In my experience theory does not totally prepare practitioners for every eventuality, working with children and young people can be unpredictable at times which means that as a practitioner you have to think fast on your feet.
Theory does, however, give me a firm basis from in which to start and understand approaches for my service users. By understanding and being aware of a wide range of techniques I am therefore able to apply theory to practice more quickly. (Supervision Notes 2007)
During the course of my placement I have been able to observe other staff and model practical ways in which to communicate an approach, empower and engage young people.
During the course of the placement it had become visible to me that most of the young people I had on my caseload were suffering behavioural and anger management problems. I observed the young people and how they handled conflict and how they reacted to it as well. After the initial meeting I discussed with them ways in which they could handle the situation that presented itself to them. Also giving them and allowing them to use coping strategies to deal with certain situations. Therefore allowing the child or young person to look at the situation for themselves, they found they were able to reflect on their behaviour and develop strategies for dealing with future conflict. This in turn showed cognitive behavioural methods.
The group work and task centred learning theory that was applied enabled me to put theory to practice. I found this theory most useful when used as a combination. As humans are different I found that by combining two theories I could modify or adapt my approach easier. For example with those who appeared to learn more by doing I incorporated more task centred learning activities.
I found the Cognitive Behavioural approach instrumental in helping me to help the young people build on what they already knew, and examine their behaviour and develop their own strategies for coping in difficult situations.
By leaving the power with the service user and allowing for self-determination, this enabled me to re-enforce with the service user the need for them to take ownership of their own behaviour. The making of decisions for oneself without the influence or interference from others. (Thomas and Pierson, 1995)
Whilst on placement I feel I have learnt so many new ideas and theories in which to engage and communicate with a wide range of people. These skills will also enable these to be transferred to use in my future endeavours as a social worker. These skills will also adaptable to enable application to new tasks.
I have chosen a case study to demonstrate how I used a particular theory and how it was put into practice.
Tallulah is 15 years old and has recently been arrested along with two friends. This is not her first offence and she has acknowledged that she feels confused and has no-one to talk to. Additionally her relationship with family members is hostile at the present time and she has been blamed for the arrest by her friends.
The theory I chose in this instance was Cognitive Behavioural approach. This approach is concerned with the way we think. It makes the assumption that behaviour is directed by thoughts. Unlike many other concepts, which concentrate more on unconscious drivers, feelings or internal conflict.
(Cigno and Bourne 1998), believe that most of what makes us individuals rather than clones, is what shapes our personalities, including behaviour, emotion and cognition, is a result of what we have learned.
Cognitive and behavioural theories are principles from two related streams of psychological writing', (Payne 1997). Social learning theory (Bandura 1997) focuses the fact that most behaviour is learned. However it goes further than behavioural theory by implying that people's perceptions and thinking about their experiences and modelling what they see around them are vital to the process and inter-dependent to the feelings that they have regarding this. Basically Bandura believed that how we think has an effect on our behaviour and that both of these are open to change. The way we think about a situation mediates between the outside world and our inner self. (Payne 2005)
People have the capacity to change and behaviour is assimilated by goals, (Sheldon 1995). Cognitive behavioural programmes are based on the application of both social learning theory and cognitive theory to inform therapeutic methods. (Cigno and Bourne 1998).
This particular method would be used with Tallulah to help address both her offending behaviour and her issues with her family. Sheldon's assessment model (1995) would be useful in this case. This helps us to measure what is happening and to assess Tallulah’s motivation for change:
Focus on the behaviour causing problems, Offending behaviour, second offence
Attributions of meaning to stimuli, family have no time for him, Michael feels confused
Present behaviour and thoughts, confusion, no one to talk to, isolated
Target sequences of behaviour, offending behaviour needs to be decreased. Could use ABC technique. Antecedent, problems with the family, Behaviour, offending, Consequence, arrest.
This assessment would be done with the intention of helping Tallulah to see where she is at present with her own thought processes (hopes, fears, values) and to progress from these to try to make Tallulah's behaviour goal orientated, e.g. getting Tallulah to think about her offending in a different way and continuous reinforcement of a desired behaviour will work more quickly and decrease the behaviour which leads to her offending, this promotes change in the thinking behind her offending behaviour. Shaping can also be used, reinforcing small steps made towards a required behaviour. The worker also needs to challenge negative thought processes. Feedback needs to be encouraged so that Tallulah can see what she has achieved outside sessions, (Ronen and Freeman 2007). Once the desired behaviour is achieved fading would be used to reduce the amount or type of reinforcement. This enables Tallulah to transfer her behaviour to other settings (Payne1997).
The principle of self talk can be tried out with Tallulah also. (Cigno and Bourne 1998), indicate that children gain self-control over their actions as their inner speech develops. Using this formula in the form of self talk can help with self appraisal and self support.
Another use of cognitive techniques could be offered to Tallulah and her family in the form of Functional Family Therapy if her family were willing to participate. This focuses on family interaction. It uses contingency contracting, as a means of changing family interaction in the case of young offenders. It can have a beneficial effect on the interactions between families. It has become increasingly evident that working in partnership with families is important when trying to reduce the risk of re offending in children and young people. (Cigno and Bourne 1998).
The Cognitive Behavioural approach does have limitations. The nature of the work and the theories that underpin this can come across as jargon, and for assessing and evaluating results can be over addressed. This could possibly add to the subject’s negative feelings as it airs towards the necessity of gathering practical evidence as opposed to the importance of the service user/worker relationship. (Beckett 2006)
This technique can also have implications for anti-oppressive practice. The worker to all intents and purposes engineers the behaviour of the service user. In an arena such as the youth justice system the young person has no control over the process which can be deemed as oppressive.
If a worker makes assumptions about the cultural, social or religious beliefs and influences on the service user may have implications for negative behaviour, this too can be oppressive. This can lead to questioning who actually wants the change in behaviour. Is it the service user, or are it professional and the wider society who are endeavouring to fit behaviours in to its system of norms.
(Payne 1997) believes that 'there is a risk that therapy which seeks to change behaviour so that it adapts to an environment undervalues minority forms of behaviour and less dominant aspects of culture'.
Although behavioural and Cognitive approaches are valid and effective because of their explicit structure and guidance, can good results be maintained over a period of time? When the intervention ceases can the child or young person keep up with the techniques taught, without the support they had previously received?
Additionally it is questionable that some of the individualistic therapies, such as Sheldon (1995) can be easily transferred to general social work settings, (Payne 1997). Another problem is that Behavioural programmes require supervision by a person who is an expert in the field, as they are complex and require skills to apply. This can be very difficult to provide if there is no existing group of practitioners. (Payne 1998)
Additionally service user resistance could also be a factor depending on how motivated the client is to change their behaviour.
Lastly Cognitive approaches only take into consideration the person concerned, (behaviour and cognition). Not much thought is given to the societal aspect of the person’s life, e.g. environment, family, education. These are factors which are beyond a person’s control. This approach tends to work towards making the person 'fit in' as opposed to working to help them realise their place in society. (Sheldon 1995)
One method which could be used to address some of the limitations of the Cognitive Behavioural method is Solution Focused Therapy. It has an emphasis on positive rather than problem solving work. It focuses on behaviours which may not be typical of the problems identified and uses these as a base for change. Change is assumed to be continual, with small changes leading to bigger ones.
This is based on deShazer (1985,1988,1991) and Insoo Kim Berg's (1988,1990) model. It is focused on the same idea as family therapy (interactional). However it is very different in a number of ways. It views the process of change as inevitable. (Hubbard 2007)
Taking this view pays close attention to exceptions to problems, e.g. when there is a change to the stability of the problem. It sees this as the key to finding solutions. (Kim Berg 1999).
If we can find a way to repeat the behaviour which surrounds the exception the problematic situation can become less overwhelming and more manageable, it can even eventually disappear.
Change occurs in different ways, emotional, perceptual and behavioural. If a feeling toward a situation is changed, a perceptual shift is possible, and in turn shows a different behaviour. When a problem is seen as positive, we can make behavioural changes in respect of the problem which lead to the service user feeling differently about it. If we can create a different emotional reaction to the same problem change can occur. (Kim Berg 1999).
This type of therapy is about constructing solutions, not focusing on problems. In the case of Tallulah it would be an idea to focus on education as a pre-session change. Even after being isolated from her friends and beaten up by a group of youths, she has not stopped attending school. This may lead us to think that there is something about school which has positive rewards or stability for Tallulah. Whether it is that she is doing well with subjects, she has someone to support her there (teacher), she feels safe there or she looks on it as the area where she is doing well. This is an area where there is an exception to her problems. Therefore it could be used as the key to finding a solution in her problems.
We would start by creating a small goal which would be set by Tallulah. After establishing where she wants to be in her life at the present time, we would try to find the quickest way to get her there. Constructing solutions and helping her to focus and discover her own resolution are also part of the therapist role. (deShazer 1982)
Scaling can help in this type of therapy in order to get the pitch of the problem right, e.g. how does Tallulah feel before she commits an offence on a scale of 1-10? Then by setting achievable goals and feeding back as to whether things are working for the young person, we can help to bring about change. Once we know what works as practitioners we can repeat the exercises in order to keep supporting change.
These techniques could also be applied to Tallulah's family as a whole, if they were willing to take part. It could focus on the strengths of the family as a whole and set goals for them, which are achievable. Reframing and focusing on a preferred future rather than the unsatisfactory present helps the family to shift from the negative to the positive attainments of the relationship, behaviours and emotions. The interventions are short and would suit a family such as this. (Beckett 2006)
Using Solution Focused Therapy along with Cognitive Behavioural methods would help to improve service delivery for the service use because it would give a more robust performance. Tallulah along with all service users need a wide range of interventions available to them in order to give a holistic overview of the support given.
Although certain methods give very good results in working with groups of service users, these methods should not be used in isolation as this makes the practice very single-minded. Methods should be used to complement each other for different individual needs. This is not to say that a worker should use all of the theories at one time with a person, as this could become confusing for both the worker and the service user. However factors such as family, environment, education, health and peer relationships all need to be considered when dealing with people in the caring profession. All people are individuals and deserve the right to be treated as such. To do anything less would be seen as an act of oppressive practice. Social workers need to draw on many different resources and theories available to them in order to truly meet service user’s needs. (Beckett 2007)
References
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