The Psychosocial Approach

The psychosocial approach helps us to develop a healthy questioning of the obvious. An open mind, imagination and knowledge of personality functioning, human behaviour and emotional suffering are inherent in the ideas; they assist in reaching;differential diagnoses and treatment plans. This is another way of saying that clients interact with their environments in unique ways and if we are to give service which is accurately targeted then, when appropriate, we have to comprehend underlying feelings and motives which can block people from making optimum use of such help.

Freudian psychoanalytic ideas, particularly personality theory, began to feed into what became known as psychodynamic casework. Freud’s approach was the attempt to explain the internal processes that motivate behaviour, Freud’s belief was one of psychic determinism; that is, that all behviour has a cause that is to be found in the mind. Various theories of how the mind works have derived from Freud’s theories, which were strongly associated with the biological nature of human beings, particularly the sexual drive. Later developments have become more focused on the social nature of human beings, but Freud’s belief that the mind has a conscious and an unconscious part remains a powerful influence on western culture and beliefs.

Psychodynamics has been hugely influential in the development of social work because freud was a pioneer in an approach to complex human behaviour which sought to give rational explanations based on the human condition. This is often forgotten, particular by the critics of Freud, who stress the controlling aspects of his approaches to analysis, and its sexism. The stock in trade question ‘how do you feel?’ comes from the influence of Freud, who stressed the importance of the feelings of his patients, rather than treating them as if they were objects of ‘treatment’.

The goal of more- mainstream psychosocial techniques is to assist the person, the situation or both by reducing internal and /or external conflict. Therefore while the focus may be on the behaviour, some attempts is made to understand and resolve inner conflicts. Two main procedures are used – sustaining and modifying.

Sustaining procedures

These are techniques familiar to practitioners who talk about offering support or building relationships. They include:

Ventilation

Realistic reassurance

Acceptance

Logical discussion

Demonstrating behaviour

Giving information

Offering advice

Environmental manipulation

Modifying procedures

These also aim to reduce outer pressures while increasing ego awareness of previously unrecognized aspects of personality dynamics. In social work terms this would be the client gaining insight. Providing that diagnosis of ego strengths has confirmed that self- scrutiny can be tolerated, techniques include:

Reflective communications

Confrontation

Clarification

Interpretation

The techniques do not aim to elucidate unconscious motives, restructure personalities, all that we are hoping for is that the person might see things a little differently and feel they have more control over their problem.

An example of the psychosocial theory can be applied to john, john is a 26 year old man who is currently living with his parents. John attends a day centre for people with learning difficulties. John currently gets to the centre by the day centre bus or a family member escorts him. John would like to self-travel , buts gets anxious at the prospect and usually backs down close to starting a self-travel programme, we could explore with john any previous experiences of self- travel that went wrong, ventilation, ask him how he feels about it all. Try to find out if john is using defence mechanisms too often, if so, try to build up his confidence and self-esteem by reassuring him that he is able and that many people self-travel. The worker could demonstrate the behaviour of self-travel, enabling john to role model the worker, this keeps john calm, and helps build up relationships of trust.

Psychosocial practice in social work can be found in group care settings and in some therapeutically oriented residential provisions. The therapeutic community movement has always nurtured its own traditions of theory and practice and its principles have become widely disseminated in psychiatric day centre work and some in-patient settings.

In the UK, with the advent of policies of care in the community for people who had previously often been consigned to institutions, the need arose for a theory and practice of psychosocial care applied to community networks and support systems. Overall, psychosocial perspectives have developed increasing importance for social work and other professional groups where multidisciplinary primary care has become widespread in developed welfare states and where the main challenge now stems from managerialist tendencies in welfare rather than radical political critiques.

Systems Theory

The core of systems theory comes from biology and engineering, and has been translated into social work practice by the identification of social systems as open systems. The significance of this is that:

all parts of the system are connected and what happens in one part of the system will have an effect on all other parts of the system;

the system needs to keeping a steady state and will always adjust itself or adapt to try to maintain that steady state; and

there is a feedback loop within the system, which provides the capacity for change.

A systems approach allows for an analysis which encourages workers to be more innovative in the way that they approach situations. This is particularly relevant to care management where the focus in on the person and their situation, the problem and the strengths and resources.

In systems theory there is also the model of Input – Output – Transformation – Feedback. you look at what input comes into the system, what output resultsor what goals set, what transformations are taking place in this process and what feedback is evident where.

Output

can be what happens or it can be a goal

Input

What you are taking in from around you. The output of onesystem contributes to the input of another system. Inputs from the environment systems affects outputs of the clients system. Can get input from community education, social work, education, past life experiences etc. these have an effect on your output. If you have a good education and a positive family experience growing up (input) then you are more likely to give positive output in return.

Transformation

The manner in which clients system uses inputs from the environment. In psychoanalytic theory transference is a form of inputs i.e. the therapist offers help and the client transfers her feelings for her mother on to the therapist and starts to relate to her as though she was her mother. It is misinterpreting behaviour or transforming communications.

Feedback

When the coutput of the client system isn’t helpful, feedback may help the client system to correct itself and thus encourage more appropriate behaviour.

For example, joe is depressed. His output is that he stays in the house and stops socialising. He turns peoples offer of help down and so friends stop inviting him to as many social events as before. He gets invites to go out (input), but he decides that people don’t care anymore and don’t want to be around him (transformation). His social worker told him that people do care, but when you turn them down so often or don’t return calls then they think he isn’t interested (feedback). Joe decides to go to a local mental health drop in centre (output) to try and get out of himself a bit more. He experiences encouraging conversations from staff and users (input) and he becomes more involved in the centre and generally socialises more.

In systems theory there are phases of planned change. These phases include the use of a variety of skills. The phases are as follows:

Assessing Problems – What is the problem? Analysing the systems? Who is to be involved?

Collecting Data – Questioning, observing and checking records.

Making Initial Contacts – Contacting different people in all the systems.

Negotiating Contracts – Contracts with Client or Target System. Being clear on everyone’s tasks.

Forming Action Systems – Deciding who is going to do what work with whom?

Maintaining and co-ordinating Action Systems -Making sure things run smoothly, watching out for communication and power issues.

Influencing Action Systems – Being aware, and using the knowledge, that if you affect one part of a system you bring about change in another.

Terminating the Change Effort – Conclude the work and evaluate it.

Systems Theory as you can see uses a variety of models. This makes it quite a structured approach which also very focused and can be easy to follow even although it uses a lot of Biological/ Engineering jargon.

Systems theory has been criticized for being functional, i.e. for only describing what is rather than what might be, and for placing insufficient emphasis on differences in power within various systems.

QUESTION 2

Task- centred work

Task-centred practice is based upon a clear mandate for action from either the user or the courts, or from both. The agreement for work may be with
individuals, or groups.

The purpose of practice is to move from agreed problems (what is wrong) to agreed goals (what is needed) in a set period of time. Users must be concerned about the problems and want to achieve the goals. The movement from problem to goal takes place via tasks. These are undertaken by the users or by others. Tasks are the core of the model. Negotiation is needed to establish the agreement, to specify goals and to develop tasks.

There is clear respect for users cultures and views in this approach (Ahmad,1990), and negotiation will help make the mandate for work clear and the tasks as effective as possible. The particular contribution of task-centred work is that tasks will allow the need for other services to be kept under review and demonstrated through actions rather than solely through discussions. Tasks act as a mechanism to allow workers to assess the need for other services: for example, discussing which tasks might work best, or how a new service may help with a task which so far has been difficult to complete.

The five key points to task-centred approach are

Task-centred practice is based on usres agreement, or user acknowledgement of a legal justification for action.

Task-centred practice aims to move from problem to goal, from what is wrong to what is needed.

Task-centred practice is based around tasks, which are central to the process of change and which build on user strengths as far as possible.

Task-centred practice is open to other approaches and services, and can link with them via tasks.

Task- centred practice develops and changes by continuing evaluation.

The sequence of the problem solving is:

Problem>task>task>task>task>Goal

To implement a task the following sequence is to be followed- enhancing commitment- the worker asks the client to review the benefits of carrying out the task.

Make sure plans and details are as clear as possible.

Obstacles and pitfalls are analysed and ways to overcome them are explored.

Summarising and restarting the task and the plan if things are not working.

O,Hagon states that there are 4 important elements that you need to intervene effectively in a crisis situation.

1. A Sound Ethical Base

2. A Theoretical Framework

3. Self-Awareness

4. Principles, Techniques and Skills

Initial interview; One should focus on the present circumstances and not seek to look for the root of the problem at this stage. The worker and the client together assess the situation and prioritise. Whatever problem is the most overwhelming or stressful is considered first and broken down into manageable components. If you arrive into a crisis situation, you often end up on the receiving end of abuse because your presence is threatening. Its helpful to alleviate fears and show you are there to assist as far as possible. O,Hagon suggests that if a person is identified as the client and all attention or focus is on them, then the worker should seek to shift this focus to reduce the tension. This can simply be done by asking the others questions about themselves and their relationship etc to the client.

Coulshed states the importance of conveying a sense of hope to the client and showing commitment on the workers part. The worker also helps to clarify thinking and help keep them rooted in reality. As a person becomes clearer in their thinking you should seek to help them gain some control again by giving them manageable task to complete by the next interview.

O’Hagan states that a worker should not attempt to “rescue” clients in crisis by removing them from the situation to a different environment. He maintains a person’s mental, emotional and physical state may not be able to adapt to such a change.

The middle phase is more on getting missing information to get a clearer picture of the causes of the crisis. Possible links with previous problems should be investigated.

a) the worker should enable the person to talk and so vent their feelings, which clears thinking.

b) Together you should look at ways the client has successfully coped with situations in the past, get in touch with these strategies and strengths again.

c) Look at alternative solutions or unused resources and so develop new coping strategies.

d) Set specific achievable tasks together.

The final stage, the client will be through the crisis stage now and equilibrium should have returned. This is the stage for reviewing progress and planning for the future.

Care plans

The community care act 1990 outlined the role of Care Managers and the format of Care Plans. The format is Assessment, Implementing, Monitoring and Reviewing.

Assessment

Involve the resident by agreeing dates and times, offering appropriate support, and explaining the process, also obtaining as much personal information as possible. Ensure that the residents are fully involved from the earliest possible stage of the care planning stage. Where there is someone providing care, their view also need to be taken into account, the following points should also be taken into account;

Wishes and preferences.

Expressed needs for support

Care provided.

Implementing

Implementing the care plan consists of achieving the objectives of the plan with least intervention necessary. Plans should also have clear objectives. It is also very important to involve the resident at all times throughout the implementing of the care plan, this allows them to have a degree of ownership to their care plan.

Monitoring

The aim of the monitoring the care plan is to confirm the achievement of set objectives over a period of time, and to change the plan in line with the differing needs of the resident. Any alterations that are needed to the care plan must have consent from the resident.

Review

This is the formal process which occurs at regular intervals of time, (usually every six months), where the resident, key worker, care manager and sometimes social worker meet to reassess the needs of the resident and make any necessary revisions.

References

Bibliography

Social Work Practice An introduction Third edition, Veronica Coulshed & Joan

Orme.

The Blackwell Encyclopedia of Social Work edited by Martin Davies

Modern Social Work Theory second edition Malcolm Payne

Systems Theory (class Handout)

Care plans (Class Handout)