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Reflective social work practice

The rationale of this assignment is to discuss and critically appraise my own reflective practice developed within the MSc programme of study. Using reflective practice, in this assignment I demonstrate how I have experienced the swampy low lands of my social work practice as envisaged by Schon (1983:54). I have chosen to use some elements of Schon's (1983) theory of reflection and Fook and Gadner's (2007) critical social theory to elucidate my understanding and learning process. Critical social theory focuses on power domination in both personal and structural arena; therefore it has enabled me to understand the connection between the individual and society (Fook and Gadner 2007). It is significant to highlight that in agreeing with Schon (1983) ,and Yelloly & Henkel (1995:8) I have attempted to unpack elements of reflective practice in relation to learning Log 20 ( appended) basing on Yelloly and Henkel's (1995) notion that social work is a multifaceted profession. Fook and Gardner, (2007) further elaborate that contemporary social work deals with complex issues, uncertainty and risks hence the need to have practitioners that are reflective and responsive to various situations. Personally, I think that social work is a challenging profession by virtue of being constantly subject to societal interpretation which is highly influenced by media perspectives. Moreover, the curriculum and standards set by NOS, GSCC and training in Universities does not prescribe answers to peoples issues, but instead I found more gaps and inconsistencies being exposed as reflected in the case study below.

Case study

I met up with VB in her ward following a pre-arranged meeting. VB had actually forgotten that we were meeting up, on that day, so she was preparing to go out to have a cigarette, and had indicated to me that she was not in a good mood. I assured her I was going to wait till she was ready and let her have her cigarette. In coming back, we found a quiet room to go through the national voices scheme. The form referred to people like VB as service users with mental health issues. VB has brain injury, for this reason she voiced that she felt it was not proper for her to be referred as a person with mental health disorder. She also said she found it very inappropriate to be called a service user. With all due respect I found out how she would prefer to be addressed if it was not for the sake of filling out the forms. After finding our equal grounds on how she identifies herself, we began to have a dialogue unfolding logically.

Context Of Placement

The Agency is a not-for-profit private psychiatric organisation that receives referrals largely from NHS institutes with age groups ranging from 13 to plus 100. Statutory duties in this agency entail writing social circumstances reports and presenting them to Mental Health tribunals and undertaking Mental Health Act 1983/2007(MH Act 1983/2007) assessments as an independent professional such as provision of aftercare arrangements under s117. On the other hand the duties also necessitate assessing carers under Carers Recognition and Services Act 1995. Non statutory roles incorporate providing social needs assessment and ensuring confidentiality regarding issues pertaining to service user's disclosures under Data protection Act (1998) and Public interest Disclosure Act (1999).

In my initial visits, I intended building a good working relationship and knowing more about VB (Thompson, 2005). I found compiling a Genogram and an ecomap remarkable and the best way of identifying significant people that played a role in VB's care (Appendix 1). Parka and Bradley argue that, one of the advantages of formulating a genogram is because of “…its capacity to engender discussion and to raise important issues that social workers need to deal with and which may not have been recognised…” (Parka and Bradley, 2004:41). Compiling a genogram with VB gave me a snapshot of people that she regarded influential in her well being.

However, it is significant to highlight that my discussion focuses on the case study above as an example of my social work practice; to be precise, my involvement with VB, entailed completing membership forms and supporting her in attending regular national meetings in representing the entire hospital. My aim was to work in partnership with VB, her family and other professionals to provide a safe environment which promotes her recovery. While, I may have not paid detailed attention to the form requirements, my sole aim was also to ensure that VB had a binding membership with the national organisation. I envisage that in the process I overlooked essential issues of identity. The complex nature of labels and stigma is vividly evident in the medical model where diagnosis seems to locate ones position in society. VB has brain injury and her diagnosis according to medical Doctors is within the mental health continuum whether or not she agrees with it. In this scenario, I found the process of social work quite ambiguous in dealing with such intricate issues where there are no prescribed solutions Yelloly & Henkel (1995:8).

On the other hand, Identity “refers to the ways in which individuals and collectivities are distinguished in their social relations with other individuals and collectivities" (Jenkins 1996: 4). Whereas, personally, I choose to identify with a particular identity or group, sometimes I feel that some people have more choice than others. In this sense, although as individuals we have to take up identities actively; those identities are necessarily the product of the society which we live in and our relationship with others. I believe that each individual is unique and therefore Identity provides a link between individuals and the world in which they live. Identity combines how I see myself and how others see me, it is a socially recognised position, recognised by others, not just by me. Identity involves the internal and the subjective, and the external (Jenkins 1996:4). However, how I see myself and how others see me does not always fit. For example, VB may view herself as someone that just lives in the hospital, yet be viewed by staff within the hospital as a service user with mental health disorder ( because staff use the medical model to categorically systematise people).

Whereas, I was a bit sceptical about VB's hospital restrictions due to her aggressive behaviour, I found the medical model lacking considerations that VB is human; therefore being upset is an inevitable feeling regardless of ones mental state (Golightley, 2007). Goffman (1961) ascertains that mental health institutions have always been discriminative in nature fundamentally because of the power distinctions that are apparent between the staff (who hold the power) and the service user's (who are there for treatment; “supposedly”). Considering that I tend to flourish well when I am well informed and proactively engaging in my own learning; In this case I took the opportunity to research on the principles underlying the term service user participation in national forums and the process of mental health diagnosis. I took the opportunity to discuss some issues even with my assessor, in an attempt to ensure that my intervention was up to professional standard.

However, my assumptions that the term “Service user” would be fine with VB, obviously had effects on her. My own personal identity regarding my position in the agency in working with VB and my identity regarding my mental well being could have had an effect as well. VB strongly resents certain imposed terms such as “Service user” and being referred to as someone with Mental Health related issues. She feels that she is not valued as a full citizen as professionals seem to fail to recognise that she is unique in her own manner. VB clearly stated that she did not see the essence of living where she was at the moment because of dissimilarities with her peers in terms of degree of brain injury. VB's perception of herself links well with Yelloly and Henkel (1995) notion of uniqueness. Obviously VB's own identity does not link up with the medical model which see's pathology in her. For this reason, VB may continue to feel frustrated as professionals will continue to treat her as a group in terms of defining her disorder than treating her as an individual. On the other hand, I believe it was prejudice for me to take it for granted that such national terms (Political Correctness) will be fine to use with everyone. I quickly realised that my assumptions were wrong, I reflected in action by apologising and honestly being open about that it was an oversight on my part. I followed up by politely asking how she would prefer to be addressed. I was quite amused that she openly made me aware of her own identity, this enabled me develop a good rapport with her

Deconstruction is a process defined by Fook and Gadner (2007) essential in unpacking notions of how we are part of constructing power that discriminates service users in some instances. According to Thompson (2006) knowledge of one's human development is essential in reflective practice and intervention process of social work. For this reason I found it fundamentally crucial that I established VB's stage in the life course. Establishing her life course encapsulated considering her age and life experiences. Using Erickson's stages of human development, I located VB in the middle age, where one hopes to contribute to society by being productive (Beckett, 2007). Recognising her human development stage enabled me to understand her frustrations of failing to lead a normal life of at least fending for herself through working as a pharmacy assistant. I envisaged that, VB was finding it complex to consolidate her life achievements in a secure psychiatric hospital, hence the need for independence from living in the ward. Continuous reflection on her life experiences enabled me to remain focused on the task of using evidence based practice to inform my decisions.

GSCC code of practice (1) emphasises on respect for individuals and acting in the service user's best interest (GSCC, 2004). Similarly, Carl Roger's Client centered humanistic theory that focuses on individualism links up well with uniqueness highlighted by Yelloly & Henkel (1995:8) as the basis for multifaceted nature of social work practice.Rogers goes on to state that the therapist has to be deeply himself or herself - not "acting" - and that they should draw on their own experiences to facilitate the relationship (Payne, 2005). With reference to VB's issue of identity, I understood this to mean that I had to make some self-disclosures pertaining my understanding of terminology used in the hospital. I did this by discussing with VB that I had made assumptions that the term “service user” would be applicable to everyone. I made my apologies known to her; we managed to explore more about how she found the term unsuitable for her. This enabled me to focus on her as an individual and to be conscious of my own values about addressing individuals.

Having been aware of the fact that VB was not happy with the terminology, enabled me to address her properly and practice what Roger's called “positive regard” (Payne, 2005). I did this by valuing VB for who she felt she was and being compassionate as she related her story to me. Ultimately, best practice in the service delivery is to ensure that we respect the Human Rights Convention ( ) since the UK has been signed up to it for 50 years. The tendency is that Health and social care practice has the potential to affect some of the rights and freedoms in the ECHR ( ). Human rights point out that it is VB's right to identify with who she feels she is. While I agree that diagnosis helps to systematically categorise people, I argue that such issues must be viewed from a wider spectrum, ranging from personal, cultural to societies system as a whole. Whereas, society at large plays a role in modifying us, culture shapes our choices and our own personality/individuality influences what we may become. A combination of these factors can not be dealt with separately if an effective solution is to be sought.

With regards revisiting the case study above, reflection for me has been about drawing on my values, knowledge and experience throughout the course systematically and looking back to what I had done during placement and looking forward to what the next will be if presented with a similar situation. Similarly, Tovey (2007) refers to such practice as transformational practice that requires connotations of fundamental change (Payne, 2008). In other words, transformational practice entails challenging and changing status quo of practice. In this scenario this may have required looking into identity as an immediate concern to my initial engagement with VB. In this sense I found the issue of identity and labelling a significant factor in contributing to the complexity of this activity. Whereas I was aware of political correctness, I reckon I did not pay much attention to the requirements within the forms. This may have caused oversight on my part which I equate to unconscious competence stage of reflective practice (Knott and Scragg 2007). . .... argues that unconscious incompetence is a process where a person is not aware that they have a particular deficiency in the a certain area. For me, the learning curve motivated me to be more open to change and more receptive in gaining knowledge.

Having done a unit on critical reflection, my ability to essentially appraise my values and assumptions within various ethical and social contexts has significantly improved. This has been so because I have taken the initiation to proactively engage in my own learning by seeking to explore and understand my learning styles and effectively using support systems such as learning sets to tease my reflective practice. As reflected in assignment 1, I had envisaged that 45 logs was enough reflection, however little did I realise that reflection without good self assessment and deeper reflection warrants an incomplete spiral process of reflection.

Comparatively, I have never really doubted my learning style, but I must admit that the opportunity I had in learning about different writing and learning styles enabled me to see the significance of adopting different ways to problem solving. While I may have been content with my own style of writing, trying other approaches to writing tremendously enhanced my skills of writing and taking in information. Not only were my proficiency in reflection improved, I reckon the progression enabled me to move away from my comfort zone of routine approach. This obviously has a knock on effect on my practice which I intend to keep on conscious competent level of reflection. ....... ( ) ascertains that conscious competence is the process of awareness of skill existence and reliable performance of that particular skill.????elaborate Indeed I have grown to think things through in a more sophisticated manner, from a wider and deeper perspective. I have understood this to require my ability to remain self aware and focused on the task in whatever activity and environment. I believe this is a high and multifaceted expectation which requires a continuous search for various perspectives to different situations. In a way, being focused on task is acknowledging that every individual is unique hence the need to tailor my social work practice to suit their needs in an attempt to individualise my service. However, individualising services has implications on resources, therefore I am fully aware that success of this is highly depended on the Agency aims and objectives and how resourceful as social workers we can be.

In an attempt to appraise my practice process with VB I decide to employ a critical incident technique by presenting it in one of my learning sets sessions. Fook and Gadner (2007) regard a critical incident as any event that is significant to a person. I considered VB's identity encounter significant largely because it exposed the medical model's nature of labelling and uniqueness of individuals. As I narrated the story, I apprehend that I might have not been precise in giving a detailed picture of the incident; this lead to my colleagues following with clarifying questions. On the other hand, such questioning may have indicated that their perspective to the whole situation differed to mine. This experience has enabled me to recognise the significance of detail and setting the scene in relating any information.

Working together in learning sets to look into each others logs enabled us pull our diverse perspectives from different situations. Using this pool of knowledge from the group work enabled me to acknowledge working collaboratively with other professionals even in practice. Having experienced deeper reflection, support from classroom interactions and learning sets, I have realised the significance of working collaboratively with other people to share different perspectives of situations. Every Child matters (2004) require different professionals working with children to work collaboratively together. In essence, this kind of working gives us the opportunity to look at people's problems from various perspectives. I also feel that I have come to understand that while theory helps us to understand issues, the reflective process gives me the intuitive knowledge of weighing what could suitable work in any given situation. In our learning sets, this entailed exploring my initial assumptions, thoughts and feelings even during the process; then unpicking elements in this event using theory and reflective support tools. I was a bit sceptical about opening up my personal feelings, assumptions and thoughts to my colleagues because its people I am not very close to. The learning sets encouraged me to communicate openly with other people with regards to my learning. As a next step, I hope to interact more with other professionals in my next placement.

Recognising influence medical model has in stigmatising and labelling people prompted me to continuosly search my assumptions, thoughts and practice. However, diagnoses by Doctors are social constructed because society readily accepts medical profession as the answer to problems faced by individuals. According to Biggs et al (1995), the Social construction perspective, holds the notion that labelling and stigmatisation is created and maintained through social institutions that instil in people certain beliefs about people's mental state thereby reinforcing bigotry and absolutism. The fact that society has often clustered services according to health and being well, implicates that being healthy points the locus of one's status in society; thus creating opportunities for discrimination to take place. Mental disorder in psychiatric settings bears a lot of stigma which appear to be reinforced by systems of assessment and intervention provided by Mental Health Practitioners and other professionals. In other words, society accepts that professionals like psychiatric Doctors have the scientific know how to determine who should and who should not be detained

While I might have thought that my ideas were brilliant then, I recognise elements of my practice that I had overlooked. I envisage, that the reflective experience and opportunity I have had in this unit, especially during learning sets has had tremendous effects in how I think and process things in my mind. As .. clarifies that learning by doing is the greatest teacher as information is retained in a more memorable way. I found Learning sets a great tool for taping into my underlying assumptions which I may have taken for granted. Realising how much easy it is for practitioners to label people through reluctantly accepting the status qou; pointed out to me how I could easily have been an unconscious incompetent practitioner.

I recognise the complexities reflective practice imposes on myself as a Practitioner. On the other hand, my profession compels me to accentuate on informed value assessments with reference service user involvement and participation in decision making forums. Similarly, justification of distribution of benefits and risks is fundamental in my principles of practice (Banks, 2006). In other words this means having to balance risks involved in ensuring individual appropriate services are delivered to them. These considerations obviously have tremendous effects on my own values as a person; thereby creating some ethical dilemmas in my role as a social work practitioner.

Bowels' et al (2006) inclusive model highlights the significance of having a sequential approach in coming up with alternative solutions for ethical dilemmas. He emphasises in being creative and having multiple solutions which are culturally diverse in these modern times. It is equally indispensable to recognise the connotations of basing on evidence based practice as fundamental principles in adhering to social work values and ethics. Over and above, awareness of uniqueness in people has enabled me to respect and realise each individual's capabilities of making their own decisions. The complexity of the social work task requires use of professional self: that is the ability to remain self aware and client focused whatever setting.

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