Schon (1983) describes reflective practice as the process of reflecting on an action or experience which gives professionals the opportunity to continue learning about their practice. The ability to reflect gives professionals the chance to identify the strength and weakness of their practice. It is also an account with a particular service user’s group or an account with an individual service user.
In this essay, I will critically reflect on my practice learning in relation to the service user, “D”, who I worked with in a voluntary organization specifically for people with problems in mental health called “OCL”.
I will show how I have worked with the service user, how I have properly done my role as a social work practitioner, how I have understood and achieved the needs of the service user, and how I gained and developed further learning for social work practice.
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I will begin by providing a brief history of the organization, its aims, and services provided. I will critically examine the processes of assessment, intervention, theories, and approaches that I used in working with the service user. I will also look at the ethics dilemma and challenges involved in working with D. I will finally conclude on how the experience may benefit my social work practice including professional development, accountability and competence.
For confidentiality purposes, I will refer to the service user as D, and the organization as OCL, according to the General Social Care Council Code of Practice of 2002.
Organization Background Information
OCL is a charity-based organization that provides rehabilitation services to young people and adults suffering from mental health illnesses. It seeks to inclusively improve the quality of life and independence of people with mental health needs from the Black Minority and Ethnic Communities (BME).
It aims to develop a person’s capacity to realize their potential and lead an active and positive live, by ensuring that a non-judgmental and culturally-sensitive support service is tailored to achieve the optimum degree of independence, encouragement and stimulation.
OCL offers support services such as:
employment skills services
self-help groups and leisure activities
money advice and debt counseling
information and advice services
outreach support services
OCL also has social work roles, tasks, and responsibilities aside from providing support services to people living with mental illnesses. These are to:
assist in identifying their skills, interests, and aspirations
help to identify their suitable employment
help to develop their technical and social skills
support them in job placements
Service User Background Information
The service user is known as D who was a 43-year old British man. He had been recently discharged from the hospital and had been getting treatment for depression and other mental illnesses. D claimed that his depression and mental illnesses were the results of his unsuccessful marriages. He had been referred to my placement office to get support stated under section 117 of the Mental Health Act of 1983, and provision of after-care service for people who had been detained stated under section three of the same mental health act.
I discovered that D had lost his parents at an early age of one and a half. He was taken care then eventually given to an adoption center by the age of six. When he was already 13 years old, he was taken back from his adoptive parents because of his strange behavior. His manners were unacceptable; he became disrespectful and disobedient until he eventually went violent by swearing at everyone.
When D reached 18, he was given a one-bedroom apartment where he began living on his own. He got into a relationship and had two children. Since the relationship was between teenagers, it did not become successful and ended in a breakup. D lost contact with the woman and their children.
After a few years, he got into a relationship again and had a daughter. This relationship ended just this 2007 and the mother imposed a restraining order against D to keep him from seeing their daughter. This was the time when D started to feel isolated and rejected.
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D told me that he needed support to rebuild his life socially and mentally. While we were having the initial assessment interview, he was not in a good mood because he was so depressed from his separation from his family. He kept on talking about his well-loved nine-year old daughter and the fact that he cannot see her again because of the contact restraining order against him.
He was so worried that the restraining order that keeps him from seeing his daughter would affect their happy and strong father-daughter relationship. The separation from his daughter was affecting his parental responsibility as a father, and became one of the main causes of his mental condition.
Also, D was suffering from loneliness in his one-bedroom apartment and had affected his social life. He tried to kill himself through medication overdose. Upon learning these things about D, it clearly states that he needed help to remove the restriction order against him and be able to see his daughter again.
The purpose of this stage is to understand and establish the context of intervention. This involves understanding the reasons for referral, and any action plan must be clarified with the service user as it is important to involve the service user in every aspect of intervention process.
My first step was to read the organization’s profile in order to familiarize myself with policies and legislations which will guide my practice. Following this, I had read through D’s referral notes and the accompanying risk assessment. I was able to make a detailed service user profile of D, taking note of his past contact with the Law, involvement with intoxicating substance, hospital admission due to his mental health need, risk factors, and signs to watch out in his life prior to him relapsing in his mental health well-being. I had also read through his early childhood family relationship and his past marriage life and relationships.
I found out that D is suffering from depression. According to Nesse and Williams (1994), the feeling of depression often results in physical inertia, which means that the compulsion is at rest.
Paul Keedwell stated that “support and interdependence were important in the formation of the human environment.” The organization or social worker should give help to the person until the condition has been stabilized (Spinella, 2008).
Also, he mentioned that “a depressed individual may affect the attitudes of other people that surround him. It makes them have the feeling of sympathy to his needs and this would lead to giving him a long term social or reproductive advantage” (Spinella, 2008).
Milder depression is coined as realism, or the “sadder-but-wiser” term. It is a perspective of the world that is not distorted by positive biases (Taylor, 1991). Upon learning what depression can do to the person, I discovered what better ways to deal with D’s situation.
Mental illness is the result of a progression throughout childhood development that turned out to be not successful. It results in problems with the personality. Because of unresolved childhood conflicts, the mentally ill person is not aware why he acts the way he does. Upon discovering D’s depressed mental state, I have better views on how to deal with him and his situation.
The information gathered helped me decide how to start my involvement in supporting D’s needs in the best way possible. By reflecting on the processes of assessment, I felt that it was important for me to gain a whole picture of D’s circumstance in order to provide an appropriate support. I was also mindful of the common Assessment Framework which embraces three key areas namely the child development needs, parental capacity for care, and the environmental factors (DH, 2000 a).
I was aware of confidentiality and its limits when dealing with D’s case. Based from the information I gathered, I became aware that D was given up for adoption at an early age and later taken care by his adoptive parents. It seems that this incident has affected him a great deal psychologically. D is seen as a lonely person because he lives alone. He is at risk of feeling isolated and neglected.
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He was also very concerned that the lack of contact with his daughter will affect the strong attachment he has built with her, thereby reducing on the circle of people who accept him in life. It was also affecting his parental responsibility to his daughter. D attributed this separation as one of the key cause for his current mental state. The referral to the OCL was due to get support under section 117 of the mental health Act 1983 “Provision of after care service for people who had been detained under section 3 of mental health Act 1983”.
Assessment is a process in which a client participates in the purpose to help the practitioner to find some objectives (Coulshed & Orme, 2006). Thompson et al (2008, p59) states that assessment is a method that practitioners undertake with clients and not something they do to them.
After gathering the relevant information which helped me to decide how to start my intervention, I arranged to meet face to face with D to assess his needs. This was a good way of empowering D to make him feel understood and involved.
Darymple & Burke (2005, p286) points out that the approach to empower requires direct focus on helping service users to gain control over their lives, be aware and be able to use their own resources, overcome difficulties in achieving their needs and goals, let them be heard in terms of decision-making process, and be able to bravely enter situations where there is inequality and oppression.
I used the exchange model wherein the service user was an expert of his own life and situation. Payne (2005) argues that exchange model is not about ignoring the issues of power and empowerment but about having them seen as transparent and explicit by the service users in order for them to make decisions effectively and influence their own lives.
As a professional, I have to be aware that in some circumstances, it could be not very helpful to use this model particularly when the user’s mental ability to make decisions are very limited, including people with severe learning disabilities.
However, the relation that I developed with D enabled him to identify his strengths and resources as well as weakness and limitation. This enabled me to empower D to take more control of his assessment process and he would be involved in the resolution of any difficulties and dilemmas.
In order to assess D’s needs in a perfect and empowering manner, I used a range of communication skills such as questions. I reflected, focused, summarized, and listened effectively to what D was saying. According to Barker (2003), communication is verbal and non-verbal exchange of information including all ways in which it is transmitted and received.
Watson et al (2006) states that effective communication is required to help put people at ease and gather information which enables and empowers the service users to feel part of the social worker process. Moreover, Watson et al (2006) said that failure to communicate effectively can lead to service users being confused about what is expected of them or failing to understand the reason for social work intervention.
I chose to use the person-centered approach. It was a way for me to support D and determine what he wanted and needed. This is the manner in which it does not violate his independence to make his own personal development in trying to cope with his depression. Kitwood (1997) explains that “a person-centered approach ensures that the person experience and needs are central” (Koprowska, 2005).
From the assessment visit, I found out that D’s depression did not interfere with his ability to function as a normal person. But depression still has potential risks to consider, especially when the symptom of the illness becomes worse. Furthermore, with limited family support, the worse depression risk would be greater.
Carl Rogers developed the person-centered approach from a humanistic perspective. It means that it is more focused on the client telling their story. With D’s state of depression due to his experiences, gathering of information using the person-centered approach was the best. It would enable D to process his thoughts and go back to his memories in his own free will to be able to identify the issues about his current situation.
Rogers’s theory of person-centered approach gives more meaning to this practice in the sense that having more personal conversations with the service user helps a lot in forming a trusting relationship between D and me, and gives a thorough understanding of his life.
It means that good relationship with the service user must be developed. Obstacles and other difficulties need to be overcome.
For this to be achieved, the social worker must have the three fundamental skills (Hough, 2006) that would encourage service users to be open and be able to identify problems and find solutions:
unconditional positive regards
Once D’s needs were identified and classified using the eligibility criteria, the social worker has to make the decision whether the identified needs would be met. After the decision is made, the social worker has to inform the assessed individual of the decision of whether services will be provided.
This is in line with section 47 (2b) of National Health Service and Community Care Act 1990 which states that “the Authority shall inform him that they will be doing so and of his rights under that Act.” Parker & Bradley (2003) suggest that social workers should use their own judgment to prioritize the needs of their clients in order to meet them.
I arranged an introductory meeting with D. Together we set achievable tasks such as the task to take over his parental responsibilities for building a good relationship with his daughter. This will allow him to overcome the feeling of rejection as he builds a circle of friends around himself.
I used several interlinking interventions which helped me to meet D’s needs. I used task-centered approach which focused on several and different tasks such as:
Support D during his IT training
Refer him to advice bureau to get clear information and advice regarding his rights
Task to get him a solicitor
Advocate, on his behalf, with job centers and find out more information regarding his benefit entitlement and other support he may be entitled to
Refer him to different activities such as cinemas, swimming, day center, museums, and many more
Task-centered approach is part of the family of problem-solving models wherein tasks are broken down to directly address the target problems to develop the user’s problem-solving skills (Dominelli & Payne 2002; Healy 2005). It means working together with service users to set goals which are achievable, and to monitor their accomplishments.
Cognitive-behavioral therapy and counseling were also used in the context of D’s feeling about his daughter and the problem in his personal life. In addition, group therapy and system theory were also used in working with D.
In using system approach, the main objective was to take into account the structural and environmental factors which influence D’s circumstances.
However, as the issue of a child was involved in D’s case, the social worker has to be aware when working on the best interest of D who has mental health problems. But it is also important that the social worker work collaboratively with other professionals, because to meet the needs of service user is not one-sided but will be meeting the whole needs of D. This will require all the professionals involved with the case to assess the situation and decide on how the needs identified could all be achieved.
However, multi-agency work might be difficult in this situation because each professional will be working from different code of ethics. The social worker has to be given permission to pass on any adequate information to other professionals.
Systems theory stresses the inter-relatedness of people, families, agencies, and institutions in our society. The social system includes everyone from individual to communities and all these groups of people influence each other. In the systems model, the assessment is central.
The model suggests that if the social workers see individuals as being part of a larger interacting social systems, they will be aware of a wider greater range of possible solutions to people’s difficulties.
Pincus & Minihan (1973) argue that the life of individuals depends upon all kinds of people, agencies, and organizations in terms of material and emotional support. In D’s case, work was also done with the outside of the organization such as solicitor, advice bureau, job center, housing, nurses, doctors, social workers, and many more.
D wished to get a job or a voluntary work to keep him busy. Together with my advocating, we contacted the appropriate agencies and registered with them in order to help him get initially a job or a voluntary work. He also started IT training with the project. Having looked at the interventions, we will discuss some of the theories which informed my intervention to D’s circumstances.
Practice and Perspectives
Social work is practical action in a complex world. Theory perspectives and models are all useful tools that try to offer explicit guidance to a practitioner. However, I found it difficult to find theories that match to D’s circumstances.
Milner & O’Byrne (2002, p74), argue that matching theories to types of problem is difficult because each of theoretical approach maybe helpful in any other.
My intervention was informed by range of theories, which include Bowlby’s attachment theory, Bandura’s social learning theory, and Freud’s psychodynamic theory.
Beckett (2004) defined theories as set propositions that are made from isolated facts. Theories are also tools to be used to further our understanding. Beckett (2004) further stated that stage models of development tend to turn out to be too “neat” when applied to the real world.
I felt that these theories to some extent appeared to offer an explanation on some of the circumstances that D faces. The fact that he was given up for adoption and later taken into care by his adoptive parents, also the fact that he was restrained from seeing his daughter, seems to have psychologically affected him a great deal. I also felt that these incidents might be one of the contributing factors to his inability to cope in his life.
When I assessed D’s situations, I used a psychodynamic approach because I wanted to know whether his separation with his biological parents or with his daughter, could be one of the contributory factors of his current situation. In addition, I felt that the failure to bond with his wives might be another contributing factor. I considered the relationship he had with his daughter. I also considered his early childhood experience and they also framed him within adoption and care.
One of the theories that formed my intervention was Bowlby’s theory of attachment. Bowlby’s theory seeks to understand human behavior and development because of psychological impact. The theory looks at the importance of the quality of the relationship between the primary caregiver and the young child and this has significant on all subsequent relationships.
The attachment theory is very important as it can be applied by social workers to identify certain stages of development that a child has missed (Smith et al 1998). In relation to this case study, D’s feeling lost, rejected, and lacks attachment from his biologic parents, from his adoptive parents, and separation with his daughter might be contributing factors to his mental state.
Bowlby believed that there are four distinguishing characteristics of attachment namely:
Proximity Maintenance - It is the desire to be near the people we are attached to.
Safe Haven - It means returning to the attachment figure for comfort and safety in the face of a fear or threat.
Secure Base - It is when the attachment figure acts as a base of security from which the child can explore the surrounding environment.
Separation Distress - It is the anxiety that occurs in the absence of the attachment figure.
Bowlby (1951) saw the mother as the primary caregiver and the primary attachment figure. Bowlby saw the main role of the father as supporting the mother.
However, Ainsworth et al (1978) explained deeply the principles and perspectives of attachment based on experiences and relationship with the main caregivers. These attachments were grouped as secure, anxious-ambivalent, anxious-avoidant, and disorganized.
Ainsworth (1978) claimed that early relationship is important in order for a child to form a health relationship. A secure child is likely to grow up confident and feel safe.
Secure attachment can be described as when a child does not want to accept the mother’s departure and quiets down when the mother return (Ainsworth, 1973). He/she accept comfort from her and then return to play. This relationship is classified as a secure attachment.
Avoidant attachment can be described as a child that shows little to no signs of distress when the mother leaves, or willingness to play, and little to no visible response to the mother when the mother returns. This relationship is classified as avoidant.
Ambivalent attachment can be described as a child that shows sadness when the mother leaves. But is willing to be comforted by a stranger and even when the mother returns, he shows signs of anger, lack of enthusiasm to cuddle up to her, and return to playing. This relationship is classified as ambivalent.
Disorganized attachment is problematic attachment, which leads to personal difficulties (Beckett, 2002). This attachment relate to those children who experienced rejection and unresponsiveness from their caregivers.
For example, a mother fell pregnant without planning, the majority of these children experience rejection and unresponsiveness attitude from their caregivers (Ainsworth et al, 1978). Furthermore, a study by Goldfarb and Spitiz in 1947 suggested that there was link between separation experiences in childhood and delinquency or behavior problems in adolescent. For example children whose parents are divorced have a higher risk of behavioral problems in adulthood.
Bowlby’s attachment theory has its limitations. It has been criticized for failing to consider cultures. This theory is applicable to social work practice when working with children and families. Research says that younger ones are likely to build primary attachment with the most approachable and motivating person around them. This person may or may not be the mother or main caregiver (Parke, 1999). The theory appears to fail to promote anti-oppressive practice. A social worker needs to work in an anti-oppressive and anti-discriminatory way to promote the wellbeing of children who miss the opportunity to live with their mothers. For example, those who lost their mothers at the birth or the mothers in critical conditions that do not enable them to approach their children.
Social Learning Theory
Bandura (1965) argued that behavior is primary learned, therefore it can be unlearned (Malim and Birch, 1998). According to behaviorists, behavior that is reinforced or rewarded is likely to be repeated and learned.
Behavior is reinforced if it brings about the desired outcome. The behavior perspectives have been used in social work with a range of different service user. For example, drug and alcohol service users, people with learning disabilities and those experiencing neurotic disorders, and work with offenders (Payne, 2005).
Humans learn by observing other people’s behavior, attitudes, and outcomes of those behaviors. According to Bandura, human behavior is learned by observing through modeling. It means that by observing others, a person forms a thinking of how new behaviors are made. In later parts, this observed information can be a guide for action.
The necessary conditions for effective modeling according to Bandura are:
Attention — various factors increase or decrease the amount of attention paid.
Retention — remembering what you paid attention to.
Reproduction — reproducing the image.
Motivation — having a good reason to imitate.
Thus, behavior can be learned through observation, modeling, and imitation. In D’s situation, we can see the connection between his past experiences in family relationships and the difficulties it contributes to his behavior when he grew up.
The Psychodynamic Theory, which was discovered by Freud, is based on the principle that human behavior and relationships are developed through conscious and unconscious influences (Bowlby, 1999). In D’s case, this theory is applicable since he has problems with behavior, relationships, and depression.
Psychodynamic Theory is one of the theories in wherein persons with mental illness are treated in a way that attempts to find out something that is lacking in their lives. According to this theory, every person is made up of a dynamic that starts in childhood and continues through the entire life.
Psychoanalysis, which is a part of this theory, believes that all problems in adulthood are directly associated with the experiences during childhood. With D’s current state, it is assumed that his past childhood experiences growing up in an orphanage without real parents had affected his present behavior.
Psychodynamic therapies are used to treat people suffering from depression. It focuses in helping to determine the depressed person’s conflicted feelings and its possible causes and solutions.
Psychodynamic counseling, on the other hand, emphasizes on the influence of past experiences on the current behavior. It is often related to the object relations theory which states that previous relationships have an effect on a person’s self-esteem and may result in changes of behavior.
The main concepts of Freud’s (1923) Psychodynamic Theory are:
Concerned with psychological processes
Concerned with early childhood experiences
Concerned with the unconscious motivation
Concerned with the person’s ego and superego
Concerned with the person’s defense mechanisms
The psychodynamic theories focus on the influence of a person’s drives and forces, and the importance of experiences in building the personality. In this theory, conscious experience, its effect in the unconscious, and the social factors are important in the development.
The study of human behavior includes factors such as personality, motivation, and childhood experiences. In the case of D, it is very crucial to understand the effects of his past experiences to his current mental state.
Freud, in his theory, believed that there was a cure for the mental disorder. It was through interpretation. In this method, the psychoanalyst would give meaning to past experiences in order to enlighten the mentally ill person. But there is challenge created from the defense mechanisms of the person with mental illness.
The method is not intended to remove the defense mechanisms but change the unhealthy mechanisms with something more adaptive and functional. Psychoanalysis method, in the psychodynamic theory, tries to help the person recognize his psychological needs and drives, and provides healthy ways to obtain them.
Psychotherapists who believe and apply this theory looks at the person as the combination of their parental upbringing experiences. Their manner of treatment is through resolving conflicts within the mentally ill person and between their parents. In the case of D, he had certainly developed problems with parents at an early age. He did not have proper parental upbringing and was not able to experience a harmonious family relationship.
The progress of an adult’s individuality is seen in terms of whether he or she was able to go through the stage of childhood successfully. Due to this, adults do not know how they got mentally ill. As a result, they may not notice the symptoms of mental illness.
I have chosen this work with D because it was where I can show the best of my ability. I learned so much from this experience. D’s situation is common but his was unlike any other. It made me look outside of the box. It made me see what is beyond the mental illnesses and psychological patterns.
In studying D and his life, I found out a lot of important things that normal people usually take for granted. Family was the issue with D. He was deprived of it when he was just a child, and still was not successful in building his own when he grew up.
A social worker’s interaction with a person with mental illness is normal and common in the profession of social work. I experienced counseling with D and I understood the efforts to prevent the cause of mental illnesses and its consequences. The importance of developing programs, advocacies, and funding in the service of the people suffering from mental health problems such as D was realized.
I have been exposed in the available and applicable theories and interventions which have helped me go through this practice learning. I was able to maintain my focus on the practice, for the individual service user, and the social environment.
In the recent years, social workers remain the best provider of mental health services. The practice offers more services than other mental health care providers in terms of being able to give comfort, attention, and inner needs.
I am sure that the service user “D” and I both took benefits from this social work practice. It feels good that I was able to support D. I will certainly take all the things I’ve learned in my future practices.
As a social work practitioner, I wisely used my knowledge and skills to help D in his depression struggle. I was able to make D express his views freely and listened to his concerns. I learned how to accept D as a normal person and not with a mental illness, respected him as who he is.
But even if I had gained more knowledge and understanding in this learning practice, it is still not enough. D’s situation differs from all others. Future practices may be different and would require different approaches. I might have ended well with my dealings with D, but in future cases, more challenges and dilemmas need to be overcome in a new manner.
This practice learning has given me the chance to assess my own self. I was able to weigh my skills. There were those that I needed to improve and some that I can consider my abilities. I learned to prioritize what is more important by doing what needs to be done first. In this practice, it is necessary to weigh and balance the work. I am aware of the importance of critically evaluating my own work as part of building up my practice. This activity enables me to recognize strengths and weaknesses and consider ways of developing. For example, I used feedback from K as a way of evaluating my practice, as well as the area that needs improvement. In addition, supervision enabled me to improve my practice. I used the sessions to help identify areas for further development of learning but it also offered me encouragement.
In dealing with D, I learned to be careful with the practice standards and rules of confidentiality. I made sure that D was respected by letting him participate in the whole process of this practice. His thoughts and needs are very well considered.
The most important thing in this practice is that it is bound by theories and law. In different cases, different theories are applicable depending on the situation of the service user. In my case of dealing with D, there are certain theories that I used to be able to identify his problems and support his needs. But theories just guided me in this practice. Awareness in terms of personal values, individual cultures, and proper treatment of service users were crucial in my intervention.
Dealing with service users who have behavioral problems can be challenging at times. With D, the dilemma was during the times when depression attacks him most. I had to keep up with him and support him with lots of encouragement. It is very important to be aware of own values such as patience. The social worker’s emotions and movements can influence the service user.
In my practice learning placement, I keep on focusing for the benefit of the practice and learn to handle dilemmas and conflicts. My practice learning has indeed taught me how to become a better person entirely. I am able to develop my skills and be able to stand up for my rights and those of the service users.
Finally, I feel that I have obtained a better and wider understanding of what my practice is all about. My knowledge of the codes of practice, key roles, and legal procedures, which made me become an improved person in the field of social work.
Social work is indeed a profession that is constantly evolving. There is a need to be updated with the latest developments in terms of new practices, methods, and policies.
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