It is of paramount importance that by building and developing a good working relationship we are able to strive to establish and maintain their trust and confidence in line with 2.1, 2.2 and 2.3 of GSCC codes of practice (Trevithick, 2006). However, having just completed the 75 days placement within a day service for adults with learning disability this can sometimes be a challenging task due to the complex nature of this service user group.
In this essay I will illustrate how I worked and established a working relationship with service user J in order to help him develop new skills but primarily to lower his aggression towards others in the day centre. Furthermore, I will also discuss how I brought the relationship to a close. I will divide the essay into five sections. The first section will discuss the description of the work. The second section will provide an analysis of process which the relationship was established. The third section will identify anticipated and actual barriers in the relationship. The fourth section will talk in depth how the relationship was brought to a close. The final section will provide an evaluation of my success (if any) in establishing the relationship with J. The essay will than be concluded.
Description of work
Barncroft Day Centre provides developmental training for people with learning disability, in the age range 16+, in order that they can live more independently in the community. People in the day centre are known as students rather than service users as this prevents labelling. It currently has 60 students ranging from mild to severe learning disability that accesses the day services full and part time.
Part of my role at the organisation was to help service users develop new skills which would benefit them in their life. Therefore, for my placement I was asked by my onsite supervisor to work with J.
J is a forty nine year old male who has the developmental age of 7-8 year old and also suffers from Obsessive Compulsive Disorder (OCD). He came to Bancroft from Willow Woods day centre after a number of serious incidents with anxiety and aggressive expressions often being influenced by his sister who also attended Willow woods at the time and who he has a bad relationship with.
He is a pleasant, polite and courteous man who enjoys being helpful and active however, on occasions J may exhibit outburst of aggression towards others resulting in very serious incidents. J was not born with his learning disability and therefore, it has been assessed that this may contribute for his aggression as he may not be happy with his situation. His outbursts can occur suddenly and can be largely triggered by others not acting in accordance with his rules or expectations of appropriate actions or behaviour, whereby he will take it on himself to intervene physically.
Therefore, the aim of the engagement was to establish, build and sustain a relationship with J for the entire duration of my placement (75 days). The purpose of this is to have a care worker/student relationship to benefit J by working with him and finding ways to lower his episodes of aggression towards others and as a result begin forming new relationship. Another aim was to teach him life skills for e.g. sharing, working with other service users, helping him with his OCD and improving coping mechanisms. However, it should be noted that I was aware seventy five days may not give me enough time to make a significant improvement in his life.
Due to the problems J had with his sister in the past, female staff at Barncroft found it very difficult to work with him. Furthermore, as there are only two male care workers at the organisation it was difficult for Barncroft to allocate one of them to do intensive work with J. Therefore, I was allocated as it was an ideal opportunity for Barncroft to use me to do intensive work with him because I am a male.
To be able to sufficiently work with J and to gain a greater understanding about this task I familiarised my self with relevant policies for e.g. the Department of health’s white paper on ‘Valuing people a new strategy for learning disability for the 21st century’. I also familiarised my self with key legislations for e.g. 3.3 of the Mental Health Act 1983, NHSCC Act 1990, and the Health and Safety at Work Act (1974). As a result this enabled me to move forward and feel confident to be able to undertake this task.
Analysis of process & skills employed
“The first contact with a potential service user sets the tone for the rest of your work” (Doel et al, 2005, p.61). Therefore, I planned the initial contact to take place in an environment he enjoyed the most which was painting. This initial contact was facilitated by my supervisor who was also his key worker. J was doing a two day project in which he had to draw and paint the things he enjoyed doing the most in his life. I felt that working on this project with him will be act as a foundation on establishing our relationship and aid him to ease any anticipated tension or uneasiness he may have. Furthermore, it gave him an opportunity to find out things about me. For example I disclosed to him that I am also student like him. This brought equality to the relationship and also enabled him to relate to me.
A formal meeting was than facilitated by his key worker and the aim of this was to give him control over by his life by allowing him to make an informed choice to work with me. The GSCC codes practise 1.3 supports this in which social care worker must support service user’s rights to control their lives and make informed choices about the services they receive. Furthermore, by giving him this choice we were also promoting his independence.
Social workers must enhance the power of people who lack it and this is why I can relate empowerment to this situation. Empowerment helps minorities by reducing discrimination, oppression and devaluation (Thomas, 2003, p.102). At the core of the concept is the idea of power and therefore, by giving J a choice we were helping him to increase his capacity as an individual and enabling him to gain power of decision and action over his life.
Following the formal meeting it was important to allow J to build a trust in me. By doing this, I was able to build a good working relationship that allowed him to work with me in an effective way, identify goals and develop appropriate approaches for obtaining these. I clearly explained to J and always reminded him that anything he says to me will not be passed on to other service users. This was in the remit of the organisations confidentiality policy which coincides with the GSCC codes of practise 2.3 in which social care workers must respect confidential information.
I used person centred approach to ensure that that everything I do is based upon what is important to J from his own perspective. Person centred planning enabled me to discover and act on what is important to him. Furthermore, it also allowed me to build a shared commitment to action that recognises his rights and therefore, by working together we can make changes which will improve the quality of his life.
Establishing a relationship with J required all my skills in order to find ways to relate to him. The key to working effectively in this setting is appropriate and effective communication skills. Effective communication is regarded as a tool for engaging with vulnerable people which helps to develop a working relationship. Trevithick (2006) outlines that “like other interventions, it is through our capacity to communicate with others that we reveal the knowledge, skills and understanding’ that we can use to form good, positive and strong lasting relationships” (Trevithick, 2006, P117). Therefore, in order to address J’s issues I used different methods of communication. Although most of our communication was through speech I also used activities to communicate with him for e.g. soft music, art, makaton, etc.
Body language was also an important method of communication. For example while sitting down I would make sure that I was always as the same height as him which ensured equality. Also whilst seated I would regularly change my posture in order to illustrate active listening and participate in the discussion. Furthermore, other skills I used in our relationship included awareness, observational skills, goal setting skills, listening skills, being empathetic and self aware as possible.
Each week I used my interview skills to have a one to one session with J and worked with him in order to set a task for that week which would enhance a particular type of skill. However, in the beginning he needed constant motivation and positive interaction, as he often found it difficult to talk and express his feelings and thoughts. I worked with J in a non-oppressive manner, by allowing him to work at his own pace. Each week we reviewed how far and how well he was performing in his given tasks and also identifying areas where he was struggling and needed support and how I could assist him.
An example of a successful task we worked on was week 9 in which J took part in gardening. The aim of this task was to enable him to work with other students in order to achieve a common goal. This was a hands-on approach task which involved working with other students and supporting them. I was afraid that due to certain environmental factors such as it being a hot day he may exhibit outburst of aggression towards others however, this was not the case as I observed that he fully engaged in this task by helping and supporting other students.
In reflection, does J have the capacity to work with people? I think he does. Also this task extends his horizon as he gets visual experience and can feel to be happy by working with others.
I used cognitive behavioural therapy as a method of intervention in order to address his strong emotions. ‘Cognitive-behavioural methods are therapeutic procedures which focus on changing thoughts and feelings alongside, instead of or as a precursor to, changing behaviours’ (Payne, 2002 P122). This approach aims to intervene by changing the way he thinks and enabling him to cope in stressful situations. As a result to manage his aggression I took account of his learning disability as it was important to ensure that I used relevant social work methods. Also by analysing why he becomes aggressive I used behaviour modification as a method of change. I did this by teaching him that being aggressive towards others was wrong and constantly reinforced him. However, I used low level punishment if he did something wrong for example taking away his painting privileges for a day. Furthermore I also used modelling behaviour with the aim that J can model his behaviour by learning from me and others around him.
In any social worker/client relationship there is always a potential risk of there being barriers whether it’s a personal anticipated barrier or an actual barrier. This was also present in the course of establishing an appropriate and productive relationship with J as I assumed that barriers may affect my working relationship with him.
As J has learning disability I anticipated that I will find it difficult to communicate with him because I would not know his methods of communication. Therefore, I questioned myself on how I was going establish a relationship with someone who I cannot communicate with.
The lack of communication skills is a common denominator. One approach is the social model of disability and its implications to social work. The social model of disability defines disability “as the societal response to impairment” (Grant et al, 2005, p.725). The challenge is the level of insight that would facilitate communication in service user/worker relationship because it is difficult to facilitate each person’s use of language and form of communication of their choice. Tom Shakespeare (2003) sums it up when he stated that “people are disabled by social barriers and failures of provision, not by their body” (Cited in Grant et al, 2005, p.725).
In order to minimise the impact of this I needed to change my communication technique in style by adapting to his communication needs. However, I had to do this without being patronising because this can occur within any sort of oppressed minority group in which the worker feels that they are better than the service user and this is not the role of a social worker.
I anticipated age to be a potential barrier because he was a forty nine year old vulnerable adult who has learning disability and I am a twenty two year old man. Thompson (1997) state’s that “age is not just a simple matter of biological maturation-it is also a social division; it is a dimension of the social structure on the basis of which power, privilege and opportunities tend to be allocated” (Thompson, 1997).
Age was initially an actual barrier because the fact was that although he was an adult he had a developmental age of 7-8 year old.
This was a challenge because I had to take account of his developmental age but at the same time I had to recognise that he wasn’t a child. The challenge was that as he has low developmental age old I couldn’t solve this. Therefore, the difficulty was that how can I work with a person of forty nine who does not have the intellectual ability to think within the framework of an adult.
On the other hand to minimise this impact as a worker I was aware of his individual human rights in accordance with values and ethics b.Therefore, I treated him as an individual but at the same time took account of his developmental age.
I also anticipated race to be a potential barrier as I am an Asian young male and he is a white middle aged man. I felt that this would affect my working relationship with him because as I was the only Asian male in Barncroft he might find it uncomfortable to work with me. As a result I had doubts on how far I would be able to assist him. Furthermore, I also thought I might find it difficult to empathise with him on certain issues considering our different ethnic backgrounds.
This was not an actual barrier in practise and therefore, I did not have to prepare in order to minimise the impact. However, in reflection, if this was a problem than as a professional I would have worked effectively with J by treating him as an individual. Respecting his views and wishes and also respecting diversity and different cultures and values in line with the 1.1, 1.2 and 1.6 of GSCC code of practice.
Finally, I also anticipated the issue of power to be a barrier in this case me being powerful and J being powerless. According to Adams (2003) “service users are usually people who are relatively powerless in contrast to social workers who are relatively powerful” (Adams, 2003, p.76). The notion power/powerlessness exits in almost all social care worker/ client relationship. I was aware that if this power is used negatively it can bring discrimination, oppression and inequality and as a result I would not be able to establish a good working relationship.
However, in order to minimise the impact of this I used my knowledge and experience to always promote anti-discriminatory practise as well as promoting values and ethics a, b, c, d, e, and f. I worked with J to enable any barriers which do not allow control of his life to be removed. This enabled him a sense of power instead of powerlessness and lead to him being empowered in his life. Furthermore, I used professionalism at all times and used the power I had constructively as a useful tool to promote equal opportunity for him in line with 1.5 of the GSCC code of practise.
Closure is an emotional component in any social worker/ client relationship. I was aware that after my placement finishes I can’t invest any more time with J and I will have to leave him behind. Therefore, at the formal meeting I informed him that I will only be working with him for seventy five days.
I knew that I am working with him as a social care worker and not as a friend. I was aware that the aim of the relationship is to help J increase his awareness and to enhance his skills which will help him reduce his aggression towards others and this will be beneficial to his life. However, I was also aware that by inviting him to be dependent on the relationship at the end of the placement I will have introduce him back to his independence as this is the kindest thing I could for him.
Achieving relationship closure is not an easy task however, my approach to social work is firmly rooted in the belief that each person must be treated as an individual and therefore, in J’s case I made sure that he was always informed although I recognised his limitations. As the placement gradually came to an end, I always reminded him that I am also a student and that I have to go back to school as this gave him enough time and notice to digest the information. On my last day of placement I properly said good bye and detached because it will be inappropriate to stay in touch as I would not be able to keep my promises.
I can relate loss and bereavement to this situation because he will go through a grieving process and will have to accept the reality of this separation and loss.
As one of the reactions to grief is anger I was afraid when I leave he will become aggressive towards staff and/or other service users. However, parameters were in place for his key worker to manage any situation as she is a trusted person with years of experience. Furthermore, parameters were also set up to offer J support and would be liaising with other agencies (if required) to offer services and to ease him back to independence. This is supported by Oswin (1993) who states that people with learning difficulties need time to recover, and sensitive support as they go through normal reactions of grief such as anger, weeping and depression (Cited in Thomas et al, 2003, p. 130).
Before coming to Barncroft I did not have any experience working with people with learning disability. The placement enabled me to get out of my comfort zone and work in a new surrounding. However, I was able to gain a wealth of knowledge from this experience and develop my understanding of this service user group.
In evaluating my established relationship with J, I feel that there is plenty of evidence to suggest it was successful and I was able to achieve my aims of the engagement. I feel that I was able to influence and affect J positively within professional social work ethics. Throughout the working relationship I did not observe any incidence of aggressive behaviour towards staff member or service users. However, on a one off particular day I was on study leave and was told by my supervisor that an incidence took place during lunch time in which J had hit another service user because she sat on the same chair that I usually sit on. Although this showed the closeness he felt in our working relationship, I feel that this incidence illustrates he had become too dependent. Therefore, I recognise that I should have placed more distance in the care worker/ student relationship.
Another evidence to suggest the engagement was successful is each week I observed that by completing tasks successfully J had enhanced a particular life skill. For e.g. gardening task in week 9 I noticed he had improved his people working skills and sharing skills.
A way I recognise that the engagement could have been better is having more time with J instead of seventy five days because it is a slow process and I feel by having more time it may have been more beneficial to him.
Despite not having any experience working with this service user group this placement has provided me a great deal of knowledge and insight into lives of people with learning disability. I feel that from my working relationship with J I was able to contribute positively to his life. I used appropriate theoretical concepts -e.g. person centred approach, cognitive behavioural therapy, behaviour modification, communication models and the social -v- medical models of disability and/or mental health. This gave me the ability to sufficiently work with J and enabling him to begin learning new skills.
Overcoming anticipated and actual barriers has been the major challenge in this placement. However, I have grown in confidence as a prospective practitioner and will put this to good use in improving my practise further.