Navigating the ‘shadow of loss’ in mental health social work

ABSTRACT

The human experience of loss has been at the centre of psychoanalytic understandings of the human condition since Freud’s first writings on ‘melancholia’. This essay draws on psychodynamic theory to show how workers who are attuned to the experience of loss in service users can shape their interventions accordingly. By reflecting on how a diagnosis of ‘depression’ might better be understood as the rippling wave of past grief, professionals can utilise the dynamics of projection, transference and containment to help understand the emotional pain of individuals they support. But this essay also suggests that the use of psychodynamic practice works best when it is bolstered by other frameworks – in this case an understanding of systems theory. When the two traditions are utilised together, they provide an understanding of psychic phenomena which can enable social workers to build a basis for effective interventions with service users experiencing mental distress.     

Teaching and learning: an exchange of knowledge in the university among students,service users,and professors

The education system's responsibility for social workers to be is a central argument in the academic arena. The purpose of the article is to present an innovative perspective about social work education promoted for several years in the Catholic University in Milan. The education experience with students, social workers to be, gave life to a particular workshop ‘Social Work Orientation’ characterized by different and innovative activities. The experience presented focuses on relational principles such as empowerment, peer facilitation, involvement of service users, and facilitation, following the idea that teaching and learning could be a simultaneous process. Revealing is the experience of ‘service users as professors’, a meeting day in the university between students and service users, a sharing of life stories and relationships. The future social workers learn from the service users, accustoming themselves to considering the service users as people able to cope with their life situations even before enrichment with all the professional tools. The feedback collected about this experience (from students, service users, and professors) shows that the possibility to experiment from the beginning in this approach facilitates the students to become social workers oriented to empowerment and relational processes.     

Narrative social work: conversations between theory and practice

This paper begins by reviewing the current situation in social work practice. It is contended that much of the literature around social work consists of diverse models of practice that urge social workers to take up various theoretical positions. Equally, social workers are often encouraged to listen to the views of service users. In this complexity, it is often difficult for social workers to know which approach to take. This paper goes on to propose a narrative-based approach to social work practice. Narrative social work is defined as a conversation between theory and practice, which can lead to development in both social workers and service users. An example from the lead author's practice is used to outline the model in action. The paper concludes with some comments about the values inherent in narrative based social work.     

Substance Use and Disabilities: Experiences of Adults' Social Care Professionals and the Implications for Education and Training

This paper draws on data from a national survey of social workers and social care practitioners in England undertaken in 2010–2011. It focuses on practitioners working in services for adults with either learning or physical disabilities and, in particular, their experiences of responding to alcohol and other drug use among their service users. Based on secondary analysis of survey and focus group data from the earlier study, the paper outlines the extent to which workers in these areas of practice encounter alcohol and drug problems and discusses the key challenges this poses for them. The findings show that between 4% and 10% of adults' practitioners' service users have alcohol and drug problems depending on the nature of the disability. Regardless of the type of disability, practitioners reported difficulties in talking about substance use with their service users as well as identifying tensions around life-style choice and risk management. They also reported the need for education and training in a number of areas. Social work education and subsequent training in working with substance use problems needs to be available to adults' practitioners and it needs to address the specific issues and needs in different areas of social work practice.     

Intercultural consolidation: exploring the experiences of internationally qualified social workers and the English post-qualifying framework

The increasing movement of social workers from one country to another, especially with the expansion of the European Union, appears likely to pose a number of challenges to host countries in terms of receiving, supporting and developing social workers who trained in other countries. This paper explores the provision of a post-qualifying ‘consolidation’ module to a group of 15 internationally qualified social workers and evaluates both the student experience and the cultural challenges faced by individual social workers who came to practise in England after qualifying in their home countries. These social workers undertook the module at the University of Greenwich in London, England, and were selected for this as a part of a project with two London boroughs. Factors which have an important influence on successful ‘settlement’ into a new role and culture are discussed and analysed. It is argued that the provision of post-qualifying training can be a key part of the acculturation process but timing and other factors need to be considered. The paper explores what was learned from the project and its evaluation about the experiences and support needs of internationally qualified social workers. The project took place in 2007–2008 and was evaluated by students, the teaching team, stakeholders from services and service users.     

The Theory Circle: A Tool for Learning and for Practice

Social workers have grappled for many years now with the tension between theory and practice. The struggle may be to bridge a perceived gap between the academic knowledge base of social work and the complex realities of practice. Equally, it may be to move from common‐sense interpretations of human need and professional responses, towards a more informed and accountable approach to practice. In recognition of the challenges faced by social work academics, practitioners and students, in relation to applying theory to practice, two of the authors of this paper developed a model, which aimed to facilitate productive discussions between practice teachers and students about the nature of theory and its link to practice. In addition, the model was designed to promote partnership approaches where service users participate fully in identifying their own issues and in shaping the services they receive. This paper describes the model—The Theory Circle—and reflects upon its effectiveness, based on the views of 19 practice teachers from central Scotland. The findings suggest that the pictorial model is one that practice teachers and students find accessible and valuable; it helps them to build a theoretical understanding of service users' situations and to work alongside service users to agree the most appropriate methods of intervention.     

The terrors of night and the arrows of day. Social workers' processes in the aftermath of murder

This paper provides extended extracts from interviews conducted with three social workers interviewed for a study enquiring into social workers' experiences of stress. For the purposes of this study, experienced practitioners were asked to recall a time that stood out for them in their minds as causing them stress. They were asked to describe the experience, to say how it had affected them, how they responded to it and what they had found helpful and unhelpful when attempting to deal with the experience. The three participants quoted in the paper all talked of their involvement with service users who had killed others. They describe personal and organisational responses to the murders and tell of internal processes and responses from others that were found to be helpful and unhelpful. The 'haunting' quality of such experiences is apparent throughout accounts, as is the relevance of psychodynamic theory and concepts. The importance of creating and using a therapeutic space in which it is possible to have ideas about how such stress can be thought about is emphasised.     

Reimagining social work case studies: a social work—creative writing collaboration

This paper describes a joint social work and creative writing project which analysed case studies from textbooks on reading lists for the Bachelor of Social Work course at Edith Cowan University. The textbook case studies were analysed from the perspectives of both social work and literary craft and it was found that they presented simplified scenarios which were limited in terms of diversity and rarely portrayed depth or complexity. The case studies were also often bereft of information about social workers’ or service users’ human qualities and frequently portrayed service users in terms of the problems they presented to the social worker. The authors argue that depicting social workers and service users in this way can create the impression that social work is a distanced procedural activity and can also serve to distance service users’ lives and experiences from social work students. Drawing on research in creative writing craft, as well as analysis of the textbook case studies, principles for writing engaging text-book case studies were developed and the paper concludes by arguing for the use of these principles when crafting social work case studies.     

The Caring Experience: Learning about Community Care through Spending 24 Hours with People Who Use Services and Family Carers

This paper describes a teaching and learning initiative developed in a UK social work programme that has involved carers, service users, academic social work staff and practitioners. Post‐graduate student social workers spend 24 hours in agreed periods with family carers or people who use social work services. The paper explains the origins of this initiative, rooted in a model of service user and carer involvement established over a number of years within the social work programme at the University of Dundee, Scotland. The development of this teaching and learning method is outlined and an account is given by a family carer describing their experience of being involved in the programme. Findings from the evaluation of this first year of operation are reported.     

Assessing Fitness to Practise and Managing Work‐based Placement

This article describes the experience of Nottingham and Birmingham Universities in partnership with workers from Advocacy In Action and shows that service‐users, carers and other eligible citizens can and should be involved in deciding fitness for practice and in the managing of that practice, and that such involvement enhances the student experience and lays the foundations for partnership working in the professional arena. The users and citizen stakeholders of social services are a valuable resource in respect of all aspects of service planning, delivery and control. In respect of social work education, their involvement is too valuable an opportunity to miss and we look forward to further exciting partnerships in the field of practice learning.     

Inter‐professional Learning to Prepare Medical and Social Work Students for Practice with Refugees and Asylum Seekers

Social workers and medical practitioners, particularly those in general practice, provide services for individuals who experience social exclusion. Access to medical, health and social care services has been identified as problematic for refugees and asylum seekers, reflecting their marginalised status within society. It is widely accepted that multi‐agency responses and working together are key requirements in improving access to services and promoting social inclusion; however, achieving this across professional and agency boundaries often remains challenging. Joint planning and training have been suggested as being important in improving communication, leading to more flexible and creative services.

This paper describes the genesis and implementation of a series of innovative inter‐professional workshops for medical and social work students, focussing specifically on marginalised groups. Learning and teaching input was developed by, and came from, service users and qualified medical, health and social work practitioners. The paper focuses particularly on the sessions relating to refugees and asylum seekers. The content and structure of the sessions are discussed and students' responses are reported. The implications for future inter‐professional learning and practice in relation to socially excluded groups are highlighted.     

Telling it like it was. Audio-taping stories told by mental health service users and carers

This paper begins by claiming that the telling and hearing of stories is intrinsic to the social work task. Examples of the value of hearing stories in a variety of social work roles are provided, as are examples of the theoretical underpinnings which substantiate the importance of enabling service users and carers to tell their stories. The main focus of the paper is on relating how audio-taping the experiences of service users and carers evolved as part of the author's work. With the permission of those interviewed, examples are quoted from accounts of three different family members attempting to deal with a relative's progressive deterioration into severe dementia. These accounts are followed by the memories of a woman who took an overdose and was subsequently ‘ectioned’ under The Mental Health Act 1983. An interview with two parents attempting to respond to the needs of their schizophrenic son is discussed. Some of the unexpected positive repercussions of recording interviews with these service users are described and some cautions are also highlighted. The paper concludes with suggestions of how audio-taping the stories of service users can be used to benefit social workers engaged in various aspects of social work today.     

Grasping the Nettle: Integrating Learning and Practice Revisited and Re‐imagined

This paper reports on findings from a practice audit and literature review into Integration of Learning for Practice, conducted in Scotland between November 2003 and February 2004. Findings from the practice audit suggest that although the integration of learning is one of the key aspirations of social work education, and there are many different approaches currently in use which attempt to enhance learning integration, students, practitioners, service users and social work lecturers all agree that more needs to be done in this area. The review of literature indicates some ways in which this might be taken forward. The paper concludes that for integration of learning for practice to succeed, we need a re‐imagining of the traditional boundaries between field and classroom, and practice teacher and social work academic.     

Building Capacity for Service User and Carer Involvement in Social Work Education

Requirements set out for the social work degree and post‐qualifying framework specify the involvement of service users and carers on a number of levels. Research indicates that service user and carer involvement can benefit students, professionals and service users and carers themselves. To keep up with demands placed on service users and carers by higher education institutions and other social work bodies, the issue of capacity needs to be addressed. This paper describes a programme (Getting Involved) designed by Skills for Care to build capacity to participate among service users and carers new to social work education. It describes the experience of piloting the programme in Dorset by a team at Bournemouth University consisting of service users and carers and staff from the Centre for Post‐Qualifying Social Work. Getting Involved is a welcome development and the outcomes of the pilot have been extremely positive for all involved. The process of undertaking and evaluating the pilot raised issues concerning setting up programmes, project management, service users and carers as co‐researchers and sustainability. These are discussed in terms of our experience and how they link with the literature. Lessons learnt and implications for similar work in the future are highlighted.     

Making it ‘APP’en: service user feedback: developing and implementing a service user APP: reflections from Northern Ireland,England and Scotland

Despite the advent of social media and increasing use of smart phone technology amongst global and UK populations, APP’s for social work remain in their infancy. Several have been developed which focus on the education of social workers and practitioners providing information on specific social work issues, and one we are aware of that explores ethics and values using a games-based approach. In this paper, we discuss the importance of service user perspective in social work practice and how this informed the development of the feedback App. We reflect on developing this instrument using digital technologies which social workers can use to gather anonymous feedback from service users about their experiences of social work interventions. This project, developed in response to demands placed on social work agencies to evidence the effectiveness of service interventions, provide robust data from service users for inspection regimes and sustain service user involvement in improving services. The evaluation model is designed to document the implementation process, exploring what works and what barriers, challenges and lessons were learned by the project team together with how some of the tensions in the process were addressed and resolved.     

Social care stakeholders' perceptions of the recruitment of international practitioners in the United Kingdom—a qualitative study

Mobility of labour is common within Europe and globally, particularly in social and health care. This article examines the findings from a qualitative study of 15 expert or stakeholder views that explored supply and demand factors in international social care staff recruitment to the United Kingdom (UK). Findings are that international social care workers have a better reputation and are perceived as being harder workers, more productive, more reliable, more focused and more likely to stay in a post longer than local workers. However, there is also the perception that employment in social care is a stepping-stone into other forms of employment both in the UK and when returning to home countries, through access to training, experience and improved job opportunities. The impact of migration policies on the composition of international workers is further noted because greater numbers of social care staff are coming to the UK from the European Union and fewer from Commonwealth states. Changes in the profile of international workers are discussed, with a need identified to address cultural and language differences to ensure good outcomes for service users.     

‘I'M NOT A PERFORMING MONKEY’: REFLECTIONS ON THE EMOTIONAL EXPERIENCE OF DEVELOPING A COLLABORATIVE TRAINING INITIATIVE BETWEEN SERVICE USERS AND LECTURER

In recent years there has been much interest in exploring how to meaningfully involve service users in social work education and training but there has been little attention paid to the emotional experience of such work. Working together involves emotional labour on the part of both the lecturer and the service user which is often overlooked in both the planning and evaluation of such work. Drawing on a collaborative training initiative undertaken by the authors on the subject of mental illness, this paper seeks to unpick some of the unconscious dynamics that can be at play. Using psychodynamic concepts such as transference, projection, reverie and containment, this paper aims to explore the emotional experience of service user and lecturer, as well as students, when working collaboratively. Assumptions and expectations underpinning service users' involvement in social work education will be unpicked with a view to facilitating an alternative understanding of experiences in the classroom and lecture theatre.     

Reducing youth's drug abuse through training social workers for cognitive–behavioral integrated treatment

Cognitive–behavioral integrated treatment (CBIT) is an intervention that social workers can learn to treat youth's drug abuse by cognitive restructuring, behavioral modification, and goal setting. A way to enhance the learning is training specifically for CBIT. Evaluation of the effectiveness of such training in raising social workers' CBIT practice and their young service users' illicit-drug-free days is the aim of this experimental study. This study first randomly assigned 14 outreach social workers to receive training for CBIT and 14 outreach social workers not to receive the training. The study also assessed 222 young service users (aged 11–22 years) engaged by 28 outreach social workers before the training and 169 of them after the training in a six-month follow-up. Furthermore, the study identified the reduction in the youth's dysfunctional cognition of playfulness as a means to deter the youth's drug abuse, based on personal interviews with outreach social workers and their young service users before the training. Derived from the statistical analysis of assessment data, results principally showed cascading effects from the social worker's reception of the CBIT training to the young service user's reception of CBIT, reduced playfulness, and lengthened drug-free days. A supplementary finding was that the young service user's time in the outreach social work service prolonged drug-free days and reduced playfulness. These results imply that the outreach social work service, CBIT training, and CBIT are useful for treating youth's illicit drug abuse.     

Exploring the Concepts of Recognition and Shame for Social Work

Recognition and shame are both concepts that potentially offer social workers a structure to build practice on; two states experienced by both social workers and service users. ‘Recognition’, within social, political and economic thought, has been established as a field in which inequality and exclusion can be analysed. Social work theorists have also made inroads into exploring its reach. ‘Shame’ in twentieth century and contemporary sociological and psychoanalytical accounts, is understood as a force in limiting human agency, well-being and capacity This paper briefly outlines some of the defining ideas in circulation in relation to recognition and shame, and then briefly considers how psychoanalytical and contemporary social structural analysis builds on this, making links to contemporary social work thinking throughout. The paper also specifically considers some of the uses of recognition and shame for thinking about social worker and service user ‘well-being’, and the connections, through both the relational and the socio-political, which inflect social work practice.     

Involving Services Users in Social Work Training on the Reality of Family Poverty: A Case Study of a Collaborative Project

In the last five years there has been an increased drive to include the perspectives and contributions of service users in social work education in the United Kingdom. In this paper we discuss the experience of one project that attempted to bring together service users, academics and practitioners to jointly develop and deliver a module that sought to examine the perspectives of families living in poverty who were in receipt of children and families social work services. Through doing this it was hoped that it would be possible to raise practitioners’ awareness of how poverty impacts on parenting and how they could develop an approach that was non‐punitive and genuinely supportive. The paper starts by exploring the context of service user involvement in social work education and then describes the development and process of this collaborative project. The paper concludes with recommendations for both projects seeking to engage service users in empowering and meaningful ways, as well as social work practice within an anti‐oppressive framework.