Contents Introduction In any health and social care setting, employees at all levels will be required to listen to patients, clients, their friends and relatives expressing their views, concerns and emotions. These can be complex and sometimes difficult interactions; therefore it is important that employees have the skills and necessary professional boundaries to be effective helpers in these situations, and to keep themselves emotionally safe. Employees need to be aware of the scope and limitations of helping relationships and how best their knowledge and skills can be utilised with, and on behalf, of the client.
The extent to which health and social care practitioners become effective listeners can depend on both inherent and taught skills. This unit focuses on the identification, practice and development of a range of interpersonal and counselling skills. Learners will develop the underpinning knowledge and ability to initiate, sustain and conclude an interaction with a client/patient, beyond that of being an effective listener to the level of skilled helper.
They will understand and practise the parameters of the skills utilised in such helping relationships, including managing the process and, where necessary, referring the client to alternative sources of support. It is important to note that on completion of this unit learners are not qualified to undertake client work in a counselling context.
An extensive programme of additional, higher level study and commitment to a period of personal therapy are required in order to become a counselling practitioner, eligible for professional body membership and/or accreditation. Effective listening and questioning techniques, and adherence to the boundaries of an ethical helping relationship, will be taught along with the understanding that an individual’s skills need to be continually reviewed and developed. Psychodynamic perspective Psychology is the study of human behaviour, thought processes and emotions.
It can contribute to our understanding of us and our relationships with other people, if it is applied in an informed way. Health psychology refers to the application of psychological theory and research to promote evidence-based personal and public health. To do this, psychology must take account of the context of people’s lives. Certain sets of beliefs and behaviours are risk factors for illness; therefore some knowledge of public health and the public health agenda for change is essential.
Those we care for come from a variety of different social and cultural backgrounds that value certain beliefs and behaviours above others. These may place some people at greater or lesser risk of illness than others; therefore some knowledge of sociology is essential. In order to understand the link between psychological and physiological processes, some knowledge of the biomedical sciences is also essential. Therefore psychology sits alongside these other disciplines to make an important contribution to the health and well-being of the population.
But it is important to note that the psychology we draw on has evolved entirely from western philosophy, science and research, and may therefore be viewed as specific to western cultures. Those working in the caring professions spend most, if not all, of their working lives interacting with other people. A key part of their job is to promote health and well-being. Most people are familiar with the following definition of health: ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (WHO 1946). If this is seen as an important goal, those working in health and social care need the knowledge and skills to help people work towards achieving it.
There are many ways in which psychological theory and research can contribute to improvements in health and social care including: • appreciate how people’s understandings and needs vary, so that we can try to ensure that the individualized care we provide is both appropriate and optimal; • gain a better understanding of communication processes so that we can identify ways of improving the therapeutic relationship and work more effectively in inter professional and inter-agency contexts;
• identify factors that affect how people cope with such situations as acute and chronic illness, pain and loss, and the demands of everyday life, so that we can help them, and ourselves, to cope better and reduce the risks of stress-related illness; • inform us about factors that influence people’s lifestyles and what motivates certain health-related behaviours such as smoking, dietary change and exercise; • apply evidence-based interventions to enhance health and well-being, and help people to change or modify their lifestyles. Western medicine emphasizes the importance of evidence-based health care.
Whereas much of twentieth-century health psychology was characterized by models and theories, the twenty-first century demands research based evidence to support these. An important recent contribution to the psychology of health has emerged through a field of study called PSYCHONEUROIMMUNOLOGY (pronounced psycho-neuro-immun(e)ology). Studies now show that our emotions play a key role in the link between the world we inhabit and our immune responses.
This is conceptualized within the ‘bio psychosocial’ model of health which emphasizes the complex interaction between biological factors and physiological systems (life sciences), psychological processes (thoughts, feelings, behaviours) and the social and cultural context in which people live and children grow up (see sociology and social policy). This field of Study provides strong evidence to support the need for holistic care.
The main purpose of this book is to enable practitioners to apply evidence based psychology to enhance their therapeutic work, work more effectively with members of the multi-professional team to promote the health and well-being of patients (or clients) and their caregivers, and preserve their own health and well-being.
Behavioural Perspective Learning theorists believe that learning has occurred when you can see changes in behaviour. The behavioural learning model learning is the result of conditioning. The basis of conditioning is that a reward following a desirable response acts as a re enforce and increases the likelihood that the desirable response will be repeated. Reinforcement is the core of the behaviourist approach. Continuous reinforcement in every instance of desirable behaviour is useful when behaviour is being introduced. Once a desired behaviour is established, intermittent reinforcement maintains the behaviour. Behaviourist theory approaches are frequently used in weight loss, smoking cessation, assertiveness training, and anxiety-reduction programs.
The importance of regularly and consistently rewarding desired behaviour immediately and not rewarding undesirable behaviour is crucial to the success of a behaviourist approach to learning. Learning is broken down into small steps so that the person can be successful. The nurse provides reinforcement at each step of the process. For example, when a patient is learning how to inject insulin, the nurse looks for a positive behaviour and then gives the patient immediate reinforcement by saying, “I liked the way you pulled back the syringe,” or “You did an excellent job of withdrawing the insulin. ”
Cognitive Perspective Cognitive learning theorists believe that learning is an internal process in which information is integrated or internalized into one’s cognitive or intellectual structure. Learning occurs through internal processing of information. From the cognitive viewpoint, how new information is presented is important. In the first or cognitive phase of learning, the patient learns the overall picture of what the task is and the sequences involved.
In the second, or fixation learning phase, the learner begins to gain skill in performing the task. Whether a physical task is learned as a whole or part by part depends on its complexity. For example, learning how to take a blood pressure is a complex task. The patient must learn how to physically manipulate the blood pressure manometer, learn how to hear blood pressure sounds, and understand the meaning of the sounds. Each of these tasks can be practiced as a separate activity, and then combined. In the last phase of learning, the automatic phase, the patient gains increasing confidence and competence in performing the task.
Humanist Perspectives Humanist learning theorists view learning as a function of the whole person and believe that learning cannot take place unless both the cognitive and affective domains are involved. The individual’s capacity for self-determination is an important part of humanist theory. For example, humanist theory is used to help post myocardial infarction patients regain a sense of personal control over their health care management. It is possible to select elements of each theory that you find useful in patient teaching. Boundaries and ethical codes.
The boundary between what is acceptable and unacceptable for a professional to do both at work and outside work (for example, whether a social worker should have a sexual relationship with a former service user); the boundaries of a professional’s expertise to practise (for example, whether complementary therapies can be undertaken by the professional as part of their work); and inter-professional boundaries (for example, whether a social worker should do a task usually undertaken by a nurse). An innovative aspect of this study has been the use of a modified snowballing technique.
In preliminary discussions with the GSCC (commissioners of the research) it was agreed that the term ‘boundaries’ suggested grey areas and that, in some respects, obviously illegal activities did not fall within the remit of the research. For example, if a social worker were to steal from a service user, that would be so clearly out of bounds that further discussion is not necessary. Twelve very brief scenarios were developed to illustrate the different kinds of more difficult boundary issues (see Appendix 2); these were emailed, with an introductory and personalised email message, to a convenience sample of 142.
informants throughout the UK and abroad (see Appendix 3). Each informant was asked to consider forwarding the scenarios to further potential informants who might be interested to respond, hence the Since the purpose of the responses to the scenarios was illustrative rather than systematically scientific, it did not matter that the sample was not ‘representative’, or that we had little control over who might respond. 49 responses were received before the deadline date and these were all included in the analysis. Role of counselling interactions.
The social values which underpin this interactive definition of mental health are strongly congruent with the “humanitarian and egalitarian ideals” which form the value base of social work. Further, the emphasis on “interaction” between person, group and environment fits closely with social work’s “person-in-environment” practice domain: “The primary focus of social work practice is on the relationship networks between individuals, their natural support resources, the formal structures in their communities, and the societal norms and expectations that shape these relationships. This relationship-centred focus is a distinguishing feature of the profession.
” Work in the mental health field requires an ability to work collaboratively and is strengthened by a systems perspective. As these knowledge and skill areas are emphasized in social work education, social workers are well positioned to play a significant role as our society strives to achieve mental health goals in the twenty-first century. In mental health settings, preventive activities include public and client education regarding emotional self-care and healthy relationships, building community knowledge and skills (community development), social action, and advocacy for social justice.
In mental health settings, treatment activities are focused on individuals experiencing acute psychiatric symptoms, emotional trauma, relationship problems, stress, distress or crisis and include assessment, risk management, individual, couple, family and group counselling, intervention or therapy and advocacy. Social work uses relationship as the basis of all interventions.
In mental health settings, rehabilitation activities focus on clients who are disabled by mental illness and may include individual, couple, family, and group interventions to build knowledge and skills, provision of specialized residential, vocational and leisure resources, and advocacy to ensure the development of needed services and to change community attitudes.
Specific to their employment setting, social workers in mental health deliver the following professional services: •Direct Services to individuals, couples, families and groups in the form of counselling, crisis intervention, therapy, advocacy, coordination of resources, etc. •Case Management – coordinating inter-disciplinary services to a specified client, group or population. •Community Development – working with communities to facilitate the identification of mental health issues and development of mental health resources from a community needs perspective.
•Supervision and Consultation- clinical supervision/consultation, maintaining quality and management audits and reviews of other social workers involved in mental health services. •Program Management/Administration – overseeing a mental health program and/or service delivery system; organizational development •Teaching – University and college level; workshops, conferences and professional in-services •Program, Policy and Resource Development – analysis, planning, establishing standards •Research and Evaluation.
•Social Action •Social work knowledge base which facilitates practice in this field includes theories of intervention, practice-based research, concepts and theories of human development through the lifespan, mental health, family functioning, group behaviour and the broader socio-political processes that shape society. •Specialized knowledge of mental disorders and their impact on individual family and community including the psychiatric classification system, major syndromes, theories and knowledge of aetiology, and current concepts of intervention, treatment, risk assessment and rehabilitation; organizational
aspects of mental health services; community structure, social and political processes, development and resources; and knowledge and understanding of the paradigms for practice of the other mental health disciplines. •Continuing education/professional development is essential. •Registration in the appropriate Provincial/Territorial Social Work Association is often required. References •http://www. udel. edu/PT/current/PHYT600/2012/Lecture4Handouts/CES_25_ CulturalCompetence_012003%5B1%5D. pdf •http://mrwhatis. net/environmental-factors-in-a-health-and-social-care-setti