Social Work: A case study in applying theories to practice
Presenting Circumstance Mr. A is age 40, unemployed and living with his wife and six year old son; C in a twobedroom council flat in London. He is not only a gambler with drink problem, he is known to the police and social services for domestic violence towards his wife; Mrs A. He is notorious within the neighbourhood for his constant rows and aggression; sometimes accompanied by violence towards his wife. The latter is a catalogue shopping addict. As a consequence of their spendthrift lifestyles, the family is facing action from the bailiffs for mounting debts. Additionally, their son’s aggression towards local children within the estate means that the family is also facing the possibility of eviction from their council home for reasons of persistent Anti Social Behaviour (ASBO). As a further insight into the family’s circumstance, the couple’s parents are living way from London.
So why, and which social work theories can be used to assess, explain and justify the processes of intervention in this case? The positive indicators in this case are that apart from having an insight into their situation they were welling to receive help in resolving their problem. Most importantly, they wanted to rebuild their relationship as opposed to a divorce
Introduction While there is consensus that “the concept of theory is a social construct”, Payne, (1997, p. 26), for the purpose of this discourse, theory denotes, “a set of proposiotions which posit the nature of the relationships between predefined constructs or variables” Glynis et al., (1995, p. 5). Similarly, while applying theories to practice may not necessary lead to positive outcomes; it establishes a systematic approach to social work processes. The problem with choosing a particular
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perspective is that, while no particular theory is implicitly comprehensive; objectively applied, any theory can prove contextually appropriate. However, Payne, (1997, p. 36) asserts that theories are most effective when combined and that in isolation, “the theory’s value is vitiated” Indeed in contemporary complex and dynamic society with corresponding heterogeneity in its social problems, theory triangulation (combining theories) is
essential to better
understand, explain and address the myriads of interrelated problems that is ‘social work’. The very use of theory in social work per se is indispensible in establishing some degree of rationality in what would otherwise be a chaotic occurrence.
Reasons for choosing particular theories Argued on appropriateness rather than convenience; the ‘Psychodynamic theory by Freud and the ‘Attachment theory by ‘Bowlby’ in particular; and the system theory in general seem most applicable to this case study. This preference is based on the premise that family and relationship problems may be rooted in ineffective personality developmental childhoods. Within this context, Thomas and Pierson, (1999, p.302) state that, “the psychodynamic approach views the adult PERSONALITY as product of childhood development” Similarly, Payne, (1997, p. 79) states that “the important focus on social work on childhood and early relationships and maternal deprivation comes from psychodynamics theory” Indeed, Lishman, (2003, p. 14) suggests the use of the attachment theory in cases of relationship and dysfunctional family situations because it seems to appropriately explain behavioural and relationship problems as typical of this case. The suggestion here is that, Mr A’s drinking, gambling, aggression with associated violence; and Mrs A’s indiscriminate spending could be consequential of their deficient or ineffective childhood developments. Additionally, according to Payne, (1997, p. 291) both theories provide comprehensive models “that claim to offer a system of thought to cover all the practice social workers might want to undertake” Payne, (1997, p.291). Additionally, Wood and Hollis, (1990, p. 9) perceive psychodynamic theory as inseparable from family therapy. It is the combination of these arguments, capped with my critical judgement that has influenced the choice
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of these formal theories. With the family as a system; the sum of whose integral contributions is a factor of the wellbeing of the whole unit, the system theory adequately establishes the cause and effect relationship in the problems of the A’s family. For example, resolving the conflict between the parents is bound to produce similar effect of their child; C, and possibly resulting in a united and happy family. Now what are these theories?
The Psychodynamic theory and its principles Developed from the works of Sigmund Freud, psychodynamic theories assume that, “behaviours come from movements and interaction in people’s minds” Payne, (1997, p. 72). It “relates to the internal psychological conflicts between the irrational pleasure drives of the id and the social conscience of the ‘Superego’, mediated by the ‘Ego’ or psychological regulator.” Thompson, (2000, p. 63). Therefore, a welldeveloped ego and superego would have ensured for a better relationship within the A’s family. Psychodynamic would suggest that, Mr A’s drinking and aggression could be a way of avoiding facing reality and his responsibility within their relationship by falling back (regression) to his irrational ‘id’ behaviours. Wood, (1971). Equally, Mrs. A’s compulsive catalogue buying and Mrs A’s gambling could be “drives to satisfy some personal unidentified tension or libido within them.” Payne, (1997, p.73). Additionally, Mr A’s aggression with associated violence in particular, and their stormy relationship in particular, could signify under-development of their egos and super egos to enable them socialise and behave rationally as married couples. The implication is that, apart from their own neglected wellbeing; the A’s traumatic relationship has deprived them of the effective communication and joint decisionmaking about the welfare of their son. In conflict, parents are “too preoccupied with their own feelings to understand their children’s needs” Mitchell, (1985).
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Attachment theory. Bowlby defines attachment theory as; “a way of conceptualising the propensity of human beings to make strong affectional bonds to particular others and of explaining the many forms of emotional distress and personality disturbance, including anxiety, anger, depression, and emotional detachment, to which unwilling separation and loss give rise” Bowlby, J. (1984, p. 27)
Like Freud, Bowlby believed that the root of the development of personality lay in early childhood development, and that any trauma or failure in this early relationship would permanently shape the development of the child’s personality. The premise here is that ineffective or the lack of attachment in childhood or the excess of it could have been responsible for the problems in this case study. Similar to the psychodynamic theories, the attachment theory suggest that the roots of the couples’ difficulties may be due to ineffective or deprived affectionate bonding to their mothers or care-givers in their childhoods. There is consensus that experience of it affects the development of other relationships; with the deprivation and disadvantage having major damaging effects on children’s development and later life.” Payne, (1997, p. 75); Howe, (1987). Thus, C’s aggressive behaviour could be suggestive of the same deficiency. Another explanation for C’s aggression could be that, rather than the lack of attachment, he might “have been over protected by his mother, so that he never learned the socially acceptable methods of relating to others” Payne, (1997, p. 80). The lack of intimacy in the A’s relationship (may be due to their inability to share and relate as couples) could also be creating frustrations that are expressed in terms of aggression, drinking and gambling. In relation to bonding, Adams, L. et al., (2002, p. 170) states that, “a woman neglected as a child may have low self-esteem, feels anxious and agitated in close relationships”. Presuming that Mr A experienced a similar childhood, Adams, L. et al (2002, p. 170) further state that, “mutual anger as each partner believes that the other is capable of causing them hurt makes the relationship full of conflict and turbulence, anxiety and depression.” Presuming this to be the case, could Mrs A’s compulsive buying be a
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coping mechanism for yet undiagnosed depression or a vengeful and misinformed id response to her husband’s behaviour? Similarly, where Bowlby directs the “psychoanalytic interest in early mother-child relationships to maternal deprivation” Howe, (1987), could Mrs A’s compulsive shopping be explained by the tendency to indiscriminately acquire those material privileges she never experienced in her childhood? Where a supportive social environment would have mitigated the impact of this ineffective attachment, the family resides beyond easy reach of their parents. Even in the case where neighbours would have provided support for the family, their anti social behaviour has rendered them outcast within the neighbourhood. While both theories could account for Mr A’s aggressive behaviour, in terms of unresolved childhood conflicts, Crawford and Walker (2003, p. 61) suggest that it could be due to gender role and identity whereby he is imitating his father’s “dominating behaviour, finding it hard to express emotions and demonstrating caring actions and skills.” C’s aggression could be explained from similar perspective. Conversely, Mrs A is passive; unable to express her individuality and independence. Holistically both theories are unanimous that dysfunctional relationship can be attributed to deficiencies in childhood development. Understanding social problems from such perspectives provide rational arguments to justify a social work rather than medical model approach in addressing social problems. For example, detaining Mr A for substance abuse without recourse to inquire into the underpinning reason for his deviance, or providing him with a supportive rather than punitive exit option can only produce short-lived solutions. Applying the psychodynamic and attachment theories, the sustainable approach should be to empower the clients to acquire those social skills that they missed in their childhood; and which have been at the roots of their difficulties. According to Payne, (1997, p. 64), these supportive and therapeutic approach can help clients “change their deviant pattern of behaviour” Using the arguments from the psychodynamic and attachment theories as bases for intervention, relevant care plans should therefore be set against the background that the members of this family need to re-learn or acquire those skills that would henceforth enable them to live and behave as social beings if they are not to be like they parents. As earlier mentioned, the problem with using theory to explain social problems is that no one theory can be comprehensively adequate. In agreement,
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Payne, (1997, p. 93) points out that psychodynamics “is a theory for talking therapy, preferring verbally able clients with psychological problem”. Intervention According to Winnicott’s work, parents like Mr and Mrs A should be sensitise “on how to adapt from focussing on their inner world by developing capacity for dealing with the outside world” Payne, (1997, p. 75). Using person-in-situation approach, both parents should be encouraged to think and understand their debts, gambling, drinking, compulsive buying as provoking agents in instances of aggression and general disharmony. Within the context of ego and superego reformation, initial actions should suggest, encourage and assist the couple to start communicating in a rational and socially acceptable ways. This will include the respect and acceptance of their respective individualities, concerns and opinions. Starting with simple joint activities like taking their son to the park, the whole family may start to engage in meaningful socialisation. The rational is that by so doing, they would develop and perfects those acceptable social ethics that they never acquired in their childhood. Indeed, they may start to engage with their local community; they are part of social systems and play a social rule. Pertaining to their financial difficulties, the role of the social worker should be to provide them with the necessary information to jointly examine their situation and if need be, use the service of debt counsellors. Same applies to the marriage as a whole, if things do not work out through mutual negotiations; maybe with the social worker acting as an impartial mediator or facilitator, then marriage counselling services may have to be engaged. Equally, if attempts to sort out their financial problem do not cut out Mr A’s drinking and their spending, then he may have to consult an alcohol as well as a gambling addiction advisory service. The rational in all these initiatives is that by first maximising on their own potentials, clients are empowered to be their own doctor. Using external services should be a last resort and a formal way of providing what clients are unable to achieve through their own efforts. Understood and explained from the psychodynamic and attachment perspectives, but addressed from a system perspective, if these actions could enable Mr A to become the major bread-winner, this feeling of responsibility and self-worth could filter to other areas of their family and relationship.
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Children-focused intervention As a vulnerable client; legally incapable of providing informed consent, social work intervention on behalf of a child like C’s has to be legally compliant and appropriate as well as being based on systematic approaches. Thus, while exceptional circumstance may suggest the evocation of “control order to protect the child” Watson et al, (2004, p. 107) the legal preference as suggested by the children Act 1989 is to “support children and family to stay together.” Parker and Bradley (2003, p.21). However, since according to Schaffer, (1990) “the situation most conducive for children’s welfare is minimum overt conflict”, the direct exposure of C to Mr A’s aggression and violence on his mother; and the constant rows does not only constitute domestic violence, but child abuse, Hague and Malos, (1998, p. 19). While arguments based on the psychodynamic and attachment theories may suggest a more supportive and therapeutic intervention to enable C’s parents to carter for his welfare, the potential to suffer significant harm from this situational hazard may legally suggest a more drastic or punitive approach. As mandated by the legal framework under “the children Act 1989, Policy and procedural guidance under Area Child Protection Committee (ACPC) and the Home Office (2000); “Framework for the Assessment of Children in Need and their families“ Watson, F. et al (2004, P. 89), a “child-focused risk assessment” will establish where C’s best interest would be best served while things are sorted out.
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Appraisal As evident in this case study, the application of either the psychodynamic or attachment theories is contextual and dependent on the preference of the applicator. Consequently, the lack of a standardised bench-mark makes the evaluation of their effectiveness and appropriateness problematic and relative rather than absolute. However, the use of theories in the understanding, explaining, planning and intervening in social work is indispensible if practice is to be systematic. Nevertheless, any incoherence in applying these theories to practice could be a mirror of the complexities of life’s realities themselves? Similarly, no social work contexts are ever identical, neither are client groups homogeneous; a situation that would render the standardisation of perspective approaches futile. Recalling that stated that I opted for the Psychodynamic and attachment theories because of their appropriateness, critiques point to inherent shortcomings in both perspectives. Indeed, critics argue that “psychoanalysis has a scientific and originally biological approach to explanation that cannot be easily tested in conventional
scientific
ways.”
Harris,
(1984,
p.
24).
Others
assert
that,
psychodynamic does not respect human self-determination; pointing out that, in social work practice where the quest is to eliminate discrimination, “psychodynamics is a means of understanding how men achieved and maintain supremacy in patriarchal society.” Stream, (1979). Moreover, psychodynamic seen as limited to clients with verbal ability who can contribute in discussions and self-determination at the exclusion of service-users with psychological problem. As for the attachment theories, critics point out that a child like C can make attachment relationship to other people, not just the mother. Additionally,
that “reliance on one exclusive
relationship can itself be damaging, as it does not allow for supportive healthy relationship with others” Crawford and Walker, (2003, p. 44). Holistically, by trying to apply both theories to predict people’s behaviour, “the danger is that this argument can stereotype characteristics and people, thus potentially supporting prejudice and oppressive behaviour” Crawford, (2003, p. 10). Moreover, reducing complex human behaviours as in this case study using abstract concepts that are socially constructed is bound to produce reciprocal outcome and contestations.
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Conclusion The centrality of theories in social work practice is that they provide and establish rationality and systematic ways of addressing otherwise haphazard occurrences. Additionally, as in this case study, they draw attention to the rationale control that human beings have over their environment and their own behaviour” Payne (1997, p.297). While social work outcome may not be perfect nor even always satisfactory, the critical and systematic approach provided by the theories ensure that goodenough decisions are consistently made on the best information and judgment available. Where psychoanalysis and attachment theories have linked social problem as consequential of developmental deficiencies in childhood, the prognosis is that without a systematic social work intervention to safeguard a replication, the micro and exosystems of the family will collude to sustain the ongoing crisis, while producing a conducive environmental for a reciprocal consequence. Within the complex environment of interrelated and complex social problems, a better insight into particular problems is better gained through the multiple application of theories (triangulation); in isolation, “the theory’s value is vitiated” Payne, (1997, p. 36). In family interventions, any effective intervention to an integral part will eventually reciprocate similar impact of the wellbeing of the system as a whole.
Bibliography Adams, R. et al., (2002) Social work: Themes, Issues and Critical Debates. (2nd edn. ). Basingstoke Hampshire: PALGRAVE. Bowlby, J. (1984) The Making and Breaking of Affectional Bonds . In British Agency for Adoption and Fostering (BAAF) (eds) Working with children. London : BAAF
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Crawford, K and Walker, J (2003) Social Work and Human Development. Exeter: Learning Matters. Glnis, M., Breakwell, S. H. and Chris, F. (1995) Research Methods in Psychology. London: Sage Publications. Hague G. and Malos E. (1998) Domestic Violence; Action for Change. Trowbridge, The Cromwell Press. Howe, D. (1987) Attachment Theory for Social Workers Practice. London: Macmillan Lishman, J. (1991) Handbook of Theory for Practice Teachers in Social Work. London: Jessica Kingsley. Mitchell, A. (1985) Children in the middle. London: Tavistock. Parker, J. and Bradley, G. (2003) Social Work Practice: Assessment, Planning, Intervention and Review. Exeter: Learning Matters Payne, M. (1997) Modern Social Work Theory. 2edn. Basingstoke, Hampshire: PALGRAVE. Schaffer, H.R. (1990). Making Decisions About Children: Psychological Questions and Answers. Oxford: Blackwell Stream, H. S. (1979) Psychoanalytic Theory and Social Work Practice. New York: Free Press. Thomas, M. and Pierson, J. (1999) Dictionary of Social Work. London: Collins Educational. Wood, K. M. (1971) The construction of psychoanalysis and ego psychology to social work in Herbert S. Ed. Social casework: Theories in Action. Metuchen, NJ: Scarecrow Press. Woods, M. E. and Hollis, F. (1990). Casework: A Psychosocial Therapy. 4th Edn.. New York: McGraw-Hill Publishing Company/ Watson, F. Et al., (2004) Integrating Theory and Practice in Social Work Education. London: Jessica Kingsley Publishers.
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