Although my remit is mental health, D has recently given birth to a baby. Therefore, The Children (N.I) Order 1998, is going to be a necessary piece of legislation to know. This Order states that “the welfare of the child is paramount” () no matter what else if happening within the family home. It would be my responsibility to ensure that any information I may be told relating to risk to the child would be reported to the appropriate agencies immediately. At this stage I already know that childcare are involved with D and her baby. It would be important that I kept my knowledge of this legislation up to date and explained my statutory duties regarding this to D.
Mental Health is an area that carries significant stigma in society, no matter how much legislation or policies and procedures there are around it. It is a taboo subject and one that many people feel embarrassed about or hide away from. For example, when working with one service user, he stated that the only reason he came to the appointment was because it did not say “mental health team” on the front door. He said that he would be too embarrassed and afraid of what people might think to admit that he was seeing someone from the mental health profession. When I questioned him further he went on to explain that before he was diagnosed with depression he seen mental health problems as something that happened to “bad people”, to “lunatics” and to “nutters”. He explained that if this was how he thought, then everyone else in society must feel the same. People tend to avoid stigma and stay away from institutions that label them, therefore many mental illnesses can go untreated for many years.
Another relevant theory would be systems theory, which is an explicitly sociological approach. Social work situations are understood as “a series of interlocking social systems (the family system, the neighbourhood system and so on)” (Thompson 2005:67). The role of the social worker is to see how these systems work together and any problems they may be causing, so that the pattern of systems can be altered and the problems resolved. An example of this may be, a service user could be having problems within their family system that may be causing them distress and therefore impacting on their mental health. A resolution may be a course of family therapy, which would look at changing the family system as a whole, rather than working with individual factors. Obviously family therapy would not be conducive in D’s situation as she has no partner and her daughter is only 10 weeks old, but systems theory will still be relevant.
Theories of loss are always important in mental health. Horner (2003) suggests that loss does not need to be a physical loss e.g. a limb, a sense or a person, but can be an emotional loss or a loss of identity or self. When someone is given a diagnosis of a mental illness or is referred to be seen by a mental health professional they may feel lost or confused. When working in St. Luke’s Hospital as a Trainee Social Worker, a phrase which I heard frequently was “I just don’t know who I am anymore”. Adams et al (2001) state the service users sense of identity is lost, they feel like they do not belong and are unsure of what their social role is.
Something, which I feel may be useful to be aware of when dealing with service users who have a mental health problem, is motivational interviewing. Miller and Rollnick (2002:25) describe motivational interviewing as “a client-centered, directive, method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”. As a worker you need to express empathy, develop discrepancy, roll with resistance and support self-efficacy. This type of intervention is seen as a natural process as it can be developed into a conversation without it having to be discussed and explained first. It is very much about autonomy. This method can work well on its own, but also with other methods. For example, if someone was involved with psychology and receiving CBT, this method could work well as a preface to this. This method is very much about the individual, the worker is to be reflective and encourage the service user to talk openly and honestly about issues that effect them.
Looking at my own experience, it is clear to see that we use motivational techniques on a regular basis without even realising. It is important to be aware of my own value base, personal and professional, when using this technique. It would be easy to impose my own values on a service user when trying to motivate them, but it is their values that are important. I need to focus on their vales throughout the contact as this will give me an insight into the direction they want their life to go and how they want things to change.
In order to practice effectively and anti-oppressively, it is helpful to consider the humanistic psychological view of Carl Rogers (1961) and his “person-centred” approach, as this has helped to shape social work values and is therefore important when carrying out anti-oppressive practice. He believed there were three main concepts that needed to be followed in order to remain anti-oppressive. The first of these was congruence, which refers to the workers willingness and ability to be genuine and open. Rogers (1961:61) believed “personal change is facilitated when the psychotherapist is what he is” and does not play manipulative games. An example may be when carrying out an initial assessment with a service user, you should be open and honest about the information you are gathering, make sure all questions are asked clearly and without a hidden agenda. Rogers believed that if this was not the case an unhealthy working relationship would be formed.
The second concept is empathy. He believed this was a skilful activity as it “involves having a degree is control over out own feelings while remaining open and sensitive to the other person’s feelings” (Thompson 2005:118). Without this sense of control over out own feelings, we would become too emotionally involved and exhausting ourselves through emotional overload. In the field of mental health, we see people every day who are living with a wealth of problems and they open up to us about their feelings on a deep level. If we were to take all of these feelings on board we would become what is often referred to as “burnt out” and no longer be able to practice effectively. Empathy, therefore, is not only a social work value we should aspire to have, but a practical necessity to avoid intense emotional pressures.
The third and final concept is unconditional positive regard. This is about working positively and effectively with all clients we work with, and not just those whom we approve of or feel most comfortable with. With this comes two values, namely acceptance and a non-judgemental attitude. It would be impossible to have positive regard for every one of our clients if we did not hold these two values. Although this may not seem like a hard task, an example would be working with a service user who had depression, but also had a history of sexually abusing children. Rogers would say that if we let our feelings of disapproval to influence our work in a negative way then we are less likely to be able to influence the service user to make positive changes in their lives. Morrison (2000) would say that high-quality supervision is essential here, as it would help us to deal with our own feelings and therefore work positively in such circumstances.
Tuning In to Service Users Feelings
As this is my initial contact with D, there are many possible things she may be feeling about our meeting and about her individual situation. D may be feeling apprehensive about our meeting and what exactly it might entail. As I have already made her aware that I am a student she may be feeling nervous about not getting a “proper” professional to work with. She could be thinking “what would she know, she’s only a student!”, or “what age is this girl if she is only a student?”. These are all normal things for D to be thinking, and things that I must prepare myself to answer. It would be extremely important to address these concerns and take time to explain my role, how I am supervised and how I can help. Failure to do this may hinder any chances of developing a good working relationship with D.
As D has just given birth to her first child, she may be feeling vulnerable and confused. It is hard for all first time mothers to adapt to having someone whom is totally dependent on you and you alone. These feelings may be contributing to her panic attacks and lack of sleep and so they need to be addressed. I would use my skills of questioning and general communication to try and understand exactly how D is feeling about being a mum. I would then reassure her that these feelings are normal, and it would be unrealistic to expect to know everything there is to know about parenting in the space of ten weeks. I feel that because D’s child is mentioned in the referral, it would be important to address this issue. Failure to do so may make her think that I have not even tried to gather any knowledge about her prior to the meeting and that I know nothing about her situation. On the other hand, I need to ensure that I do not spend the meeting focusing on D’s child. I am there to assess her mental health, not her parenting.
D is going to be aware that my practice teacher is going to be observing our contact. This may make her feel uneasy or that she is being assessed. As I have not worked with D before, I am unaware of her general level of communication, how she responds, what her non-verbals are and what her body language is like. It will, therefore, be harder for me to observe any changes in how she presents due to feeling uncomfortable about my practice teacher being there. I will however, stress that I am the one being assessed, not her and that the same limits of confidentiality apply. If D is still not comfortable with the assessment being observed, we will have to discuss the issue and come up with another arrangement.
D is diagnosed with panic attacks. Panic attacks can be brought on by anything, usually stress or unnecessary excitement (. Coming in for this assessment may be causing D undue stress and she may feel a sense of panic during the meeting. Signs that a panic attack may be coming on can be, sweaty hands, rapid speech, shortness of breath or shaking (. I need to be aware of these signs and observe how D is managing with the interview. I need to be careful not to assume just because her speech gets a little faster that she is going to take a panic attack. I feel it would help our working relationship for me to show understanding at the beginning of the meeting, and inform D that if at any time she feels she is panicking or getting stressed to let me know and we will take a break.
Tuning In to My Feelings
This is my second direct observation with my practice teacher. I feel that I am more nervous about this one, as the first one was in a group there were more people and the focus was not on me as much. This time it will just be D and me and I feel more under pressure about what my role is and what to do if I can’t answer a question. I believe it is important for me to address these concerns at this stage as I do not feel it would be best practice for me to allow my insecurities and nervousness to effect the level of care D should receive. If D asks me a question that I cannot answer, I will explain my reason for not knowing and inform her that I will try to find out for her. I need to be aware that I cannot use my student status as an excuse for not answering questions I don’t think D would like the answer too.
During team meetings, when colleagues are discussing assessment and the outcomes, I always feel nervous that by the end of the assessment I am not in a position to decide what the best way forward for a client is. I never feel qualified enough to do this. This makes me nervous and makes me feel under-prepared. Howe (1992) believes that if you feel you cannot make the most effective decision on the spot, it is good practice to discuss it with other team members and then get back to the service user within an acceptable time. I need to remember that I am not expected to know every service open to D or which the best one would be. If I do not feel comfortable making the decision at the end of the meeting, I will inform D that I would like to discuss the assessment with my practice teacher and then taking D’s view, my practice teachers view, and my own view into account, we will decide together what the best way forward is.
A key social work value is partnership. This is a value that was continually stressed during the first year of my degree, and one that I try to work towards. However, there are always going to be power inequalities between the social worker and the service user group. “Power is a very complex issue and operates at a number of different levels” (Thompson 2005:59). The fact that social work is a profession, where the worker has the ability to make assessments, automatically puts them in a position of power. Milner and O’Byrne (2002) suggest social workers should acknowledge the power they have and discuss it with the service users they are working with. I do not want D to feel that I am just another authority figure that she has to answer to, I want her to see me as someone who can help her change her current situation. I want D to be able to talk, and know that I am listening without judging. In order to do this, I feel I need to openly talk to D about it. I will tell her that I am there to listen and to help in whatever way I can.
It is one thing to tell someone you are listening, but another to convey active listening. Coulshed and Orme (1998) believe active listening is a fundamental part of the social work process. I am afraid that D might think I am “going through the motions” with her, the way I do with everyone else. She may feel she is not an individual, just another person on my caseload. D is an individual “with problems, concerns and needs which are specific to them and their circumstances” (Thompson 2005:110). I need to be aware of this and remember to respect all individual differences and be open and welcoming to diversity. Failure to do this would be oppressive and would be bad practice. It would dehumanise D and she would become a“thing” rather than a human being with dignity and rights (Parker and Bradley 2005). This is something which I want to avoid. I want to show her that I am listening to her situation that is unique to her, and responding to her needs, not anyone else’s. I will try to do this through my eye contact and body language, but also through my use if appropriate questioning, summarising and clarifying information with D. I feel this will help the interview process, as D should feel valued and believe that I really want to her what she has to say.
Bibliography
Adams, A., Erath, P., and Shardlow, S.M. (eds) (2001) Key themes in European Social Work: theory, practice perspectives Lyme Regis: Russell House
Coulshed, V., and Orme, J (1998) Social Work Practice: an introduction. Basingstoke: Macmillan
Horner, N (2003) What is social work: context and perspectives. Exeter: Learning Matters
Howe, D (1992) An introduction to social work theory. Aldershot: Arena
Milner, J and O’Byrne, P (2002) Assessment in Social Work. 2nd Ed Basingstoke: Palgrave
Parker, J and Bradley, G (2005) Assessment, Planning, Intervention and Review Exeter: Learning Matters
Rogers, C (1961) Client-Centred Therapy: It’s Current Practice, Theory and Implications London: Constable
Smale, G., Tuson, G., and Statham, D (2000) Social Work and Social Problems: working towards social inclusion and social change. Basingstoke: Macmillan
Thompson, N (2005) Understanding Social Work Basingstoke: Palgrave Macmillan
White, C (2006) Northern Ireland Social Work Law Tottel, Sussex
Websites
Accessed on 26/10/08
Accessed on 26/10/08