Wednesday, May 25, 2016
Sunday, September 6, 2009
Case Work and counselling
Working with Individuals in Urban Settings
SHANKAR DAS
Social workers are required to work with individuals in a variety of settings on account of the constantly changing global and local environment, which is adversely affecting individuals and their families. Keeping the individual as the focal point, this article discusses the need to use a multi-theoretical approach such as the task-centred, behavior modifications systems, and crisis intervention approaches at micro, mezzo and macro levels. The knowledge and skills of practitioners must evolve with time and context.
Dr. Shankar Das is an Associate Professor, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India. He is involved in teaching, training, research and consultancy work in the field of human development, health and human resource management.
INTRODUCTION
Social work with individuals is one of the oldest methods of a generalist approach to social work practice. Historically this method could be traced from the very inception of social work profession, where worker helped individual clients and their families to help themselves in wide array of problem situations. Helping individuals in the time of distress and need must have existed in one form or another since the very beginning of human civilization. According to Grace Mathew (1992), though social work as a profession is a product of the twentieth century, social work as a helping activity is as old as mankind.
The worker’s knowledge, skill and professional value system are employed to help individuals and families solve psychosocial, interpersonal, and environmental problems through direct one-to-one and face-to-face relationships. Regarding the efficacy of this method, some argue that working with individuals on a one-to-one basis allows better possibilities for success than perhaps any other methods of social work. During the help giving process social work professionals interact, explore and appropriately intervene at various levels to build on capacities and empower the client with problem solving and coping skills.
Since the beginning social work as a profession has helped individuals to help themselves. A trained social worker is well-versed and skillful in the application of all methods of social work practice. The worker may fundamentally work with individuals and families within the agency settings. However, to achieve the broader goal, the worker may also employ group or community intervention in his/her practice. The need of the hour is that the worker chooses to practice with a combination of all methods. According to Skidmore, Thackeray and Farley (1997), traditionally the term case work was widely used in social work practice which implied narrower connotation in practice where the method was used only in clinical social work settings. But more recently the term case work has been broadened and designated as work with individuals.
CHANGING CONTEXT OF CASE WORK PRACTICE
There are many popular conceptions about the functions of social workers. A distinguishing characteristic of 20th century social work has been its emphasis on environmental factors in understanding the human conditions which has definitely shaped practice and education in the recent years. Reflecting on several contemporary forces, it is clear that economic, political, cultural and technological events have all had an impact on the evolution of social work practice in most countries. The current global concerns and influences that pose significant challenge in the social work practice, are changes in the physical environment (e.g. global warming, frequent onslaught of natural disasters, the erosion of the ozone layer, the destruction of the natural habitat and forest), threats to public health (e.g. the HIV/AIDS epidemic, other potential bacterial and viral pandemics such as Cholera, Plague, SARS, Bird Flu), technological developments (e.g., electronic gadgets, computers), and the combined impact of conflict, militarism and terror campaigns. The consequences of these issues greatly influence social work practice in the contemporary world and the social workers are required to develop great degree of resilience and contemporary professional capacities to deal with the newer challenging situations. Though the Social Case Workers are often at the interface between powerful organisations and relatively powerless applicants for service, they promote or restore a mutually beneficial interaction between individuals and society in order to improve the quality of life for everyone.
In India, social workers practice case work in a variety of conventional settings, e.g. Hospitals, Schools, Child and Adolescent Guidance Centers, Correctional Settings, Community Health Centers, Mental Hospitals, Family Welfare Centres, Vocational/Career Guidance Centres, Industries/factories etc. which have existed from the commencement of social work practice in India. On the other hand, relatively newer thrust areas of practice such as HIV/AIDS Voluntary Testing and Counselling Centres (VTCC), Women’s Cells, Disaster Management Cells, Crisis Intervention Centers have emerged and some existing ones such as De-addiction Centers, Adoption and Foster Care Centres, and Community Development Centers have become more prominent in response to different kinds of problems coming to light. For instance adoption and foster care centers’ have gained prominence and acceptance in the society as such practices have became common due to ‘fall in fertility rates especially in urban areas’ (see IIPS 2007:78). There is also significant rise in the inter-country adoption as well which has put additional responsibility on to social workers. The inter-country adoption has resulted in different domain of social work practice where a social worker is entrusted with the tasks of assessing attitude towards openness about a child’s background, culture and identity.
Thus, social workers are required to work with individuals in variety of settings using a multi-theoretical approach. Keeping up with the contemporary challenges and situational demands the social case workers are constantly responding to mitigate and intervene in the newer challenging areas including natural disasters, communal riots, HIV/AIDS epidemic and environmental issues.
In addition, the clientele of social workers hail from wide variety of socio-cultural, educational and religious backgrounds with a multiplicity of bio-psycho-social problems. In fact, case workers work with clients of all ages, often with the particular psychological and social problems of their life-stage; namely children, adolescents, young adults, middle-aged adults and the aged. During a survey of case work records in India the problems reported by clients to the social work agency were classified as (Mathew 1992: 48-65); illness and disability related, lack of material resources, school associated, institution related, behavioural, marital discord, addiction and women centered problems like unmarried motherhood etc. Apart from these, Nagpaul (1996:32-68) has listed some dominant urban problems like poverty, beggary, unemployment, population, crime and delinquency, disability related problems, addiction, prostitution, corruption and problems faced by the backward communities. Though these issues and problems as cited by Nagpaul have macro influences; nonetheless, its impact on the individual is not universal. The same problem manifests itself differently under different circumstances and required intervention at the individual level.
In view of the above broad ranging psychosocial and economic nature of problems social work practice with the individual is considered as a very important method used by social workers in a wide variety of urban settings even with its limitations. However several factors have combined to foster an accepting environment for this method in India. Due to the globalization process, there has been a significant change in social, economic, scientific, ideological and spiritual spheres throughout the world; consequently the ramifications are well existent in the country. Socially, people have been: i) moving from rural to urban settings, ii) living in more stressful life conditions, iii) witnessing changes in family structures, iv) suffering more life style related diseases, and v) becoming concerned about social inequities.
Urban forces known to cause a wide range of specific problems affecting individual’s interpersonal relationships, physical and mental health. Social work practice with individuals assumes paramount importance in urban settings due to the intra-psychic and individual nature of the problems. Life and its related problems have become much more complex in the area of social relationships. People have lost the close personal relationships that in the past may have helped them in facing new and complex concerns. Due to the loss of family ties and other social support systems, the individual has turned increasingly to social workers amongst other helping professionals, for help. Social work with individuals has mitigating and therapeutic effects on individuals who are faced by anomie and isolation due to urbanization.
Since the scope of working with individuals is too large to handle in a brief paper, the major emphasis will be on the relevant and emerging dimensions of both theory and practice. This article attempts to examine principles underlying practice of social casework and discuss some of its major theoretical approaches. Further the article analyzes the significance of social work practice with individuals in urban settings and examines the current and future challenges of the profession. The author has interchangeably used the terms ‘social casework’ and ‘working with individual’ as these have been well defined and these terms are indigenous to social work practice. It may be imperative to initiate the discourse by elucidating the principles which guides social work practice.
PRINCIPLES UNDERLYING PRACTICE
The main emphasis of working with individual is not upon social problems themselves but upon individuals or families suffering from psychosocial problems or unable to cope satisfactorily with their social situation or relationships. Working with individual as a method of social work practice facilitates personal and interpersonal functioning across the life span with an emphasis on emotional, social, vocational, educational, health-related, developmental and organisational concerns. By integrating theory, research, and practice with the awareness and skills to work with diverse populations, this specialty includes a broad range of practices that help people improve their well-being, alleviate distress and maladjustment, resolve crises, and increase their ability to function productively.
Social casework has been defined by many authors and practitioners (see Robinson 1930, Hollis 1964, Zastrow 1995) but a wholesome definition has been offered by the National Association of Social Workers (1992) as a method of providing services whereby a professional social worker assesses the needs of the client and the client’s family, when appropriate, and arranges, coordinates, monitors, evaluates, and advocates for a package of multiple services to meet the specific client’s complex needs. This is a more wide-ranging definition of social case work as it lists the entire array of intervention process that a professional social worker provides help towards the client’s complex needs.
No matter when the definitions were proposed, what has remained universal across the endeavour is the inherent value of client’s self determination, participation, contribution and recognising innate potentials of individuals seeking help from the agency. However, most definitions are valuable towards building a comprehensive understanding, which encompasses multi-dimensional approach in Social Casework.
The universally accepted, the much valued philosophical assumptions originated as the main foundational belief of social work profession have been well recognised and adopted in indigenous practice of professional social work. Basic philosophical assumptions about human beings profoundly influence professional practice. The following value postulates are examples of influences in the practice of social work and social work with individuals; respect for the individual as a whole person with self-worth and dignity, recognizing the inherent potential of every individual for self-growth and achievement, and recognizing that all humans are interdependent beings.
This means that the social worker operates from a neutral and objective paradigm, at the same time may share thoughts, feelings, and experience along with concern, empathy and altruistic attitudes. The worker applies knowledge, understanding and skills with discipline, intelligence and with basic value assumption that the individual has the need and the right to make his or her own choices and decisions (Skidmore et al 1997).
The worker’s intervention with clients rests on the strong edifice of principles that have crystallized from the basic values and philosophical assumptions associated with the social work profession. An understanding of these principles is imperative for today’s complex practice terrain. The fundamental principle of working with individuals is Acceptance. It is a broad idea with multiple meanings. Looking at it from one’s perspective would require recognition of the client as human being and worker’s sensitivity towards his/her problems. Another perspective holds that acceptance generates a kind of attentive restraint as we attempt to follow the client’s lead in determining the factors that might improve his/her situation (Berlin, 2005). Another principle of case work which recognizes the client as a unique individual is Individualization. The client as an individual demands a respect for his/her persona. Individualization means freedom from bias and prejudice, appreciation of diversity and knowledge of human behaviour.
Yet another principle closely related to acceptance and individualisation is non-condemning attitude for the client. A non-condemnatory attitude on part of the Caseworker, “implies refusal to express disapproval of the person, to insinuate blame through arguments of cause-effect connection, or to pass judgement indicating that the person deserves to be punished for his/her behaviour” (Mathew, 1992).
It is essential for the caseworker to find a vent for client’s bottled emotions for therapeutic reasons. The client must be helped to express his/her feelings because it is an important part of the casework process. This principle is called purposeful expression of feelings. Caseworkers are required to be skilled at practicing controlled emotional involvement with the client. There are three components to a controlled emotional response to a client's situation: sensitivity to expressed or unexpressed feelings, understanding based on knowledge of human behaviour, and a response guided by knowledge and purpose (DuBois & Miley, 1992). The caseworker must also remember that extreme coldness in the relationship conveyed verbally or non-verbally to the client could prove detrimental to the therapeutic relationship.
The principle of client’s self-determination is based on the recognition of the right and need of clients’ freedom in making their own choices and decisions. Social Caseworkers have a responsibility to create a working relationship in which choice can be exercised (DuBois & Miley, 1992). The last principle is called confidentiality, which directs the Caseworkers to grant the right to privacy to his/her clients. The clients share their personal matters with the caseworker with a trust and confidence that the shared information would not be divulged to anyone without their consent. The caseworkers must respect the feelings of their clients and should maintain confidentiality under all circumstances.
Caseworkers are implored to assure that they internalize these principles so that they may live up to the high ideals and expectations of the profession. The forthcoming section would delve into some major theoretical approaches of social casework practice.
MAJOR THEORETICAL APPROACHES
Theories determine the nature and style of professional practice. The knowledge of the various thought systems influencing social casework is essential for effective practice. There is a large element of interconnectedness and inter-influence between the existing theoretical approaches to social casework. The need of the hour is to interlock these theoretical perspectives for effectual practice.
The pioneering contribution towards scientific theory development was initiated by Mary Richmond in 1917 through her much valued book, Social Diagnosis. She proposed an extensive set of schemas for assessment, and accurate diagnosis of problems. Another major influence on theory development in social casework came from Freud. They are called the psychodynamic models; the underlying theory assumes that behaviour comes from movements and interactions in people’s minds and also because it emphasizes the way in which the mind stimulates the behaviour and both mind and behaviour influence and are influenced by the person’s social environment (Payne, 1991). Psychodynamic theories paved the way for ego psychology in 1950s and 1960s with its emphasis on the ego as the rational problem solving part of the mind, dealing with the outside world and minimizing the aspect of managing unconscious drives (Goldstein, 1984).
Psychosocial theory, a derivative of psychodynamic theory, proposes that social work must focus on the ‘person-in-situation’, it is important for social workers to know the client’s interaction with the environment. Today, the psychosocial approach is committed to individualized assessment within the systems perspective and tries to achieve a balance among biological, psychological, interpersonal, environmental and cultural factors in assessment and intervention. Its arena has now grown to individual, family and group modalities; crisis, short-term and extended intervention and also a greater range of client problems (Goldstein, 1995). In India the psychosocial approach is widely used by social workers working in the health and mental health care settings. The apparent reason may be the long term bio-psycho-social intervention considered necessary in such cases, the worker able to theorize and practice a comprehensive care model required for the clients. The psychosocial approach is found to be apposite by social workers, hence widely practiced in the child and adolescent mental health centers, residential settings like de-addiction centers, geriatric homes, counselling centers and correctional homes.
Helen Perlman (1957) devised the problem solving approach rooted deeply in ego psychology which focuses on four aspects of the situation: the person with whom work is done, the problem which is presented, the place where the work is done and the process of the work. Perlman’s approach gave rise to task-centred casework. The social workers in contemporary period also draw on a problem-solving approach while working with individuals, families and groups. Steps in the problem-solving process can be affirmed in a multiple of ways. A simple description of this practice follows:
Identify as accurately as possible the problem or problems.
Generate possible alternative solutions.
Evaluate pros and cons of all alternative solutions.
Decide on a solution or solution to be used, and set goals.
Implement the solutions.
Follow up to evaluate how the solutions worked.
Task-centred approach rejected any specific psychological or sociological base for its methods. It arose from dissatisfaction with long term psychodynamic casework; in task- centred practice, social workers resolve problems presented by the clients. The theory of social work should therefore elucidate how problems arise, what they are, and how they may be dealt with. “Brief work with explicit time limits” is an essential feature of this approach (Goldstein et al, 1985). Locally many social work agencies utilize the task-centred approach for their intervention, especially where the clients present episodic nature of problems and are in touch with the worker for a shorter duration. This holds especially true in urbanized areas where there is constant struggle for time and resources. Much of the clientele approach the social worker with specific nature of problems and once their problems are solved within a specific time frame, the cases are terminated.
Another very pertinent social work approach which shares some features with the task- centred model is crisis intervention. Crisis intervention considers the acute emotional disturbances presented by individuals and families as being the result of the traumatic situation that an individual faces, and core emotional outburst that come to the surface only in a crisis situation. Crisis intervention is classically, actions taken to mitigate and provide support to clients due to sudden crisis and disruption in people’s normal functioning in life. In such emergency situations, services such as post traumatic counseling, rescue, relief and rehabilitation are needed most and have the highest probability of having a positive effect. The crisis situations created as a result of the massive earthquake in Kutch-Gujarat in 2001, the tsunami in Tamil Nadu in 2006 witnessed extremely detrimental effects on the victims along with immeasurable loss of life and property. Case work in disaster situations is the most challenging task when the worker has to be equipped with the required skills to minimize the adverse effect of the crisis on the client.
The use of behavioural approach to case work has increased dramatically in the past two decades. Behaviour therapy intervention techniques are now among the most widely used techniques in case work and counselling. The foremost postulation of this therapy system is that maladaptive behaviour is acquired primarily through learning and can be modified through additional learning. A major trend in behavioural case work in the contemporary practice has been toward recognition of the role of cognition (thinking processes) in human behaviour. Cognitive behaviour therapists have accepted the notion that changing thoughts will often change feelings and behaviour (Beck 1976). The traditional paradigm of behaviour therapy has been S (stimulus) – R (response). Cognitive behaviour therapists insert an additional step in this paradigm: S (stimulus) – O cognitions of organism) - R (response).
Some of the most commonly used behaviour therapy techniques during the work with individuals are: assertiveness training, token economy, contingency contracting, systematic desensitization, in-vivo desensitization, implosive therapy, aversive techniques, and cognitive behaviour-modification techniques. It is often recommended that certain techniques should be used only by experienced case workers with extensive training because improper application may create undesired side effects. The behaviour modification approach is extensively used in child and adolescent guidance centers while working with clients having conduct disorders such as childhood aggression, truancy, precocious sexual activity, lying, theft, substance addiction etc. These symptomatic problem behaviours could be treated by using behaviour modification for both family and clients. The case worker could employ techniques like modeling, selective reinforcement, and behavioural role playing for targeting change in unwanted behaviours. In India, the behaviour modification approach is often practiced by qualified and experienced case workers as a suitable approach in mental health settings, de-addiction centers and child protection homes and special homes for children.
A perspective emanating from the behaviourist paradigm concentrates on observable behaviour. These behavioural approaches find their place in specialized settings and for limited purposes. A cognitive approach holds that the principal determinant of emotions, motives, and behaviour is an individual’s thinking, which is a conscious process. Cognitive behavioural theory is a broad category that encompasses Adler’s individual psychology, Ellis’ rational-emotive theory, Glasser’s reality therapy and other approaches which regard to emotions and behaviours as products of thinking. The cognitive approach is based on three premises; a change in thinking alters emotions, goals and behaviour, change in emotion is especially influential in altering behaviour and new activities, and new kinds of behaviour alter perception (Werner, 1979). The cognitive Approach is particularly relevant in work with anxiety and depression and form a major part of programmes for anger control, offending behaviour, and drug and alcohol related problems.
Another significant development was the application of sociological theories in social work practice. Where the client’s milieu is complex and where in a critical way a range of significant environments are involved, a perspective emerging from the Systems theory could prove beneficial. The Systems theory focuses on complexity and interdependence of relationships. A system is composed of regularly interacting or interdependent groups of activities/parts that form the emergent whole. Another thought system which could be equally pertinent would be the ecological approach, which is similar to the systems theory in many ways, the difference however is that it provides a richer understanding of the potential for growth that can take place in both the client and in the environment (Turner, 1979).
In the past several years, social work has increasingly focused on an ecological approach. Ecological approach is a subcategory of systems theory and it has become prominent in social work practice. Research had demonstrated that psychoanalysis was probably ineffective in treating clients’ problems (Stuart, 1970). The ecological approach integrates both treatment and reform by conceptualizing and emphasizing the dysfunctional transactions between people and their physical and social environments.
FIGURE 1
Interaction of Subsystems and Individual
(Adapted from Zastrow, 1995)
Educational system
Family system
Community system
Social service system
Market systems
Employment system
Religious system
Political system
Individual
As is apparent from Figure 1 shown above, people in the society constantly interact with numerous systems such as family, community, social, political, religious, educational and market systems. At the first stage the ecological approach focuses on the individual and seeks to build up the client’s problem-solving skills, coping behaviours, and developmental potentials. In addition, its emphasis is on the relationship between a person and the systems the client interacts with and links the individual with needed resources, services, and opportunities. And finally it focuses on the systems and seeks to reform them to meet the needs of the individual more effectively. Such an approach requires exceptional analytical and networking skills on part of the social caseworker. This is a holistic approach and endeavours to deal with comprehensive aspects of the individual problem. In the Indian socio-cultural context the possibility of usage of the ecological approach is much broader and imperative as the approach attempts to draw from holistic perspective for practice.
The preference of approaches depends entirely on the caseworker’s orientation and skillfulness with certain approaches. No matter which approach he/she adopts, there needs to be clarity of purpose and rationale for action. The caseworker has to judiciously design an intervention plan based on a particular social work treatment approach, otherwise employ an eclectic approach for helping the client solve his/her problems. Das (2003) noted that many practitioners in recent years have been able to practice comfortably with several methodologies and this trend appears to be continuing and growing. What is being advocated is the need to continue to be open to the influence from all seriously presented bodies or systems of thought and to be more comfortable as individual practitioners with a multi-method and multi-theoretical approach.
PROFESSIONAL PREPARATION AND STANDARDS
Quality of Case work and professional efficiency is closely related to the quality of professional preparation and training. An example here could add significant clarity to the discourse; at the Tata Institute of Social Sciences the trainees are provided with an opportunity to study the methods courses including working with individuals. They are facilitated with experiential classroom learning along with the concurrent field practice, where the learners get the opportunity to integrate the classroom learning into the field practice. Thus, the first and foremost professional considerations are to prepare prospective students with the necessary skills, professional attitude and adequate knowledge.
Education and professional training in the field of Social work is very vital. Such learning is uniquely related to the profession that empowers professionals to provide services that are most likely to help clients, on other hand, nebulous and amateur social worker may harm the client than doing any good. After completion of the professional training they assume the privileged role of a social worker on the assumption that they possess and use definite kinds of expertise. Therefore, social work educators and practitioners of this country are required to pay greater attention to the crucial matters of the professional growth and development including selection and training of its members.
Since six decades, the social work profession in India has been growing steadily; yet there is no legislation equivalent to those governing professions like medicine, law, or accountancy. In addition, there is no statutory professional organization like the Indian Medical Association or the Bar Council of India, which can control professional allegiance and enforce adherence of certain professional and ethical standards. A statutory body or national level council for professional Social Work is the need of the hour where the council may identify the educational standards and review the adherence of standards in various schools of social work in the country.
International discourses assert that an important commonality of social work around the world is its acceptance of the idea that scientific knowledge should guide professional intervention (Hokenstad et al., 1992). In India such concerns have been voiced in professional gatherings as there has been greater apathy in upgrading and incorporating newer scientific knowledge base amongst several sections of the field practitioners. At the same time, global advancement and changes in the field of social work practice has helped motivated and open-minded practitioners to examine and indigenize their knowledge and practice base.
Universally, there has been greater influence of west in the social work practice in India. This is due to widely accessible and available western literature; nevertheless this has undoubtedly benefited trained social workers in India in building their knowledge base and field practice. Like many other fields, case work, draws its knowledge base and principles of practice from a number of disciplines. Hence, social work professional knowledge and skills by their vary nature are in need of constant revision and upgradation.
URBAN CONTEXT FOR PRACTICE
The world has experienced unprecedented urban growth in recent decades. In 2000, about 47 percent of the world's population lived in urban areas, i.e. about 2.8 billion. More developed nations are about 76 percent urban, while 40 percent of residents of less developed countries live in urban areas. However, urbanization is occurring rapidly in many developing countries. It is expected that 60 percent of the world population will be urban by 2030, and that most urban growth will occur in less developed countries (Population Reference Bureau, 2006).
During the 19th and early 20th centuries, industrialization resulted from and contributed to urbanization. The rural population got attracted to the cities for earning their livelihood. The emerging factories required cheap labour which was provided by the migrants. Urbanization in most less developed countries in the past fifty years contrasts sharply with the experience of the more developed countries. Migration fuels urban growth in less developed countries as people leave the countryside in search of better jobs. This steep rate of growth of urban population along with the urban bias in developing countries has brought in its wake problems like population explosion in cities, grinding urban poverty, unemployment, poor health status, malnutrition and slum formation. Industrialisation and its correlate urbanisation are associated with a realignment of relations between the individual, the household, the community, the market and the state.
Burgeoning with the urbanization, the present day is witnessing a sea change due to phenomenon of globalisation, liberalisation and privatisation; these are indeed posing multifarious challenges for social work profession. Industrialization and automation have led to increased productivity, life-style change and level of stress in urban population. The onset of all such forces has augmented greater significance of fostering social work practice in individual context. The realities of an ever increasing globalised world and rising inequities demands social workers to be at the forefront. It is critical for social workers to understand that the newer trends in the social, political and economic sectors are impacting human psychology in many negative ways too. The result is manifested in poor mental health status, reduced resilience and breakdown of social support networks. The changes in human psychology and lifestyle in urban context makes it essential for the social workers to consider the implications of ecological perspectives and client centred work.
India, a nation with the populace of more then one billion is facing major challenges due to rapid urbanization. The problems caused by rapid urbanization are deteriorating health status of the populace. Air pollution, lack of water, sanitation and drainage facilities, vehicular accident, lifestyle disease and mental stress are considered to be the major threats to the health of the urban population (Sarkar et al 2005). In view of the current trend, it may be anticipated that the existing water and vector borne diseases will continue to be the leading cause of morbidity and mortality. On the other hand, malignancies, HIV/AIDS, and lifestyle and stress related diseases would emerge as major newer challenges for health social workers. It is imperative to note that health has been defined as not merely the absence of disease but also the total physical, mental and social well being of the person. Mental health is determined by multiple social, environmental, biological and psychological factors (WHO, 1986).
It may be pertinent to look at a recent study of urbanisation and incidence of psychosis and depression that was based on data from the Swedish population registers. The results reported that with increasing levels of urbanisation the incidence rates of psychosis and depression rose (Sundquist et al, 2004). The study vividly pointed out the direct proportionality between urbanisation and incidences of mental illnesses amongst the population. These types of mental illnesses has long been associated with psychologically affected behaviour such as irritation, lost tempers and damage to interpersonal relationship. Such repercussions are universally heard off and are daily reported in form of anecdotal account in daily national news. In India the suicide rate in cities (12.8) was higher as compared to All-India suicide rate (10.5). Nearly 3.8 per cent of suicides were committed due to ‘Unemployment’ as against 1.6 per cent of such suicides at National level as per causal analysis of suicides in cities. The four Metropolitan Cities – Chennai, Bangalore, Delhi, and Mumbai have reported higher number of Suicides. These four cities together have reported 50% of the total suicides reported from 35 mega cities (NCRB 2008).
Thus, greater emphasis may be laid on the urban concerns as they impact negatively on an individual’s health and social well-being who are suffering, disempowered and disadvantaged. These person-specific problems require intervention at the individual level with the appropriate use of the skills of effective case work practice. There is no panacea of one single approach for dealing with the diverse problem situations produced by the urbanised environment today. But a multi-pronged approach with eclecticism may go a long way in terms of alleviating and helping individuals with problems.
CONTEMPORARY AND FUTURE PERSPECTIVES
The social work practice has evolved with the changing contexts. The world is undergoing a transition on account of the global forces that are impacting every sphere of human life. Social workers like other professionals are facing newer challenges in terms of upgrading their knowledge and skills to suit the changing times. The current globalization of the economy requires the social workers to broaden their horizons and view many domestic social justice issues within the global framework (Polack, 2004). Further globalization brought about sporadic unemployment accompanied by family disintegration, poverty, violence, despair and drug addiction. Currently the situation also had created massive new population movements, which have resulted in dislocation and problems of cultural adaptation and acceptance. There is heavy influx of illegal migrants from bordering countries as well as inter country rural migration. Large scale migration has created new social problems that are not yet properly recognized in social work circles.
The impact of globalization on employment conditions and social welfare benefits is negative. As the social work profession is closely linked with social welfare and working with the marginalized sections of the populations like the women and children, migrants, unemployed and homeless, there is an imperative need to develop a global perspective of their individual problems. Continuation of such trends would mean an increase in income inequality, poverty, and social dislocation and an accompanying rise in tension, violence and marginalization. Further, in terms of practice, social workers will likely be called on to deal with some of the manifestations of the increased stress of unemployment and economic insecurity, in the accompanying heightened child abuse, alcoholism, depression as well as in general societal tension and violence (Rose, 1997).
Ironically, the traditional practice of social casework has emphasized the clinical role of casework almost to the point of excluding other roles. But the problems of an individual can be perceived in terms of ranging from the individual, being unable to carry out certain behaviour and roles, to problems in the structure or performance of proximal or broader community or social systems (Fischer, 1978). This statement may blur the demarcation between social worker and social caseworker. There is no doubt about the fact that a social caseworker is a social worker first. What preserves the identity of the caseworker is the focus on case-by-case approach, dealing with an individual or family. It is vital for the caseworker to understand the interplay of micro (working on a one-to-one basis with an individual), mezzo (working with families and other small groups) and macro (working with agencies, communities or seeking changes in existing order and social policies) systems and work towards redress of the client’s problems in a more holistic approach.
CONCLUSION
Social work is a distinctive profession that is committed to - care-giving, offer services, therapy and rehabilitation, bring about required change, and also work towards sustainable development. With this uniqueness the social work profession today is governed by many complex forces pertaining to social, psychological, economic and political arena. There is a greater need to be aware of these macro phenomena which have a direct bearing on individual-centred practice. Working with individuals in present scenario does not strictly mean confining the intervention to individual only. The worker must analyze the situation and plan his/her intervention at micro, mezzo and macro levels with individual as the main focal point.
In the field of individual social work practice there is a large array of theoretical and practice approaches which govern the casework practice. Therefore, a prudent practitioner advocates the use of an eclectic approach, there should however be more clarity on this stance. Eclecticism does not mean a mere integration of the theoretical approaches. The theories have to be studied through systematic analysis and pre-selected criteria. Practicing from an eclectic base requires the caseworkers to be flexible and open minded. This approach widens the caseworker’s lens and enables him/her to look for problems and solutions at different levels of the ecosystem. The caseworkers must be capable to correctly using the vast amounts of knowledge the profession has generated over the years.
Intervention approaches are central to the helping process, but there is little evidence that these approaches and models are effective in promoting the desired change. The professional attempt has been rather slack in evaluating the efficacy of professional interventions. Thus one of the imperative tasks for the profession in the years ahead is development of scientific research and evaluation as an integral part of social work practice.
An indifferent attitude towards casework still exists in India and may be attributed to the fact that some social work practitioners and educators believe that the method of working with individual is extraneous and less effective in the existing socio-economic and global realities. Ironically most social work agencies in metropolitan cities of India are engaged in providing individualized professional services. There is a tremendous demand for case work services in variety of urban situations; this was not met owing to a dearth of trained personnel. Considering the nature of intricate individual focused bio-psycho-social problems, it can be reasonably stated that working with individual has greater scope in the future years.
Finally, one critical challenge in social casework today is this constantly changing global and local environment which is adversely affecting the individuals and their families. The casework practice must evolve with time and context. A practitioner not only needs to be aware of these rapid transformations but also design his/her intervention which is suitable to the changing environment.
REFERENCES
Beck, A.T. :
1976
Cognitive Theory and the Emotional Disorders. New York: International Universities Press
Berlin S. :
2005
The Value of Acceptance in Social Work Direct Practice: A Historical and Contemporary View. Social Service Review, Vol.79, Number 3. September 2005, the University of Chicago Press.
Das Shankar :
2003
Holistic Counselling for Health and Wellbeing, in Kaila H.L. and Kushal K.B. (Eds.), Towards Development with Young People, Himalaya Publishing House, Mumbai.
DuBois, B. and : Miley, K.K.
1992
Social Work: An Empowering Profession. Boston: Allyn and Bacon, pp. 135-141.
Fischer, J. :
1978
Effective Casework Practice: An Eclectic Approach. USA: McGraw-Hill, Inc.
Goldstein, E.H. :
1984
Ego Psychology and Social Work Practice. New York: Free Press.
Hokenstad. M.C. : S.K. Khinduka and J. Midgley, eds.
1992
Profiles in International Social Work: Global Challenges for a New Cnetury. Washington, DC: NASW Press.
Hollis, F. : ::
1964
Casework: A Psychosocial Therapy. New York: Random House.
Mathew G. :
1992
An Introduction to Social Casework. Mumbai: Tata Institute of Social Sciences.
Nagpaul H. :
1996
Social Work in Urban India. Rawat Publications, New Delhi.
National Crime : Records Bureau
2008
Suicide in India, Government of India.
National : Association of
Social Workers
1992
NASW Standards for Social Work Case Management. Source:
http://www.socialworkers.org/practice/standards/sw_case_mgmt.asp.
International : Institute for Population Sciences (IIPS) and MacroInternational.
2007
National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS.
Payne, M. :
1991
Modern Social Work Theory: A Critical Introduction. The Macmillan Press Ltd.
Perlman, H. H. :
1957
Social Casework: A Problem Solving Process. Chicago: University of Chicago Press.
Population :
Reference Bureau
2006
Human Population: Fundamentals of Growth Patterns of World Urbanization. Washington: PRB.
Polack, R.J. : :
2004
New Challenges for Social Work Profession in the 21st Century. Social Work, 49, pp 281-290.
Richmond, M. : :
1917
Social Diagnosis. New York: Russel Sage Foundation.
Robinson, V.P. : :
1930
Changing Psychology in Social Casework. Chapel Hill: University of North Carolina Press.
Rose, N : :
1997
The Future Economic Landscape: Implications for Social Work Practice and Education, in Michael Reisch and Eileen Gambrill (Eds.), Social Work in the 21st Century. Pine Forge Press.
Sarkar. A., :
Mishra T, Mondal. P., Aggarwal. S.
2005.
Urbanization in India – A Biggest Public Health Challenge. Epidemiology. 16(5):S116, September 2005.
Skidmore R. A. : Thackeray M.G., Farley O.W.
1997
Social Work Practice with Individuals in Introduction to Social Work. Boston: Allyn and Bacon (Seventh Edition).
Stuart, R.B. : :
1970
Trick or Treatment. Champaign. IL: Research Press Co.
Sundquist,K., :
Frank, G. and Sundquist, J.
2004
Urbanisation and incidence of psychosis and depression. The British Journal of Psychiatry (2004) 184: 293-298.
Turner, F.J. : :
1979
Interlocking Perspective in Practice, in F.J. Turner (Ed.), Social Work Treatment. New York: Macmillan Publishing Co.
Werner, H.D. : :
1979
Cognitive Theory in F.J. Turner (Ed.), Social Work Treatment. New York: Macmillan Publishing Co.
World Health : Organisation :
1986
Ottawa Charter for Health Promotion. Geneva: World Health Organisation.
Zastrow C. : :
1995
The Practice of Social Work. Fifth Edition. Brooks/Cole Publishing Company, Pacific Grove, California.
THE INDIAN JOURNAL OF SOCIAL WORK, Volume 69, Issue 2, April 2008
SHANKAR DAS
Social workers are required to work with individuals in a variety of settings on account of the constantly changing global and local environment, which is adversely affecting individuals and their families. Keeping the individual as the focal point, this article discusses the need to use a multi-theoretical approach such as the task-centred, behavior modifications systems, and crisis intervention approaches at micro, mezzo and macro levels. The knowledge and skills of practitioners must evolve with time and context.
Dr. Shankar Das is an Associate Professor, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India. He is involved in teaching, training, research and consultancy work in the field of human development, health and human resource management.
INTRODUCTION
Social work with individuals is one of the oldest methods of a generalist approach to social work practice. Historically this method could be traced from the very inception of social work profession, where worker helped individual clients and their families to help themselves in wide array of problem situations. Helping individuals in the time of distress and need must have existed in one form or another since the very beginning of human civilization. According to Grace Mathew (1992), though social work as a profession is a product of the twentieth century, social work as a helping activity is as old as mankind.
The worker’s knowledge, skill and professional value system are employed to help individuals and families solve psychosocial, interpersonal, and environmental problems through direct one-to-one and face-to-face relationships. Regarding the efficacy of this method, some argue that working with individuals on a one-to-one basis allows better possibilities for success than perhaps any other methods of social work. During the help giving process social work professionals interact, explore and appropriately intervene at various levels to build on capacities and empower the client with problem solving and coping skills.
Since the beginning social work as a profession has helped individuals to help themselves. A trained social worker is well-versed and skillful in the application of all methods of social work practice. The worker may fundamentally work with individuals and families within the agency settings. However, to achieve the broader goal, the worker may also employ group or community intervention in his/her practice. The need of the hour is that the worker chooses to practice with a combination of all methods. According to Skidmore, Thackeray and Farley (1997), traditionally the term case work was widely used in social work practice which implied narrower connotation in practice where the method was used only in clinical social work settings. But more recently the term case work has been broadened and designated as work with individuals.
CHANGING CONTEXT OF CASE WORK PRACTICE
There are many popular conceptions about the functions of social workers. A distinguishing characteristic of 20th century social work has been its emphasis on environmental factors in understanding the human conditions which has definitely shaped practice and education in the recent years. Reflecting on several contemporary forces, it is clear that economic, political, cultural and technological events have all had an impact on the evolution of social work practice in most countries. The current global concerns and influences that pose significant challenge in the social work practice, are changes in the physical environment (e.g. global warming, frequent onslaught of natural disasters, the erosion of the ozone layer, the destruction of the natural habitat and forest), threats to public health (e.g. the HIV/AIDS epidemic, other potential bacterial and viral pandemics such as Cholera, Plague, SARS, Bird Flu), technological developments (e.g., electronic gadgets, computers), and the combined impact of conflict, militarism and terror campaigns. The consequences of these issues greatly influence social work practice in the contemporary world and the social workers are required to develop great degree of resilience and contemporary professional capacities to deal with the newer challenging situations. Though the Social Case Workers are often at the interface between powerful organisations and relatively powerless applicants for service, they promote or restore a mutually beneficial interaction between individuals and society in order to improve the quality of life for everyone.
In India, social workers practice case work in a variety of conventional settings, e.g. Hospitals, Schools, Child and Adolescent Guidance Centers, Correctional Settings, Community Health Centers, Mental Hospitals, Family Welfare Centres, Vocational/Career Guidance Centres, Industries/factories etc. which have existed from the commencement of social work practice in India. On the other hand, relatively newer thrust areas of practice such as HIV/AIDS Voluntary Testing and Counselling Centres (VTCC), Women’s Cells, Disaster Management Cells, Crisis Intervention Centers have emerged and some existing ones such as De-addiction Centers, Adoption and Foster Care Centres, and Community Development Centers have become more prominent in response to different kinds of problems coming to light. For instance adoption and foster care centers’ have gained prominence and acceptance in the society as such practices have became common due to ‘fall in fertility rates especially in urban areas’ (see IIPS 2007:78). There is also significant rise in the inter-country adoption as well which has put additional responsibility on to social workers. The inter-country adoption has resulted in different domain of social work practice where a social worker is entrusted with the tasks of assessing attitude towards openness about a child’s background, culture and identity.
Thus, social workers are required to work with individuals in variety of settings using a multi-theoretical approach. Keeping up with the contemporary challenges and situational demands the social case workers are constantly responding to mitigate and intervene in the newer challenging areas including natural disasters, communal riots, HIV/AIDS epidemic and environmental issues.
In addition, the clientele of social workers hail from wide variety of socio-cultural, educational and religious backgrounds with a multiplicity of bio-psycho-social problems. In fact, case workers work with clients of all ages, often with the particular psychological and social problems of their life-stage; namely children, adolescents, young adults, middle-aged adults and the aged. During a survey of case work records in India the problems reported by clients to the social work agency were classified as (Mathew 1992: 48-65); illness and disability related, lack of material resources, school associated, institution related, behavioural, marital discord, addiction and women centered problems like unmarried motherhood etc. Apart from these, Nagpaul (1996:32-68) has listed some dominant urban problems like poverty, beggary, unemployment, population, crime and delinquency, disability related problems, addiction, prostitution, corruption and problems faced by the backward communities. Though these issues and problems as cited by Nagpaul have macro influences; nonetheless, its impact on the individual is not universal. The same problem manifests itself differently under different circumstances and required intervention at the individual level.
In view of the above broad ranging psychosocial and economic nature of problems social work practice with the individual is considered as a very important method used by social workers in a wide variety of urban settings even with its limitations. However several factors have combined to foster an accepting environment for this method in India. Due to the globalization process, there has been a significant change in social, economic, scientific, ideological and spiritual spheres throughout the world; consequently the ramifications are well existent in the country. Socially, people have been: i) moving from rural to urban settings, ii) living in more stressful life conditions, iii) witnessing changes in family structures, iv) suffering more life style related diseases, and v) becoming concerned about social inequities.
Urban forces known to cause a wide range of specific problems affecting individual’s interpersonal relationships, physical and mental health. Social work practice with individuals assumes paramount importance in urban settings due to the intra-psychic and individual nature of the problems. Life and its related problems have become much more complex in the area of social relationships. People have lost the close personal relationships that in the past may have helped them in facing new and complex concerns. Due to the loss of family ties and other social support systems, the individual has turned increasingly to social workers amongst other helping professionals, for help. Social work with individuals has mitigating and therapeutic effects on individuals who are faced by anomie and isolation due to urbanization.
Since the scope of working with individuals is too large to handle in a brief paper, the major emphasis will be on the relevant and emerging dimensions of both theory and practice. This article attempts to examine principles underlying practice of social casework and discuss some of its major theoretical approaches. Further the article analyzes the significance of social work practice with individuals in urban settings and examines the current and future challenges of the profession. The author has interchangeably used the terms ‘social casework’ and ‘working with individual’ as these have been well defined and these terms are indigenous to social work practice. It may be imperative to initiate the discourse by elucidating the principles which guides social work practice.
PRINCIPLES UNDERLYING PRACTICE
The main emphasis of working with individual is not upon social problems themselves but upon individuals or families suffering from psychosocial problems or unable to cope satisfactorily with their social situation or relationships. Working with individual as a method of social work practice facilitates personal and interpersonal functioning across the life span with an emphasis on emotional, social, vocational, educational, health-related, developmental and organisational concerns. By integrating theory, research, and practice with the awareness and skills to work with diverse populations, this specialty includes a broad range of practices that help people improve their well-being, alleviate distress and maladjustment, resolve crises, and increase their ability to function productively.
Social casework has been defined by many authors and practitioners (see Robinson 1930, Hollis 1964, Zastrow 1995) but a wholesome definition has been offered by the National Association of Social Workers (1992) as a method of providing services whereby a professional social worker assesses the needs of the client and the client’s family, when appropriate, and arranges, coordinates, monitors, evaluates, and advocates for a package of multiple services to meet the specific client’s complex needs. This is a more wide-ranging definition of social case work as it lists the entire array of intervention process that a professional social worker provides help towards the client’s complex needs.
No matter when the definitions were proposed, what has remained universal across the endeavour is the inherent value of client’s self determination, participation, contribution and recognising innate potentials of individuals seeking help from the agency. However, most definitions are valuable towards building a comprehensive understanding, which encompasses multi-dimensional approach in Social Casework.
The universally accepted, the much valued philosophical assumptions originated as the main foundational belief of social work profession have been well recognised and adopted in indigenous practice of professional social work. Basic philosophical assumptions about human beings profoundly influence professional practice. The following value postulates are examples of influences in the practice of social work and social work with individuals; respect for the individual as a whole person with self-worth and dignity, recognizing the inherent potential of every individual for self-growth and achievement, and recognizing that all humans are interdependent beings.
This means that the social worker operates from a neutral and objective paradigm, at the same time may share thoughts, feelings, and experience along with concern, empathy and altruistic attitudes. The worker applies knowledge, understanding and skills with discipline, intelligence and with basic value assumption that the individual has the need and the right to make his or her own choices and decisions (Skidmore et al 1997).
The worker’s intervention with clients rests on the strong edifice of principles that have crystallized from the basic values and philosophical assumptions associated with the social work profession. An understanding of these principles is imperative for today’s complex practice terrain. The fundamental principle of working with individuals is Acceptance. It is a broad idea with multiple meanings. Looking at it from one’s perspective would require recognition of the client as human being and worker’s sensitivity towards his/her problems. Another perspective holds that acceptance generates a kind of attentive restraint as we attempt to follow the client’s lead in determining the factors that might improve his/her situation (Berlin, 2005). Another principle of case work which recognizes the client as a unique individual is Individualization. The client as an individual demands a respect for his/her persona. Individualization means freedom from bias and prejudice, appreciation of diversity and knowledge of human behaviour.
Yet another principle closely related to acceptance and individualisation is non-condemning attitude for the client. A non-condemnatory attitude on part of the Caseworker, “implies refusal to express disapproval of the person, to insinuate blame through arguments of cause-effect connection, or to pass judgement indicating that the person deserves to be punished for his/her behaviour” (Mathew, 1992).
It is essential for the caseworker to find a vent for client’s bottled emotions for therapeutic reasons. The client must be helped to express his/her feelings because it is an important part of the casework process. This principle is called purposeful expression of feelings. Caseworkers are required to be skilled at practicing controlled emotional involvement with the client. There are three components to a controlled emotional response to a client's situation: sensitivity to expressed or unexpressed feelings, understanding based on knowledge of human behaviour, and a response guided by knowledge and purpose (DuBois & Miley, 1992). The caseworker must also remember that extreme coldness in the relationship conveyed verbally or non-verbally to the client could prove detrimental to the therapeutic relationship.
The principle of client’s self-determination is based on the recognition of the right and need of clients’ freedom in making their own choices and decisions. Social Caseworkers have a responsibility to create a working relationship in which choice can be exercised (DuBois & Miley, 1992). The last principle is called confidentiality, which directs the Caseworkers to grant the right to privacy to his/her clients. The clients share their personal matters with the caseworker with a trust and confidence that the shared information would not be divulged to anyone without their consent. The caseworkers must respect the feelings of their clients and should maintain confidentiality under all circumstances.
Caseworkers are implored to assure that they internalize these principles so that they may live up to the high ideals and expectations of the profession. The forthcoming section would delve into some major theoretical approaches of social casework practice.
MAJOR THEORETICAL APPROACHES
Theories determine the nature and style of professional practice. The knowledge of the various thought systems influencing social casework is essential for effective practice. There is a large element of interconnectedness and inter-influence between the existing theoretical approaches to social casework. The need of the hour is to interlock these theoretical perspectives for effectual practice.
The pioneering contribution towards scientific theory development was initiated by Mary Richmond in 1917 through her much valued book, Social Diagnosis. She proposed an extensive set of schemas for assessment, and accurate diagnosis of problems. Another major influence on theory development in social casework came from Freud. They are called the psychodynamic models; the underlying theory assumes that behaviour comes from movements and interactions in people’s minds and also because it emphasizes the way in which the mind stimulates the behaviour and both mind and behaviour influence and are influenced by the person’s social environment (Payne, 1991). Psychodynamic theories paved the way for ego psychology in 1950s and 1960s with its emphasis on the ego as the rational problem solving part of the mind, dealing with the outside world and minimizing the aspect of managing unconscious drives (Goldstein, 1984).
Psychosocial theory, a derivative of psychodynamic theory, proposes that social work must focus on the ‘person-in-situation’, it is important for social workers to know the client’s interaction with the environment. Today, the psychosocial approach is committed to individualized assessment within the systems perspective and tries to achieve a balance among biological, psychological, interpersonal, environmental and cultural factors in assessment and intervention. Its arena has now grown to individual, family and group modalities; crisis, short-term and extended intervention and also a greater range of client problems (Goldstein, 1995). In India the psychosocial approach is widely used by social workers working in the health and mental health care settings. The apparent reason may be the long term bio-psycho-social intervention considered necessary in such cases, the worker able to theorize and practice a comprehensive care model required for the clients. The psychosocial approach is found to be apposite by social workers, hence widely practiced in the child and adolescent mental health centers, residential settings like de-addiction centers, geriatric homes, counselling centers and correctional homes.
Helen Perlman (1957) devised the problem solving approach rooted deeply in ego psychology which focuses on four aspects of the situation: the person with whom work is done, the problem which is presented, the place where the work is done and the process of the work. Perlman’s approach gave rise to task-centred casework. The social workers in contemporary period also draw on a problem-solving approach while working with individuals, families and groups. Steps in the problem-solving process can be affirmed in a multiple of ways. A simple description of this practice follows:
Identify as accurately as possible the problem or problems.
Generate possible alternative solutions.
Evaluate pros and cons of all alternative solutions.
Decide on a solution or solution to be used, and set goals.
Implement the solutions.
Follow up to evaluate how the solutions worked.
Task-centred approach rejected any specific psychological or sociological base for its methods. It arose from dissatisfaction with long term psychodynamic casework; in task- centred practice, social workers resolve problems presented by the clients. The theory of social work should therefore elucidate how problems arise, what they are, and how they may be dealt with. “Brief work with explicit time limits” is an essential feature of this approach (Goldstein et al, 1985). Locally many social work agencies utilize the task-centred approach for their intervention, especially where the clients present episodic nature of problems and are in touch with the worker for a shorter duration. This holds especially true in urbanized areas where there is constant struggle for time and resources. Much of the clientele approach the social worker with specific nature of problems and once their problems are solved within a specific time frame, the cases are terminated.
Another very pertinent social work approach which shares some features with the task- centred model is crisis intervention. Crisis intervention considers the acute emotional disturbances presented by individuals and families as being the result of the traumatic situation that an individual faces, and core emotional outburst that come to the surface only in a crisis situation. Crisis intervention is classically, actions taken to mitigate and provide support to clients due to sudden crisis and disruption in people’s normal functioning in life. In such emergency situations, services such as post traumatic counseling, rescue, relief and rehabilitation are needed most and have the highest probability of having a positive effect. The crisis situations created as a result of the massive earthquake in Kutch-Gujarat in 2001, the tsunami in Tamil Nadu in 2006 witnessed extremely detrimental effects on the victims along with immeasurable loss of life and property. Case work in disaster situations is the most challenging task when the worker has to be equipped with the required skills to minimize the adverse effect of the crisis on the client.
The use of behavioural approach to case work has increased dramatically in the past two decades. Behaviour therapy intervention techniques are now among the most widely used techniques in case work and counselling. The foremost postulation of this therapy system is that maladaptive behaviour is acquired primarily through learning and can be modified through additional learning. A major trend in behavioural case work in the contemporary practice has been toward recognition of the role of cognition (thinking processes) in human behaviour. Cognitive behaviour therapists have accepted the notion that changing thoughts will often change feelings and behaviour (Beck 1976). The traditional paradigm of behaviour therapy has been S (stimulus) – R (response). Cognitive behaviour therapists insert an additional step in this paradigm: S (stimulus) – O cognitions of organism) - R (response).
Some of the most commonly used behaviour therapy techniques during the work with individuals are: assertiveness training, token economy, contingency contracting, systematic desensitization, in-vivo desensitization, implosive therapy, aversive techniques, and cognitive behaviour-modification techniques. It is often recommended that certain techniques should be used only by experienced case workers with extensive training because improper application may create undesired side effects. The behaviour modification approach is extensively used in child and adolescent guidance centers while working with clients having conduct disorders such as childhood aggression, truancy, precocious sexual activity, lying, theft, substance addiction etc. These symptomatic problem behaviours could be treated by using behaviour modification for both family and clients. The case worker could employ techniques like modeling, selective reinforcement, and behavioural role playing for targeting change in unwanted behaviours. In India, the behaviour modification approach is often practiced by qualified and experienced case workers as a suitable approach in mental health settings, de-addiction centers and child protection homes and special homes for children.
A perspective emanating from the behaviourist paradigm concentrates on observable behaviour. These behavioural approaches find their place in specialized settings and for limited purposes. A cognitive approach holds that the principal determinant of emotions, motives, and behaviour is an individual’s thinking, which is a conscious process. Cognitive behavioural theory is a broad category that encompasses Adler’s individual psychology, Ellis’ rational-emotive theory, Glasser’s reality therapy and other approaches which regard to emotions and behaviours as products of thinking. The cognitive approach is based on three premises; a change in thinking alters emotions, goals and behaviour, change in emotion is especially influential in altering behaviour and new activities, and new kinds of behaviour alter perception (Werner, 1979). The cognitive Approach is particularly relevant in work with anxiety and depression and form a major part of programmes for anger control, offending behaviour, and drug and alcohol related problems.
Another significant development was the application of sociological theories in social work practice. Where the client’s milieu is complex and where in a critical way a range of significant environments are involved, a perspective emerging from the Systems theory could prove beneficial. The Systems theory focuses on complexity and interdependence of relationships. A system is composed of regularly interacting or interdependent groups of activities/parts that form the emergent whole. Another thought system which could be equally pertinent would be the ecological approach, which is similar to the systems theory in many ways, the difference however is that it provides a richer understanding of the potential for growth that can take place in both the client and in the environment (Turner, 1979).
In the past several years, social work has increasingly focused on an ecological approach. Ecological approach is a subcategory of systems theory and it has become prominent in social work practice. Research had demonstrated that psychoanalysis was probably ineffective in treating clients’ problems (Stuart, 1970). The ecological approach integrates both treatment and reform by conceptualizing and emphasizing the dysfunctional transactions between people and their physical and social environments.
FIGURE 1
Interaction of Subsystems and Individual
(Adapted from Zastrow, 1995)
Educational system
Family system
Community system
Social service system
Market systems
Employment system
Religious system
Political system
Individual
As is apparent from Figure 1 shown above, people in the society constantly interact with numerous systems such as family, community, social, political, religious, educational and market systems. At the first stage the ecological approach focuses on the individual and seeks to build up the client’s problem-solving skills, coping behaviours, and developmental potentials. In addition, its emphasis is on the relationship between a person and the systems the client interacts with and links the individual with needed resources, services, and opportunities. And finally it focuses on the systems and seeks to reform them to meet the needs of the individual more effectively. Such an approach requires exceptional analytical and networking skills on part of the social caseworker. This is a holistic approach and endeavours to deal with comprehensive aspects of the individual problem. In the Indian socio-cultural context the possibility of usage of the ecological approach is much broader and imperative as the approach attempts to draw from holistic perspective for practice.
The preference of approaches depends entirely on the caseworker’s orientation and skillfulness with certain approaches. No matter which approach he/she adopts, there needs to be clarity of purpose and rationale for action. The caseworker has to judiciously design an intervention plan based on a particular social work treatment approach, otherwise employ an eclectic approach for helping the client solve his/her problems. Das (2003) noted that many practitioners in recent years have been able to practice comfortably with several methodologies and this trend appears to be continuing and growing. What is being advocated is the need to continue to be open to the influence from all seriously presented bodies or systems of thought and to be more comfortable as individual practitioners with a multi-method and multi-theoretical approach.
PROFESSIONAL PREPARATION AND STANDARDS
Quality of Case work and professional efficiency is closely related to the quality of professional preparation and training. An example here could add significant clarity to the discourse; at the Tata Institute of Social Sciences the trainees are provided with an opportunity to study the methods courses including working with individuals. They are facilitated with experiential classroom learning along with the concurrent field practice, where the learners get the opportunity to integrate the classroom learning into the field practice. Thus, the first and foremost professional considerations are to prepare prospective students with the necessary skills, professional attitude and adequate knowledge.
Education and professional training in the field of Social work is very vital. Such learning is uniquely related to the profession that empowers professionals to provide services that are most likely to help clients, on other hand, nebulous and amateur social worker may harm the client than doing any good. After completion of the professional training they assume the privileged role of a social worker on the assumption that they possess and use definite kinds of expertise. Therefore, social work educators and practitioners of this country are required to pay greater attention to the crucial matters of the professional growth and development including selection and training of its members.
Since six decades, the social work profession in India has been growing steadily; yet there is no legislation equivalent to those governing professions like medicine, law, or accountancy. In addition, there is no statutory professional organization like the Indian Medical Association or the Bar Council of India, which can control professional allegiance and enforce adherence of certain professional and ethical standards. A statutory body or national level council for professional Social Work is the need of the hour where the council may identify the educational standards and review the adherence of standards in various schools of social work in the country.
International discourses assert that an important commonality of social work around the world is its acceptance of the idea that scientific knowledge should guide professional intervention (Hokenstad et al., 1992). In India such concerns have been voiced in professional gatherings as there has been greater apathy in upgrading and incorporating newer scientific knowledge base amongst several sections of the field practitioners. At the same time, global advancement and changes in the field of social work practice has helped motivated and open-minded practitioners to examine and indigenize their knowledge and practice base.
Universally, there has been greater influence of west in the social work practice in India. This is due to widely accessible and available western literature; nevertheless this has undoubtedly benefited trained social workers in India in building their knowledge base and field practice. Like many other fields, case work, draws its knowledge base and principles of practice from a number of disciplines. Hence, social work professional knowledge and skills by their vary nature are in need of constant revision and upgradation.
URBAN CONTEXT FOR PRACTICE
The world has experienced unprecedented urban growth in recent decades. In 2000, about 47 percent of the world's population lived in urban areas, i.e. about 2.8 billion. More developed nations are about 76 percent urban, while 40 percent of residents of less developed countries live in urban areas. However, urbanization is occurring rapidly in many developing countries. It is expected that 60 percent of the world population will be urban by 2030, and that most urban growth will occur in less developed countries (Population Reference Bureau, 2006).
During the 19th and early 20th centuries, industrialization resulted from and contributed to urbanization. The rural population got attracted to the cities for earning their livelihood. The emerging factories required cheap labour which was provided by the migrants. Urbanization in most less developed countries in the past fifty years contrasts sharply with the experience of the more developed countries. Migration fuels urban growth in less developed countries as people leave the countryside in search of better jobs. This steep rate of growth of urban population along with the urban bias in developing countries has brought in its wake problems like population explosion in cities, grinding urban poverty, unemployment, poor health status, malnutrition and slum formation. Industrialisation and its correlate urbanisation are associated with a realignment of relations between the individual, the household, the community, the market and the state.
Burgeoning with the urbanization, the present day is witnessing a sea change due to phenomenon of globalisation, liberalisation and privatisation; these are indeed posing multifarious challenges for social work profession. Industrialization and automation have led to increased productivity, life-style change and level of stress in urban population. The onset of all such forces has augmented greater significance of fostering social work practice in individual context. The realities of an ever increasing globalised world and rising inequities demands social workers to be at the forefront. It is critical for social workers to understand that the newer trends in the social, political and economic sectors are impacting human psychology in many negative ways too. The result is manifested in poor mental health status, reduced resilience and breakdown of social support networks. The changes in human psychology and lifestyle in urban context makes it essential for the social workers to consider the implications of ecological perspectives and client centred work.
India, a nation with the populace of more then one billion is facing major challenges due to rapid urbanization. The problems caused by rapid urbanization are deteriorating health status of the populace. Air pollution, lack of water, sanitation and drainage facilities, vehicular accident, lifestyle disease and mental stress are considered to be the major threats to the health of the urban population (Sarkar et al 2005). In view of the current trend, it may be anticipated that the existing water and vector borne diseases will continue to be the leading cause of morbidity and mortality. On the other hand, malignancies, HIV/AIDS, and lifestyle and stress related diseases would emerge as major newer challenges for health social workers. It is imperative to note that health has been defined as not merely the absence of disease but also the total physical, mental and social well being of the person. Mental health is determined by multiple social, environmental, biological and psychological factors (WHO, 1986).
It may be pertinent to look at a recent study of urbanisation and incidence of psychosis and depression that was based on data from the Swedish population registers. The results reported that with increasing levels of urbanisation the incidence rates of psychosis and depression rose (Sundquist et al, 2004). The study vividly pointed out the direct proportionality between urbanisation and incidences of mental illnesses amongst the population. These types of mental illnesses has long been associated with psychologically affected behaviour such as irritation, lost tempers and damage to interpersonal relationship. Such repercussions are universally heard off and are daily reported in form of anecdotal account in daily national news. In India the suicide rate in cities (12.8) was higher as compared to All-India suicide rate (10.5). Nearly 3.8 per cent of suicides were committed due to ‘Unemployment’ as against 1.6 per cent of such suicides at National level as per causal analysis of suicides in cities. The four Metropolitan Cities – Chennai, Bangalore, Delhi, and Mumbai have reported higher number of Suicides. These four cities together have reported 50% of the total suicides reported from 35 mega cities (NCRB 2008).
Thus, greater emphasis may be laid on the urban concerns as they impact negatively on an individual’s health and social well-being who are suffering, disempowered and disadvantaged. These person-specific problems require intervention at the individual level with the appropriate use of the skills of effective case work practice. There is no panacea of one single approach for dealing with the diverse problem situations produced by the urbanised environment today. But a multi-pronged approach with eclecticism may go a long way in terms of alleviating and helping individuals with problems.
CONTEMPORARY AND FUTURE PERSPECTIVES
The social work practice has evolved with the changing contexts. The world is undergoing a transition on account of the global forces that are impacting every sphere of human life. Social workers like other professionals are facing newer challenges in terms of upgrading their knowledge and skills to suit the changing times. The current globalization of the economy requires the social workers to broaden their horizons and view many domestic social justice issues within the global framework (Polack, 2004). Further globalization brought about sporadic unemployment accompanied by family disintegration, poverty, violence, despair and drug addiction. Currently the situation also had created massive new population movements, which have resulted in dislocation and problems of cultural adaptation and acceptance. There is heavy influx of illegal migrants from bordering countries as well as inter country rural migration. Large scale migration has created new social problems that are not yet properly recognized in social work circles.
The impact of globalization on employment conditions and social welfare benefits is negative. As the social work profession is closely linked with social welfare and working with the marginalized sections of the populations like the women and children, migrants, unemployed and homeless, there is an imperative need to develop a global perspective of their individual problems. Continuation of such trends would mean an increase in income inequality, poverty, and social dislocation and an accompanying rise in tension, violence and marginalization. Further, in terms of practice, social workers will likely be called on to deal with some of the manifestations of the increased stress of unemployment and economic insecurity, in the accompanying heightened child abuse, alcoholism, depression as well as in general societal tension and violence (Rose, 1997).
Ironically, the traditional practice of social casework has emphasized the clinical role of casework almost to the point of excluding other roles. But the problems of an individual can be perceived in terms of ranging from the individual, being unable to carry out certain behaviour and roles, to problems in the structure or performance of proximal or broader community or social systems (Fischer, 1978). This statement may blur the demarcation between social worker and social caseworker. There is no doubt about the fact that a social caseworker is a social worker first. What preserves the identity of the caseworker is the focus on case-by-case approach, dealing with an individual or family. It is vital for the caseworker to understand the interplay of micro (working on a one-to-one basis with an individual), mezzo (working with families and other small groups) and macro (working with agencies, communities or seeking changes in existing order and social policies) systems and work towards redress of the client’s problems in a more holistic approach.
CONCLUSION
Social work is a distinctive profession that is committed to - care-giving, offer services, therapy and rehabilitation, bring about required change, and also work towards sustainable development. With this uniqueness the social work profession today is governed by many complex forces pertaining to social, psychological, economic and political arena. There is a greater need to be aware of these macro phenomena which have a direct bearing on individual-centred practice. Working with individuals in present scenario does not strictly mean confining the intervention to individual only. The worker must analyze the situation and plan his/her intervention at micro, mezzo and macro levels with individual as the main focal point.
In the field of individual social work practice there is a large array of theoretical and practice approaches which govern the casework practice. Therefore, a prudent practitioner advocates the use of an eclectic approach, there should however be more clarity on this stance. Eclecticism does not mean a mere integration of the theoretical approaches. The theories have to be studied through systematic analysis and pre-selected criteria. Practicing from an eclectic base requires the caseworkers to be flexible and open minded. This approach widens the caseworker’s lens and enables him/her to look for problems and solutions at different levels of the ecosystem. The caseworkers must be capable to correctly using the vast amounts of knowledge the profession has generated over the years.
Intervention approaches are central to the helping process, but there is little evidence that these approaches and models are effective in promoting the desired change. The professional attempt has been rather slack in evaluating the efficacy of professional interventions. Thus one of the imperative tasks for the profession in the years ahead is development of scientific research and evaluation as an integral part of social work practice.
An indifferent attitude towards casework still exists in India and may be attributed to the fact that some social work practitioners and educators believe that the method of working with individual is extraneous and less effective in the existing socio-economic and global realities. Ironically most social work agencies in metropolitan cities of India are engaged in providing individualized professional services. There is a tremendous demand for case work services in variety of urban situations; this was not met owing to a dearth of trained personnel. Considering the nature of intricate individual focused bio-psycho-social problems, it can be reasonably stated that working with individual has greater scope in the future years.
Finally, one critical challenge in social casework today is this constantly changing global and local environment which is adversely affecting the individuals and their families. The casework practice must evolve with time and context. A practitioner not only needs to be aware of these rapid transformations but also design his/her intervention which is suitable to the changing environment.
REFERENCES
Beck, A.T. :
1976
Cognitive Theory and the Emotional Disorders. New York: International Universities Press
Berlin S. :
2005
The Value of Acceptance in Social Work Direct Practice: A Historical and Contemporary View. Social Service Review, Vol.79, Number 3. September 2005, the University of Chicago Press.
Das Shankar :
2003
Holistic Counselling for Health and Wellbeing, in Kaila H.L. and Kushal K.B. (Eds.), Towards Development with Young People, Himalaya Publishing House, Mumbai.
DuBois, B. and : Miley, K.K.
1992
Social Work: An Empowering Profession. Boston: Allyn and Bacon, pp. 135-141.
Fischer, J. :
1978
Effective Casework Practice: An Eclectic Approach. USA: McGraw-Hill, Inc.
Goldstein, E.H. :
1984
Ego Psychology and Social Work Practice. New York: Free Press.
Hokenstad. M.C. : S.K. Khinduka and J. Midgley, eds.
1992
Profiles in International Social Work: Global Challenges for a New Cnetury. Washington, DC: NASW Press.
Hollis, F. : ::
1964
Casework: A Psychosocial Therapy. New York: Random House.
Mathew G. :
1992
An Introduction to Social Casework. Mumbai: Tata Institute of Social Sciences.
Nagpaul H. :
1996
Social Work in Urban India. Rawat Publications, New Delhi.
National Crime : Records Bureau
2008
Suicide in India, Government of India.
National : Association of
Social Workers
1992
NASW Standards for Social Work Case Management. Source:
http://www.socialworkers.org/practice/standards/sw_case_mgmt.asp.
International : Institute for Population Sciences (IIPS) and MacroInternational.
2007
National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS.
Payne, M. :
1991
Modern Social Work Theory: A Critical Introduction. The Macmillan Press Ltd.
Perlman, H. H. :
1957
Social Casework: A Problem Solving Process. Chicago: University of Chicago Press.
Population :
Reference Bureau
2006
Human Population: Fundamentals of Growth Patterns of World Urbanization. Washington: PRB.
Polack, R.J. : :
2004
New Challenges for Social Work Profession in the 21st Century. Social Work, 49, pp 281-290.
Richmond, M. : :
1917
Social Diagnosis. New York: Russel Sage Foundation.
Robinson, V.P. : :
1930
Changing Psychology in Social Casework. Chapel Hill: University of North Carolina Press.
Rose, N : :
1997
The Future Economic Landscape: Implications for Social Work Practice and Education, in Michael Reisch and Eileen Gambrill (Eds.), Social Work in the 21st Century. Pine Forge Press.
Sarkar. A., :
Mishra T, Mondal. P., Aggarwal. S.
2005.
Urbanization in India – A Biggest Public Health Challenge. Epidemiology. 16(5):S116, September 2005.
Skidmore R. A. : Thackeray M.G., Farley O.W.
1997
Social Work Practice with Individuals in Introduction to Social Work. Boston: Allyn and Bacon (Seventh Edition).
Stuart, R.B. : :
1970
Trick or Treatment. Champaign. IL: Research Press Co.
Sundquist,K., :
Frank, G. and Sundquist, J.
2004
Urbanisation and incidence of psychosis and depression. The British Journal of Psychiatry (2004) 184: 293-298.
Turner, F.J. : :
1979
Interlocking Perspective in Practice, in F.J. Turner (Ed.), Social Work Treatment. New York: Macmillan Publishing Co.
Werner, H.D. : :
1979
Cognitive Theory in F.J. Turner (Ed.), Social Work Treatment. New York: Macmillan Publishing Co.
World Health : Organisation :
1986
Ottawa Charter for Health Promotion. Geneva: World Health Organisation.
Zastrow C. : :
1995
The Practice of Social Work. Fifth Edition. Brooks/Cole Publishing Company, Pacific Grove, California.
THE INDIAN JOURNAL OF SOCIAL WORK, Volume 69, Issue 2, April 2008
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