Work and Community Care. Macmillan Phillips,J. Penhale,B. (1996) Reviewing Care Management of Older People and their Families. Jessica Kingsley Publishers Pilling,D.(1992) Approaches to Case Management for People with Disabilities. Jessica Kingsley Publishers Sherpherd,M. (1995) Care Management and the New Social Work: A critical analysis. Whiting and Birch Ltd.

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CONTEXT AND ASSESSMENT


Context is of critical important within the assessment process if we are to truly understand the relationship between outcomes and the events and stresses in peoples lives. Reder and Duncan identified this in their key issues for assessment. Context gives meaning to behaviour Individuals exist in relationship to each other Relationship and communication are a function of each other Current relationships arise out of historical influences Interactions revolve around the meaning of one person for another There is a circularity between a persons inner and outer world

Reder,P. Duncan,S. (1999) Lost Innocents. Routledge

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MOTIVATION
Attribution Theory and Achievement Another related theory to help us understand behaviour and motivation, like Johns procrastination, is attribution theory. In the 18th century, Hume (1739) argued that assuming there are causes for everything that happens is an inherent part of observing the world, because it makes the world more meaningful. Humans want to know. For instance, if someone bumps into you, you wonder why. You may assume he/she is aggressive, clumsy, flirting, that you are in the way etc. Obviously, what you assume is the cause of the bumping makes a big difference. Likewise, John might ask himself, Why do I put off studying? And answer, because I am dumb or because it is boring. He attributes his procrastination to his slowness or to the dullness of the reading. These kinks of assumptions about causes (we seldom know for sure the real causes) will certainly influence how we behave and how we feel. Heider (1958) was one of the first modern psychologists to write about how the ordinary person thinks about causality what causes what, or what is attributed to what. Since 1960, hundreds of studies have contributed to understanding why some are highly motivated to achieve and others are not. According to attribution theory (Weiner,1980) a high achiever will 1. Approach rather than avoid tasks related to succeeding because he/she believes success is due to high ability and effort which he/she is confident of. Failure though is caused by bad luck or a poor exam, i.e. not his/her fault. Thus failure doesnt hurt his/her self esteem but success builds pride and confidence. Persist when the work gets hard rather than giving up because failure is assumed to be caused by a lack of effort which he/she can change by trying harder. Select challenges of moderate difficulty (50% success rate) because the feedback from those tasks tells you more about how well you are doing, rather than very difficult or very easy tasks which tell you little about your ability or effectiveness. Work with a lot of energy because the results are believed to be determined by how hard you try.

2.

3.

4.

The unmotivated person will: 1. Avoid success-related chores because he/she tends to (a) doubt his/her ability and/or (b) assume success is related to luck or to who you know or to other factors out of his/her control. Thus, even when successful, it isnt as rewarding to the unmotivated person because he/she doesnt feel responsible, it doesnt increase his/her pride and confidence.
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2. 3. 4.

Quit when having difficulty because he/she believes failure is caused by a lack of ability which he/she cant do anything about. Choose easy or very hard tasks to work on because the results will tell him/her very little about how poorly (presumably) he/she is doing. Work with little drive or enthusiasm because the outcome isnt though to be related to effort.

Obviously, our beliefs about what causes and influences our behaviour have a marked impact on our expectations and thus, our motivation. Therefore, one way to change our motivation is to change our beliefs our attributions. For example, we could teach (and prove to) unmotivated, underachieving, and depressed people that they can control life events by exerting more effort. There have been demonstrations that intentionally trying harder, say on every other day, actually results in more behavioural changes, but it is hard for some people to exert extra effort. The next section is a case in point. The Motivated Underachiever Harvey Mandel and Sander Marcus (1988, 1995) have an interesting view of the unmotivated student. They say an underachiever with an academic problem is not unmotivated, but in fact is highly motivated to do poorly and get mediocre grades! Why? Because they want to avoid success! Why and how would anyone choose to blow off school work which is clearly connected with what one does for a lifetime? Because they are afraid of achievement and want to avoid responsibility. The underachiever unconsciously utilizes excuses to explain why he/she is doing poorly and why it isnt his/her fault. They say, The exam didnt cover what the teacher said it would or everybody did bad or my parents had all kinds of things planned for me the night before the exam. The trouble is they believe they want to succeed and they believe their own excuses. The authors call this self-deception the crap gap. The underachievers also believe that the situation is beyond their control, that they are innocent victims of circumstances. They arent uncomfortable enough to fight their way out of the gloomy situation they are in. Since the underachiever is afraid of achieving, the usual efforts of parents and teachers e.g. offering rewards, threatening punishment, and being assigned a terrific teacher are ineffective because these methods dont deal with the self deception and the fears. These underachievers dont want to look honestly and carefully at themselves, their motives, their values, or their future. Why not? Because being successful and realizing that one has the ability to make As take out the garbage on time, change the oil, pay ones own expenses, choose a career, work full-time ext., means the person is ready and able to be on his/her own, to be responsible, to be independent, and to keep on taking care of him/herself for the rest of his/her life. On the other hand, being unable to manage your life (without it being your fault) keeps others from expecting you to be mature and capable. Growing up is

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scary and some, like Peter Pan, dont want to do (on a conscious and/or unconscious level). Since this kind of underachiever is not aware of this self-deception, it may be hard for him/her to help him/herself. So, lets see how, according to Mandel and Marcus (1988), a therapist would close the crap gap, the difference between what the student thinks he/she wants (good grades) and his/her actual behaviour (mostly avoidance of all responsible behaviour through the use of excuses). The critical first step is to simply ask the student how well he/she would like to do in school. Get them to state a specific goal e.g. a B average. Second the therapist, assuming the role of helper, would find out everything about course requirements and exactly how the student prepares to meet the requirements. Third, ask the student what is the problem in one of his/her courses (actually this usually solicits an excuse). Then get all the facts e.g. if he/she says, I study about an hour a day but it doesnt do me much good, the therapist will find out exactly how much and how effectively the student studied yesterday (maybe 10 minutes because TV was on). Fourth, make sure the student realizes the connection between studying and his/her grade two months later, What will happen if you continue to only study 10 minutes a day on math? Ill probably get another D. Fifth, the therapist asks the student for some solution for this particular problems or excuse. A detailed plan, including how to handle barriers, is worked out by the student e.g. Ill put in a full hour every night. Sixth, make sure the student knows exactly what he/she proposes to do before the next therapy session. This is done knowing that the student will probably not follow his/her plan he/she hasnt done what they intended to do before, so why now? The therapists goal, at this point is excuse-busting i.e. to merely reduce the crap gap by getting the students views of the situation (I will study one hour without TV) closer to his/her actual behaviour (10 minutes again), to recognise his/her use of excuses, and eventually, to see his/her role in causing the underachievement. Seventh, find out if the plan was actually followed. Usually, as expected by the therapist, the student avoids the plan or does poorly for some other reason. Almost always he/she gives the therapist another excuse e.g. I forgot my books, I studied the wrong stuff, or I tried to study for an hour but friends kept calling, because to stick with the old excuse (TV was on) is admitting that he/she really wants to do poorly (the student is strongly motivated to not recognise this fact). Eighth, excuse after excuse is eliminated by going though steps 3 to 7 with each excuse for not reaching goal. Gradually the student begins to see his/her self-conning use of excuses, that he/she is responsible for her/her behaviour (and the resulting grades), that he/she has some power to control his/her life. Lastly as the excuses are striped away and insight gained into procrastination and avoidance of responsibility, the student will want to openly discuss his/her fears, what does he/she really want in life, and how does he/she get there from here. Therapy now becomes a very different process, more nondirective, because the student is responsible, introspective, self-directed, fare more emotional and alive but ready to face life as an independent individual, even if scared.

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Hopefully some people will be able without therapy to see that they are lying to themselves by the use of excuses. Then by consciously taking control of their lives (stopping the self conning), they can help themselves. Others will not be able to see whey they are underachievers but they will realise they are not performing up to capacity; they should seek professional help. Besides the academic problem type (about 50% of all underachievers), Mandel and Marcus, especially in their 1995 book written for parents, describe several other kinds of underachievers, usually related to moderately serious psychopathology requiring professional treatment, such as Anxiety Disorder, Sociopath Disorder (lack of conscience, manipulative), Identity Disorder (confusion about life goals), and Defiant disorder. Other writers have described the academic indifference of some people as being due to cultural differences, e.g. if you assume that only white middle and upper class students care about getting good grades, and if you arent in the social economic group or hate that type of person, then it becomes difficult to take school seriously. Kohl (1995) writes about students who become offended or resentful and say, I wont learn from you. There may be many ways to be unmotivated. In any case, a wasted mind is a terrible loss to society, but it is even more serious for your own life when it is your mind that is wasted. Do something!!

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ATTRIBUTION THEORY
There is a theory about how people explain things. It is called Attribution Theory. The theory is really quite simple despite its rather strange sounding name. (When you see the term, attribution, you should think of the term, explanation, as a synonym.) The theory works like this. When we offer explanations about why things happened, we can give one of two types. One, we can make an external attribution. Two, we can make internal attribution. An external attribution (get ready for this) assigns causality to an outside agent or force. Or as kids would say, The devil made me do it. An external attribution claims that some outside thing motivated the event. By contrast, an internal attribution assigns causality to factors within the person. Or as the sinner would say, Im guilty, grant me forgiveness, An internal attribution claims that the person was directly responsible for the event. Here are some common examples. You are taking a class and you get test results back. You take a peek and see, ahhh, a 65%. You think about these disappointing results for a minute and realize what a lousy teacher youve got and how badly written the textbook is and how unfair the test was and you make a lot of external attributions. What caused the 65%? Events outside of you. External things. Now on the next test you take a peek and see, ahhh, a 95%. Well, what can I say? When youre hot, youre hot. If youve got it, flaunt it. Some people are born great. Wheres the causality? Inside of you, right? You assign causality to factors within the person and make internal attributions. Okay, this is real simple. When the world asks us, Why? we provide either an internal attribution or an external attribution. Pretty obvious, but what has this got to do influence? Consider this chain of events. 1. The world asks me, Why? 2. I provide an attribution 3. My future behaviour depends on the type of attribution ATTRIBUTION IN ACTION I want to share two illustrations from the classroom. Both examples are published research studies that were conducted with elementary school children in their classrooms with their teachers. Thus, these examples are not laboratory studies of influence, but rather are real-world events. This makes their outcomes useful and interesting for us. The first study concerns getting kids to clean up the classroom. The second involves improving math performance and self-esteem. Littering. A constant battle with younger children is to get them to clean up after themselves. Especially in the classroom where there are twenty or thirty kids, neatness really makes a difference. How can you get kids to be neater?
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Our first example made kids neater with Attribution Theory. They set the kids up such that the kids performed a desired behaviour, then were provoked to think about why they did that behaviour. And, of course, the situation was set up so that the children would make an internal attribution (I did it because Im that kind of kit.) Heres what happened First, the researchers established a baseline for littering. They visited the 5th grade class just before recess and handed out little candies wrapped in plastic. After the kids went to the playground, the researchers counted the number of candy wrappers that were on the floor or in the waste can. And there were many more wrappers on the floor than in the can, of course. Now the study. Its simplicity is going to surprise you. Over the next two weeks people visited the classroom. For example, the principal stopped in for a little chat and on her way out she said, My, this is a neat classroom. You must be very neat students who care about how their room looks. And one morning the class arrived to find a note on the blackboard from the custodian, which said, This is the neatest class in school. You must be very neat and clean students. Finally, the teacher would make similar kinds of comments throughout the two week training period (Neat room, neat kids). Thats all the researchers did. Then they came back for a second visit again just before recess. And again they handed out little wrapped candies. This time when they counted whether the wrappers went on the floor or in the waste can, they found a lot more wrappers where they belonged: In the garbage. There was a very large change in the littering and cleaning up behaviour of the kids. Lets review this simple study and make sure we understand what happened. First we use candy wrappers before and after as an objective measure of littering. Second we have a variety of sources observing the classroom and offering explanations (neat room, neat kids) Also realize the things that were not going on. None of the sources modelled the correct behaviour, so the kids were not copying a source with observational learning. None of the sources provided consequences of reinforcement, nor were rewards or punishments given for specific acts of behaviour. None of the sources provided arguments about why kids should be clean and not litter. All the sources did was provide attributions. (A little side note: the researchers also tried another treatment along with the attribution training. They called it the Persuasion Treatment. With a different classroom, all the various sources essentially gave the typical adult lectures about cleanliness and neatness. They said all the things good teachers say about littering. It had not effect on the candy wrapper test. Kids, huh? Back to the main point.) The analysis the researchers made is this. When the kids heard, neat room, neat kids, they had to think about what happened. In essence, they had to answer the question, Explain why the room is neat? And their answer was simple. The room is neat because we dont litter. Were the kind of people who pick up after ourselves.

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In other words the children made internal attributions. And if you believe that you are the kind of person who is neat and does not litter, what happens when you have a candy wrapper? Thats right; you throw it away in the waste can. Math Achievement and Self-Esteem. Our second study goes much deeper, I think, in illustrating the impact of attribution. Littering behaviour is an obvious thing. It is also a fairly simple behaviour that does not depend on a lot of other factors. So, it should be easier to change. But what about something like math achievement or enhancing a childs self-esteem? These things are complex. They are related to other factors ability, persistence, training with math and family, life experience. http://www.as.wvu.edu/~sbb/comm221/chapters/attrib.htm

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APPROACHES TO SOCIAL WORK


BEHAVIOUR MODELS Links to Theory These draw on the work of behaviour psychologists and apply ideas about learning theory and social learning theory to social work. They are based on separating observed behaviour from ideas about why the behaviour comes about, or its meaning to the individual. Put simply, people change their behaviour by learning new ways to behave. Techniques focus on how to teach new behaviour which is seen as more desirable. Its Use in Social Work Behavioural approaches have been very influential in residential social work, particularly with children and young people, and in work with people with learning disabilities. These range from the use of token economies, where desired behaviour is rewarded with money or goods or privileges, to the use of time out to reduce undesired behaviour, and some systems of punishment, particularly withdrawal of privileges. The approach has also been used in group work; the commitment to the group is used to reinforce efforts to change. This has been notable in work with substance abusers and latterly with those who have been convicted of child sexual abuse. Behavioural approaches are controversial because of concern about who defines what is desirable behaviour. At their best, when combined with a caring relationship between the worker and service users, they can help enormously in overcoming unwanted behaviour (for example, obsessional disorders, agoraphobia). At their works, they can lead to regimes which are controlling dictatorial and inhumane. Their use in social work is probably not that great at present, although work which aims at teaching social skills, and in preparing people who have been institutionalised to live in the community draws on learning theory and social leaning theory to a large extent, even if it doesnt use specific behavioural techniques of conditioning. Social skills training may be done with individuals or groups, and is widely used as part of rehabilitation programmes. For example, people recovering from an injury or illness which affects their behaviour, for example a stroke, or head injury, may need to learn how to overcome disinhibited behaviour, or to gain confidence in common social situations. Such skills training often uses insights from behaviourism to learn new ways of dealing with the world in changed circumstances. BIOGRAPHICAL WORK Links to Theory The biographical approach has its roots in sociology and social psychology, notably in symbolic interactionism. It is concerned with how the individual sees and interprets the world and defines reality for themselves. The belief is that we all have an interpretive self, which helps us to discover who we are, in other words, our identity. This enables us to construct a story or
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biography of ourselves, of how we come to be the person we are. This is a process of construction and reconstruction as life unfolds. In contrast to some classical Freudian ideas, which hold that identity is formed in early life and is relatively fixed, this approach emphasises the social processes which are involved in defining and redefining our selves. Its Use in Social Work A great deal of social work is about listening to people, often people who are under stress or who are in crisis, who are struggling to survive, or make sense of what has happened to them. This often involves telling the story of the events to someone who is willing to listen. Social workers are also involved in taking social histories for a variety of purposes, from reports for court, or to facilitate and adoption or foster placement. Those who work with older people, or people whose lives have been disrupted (for example, children in the care system), also work to help service users construct and reconstruct their life stories, often for therapeutic purposes. Working biographically is not just about the facts of someones history, but more about the exploration of meaning, and the discovery of identity. Many migrant groups who find themselves as minorities in a dominant culture often have to struggle to maintain or rediscover their identity. For example, older African-Caribbean people have worked with black social workers to tell their personal and collective stories of arrival and struggle, to create an identity which affirms their cultural origins, but in a new context. Social workers have also been influenced by anti-racist theory to see the important of helping young black people to understand and affirm their identity as black, and what this means to them. Work of this kind can help when events, often tragic, so radically transform a persons life that they have to re-evaluate the past and seek new meanings. For example, women who have discovered that their long-time male partners were sexually abusing their children may experience a crisis of identity, often cantered on their ideas of themselves as good mothers. Work may involve re-evaluation of past events, and time to explore their feelings of anger, helplessness and guilt. Further Reading Burgess,R.Jewitt,R.Sandham,J. and Hudson,B.L. (1980) @Working with sex offenders: a social skills training group. British Journal of Social Work, 10(2) 133-42 Herbert,M.(1987) Behavioural Treatment of Children with Problems: a Practice Manual, 2nd edn, London, Academic Press Jehu,D.(ed) (1972) Behaviour Modification in Social Work, Chichester, John Wiley Sheldon,B. (1982) Behavour Modification, London, Tavistock

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Bornat,J. (ed) (1994) Reminiscence Reviewed: perspective, evaluations, achievements, Buckingham, Open University Press Clifford,D. (1998) Social Assessment, Theory and practice: A critical autobiographical framework, Aldershot, Ashgate Hunt,L. Marshall,M. and Rowlings,C. (1997) Past Trauma in Late Life: European perspectives in therapeutic work with older people, London, Jessica KInglsey Martin,Ruth,R. (1995) Oral History in Social Work: research, assessment and intervention, London, Sage Publications Ryan,T. and Walker,R. (1993) Life Story Work. London, British Association for Adoption and Fostering Usher,J. (1993) Life Story Work: A therapeutic Tool for Social Work, Social Work Monographs, Norwich, University of East Anglia

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A STAGES OF CHANGE APPROACH TO HELPING PATIENTS CHANGE BEHAVIOUR


Gretchen L Zimmerman, Psy.D. Cynthia G Olsen M.D. and Michael F Bosworth D.O. Wright State University School of Medicine, Dayton, Ohio
Helping patients change behaviour is an important role for family physicians. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions. The concepts of patient non-compliance and motivation often focus on patient failure. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process. In this article, we review the Tran theoretical Model of Change, also known as the Stages of Change model, and discuss its application to the family practice setting. The Readiness to Change Ruler and the Agenda-Setting Chart are two simple tools that can be used in the office to promote discussion. (Am Fam Physician 2000; 61:1409-16).

One role of family physicians is to assist patients in understanding their health and to help them make the changes necessary for health improvement. Exercise programs, stress management techniques and dietary restrictions represent some common interventions that require patient motivation. A change in patient lifestyle is necessary for successful management of long term illness, and relapse can often be attributed to lapses in healthy behaviour by the patient. Patients easily understand lifestyle modification (i.e. I need to reduce the fat in my diet in order to control my weight.) but consistent, life long behaviour changes are difficult. Much has been written about success and failure rates in helping patients change, about barriers to change and about the role of physicians in improving patient outcomes. Recommendations for physicians helping patients to change have ranged from the just do it approach to suggesting extended office visits, often incorporating behaviour modification, recordkeeping suggestions and follow-up telephone calls. Repeatedly educating the patient is not always successful and can become frustrating for the physician and patient. Furthermore, promising patients and improved outcome does not guarantee their motivation for long-term change. Patients may view physicians who use a confrontational approach as being critical rather than supportive. Relapse during any treatment program is sometimes viewed as failure by the patient and the physician. A feeling of failure, especially when repeated, may cause patients to give up and avoid contact with their physician or avoid treatment altogether. After physicians invest time and energy in promoting change, patients who fail are often labelled noncompliant or unmotivated. Labelling a patient in this way places responsibility for failure on the patients character and ignores the complexity of the behaviour change process.

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Lessons Learned From Smoking and Alcohol Cessation Research into smoking cessation and alcohol abuse has advanced our understanding of the change process, giving us new directions for health promotion. Current views depict patients as being in a process of change; when physicians choose a mode of intervention, one size doesnt fit all. Two important developments include the Stages of Change model and motivational interviewing strategies. The developers of the Stages of Change model used factor and cluster analytic methods in retrospective, prospective and cross sectional studies of the ways people quit smoking. The model has been validated and applied to a variety of behaviours that include smoking cessations, exercise behaviour, contraceptive use and dietary behaviour. Simple and effective stage-based approaches derived from the Stages of Change model demonstrate widespread utility. In addition, brief counselling sessions (lasting 5 to 15 minutes) have been as effective as longer visits. Understanding Change Physicians should remember that behaviour change is rarely a discrete, single event. Physicians sometimes see patients who, after experiencing a medical crisis and being advised to change the contributing behaviour, readily comply. More often, physicians encounter patients who seem unable or unwilling to change. During the past decade, behaviour change has come to be understood as a process of identifiable stages through which patients pass. Physicians can enhance those stage by taking specific action. Understanding this process provides physicians with additional tools to assist patients, who are often as discouraged as their physicians with their lack of change. The Stages of Change model shows that for most persons, as change in behaviour occurs gradually, with the patient moving form being uninterested, unaware or unwilling to make a change (pre-contemplation), to considering a change (contemplation), to deciding and preparing to make a change. Genuine, determined action is then taken and over time, attempts to maintain the new behaviour occur. Relapses are almost inevitable and become part of the process of working toward life-long change. Behaviour change is rarely a discrete, single event; the patient moves gradually from being uninterested (pre-contemplation stage) to considering a change (contemplation stage) to deciding and preparing to make a change. Pre-contemplation Stage During the pre-contemplation stage, patients do not even consider changing. Smokers who are in denial may not see that the advice applies to them personally. Patients with high cholesterol levels may feel immune to the health problems that strike others. Obese patients may have tried unsuccessfully so may times to lose weight that they have simply given up.

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Contemplation Stage During the contemplation stage, patients are ambivalent about changing. Giving up an enjoyed behaviour causes them to feel a sense of loss despite the perceived gain. During this stage, patients assess barriers (e.g. time, expense, hassle, fear, I know I need to, doc, but ) as well as the benefits of change. Preparation Stage During the preparation stage, patients prepare to make a specific change. They may experiment with small changes as their determination to change increases. For example, sampling low-fat foods may be experimentation with or a move toward greater dietary modification. Switching to a different brand of cigarettes or decreasing their drinking signals that they have decided a change is needed. Action Stage The action stage is the one that most physicians are eager to see their patients reach. Many failed New Years resolutions provide evidence that if the prior stages have been glossed over, action itself is often not enough. Any action taken by patients should be praised because it demonstrates the desire for lifestyle change. Maintenance and Relapse Prevention Maintenance and relapse prevention involve incorporating the new behaviour over the long haul. Discouragement over occasional slips may halt the change process and result in the patient giving up. However, most patients find themselves recycling through the stages of change several times before the change becomes truly established. The Stages of Change model encompasses many concepts from previously developed models. The Health Belief model, the Locus of Control model and behavioural models fit together well within this framework. During the precontemplation stage, patients do not consider change. They may not believe that their behaviour is a problem or that it will negatively affect them (Health Belief Model) or they may be resigned to their unhealthy behaviour because of previous failed efforts and no longer believe that they have control (external Locus of Control). During the contemplation stage, patients struggle with ambivalence, weighing the pros and cons of their current behaviour and benefits of and barriers to change (Health Belief model). Cognitive behaviour models of change (eg focusing on coping skills or environmental manipulation) and 12 step programs fit well in the preparation, action and maintenance stages. Most people find themselves recycling through the stages of change several times (relapsing) before the change becomes truly established.

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TABLE 1 Stages of Change Model Stage in Tran theoretical model of change Pre-contemplation Incorporating other explanatory / treatment models Locus of Control Health Belief Model Motivational interviewing

Patient stage Not thinking about change May be resigned Feeling of not control Denial: does not believe it applies to self Believes consequences are not serious Weighing benefits and costs of behaviour, proposed change Experimenting with small changes Taking a definitive action to change Maintaining new behaviour over time Experiencing normal part of process of change Usually feels demoralized

Contemplation Preparation Action Maintenance Relapse

Health Belief Model Motivational interviewing Cognitive behavioural therapy Cognitive behavioural therapy 12 step program Cognitive behavioural therapy 12 step program Motivational interviewing 12 step program

Information from Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Am Psychol 1992;47:1102-4 and Miller WR, Rollnick S. Motivational interviewing; preparing people to change addictive behaviour. New York; Guilford, 1991:191-202

Interventions The Stages of Change model is useful for selecting appropriate interventions. By identifying a patients position in the change process, physicians can tailor the intervention, usually with skills they already possess. Thus the focus of the office visit is not to convince the patient to change behaviour but to help the patient move alone the stages of change. Using the framework of the Stages of change model, the goal for a single encounter is a shift from the grandiose (Get patient to change unhealthy behaviour) to the realistic (Identify the stage of change and engage patient in a process to move to the next stage). Starting with brief and simple advice makes sense because some patients will indeed change their behaviour at the directive of their physician. (this step also prevent pre-contemplators from rationalising that, My doctor never told

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me to quit). Rather than viewing this step as the intervention, physicians should view this as the opening assessment of where patients are in the behaviour change process. A patients response to this direct advice will provide helpful information o which physicians can base the next step in the physician-patient dialog. Rather than continue merely to educate and admonish, interventions based on the Stages of Change model can be appropriately tailored to each patient to enhance success. A physician, who provides concrete advice about smoking cessation when patient remarks that family members who smoke have not died from lung cancer, has not matched the intervention to the patients stage of change. A few minutes spent listening to the patient and then appropriately matching physician intervention to patient communication and outcome. Patients in the pre-contemplative stage appear to be argumentative, hopeless or in denial and the natural tendency is to try to convince them, which usually engenders resistance. Patients at the pre-contemplation and contemplation stages can be especially challenging for physicians. Motivational interviewing techniques have been found to be most effective. Miller and colleagues replicated studies with problem drinkers, demonstrating that an empathetic therapist style was predictive of decreased drinking while a confrontational style predicted increased drinking. Motivational interviewing incorporates empathy and reflective listening with key questions so that physicians are simultaneously patientcentred and directive. Controlled studies have shown motivational interviewing techniques to be at least as effective as cognitive-behavioural techniques and 12 step facilitation interventions, and they are easily adaptable for use by family physicians. TABLE 2 The Stages of change and Opportunities for Physician Intervention The rights holder did not grant rights to reproduce this item in electronic media, For the missing item, see the original print version of this publication

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FURTHER INFORMATION
Attachment Research Centre This website links to a number of papers on attachment theory. By Juan Carlow Garelli EXPERSIM Project Here you can read about imprinting, and design controlled experiments on the phenomenon. By Gary H McClelland Stonybrook Attachment Theory and Research Website This website contains much useful material. By Judith Crowell and Everett Bell Waters. Attachment theory: Reference Source Suggested Readings A list of suggested readings on this topic is also available. By G Scott Acton

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CRISIS INTERVENTION
Links to Theory Crisis intervention is based on ego psychology, which derives from Freud and those who build on his work. It developed around the observations of Caplan (1965) and others of how people coped with a crisis in their lives, particularly one which involved a mental health problem or bereavement. They observed that people dealt better with a crisis if they had successfully dealt with a previous crisis. Their work developed into an approach designed to prevent mental health problems by intervening in a timely way and by helping people to build supportive social networks. The connection with the ego is the belief that we strive to deal with threats to our ego and when in crisis we are highly motivated and more likely to accept help, or try new strategies to avoid disintegration. Its Use in Social Work In addition to informing work which aims to help people with mental health problems who live in the community build their social networks, crisis intervention in social work can be widely used in any situation in which a crisis is predictable. For example, it would be reasonable to assume that a child in care whose mother was pregnant might experience a crisis around the time of the expected birth. Intervention could focus on the childs previous experience of similar events (if there were any) and on planning how to support the child through the likely crisis. As well as being a helpful approach to preventive work, crisis intervention also applies to unpredictable life events, such as sudden death, rape, other forms of assault, burglary, etc. It provides a clear framework of ideas about how people typically react to such events, and intervention can be organised on the basis of this pattern of response. It has the advantage of being timelimited, and of preventing later, more damaging responses and need for help. It is based around stages (relieving immediate problems, making connections with past events, and helping to build supportive networks). The emphasis is on building on the persons resources while at the same time providing enough support to help them get through the initial trauma. References and further Reading Caplan,G. (1995) Principles of Preventive Psychiatry, London, Tavistock OHagan,K. (1986) Crisis Intervention in Social Services, Basingstoke, McMillan Murgatroyd,S. and Woolf,R. (1982) Coping with Crisis: Understanding and Helping People in Need, London, Harper and Row Thompson,N. (1991) Crisis Intervention Revisited: A guide to Modern Practice, Birmingham, PEPAR Publications

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COMMUNITY WORK AND COMMUNITY SOCIAL WORK


Links to Theory Community work is much more focused on theories about society (sociology) than it is about the behaviour and personality of individuals (psychology). Some forms of community work are influenced by radical and Marxist theories, while others draw on the functionalist school of sociology, which sees community work as a mechanism to help society achieve a relatively stable equilibrium by finding ways of including otherwise excluded groups. Its Uses in Social Work The Barclay Report (1982) stated that community work is generally accepted as embracing both direct work with community groups and work at the interorganisational and planning level. It is undertaken with communities, which may be large or small, and based on geography (a place, locality or neighbourhood), or community of interest (for example the gay community). Its basic concern is to enable its members collectively to overcome problems and improve their conditions of life while at the same time enhancing the sense of common feeling, solidarity and competence of the community. (Barclay Report, 1982) Community work had its heyday in the 1970s, but continues today, particularly in inner city areas. It is widely believed that involvement in community activity is, in itself, helpful to those who may otherwise be marginalised or stigmatised. It can focus on promoting the interests of a community (for example), by improving the way services such as social work and health departments work together in an area). There are different traditions in community work which affect its focus and style. In some, community workers seek to lead (directive), in others to facilitate / follow (non-directive). Similarly, the focus for initiative may be an issue (what to do with groups of bored you people on an estate). Or a general desire to create a sense of community in a place or with a group of people who may identify with each other. Community work is the domain of community workers rather than social workers. It has traditionally challenged the professional role of social workers and sought to work with people as citizens or members of communities rather than as service users. The Barclay Report introduced the notion of community social work. It recommended that social workers should develop a more community-oriented approach to social work, working with clients not just as individuals but as members of informal networks and communities. Decentralisation, it was argues, enabled social workers to get closer to local communities, to understand both their problems and strengths, and to work therefore in a more preventive and less reactive way.

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The introduction of new legislation in the early 1990s and the application of market principles to service provision has done much to undermine the spriit of community social work.

References and Further Reading Barclay Report (1982) Social Workers: Their Role and Tasks, London, Bedford Square Press. Clarke,S. (1996) Social Work as Community Development, Aldershot, Avebury Etzioni,A. (1995) the Spirit of Community: Rights, Responsibilities and the Communitarian Agenda, London, Harper Collins Hawtin,M. Highes,C. and Percy-Smith,J. (1994) Community Profiling: Auditing Social Needs, Buckingham, Open University Press. Hearn,B. and Thomson,B. (1987) Developing Community Social Work in Teams: A Manual for Practice, London, National Institute for Social Work Mayn,M. (1994) Communities and Caring, Basingstoke, McMillan Smale,G. Tuson,G. Cooper,M. Wardle,M. and Crosbie,D. (1988) Community Social Work: A Paradigm for Change, London, National Institute for Social Work

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THE THEORY OF EMPOWERMENT


Empowerment is related to radical and Marxist theories about social change, particularly with respect to class, and later to feminism and anti racism. To practice empowerment social workers / social care workers must focus on the realities of powerlessness, including the power issues in their relationships with service users. All of the social care workers efforts should be directed towards removing the obstacles which prevent the service users from taking control of their own lives. The emphasis is to work with the service user to over come blocks to solving problems. These blocks might be the attitudes and beliefs of the service user about their own powerlessness, which is largely seen to be caused by oppression rather than personality. The service user might feel powerlessness in relation to society and institutions such as education, social services, health, housing, employment etc. A crucial role for a social carer is to apply the theory of empowerment to their work. This can be achieved by using their knowledge of services, systems and law, and pass this knowledge on to the service users. Empowerment is not only about passing information on to service users, true empowerment would be to encourage the service user to gain the skills needed to acquire their own knowledge. Another way to help service users take control of their lives would be to encourage and support them in challenging their own belief systems about themselves. Empowerment The process by which individuals, groups and or communities become able to take control of their circumstances and achieve their own goals, thereby being able to work towards maximising the quality of their lives. (Robert Adams 1990: Self Help Social Work and Empowerment, British Association of Social work) Criticisms of Empowerment It could be argued that permanent power can never be given to another person, and the only way a person, can obtain power is to seize it for themselves. (Richard Web and David Tossell, 1991 p129: Social Issues for Carers, Edward Arnald) Another criticism could be that empowerment and advocacy theories concentrate on the development of the individuals and small groups, and yet does not seek to change oppressive social structures. It could be agued that by empowering individuals, this places the responsibility for social change on the service user. Following on from this, empowered service users may be taking up the power and resources from other individuals who are equally oppressed.

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In a social and political environment where resources are limited, empowerment may be setting one oppressed or deprived group against another, rather than uniting them. (Malcome Payne, 1991, p234: Modern Social Work theory, MacMillan) Christine Murphy 30.1.01

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RADICAL AND MARXIST


Links to Theory Radical social work enjoyed a brief but influential heyday in the 1970s (rather like radical community work). It was then based largely on Marxist theory about the nature of capitalist society, which was itself an influential theory in society. Social workers could be seen either as oppressors of the working class, or, as radical social workers argued, as agents of change. A more sophisticated argument held that they where both, i.e. that they represented an essential contradiction in capitalist society that required social workers to control the working class, but then unleashed the potential to radicalise social workers to become part of the process of the downfall of capitalism. Another strain of theory which influenced social work was the ideas of Ivan Illich et al. (1977) in his critique of the professions. He argued that professions, far from serving the interest of their clients as they claimed, were designed to serve the interests of their members. The tendency to professionalize social work was criticised as part of this process. Its Use In Social Work With the benefit of hindsight, the outline above may seem fanciful, but the ideas have influenced social work, augmented as they are now by feminist ideas and ideas drawn from anti-racism. Radical theories were a reaction against the tendency of social work to place its emphasis on the individual, rather than the social relationships which arose through the unequal and oppressive nature of societal structures. The link is thus made to connect the individual to the true origins of their personal problems, i.e. oppression (particularly racism, sexism and ageism). Radical approaches influence the type of practise which may be seen as antioppressive, where the emphasis, where the emphasis will be on working collectively, rather than with individuals, seeking to raise consciousness, taking action to defend oppressed individuals and groups, understanding social relations (for example, between men and women, black people and white people, older and younger people) and personal problems as arising out of oppression. Although the emphasis is currently not on class as such, poverty, unemployment, poor housing and unequal access to education, the law and health care are central to much social work practise. Radical social workers would seek ways to help individuals to take collective action to protect services, welfare and civil rights and to help people to understand the way in which such circumstances are sustained and can be fought against.

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REFERENCES AND FURTHER READING


Bailey, R. and Brake, M. (eds)(1975) Radical social work, London, Edward Arnold. Corrigan, P. and Leonard, P. (1978) Social Work Practise Under Capitalism: A Marxist Approach, London, Macmillan Dominelli L. (1988) Anti-racist Social Work, London, Macmillan Dominelli,L. and McLeod,E. (1989) Feminist Social Work, London, McMillan Hammer,J. and Statham,D. (1988) Feminist social work: Towards a womancentred Practise, London, Macmillan Illich,I. Zola,I.K.McKnightJ.C. and Shaiken,H. (1977) disabling Professions, London, Marion Boyars Langan,M. and Lee,P (1989) Radical Social Work Today, London, Unwin Hyman Reynolds,J. (1993) Feminist theory and strategy in social work in J. Walmsley,J.Reynolds,P.Shakespeare; and R.Woolfe (eds) Health Welfare and Practice: Reflecting on Roles and Relationships, London, Sage.

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SOCIAL LEARNING THEORY


(A Bandura) Overview The social learning theory of Bandura emphasizes the importance of observing and modelling the behaviours, attitudes, and emotional reactions of others. Bandura (1977) states: Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behaviour is learned observationally through modelling: fro observing others one forms an idea of how new behaviours are performed, and on later occasions this coded information serves as a guide for action. )p22) Social learning theory explains human behaviour in terms of continuous reciprocal interaction between cognitive, behavioural, and environmental influences. The component processes underlying observational learning are: (1) Attention, including modelled events (distinctiveness, affective valence, complexity, prevalence, functional value) and observer characteristics (sensory capacities, arousal level, perceptual set, past reinforcement), (2) Retention, including symbolic coding, cognitive organisation, symbolic rehearsal, motor rehearsal), (3) Motor Reproduction, including physical capabilities, self observation of reproduction, accuracy of feedback, and (4) Motivation, including external, vicarious and self reinforcement. Because it encompasses attention, memory and motivation, social learning theory spans both cognitive and behavioural frameworks. Banduras theory improves upon the strictly behavioural interpretation of modelling provided by Miller and Bollard (1941). Scope/Application Social learning theory has been applied extensively to the understanding of aggression (Bandura, 1973) and psychological disorders, particularly in the context of behaviour modification (Bandura, 1969). It is also the theoretical foundation for the techniques of behaviour modelling which is widely used in training programs. In recent years, Bandura has focused his work on the concept of self efficacy in a variety of contexts (eg Bandura, 1993). Example The most common (and pervasive) examples of social learning situations are television commercials. Commercials suggest that drinking a certain beverage or using a particular hair shampoo will make up popular and win the admiration of attractive people. Depending upon the component processes involved (such as attention or motivation), we may model the behaviour shown in the commercial and buy the product being advertised. Principles 1. The highest level of observational learning is achieved by first organising and rehearsing the modelled behaviour symbolically and then enacting is

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overtly. Coding modelled behaviour into works, labels or images results in better retention than simply observing. 2. Individuals are more likely to adopt a modelled behaviour if it results in outcomes they value. 3. Individuals are more likely to adopt a modelled behaviour if the model is similar to the observer and has admired status and the behaviour has functional value.

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SYSTEMS AND ECOLOGY


Links To Theory At first sight, systems theory is rather unpromising for social work, as it has arisen from biology, and was influential in the development of missile guidance. When applied to people, it sees human beings as systems in their own right, but also as sub systems of a larger system (or super-system) e.g. society. Various rules apply to the way systems are seen as working, perhaps the most important of which for social work is the concept of boundary, which is the point between systems and sub systems where energy is exchanged (mental and physical). Feedback loops enable a system to know the impact of its outputs, and entropy (loss of energy) results unless a system gets inputs from outside its own boundary. How a system maintains its equilibrium is crucial, as is the belief that any system is greater than the sum of its parts. Finally, the belief that any change in one part of a system inevitably results in changes in other parts is also a strong influence on the application of this theory to social work. This theory has influenced the way in which social workers understand families, particularly through family therapy. The family is seen as a system in its own right, interacting with society, but with a permeable boundary, requiring that is maintains its integrity and its equilibrium. The family comprises sub systems (individuals, sibling groups, parents, etc), each of which has its own integrity but interacts to create a system which is greater than the sum of its parts. Seen in this way, social work can help by intervening to adjust the way the system works if it gets out of equilibrium; for example, when a member becomes disturbed, or delinquent, or when the parental sub system is in crisis, thereby causing other sub systems (for example, the children) to come under pressure. The focus is thus on the interaction within the family system, and the boundary between the family and the outside world (for example, schools, the workplace etc). This general systems theory has been joined by ecological theory, which sees the world as a highly complex web of interacting systems which are mutually dependent (perhaps the food chain is the best known example of this). Applied to social work, human society is seen as a network, implying that intervention in one part can have drastic effects on others. The tendency to see such a network as a hierarchy (with the individual at the bottom and society at the top).has led to the idea that intervening to help an individual requires attention to a higher level. For example, to help a child who is truanting may require intervention at the level of the family and the school. Its Use in Social Work In addition to the influence of family systems ideas in family therapy on both the way in which social workers work with families, and how they understand family functioning, these theories have also been influential in work with

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people with mental health problems to build on their social networks. The work of Pincus and Minahan (1973) has influenced the way in which social workers focus on different systems (natural systems such as family and friends, formal systems such as local organisations, political parties, and societal systems such as hospitals and schools). Problems are encountered when service users cannot access such systems because of ignorance or their inaccessibility, or when the systems themselves create problems, or are in conflict. For example, if you ask a school why a child is not attending, you may get the answer that the family is to blame. If you ask the child, it may be the teacher, etc. Choosing the site of intervention depends on the analysis of the type of system problems. This approach allows for the possibility that social work itself can become the problems (perhaps through the creation of dependence). References and Further Reading Dimmock,B. and Dungworth,D.(1985) Beyoned the family:using network meetings with statutory childcare cases, Journal of Family Therapy 7: 45-68 Forder,A.(1976) Social work and systems theory, British Journal of Social Work, 6(1) 24-41 Germain,C. and Gitteram,A. (1980) The Life Model of Social Work Practice, New York, Columbia University Press Vickery,A. (1974) A systems approach to social work intervention: its uses for work with individuals and families British Journal of Social Work 4(4) 389-404

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TASK CENTRED WORK


Links To Theory Like crisis intervention, task centred work fits into a pattern of intervention which is predictable and planned. In a way, it is linked to psychodynamic theories in that it developed as a reaction against them, particularly the way they appeared to require lengthy relationships which could result in dependence. It focuses on problem solving, and the problem is accepted as it is, rather than analysed for its origins or causes. In this sense it is very pragmatic, a term which is often used by social workers to suggest that it is practical and focused on outcomes which are agreed and worked for. It is essentially service user directed; the skill of the worker lies in helping the service user to define the problem in a way that lends itself to tasks which can be accomplished. This approach often uses written agreements, sometimes referred to as contracts which specify what each party will do in such a way that tasks can be reviewed. Its Use in Social Work It is useful in those situations where service users are able to maintain a focus on a single problem, or at most a few problems, and are sufficiently rewarded by achieving a task, rather than in need of a supportive relationship with a social worker. It has been used successfully as part of plans to protect children by working with parents to define goals which reduce risk and abusive behaviour. It also lends itself to evaluation, which can be crucial when making decisions about high risk strategies. It can be a useful part of a programme to help people regain control of their finances. The skill in such approaches lies in being able to help service users define, or redefine, problems which make them amenable to measurable change. For example, the statement my kids dont respect me can be redefined as a problem, I cant get my kids to come in when its time for bed. This then lends itself to defining a goal (I want my kids to come in within ten minutes of me telling them four times out of five). This then moves on to identifying obstacles (my mother tells me to stop nagging the kids, theyre just having fun), and how such obstacles can be overcome. Plans for achieving the goals can be made and various aspects of accomplishing the goals can be rehearsed under the supervision of the social worker. These approaches may need to get the active involvement of others is they are to work, and part of the social workers role is to help this come about. Further Reading Doel,M. and Marsh,P. (1992) Task Centred Social Work, Aldershot, Ashgate Goldberg,E.M. Gibbons,J. and Sinclair,I. (1985) Problems, Tasks and Outcomes: An Evaluation of Task Centred Casework in three Settings, London, George Allen and Unwin.

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PSYCHODYNAMICS AND CASEWORK


Links to Theory This is one of the older traditions of social work, based on Freudian ideas. Underlying the various models using psychodynamic theory is the belief that behaviour is driven by the mind (not to be confused with the brain). Various theories of how the mind works have derived from Freuds theories, which were strongly associated with the biological nature of human beings, particularly the sexual drive. Later developments have become more focused on the social nature of human beings, but Freuds belief that the mind has a conscious and an unconscious part remains a powerful influence on western culture and belief. Psychodynamics has been hugely influential in the development of social work because Freud was a pioneer in an approach to complex human behaviour which sought to give rational explanations based on the human condition. This is often forgotten, particularly by the critics of Freud, who stress the controlling aspects of his approaches to analysis, and its sexism. The stock in trade question how do you feel? comes from the influence of Freud, who stressed the importance of the feelings of his patients, rather than treating them as if they were objects of treatment. Psychodynamic ideas have underpinned most developments in child care, including the move towards substitute families rather than institutional care, and the importance placed on stable, loving adults and concern about the emotional needs of children. Psychodynamics has been influential despite widespread criticism. For example, the nature of its view of women has contributed to alternative models of female psychology (any women have been leaders in psychodynamic theory and practice throughout this century). Its cultural limitations, particularly its development in middle class Europe, and the ludicrously expensive form which psychoanalysis has developed have led to other approaches which borrow many of the ideas, but use them in different ways, Its Use In Social Work Two clear systems in particular have emerged, the first associated with the development of psychiatric social work (one of the first areas in which qualifications were offered in social work) closely allied to medicine, particularly psychiatry. The second has been in child care work, particularly following Bowlbys work on maternal deprivation during and after the second world was, and in work with families in child and family guidance clinics. In additions, the tradition of casework had developed. This combines ideas about how pressures from the social world of the client (relationships, money, housing, employment, etc). and the internal world (of emotions) result in problems which require skilled diagnosis and treatment to overcome. The method allows time for the service user to express their feelings and frustrations, and uses the working relationship as a model to help correct problems which have emerged in the service users own relationships,

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primarily with their parents. The social worker helps the client to gain insight into the way such relationships affect current behaviour, at the same time offering support and help with day to day practical problems (like a caring parent). Although it is easy to criticise such approaches, which may seem out of date, or just impractical in the current world of social work, they are very influential in the stress they put on the quality of the relationship between social worker and service user. Although criticised for being time consuming and unfocussed, the tradition of casework requires that service users are given copious amounts of time and help to overcome problems which are viewed as complex and serious. Although case work has been criticised for keeping service users dependent, it cannot be accused of trivialising or neglecting their emotional needs. Further Reading Hollins,F. and Woods,M.E. (1981) Casework: A Psychosocial Therapy, New York, Random House. Jacobs,M. (1986) The Presenting Past: An Introduction to Psychodynamic Counselling, Milton Keynes, Open University Press Pearson,G. Treseder,J. and Yelloly,M.(eds) (1988) Social Work and the Legacy of Freud: Psychoanalysis and its Uses, Basingstoke, Macmillan.

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Major Theories
Some of the major theories which have been developed are described below. If you want to find out more about the different theories on child development, look at the Further reading list. Psychoanalytical theories Freud (1856-1939) Freuds research connected the early emotions of a child with possible problems in later life. He believed that it was essential for a well adjusted adulthood for children to go through different stages in their emotional relationship with their parents. Bowlby (1907-1990) Bowlby believed that babies suffer emotional damage if their link with their prime carer is broken. Although his work was helpful in informing us about the nature of relationships formed by babies and young children, it has also been wrongly used as an argument for keeping women at home with children, and not funding adequate childcare. Research in the US (eg Belsky) has since questioned Bowldys theory about emotional damage (see Singer, 1992). Winnicott (1896-1971) Winnicotts ideas provided reassurance to parents that with loving care babies would develop instinctively. His concept of the good enough parent helped allay anxiety generated my notions of perfect parenting. He argued that the world of the infant was about all an interpersonal one. Erikson (1902-1994) Erikson was interested in the influence of culture and society on child development. His book Childhood and society (1950) became a classic in its field. Behaviourist Theories Pavlov (1849-1936) Pavlov researched causes of behaviour and his most famous experiments (with dogs) demonstrated conditioned and unconditioned responses. His work greatly influenced later behaviourist theories. Skinner (1904-1990) Skinner explained human behaviour in terms of physiological responses to external stimuli. He also originated programmed instruction, a teaching technique whereby the child or student is presented with a series of ordered, discrete pieces of information (in whatever form) which she must understand before being presented with the next stage. Cognitive Theories

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Vygotsky (1896-1932) Vygoskys work has only recently stated to become well known in the West. He argued that children develop through social interaction and that the role of the adult is to support the child. He also stressed the importance of pretend play in encouraging childrens thinking. Vygoskys work has only recently stated to become well known in the West. He argued that children develop through social interaction and that the role of the adult is to support the child. He also stressed the importance of pretend play in encouraging childrens thinking. Piaget (1896-1980) Piagets work defined several stages of intellectual development, and has been very influential in the modern view of childrens thought processes. He stressed the importance of pre school experiences for intellectual development because he believed that hands on experience of physical objects is essential to later understanding of the symbolic worlds of reading, writing and mathematics. However, Piaget is now out of favour with many early years educators because people now think that children are much more able and socially developed than he believed. In addition his studies were not representative of a range of children (he only studied his own children). Bruner (1995- ) Like Piaget, Burner considered that children passed through various stages of intellectual development but, unlike Piaget, he argued that we do not discard the early ones as we develop but continue to use all stages as appropriate throughout life. He stressed the role of the adult in scaffolding childrens learning experiences in either play or non-play situations. His work has been highly influential in recent developments in the early childhood curriculum. OTHER WRITERS AND PRACTITIONERS Froebel (1782-1852) In 1837 Froebel set up a kindergarten (literally a childrens garden) which had a child centred curriculum, and emphasised the study of nature. Children were given progressively more complex toys, and encouraged to explore their world (with support from trained adults). Froebel influenced many to set up similar kindergartens.. Steiner (1861-1925) Writing in the late nineteenth century, Steiner wished to develop the whole child (spiritually, intellectually and physically), and considered the care environment and the relationship between teacher and child crucial in development. Montessori (1870-1952) In the early twentieth century, Montessori set up centres to educate young children (casa dei bambini childrens house) which were designed to allow children to choose materials to help them develop concepts, with minimal

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instruction from the directress. The Montessori method uses a variety of special equipment of increasing complexity to aid learning and understanding.

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Group Work

Theories

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APPROACHES TO SOCIAL WORK


GROUPWORK Links to theory Rather like counselling, groupwork theory focuses mainly on the nature of the relationships, and the context in which they happen (i.e. a group). There have been many attempts to try to classify models of groupwork. Broadly speaking the first is based on theories about empowerment, arguing that the experience in the group, and the learning which takes place, transfers to relationships which they have missed in the past, or which have not worked. The third sees groups as an opportunity for people to look at their social roles and to learn through challenge and counter challenge. The latter is based on humanistic psychology. Its use in Social Work Groupwork is commonly used with offenders, where it is used to examine offending behaviour and ways of establishing alternative life-styles. Groupwork is often used as an approach to working with substance abusers, fellow participants commonly know all the tactical moves involved in denial of their problem and how difficult it is to overcome addiction. Here the groupworkers role is facilitative. Indeed, in general groupwork requires expertise in group process rather than the subject matter of the group per se. Further reading Brown A (1992) Groupwork (3rd Edn), Aldershot, Ashgate Brown A & Clough R (1989) Groups & Groupings: life and work in day & residential centres, London, Tavistock/Routledge. Douglas, T (1991) Common Groupwork Problems, London, Routledge Mullender, A and Ward D (1991) Self-Directed Groupwork: Users take action for Empowerment, London, Whitting & Birch Preston-Shoot, M (1987) Effective Groupwork, Basingstoke, Macmillan in association with BASW

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Vernelle, B (1994) Understanding & Using groups, London, Whiting Birch

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TUCKMANS MODEL OF GROUP LIFE


Tuckman described a group of passing through 5 stages. Some groups will progress sequentially, whilst others may move backwards and forwards from one stage to another. The stages are identified as follows: FORMING The group will be dependent for an emerging structure on its leader, and it is likely that some anxiety will be present. The group will be establishing albeit unconsciously an initial code of conduct, testing out what behaviours are acceptable. Concerns at this stage might be how supportive will the group be? Will I be up to the mark? Uppermost in peoples minds is likely to be what will we be doing? And whets it going to be like? Group members will often seek out people they know (if any) and sit next to them. There is little open exchange between members at this stage, as levels of security are low. N.B Some group theorists have argued that, even if just one new member joins (and regardless of the group size), the group will revert, however briefly into a Forming situation, whilst it inducts and absorbs the new individual. STORMING The group atmosphere can change to one of conflict; there may be some disquiet with the leader (which can lead to open rebellion), polarisation of opinions, some tension between any sub-groups which may have formed by this stage and resistance to control. Tasks may have been identified and seen to be either difficult or impossible to achieve. Tasks may have been identified and seem to be either difficult of impossible to achieve. There may have been insufficient consultation with the group, with leadership being excessively and inappropriately directive. The mood of the group is is this for real? It cant be done and Im not doing this. Notice the I (rather than we) people can become polarised and lose some group identity. Communication may become negative and critical; members may get into soap boxes, justifying their position and not listening to anyone else. This stage is often a

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test for the leadership, if successfully negotiated; a more positive mood is likely to emerge with tasks appearing less daunting and more achievable. N.B A group that gives due care and attention to the Forming stage may avoid Storming altogether. Conversely mature and generally stable groups are not immune from Storming, especially if subjected to imposed or externally-driven change! NORMING At this stage group cohesion develops and norms begin to emerge, either automatically or with some conscious discussion and agreement. Norms can be defined as the different behaviours and processes acceptable to, and accepted by, the group. Previous resistance begins to fade and any conflicts are patched up. The group at this stage is stronger and more cohesive, and is able to offer mutual and/or collective support to members. There is an increased determination and confidence about task achievement and the tasks themselves are more clearly defined as the Group reaches consensus on its own internal processes. Views are exchanged more openly and there is a general atmosphere of co-operation and increasing well-being. PERFORMING Tasks are now well-defined; members knowledge, skills and competences are also clear and are at the disposal of the leadership and the group as a whole. Viable roles within the group have emerged, based both on functional and behavioural factors. Inter-personal issues have largely been resolved and individuals feel free to express differences of opinion. There is a lot of energy for problem-solving and sufficient maturity for compromises and accommodations when required. The group is no longer a group, but a team. MOURNING The final stage in group life, when its tasks have been completed. Members will reflect on the experience and the life; they will miss, some will find it difficult to let go and will arrange re-unions. Sometimes the group will form sub-groups which continue to meet for mutual friendship and support; often
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these will become new groups which continue to meet for mutual friendship and support, often these will become new groups of their own with a different dynamic and purpose from the parent group. As they are less task-based they will stay more informal, with less-rigid norms of their own, which will be more about behaviours than function. Eventually, members will accept the permanent demise of the old group and move on. N.B in practice, our groups/teams tend to be long-lasting as they are less tightly bound to specific tasks. Tasks and activities ma change over the years, but they do not as a rule define the group, the group will usually adapt to take on new responsibilities, without necessarily disbanding. However, if a member leaves, there may be a sense of a temporary loss.

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COUNSELLING

THEORIES

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STRATEGIES FOR HELPING Scally and Hopson Counselling] [1979: A Model of Helping and

Have distinguished between six types of helping strategy:


1.

GIVING ADVICE - offering somebody your opinion of what would be the best course of action, based on your view of their situation. GIVING INFORMATION - giving a person the information he/she needs in a particular situation (e.g. about legal rights, the whereabouts of particular agencies etc). Lacking information can make one powerless - providing it can be enormously helpful. DIRECT ACTION - doing something on behalf of somebody else; acting to provide for another's immediate needs e.g. providing a meal, lending money, stopping a fight, etc. "TEACHING" - helping someone to acquire knowledge and skills; passing on facts and skills with will improve somebody's situation. SYSTEMS CHANGE - working on influence and improve systems which are causing difficulty for people. Working on organisational development rather than with individuals. COUNSELLING - helping someone to explore a problem and alternative ways of dealing with it so that they can decide what to do about it, i.e. helping people to help themselves.

2.

3.

4.

5.

6.

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The following pages are adapted form P. Sanders First steps in Counselling Where do Ideas in Counselling come from? Look down the following words. These are all ones we may associate with counselling, listening to and helping people. Which ones are most likely to come to mind when you think about helping? *Empathy *Manipulative *Positive thinking *Genuine *Hidden meaning *Client centred *Unconscious *Making plans *Non-interpretative *Symbols *Non-judgemental *Getting it in perspective *Different people and problems need different sorts of help *Behaviour *Defences *Active Listening *Goals *Non-directive *Problem solving *Dreams *Logical thinking *Irrational beliefs *Step-by-step *Avoidance *Homework

All of these words can be traced to the five fundamental and very influential approaches to psychology. You may be familiar with many of the ideas, which are reflected in these approaches. We make certain assumptions about effective helping in our culture, which again are reflected in these approaches to human psychology. Each approach has its founders and many more recent approaches to helping have been directly or indirectly influenced by these schools of thought. The founders of the approaches didnt invent these ideas out of thin air. Each was influenced by the social, political and economic context in which they lived, and sometimes these were acknowledged, sometimes not. The real picture of where ideas come from is of course much more complicated!

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Defences, Dreams

Hidden meaning Manipulative Unconscious Symbols, Avoidance

Psychodynamic Approaches Several contemporary approaches can all be traced back to the original work of Sigmund Freud, (1856-1939) founder of Psychoanalysis

Active Listening

Non-directive Non-judgemental Empathy, Genuine Client-centred Non-interpretative

Humanistic Approaches Developed by a group of American psychologists in the 1950s. In counselling terms, the most influential was Carl Rogers, (1902-1987) founder of the Person Centred Approach

Behaviour

Homework Goals Step-by-step Making Plans

Behavioural Approaches Modern psychological approaches based on scientific learning theories of Russian psychologist I.P.Pavlov (1849-1946) and American psychologists J.B.Watson (18781958) and B.F.Skinner, founders of Behaviourism Cognitive Approaches Emphasising the central role of thoughts in mental processes, cognitive approaches were developed by Aaron Beck and Albert Ellis, founder of Rational Emotive Therapy

Irrational beliefs

Homework Positive thinking Making plans Logical thinking

Different people and

problems need different sorts of help Getting it in perspective Problem-solving

Integrative Approaches The quest to blend components of different theraputic approaches has enjoyed varying success since the mid 1970s, poularised by Gerard Egan, founder of Developmental Electism

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Psychoanalysis (Freud)

The nature of mental activity Freud believed mental activity existed in three domains: Unconscious or beyond our awareness and inaccessible. An individual cannot gain access to his/her conscious mind. Hidden and inaccessible though it is, unconscious mental activity motivates much of our daily actions. The unconscious makes itself known through symbols, for example in dreams, which our conscious mind needs help in interpreting. Only through the process of psychoanalysis can this be revealed. The mental processes in the unconscious domain are chaotic and bizarre, obeying no laws of logic. Pre-conscious activities are those which although unconscious can be drawn into awareness through memory. Anything out of our immediate awareness which can be recalled, such as telephone numbers, post codes, names etc are pre-conscious. Conscious mental activity, fairly obviously, is the domain of full awareness. All thoughts and feelings of which I am aware are conscious. The conscious domain is governed by logical processes obeying the laws of reason. Freud believed that everything we do and think has a goal. There is no such thing as an accident or chance event. This is where the phrase Freudian slips comes from indicating that our slips of the tongue are by no means accidental. Structure of personality Freud divided human personality into three distinct structures or ideas: Id This is part of the personality that we are born with. Freud described the id as a seething cauldron of instincts and desires which seek gratification at all costs. Id processes are unconscious, therefore chaotic and are ultimately pleasure and comfort seeking. The id has no values, morals or concept of right and wrong. Its workings are most clearly seen in the behaviour of a new born baby. Freud called the inborn energy of the id the life energy or libido and he believed that it was largely sexual in nature. Super-ego This is the conscience, the internalised parent part of the personality. Freud believed that the super-ego formed when the child identifies with the same-sex parent, changing You mustnt do this to I mustnt do this so internalising rules, morals, notions of right and wrong, sex roles etc. The development of the super-ego is basically a learning process. The strength of the super-ego is accounted for by the fact that it develops at a very early age (around five years old) when young children are very vulnerable and impressionable.

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Ego The ego develops through childhood, first as a mediator between the chaotic id and the outside world. The ego works out the consequences of behaviour aimed at satisfying the id and checks the id impulses based on reality. Later the ego has to appease the demands of the super-ego, so its task becomes a delicate balancing act. The ego is only fully developed at maturity. A properly adjusted adult is governed by the ego, balancing the I want now! demands of the id against the You mustnt do this! admonishments of the super-ego. The ego maintains control by using defence mechanisms which are unconscious. The help protect us from the demands of the id, often by simply avoiding the issue. Psychodynamic Approaches The modern generic name for approaches based on Freuds theory is psychodynamic. Nowadays, only the traditional psychoanalysts hold the more rigid ideas, such as the unknowable unconscious, strictly. Many psychodynamic therapists will, for example, incorporate in to their practice the instrumental use of, for example, empathy and positive regard for their clients. Humanistic Approaches (Maslow and Rogers) The views developed by several American psychologists in the 1950s constitute what has become known as humanistic psychology. Whilst there are some differences between their ideas, there is an overwhelming agreement about key themes. Rogers is best known for his theories as they relate to the practice of counselling and psychotherapy, but Maslows ideas are also important. Humanistic theories of personality maintain that humans are motivated by the uniquely human need to expand their frontiers and to realise as much of their potential as possible. These theories emphasise growth motives and so contrast with both psychoanalytical and behavioural approaches which highlight the reduction of biological needs. According to Maslow, the motive to develop ones basic potential can take precedence over other motives including, occasionally, those related to biological needs. Maslow called this striving to achieve personal potential self actualisation. He saw it as a pyramid of needs with the needs at each level having to be met before the next level can be approached meaningfully. We are always striving for self-improvement according to Maslow, and this goes beyond the simple meeting of our basic needs.

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4 3 2 1

Self Actualisation:the need to realise ones potential Self respect and esteem:the need for status and self-confidence Social Needs:the need for friendship and acceptance by peers Safety Needs:protection from danger and need for security Physiological Needs:need for survival, food, water, shelter

Carl Rogers work concerning the process of change in therapy and education is based on the following fundamental propositions: That the fundamental underpinning or core of human personality is constructive and forward moving. That human shave this instinctive movement towards achieving their full potential in a constructive way, which he calls being fully functioning. That this movement towards fulfilling ones potential (actualisation) includes the organisms capacity for self-healing (including psychological healing). That if the counsellor can provide the right conditions, then this selffulfilling, self-healing process can flourish. That the right conditions are primarily when there is a complete absence of threat to the individual. That the best vantage point from which to understand another persons behaviour is from their subjective viewpoint. That people respond better if they experience the helper as a genuine (real) person, rather than someone in the role of expert. It is easy to see why Carl Rogers called his approach Person-Centred, since the client is the centre of the helping process in the sense that helping is seen as activating the self-healing process located in the client themselves by providing basic or core helping conditions. It is a respectful, non-threatening method, letting the client direct the process themselves through the wisdom of their self-healing tendencies. In 1957 Rogers detailed the six conditions that are necessary for therapeutic change. These are: that the helper makes psychological contact with the person to be helped that the client is vulnerable or anxious that the helper is congruent or genuine that the helper experiences non-judgemental warmth or acceptance towards the client that the helper experiences empathy that the client receives the empathy, UPR and genuineness of the helper

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Behavioural Approaches (Skinner)

Academic psychology has made a patchy contribution to theories of helping and counselling. What often happens is that psychotherapists and counsellors call upon the findings of academic psychology to support their ideas, usually integrating several diverse findings to try to form a coherent therapeutic approach. This way of doing things is not limited to one of the counselling approaches they all do it to a greater or lesser extent. The behavioural approaches, more than any other theory, uses academic psychology as its starting point. Miuch of modern psychology owes a great deal, at least in part, to the work of early behaviourists. Behaviourism grew in the early 1900s to all but dominate American psychology in the middle of the century. J.B.Watson and B.F.Skinner working separately and on different learning processes founded the movement which Skinner hoped would set humans free from shackles of their existence by developing a technology of change and making it available to everyone science to set the common man free. Armed with and understanding of learning processes, humankind would take control of their destiny. The basic principles of behaviourism are: Apparently complex behavior is a collection of more simple elements which can be understood in terms of basic learning principles. Learning, or the acquisition of new responses, requires reward. Ignoring unwanted behaviours leads to their extinction or disappearance. (Punishment surpresses the expression of responses but doesnt eliminate them.) Human personality is acquired entirely through learning, i.e. human personality is a collection of favourite or most used responses based on those that have brought success in the past. Behaviour is a set of responses where internal stimuli such as hunger, thirst, etc., are paired with external stimuli such as the sight of food, drink, etc., in variously complex ways. Behaviour is therefore seen as being directed towards a specific goal Whatever has been learned can be unlearned and modified through the application of learning principles. These rather harsh and uncompromising views of the early behaviourists have been tempered in recent years by the incorporation of more human facctors such as thinking processes (e.g. positive thinking), attitudes and emotions, etc. The nature on the learning processes themselves has been broadened to include more soft processes such as learning by observation and learning without obvious psychological reinforcement (i.e. getting food or drink as a reward) Some of these basic principles were marshalled into theraputic methods by therapists such as Joseph Wolpe who refined a step-by-step method of overcoming irrational fears (phobias) by presenting people with more and more fear provoking stimuli whilst they were relaxed (called systematic
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desensetisation). Similar efforts led to systems of reward where tokens were given to (for example) patients in mental hospitals for good behaviour (perhaps related to their individual treatment plan) which they could exchange for privileges such as tobacco (called token economy systems). Behavioural approaches identify a clear goal which is achieved by repeated rewarded practice, often in small steps leading to the desired change. They are built on the odea that human difficulties and distress can be overcome by unlearning (or extinguishing) unproductive ways of thinking, feeling and behaving, then learning better, more fulfilling ways of behaving, thinking and feeling. Cognitive Approaches REBT (Ellis) The widespread emphasis on feelings in counselling was challenged by both Aaron T Beck and Albert Ellis in the 1060s and 70s. Ellis developed Rational Emotive Therapy, or RET, later changing the name of his therapeutic approach to Rational Emotive Behaviour therapy or REBT. These approaches are now known as cognitive behavioural approaches cognition is the psychological term for thinking. The literature suggests that Ellis and Beck (both originally trained in psychoanalysis) developed their ideas more or less in parallel but the following refers in more detail to Ellis because his ideas are easily put in everyday language. Ellis suggested that thoughts are important factors in determining feelings and that in fact it is our thoughts that are at the centre of human disturbance. In particular Ellis suggested that it is the beliefs we have about ourselves and the world that shape our emotional and behavioural reactions. This isnt so different from any other set of ideas about human functioning, since most approaches put beliefs about ourselves and the world pretty much at the heart of things. Ellis went on to suggest that there were two basic types of belief we could have, rational and irrational. In Ellis terms, rational beliefs were those which promoted personal fulfilment and irrational ones were self defeating or ideas that frustrated our natural efforts to lead personally fulfilling lives. He then went on roughly to list types of irrational beliefs. For example, he suggested that human beings have a tendency to: Make mountains out of molehills, or in Ellis terms, awfulize. This means, for example, taking an event or experience which may be mildly distressing and believing that it is a catastrophe or the end of the world. Personalising events in the world thinking that things are done specifically to get at us, e.g. believing that the traffic warden singled me out for a parking ticket, rather than thinking that she/he was just doing her/his job.

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Over generalise by, for example, thinking that something bad will always happen when it has just happened once or twice. Many readers will, recognise these as unhelpful ways of thinking, and may be able to identify such thought patterns in their own lives. Perhaps because such beliefs are widely held is one of the reasons behind the popularity of REBT and the other cognitive approaches. The question is, how can an awareness of these unhelpful beliefs be turned into an active helping method? Ellis maintained that because these thoughts or cognitions were essentially intellectual events, they should be tackled at that level. He proposed that the best way to defeat these ideas was for the helper to argue with the person being helped, or refute the irrational ideas until the person being helped sees the error of their ways. This may seem a little brusque for a helping method. According to Ellis, helping is not about pleasing the person being helped, or being nice to them. The best form of helping is to be brutally honest without any gentle let-downs, frills or apologies. To argue with the person you are trying to help so that they see how irrational their ideas are is the kindest thing to do. After successful Rational Emotive Behaviour Therapy, Ellis believes that the client will have a therapist in their head who can carry on the battle against irrational beliefs.

Integrative Approaches (Egan)

With several approaches to helping being developed in the 50s and 60s some helpers began asking the question Which, if any, has the correct theory and practice for helping people in distress With each approach making claims to be the right one, or the most effective, a vigorous debate developed amongst devotees of each approach. In the midst of the claims and counter claims the current trend towards integration was forged. The first edition of Gerard Egans popular book The Skilled Helper was published in 1975. He turned away from constructing grand theories of the person and concentrated on looking at the process of helping itself. He described what he thought were the key skills of helping someone with a problem by selecting what he believed to be the most effective elements of other approaches, thus he assembled a number of techniques to be practised in a series of stages, i.e. that you followed a set of steps in a particular order. Egan did not propose a personality theory, but suggested that human problems were acquired and perpetuated by a number of internal and external factors. The internal factors, he suggested, were deficits in skills (e.g. of problem-solving, having self-defeating attitudes, etc.) and the external factors were mainly destructive social or interpersonal systems (e.g. families, social
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conditions etc.). It made sense, then, to help people manage their problems in a skills-centred way. This idea that psychological helping (still regarded by some as the exclusive domain of medically qualified psychiatrists) could be reduced to a series of skills or techniques, was inspirational to some and contentious nonsense to others. On the one hand it continued the trend, started by Carl Rogers, to see helping as an activity that is not expert based. On the other hand, it offended some helpers who saw Egans approach as stripping away the human qualities of helping and replacing them with handy, de-humanised techniques. Helpers, then were to become skilled technicians in Egans model. Egan took his idea from behavioural psychology, where the whole process could be broken down into steps. This was the beginning of the equally contentious idea that psychological change (counselling and therapy) could be manualised. In other words the steps could be written down cook-book style in a manual and the technicianhelper would simply carry them out in the right order. Central to this approach is the ability to assess or diagnose what the problem is, in order to apply the right treatment. The contribution made by Egan and other integrative pioneers has forced helpers to think hard about what they are doing and why. Key questions are: Is it possible to know what the best bits of the various approaches are? Can they be put together to form a seamless and effective helping style. Is it necessary to have a theory of personality to help understand why a person is asking for help and to give some idea of what must be done in order to get some relief from their suffering? Why have the techniques been assembled in this particular way? (Is there a theory?) Is a sequence of techniques sufficient for anything other than the most basic levels of helping, or as Egan termed it later Problem management? (Egan, 1982.) For many people wishing to improve their basic helping skills, Egans approach has proved to be simple and useable. However, for many wishing to graduate to counselling proper it has proved to be insubstantial.

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How they work- in a nutshell

Behavioural Approaches

Cognitive Approaches

We were born as blank slates. Human personality, in fact everything we are, is learned.

We are happiest when the things we do help us achieve personally meaningful goals

Behaviour is the objectivity observable manifesation of our personality, although thoughts and feeling are important

We have a tendency to think in ways that prevent us from leading fulfilling lives. These ways of thinking are irrational.

Learning leads to only a relatively permanent change, so what can be learned can be unlearned.

These irrational beliefs cause unpleasant feelings about the things that happen to us in life because our feelings are controlled by our thoughts. We then adjust our behaviour to fit this pattern

We can unlearn behaviour, thoughts and feelings which cause us distress and replace them by learning good ways of thinking feeling and behaving.

We can unlearn these irrational ways of thinking and learn rational beliefs by arguing with us, putting forward logical reasons showing us how to change.

The therapist helps us identify our aims and goals then designs learning programmes that will achieve the desired goal if we follow them.

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How they work- in a nutshell

Psychodynamic Approaches

Humanistic Approaches

Inborn instincts are the foundations upon which childhood experiences build our personality

All human beings have an inbuilt capacity to grow and achieve their full potential

Our true motives are unconscious and hidden from us because the instincts and urges are taboo.

This is called actualisation

Our unconscious only lets itself be known to us indirectly through symbolic events like dreams or behaviour

If the actualising tendency can be harnessed, human beings can solve their own problems and deal with their own psychological hurts

Using their knowledge and skill, the therapist interprets our experiences and behaviour (e.g. dreams) to unveil our unconscious motives, giving us an opportunity to be free of these unconscious controls.

Actualisation will happen quite naturally if we have the right conditions for it

The therapist provides these conditions in which we can explore our own experiences. This will help sterngthen our self structure and our tendency towards actualisation

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How they work- in a nutshell


Integrative Approaches

People suffer from a wide range of psychological distress and disturbance caused by a lack of personal skills and being caught in destructive social systems

No one approach could possibly be flexible enough to be helpful to all, or even the majority of people.

The best idea is to take the most effective bits of a number of approaches so that the widest range of problems can be tackled.

The helper learns techniques from many approaches with a view to help people learn better problem-solving skills.

The helper might either apply skills and techniques in a set sequence or select from a range of skills according to the problem and the person.

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DEFINITIONS OF COUNSELLING AND COUNSELLING SKILLS Counselling is: 'People become engaged in counselling when a person, occupying regularly or temporarily the role of counsellor offers or agrees explicitly to offer time, attention and respect to another person or persons temporarily in the role of the client. The task of counselling is to give the client an opportunity to explore, discover and clarify ways of living more resourcefully and towards greater well being.' BAC

Counselling Skills are: 'What distinguishes counselling skills form these other two activities' [listening skills and counselling] are the intentions of the use, which is to enhance the performance of their functional role, as line manager, nurse, tutor, social worker, personnel officer, voluntary worker etc, the recipient will, in turn perceive them in that role.' BAC

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COUNSELLING SKILLS The basic skills of the Counsellor can enhance the work of a range of other 'helpers' who may have quite specific roles or tasks to accomplish, and neither the time, skills or mandate to offer counselling per se. Counselling Skills assist clients to give a broad account of their circumstances and history, which will usually allow helpers to make the best assessment, and often afford clients a measure of relief, simply from being able to 'get things off their chests'. Sometimes this is all they need in order to re-gain a sense of control and direction. Counselling skills include: (a) (b) (c) The ability to listen carefully to what is being expressed interested, sympathetic, concentrated listening. The ability to resist intruding with our own interpretations, our own attitudes, our own reminiscences immediately they occur to us. The ability to respond in ways, which encourage the fullest disclosure of the client's difficulties, that is by demonstrating verbally and non-verbally, our interest, our concern and our understanding of what is being expressed. To be reassuring. The ability to accept the client. This means being open to what the client presents without making judgements, assessments or evaluations of the client's personality or predicament. It requires that we avoid verbal or physical manifestations of disgust, contempt, boredom, outrage, amusement etc, at what the client presents. The ability to convey confidence and belief in the client's capacity ultimately to act for himself/herself. The ability to acknowledge the limitations of the help we are able to offer, to resist the temptation, or invitation, to take responsibility for the client, to take care of ourselves and make appropriate referrals for more specialist help.

(d)

(e) (f)

A SIMPLE GUIDE Don't feel you have to 'solve' the client's 'problem'. Put to one side your distilled wisdom, your own recollections and interpretations and simply LISTEN. Your job in this situation is to help the other person find some satisfactory resolution or way of coping. The 'answer' should come from

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RESEARCH INTO PRACTICE

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Berlins Social Work Theory Garners Prize


By William Harms Sharon Berlin, who has spent her career studying the effects of interventions on peoples lives has proposed a model of social work that addresses both problematic internal through processes and external hardships. Berlin, the Helen Ross Professor in the School of Social Service Administration is being recognised for her work this weekend with the 2002 Richard Lodge Prize from the Adelphi University School of Social Work. The prize honours people who have made significant contributions to social work theory. The prize recognises Berlins efforts to develop a theory for social work practice that builds on traditional cognitive therapy. Berlins model focuses on how individuals construct meaning in their lives, and how that meaning is confirmed or challenged by current life circumstances. She has written extensively, and she recently published Clinical Social Work Practice: A Cognitive-Integrative Perspectitive, based on her research and how her own experiences as a social work practitioner. In the book, Berlin explores the use of the cognitive-integrative perspective and how it builds on traditional cognitive therapy methods to respond to the complexities of life situations. The traditional therapy focuses on changing the way people think about their experiences. The idea is that over the course of repeated experiences, we all lay down memory records about who we are, what life is like, and how things tend to go for us in our relationship with others She said: These memory records give individuals set ways to understand and respond to lifes situations.

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What is Research? Research is quite simply about asking questions, gathering information and finding out answers. We all collect information on a daily basis in our work some of it we use and record, some of it we disregard, and probably never call it research. All the term research means is that information we collect and analysis is done so in a more systematic way. Anyone can do research within their own voluntary organisation, community project or group. Why is it Needed? To influence and challenge decision and policy makers To allow you to monitor and evaluate your project or group e.g. is it To check if polices are working in practice e.g. equal opportunities policies, user or client involvement, anti-discriminatory practice. To examine whether the services a project or group provides/meets the needs of the users and/or the community are they responding to local demands? To provide more comprehensive information and details e.g. for grant purposes, informing others of a projects work For planning purposes and targeting resources more effectively To support a campaign for better services and/or a new service Research creates knowledge. Knowledge is power.

How Do You Do It? The method of research you choose will depend on, for-example, what subject or issue you need to research, the type of volountary organisation or community project or group and what services etc. It provides to the local community. Interviews You may intend undertaking some interviews with users of clients of a project to obtain their views of the service etc they receive Questionairre

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You ask people in the community to complete a questionnaire to find out whether there is adequate support for individuals with a heroin addiction in the community and if this support can be improved. Survey/Action Research You carry out a general needs survey of your community which examines such issues as poverty, needs of the elderly, racial harassment, local transport with the aim that it may enable local people to take action themselves. Collect & Analyse Information A community group wishing to set up a carers network but needs to collect and analyse information on existing local and national carers networks so that it can consider this information before deciding how to establish their own network. Participatory Research The users or clients of a project or group or members of the community define the research problem themselves, they choose the appropriate method or way of collecting the information and analyse ant interpret the data or information themselves.

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Principles Into Practice The principles of using research to inform practice is widely accepted but how can managers and agencies ensure that this principle is put into policy and practice, asks Rhiannon Hodson. The interventions social care staff make into people lives can be far-reaching and have permanent consequences. Professionals should ensure they intervene on the basis of the best available evidence; otherwise their actions become nothing more than experiments. Research in Practice, the largest research implementation project in England & Wales, is helping practitioners make sure their decisions and judgements are shaped by an understanding of: The best available research evidence about what is effective (from academic research studies but also from local data gathered systematically for example, through user consultations or service evaluations. Practice wisdom (built up through learning from operational experience). Feedback from service users (for example, about expectations, preferences or the impact of interventions). As social care staff increasingly find themselves in multi-disciplinary teams, they will have to ask fundamental questions about their traditional role such as what makes my contribution distinctive? And on what do I base my judgements and decisions? Having confidence in their professional knowledge base and extending this through learning from research and reflection will be crucial in maintaining the distinctive contribution and identity of each professional discipline. So evidence-informed practitioners think critically, reflect on their experiences, keep themselves up to date with research and consider how research knowledge might influence assessments or proposals they make. The

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challenges of working in this way are immense including conflicting or competing demands and workload pressures. But is it reasonable to expect staff to take on this challenge alone? Our experience suggests that there is only so much even the most committed practitioner can do to continue to develop and apply their research-based knowledge in the absence of their agency support. Indeed the Social Care Institute for Excellence concludes: There is little point in simply turning up the rate at which research flows to the social care workforce little research in fact has direct applicability, many practitioners are not equipped to digest research, and support systems are lacking The Research in Practice network has been working intensively with agencies over the past six years to explore how to embed evidence-informed practice into the lifeblood of an organisation. What is clear is that the right culture and practical facilities must be in place to enable staff to have the evidence to inform their practice. The sort of organisational support that our work suggests needs to be in place which is beyond the capacity of individual practitioners and teams to provide falls into five broad categories. 1 Providing Strategic Leadership A committed and enthusiastic senior leader is important to spearhead the drive for greater use of research in policy and practice. This gives the initiative profile and priority, and provides a champion to drive it forward as a crucial element of practice development. Agencies that have been most successful in embedding a culture of using evidence to inform practice have a figurehead who unites staff around a clear vision about research use in professional practice. Having a broad base of strategy that publicly sets out what the agency will do to promote access to research and encourage its use has also proved important. Auditing the agency strengths and weaknesses can be helpful and provides a baseline against which to measure progress. 2 Setting Expectations that Policy and Practice Decisions will be Evidence Informed. The social care workforce reforms and the national occupational standards for social work set out general requirements for social workers on continuing their
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professional development and drawing on research to guide the way they work, They are rather lighter on the specifics. So agencies must clarify what is expected of individual staff: what evidence should be used, where how, and by whom. For example, how should front line practitioners keep abreast of new research, integrating it into their practice and using it to guide individual cases? Job descriptions, person specifications and competency frameworks need to record reasonable and feasible expectations of qualified and unqualified staff. It is also crucial to set out how processes such as strategy development, business planning, performance improvement and supervision, should be using research. 3 work. As one senior leader we have worked with put it Nobody gives time to us we organise our own time. For practitioners and their managers there is an issue about how they build time into a very punishing schedule to make sure they keep abreast of whats going on. Making use of team meetings, development days and supervision sessions to discuss new research, user feedback and learning from individual cases is important. Tying into initiatives such as post-qualifying awards and reregistration can also generate capacity to develop research-based knowledge. But agencies must also initiate new opportunities to learn including messages from research events, practice development groups or journal clubs. This must be accompanied by efforts to create a fertile environment in which evidence seeds will grow. Managers are influential in shaping culture, for example, by valuing constructive questions and debate, encouraging a genuine attempt to learn from mistakes and being receptive to new ideas and new innovations. Some staff may see the use of research as threatening, because it implies a reexamination of ways of working and certainties. Leadership development to Encouraging learning from research These expectations need to be supported by protected time and space at

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ensure managers focus on outcomes and create a learning climate is therefore crucial. 4 Improving Access to Research Its important to provide physical facilities such as quiet rooms, library resources (in house or purchased) journal subscriptions and internet access. Targeted dissemination of evidence that makes sure new material gets to relevant people is key. The availability of practical help for staff in searching for, reading or applying research messages has also provided important. This can sometimes be delivered through strategic partnerships (for example with local universities, 5 Providing support to staff research Specialist support for local studies, evaluations and service user consultations and funding even for a modest study of gap-filling, exploratory research are important elements for agencies to have in place. Being evidence-informed is the professional responsibility of practitioners. But this responsibility must be supported and encouraged by an organisational culture that values continuing professional development and learning and an infrastructure that ensures easy access to high-quality, relevant research evidence and the resources to support its use. The development of this culture and infrastructure needs to be actively planned and led as a key element of any organisations strategy to develop the professional practice of its staff.

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