The Doctor who gave up drugs

This is the title of a new documentary and I've personally found it fascinating. Over-prescription of drugs is a huge problem. I work in a health setting and many people who use the service expect drugs some of which are very damaging to their health. As part of the assessment I often say "there is no magic tablet" but people still expect a quick fix. This masks the 'real' problem and people may go years without addressing the underlying causes of their mental health condition. I am not for a moment suggesting that medication does not have a place but I am concerned that alternatives are not explored thoroughly partly because it is easier and partly because of the hierarchy within the setting itself. People deserve adequate and evidence based alternatives but there is not enough of them about.

Tough Battler, Logical Thinker or Friendly Helper?

I did some training the other day about the three broad types of thinking that most of us lean towards. In the stress of a moment, when the pressure is on, when it all boils down to it- which group do you lean towards?

Tough Battler
Tough Battlers are big picture people, they want things done fast and they don't care how, they will fight your corner, are fiercely on your side and want answers. Typically a tough battler is assertive, driven and motivated. They see the world through battle eyes and try to influence people by ordering, challenging or repeating. Sometimes Tough Battlers can be quite abrasive.

Logical Thinker
Logical Thinkers are concerned with the process, they want to do things right, they are organised, calm and collected. Logical thinkers love facts, debate and argument. They are typically team players, get things done in a logical orderly fashion and are concerned with the detail. They see the world through rational eyes and seek to influence others by appealing to facts, logic and presenting arguments. They can also be quite critical.

Friendly Helper
Friendly Helpers are naturally nurturing. They want to know how you're doing, what you are feeling and how they can make life better. They are typically open, cooperative and friendly. Friendly helpers appeal to emotions, want to ameliorate and avoid any type of conflict. They seek to influence through making friends, doing favours or eliciting pity. They can be passive or easily upset.

Obviously these are typecasts but you can sort of see the thinking behind it. Most likely we are on a scale somewhere between two of them. But you can see how communication between a tough battler and a friendly helper may go awry, or a logical thinker and tough battler. How about a friendly helper and a logical thinker? We are human and can learn the traits of each but when the pressure is on, in our most nude state, when our barriers are down we will revert to what we truly are. I am a friendly helper with a surprising amount of logical thinker traits.  But when my guard is down I revert along the friendly helper route. My husband is a pure logical thinker and one of the problems we have is me thinking he is overly critical, he goes into tedious detail about the most minor of things and asks a lot of process questions. Whereas I avoid conflict like the plague and become defensive when I feel threatened. They all have positive and negative traits. And you may not fit neatly into one category, for example, I wouldn't describe myself as a particularly open person.

When it comes to work I am definitely going to bear these principles in mind. If I can identify that I am working with a Logical Thinker then I can devote time to explaining the process, exactly how a person will be referred etc. If I am dealing with an irate Tough Battler then I can change my manner to assure them that I do have the qualifications to do my job and gain more of their respect. I will get it wrong, there are just some people that don't 'click' but part of being a social worker is learning how to deal with people and our very messy lives. Maybe now I can understand my husband a bit more!

What does it mean to be resilient?

Put the word 'resilience' into a search engine and you end up with definitions that include bouncing back, springing back into shape and able to resist hard/tough/difficult times. But what does it actually mean to be a resilient person? Why does it matter to social work?

There are two sides to this; practitioner resilience and working with people to build their resilience. As practitioners we need to be aware of our own breaking points and stress triggers. We will quickly become cynical, burnt out or indifferent if we are unable to recognise and deal with stressful situations. We are to be empathetic with people's situations but it's not going to help the person if we end up weeping messes in front of them. Anyway, I'll leave empathy for another post. We all have a breaking point and unlike a piece of inanimate steel with unchanging properties this breaking point is not fixed. Different factors will affect how able we are to deal with situations; enough sleep, a recent bereavement, fall-out with a friend etc. These will affect how we interact with people.

The longer I've been working as a social worker the more I find that my resilience is a dynamic and changing part of who I am. I used to think that resilience was me being unchanged by situations, bouncing back, but have now come to realise that resilience is much deeper. Being unchanged by situations leads to a cold and unfeeling method of practice; simply bouncing back is not going to alter the small injustices that we see every day. You have to feel injustice to be able to combat it. Equally if I let every situation affect me to the point of snapping then I would be a completely useless practitioner. Resilience is a strength rather than a skill and I believe we must exercise that strength for it to become stronger.

For those clients who have reached snapping point it is important for me to recognise that they can build resilience, which doesn't mean that they become unaffected by their situation, but that they utilise the strength within to cope with and eventually change their circumstances. As a mental health social worker it is easy to 'give up' on a service user, they've gone through the same cycle again and again and things seem to be worse rather than better. I think people pick up on this mentality and they start giving up on themselves. If I work with them in a slow process to identify evidence of resilience and point it out to them then I think the relationship would be much more positive. Most people who are involved with mental health services are or have been though a crisis where they just have not been able to cope and it is at these time that we need other people's resilience to bring us through.       

Reflexive Practice

Part of developing as a social work practitioner involves reflecting on practice experience and learning from whatever outcomes occur. Let’s assume there are no serious question marks over competency or fitness for practice and we are left with questions such as “how could I have acted differently to encourage that person in their situation to take control over their own life” and “could I have been more assertive to ensure that their needs are met in the way that is least restrictive” or even “how could I have introduced myself better”? I am constantly learning from my little mistakes so that next time I can be more effective as a practitioner.

And this involves reflection and intentional change on my part to foster a sort of self-critique rather than cruising through my professional life. By critique I mean noticing the positive alongside the negative, not simply noting what did/did not go well but thinking upon it and allowing it to inform the way I practice social work.  There are times when I am a cruiser; I admit it. Sometimes time is so stretched that I just don’t have the energy to reflect. But I try to. And when I do, the process will often bring to light an alternative course of action or simply an affirmation that I do a job that I (mostly) enjoy and that makes a difference to people’s lives. It also causes me to think about issues that I might skim over in the day-to-day fighting fires ‘I-just-don’t-have-time’ rush. For example, when I meet with the service user who can’t speak English I am usually thinking something like “it’s so inconvenient to work through an interpreter, how on earth do they expect me to be able to assess mental health if I can’t directly ask, this is taking twice as long”? When I reflect upon the same situation, I am more aware of the power difference between us and I realise that mental health problems in other cultures are often talked about (or not as the case may be) in different ways. I also realise that the fact that I forgot to take my shoes off was probably very rude and make a mental note to redouble efforts to remember next time (the service user did mention this before)!

So, I have decided to begin a blog to help me with my reflections and to post interesting social work related things and occasionally to have a good old moan. If you are interested, please comment and share your own experiences but make sure that no one can be identified. That would raise serious question marks! Thank for stopping by,

SW

Mental Health Social Worker