Reflection forms a central part of social work practice and education, and it is particularly important for social workers in placement settings or newly qualified social workers (D’cruz et al, 2007; Parker, 2010). In its simplest terms, reflection “provides us with an opportunity to review our decisions and decision-making processes” however, in practice, reflection is a far more complex concept (Trevethick, 2005: 251). It is essential that social workers have the confidence to question their own practice, the organisation that they work in, and dominant power structures in society at large (Fook, 1999). Reflection, and in particular critical reflective practice, forms a key part of this, as social workers are called on to reconsider and reconstruct the dominant social discourse. In this essay I will explore my experience of reflection during my practice placement, and in particular in relation to a specific case study. I will start by outlining my practice setting, and the details of the particular case study. I will then explore my experience of reflection, and how reflective practice supported me to apply theory to practice. Finally take a critical look at my practice, and suggest things that I could have done differently.
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Although I engage with and explored multiple models of reflection during my placement, the model of reflection that I found most useful was Schon’s theory of reflection (Schon, 1983; 2002). Schon advocated 2 types of reflective practice. Firstly, reflection-on-action, which involves reflecting on an experience that you have already had, or an action that you have already taken, and considering what could have been done differently, as well as looking at the positives from that interaction. The other type of reflection Schon notes is reflection-in-action, or reflecting on your actions as you are doing them, and considering issues like best practice throughout the process. Due to the limits of the current medium, I will be focusing mostly on reflection-on-action. However, appropriate use of this type of reflection should inform future practice, and encourage appropriate reflection-in-action when presented with a similar situation again.
My placement was based at a not for profit mental health agency, where we provided psycho-social support for people who have experienced mental health difficulties. Many of the people that we worked with had been subject to section 2 or 3 orders under the Mental Health Act 1983/2007, and were now experiencing aftercare under section 117. Referrals to the agency could come from social services, GP surgeries, and other not-for-profit organisations.
The people with whom we worked usually had a multitude of presenting issues and concerns, and I was aware from the onset that complex settings like this require social workers to be reflective in their practice in order to be able to deal with a variety of situations (Fook and Gardner, 2007). However, it soon became clear to me that the fast-paced working environment, where at times paperwork was promoted over practice, meant that reflection could potentially be ignored in favour of bureaucracy and targets (D’Cruz et al, 2007). This type of difficulty and uncertainty around reflection is common in placement settings and when starting a new role (Knott and Spafford, 2010).
Reflection was particularly important when making the transition from university learning to the learning experienced in a placement setting. Social workers are provided with some guidance in practice to support this process. The Practice Competency Framework (PCF) domains provide some direction about what areas social workers are expected to emphasise in practice, and what needs to be evidenced in order to successfully complete a placement. Values and ethics are central to this framework, and comprise domain 2. Critical reflection is also part of this framework, making up the entirety of domain 6.
However, it is essential that social workers do not become complacent in their personal reflection, and they cannot fall back on these types of guidance and procedures as a shield against engaging in reflection on complex ethical subjects (Banks, 2006).
Many of the service users that we worked with had a dual diagnosis (problems with mental health and addiction). These service users particularly challenged me, as I found their intersecting issues usually stretch well beyond their dual diagnosis, to other areas like housing or physical health. I have, therefore, chosen to discuss one such case, where I engaged in substantial reflection. The background to this case study, and my involvement with him, will now be discussed.
JK is a man in his 50s who was born in Nigeria but moved to the UK at a young age. When I worked with him, he lived in a housing project that was specifically meant to house ex-offenders. Although JK had a lead key-worker at my agency who was a permanent member of staff, I was responsible for the majority of the key working sessions with JK during my time on this placement. JK had a long history of substance misuse and mental health problems. He was diagnosed with bi-polar disorder, and dealt with significant anxiety and depression. He received depot injections monthly for his mental health difficulties, and he found these instances particularly distressing. JK also had a substantial history of criminal activity, which he said became necessary in order to maintain his addiction to certain illicit drugs.
I would meet JK in a location of his choosing. Although usually this would mean either in our office or in his room, sometimes we went for a walk and I accompanied him to appointments at times also. This more informal working setting was where he felt he could speak most openly to me. Although I will discuss my involvement with JK more broadly,I will focus on one particular key working session that we had, where JK was most descriptive about all his concerns and the issues that were effecting him (session A). This is significant because reflection is particularly important when a critical incident like this has been experienced, and a less reflective approach could lead to a less holistic or even inadvertently oppressive account of what had transpired (Ruch, 2002).
Different models of reflection supported me throughout the reflective process. Gibb’s Model of Reflection (1988) and Atkin and Murphy’s Model of Reflection (1994) both promote a cyclical approach to reflection, whereby reflection is ongoing and not a linear process. I found this to be the case, as I did not move through stages of refection one after the other, but moved between them, often returning to my conceptual starting point multiple times before settling on a holistic understanding of an event or situation that incorporates all systems influencing that scenario. Keeping a reflective diary of critical issues and my own thought process encouraged me to construct my understanding of the work I was doing, and justify what actions I had taken (White, 2001). Support from colleagues and supervisors was also invaluable in this process (Ruch, 2002). Yip (2006) aptly notes that models like those described above are most useful when starting out the reflective process, and I quickly adapted and developed a model of reflection that was most appropriate for me.
Social work has traditionally been constructed as the professional knowing best, and continues to be practised in a way where the practitioner holds most of the power (Holmes and Saleeby, 1993). The power dynamics are slightly different in a non-statutory setting like I was working in. However, these power dynamics cannot be ignored, and underline all social work practice.I acknowledged the inherent power dynamics from the inception of my interactions with JK. I recognised that where unequal power dynamics exist in a relationship, it is usually the partner with the most power that benefits most from the interaction (Milner and O’Byrne, 2002). This is why it is important for social workers to listen to the perspectives of the people with whom they work, and be willing to accept different paradigms than their own or the dominant paradigm (Milner and O’Byrne, 2002).
When working with JK, I was made aware of his engagement with mental health services, usually provided through the medical professions. He had an allocated community psychiatric nurse (CPN) who would visit occasionally, and at times he also met with a psychiatrist. Throughout my social work education, the difference between the medical model and the social model of experiencing mental illness has been stressed to me, and I clearly saw this when working with JK. The historically oppressive nature of mental health services is widely recognised in literature (Szasz, 1961; Foucault, 1967), and JK expressed to me at times that he felt that he was not listened to by medical professionals, and just moved from service to service having things done to him, rather than with him.
Tew (2005) noted that the in the social model of mental distress, core values required include looking at the person and their situation holistically, removing the “us” and “them” thinking that tends to dominate mental health services, listening to what people really have to say, and being committed to anti-oppressive practice. I found these to be very helpful in working with JK. During Session A, the fact that I chose to explore JK’s mental distress alongside the other issues that were going on in his life allowed me to identify that his physical health, including intense back pain that he has been experiencing, was having a substantial effect on his mental health, and I encouraged him to seek help and support with this. JK clearly appreciated my anti-oppressive approach, where I tried to work with him in partnership, and he was always keen to know when we would meet next.
There is a stigma attached to having a mental illness, and even when contact with services has ceased, that stigma usually persists (Miles, 2005). JK had clearly been the subject of this stigma throughout his life. Tew (2005) believes if mental health services were more receptive to the social model of looking at mental distress, then significant amounts of this stigma and the resultant oppression would be removed.
Applying Theory to Practice
An important part of reflection in social work is the application and consideration of theories in practice (Trevethick, 2012). The theory base of social work is essential to all the work that we do in practice (Teater, 2010). Social workers need to be prepared to critically reflect on the theory that they are bringing to practice. It has been noted that the theory base of social work is dominated by euro-centric discourse, meaning that certain paradigms or perspectives may be excluded unintentionally (Trevethick, 2012). Being from Nigeria originally, and coming from a different cultural background than myself, meant that I had to be particularly careful in applying theory to the work that I did with JK.However, it is also clear that practice cannot just be based on routine or habit, with no basis in evidence (Thompson, 2009).
The increasing influence of post-modern theory, which does not promote one paradigm over another, but focuses on the subjective nature of truth, has helped to alleviate these issues in social work to some extent (Fook, 2012). Our agency worked with some of the most marginalised and vulnerable members of society, and engaging in uninformed work with these types of service users is a dangerous undertaking (Collingwood et al, 2008). Through active engagement with reflection, I was able to work with JK using an eclectic theory and knowledge base, but was also careful to note if JK was not comfortable with some aspects of my approach, and adjusted the approach accordingly. Working closely with JK over a period of several months supported me to be able to identify any issues quickly, and by the time I we were engaged in Session A, we had a good working relationship.
Of particular importance when working with service users who have a dual diagnosis was systems theory, and I found this theory to be particularly important when reflecting on Session A. Healy (2005) has recognised that systems theory have been highly influential on the knowledge base of social work. As noted above, people experiencing problems with addiction tend to have other issues in other areas of their lives (Tober and Raistrick, 2004).I was able incorporate specific applications of systems theory for the service user group I was working throughout my placement, and in particular with JK. The Six Cornered Addictions Rescue System (SCARS) was useful in that it took into account a person who was dealing with an addictions situation holistically, rather than just focusing on the addiction in isolation (McCarthy and Galvani, 2004). In Session A this allowed me to see how JK’s addiction and mental health problems were also linked to issues with accommodation, physical health, relationships and employment.
What could have been done differently?
I have discussed my work with JK, and reflected on specific incidents and issues with him. However, returning to Schon (1983), he notes that reflection takes place within our own understanding and the meaning that we attribute to an event, rather than within the event itself. Therefore, social workers need to look at their own underlying assumptions, as well as dominant social narratives, in order to shape their holistic understanding and experience of a given incident. Dewey (1993) recognised the importance of discovering new information in reflection. This can come from both internal sources (personal reconsideration) and external sources (professional support or research), and this new information can completely re-construct the way that an incident or event is considered, and change the narrative that we are engaged in. This is helpful in reconsidering an event, and determining whether something could have been done differently or better.
In relation to Session A, one area that I reflected on was that I may have focused too much on theory when working with JK. It has been recognised in literature around theory in practice that overly focusing on theory when working with service users can actually hinder the work being done, as the service user can feel depersonalised (Parker, 2010). As noted above, this was particularly important in the case of JK, who was from a different culture than me.
More time could have been spent on listening to JK and his perspective, rather than trying to fit him into a theory or model for the sake of evidencing my own case notes or reflective journals.
I worked with JK very much in isolation. Although I met his CPN and his drug worker, at no stage was a multi-agency meeting held that I was invited to. To some extent, this was the fault of the other professionals, who did not consult me on the work they were doing with JK, and literature has noted that collaboration is particularly difficult when working with dual diagnosis service users, as mental health and addiction services can disagree over the correct course, or who should take the lead (Clement et al, 1993; Champney-Smith, 2004). However, I could have made more of an effort to engage with them, or at least discuss with JK how much consultation he would like me to have with those other workers. Suter et al (2009) have found that a willingness to communicate is a key characteristic needed for effective collaboration, and after the other professionals were not active in engaging with me, I lost this willingness, potentially to the detriment of my work with JK.
It has to be noted that reflection is not always recognised as a self-evidently positive mechanism. There are critics of the way reflection is promoted in current practice environments, with some bemoaning the “cult following” that has developed around reflection in the social work sphere (Ixer, 1999: 513). Boud and Knight (1996) equally describe how reflection has come to be seen as “self-evidently worthwhile” without significant critique (p.32). Ixer (1999) recognises that focusing too much on assessing reflection can lead to a prescriptive approach to reflection that is uncompromising. I found this to be the case at times, when I was expected to write my reflections at a certain time, and have reflective supervision in a certain way. As well as this, having someone essentially assessing my reflection made this even more difficult, as I was not able to reflect in a way that was personal for me. Parker (2010) has noted that reflection is not something that can be assessed based on traditional reductionist techniques. Therefore, I found it important to not just reflect on my work and the working environment, but also the process of reflection itself.
The issues that social workers are engaged with, and that I have discussed here, do not only reflect the concerns of the service user, but are a reflection of the issues that are inherent in wider society (Davis, 2007). Unequal power dynamics, concerns around oppression and issues with stigma are all societal problems that social workers need to engage with not just on a micro-level, but also a macro-level. To some extent this is an area that I found reflection lacking in. I was able to look at my own practice, and my own assumptions and narratives; however, I was unable to determine how best to address wider inequality and societal oppression of people like JK.
In this reflective essay, I have explored my practice setting in relation to a particular case study. I introduced the placement setting and the case study, and then looked at my experience of reflection within this setting. I discussed how I engaged with different models of reflection, experienced power dynamics, and explored different interpretations of mental distress. I then moved on to look at how reflection promoted me to engage with theory in practice, in particular in relation to systems theory. Finally, I used this reflection to look at things that I could have done differently, including a decreased focus on theory and engaging more with other services. This type of critical reflection should be ongoing for social workers in practice, and to some extent it would be difficult to work in a complex setting like I was without being reflective. Although I noted some areas I could have improved on in my interactions with JK, what was most apparent in my work with him was that my willingness to explore his paradigm and perspectives opened him up to engaging with me on a range of issues, that otherwise may have remained hidden.
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