Simulated interviews reflection and approach work
The purpose of the interview was to explore the service user’s situation and investigate his needs and problems.
When reflecting on the interview techniques I asked both open and closed questions, for example “Do you want to tell me what’s happened recently?” I probed into his responses several times for example “would you like to talk in more depth about that?” These questions can promote client involvement, inviting the service user to talk in more depth. Using this technique shows that I listened by asking questions about points he had discussed. The service user mentioned that he felt I listened well to what he was saying because I asked him to talk about what he’d discussed in more detail.
I tried to use the non verbal attending SOLER techniques (Egan, 2007) these included facing the client squarely, having an open posture, leaning towards the service user and keeping good eye contact during the interview which when looking back at the interview I believe I did constantly.
I did try one technique called scaling, upon reflection I concluded that it was not the correct time to use it. I think I was too eager to try too many techniques at once. Understanding this will help establish the correct skills to use in different situations.
During the interview the service user was fidgeting, this may be a response to how he dealt with their anxieties and depression. However upon reflection I understand that anyone having an interview with a social worker could be nervous and fidget. It’s unfair to conclude that it was his anxieties that caused him to fidget. Upon reflection I found that his answers were closed at first until I tried to make him comfortable, probing his responses until he felt more relaxed and happy that I was listening. He then became more confident at answering the questions and gave more in depth responses. However this may not have been because of the techniques I used. The service user has had dealing with mental health teams in the past. Having had experience of interviews he would find it easier to talk to a social worker and give answers out of habit. Mental health services have a habit to affect service users. Helping them in certain situations in the past, the service user will be used to working with them in this setting and want them to help again so willingly involve themselves interviews.
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I tried to empathise with the service user when it was possible for example “I can see things have been really difficult for you”. I showed support when it was needed for example he knew what he did not want but not what he wanted in regards to having help. I explained that it was a good situation to be in and we can move on further from this. I believe I showed understanding and empathy towards his situation by using non verbal skills like smiling and nodding when he explained something
Within the interview I was nervous and did not appreciate that this service user had previous experience of mental health services and already had strategies that enabled him to live with his mental distress. I focused solely on his mental health and this impeded my techniques and how I acted as the interviewer. I should have focused on the situation and asked him what his current situation was and why he was currently using mental health services. I did find out the main part of his situation, that he is about to be made homeless but I didn’t explore it in depth after he’d mentioned it. I just carried on with using techniques I had learnt and ignored the severity of his situation. I think my understanding of the purpose of the interview and the actual purpose had affected the way I acted and asked questions. Ignoring the whole reason why the service user was in crisis may have been due to my own personal experience of mental health. Understanding that my previous experience may impede my practice is something that reflection has uncovered.
My age and gender may have affected the interview process. Being a young woman who’s a social worker when my client is an older male with mental health problems understandably there are boundaries these may have affected how I asked questions and what I wanted to cover and how he answered questions. This man was not much younger than my father I may have ignored his most pressing problem because I associated him to a close figure that never has problems and always deals with things independently. Unconsciously I may have associated this and that may be why I ignored the severity of his imminent homelessness.
I used a notebook throughout the interview. Upon reflection I believe I unconsciously used this as a barrier because of my own nerves and understanding of individuals using mental health services. I am rather disappointed in myself even if it was an unconscious action an individual using the mental health team needs a social worker who will not put up barriers that may suggest they want to distance themselves from the service user. Being aware of this will help me in the future when working within the mental health services.
Biestek (1961) produced a set of values that social work is based on including individualisation and acceptance (Adams, Dominelli and Payne, 2009). I showed anti discriminatory practice by understanding that individuals should be treated as unique. You may already have previous experience of similar cases and already know what might work. However it’s important not to direct the service user but let them make their own decisions. Within the interview I believe I used this approach asking the service user “What would you like us to do to help you?” ensuring the service user makes the decisions. The social worker can safeguard the service user against making decisions for him by using reflection as a technique. Reflecting individually and being able to use your team to reflect upon what you as the social workers have done and why you have done. Colleagues may identify an important aspect which the social worker had not previously considered.
During the interview I tried to keep my emotions controlled to make sure the service user was not affected. However whilst reflecting I feel emotional about the situation. I think it’s important to be able to feel emotions regarding the situation otherwise I may be more affected by the situation later on.
The service user’s situation is such that he will be imminently evicted and become homeless. As such the approach to take requires an intervention that will help and be effective in the short term. A crisis intervention and task centred approach helps people faced with sudden problems (Adams et al, 2009). When in crisis individuals find that they have no solutions, because of this may be more susceptive to outside help, in this case from mental health social workers (Roberts, 2000). These approaches would be the most effective in this situation as the service user is facing sudden problems.
Crisis intervention uses elements of the psychodynamic approach and cognitive approach focusing on emotional responses to events and how to control them realistically. The task centred approach focuses on major continuing problems in life. Both improve the individual’s ability to deal with their problems (Payne, 2005).
There are different phases of crisis intervention, the beginning phase focuses on the situation but should look into his emotional state and well being. Using Roberts, 2000 seven stage crisis intervention model helps understand what this approach involves. The first stage is conducting the assessment. This leads to establishing rapport with the service user. Major problems are then identified and the causes of crisis are investigated to ensure these do not continue to affect the service user. The social worker helps the service user deal with emotions regarding the situation. The next stage involves the social worker and service user identifying different routes to take to ensure the service user is involved with decision making with regard to his plan (Roberts, 2000). I believe that this model is the most useful when understanding crisis intervention as during the fifth stage when they are looking at different routes to take they can look at the service users previous responses at coping with difficult situations and how they had dealt with them then therefore focusing on strengths. During this stage the social worker could help the service user reduce the crisis into smaller manageable amounts this may decrease the service user’s level of anxiety. Helping involve him in coping mechanisms and decision making to develop and implement a plan.
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Firstly the social worker and service user must identify the crisis, assess the situation, explore strengths and the resources the service user may have and then implement a plan (Payne, 2005). Crisis intervention identifies practical tasks that the individual’s need to readjust when crisis has occurred (Payne, 2005). This service user’s crisis has already been identified as his imminent homelessness. During the interview the situation was explored to find out other problems he is facing, he currently has depression and levels of anxiety and has had previous gambling problems. The strengths that the service user has are his commitment to want to work in the future and knowing he needs help but does not know what kind of help he needs. A major strength the service user has is his ability to form strategies to cope with his mental illness to enable him to live within society without difficulty until crisis had happened.
From this initial interview further work would need to be done with the service user this would involve looking holistically, investigating his environment, familial relationships and other situations and find out any other needs which the service user may wish us to meet.
Task centred intervention would be incorporated within this time whilst crisis intervention was ongoing. This is a practical approach and would be effective as it looks at his problems and why he might be facing crisis to try and prevent him facing crisis again. This is a short term problem solving approach using partnership and empowerment, building on people’s strengths. This approach focuses on the service user’s problems. Payne, 2005 explains that task centred looks at problems that the service user acknowledges and what they want to change. Task centred is effective when solving problems involving social relationships and decision making problems, both of which the service user has. The client identifies problems the tasks are then planned, these may involve small actions or involve different actions, for example in this case help with familial relationships and take part in gambling help. The tasks can be physical actions for example the service user is this case could call a gambling anonymous helpline and ask for further help. These tasks are then evaluated to see if they have been achieved (Doel and Marsh, 2005). The purpose of task centred is to help resolve problems and give them capacity to deal with them in the future.
Criticisms of both crisis intervention and task centred are that neither is effective when the service user is constantly facing crisis and some individuals may find it difficult to face their problems head on like in task centred.
If timing was not a problem another approach which may have been useful would be Cognitive Behavioural Approach. This approach involves the application of the social learning theory and would help me as a social worker and the service user to understand how emotional and behavioural problems can arise and how they can then be maintained or changed. This theory was chosen as its one of the most effective treatments for conditions where depression is the main problem. It looks at triggers which might affect how the service user functions within society for example his gambling problems may have caused a difficult financial situation leading to his imminent homelessness (Westbrook, Kennerley and Kirk, 2007).
Cognitive behavioural therapy focuses on client self determination, empowering the service user to make their own decisions and also boosts the service users confidence when making these decisions and avoids having a dependent service user. It encourages service users to reinforce desirable behaviours rather than punish those that are undesirable (Adams et al, 2009) (Westbrook, Kennerley and Kirk, 2007).
Cognitive behavioural therapy is not a short process which is why it wouldn’t be useful in this case. If further on when the crisis has resolved and the service user and social worker have built rapport it may be a useful approach to use when dealing with his other problems. The service user already had an idea of what cognitive behavioural therapy was as his psychiatrist has already referred him for short term cognitive behavioural work. Working with the therapist allocated to this service user may enhance his progress, if all professionals are working towards the same goal using the same approach it may be beneficial to the service user in the long run.
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