Author: Andre Coleman

Stereotype reflects the perception one has of other individuals based on their different physical abilities, emotional appearance, religious, cultural disposition, sexual orientation or ethnicity without knowing anything personal about that person and these views are often connected to experiences, observations or other influences such as the media. I will first outline below some of the reasons why it is important to avoid making assumptions based on stereotypes when providing care for someone and then later on show how individual care workers can guard against doing this.

Making assumptions, based on stereotypes, when providing care for someone can have a negative effect on the quality of care, as illustrated in the case of Mhairi who suffered from a stroke and needed a wheelchair but opted instead for personal care at home. The care manager, Stuart, who did the assessment could have found out about her sexual preference had he not assumed because she was married that her relationship with partner Gillian was heterosexual. This would have allowed more sensitivity to be shown by the carers when attending to her personal needs.

The stereotypical assumption that disabled people cannot communicate would have the consequence of them not being listened to properly and this would deny them the right to appropriate services and having a voice. This would impact on their individuality and personal needs, thereby affecting the quality of care being provided. As one participant wheelchair user pointed out in “It’s like when you go to the hospital or the doctors, if you go with anybody because you’re in a wheelchair they don’t address you, they look over you and that really infuriates me”. This underscores the need to speak directly with the service users rather than making assumptions that they are helpless or not capable of discussing their caring needs.

Showing narrow-mindedness because an assumption is made based on stereotype, is being prejudice and this was highlighted in Gypsy Travellers report about prejudice within the health care service. It can prevent Gypsies from gaining access to appropriate medical services such as the barrier presented by a receptionist “the receptionist are harder to get past aˆ¦ I think they’re doing the doctor a favour aˆ¦ ‘I did something good today, I kept the Gypsies away’. Another stereotypical assumption illustrated in is that people with mental health problems are ‘prone to violence’ – such was the case of Simon Jackson. However, he was just reaching out for help and often misunderstood, as he was suspicious of any ‘authority figure’. Making stereotypical assumptions can prevent people receiving appropriate care and if a carer has a prejudicial view it could further complicate the matter and deter users from accessing the services. For example, as given in, a disabled lesbian felt that she was seen as somehow ‘unnatural’ or abnormal. However, when these beliefs are carried through, it becomes discrimination. An example of this provided in K101 Block 3 Unit 10 where council estate residents were seen as ‘failures’ and not interested in academic success.

In providing care for someone in a local community, care workers should recognise and value diversity, that is, people are different and should be treated differently but fairly to avoid inequality and discrimination. Therefore, it should not be assumed that providing personal care for an Asian female would be the same or similar to that for a white European female. Care workers need to be culturally sensitive and take into account the differences in people’s lifestyles and family relationships.

As in people with speech impediments are sometimes stereotyped as being deaf and are often shouted at when communicating and this should not be indicative of all people with such a disability. When providing care for someone with this disability, a carer needs to be more informed about that person’s capabilities before engaging to avoid any communication barriers or leaving that person feeling demoralised.

It may sometimes be necessary to use stereotypes and make assumptions as it can act as a guide to help in decision-making, such as when organizing a social event for older people in a care home – as this could be the target audience and provide the opportunity to cater to their specific needs.

Individual care workers can guard against making assumptions based on stereotypes by being more tolerant and make every effort to understand that person better. The care worker should find out what help a disabled person needs instead of assuming what they think they need based on previous experiences or observations. It is important for care workers to avoid being condescending when disabled people are accompanied by their cares but should communicate directly with the disabled persons. If the care worker is not able to understand someone with a hearing impairment, they could ask the person to tell them how they prefer to communicate and not pretend to have understood them when they have not or they could become familiar with that person’s method of communication and find ways of keeping that communication going with aids such as Mankaton or other similar sign language. It is essential to identify that there are different religious, cultural and other particular needs of people, therefore care workers should also see service users as individuals and tailor care according to their individual preferences so that appropriate services can be provided. Care workers need to develop a knowledge and understanding of how the law affecting disability and discrimination as the Disability Discrimination Act 1995 protects disabled people and does not only apply to people who have a physical disability, visual or hearing impairment but can also cover people with learning disabilities. In addition, they should also be familiar with the Race Relations Act 1976, as it is unlawful to discriminate against a person on ground of race, colour, ethnic origin or nationality. An example of this was demonstrated in with an account given by Roz, a white nurse when a patient’s wife made loud racist remarks that ‘she thought it was disgusting that her husband should be in a bay with three black men on their own’ which offended the men. Roz did not collude with this racist view by changing their bays but instead left the men to sort it out amongst themselves, after gaining their views.

In conclusion, an assumption based on stereotypes when providing care for someone should be avoided as it could be construed as being prejudicial or discriminatory and is likely to have a negative Impact on the service user. Individual care workers can guard against doing this by recognising the diverse ‘global village’ we live in and be respectful of other people’s cultural, religious beliefs and ethnicity as well as any government legislation relating to disability and discrimination.

Word count: 1113

Veronica Anderson
Shalondria Wade Hill

I. Ethics and Social Work

For professions rooted in health and human services, ethics are a vital part and have the most importance. The social work profession is the epitome of both integrity and ethics. Although the majority of social workers display ideal ethics and the nature of the career tends to attract the most compassionate and principled individuals, there is a small minority that engage in behavior that is considered to be unethical. The NASW (National Association of Social Workers) Code of Ethics emphasizes that the core of any type of social work revolves around professional ethics. The mission of the social work profession is rooted in a set of six core values. It is somewhat of a map that guides each social worker’s journey and is important to all social workers regardless of working conditions. These core values serve as the root for all social workers and if followed properly will ensure that each and every social worker remain highly ethical in any situation that they may face. These core values are: (1) Service, (2) Social Justice, (3) Dignity and worth of the person, (4) Importance of Human relationships, (5) Integrity, and (6) Competence (National Association of Social Workers, 2013).

Unethical behavior for a social worker is any deviation or violation from the six core values and the several principles and standards set forth by the NASW. The reason social workers misconduct is so important is because misconduct and neglect of duty by a social worker could have harmful consequences. Misconduct by a social worker can result in serious injury, lost financial support, child endangerment, and in some cases death (Hyslop, 2015). With such fatal consequences, it is urgent that the social work profession understand why some of their workers engage in such ethical misbehavior. According to Dr. Frederic G. Reamer, there are several prominent themes when it comes to social work misconduct: (1) Desperation, (2) Greed, (3) Impairment, (4) mental illness, (5) addiction (including addiction to substances, sex, and gambling), and professional burnout (Reamer, 2012).

II. Competence

One of the critical core values set forth by the NASW is competence. Competence is the ability to perform one’s duties both successfully and efficiently. This is critical for social workers. Social workers tend to work long hours and have a number of cases, so it is important that they can work efficiently but also keep the same standards to ensure that the job is done successfully as well. The ethical principle states how “Social workers must practice within their areas of competence and develop and enhance their professional expertise” (National Association of Social Workers, 2013). For social workers it is proper to utilize their education, personal values, experience, training, and any other professional related experiences in order to properly address any situation.

Although it may be overlooked at times, being competent is a crucial factor in many cases of unethical behavior. With many of these situations, competence is the first core values that many unethical social workers neglect. Having a competent social worker is the necessary first key to resolving any situation and when it is lacking, terrible consequences could be the result. The NASW believes that social workers should continually strive to increase their professional knowledge and skills in order to apply them successfully in practice. In order to remain competent social workers must work every day to not only maintain their level of competence but to also build upon it as well.

III. Case

An example of unethical behavior in social work can be seen in the case of Candice Lassiter and Craig Smith in North Carolina. These two social workers were each charged with three counts obstruction of justice in relation to the death of a 15 month year old little girl. According to Mitch Weiss of the Huffington Post, the social workers were aware of the child abuse going on in the home, yet after the death of the child Lassiter, who was in charge, ordered Smith, a subordinate, to falsify records to make it appear like they did an fair and competent job in investigating the case (Weiss, 2013). There were several violations of social work ethics in this case which include: (1) lying, (2) incompetence, (3) service, (4) social justice, and (5) the unethical conduct of colleagues.

Gregory Achen notes how child abuse can be hard to substantiate and requires comprehensive, time-consuming assessments from social workers (Achen, 2013). If the two social workers in the previous case used the code of ethics this child’s life could have been spared. According to the Child Abuse Prevention and Treatment Act (CAPTA), child abuse and neglect is defined as: Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm (U.S. Dept. Health and Human Services, 2012). In the United States 9.3% of children were victims of abuse and/or neglect in 2009. With approximately 9% of children in this country neglected and/or abused, there needs to be a voice for the children, and that voice needs to be in skilled, ethical social workers.

To explain this problem in a social work setting, I propose this hypothetical situation. A social worker coming straight out of a Master’s program has just been hired by the Mississippi Department of Health and Human Services (MDHS) as a child protection services specialist. This social worker’s superior has been an excellent mentor so far and has provided necessary skills and knowledge on the subject matter and how to deal with a variety of situations. Over the past year, the young social worker has been to various functions with the supervisor and now considers them to be not only colleagues but close friends.

At MDHS, social workers are informed of suspected cases through the hotline and once the case gets assigned they have 3 levels. Level 1 is called the screen out; it is centered on neglect more than actual abuse. Level 2 is still neglect and abuse but more severe than level 1 and the social worker has up to 72 hours to make a home visit. Level 3 is the most severe level. Here are the cases of extreme physical abuse and sexual abuse and the social worker has up to 24 hours to make a home visit. (MDHS). Now unfamiliar to the young social worker, her supervisor has already had a level 2 call about child abuse in a pretty bad neighborhood. The supervisor has neglected numerous home visits and eventually the hotline receives a level 3 call about this same child. The supervisor still remains to follow through, and two weeks later, the same child is found dead at the home.

Upon hearing of the death, the supervisor is trying to cover their tracks and so they reach out to the young social worker. The supervisor should have handed the case to a CPS worker and oversee all of the home care visits, but did none of it. So they come to the young social worker to falsify official documents. He wants the young social worker to fill out reports showing that home visits were made and that everything seemed to be in order when they visited on the number of calls previously received. The supervisor would then sign off on all of the paperwork and even states how he himself went out to the home with the young social worker on one of the visits to ensure that everything was ok.

In this hypothetical situation the police never find out about the unethical misconduct of the social workers and they continue their friendship, however due to this incident more and more cases could possibly turn out the same way and one child’s life was lost. In this scenario, there has been a variety of social work unethical behavior demonstrated. Obviously lying to cover up another colleague’s neglect is the most obvious. The core values not used were reasonable for all six. The core value of service was not administered at all here.

A social worker’s primary goal is to help people in need, and in this case a child needed them and nothing was done. There was no social justice performed by these social workers because social workers are supposed to help get justice for weak and vulnerable individuals, and in this case this was not accomplished. They did not acknowledge the dignity and worth of this child, possibly because of the unsafe environment with which they were being raised. The importance of human relationships extends beyond clients at times. Although it is the target to obtain a good relationship with colleagues, it is not worth it if the clients, social workers are supposed to help, suffer as a result of it. Lastly there was no integrity or competence shown here with the falsifying of documents to cover the tracks of a superior.

IV. Personal Reflection

Social workers practicing in the child welfare field often face the need to make critical decisions while working in stressful work environments that can include high caseloads and limited supervision, training, and support (National Association of Social Workers, 2013). As an undergraduate social work student here at Jackson State University, the NASW Code of Ethics has played a crucial role in not only how I view social work issues but also how I look at issues in my everyday life. The role of social workers when it comes to abuse varies, but it centers on the safety and well-being of potential victims. This is one major reason why I feel that it is important to have a code of ethics and set of guiding principles that anyone can fall back on when confronted with morally unclear issues such as the prior hypothetical situation.

In my opinion, both the supervisor and the young social worker were more than wrong in the above scenario. First off the supervisor was neglectful in his duties initially. Any level two calls about child abuse are extremely upsetting and his duty was to call attention to it and respond appropriately. To compound his neglect, upon the death of the child he immediately began lying to his superiors, to the young social worker, and to himself. Lying about visiting the home and lying about the entire situation was not the way to go. To top it all off, due to his negligence he brought in the young social worker to lie on his behalf. He used the friendship he achieved with a coworker to justify and cover up his mistakes. The young social worker is also at fault because she should have had more integrity to not get involved in the cover up and report the negligence of her supervisor to the proper authorities. All she did, by covering up his mistake, was leave the door open for it to happen again and that could cost more children harm and possibly cause another life to end as well.

One of the best things about the NASW code of ethics, in my mind, is the fact that they all work with each other. Without having one core value it lessen any of the other five. That is why I feel that competence is one of the most important ones. If a social worker is not competent it makes it almost impossible to display and of the other five core values. That is why in this case I feel that the core value most in need was competence. I feel that this falls hand in hand with my personal values. My aim is to become an exceptional social worker and the way to ensure this I must remain competent with everything I do. The supervisor lacked competence by not only neglecting his duties but by involving a subordinate in the affairs as well to cover his tracks. The young social worker lacked competence, by not knowing the situation that the supervisor put her in by asking for her to falsify documents.

If I was ever in any situation that could possibly contradict with my personal values or the social work six core values, it would be hard to say one hundred percent what I would do, but I am more than confident that with the importance of my values and the NASW code of ethics that a solution will be reached that does not jeopardize my integrity, the integrity of my career, and my past, current, or potential clients. As a social worker we must rely on our values and the NASW core values to help us in any situation.

If any situation contradicts with either of the two then we must take appropriate action. Not only would I have denied the request the supervisor gave to falsify documents, I would also reported it to either his superior or to the authorities. Social workers are similar to a variety of professions, especially when it comes to the fact that lives could potentially be in our hands. There is no way that someone could die because of my negligence, and instead of owning up to a mistake and serving the potential punishment, I would just cover it up. I would not be able to sleep at night as a result. Social workers are the first line of defense when it comes to abuse victims and with this comes the great responsibility of protecting the innocence of the nation’s children, ensuring that they at least have a chance to rise above the situation and go on to live productive lives.

Bibliography

Achen, Gregory. (2013). The Importance of Ethic in Social Work. San Diego State University School of Social Work. Retrieved From: http://socialwork.sdsu.edu/insitu/social-workethics/the-importance-of-ethics-in-social-work-by-gregory-achen/

Hyslop, J. (2015). Mastering Social Work Values and Ethics by Farrukh Akhtar, Foreword by Professor Hilary Tompsett, Part of the Mastering Social Work Skills series, Jessica Kingsley Publishers, London and Philadelphia, 2012. 168 pp. ISBN 978aˆ?1aˆ?84905aˆ?274aˆ?0 (Pbk),? 17.99. Child Abuse Review.

National Association of Social Workers. (2013). NASW Standards for Social Work Practice in Child Welfare. Retrieved from: http://www.naswdc.org/practice/standards/childwelfarestandards2012.pdf

Reamer, Frederic G. (2012). Eye on Ethics: The Dark Side of Social Work: Ethical Misconduct. Social Work Today. Retrieved From: http://www.socialworktoday.com/news/eoe_051712.shtml

United States Department of Health and Human Services. (2012). 2012 Child Maltreatment Annual report. Retrieved from: http://www.acf.hhs.gov/sites/default/files/cb/cm2012.pdf

Weiss, M. (2013). Candice Lassiter and Craig Smith, social workers, charged in Aubrey KinaMarie Littlejohn’s death. Huffington Post. Retrieved from http://www.huffingtonpost.com/2013/04/14/candice-lassiter-craig-smith-social-workersbabys-death_n_3079938.html?utm_hp_ref=crime

Mississippi Department of Human Services: http://www.mdhs.ms.gov/media/9579/titleandtoc.pdf

People continually communicate with each other in one form or another whether it be through spoken or written language. Communication is fundamental to social work enabling interactions with service users, carers, communities, professionals and organisations. The following assignment discusses how social workers communicate with a variety of individuals, how this can positively or negatively affects individuals and legislation which affects communication. The assignment will also look at barriers which affect communication and how this can affect individuals, the role self-awareness has ensuring social workers have an understanding of themselves and the effects of personal and professional values on communication. Finally the assignment will look at skills required for effective communication and ways in which these enable empowerment of individuals.

Barker (2003) defines communication as ‘the verbal and nonverbal exchange of information, including all ways in which knowledge is transmitted and received.’ (Cited in Trevithick 2005: 116). Everyone communicates something, social workers need to understand how to and how people communicate enabling relationships, gaining understanding of personal circumstances and experiences through carrying out assessments, writing reports, access resources to address need e.g. multi-agency collaboration. If individuals experience a negative communication the individual may become suspicions, doubt and mistrust the social worker leading to a loss of belief in the possibility of change, however positive experiences can result in individual’s being left with a feeling of hope. (Trevithick 2005).

When communicating social workers require knowledge of legislation regarding the transfer of information, the Data Protection Act (1988) controls how individual’s personal information is used by organisations and government, who are required to follow a set of ‘data protection principles’ including ‘information used fairly and lawfully’ (www.gov.uk). The Wales Accord on the Sharing of Personal Information (WASPI) framework provides protocols and agreements enabling effective collaborative working throughout organisations, enabling barriers to be overcome for ‘sharing information legally, safely and effectively’, while still ensuring the safeguarding individuals. (wales.gov.uk)

some individuals experience barriers which disenable communication, individuals with learning disabilities or specific communication issues including hearing loss or visual impairment experience social issues such as being ignored, treated as stupid, shouted at or people losing patients if they require more time, resulting in individuals being excluded from communication interactions leaving people isolated from society (Cree and Myers 2010). Thompson (2007) suggests age as a barrier stating Children and young people can be seen as unable to ‘legitimately participate in decision making’ being on the ‘periphery of what are seen as adult matters’, some older individuals state they feel the same as becoming ‘elderly’ they are no longer adults having a valid point.

An individual’s language is not just a means of communication it is part of their culture and identity, being able to use a preferred language can impact on professional relationships. Some people feel languages such as English are more important than others, however for Individuals with Welsh as their first language are unable to express need clearly in English due to the issue being discussed or lack of confidence, resulting in a need to swap from English to Welsh, being unable to may leave individuals feeling disempowered and oppressed as needs are not identified. Welsh Language Act became law in 1993 ensuring Welsh became equal to English enabling individuals to access services in Welsh (Davies 2011). This also impact individuals from ethnic minorities whose first language is not English.

To enable effective communication social workers need to become aware of how they interact and communicate with individuals. Burnard (1992) defines self-awareness as ‘the process of getting to know your feelings, attitudes and values [and] learning about the effect you have on others’ (Cited in Thompson 2002: p3). Thompson (2002) suggests self-awareness is gained by understanding own strengths and weaknesses in different situations, recognising any prejudice and accept diversities within individuals enabling confidence in own practice. If self-awareness is not acknowledged there is a risk of creating barriers between themselves and individuals by concentrating on their issues not the issues presented by the individual e.g. traveller communities may require a female social worker to request permission from a senior male to work within their community, the social work may not agree with this but they need to understand the cultural requirements to enable engagement.

Thompson (2009) suggests personal values develop from ‘upbringing, experiences and learning’, impacting attitudes, practice and ability to empower individuals. These values impact us with or without our knowledge and influence every decision social workers makes. Warren (2007) suggests social workers need awareness of own value base for two reason, firstly for awareness of ‘manipulation and control’ which may disenable social workers to fully empower service users. Secondly to enable social workers to identify conflicts which may arise between their and the service users values, such as social workers valuing a good work ethic and the service user not working claiming benefits. Service users and carers also have individual values which impact on how they engage with the social worker.

Professional values are core values within codes of practice and organisations grounded in anti-oppressive practice. The care council for Wales has a set of 6 core values which impact the practice of social workers and employers including ‘strive to establish and maintain the trust and confidence of service users and carers’, social workers need to use good verbal skills such as interviewing skills to enable this (Care Council for Wales 2011) . Biestek (1961) suggests seven traditional social work values which can be reflected in how social workers communicate with individuals. Four of the suggested values link directly to social work engagement with individuals to ensure ensuring a ‘non-judgmental attitude’ which does not including professional judgements which are made by social workers, while showing the individual ‘respect’ and ‘acceptance’ of individual’s strengths and weaknesses as an individual. Social workers need to react appropriately in a sensitive and supportive way understanding the uniqueness of individual and their feelings about situations, acknowledging individuals have knowledge and experience of need, if social workers fail to acknowledge this they are at risk of treating everyone the same and not meeting the individual need. Two values relate to individuals ensuring ‘Client self-determination’ and ‘Purposeful expression of feelings’ by encouraging individuals to discuss and express their feelings openly, enabling partnership working and individuals making decisions about their lives. The final value ‘Confidentiality’ enables the individual to discuss sensitive and personal issues in a confidential environment recognising confidentiality to the organisation not the individual, which social workers need to make service user and carer aware of in the initial meeting as this may impact on relationships making individuals feel deceived if they are not informed. (Cited in Thompson 2009: 127)

Society also portrays values which are reflected in political policy and implemented in legislation, such as how individuals act within society, if individuals do not comply with societies norms they could be arrested, taken to court and issued an ASBO, however there are some values held by certain sections of society which cause the oppression of certain members of society such as people who claim benefits seen as work shy. (Warren 2007)

Thompson (2007) states social workers need to understand communication can oppress individuals, to ensure communication is anti-oppressive and empowering social workers need to ensure they use appropriate communication skills to enable individuals to give their views through involvement in planning, developing and evaluating services resulting in a positive impact on individuals who engage and highlight any barriers which include issues of discrimination and oppression. Communication skills required depend on the situation and individual e.g. using basic language for a child or adults with learning disabilities would differ to giving evidence in court where more professional language is required (Trevithick 2005). Social workers need an awareness of words including gestures, meanings and understanding which may accompany them. The words a social worker uses can create relationships with individuals, but if the wrong words are chosen it can also have a negative impact on the individual, such as using large complex words with individuals could cause feelings of inadequacy and reduce engagement. Good communication involves the use of tone, timing, body language and choice of words which convey information and meaning to what needs to be communicated. Without clarity of purpose and language to describe what is being done social workers are not able to see clearly what individuals’ needs are and if interventions are working. Thompson (2002) states verbal communication can be separated in to two different areas which are what is said and what is heard. Social workers need to be aware of the speed a conversation is conducted, if they speak to fast it can appear they are feeling angry or anxious which the individual may reflect, it can also be hard to follow especially if the person has a hearing impairment or they are not speaking their first language. However if the social worker speaks to slowly it can portray the social worker is unmotivated, very cautious or defensive. Hanley (2009) states having good communication skills is central to empowering and anti-oppressive practice.

Social workers need to ask a wide range of questions as part of interviews which have a wide range of functions including stimulating self-reflection and returning individuals to their knowledge base where self-determination and empowerment can be located. Open questions enable service users to express their thoughts and feelings in their own words, in their own time, this type of questioning forms a major part of an initial interview, however some individuals feel intimidated by this type of questions and might guess the answers. Closed questions are usually answered by yes, no or short answers such as name or age, this sort of question is good for fact finding, where time is limited and keeping the individual focussed. However this type of questioning can lead the service user away from what they perceive as the main issues leading to frustration (Trevithick 2005). Thompson (2002) states empowering interviews are built on strengths to overcome weaknesses or turn weaknesses into strengths. Appropriate interviewing can make an important contribution to empowerment however inappropriate interviewing can cause great harm.

Good listening skills are required in a variety of situations such as carrying out assessments, requiring the social worker not only listen to what someone says but how it is said, when they say it and if certain themes occur. Social workers need to create an environment free from distractions to enable the social worker to listen appropriately. Trevithick (2005) states social workers need to be able to listen to what is not being said which is referred to as a ‘third ear’, being aware of the wider social and cultural context of the individual. By adopting a non-selective approach to listening the intention is to minimise the social workers bias and stereotypical assumptions and follows the lead of the individual to create an opportunity for change.

Non-verbal communication accounts for two thirds of meaningful communication, there can be miscommunication between messages sent and what has been received. Egan (1982) suggests the mnemonic ‘SOLER (Straight position, Open body, Leaning, Eye contact, Relaxed) as a model for non-verbal communication through body language (cited in Hanley 2009:177). The body language of a social worker in relation to what is being said can be confusing if they do not convey the same message e.g. sitting slumped in a chair, avoiding eye contact while carrying out and assessment of need can be perceived as disinterest (Hanley 2009). Trevithick (2005) suggests observational skills are important in understanding non-verbal interactions, enabling social workers to gain understanding of a situation. Observation skills can be used as a general or specific part of an intervention to gain an understanding of the environment as well as the individual. Koprowska (2005) states by using silence this can give people the opportunity to speak, but the social worker needs to appear to show interest in the individual to encourage them to fill the silence.

Lishman (1994) states symbolic communication is important to practice, being ‘punctual, reliability and attention to detail can show the social workers ‘care, concern and competence’ which can make the individual feel they are important. (cited in Trevithick 2005) The way a social worker dresses can also reflect something about the social worker and have a lot of influence on individuals depending on their age, culture and social standing. Returning phone calls can communicate a lot and can start or stop creating a working relationship.

Fanon (1967) states ‘Language is a central aspect of discourse through which power is reproduced and communicated’ (cited in Thompson 2007:5). Social workers have power through decision making and statutory powers, through using effective communication skills, knowledge of value bases and legislation social workers empower individuals to gain equivalent power where appropriate. Social workers collaboratively work with individuals through sharing information, opinions and asking questions based on information and ideas of the individuals to ensure engagement is positive ensuring goals set are specific and achievable, empowering individuals to make positive changes within their lives.

References

Adams, R., Payne, M., Dominelli, L., (eds) (2009) Social Work themes, issues and critical debates, third edition. Hampshire: Palgrave Macmillan

Care Council for Wales (2011) Code of Practice for Social Care workers and Employers of Social Care Workers. Cardiff. Care Council for Wales.

Cree, V. and Myers, S. (2008) Social Work: making a difference. Bristol: Policy Press

Gov.uk, Data Protection. Available from www.gov.uk [accessed on 01/02/15]

Koprowska, J. (2005) Communication and Interpersonal skills in Social Work. Exeter: Learning matters Ltd.

Thompson, N. (2002) People Skills. Basingstoke: Palgrave

Thompson, N. (2007) Power and Empowerment. Dorset: Russell House Publishing Ltd.

Thompson, N. (2009) Understanding Social Work, third edition. Hampshire: Palgrave macmillan

Trevithick, P. (2005) social work skills: a practice handbook. United Kingdom: Open University Press

Welsh Government, Wales Accord on the Sharing of Personal Information (WASPI). Available from wales.gov.uk [accessed on 13/02/15]

Warren, J. (2007) Service User and Carer Participation in Social Work. United Kingdom: Learning Matters Ltd

Williams, C. (eds) (2011) Social Policy for Social Welfare Practice in a Devolved Wales. United Kingdom: British Association of Social Workers

Informed consent is not only a basic right of all clients, but it also helps to protect the client’s privacy and can be utilized to empower them to make their own educated decisions about aspects of their own therapy. Ideally, the goal of the practice of informed consent is to provide patients with the most relevant and accurate information regarding their own treatment, so that they can decide for themselves to become involved and willing participants in their own therapy sessions. One of the best methods for instituting informed consent practices is to establish a protocol for enabling clients to make their own educated decisions.

It is important to note that the practice of informed consent carries with it a number of legal implications as well, primarily due to the fact that its purpose is to protect the rights and privacy of the client. From a legal standpoint, there are three aspects of informed consent that are of primary concern: the client’s capacity for rational decision-making, the client’s comprehension or understanding of the information, and the client’s voluntariness, which ensures that decisions made by the client are of their own free will.

For the therapist, informed consent governs many aspects of administrative duties as well, such as confidentiality, record-keeping and maintenance, and the transfer and disclosure of client files. While these aspects are more clearly defined in terms of what therapists can and cannot do, therapists are also left with the additional task of ensuring that all clients are properly educated and informed about procedures and the legal implications and also that each individual client has the ability to comprehend such information and make decisions regarding their own treatment. It is this aspect of informed consent that often lacks such clearly defined rules and is often a matter of judgment on the part of the therapist.

Adequate informed consent is becoming increasingly important for today’s mental health professionals, as more and more people are seeking individual or marital counseling as a means of improving aspects of their own lives or relationships. In all aspects of healthcare, the appropriate procedures for obtaining adequate informed consent are still debatable. Because therapists have the unique opportunity to be able to work with clients in order to improve decision-making skills, this process is even more important. The goal is not to steer clients in any one direction or another, but rather provide each client with all of the information in a manner which they understand, be able to answer questions regarding the policies, and enable each client to make their own educated decision about what is best for them and their particular situation.

Informed consent for therapists is often more difficult when faced with clients who may be in danger, under psychological distress, or faced with a domestic violence situation. Often, these clients may lack the ability to make rational decisions or may be fearful of participating in their own therapy due to the risk of confidentiality breaches and concern for their own personal safety. In this instance, it is often the therapist’s responsibility to not only offer additional reassurance regarding confidentiality, but also accurately represent the legal implications of informed consent and if and when records may be disclosed, along with what kind of information can be shared and under what circumstances. In addition, when there is a great deal of psychological distress present, it may be necessary to reiterate policies at a time when clients are more stable, and also take greater measures to enable the clients to adequately make their own decisions.

In cases where a client lacks the capacity to make informed decisions on their own, due to age or disability, a parent or guardian may be necessary in order to provide adequate protection of the client’s rights and sign legal documents. In terms of comprehension of the information provided, therapists should frequently have question and answer sessions with the client regarding the goals of treatment, client participation, availability of other services, expectations, and any risks involved. Clear communication and guidelines are the best way to ensure that a client adequately understands not only the purpose of treatment but their roles and responsibilities as well.

Informed consent procedures for therapy can be seen as more than just legal practices. The continuously evolving methods of ensuring informed consent for clients also further enable and empower clients to educate themselves, take an active role in ensuring their own well-being, and learn to make more choices regarding their own personal care.

Outline your understanding of attachment theory and describe the implications of this for therapeutic counselling? Illustrate your answer with reference to clinical work. Consider the implications of this theory in a modern society, which has many alternative family structures.

Introduction:

What is early attachment theory? John Bowlby originally proposed attachment theory and defined attachment as “any form of behavior that results in a person attaining or retaining proximity to some other differentiated and preferred individual, usually conceived as stronger and/or wiser” (Bowlby, 1973, p. 292).

Attachment or bonding is the developing relationship to parents, a carer or carers and is necessary for ordinary development. Children’s attachments can have an impact on the rest of their lives. Attachment behaviours begin early in life. This trusting relationship which is developed in infancy forms the foundation for a child’s development. If children have a secure attachment, they will grow up to view the world as a safe place and they will be able to develop other emotions.

However, children who experience early separation and loss will express this through their behaviour. A secure attachment will lead to better general coping skills, and the cost of insecure attachment may lead to isolation (Bowlby, 1969).

In this essay I will present material about attachment theory. I will explore the different views and my aim is to relate it to clinical work. My illustrations will be drawn from theory and personal experience.

Theory:

According to Vera Fahlberg (1988) the most common causes of attachment problems, the highest risk being in the first two years of life, are sudden or traumatic separation from primary caretaker through death, illness, hospitalisaton of caretaker, or removal of child from the care of the established attachment figure/figures. Furthermore, she claims there are other causes for attachment problems which include physical, emotional or sexual abuse, neglect of physical or emotional needs, illness or pain that cannot be alleviated by caretaker, and frequent moves and/or placements i.e. foster care, adoptions and changes of caretaker within the family setting. John Bowlby (1988) believes if no bond or attachment is formed during early life the child is more likely to be unstable and anxious as an adult. The work of John Bowlby seems to have been the most influential in attachment theory and I feel Bowlby highlights the important implications for the counselling relationship.

Before Bowlby the behaviour of infants to seek attachment with adults was thought to be about an instinct to search for food (Bee, 1999). Bee (1999, p. 42) cites Freud (1856-1939) as saying “…love has its origin in attachment to the satisfied need for nourishment”. Freud suggested that the baby forms a bond with its mother by satisfying its hunger. He calls this stage of development the oral stage which begins soon after birth. Freud believes if the child satisfies this related need then it should promote a feeling of pleasure therefore, returning to a comfortable state (Bee, 1999).

However, according to Fahlberg there is some evidence that the social needs are more important to the attachment process than meeting the physical needs. Fahlberg refers to Ainsworth’s (1913-1999) 1952 findings, “social interactions, not routine care, are the most important part of mothering” (Fahlberg, 1988, p.27).

Erikson (1902-1994) however, shared most of Freud’s basic assumptions, but differed between inner instincts, and outer cultural and social demands. Unlike Freud who placed central emphasis on inner instincts. However, Erikson named his developmental stages as ‘psychosocial stages’ as he believes a person goes through different stages through their lives. To be able to reach self acceptance they must first fully develop each stage. If this does not happen then problems will arise (Bee, 1999).

According to Bee (1999) Erikson describes the first stage as ‘basic trust versus mistrust’. Bee went on to say “Erikson believed that the behaviour of the major caregiver (usually the mother) is critical to the child’s establishment of basic sense of trust.” (p.45). Therefore, if the caregiver responds to the child consistently, in a way the child has become accustomed, and responds in a loving and predictable way, then trust will develop. However, he believes if that doesn’t happen, and the child has had inconsistent care then mistrust may develop, which may lead to anxiety. Erikson believed that development went on through the entire life span, as the child, and then the adult developing a sense of ever-changing identity (Bee, 1999).

However, John Bowlby disregarded these theories of attachment, believing instead that the process was much more complicated. He put forward the idea that babies look for physical closeness, comfort, food and familiar interaction (Bowlby, 1988). “The young child’s hunger for his mother’s love and presence is as great as his hunger for food” (Bowlby, 1969, preface xiii) John Bowlby brought this concept to the fore and as Robert Karen states in his book, Becoming Attached, “Bowlby’s theory was bold, full of common sense, speculative but grounded in science, and threatening to the older views” (1998, p.101). However, all three theorists seem to agree that healthy secure attachments are very important for human development.

Attachment helps the child:

– attain full intellectual potential;

– sort out what he or she perceives;

– think logically

– develop a conscience;

– become self-reliant;

– cope with stress and frustration;

– handle fear and worry;

– develop future relationships;

– reduce jealousy.” (Fahlberg, 1988, p.13)

According to Ainsworth (1913-1999), attachment is an affectional bond that has been established by having a continuous loving and caring relationship with another human being. “…an affectional bond is a long enduring emotional tie to a specific individual” (Leather, 2004, pp.21-25). Studies of children raised in institutions have shown that adequate physical care is not enough. A primary person to whom the child can become attached, who responds to the child’s needs and who initiates positive activities with the child is indispensable.

Attachments are formed by the constant repetition of two very positive cycles of interaction: ‘The arousal – relaxation cycle’ and ‘The positive interaction cycle’ Fahlberg, V. (1988) Fitting the Pieces Together. (Practice Series: 17) British Agencies for Adoption & Fostering:

The following diagram illustrates a successful interaction between the caregiver and child. The child cries because of its need for food, caregiver feeds the child, the child becomes calm, therefore the child’s needs have been met which will then establish a secure and trusting attachment. This cycle must be completed to ensure a healthy development.

Fahlberg, V. (1988) Fitting the Pieces Together (p. 25)

The next diagram illustrates the positive interactions between caregiver and child. The caregiver interacts and plays with the child, meeting social needs, the child responds, therefore building a child’s confidence.

Fahlberg, V. (1988) Fitting the Pieces Together (p. 27)

If the baby’s needs are not met consistently then the baby doesn’t develop trust, becomes full of rage and perceives the world as a dangerous place. This is then carried through into adulthood, causing feelings of insecurity through to sociopathic behaviour depending on the degree of mistreatment or abandonment for the individual (Fahlberg, 1998).

The three patterns of attachment are:

Secure Attachment – exploration from secure base – active seeking of contact upon reunion.

Anxious/Avoidant Attachment – independent exploration – active avoidance upon reunion.

Anxious/Resistant Attachment – Poverty of Exploration – Difficulty separating on reunion.

Source: Mary Ainsworth (1979).Research.

Jeremy Holmes stated in his book John Bowlby & Attachment Theory, “Mary Ainsworth (1982) first used the phrase ‘secure base’ to describe the ambience created by the attachment figure for the attached person. The essence of the secure base is that it provides a springboard for curiosity and exploration.” (Holmes, 1993, p. 70) John Bowlby believed that a ‘secure base’ was the most important aspect of parenting “…a central feature of my concept of parenting, the provision by both parents of a secure base from which a child or an adolescent can make sorties into the outside world…” (Bowlby, 1988, p.11).

Cultural Implications:

Studies in other countries support Ainsworth’s belief that some form of ‘secure base’ is needed for all infants, however, there are indications that behaviour may have to be interpreted differently in other cultures. According to Helen Bee (1999, p.192) “German researchers, for example, have suggested that an insecure/avoidant classification in their culture may reflect not indifference by mothers, but explicit training towards greater independence in the baby” (Grossmann, Grossmann, Spangler, Suess, & Unzner, 1985).

Furthermore, “…in Japan a greater valuing of emotional interdependence is associated with limited separation experiences, therefore heightening the distress experienced by many Japanese infants…” (Harwood, Miller & Irizarry 1995. p.14) Therefore, it would appear that the infant behaves in a manner that responds to the maternal behavior that is both intuitive and reflective of the behaviour in its community.

It is stated in Helen Bee’s book ‘The Growing Child’ “…some form of “secure base behaviour” occurs in every child, in every culture….” (1999, p.192). Bee says, we have a long way to go to understand how cultural differences affect the development of children but they form a significant backdrop for all development and to understand nurture, we must first understand the part culture plays (1999).

Children are born into a diverse range of family structures and these structures may change during the course of childhood. Attachment theory highlights the role of the primary caregiver and in the process puts the spotlight on the person who is most likely to undertake this role in our society – the mother. This can lead to argue against mothers working. Wyse (2004) states, “Once the child has developed an attachment they will protest at separation from that preferred person and will show fear of strangers” (p. 23). However, Vera Fahlberg says the attachment figure does not have to be the child’s mother. The initial bonding can be the father or even an adoptive or foster mother, as long as the care is consistent during the early years of development.

Of course there are many alternative family structures and views have changed over the years. Many people feel marriage is outdated and prefer to just live together. There also is the difficulty that surrounds divorce and the impact this has on young children. According to Robert Banton Jack Straw, the home secretary, stated in a document called Supporting Families (1998) “…changes in

family organization we have mentioned are really linked to the social problems” (2004, p.33). With rising divorce rates, social acceptance of sexual relations outside marriage and single sex partnerships will all have an impact on the way in which children are raised and by whom.

I believe parenting practices have a greater effect on children than marital status. I divorced my husband when my children were still at school. I maintained a healthy relationship with my ex-husband because I felt it was important for the children to still see us as a family unit. I was determined that my children had constant access to their father and that he played a part in their upbringing. This has certainly had an impact on my children and they often said it was a better arrangement than two unhappy people living together.

Blakeslee & Wallerstein stated in their book Second chances: Men, women and children a decade after divorce when referring to children from divorced families, “They fear betrayal. They fear abandonment. They fear loss. They draw an inescapable conclusion: Relationships have a high likelihood of being untrustworthy; betrayal and infidelity are probable” (1989, p. 55). Although my children experienced the trauma of divorce, I feel I kept that disruption to a minimum.

Clinical references and Personal insight:

Following the birth of my first child, I chose to go back to work when she was six weeks old. Childcare was shared out between my husband, my cousin and my aunty and this situation continued for some time. I then made the decision to send my daughter to nursery when she was three, but she would not settle and screamed hysterically when I left her. When I picked her up she would cling to my legs and cry if I talked to anyone on the journey home. This seems to follow

the pattern of ‘insecure attachment’. In Dominic Wyse’s book, Childhood Studies an Introduction, Leather cites stages of separation behaviour as observed by Robertson and Robertson “…may be unwilling to trust parent if/when they return, or may become very ‘clingy’ and refuse to let parent leave them in any situation” (2004, p.23).

However, my daughter is now in her late twenties, she suffers from periodic bouts of depression and anxiety attacks. She doesn’t seem to be able to settle into long term relationships, but in spite of that, in her working environment she is a confident adult holding a managerial position. I feel however, my daughter has inherited traits from her father as he suffers with bouts of depression; furthermore, two of his siblings have had a mental breakdown. Leather says, children take traits from both the mother and father such as physical features, but they can also inherit illnesses (2004)

There is now a large body of evidence saying that children are capable of forming attachments to two or three caregivers and if the care arrangements are of good quality, and the quality of parenting has been established, then the child stands to benefit. Furthermore, Fahlberg says, it is not unusual to share the job of ‘mothering’ and that the child, providing the quality of care is good and that it is consistent, can do just as well as those attached to one caregiver (1994). My daughter’s carers were consistently part of her growing up therefore; I feel the hereditary factor does play its part in her development.

However, after my son was born I chose to give up my job and stay at home. My son didn’t experience separation from me as an infant until the age of four when he settled into nursery with no problems. As an adult he seems to cope much better with stress and frustration and he is extremely confident and self reliant. This seems to bear out the positive effects of attachment therefore, highlighting

that the relationship formed in early development seems to create a prototype for future relationships.

It is interesting to reflect on my own parenting. My mother died when I was twelve and I became ‘the little mother’ to my father and brother until my father died fifteen months later. This has left me with my own insecurities to deal with. According to Bowlby women who have lost their parent’s at an early age not only are they likely to have marital problems, after the birth of a child, they can also have difficulty interacting with their child (Bowlby, 1988).

Unfortunately, as I said earlier my marriage did breakdown, but I don’t believe I had difficulty interacting with my child. On the contrary, I feel I was over protective, because of loosing my parents, and I was anxious for my daughter. This may have contributed to my daughter’s dependency on me. Furthermore, I take into account that she was the first-born and therefore she had been the sole recipient of my attention. It would have been a different experience for her brother.

Through personal development I am aware I have carried through, into adulthood, a lot of unresolved issues. There have been moments where I have felt a great dependence on my therapist and I worked very hard being ‘the perfect client’ for my therapist to accept me. However, through exploration of my own attachment history I was able to recognise why I felt this dependency and need for acceptance. As my relationship with my therapist grows I feel I am able to be more honest about my feelings. I believe it is through establishing this warm trusting relationship I am able to work towards self acceptance, and as my confidence grows I feel more comfortable with who I am, therefore I no longer feel a need to please others to earn acceptance. This has highlighted how a client, with similar insecurities, may feel in the therapeutic relationship.

Like me, the client will bring his own history into the counselling relationship and I feel the therapist needs to be able to acknowledge, with a deep understanding

the insecurities the client may be feeling. I feel it is important to explore the client’s relational history to establish whether there may be an issue of dependency. It was not easy to explore negative feelings that have been buried for so many years, but my therapist was able to provide a safe space for this to happen. Therefore, although I had my secure base ripped from under me at an early age, I feel my therapy is now my ‘secure base’ where I can unravel my history and make some sense of it.

This intimate relationship I have established with my therapist has allowed me to challenge, explore and take risks with the confidence of feeling accepted. “…intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he is an infant or a toddler or a school child but throughout his adolescence and his years of maturity as well, and into old age” (Bowlby, 1980, p. 422).

Conclusion:

There seems to be an agreement between all the theorists that a secure attachment between a mother and infant is the ideal first relationship, and that relationship is of primary importance.

Feeling secure and having your needs met by a consistent caregiver, within all cultures during the early years, is imperative to a healthy development. I feel attachment is the same across all societies, and that fundamentally all children need a secure base.

“Relationships are of fundamental importance in:

the development of personality and sense of self;

the difficulty clients bring to therapy (relations with the self and relations with other people);

the therapeutic process (the therapy relationship is the heart of the process)” Paul, S. and Pelham, G. (2000, pp. 110 -126).

Relationships are important for our wellbeing. Whilst attachment types have helped me to understand my history, they have also helped me to understand the important elements for development. Attachment is about a close relationship, and its impact last from cradle to grave. It is now accepted that this relationship can be with more than one person as long as the care is affectionate, consistent, and provides a secure base.

It is also agreed that separation from the caregiver during infancy will predict how an individual forms relationships as an adult. As a counsellor it is important to be aware of the different attachment behaviours to be able to provide that ‘secure base’ from which the client can explore his/her own relationship history. Therefore, the counsellor needs to be able to provide support with deep understanding, Bowlby says,”….it is the emotional communications between a patient and his therapist that play the crucial part” (Bowlby, 1988, p.156)

Alyna Punjwani

Mentally ill people not only suffers from psychological distress, but “they often experience significant physical, social, and cognitive disability” (Kaur, Masaun, & Bhatia, 2013, p.404). To help patients cope up with these issues, along with psychological treatment, physical activity plays a therapeutic role. According to Moodie (2001), “Physical activity refers to virtually any sustained bodily movement that expends energy” (p.02). It ranges from simple tasks, like activities of daily living, to complex tasks like competitive sports (Doh, 2004 as cited in Creek, 2008). Participating in Physical activity helps an individual to improve physical, psychological as well as emotional health (Mcguirk, 2012).

Sedentary lifestyle among the mentally ill clients is the significant problem among all psychiatric care (Happell, Scott, Platania-Phung & Nankivell, 2012). Consequently, physical activity is the initial step to reduce their dependency on others. It conveys a sense of hope, power, and control towards their lives which encourages them to actively participate in daily living activites. Therefore, when these clients move back to their community, they would not be dependent on others and would be self-sufficient to care for themselves.

During my mental health clinical, I and my group members conducted a morning session for all the patients in Karwan-e-Hayat psychiatric hospital. While interacting with the patients, I felt that they are distressed, and not communicating their feelings and thoughts to the fullest. After 15 minutes of unhealthy communication, the group members thought to start some physical activity. We played music and instructed everyone to participate. Most of the patients participated and it was clearly evident that they are thoroughly enjoying it. Even those patients who were not communicating initially, also joined in for the physical activity. After 10 minutes of this activity, we resumed our communication. I observed that now everyone is expressing their views and thoughts. One of the patient, who was primarily not contributing at all in the communication, shared with us the beautiful poetry in Urdu. This drastic change in the patients urged me to think about the impact of physical activity on client’s wellbeing.

On analyzing the case scenario, CARE framework could be integrated effectively. Engagement is found to be the most appropriate component of this framework, whereby the physical activity could be applied. One of the goal of this component is to offer opportunities to the client in order to move together towards a therapeutic change in the client (Mcallister & Walsh, 2003). As in the case scenario, activities were demonstrated first and the clients were expected to model those acts. Hence, demonstrating, providing support, and providing a motivation that there is a possibility to enact a positive change helps achieve this goal.

Every person with mental disorder is different from the other, but they have one thing in common i.e. low level of physical activity (Dunn & Jwell 2010). Physical activity is useful as it increases cognitive function. According to Ratey and Loehr (2011), exercise causes angiogenesis in temporal lobe, frontal lobe, and parietal cortex leading to increase blood flow towards these parts of the brain which in turn results in escalation of memory, learning, and attention. As highlighted in the case scenario, the client shared an amazing poetry in Urdu which indicates that physical activity had an effect in his cognitive functioning and memory. Moreover, exercise increases the uptake of insulin-like-growth factor (IGF-1), it crosses the blood brain barrier, and increases neurogenesis in a specific part of brain called hippocampus. Hence, further enhancing the cognitive function (Trejo, Carro, & Torres, 2001 as cited in Ratey & Loehr, 2011). In addition, Cohen and Shamas (2009) states that during physical activity, the body releases high amount of nor-adrenaline, dopamine and serotonin which effects the part of brain dealing with arousal and attention. As highlighted in the case that all the clients were more focused, and more involved in communication after the period of physical activity.

In addition, physical activity also serves as a coping mechanism. As schizophrenic patients engage themselves in different activities, it diverts their mind and distracts them from hallucinations (Richardson et al., 2005). Similarly, it can be an adaptive coping strategy for aggressive patients. For example one client verbalized that whenever he gets angry or frustrated, he goes outside and walks for about 5 minutes which gives him a sense of relaxation, and the feeling of anger diminishes eventually. Moreover, Physical activity is also useful in order to boost up self-esteem of the client. The successful completion of particular task may lead to increase self-confidence and self-efficiency (Crone, Smith, & Gough 2006). Hence, it is important to analyze the ability of the client to accomplish a task before involving them in activity. For example, during our exercise session, one patient was having difficulty performing the exercise due to his asthmatic condition. As we used directive approach for the exercise, everyone was doing it but the asthmatic client had to give-up and sit back in order to stabilize his condition. The client verbalized “I cannot do it anymore”. This would have created a doubt within him regarding his abilities and competency to achieve that goal. Apart from that, clients were talking to each other, and learning from others by observing them. Hence, physical activity provides a platform to bring people together, to promote interaction, and to contribute towards community cohesion in culturally diverse group. It creates a sense of belonging among other clients thereby promoting social inclusion (Trimble, 2012).

The socio-cultural barrier I found was that the activity was done with all the male and female clients together, which was an inappropriate intervention in respect to the Pakistani culture. This was one the major hindering factor in promoting the physical activities in psychiatric setting. Hence, this practice has to be avoided in order to encourage the client to participate in these activities

As a nurse, it is very important to assess the patient’s ability to perform physical activities and recommend them accordingly. Societal, cultural and personal factors which hinders their ability to involve in activities must also be identified and addressed. Moreover, those patients who are unable to gather in activity area due to their disease process then separate activities should be planned for them to be performed in their own private space. The environment should be supportive and non-competitive to have a positive impact on client’s wellbeing. 15 to 30 minutes of moderate exercise for at-least 4 days a week is recommended for mentally ill clients (Richardson et al., 2005). It could be further adjusted according to client’s abilities. Intense physical activity at first should be avoided because it creates a sense of frustration and distress, further disrupting the patient’s condition. . It is necessary to reinforce the patients which gives a sense of achievement and boosts up their confidence level

At institutional level, integrating physical activities as part of the treatment therapy would increase adherence towards these activities. Moreover, goals should be planned collaboratively with psychologist, therapist, and other medical health care workers to ensure effective approach towards health promotion. Institution should make sure that physical activities are done on continuous basis because fragmented, inadequate, and unsupported activities are of no worth (Richardson et al., 2005).

At community, awareness sessions could be conducted to teach people about the impacts of physical activity on client’s well-being. This awareness could help mentally-ill patients in community to reduce their dependency

In our everyday lives we are faced with situations that do require us to work extremely hard. Whereas this is a very vital thing in every success of an organization, employees suffer severe health problems. This is because pressure emanating from this tight and demanding work conditions has with it several negative aspects. Amidst believes that pressure is necessary for an organization to achieve its mission it has greatly affected many lives. All organizations should educate themselves to be able to cope with this inevitable challenge and instead use it to make the health of workers less vulnerable. Also, an understanding as to the causes of work-related stress should also be studied.

Introduction

Today, most workers are faced with great challenges due to their work demands. Majority of organizations and companies invest a lot on labor. In this regard, workers play a vital role in the economic prosperity of the company they work. The profits realized are deemed to be equivalent to the amount of efforts put in by the workers. Employers, in most cases lay blame on the employees if in case their business does not perform effectively. In such circumstances employees suffer entrenchment or sucking, strict work conditions, lots of pressure among other worse conditions. This study seeks to demonstrate some of the health hazards posed to workers due to increased pressure at work.

Stress at Work Place

It is true that we all need some amount of pressure in all that we do to be able to appreciate our work and even derive satisfaction from it. This is also a valid reason why one will rush to meet deadlines. If our work environment is devoid of deadlines, workers involved would not have much to do and may even find themselves bored. This is a waste as far as their career is concerned since results and profits depend on how much we are able to deliver within certain time lines. Again, life today is full of struggles and up and downs, frustrations and endless demands. For almost everybody, stress is the order of the day and an inevitable aspect in our lives. As it has been widely believed that stress is harmful, some are of the opinion that it is not always bad. It acts as a catalyst for people to perform more productively, a means to cope with pressuring situations and pulls out the best from them. It becomes worse if the subjects are not able to control it or if the demands outweigh their capacity to handle situations. It is at this point that one’s mind and body pay the price. This becomes the beginning of many other health problems. Everyday, economic activities are changing and almost all employers are struggling to have in place products that can meet consumers’ needs. Due to this, a lot is demanded from the workers so that they can participate fully to meet the challenges and demands of the time. As demand for certain products change with time so do the expertise of the workers change, for example, a company dealing with phones may discover that mobile phones without internet services are no longer in demand. The company will put in double efforts to ensure that they have enough stock ready for the market. This increased changes occasion stress. Work-related stress poses a great danger to health both physically and socially and psychologically. This is because a worker’s efforts involve energy and muscle, emotions and thinking. For example, if an individual strains in manual work like carrying a heavy load he or she may experiences body pains, the same case applies to that individual who spends a lot of time doing mental management leading to psychological imbalances. Therefore, it cannot be assumed that stress at work place only affects the health of the workers physically but also the effects extend to their soul. Stress at work place is indisputable and it has even been argued that stress is useful. It is seen as a way to motivate workers and drive them to been more productive. As mentioned earlier, most organizations are faced with changes in time and environment; hence pressure at work place instills fire in the workers to cope with the modern circumstances. Most governments have taken cognizance of the fact that work places pose a great danger to health. Policies to ensure the safety of the workers have been put in place. The U.S. National Institute for Occupational Safety and Health (NIOSH) developed a summary of levels of interventions and categories of prevention. Intervention in the primary level refers to efforts to protect the health of people who have not yet become sick. Secondary prevention involves early detection and prompt and effective efforts to correct the beginning stages of illness (for example, reversing high blood pressure, building up of plaque in the arteries, or chronic insomnia, before a heart attack occurs). Tertiary prevention consists of measures to reduce or eliminate long-term impairments and disabilities and minimize suffering after illness has occurred (for example, rehabilitation and return-to-work after a heart attack) (Landsbergis, 2009).

Impact of Work Place stress on Health

Rapid growth in economic activities and rise in consumer needs may create a pace unfavorable to the workers. As a result workers may be unable to cope with the situations. It is in such circumstances that pressure evolves among workers. Depressing stress grows and majority of workers may succumb to depression or insomnia. There are also occupational consequences for example, dissatisfactions in one’s job, less dedication to the organization’s vision, decreased performance and failing to report to duty or non attendance. Ellis argues that in the early stages job stress can ‘rev up’ the body and enhance performance in the work place thus the term ‘I perform better while under pressure’. However if this condition is allowed to go unchecked and the body is revved up further, the performance ultimately declines and the person’s health degenerates (Allis, 2005).

There exists a great variation on how people get affected by work-related stress and this also depends on how long they have been subjected to the source of stress and the amount or level of the stress itself. Typical symptoms of job stress can be: Insomnia, loss of mental concentration, anxiety, depression, sexual problems, alcohol and drug use, diabetes, heart disease, migraine, headaches, high blood pressure, digestive problems, skin rushes, sweating, blurred vision, tiredness and sleep problems, muscular tension, stomach problems and back problems. Stress at work place interferes with family life. There are cases where spouses fail to fulfill conjugal rights of their partners. The emotional life of the employees is normally affected and their libido lowers as such. It is from this that there are mood swings, poor appetite and low spirits.

In a random sample of just over 300 medical doctors and consultants throughout Germany, various job-related variables were assessed together with sociodemographic data including time-related parameters work, and specific categories of accidents (moving vehicle and work-related). Occupational stress was related to number of weekly working hours, duration of the lunch-break, as well as age. Moving vehicle accidents were significantly correlated with the incidence of work related accidents during the last year. There was no evidence that medical doctors working longer weekly hours were more likely to be involved in a driving or work-related accident per se, but they did tend to report more accidents during house visits. Moving vehicle accidents were best predicted by the onset of working day as well as the number of dependent children (more children associated with fewer accidents). Furthermore, work-related accidents were significantly more frequent in larger communities and when surgeries were later in finishing (PsycINFO Database Record, 2009). Look around. One of ten people you see at work, at the store, and wherever you go in your daily live is over stressed at any given moment. Scientists agree that stress causes actual chemical changes in the brain, and these changes can influence the state of your health (Cornforth, 2007).

There has been an on-going observation on the impact that stress has on the entire health of a person. Stress is associated with many backaches complaints and cancerous effects and chronic fatigue syndrome. Women may succumb to failure in menstruation or unusual blood loss. Hormonal imbalances as a result of stress may propagate the symptoms of fibroid tumors and endometriosis as well as make pregnancy difficult to realize for married partners with cases of infertility or impotence. Heart problems, high blood pressure, heart attacks and stroke are also stress related cardiovascular conditions. The effects go to the extent of interfering with the sexuality of women and sexual dysfunctions such as decreased desire and vaginal dryness. As outlined earlier, case of emotional problems may also arise such as depression, anxiety and lack of sleep. Gastrointestinal disorders, for example, ulcers and lower abdominal cramps. In most cases, people undergoing work related stress will have more infections in form of colds and other infections due to lowered immune system responses. . As noted earlier, work related stress not only affects our physicality but also extends to our psychological realm. In deed, it has severe psychological coercion. It is in the work place that busy schedules, arguments between colleagues or line managers with their junior staffs, accountants under pressure to settle bills or inconveniences as a result of traffic jam cause a lot of stress. Here, the body undergoes very strong reactions similar to the reactions faced when one is challenged and has to make a choice between life and death. This is never a pleasant situation and a lot of bodily tension occurs. Workers with lots of duties and responsibilities and worries due to deadlines, their response to stress is always on high alert. In fact, there are workers who succumb to such situations in the entire working life. Such long-term exposure to stress may can translate to grave health problems and complications. This is what can be referred to a chronic stress which actually disorganizes almost every system of the body. It is in such instance that one can fall victim of blood pressure, heart attack, impotence and even the person is more vulnerable to grow old prematurely.

It would be of paramount importance to not only look into the effects of work related stress on health but also understand the causes of such stress and how to manage it. In most cases a big percentage of employees globally will confess that their work is the source of stress in their lives. No wonder comments like ‘I had a very busy day’ or ‘had a stressful day with my client’ or ‘my boss does never understand’ and many others. As noted in an article published by Bupa’s health information team… Health and Safety Executive survey, one in six of all working individuals in UK reported that their job is very or extremely stressful. Work-related stress is also one of the biggest causes of sick leave (Bupa, 2008).

Some of the causes associated with stress include vulnerable and miserable working conditions, prolonged working periods, type of relationship with colleagues since team work is entrenched on this fact, diminished job security, means of transport may be unfavorable to some employees hence challenges in trying to commute to and from work, management of the company and low salaries and wages to mention a few. There are employees who feel under worked or overworked or feel that their job designation does not match their qualifications. For example, when one is supposed to serve as an accountant but assigned as the front office manager or a receptionist. These from the word go does not give satisfaction to the employee. In rare cases will one posit a particular cause of work-related stress. All in all it can evolve due to sudden, unexpected pressures and more so due to the combination of stressful factors that develop as time goes. . As mentioned earlier, pressure is an indisputable factor in any work place. In strict sense, no work without pressure, therefore employees need to educate themselves on how to deal with stress successfully. The negative aspects of job stress need to be pruned in a number of ways. For example, every employer should seek to understand how they function at work. This builds their self esteem at all times. Good time management to avoid inconveniences, for example, in the case when one is caught up in a traffic jam and cannot get to work in time. It would be prudent to start moving early. If one is faced with many deadlines and tasks to perform, one can prioritize them in order of importance and urgency. Through team work, one can delegate some of the work to other colleagues. Break and relaxation is also highly recommended. There are employees who want to do many tasks at the same time instead of doing one task and after its completion take on the other. Managers should create a conducive atmosphere for all where each employee feels comfortable and accepted. . Organizations should at least, have a health and safety officer who can ensure that proper mechanisms have been put in place to safeguard the workers from unnecessary causes of work-related stress.

Conclusion

In deed, work-related stress is an omen that will keep on affecting the lives of many organizations. We have seen the symbiotic relationship there is between pressure and any work environment. I strongly agree that much is on how to deal with work related stress. It is clear that we cannot eradicate it in our reality as workers. Any government must put in place measures that address the basic needs of workers or rights of workers and essentially to protect them from risks posed to their health due to job stress. Any employer or organization who deliberately fails to provide a comfortable work environment should be said to commit a crime punishable by law and. In addition, a compensation policy should also be entrenched to reward all workers who suffer unjustly from work related stress.

To what extent do theories relating to risk inform our understanding of an aspect or aspects of contemporary social work? I am going to briefly discuss the meanings of risk. Whilst I am aware that there are many theories of risk, I have identified three main themes and will be exploring these in relation to contemporary social work, the themes of governmentality, cultural theory and risk society.

Present day social work is concerned with matters of vulnerability and risk (Kemshall et al, 1997), (Dalrymple and Burke, 2006), (Parton, 1996), (Titterton, 2005), (Hothersall and Mass-Lowit, 2010). Media coverage of serious case reviews regarding the deaths of children have led to an onslaught of criticism into social work practice.

In looking for definitions to define risk, I found several meanings. Traditionally risk was defined neutrally as a ‘chance’ or likelihood a behaviour or event will occur (Lishman, 2002: 154), (Munro, 2002:64), for example the possibility of a gain as well as a loss. Kemshall (2002) discusses the uses of risk to insurance and a mathematical probability approach to risk. In postmodern society, risk is now attributed to the terms of “danger” or “hazard” (Lupton, 1999 a: 12).

The concept of ‘Governmentality’ was developed by the French philosopher Michel Foucault in the later years of his life between the late 1970’s and his death in 1984. His concept provides an understanding of power, not just in terms of the power of the state from a top-down approach, but in the “more subtle forms of power exercised through a network of institutions, practices, procedures and techniques which act to regulate social conduct” (Joseph 2010:225). Power is noticeable in a positive way through the production of knowledge and discourses that are internalised by individuals, guiding the behaviour of populations and leading to more efficient forms of social control. Parton (1994) cited in Pease (2002) writes how individuals permit government at a distance through being encouraged and supported to exercise freedom and choice. Because power is de-centred individuals play a role in their own self-governance.

Criticisms of Foucault argue that he fails to recognise that power is not equal to all. It can also be argued that he lacks reference to the exercise of power in relation to race, age, gender and class, especially how accessible power is between different social groups. Cooper (1994: 450) argues about the “character” of the technologies of power regarding racist and gendered discourses being used. It was argued that Foucault was not attentive to how people respond to discourses in their daily lives (Lupton: 1999 b: 102). Critics also believed that Foucault lacked awareness in the power institutions had over individuals and that individuals behaviour in society was down to following rules of conventions (Hoy: 1986:151). Feminist critics such as Hartstock (1990:171-172) believe Foucault’s understanding of power diminishes individuals to objects of power than individuals able to resist.

Foucault’s work on defining the relations and mechanisms of power like governmentality can support social workers to think about their position of power within the structures (that maintain the oppression of service users) in their work. Empowerment uses social science to solve social problems and is a social justice discourse in social work. It allows social workers to redistribute power and knowledge in their practice, whilst challenging and combating injustice and oppression. Empowerment develops capacities of individuals, whilst emphasising individual responsibility. Pease (2002:137) argues that there is an assumption that power is something that can be given and empowering someone is to confer. Therefore as Braye and Preston-Shoot (2003:100) discuss, empowerment is about “oppressed people taking the power and demanding to be heard”. Because knowledge is central to understanding power within society, in order to empower service users there must be a reallocation of knowledge, an “insurrection of subjugated knowledge” as indicated by Foucault (1977). Listening to service users and allowing them to have more control over seeking solutions to their problems or identifying their needs within the wider social context, is another example of empowerment. We belong to many social groups, some by choice and some because they are forced upon us. Within these groups, some have more or less power over others. Social workers need to be aware of difference and diversity and develop a greater sense of self awareness about the risks of labelling, stereotyping and holding subjective beliefs.

The term ‘Risk Society’ describes a society that is exposed to harm as a result of human activity. German sociologist Ulrich Beck (1992) first used the term, although British sociologist Anthony Giddens has also written on the same subject matter.

Both authors argue humans have always been subjected to risk, e.g. natural disasters but these are seen as being caused by non-human forces. Modern society is now exposed to risks such as terrorism, chemical pollution and nuclear power. Giddens (1999) defines these as ‘external’ and ‘manufactured risks’, external being risks arising from nature (e.g. flooding) and manufactured risks being the result of human activity, e.g. developments in science and technology. As humans are responsible for manufactured risks, both Beck and Giddens argue that societies can assess the level of risk being produced in a reflexive way that can alter the planned activity itself. People are now more wary of what professionals tell us, which is different to the view of the older generation. We are more critical of professionals and more likely to question them They believe there is an increase in reflexivity (the idea that society can adapt to new risks) as a response to risk and uncertainty in postmodern society, but Beck (1992:21) relates this to more risks and hazards being produced, where Giddens (1999:3) believes in human subjectivity being more sensitive to risk.

Criticisms of risk society question the level of risk in postmodern society. Turner (1994: 180) questions whether life has become more risky in the present day, than how it affected individuals in the past. Ungar, cited in Goode and Ben-Yehuda (2009: 82) argues that the threats of today infuse fear as well as, not instead of the past fears. Culture, race and gender do not feature in both Beck and Giddens writings and it could be argued that it would be difficult for an individual to be reflexive regarding conflicts of this nature. Joffe (1999) argues that there had been a failure to recognise emotion in respect to how people cope with living in a risk society. Delanty (1999:171) draws from the criticisms by Lash, arguing that Beck and Giddens do not recognise the cultural dimension of reflexivity, due to disregarding collective agency such as the community in favour of individualism.

Social work has changed from a concern with need to one of risk (Kemshall, 2002). The media perception of social workers failing in their duty to prevent the deaths of children or protect the public from individuals known to be mentally ill, has led to more “bureaucratic solutions, through legislation, procedures and guidelines” (Ferguson, 2004). Blame is allocated due to the emphasis in risk (Douglas, 1992).

The regulation of risk replaces need as a focal point and reasoning for social work intervention. Lishman (2007: 164) writes how “working with risk will always remain a risky business, but with the assistance of sound methods and defensible decision-making it can be well managed”. Titterton (2005:50) argues “there is no such thing as a risk free option: all options hold potential risks”. Lishman explains further that in the climate of the blame culture, risk assessments need to be of a standard that contain “defensible decisions” that can hold up in cases where there has been a risk failure (2007:157).

There is the danger that in using risk assessments to check availability for a service, there is the potential for the social worker to be distanced from the service user. Involving the service user to do their own risk assessments and explain what they believe are the risks is a form of empowerment, which places them at the centre of the process. Clutton et al (2006: 18) links the involvement of the service user to empowerment, “Risk assessment may be empowering if it allows the service user to take an informed decision on future action”.

Social workers have to be able to asses the predicted outcomes of a potential risk to a service user but this is not always easy. Differing interpretations of a situation due to the cultural and social background of people and groups can make understanding risk and risk management difficult in decision making (Reed et al, 2004:149). Service users have started to make choices in how they interact with social services e.g. self-referral. In order to make plans about their lives, social workers need to interact with families in new ways that recognise their disadvantage and oppression in society. It could be asked if service users really have choice or do they have options within choice? Harris and White (2009:100) consider choice to be a key element of the government’s modernisation agenda and are established in services such as direct payments and choice of hospital.

Labelling of service users in assessments as ‘disturbed’, ‘at risk’, ‘in need’, describes behaviour from a value perspective (Dalrymple and Burke, 2006). Slovic (1999) writes how risk assessments are coloured by subjective judgements of the social worker at every stage of the assessment process. Hall et al (2006:23) argues however that categorisation of service users in reports, meetings and in the court is an expectation of social workers as a practical and professional duty to provide assessments and provide a course of action or services.

The notion of ‘Culture Theory’ developed by Mary Douglas (1966, 1798) and Douglas and Wildavsky (1982) has been influential in looking at perspectives on risk. Cultural theory aims to explain how personality and cultural traits influence risk perceptions and why different people and social groups fear different risks. Douglas argues the relation of risk to politics and its link to accountability responsibility and blame (Lupton, 1999:39). Douglas and Wildavsky (1982) introduced the ‘grid/group’ concept to explain how cultural proportions can compare society. It defines how people can be divided into four types that predict how they react to different types of hazards- Individualist, Egalitarian, Hierarchists and Fatalist. Thompson et al (1990:5) explain group as referring to how much the individual is integrated into enclosed units and grid to how much a person’s life is restricted as a cause of exterior compulsory instructions.

Douglas’s theory is not without criticism. Lupton (1999:7) questions the media’s contributory role to the risk knowledge of their audience. It can be argued that you cannot foresee how anyone will behave in response to a particular circumstance and that cultural theory is opaque, not taking into account the complexities of modern society (Rayner, 1992, Boholm, 1996). Tansey and O’ Riordan (1999) argue the theory is deterministic and takes no account of the free will of individuals. Ostrander (1992) makes a prominent argument, suggesting that cultural theory should apply to social environments in order to distinguish social systems as a whole. It could also be argued that as Douglas does not explain how risk perceptions regarding to individuals and organisations change over time, her theory could be seen as “static” (Bellaby (1990). Gross and Rayner (1985:18) argue that Douglas fails to explain, “what economic inducements or deprivations dispose persons to change their social position”.

Accountability means being answerable to others for the quality and efficiency of one’s efforts. Social workers are accountable to service users, the community, their department and their supervisors. They must be able to explain what it is they do, how it is done and that their work meets professional standards for competence. Mishra (1984), cited in Wilson et al, (2008:39) writes how there is a reduction in professional autonomy and control due to accountability and structural demands being placed on agencies. Social workers, through fear of miscalculating a situation can undertake cautious and defensive practice which falls short of considering the implications, risks and benefits to the service user of the decisions made and measures taken. Bamford (1990) writes how “social workers must develop a system of accountability which does not lose sight of the needs of the clients and their support systems”.

O’ Hanlon, cited in Parton and O’ Byrne (2000: 88), separates blame from accountability in that accountability features responsibility, is empowering and promotes self agency. Blame does not invite co-operation, is alienating and closes down possibilities. An example of the links between risk and blame is the case of baby Peter, who was killed by his mother’s partner and was the subject of a multiple amount of media attention, proportioning blame on the social workers in his care. The description of harm and danger portrayed by the media, the government and organisational responses to complaints and legal action, resulting in a blame culture is a consequence of risk aversion employed by some social workers (Furedi, 2002). This could leave social workers feeling the need to protect themselves and hesitant, leading to passing the blame onto other people. Webb, (2006:70) links blame culture to risk avoidance being the main priority, resulting in tighter measures of accountability and transparency being involved. Kemshall (2002: 94) suggests blame “serves to strengthen accountability, but also subtly to control information flow and usage and to reinforce loyalty and solidarity with particular viewpoints on risk”.

Responsibility of the social worker is linked to accountability. These are sustained in codes of practice, the law and daily verbal exchanges. Hall et al (2006: 16) describes how professionals are mindful of their interactions, should their speech causes their conduct to be accountable. Parton and O’Byrne (2000: 183) discuss the ethics of responsibility in which service users are able to talk freely about themselves, their situation and the best way to solve their problems. Social workers are supporting service users to take responsibility for their own actions, which replaces concepts of “cause and determination” Howe (1986), cited in Parton (1996:88). The responsibility of the social worker is to the well-being of service users, but there are times when they work in situations that are conflicting. Dominelli (2009:11) offers one explanation of this in a “care-control dilemma”, when there is a need to balance the determination of the service user with harm. The social workers responsibility to the wider society and adherence to the law mean that at times the well-being of the service users may not take priority.

In conclusion we have considered the impact of risk in the field of social work. In doing so we have identified three main theories, that of Govermentality, Risk Society and Culture Theory. We have analysed the impact of social work on these theories. Govermentality Theory helps us to understand power and the production of knowledge that enables individuals to govern themselves. Empowerment, as discussed previously enables service users to gain control over decisions that affect their lives. Risk Society Theory helps us to understand how communities are organised in its response to risk. This has been discussed in relation to social work in the media and the bureaucratic defensive practices that have developed as a result of extensive coverage of high profile service failings. Culture Theory seeks to explain how the social context in which we operate affects our responses to risk. As considered earlier, accountability is a means for social workers to explain their actions and the reasoning behind them, blame culture leads to social workers feeling apprehensive and self-preserving of their role. The social worker also has responsibility to the service users, but also to the wider society.

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Drawing on the concepts you have studied in Block1, critically reflect on the ways in which your own life course has affected how you work in, or use, health and social care.

In this essay I will look at the life course perspective, and how it has provided me with an essential tool to offer a more personalised service. I will describe how my own life course and ‘Biographical Disruption (Bury 1982) has changed the person I am beyond the expectations I had of my presumed journey, and how it has impacted on my practice. Where it has proved to be a strength or a weakness, and how it has made me more sensitive to people’s needs and behaviour. I will look at how my personal values have been shaped and influenced by my life course, and discuss possible ethical conflicts. I will start off explaining the concept of life course using the five principles discussed by Bengtson et al. (2005).

Recognising the course that people’s lives take is relatively new to study and research. Until relatively recently the understanding of human development was based on the life cycle approach, one of the oldest accounts of how life’s and families are organised over time (Bengtson, et al 2005, p.9). The approach is based on the idea that people’s lives go through a series of relatively predictable and chronological stages and transitions from birth to death, providing insight in peoples changing roles and identities in relation to landmark occasions such as coming of age, marriage, childbirth and old age. From the 1960’s onwards the life cycle approach began to incorporate psychological elements, which considered the relationship between an individual’s inner world, and the social context in which they live. This idea of considering the whole of a person’s life as offering opportunities for development and change (Crawford and Walker p.2) is referred to in literature as life –span development (Sugarman, L. 1986, p.3) or the life-span perspective (Baltes, P. 1987, p.3).

At the same time these approaches began to merge with the idea that age and ageing is not only related to a chronological stage in human development, but also to subjective experiences between the individuals own construction of their life course, and social constructions such as schools, labour markets and normative pathways. Ageing is a lifelong process, in general common to all of us, but throughout our journey from birth to death, events can be imposed upon us from which we may have to make decisions and choices that change the path of our life course. Timing is often unexpected and change may not happen at a time we would have chosen it to; this not only impacts upon our own life and future but on those we are linked with. understanding my own life course also supports me professionally working in social care, Crawford and Walker (2003, p.2) point out that social work practice involves interactions between people, which are influenced by each person’s life course, their experiences and perceptions about their own life, emphasising the quality of these personal relationships between service users, their families, carers and professionals. In order to understand the impact human development and life events have on individuals I need to have a critical, reflective understanding of how my own life course has shaped me, my behaviour and influenced my beliefs and values. This will enable me to engage with people better, respond more sensitively to people’s experiences and needs and explain why people don’t always act in ways that appear to be in their best interests (K319, Learning Guide 3, 2013). My self-perception and my values and beliefs are very much shaped by my own life courses’ significant events, experiences and transitions, such as growing up in a very large family in the seventies, being a divorced woman with young children and being a main carer for my terminally ill mum.

Bengtson et al (2005) identifies five principles that are essential to the life course perspective.

First there is the principle of linked lives, which emphasizes on the fact that people’s life courses are interdependent with others, especially relevant in the context of families. Having grown up in a very large family my life has been linked to my siblings and parents, so when my dad fell seriously ill, and never recovered enough to ever return to work, and he needed almost constant supervision and support. The impact on all the family was life changing, my siblings that still lived at home had to find jobs to help the household finances, and they all feel this event ended their childhood. I was 10 years old I was taken to live with my eldest brother and his family. This felt very strange and I remember feeling afraid I would not see my parents again. It was thought that I was too young to understand what was happening so I was never told how ill my dad was, I was never allowed to visit him in hospital, and he was there for a full year. I was just told to be good and not make a fuss. I then stayed for short periods of time with my grown up siblings and extended family, this went on for many months , living a very transient existents and not staying in one place long enough to develop friendships with children my own age. Looking back from my adult self, I can now relate to my difficulties in developing long term relationships and poor self-esteem. On the positive side I was able to develop a lifelong close relationship with a maiden aunt which looking back I don’t feel would have happened if I had stayed in the family home over that period.

Secondly there is the principle of historical time and place, “emphasising the importance of social and historical context in shaping individual lives” (Bengston et al, 2005 p11). This is discussed as how events such as wars, trauma, depression or a period of prosperity affects our lives, Impacting on the life courses of all generations living in that particular time and place. My dad’s illness in the seventies meant he could no longer work and provide for his family, so from being a provider he became cared for, which changed the whole dynamic of the family structure. He also had to rely on sickness benefit, which in the seventies welfare system was very difficult to get and the financial support was very low. This impacted on all the family. We were poor prior to his illness but this plunged us further into poverty. This had a negative effect on us all, but for me at a time when I was just about to start secondary school I felt the stigma of being subjectively poor. I spent many difficult days in school feeling marginalised and bullied by my peers, because I didn’t have nice clothes and had to have free school dinners, at that time children on free dinners had to queue in different lines, this compounded the feelings of inferiority. My mum did her best, and managed to get some part time work alongside her being the main carer for dad, and mother to her children. Looking back, I realise my mum must have been a very strong person to cope with the situation she found herself in, she instilled a strong work ethic into her children, believing hard work would bring rewards. She influenced me with her single minded determination, like Enid with her mother (k319, Learning Guide 3 Audio 3.1). With hindsight this period of my life forced me to become more independent as I had to fend for myself a lot, it also provide me with a valuable lesson in managing on very little money. This benefitted me when I was a single parent following a divorce I was able to budget with a small income.

The next principle considers “the timing of significant life transitions and whether they fit well with cultural expectations of when things should happen” (K319, Learning Guide 3, Activity 3.1). I came into my career as a result of two biographical disruptions in my life. First I was divorced in my mid-twenties and needed to get work to support my children. Then my mum was diagnosed with terminal cancer and I became her carer. I was able to get part time paid work as a home care assistant through social care, I found I could transfer the skills I had used as a carer and the training I received helped me to support my mum better. I discovered I had very good people skills and enjoyed supporting older people to stay independent. Even later in my life I commenced my social work degree studies in contradiction to society’s view of what is ‘normal’. As with Mike, the case study in Learning Guide 3, Activity 3.5, I had concerns that studying as a mature student would lead to ‘sub-normative’ feelings of being different but on reflection my life skills and experiences have enriched my learning experience.

The fourth principle considers the control most people have over their own lives and “they make choice about what to do and have plans for the future” (K319, Learning Guide 3, Activity 3.1). Although I did not have any influence on my upbringing and not a large amount over my divorce. My experiences have provided me with the power and choice over my future which included a career in social care. I feel my life experience has made me aware of understanding everyone has past life events that impact on their current life. So when I am working with service users and planning for social work interventions, having an understanding of the potential of disruptions such as illness, and other life changes can be major turning point in their lives, and can help people see how they can become an opportunity for them to make changes (agency) in their lives. As in the story of Doireann and Iskender (K319 Learning Guide 3, Audio 3.7), where Iskender’s heart attack became a turning point in both his and Doireann’s life.

Finally the fifth principle that affirms that ageing is relevant to both the young and old, and development is not exclusive to younger people and children. Our lives are fluid as we travel our life course and we continue to change and develop whatever age we are. My life is still developing and changing as I age, in the sense that I am developing my academic skills, and my experience of caring for my mum throughout her terminal illness and the impact this had on my life.

The life cycle assumed that people would have a ‘normative life course’ (K319 Learning guide 3, Activity 3.5).That is to say people will have a life that is expected to be desirable and virtuous by society that is free from problems. Whereas a person with a “non-normative life course” is often considered to be judged and having to justify and explain their lifestyle. As a divorced woman in my mid-twenties, with two young children, which was not the normal status in the social groups I mixed in, this resulted in me feeling ‘different’ and stigmatised. I felt I had to explain my single status and felt I was seen as a threat to my married friends. I felt I had failed both myself and my children and was worried my children would feel as I did as a child, being bullied for not having a normal childhood. These feelings gave me insight into the lives of others with ‘non-normative’ life courses, whether due to their sexuality or life style choices.it has also made me question as a social care provider, does that service user feel as I did, and feel I am judging them therefore they have to explain themselves?. My own experiences of feeling ‘different’ has made me sensitive to the feelings and needs of those who society judges as non-normative, in comparison to people who follow the expected ‘norms’ and pathways we are expected to take.

My own life course was in my early childhood a non- normative course, due to the biographical disruption of my dad falling ill and resulted in me having an unconventional childhood. As I grew into adulthood my life course was comparable to the life cycle in that it had proceeded in a socially accepted pattern within a presumed time span which Giele and Elder (1998) described as “a sequence of socially defined events and roles that the individual enacts over time.” My early adult life followed a life that was considered ‘normative’, I was following the cycle of “completing formal education, working, forming relationships, marrying and having children…”(K319 Learning Guide 3, Activity 3.3).I did not predict that in my mid-twenties my life would suffer more biographical disruption that would have a huge impact on me, my family and lead into a future I would not have predicted.

Bury (2012) describes biographical disruption to be a negative experience but I would disagree with that in relation to my own experience so far as a career in social care is concerned. If I had stayed married and my mum had not got ill, I am sure I would not have followed this path and likely I would have had a very different life now.

However I had not consciously thought about entering into the social work profession, I presumed my entry into social care was the result of events that has steered me in the direction of this profession and opportunities that have presented themselves to me i.e. I was in the right place at the right time. Having read ‘Life experience: A neglected form of knowledge in social work education and practice, by Christie et al 1998,I am inclined to agree that my career choice has not been a coincidence but a choice I have made based on the knowledge I have acquired as a result of my life experiences. I am able to draw on my experiences as a knowledge base for my practice alongside the ever developing knowledge I am gaining from my studies. However, I do not “persist in viewing social work as the profession effective in bringing about social change” (Christie et al 1998). I feel my role is to support others in bringing about their own change, as I have been able to do. However I am mindful that the experiences I draw on in my practice are my personal experiences and are owned by me, and others experiences are exclusive to them. I am aware that my knowledge within in my work is limited to my own personal experiences and my personal feelings could influence my approach to service users and the decisions I make in my assessments of them.

In conclusion the article from Christie and Weeks has in fact made me question my theory that I did not choose social work as a profession purposefully; perhaps my life experiences have directed rather than influenced my choice to be a social worker, ”my own working class background, marriage difficulties, poverty, powerlessness, has influenced me strongly” (Christie el at 1998).This assignment has shown that our life course is an unpredictable path that we follow; it is constantly being reshaped from what we have imagined our life path to follow, by the events that take place around us. But although it presents us with many situations that are out of our control that impact upon us. The understanding of our life course gives us the strength to move forward in our lives, it also presents us with choice and power and positivity to look forward to the future. And as Winston Churchill says “the farther backwards you can look, the farther forward you are likely to see” (Churchill circa 1941)

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References

Baltes, P. (1987) in Crawford, K. and Walker, J. (2003) Social Work and Human Development, Exeter, Learning Matters Ltd.

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Sexual Assault

Abstract

Sexual assault is any sexual activity to which you haven’t freely given your consent. This includes completed or attempted sex acts that are against your will. Sometimes it can involve a victim who is unable to consent. It also includes abusive sexual contact. It can happen to men, women or children. Most people feel that sexual assault occurs when you don’t know the person but that not so, it can be a friend, family member, or a co-worker. “According to the National Center for Injury Prevention and Control. Nearly 1 in 5 (18.3%) women and 1 in 71 men (1.4%) reported experiencing rape at some time in their lives.” “Approximately 1 in 20 women and men (5.6% and 5.3%, respectively) experienced sexual violence other than rape, such as being made to penetrate someone else, sexual coercion, unwanted sexual contact, or non-contact unwanted sexual experiences.”

When it comes to sexual assault, most people don’t want to talk about this because they don’t want to re-live that time in their lives. Most people want to push it in the back of their minds as if it didn’t really happen. Being sexual assault can lead to many different feeling causing a person to become physically, emotionally, and mentally disturbed. Women are more likely to be assault than men because most women don’t want to talk about what happen because they are afraid no-one will believe them. Most women don’t report what has happen to the police because they are afraid nothing will happen so they just keep quiet and keep it bottled up inside. Each year in the United States, between 300,000 and 700,000 adult women are estimated to experience sexual assault, with 40,000 of such victims typically seeking treatment in an emergency department (Kwence, Sherri). When a women is sexual assault an start seeking professional help for what she has went through can be hard just trying to move forward from such pain that she has endure.

It is said that sexual abuse is the most common and threatening behavior calculated to induce fear in all women, it means men have chosen to maintain control over women. Rape is the fastest growing crime in the country. Rape occurs in India every twenty minutes (Behere, P.B). In 2011, more than 24 thousand cases were reported-about 70 a day. New figures released by the Delhi Police reveals that a women is raped every 18 minutes or molested every 14 minutes. There are 80, 000 pending rape cases in India and nearly 1,000 rape cases are pending in Delhi courts (Behere, P. B.). In the United States, 1 in 6 women reported experiencing rape or attempted rape at some time in their lives. Being sexual assault can make a women start feeling anger toward men. When someone you know has been sexual assault they must seek professional help so, they can live a healthy life. As a social worker we must help victims who has been harm in any way possible.

The conflicts in which a social worker may face when working with women or men who has been sexual assault. The value of the social worker is to promote resources to help victim who has been mistreated. When a women has been assault it take a lot from her. Once someone take something as precious as sex from you, can make you feel bad about yourself. When you think about sex, it something that should be shared between two people who care about each other. For someone to come and take that away from you can make a person become very bitter at the world? As a social worker we must promote social justice to make sure our client get the best help possible by setting up counseling. We first has to assess the problem at hand and see what really happen and then we can move forward with the problem.

As a social we must not impose on the client right to do what she feel is right for her, we can only try and led them down the right path. Social worker values can’t get in the way when it comes to helping a client get the best help needed. The client have every right to refuse any help at any time. Social worker have to be the voice for those who are not willing to speak and the ear for those who can’t hear what is been said, and the legs to help the client walk that extra mile needed. Not only do sexual assault happen to women but it also happen to men and children. Most people don’t think that men are sexually assault but it happen, but more common in small children because it’s hard for them to fight back. Most men are victim because they choose to be gay or because they are locked up in jail. As a social worker no, matter who is seeking help it is our job to provide the best care needed. When someone has been assaulted by a family member it hard to tell someone especially when you are a small child because they are scared and don’t want to get anyone is trouble so children suffer for a long time from assault because they are afraid to tell because no one will believe them. Children will grow-up feeling ashamed of what happen to them so it will cause them to sexual assault someone. They why it’s important to get the proper help needed when you have been assault. Everyone deserve to live a happy and success life.

Results of this study showed that 66% of the women were aged 15-24 years old and 75% had met the perpetrator before the sexual assault with nearly 50% reporting that the perpetrator was a current or former boyfriend, family member or someone they considered a friend.

Women with no previous contact or knowledge of their perpetrator were more likely to report to the police and were at a higher risk of sustaining an injury, the research showed.

Looking specifically at alcohol, the study found that over 40% of women had consumed more than 5 units of alcohol. These women were more often sexually assaulted by a stranger or someone they met within 24 hours prior to the assault. Furthermore, a physical injury was found in 53% of cases and 33% of the victims had suffered a previous sexual assault (Wiley). In fact, researchers found that college women who experienced severe sexual victimization were three times more likely than their peers to experience severe sexual victimization the following year. RIA researchers followed nearly 1,000 college women, most age 18 to 21, over a five-year period, studying their drinking habits and experiences of severe physical and sexual assault. Severe physical victimization includes assaults with or without a weapon. Severe sexual victimization includes rape and attempted rape, including incapacitated rape, where a victim is too intoxicated from drugs or alcohol to provide consent (University at Buffalo). We don’t realize just how much sexual assault go unreported while in college. No-one should have to experience this kind of abuse while they are trying to learn. It hard trying to learn when sexual assault is going on at a campus sight because you are afraid to walk around at anytime day or night because you don’t know who to trust or who is watching your every move. You have to be aware of your surrounding at all times.

A student, age 24 came into my office just like any other day set down and she had a strange look upon her face. I spoke and said what, I can help you with today. She replied, I was sexual assault at a party which I had attended on Friday with a couple of my friends. My response to her was are you alright and she replied no. She started telling me in details what had happen so I just sat and listen to what she had to say. It was a surprise party for her best friend so it was a lot of people there as you know the usual crowd family, friend, and co-worker. At this part there were loud music, drugs, and lots of alcohol, so we all were having a good time so it was this guy who I’ve known for a long time was there and we started talking, laughing, and dancing. As the night grew old we went back to his place of course I had been drinking and so had he. While we were alone in his place he started hugging, kissing, and touch me and it was making me feel uncomfortable so I asked him to stop and he said you know you want it and I said no but he didn’t pay me no attention and processed to throw me down and force himself upon me. I started screaming saying stop but he didn’t you continue on until he was finish. After he finished he took me home like nothing never happen I was so scared. When I made it to my house I ran upstairs and started to shower because I was feeling so dirty. So could you please help me I am afraid to tell someone what happen because I shouldn’t went there? She replied, I just feel so helpless all I do is just sit in my room and cry it’s driving me crazy. The scene just keep playing over and over in my head. So, I felt that I needed to talk to someone before I go crazy. I don’t want my friends to know what happen to me Friday night. I don’t need no-one judging me because I had too much to drink. I thought I knew this guy that’s why I agreed to go to his place not knowing he had other things own his mind. It goes to show you, can’t trust anyone these days not even a good friend. So, I found myself walking around in a daze and it led me to your office on Monday. Please help me figure out what to do before I beat myself up about what happen.

As a social worker I assure her it wasn’t her fault and I will do everything to help her gain her self-respect back. She didn’t want to go to the police and tell them what had happen because she felt the police wouldn’t believe her because she went to his house on her own and plus she had been drinking. As we were talking, we talked about the negative and positive things that was going on with her. I had to ask some personal question such as did he use protection, do you know if he had any sexually transmitted diseases, or do you think you might be pregnant. She replied, I don’t know. So I advise her to go and get herself checked out and so she did and everything was just fine. Now that’s something you want have to worry about. After the assessment I set her up with a counselor to help her understand that she wasn’t at fault. While in session with the counselor we talk about how she can regain her self-respect back and not let this get the best of her. First just accept what had happen and talk to your family and friends so you don’t have to go through this alone. No-one will judge you because of what happen, right now you need all the support you can get. The more you talk about what happen to you that night is the only way the healing can begin. Later when you regain your strength you can go to the local authority and report him so it want happen to someone else. Always stay involved with people in the community because your story can help safe someone else someday. Remember to always hold your head up high and don’t let negative talk get you down because you survive. You have to start setting goal in your life to help you get back on the right track. We can’t change the facts about what happen or the feeling you have. The only thing we can do is just help you begin to heal. At the end of the long session she was able to deal with her feeling and regain her self-respect.

As a social worker we have to get involved with families, groups and organization or communities to help promote social justice when dealing with people. As a social worker we must be equipped with the skills and knowledge to be able to better serve clients. As a social worker we play many roles in people lives for example: negotiate, mediate, advocate, broker, and educator. As a social worker, in the work, that we do go a long way in helping client achieve their goal weather they are short term or long term we have to do whatever it take to make sure our clients are treated with the up-most respect.

When a social worker deal with someone who has been assault they have to deal with outsider also and it can make it hard on the victim. Because the victim have to re-live the whole thing all over again so many time they just sit back and deal with the problem the best way they know how by just leashing out at the world for no reason. Being the victim trying to pick up the piece and move forward can be one of the hardest things to do because they feel as if they have the weight of the world on their shoulder. They just have to be strong and not show anyone what’s really going on inside. According to The Canadian Press (2014), the most common reasons for not reporting were shame and embarrassment, fear of the offender and lack of confidence in the justice system. While 53 per cent of participants stated that they were not confident in the police, two-thirds stated that they were not confident in the court process and in the criminal justice system in general,” the study says. Participants cited ongoing, long-term effects of being attacked, including depression, difficulties with trust and forming relationships, and anxiety, fear and stress. The women described a number of means of coping with effects of the trauma, both positive (such as reading, exercising, and writing in a journal) and negative (drug and alcohol abuse, self-harm, suicide attempts).The women suggested that survivors of sexual violence become informed about the criminal justice system, and know that help is available for victims and that legal proceedings can take a long time. The best way of sharing this information is through school programs and counsellors, they said (Canadian Press).

There are many form of sexual assault it’s all around you just have to sit back and watch and see what is going on in people lives. Looking at the women and men in the military we don’t look at them as being victim but in reality they are victim. They are putting their lives on the line every day for us and look at what is happening to them. In the serves its their policy to not tell what happens in the field but look at how many lives are been ruin because of the way men are treating women or because of the way men or treating men. No-one deserve to be treated that way. The sergeant are up holding the men in their wrong doing telling them it ok what they are doing because no-one will never find out. No-one want to be label as a snitch because they will lose all their right and benefit and no-one will be able to provide care for their families. The men and women just have to live with this until they have a break-down in their lives and break the bond and tell what has happen to them while they were out fighting for their country. No man or women should have to feel in shame for what happen while they were serving their country. Yes there need to be stronger sentence for people who commit these type of crimes. In the U.S. Military academies, 5% of women report surviving rape every year, as do 2.4% of the men,for women abused as children, 92% of perpetrators were men, of those men who enter the Navy, 15% are perpetrators prior to their service, 28% of women in the military experienced rape during their military service. Of those women who men rape in the military, 96% of the perpetrators are U.S. military men (Sadler, Booth, & Doebbeling, 2005). No one should have to lose their right because they chose to speak about the truth. Although the truth may hurt a lot of people because being assault in the service will follow you for a long time. Making it hard to truth anyone in authority.

A young male 22 walk in my office and spoke and said he was gang rape and needed some help. We both sit down and I assess him on the nature of the matter of just what happen. He said, they he was walking home from a party and a group of guys pulled him into the car and drove him down a dark back road and that’s where the assault occurred. It was three guy that he recalled pulled him into the car. He said, he was scared for his life. What made the guys pull you into the car? He replied, I was dress in women clothes and when they got to the place and realize, I wasn’t a women it made them mad. To teach me a lesson the guys place a drink bottle into my rectum and begin to push with all their might. That wasn’t good enough each of the guys took turn and place there penis inside. I never imagine anything like that happening to me. I was afraid for my life they left me there to die. I was screaming but no one could hear me because we were on a dark lonely road. The counselor assured me that it wasn’t my fault and that I had nothing to be ashamed of. The counselor advice the young man to go to the doctor so he can get himself checked out. While at the hospital the police officer pulled up on the scene and gather some background information on what had happen. The guy went into detail and told the officer what happen. The counselor ask the young man would he be interested in seeking professional help and he replied yes. The counselor made come called and got him place in outpatient care. The counselor ask him some personal question. He said, as you know I am a man trapped into a woman body. The counselor asked are you sexually active and he replied no I am not. Did they use any type of protection you use protection he replied, I don’t know. The counselor said make sure you get yourself checked for sexually transmitted disease. The counselor reassured him that it was not his fault that he didn’t do anything wrong. In order for you to heal you will need to get set up in individual counselling and group therapy. You must be willing to talk with family and friends and let them know what you are going through. You must learn to let your feeling out and get involved in positive things and start setting goal in your live to help you get back on the right track. Talk to family and friend because they want judge you because at this point in your life you need all the support you can get. The counselor let him know that this wouldn’t be an easy journey. After all he went through time will heal all wounds. No-one can take the pain away after all the therapy, he did gain his self-respect.

In conclusion I provide insight on sexual assault and how it effect people in many ways. Most people don’t like talking about sexual assault because it makes them feel dirty and ashamed, but they must realize it wasn’t their fault. As a social worker it is our job to help reassure the victims that everything will be alright. If you know of anyone that has been sexual assault my advice is to please get the proper help so you don’t have to live in fear. The healing only start when you are ready to tell your story.

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