Tag Archives: change

Churning the Soil, caring professions (health, teaching and social care) and Madonna.

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Last month I enjoyed the lecture of Durham University’s new social work lead Professor Carlene Firmin, on contextual safeguarding. I was particularly energized by the language of “spaces” and shifting the risk assessment paradigm from a myopic focus on families to variously friendship groups, streets and parks, or entire school years, and as investigative social workers exploring these rich untapped veins for solutions and real dangers for children.

Whilst energized however a second thought came over me like a groaning wave, (one familiar to all key workers) – PLEASE NOT ANOTHER…. new idea, review, reinvention, piece of legislation, policy, procedure, theory, research says, academic says, think tanks says, the news says, Daily Mail headline, in country X they, in local authority Y they, new computer system, new head of service, serious case review, act of parliament, DFE says………………………………..

Children’s social care is currently going through a major review, led amazingly by a non-social worker (Josh McAlister) whose current agenda has been developed variously through rehashing either ideas he had ten years ago, or elite teacher training models, whilst staring through a pair of Tory blue Etonian binoculars. Like many confidence tricks however the solution or outcome must be seen to be the idea of the “mark”, the “mark’ being the victim of the con. Josh has achieved this through the cynical way he has used people with lived experience from care experience in a similar way that McDonalds uses salad and its grassroots football sponsorship to promote itself as part of a healthy diet.

Josh and the Conservatives will seek to implement this review and once again our profession will be asked to march unquestioningly in a new direction.

However, is there any energy or resources left in our professions to turn from caterpillar to butterfly or do a Madonna (Like a Prayer-Dick Tracy-Frozen). Do we need to stand still and reflect, or must we lunge forward, must we radically change over and over and over? And in doing so what is the impact?

Whilst this link to relentless change in social work or other caring professions may seem loose, perhaps this strangely prescient quote from the material girl makes the case;

“49% of the time I was crying, usually from over-exhaustion. But there’s something about pushing yourself out there when it’s pouring rain or you’re freezing cold or you don’t feel well or something really crazy happened in the world like Hurricane Sandy.”

As teachers, carers and social workers we can’t solider for long or we slowly surrender our essence, our life force (I’m using the word ‘soldier’ here both in the army sense and the scientific management sense of Talyorism). There is a cruel juxtaposition of being drained, burnt out and chewed up while doing the job (the human part) we adore and helping people we are committed to and love working with. Every few months, or for bigger changes each few years, we are meant to leap on board an entirely new way of teaching, or safeguarding or treating, because someone sat well away from the classroom, frontline or ward says we should.

Each time we change direction and re focus we are giving up even more of our already depleted resources (however well-intentioned the changes are)

We are collectively the soil of our professions. (Nothing will grow without us)

  • Time for some amazing Soil facts.
  • It is essential for 95% of our food
  • It stores ten times more carbon than the worlds trees
  • It’s a living complex and sophisticated system passing nutrients
  • Darwin heralded the earth worm as the most important creature on earth.
  • It takes thousands of years to make an inch of new soil

How do we treat this most vital resource and what’s the link to our professions?

  • We over work the soil (overcropping) – (High caseloads, large classrooms, workload)
  • We spray chemicals (privatization, outsiders coming in to tell us how to do it better. Soil does not need much more than not to be harmed)
  • Man made floods rip it from the land, (Regular external threats tip the balance further against us – COVID, Austerity)
  • Two thirds of the worlds soil is lost. (High turnover rate in the caring professions, most don’t last more than 5 years with one third quitting (this example from teaching))
  • Global vampire capitalists own vast sways of farmland firms like Monsanto or McDonalds (Care Tech, Credit Suisse, KPMG all involved in the review and the ££care££sector££)

History tells us that the decline of the Roman, Aztec and Mesopotamian (fertile crescent) empires can be put down to exhausting soils nutrients through war and over and mono cropping. I feel the caring professions are in a similar set of dire straits. The main culprits who deplete our professions soil being OFSTED, the government, and the media.

Endless Change = Endless Depletion

As we are cajoled and pressured by the likes of OFSTED or the care review, our resources are drained and the quality of the soil is derogated, simply ask too much too often of soil and the crops will start to fail and fail permanently.

However how do we survive this agricultural abuse as practitioners because many of us strive to do so?

I would suggest there are 4 main damaging positions we occupy in the caring professions

These positions are extremes but many of you will have seen countless examples of them partly or fully formed in colleagues across the years. They are understandable hiding places we seek to occupy as we are repeatedly damaged by external factors in our professions.

My warning is that unless our professions resources are seen as a key part of any review or change from government inevitably it will just be another act of strip farming with our capacity depleted further and further.

To get the most out of the Soil we must allow the farmers who work and care for the land to be in charge. Left alone they will prosper. Interference from those far from the field who seek profit and success over partnership with the land will be ultimately catastrophic.

About the writer…..

Bull

George has been a social worker for 10 years working mainly in child protection and Early Help. He has lectured with Jamie Scorer at New College Durham, University of Sunderland and University of Northumbria in solution focused practice.

Motivational Interviewing – be like Columbo

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Remember the television show Columbo starring Peter Falk?

The fictional Columbo was a detective who solved murder mysteries – hugely popular in the 1970’s. Having recently used this analogy with a group of second year undergraduate students on the social work programme I teach on I realise that some of my cultural references may be a little dated! But I’m going to go with it!

Columbo was a humble and unassuming character who had the ability to get anyone to tell him anything, despite their initial resistance – very disarming. When someone said something to Columbo that was conflicting or inconsistent, he would rub his head and say, “I noticed yesterday you said one thing, and now you are saying something else. I’m confused.” He would say things like, “Could you clarify this?” or “Help me understand.” Columbo did not accuse those he was questioning but rather by taking the responsibility for his confusion, he disarmed the other person who then would slowly feel comfortable telling him the things he needed to know to solve the crime. The Columbo Method is to present the facts that appear to conflict, give the person the benefit of the doubt, and then ask questions for clarification.

Miller and Rollnick in their 1991 book “Motivational Interviewing: Preparing People to Change Addictive Behavior” badge this as ‘developing discrepancies’, showing people that what they said at one point doesn’t correlate with what they are saying now, or what they say they are going to do doesn’t fit with what they say they will do. It’s the gap between where the person has been, or is, and where they want to be.  I am minded to talk about my dalliance into Slimming World but won’t because there is indeed a discrepancy between my ‘I must lose weight’ and ‘Oooo Pizza!’

Helping Clients develop discrepancy is “the active ingredient underlying motivational interviewing’s efficacy” say Miller and Rollnick, going on to state that “Motivational Interviewing is an effective, evidence – based approach to overcoming the ambivalence which stops people making desired changes in their lives”. The emphasis though – because of intrinsic motivation as a more effective method of motivation – is on personal choice and responsibility for the future.

Internal (or intrinsic) motivation is motivation that comes from within. Maybe things like ‘I want to feel healthy’, rather than, ‘I want to lose 2 stone’. The latter is an external marker, the former, an internal motivator. Intrinsic motivation is associated with greater long-term change. Research shows people with low internal motivation have worse outcomes and people with higher levels of both internal and external motivation have better outcomes. (Deci and Ryan, 1985, 1987, Curry et al 1991). So, ‘I want to lose 2 stone and I’m doing it because I want to feel healthy’, is perfect.

Motivational Interviewing was developed initially in response to working with client resistance in alcohol treatment in the late 1980’s but is now widely considered as been helpful in many areas where motivation to change is required. Most social work practice involves either supporting someone to consider change and initiate it, or supporting someone to readjust to a change thrust upon them, for example, an older person having a stroke or heart attack. It’s helpful as it can work in relatively ‘brief’ interventions and is a more helpful ‘stance’ in working with high levels of resistance in clients than a confrontational or coercive style.

Motivational interviewing builds on Carl Rogers’ optimistic and humanistic ideas that we all have the capacity to change and become the best version of ourselves – we just need to figure out how. It’s about people’s capabilities for exercising free choice and changing through a process that works towards self-actualization. Essentially, motivational interviewing activates the capability for beneficial change that everyone possesses. Once ‘activated’ some people can continue change on their own, while others require more formal treatment and support over the long journey of recovery or adjustment.

The therapeutic relationship for both Rogerian and motivational interviewers is a democratic partnership. Your goal in motivational interviewing is to elicit self-motivational statements and behavioural change from the client in addition to creating client ‘discrepancy’ (the Columbo Method) to enhance motivation for positive change.

The idea of developing discrepancies originated from cognitive dissonance theory which suggest that there can be an imbalance between the internal and the external values of the individual.  This causes a person to feel unbalanced. So, where there is incongruence between what a person feels and does this can cause a dissonance, an imbalance, or a feeling of not being true to oneself. Cognitive dissonance can make people feel uneasy and uncomfortable, particularly if the disparity between their beliefs and behaviours involves something that is central to their sense of self. For example, behaving in ways that are not aligned with their personal values which may result in feelings of discomfort. That uncomfortable feeling can be used positively to initiate motivation and therefore change.

We can ‘develop’ discrepancies by pointing them out sensitively and in doing so you create a gap between where the person has been (or currently is) and where they want to be. The individual can come to a realisation that their current behaviour is not leading them towards their goals, and they become more motivated and open to change. The goal is to resolve that the discrepancy by changing. In doing this you can offer and explore the positives and negatives of change and so ‘roll with resistance’.

The emphasis is on intervention and change not the issue which could lead us to ponder is change sustainable if an underlying problem is not dealt with successfully. Worthy of some reflection and consideration of this idea in relation to the individual you are working with.

This ‘Motivational Interviewing’ approach

  • Encourages positive engagement
  • Acknowledges and works with client resistance
  • Is collaborative, not collusive
  • Is a blend of different therapeutic approaches, inc. Person-Centred, Solution-Focused and cognitive-behavioural ideas with a process model of change.
  • It has a belief in the possibility of change
  • Shows respect for individuals
  • (Hopefully) achieves empowerment

What doesn’t work to motivate

Persuasion

It’s tempting to try to be helpful by persuading – you might want to draw the persons attention to the importance or urgency of the problem being addressed. Or maybe put to them the benefits of changing a behaviour. These strategies are likely to backfire because you are trying to motivate extrinsically – not intrinsically. It usually only increases client resistance and decreases the probability of change.

Righting reflex

Miller and Rollnick suggest as practitioners we sometimes use our corrective lens. We want to ‘put the client right’. We want to change their behaviour, so we argue or push back. This often simply leads to an impasse with the client standing their ground based on all the reasons not to change.

Strategies to use

  • Express empathy
  • Be Non-judgmental
  • Make sure that the client is being heard and understood.
  • Develop discrepancy – Help the client see the difference between their core values and their behaviour.
  • Define the most important goals.
  • Support self-efficacy – The Client’s must believe in their ability to change. I have a view that our role as social workers is to eradicate the need for social workers. We should work with people in such a way that they eventually don’t need us anymore because they have developed the skills or understanding they need. This is reminiscent of the strengths based approach in social work practice. It can be good to focus on such skills and strengths and on past successes because this….

….promotes self-esteem and builds confidence which moves the client in the direction of change.

The goal is to move the client to what is referred to as change talk rather than sustain talk. They talk about how they will change rather than how they wil