Social work placement in aged care agency – Professional learning plan

| August 29, 2015

Social work placement in aged care agency – Professional learning plan

Imagine You are a social work student doing placement in an aged care day respite centre in Australia. Many clients in this centre have dementia.

Social Work Theory and Methods Comparison Table

Theory    Key Concepts    Advantages    Limitations    Situations where this may be useful
Systems Theory     •    People are not isolated individuals but operate as part of wider networks or “systems”
•    Systems may be informal (e.g. family or friends), formal (e.g. clubs, support groups) or public (schools, hospitals)
•    Difficulties may arise if there is a lack of fit between the person and the systems they operate within.
•    Systems can be employed to support the service user to achieve change.    •    Emphasis on changing environments rather than individuals.
•    Focus on patterns rather than “cause and effect” – allows for different ways of getting to the desired outcome.
•    Sees worker as part of a system of change rather than solely responsible – may lend itself to multi-disciplinary work.
•    Does not explain why things happen or give guidance about how to act to bring about change.
•    May overemphasise “bigger picture” at the expense of details.
•    Values maintenance and integration over conflict – may not explicitly challenge inequality. Does not encourage challenge of oppressive systems.

Ecological Approach    •    Germain and Gitterman – “Life model” (1980 / 1996)  -people are interdependent with each other and their environment – each influences the other over time.
•    People move through their own unique life course and may encounter “stressors” – some of which may make them feel they cannot cope.
•    People employ coping mechanisms and draw on resources in the environment, social networks and inner resources.    •    Acknowledgement of interrelationship between person and environment.
•    Consideration of a range of resources to support people – both internal and external.    •    As above.
Task Centred Approach    •    Brief work within explicit time limits
•    Collaborative approach between worker and service user – based on a contract.
•    Systematic work
•    Includes some behavioural ideas but mainly a cognitive approach
•    Usual to take action to get what you want
•    Action guided by beliefs about self and world
•    Time-limits help motivate service users
•    People may “get stuck” if they have to deal with a certain issue over and over
•    Problems defined as “unsatisfied wants”
•    Clear and straightforward
•    Short timescale may help people feel more committed
•    Well supported by research
•    Service users supported to take control of own life.
•    Can increase service user’s coping skills to deal with issues in the future.
•    Strengths based approach which assumes that service users can overcome problems with the right support.
•    Not effective where there are longer-term psychological issues
•    Not effective where service user doesn’t accept the right of the agency to be involved.
•    May oversimplify issues people face
•    Some people may be too overwhelmed by the issues they face to have the energy to address them.
•    Does not really address power differentials between service user and worker.
•    May not address structural issues of power and oppression

Crisis Intervention    •    Brief intervention – deals with immediate issues rather than longer term problems
•    Based on ego-psychology and cognitive-behavioural models – serious events have an impact on the way people think about themselves and their emotional reactions
•    Assumes we live in “steady state” – able to cope with change
•    Crises upset the steady state and provide opportunity to improve skills / risk of failure
•    Period of disorganised thinking / behaving
•    Crises can reawaken unresolved issues from the past but offer a chance to correct non-adjustment to past events.
•    Help people to deal with major events or life transitions
•    Can incorporate other theories – solution-focussed / cognitive-behavioural
•    Time-limited and task-focussed.
•    May not help people who experience “continual crises”
•    Does not address issues around poverty or social exclusion

Cognitive-behavioural approach / Rational Emotive Behaviour Therapy     •    Rather than being an “insight based therapy” it uses techniques from behaviourism, social learning theory and cognitive theory.
•    Based on the assumption that our thoughts, beliefs, images and attitudes influence our behaviour and if these are changed, our behaviour will change.
•    “Self-talk” reinforces irrational thinking.
•    Involves identifying and reframing unhelpful beliefs. Worker teaches service user to challenge own beliefs.
•    Can involve modifying behaviour using a system of rewards.
•    Use of ABC system – activating event – belief – consequence and Ellis (1962) extends to DEF – Dispute beliefs, replace beliefs with Effective rational belief, describe the Feelings which will be the result.    •    Many empirical studies to suggest effectiveness (although evidence around degree of effectiveness is disputed.)
•    Can be used to support service users to increase their problem solving skills and coping skills.
•    Effective over a wide range of issues.    •    Directive approach
•    Starts from the assumption of deficit, ie the service user is lacking something.
•    Requires a high level of knowledge and skill to apply.
•    Focussed on the presenting issues rather than addressing causes.
•    “Much behaviour may be perceived to be emotionally driven and irrational, when it represents.. a rational response to very upsetting and disturbing experiences. (Lindsay, 2009)
•    Doesn’t take account of socio-economic factors.
Motivational Interviewing    •    Applied form of CBT, developed by Miller and Rollnick (1991, 2002) defined as “a person-centred directive method for enhancing an intrinsic motivation to change by exploring and resolving ambivalence.”
•    Worker adopts an empathic and non-confrontational approach but worker is directive.
•    Worker is alert to language person uses and looks for language of change.
•    Worker provides education / information about situation the service user is in (e.g. effects of smoking / drinking alcohol / taking drugs etc)
•    Worker encourages service user to list benefits and costs of lifestyle and alternative lifestyles
•    Explore barriers to goals
•    Reframe past events – focus on more positive aspects.
•    Supported by an understanding of the cycle of change (Prochaska and DiClemente 1986) [Pre-contemplation / contemplation / decision / active changes / maintenance / lapse.    •    Accepts change must come from intrinsic motivation and cannot be forced upon people.
•    Supports people to explore their ambivalence around change.
•    Accepts that people may “lapse” but this is part of learning process.    •    Usage and research around effectiveness have been largely around addictive behaviours
Solution-Focussed Approach    •    Cognitive approach
•    Focus on understanding solutions rather than on problems
•    Originates from Milwaukee Centre for Brief Therapy
•    Post-modern therapy based on theories of language and meaning.
•    Uses knowledge of service users
•    Avoids diagnostic labelling – considers this disempowering
•    Focus on difference and exceptions
•    Person is not the problem
•    Assessment based on strengths not deficits
•    Talking can construct experience
•    Distinction between “problems” and “unhappy situations.” Problems can be addressed, “unhappy situations” have to be coped with.
•    Encourages sense of “personal agency.”

•    Co-operative therapy with a wide application
•    Emphasis on listening to the service user’s story
•    Seek solutions with the service user’s life
•    Can fit with anti-oppressive practice and be empowering.
•    Least intrusive – takes easiest route to solutions
•    Reduces risk of “dependency” on worker.
•    Optimistic approach which assumes change is possible.
•    Time limited.    •    May not fit with agency’s own procedures
•    May not be suitable for people who have difficulty responding to questions
•    Feminist critique of language being constructed by men therefore language not reflecting women’s experience.
•    Approach of understanding solution without understanding problem could be misunderstood
•    Focus on behaviour and perception rather than feelings may limit efficacy.
•    May not be effective with people in crisis or people with very low self-esteem who may not accept that they have strengths and skills.

Person Centred Approach
(nb different to Person-Centred Care)    •    Based on the work of Carl Rogers
•    Sets out the principles of empathy, congruence and unconditional positive regard as necessary in the helping relationship.
•    Non-directive approach
•    Based on the idea that everyone has the capacity to develop and grow.
•    Allows people to find their own way in their own time.
•    Values all forms of experience.
•    Resists temptation to criticise people.
•    Emphasis on building an equal and meaningful working relationship with service users.
•    Widely applicable across service user groups.
•    Affirms the dignity and worth of all people    •    Role of SW may not allow for non-directive approach. Not a time-limited approach.
•    Difficult to apply if service user not motivated to engage.
•    Focuses on individual change rather than societal factors, although allows individuals to express their own goals which may not be the agenda of mainstream society.
Psychosocial Model    •    Based on the idea that people have inner worlds and outer realities.
•    Certain events remind us of past events we have tried to block out.
•    Events can take on greater emotional significance.
•    People develop in a series of stages and “faulty personality development” in childhood can affect our responses later in life.
•    Draws on “personality theory” – id, ego, superego and looks at defence mechanisms.
•    Considers “defence mechanisms” we deploy to protect the ego.    •    Can help with recurring emotional problems
•    Way of understanding seemingly “irrational” behaviour
•    Emphasises the importance of self-awareness.
•    Influenced a listening, accepting attitude in social workers
•    People can be empowered by insight into what is going on within themselves and between themselves and the outside world.    •    Focussed on a medical model of individual pathology. Tends to ignore issues of power and oppression.
•    Social workers act as “mini-psychoanalysts” – use of clinical jargon.
•    Tendency to focus on cause and effect.
•    Can lead to service users being labelled – “inadequate”, “narcissistic”, “manipulative”, “resistant” and can lead to victim blaming.
•    May not be culturally appropriate – based on valuing self-growth and self-awareness which are not norms shared across all cultures.
Recovery Model    •    Model used in Mental Health services which emphasises recovery rather than illness.
•    Recovery does not necessarily mean being “symptom-free” but regaining a sense of control and purpose
•    Not being defined by a label or diagnosis.
•    Recognises strengths of the individual.
•    Open to possibilities for the future – return to employment or education.    •    Individuals viewed as experts in their own situation.
•    Positive approach which attempts to give control back to the person.    •    Can challenge authority of medical profession and thus not be accepted / implemented in some MH services.
•    Currently mainly used in MH services – but could have broader applicability.
Narrative Approach    •    SW encourages the person to describe their life in their own words.
•    Opportunity to tell their story, an in the process define identity.
•    SW can support the person to feel in control of the narrative and draw their attention to the possibility of a different narrative for the future.    •    Can help people understand the pressures they have faced and the impact of discrimination and oppression.
•    Can help people make sense of change and adjust to new situations.    •    SWs may see the discussion as “rambling” or “off the point” and try to cut off the person’s narrative.
•    The person or their family may ask for a “solution” and not see the value in the approach.

Key References

Coulshed, V; Social Work Practice; 2nd ed (1991) Macmillan, Basingstoke and London.
Lindsay, T (ed) ; Social Work Intervention; (2009) Learning Matters Ltd, Exeter.
Maclean, S and Harrison, R: Social Work Theory;(2008); Kirwan Maclean Associates, Rugeley.
Milner, J and O’Byrne; P: Assessment in Social Work; (1998) Macmillan; London and Basingstoke.
Payne, M; Modern Social Work Theory; 3rd  ed (2005) Palgrave Macmillan, Basingstoke & New York.
Trevithick, P; Social Work Skills, A Practice Handbook; 1st ed (2000)  OU Press, Buckingham & Philadelphia

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