Shared Resources

Key Contexts
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Chapter 51 - Chapter 55 >>

Chapter 41

The body of knowledge about communication derives largely from the social sciences and in particular from research and practice in psychology. Individual human development and interpersonal interaction are two key contexts for making progress with communication skills. Research has focused on some parts of the life course in particular, such as interaction between parents and infants and young children and interpersonal interaction in groups, including family groups. Much learning from research and experience in commercial organisation has been acquired regarding the effectiveness (or not) of methods of staff assessment, such as interviews. This literature has provided a key context from which learning has been derived in local authority management and management and practice in health and social services.

Chapter 42

The theoretical context for cognitive behavioural therapy is cognitive and behavioural psychology. The tradition stretches back about a century. The behavioural scientists came first and produced some rather frighteningly punitive indications about how reinforcement of desired behaviour accompanied by punishment of undesirable behaviour would lead to the extinction (elimination) of the undesirable behaviour. The combination of cognitive theories with behavioural theories leavened (softened) the mixture and led to the psychological researchers creating a richer blend of cognition (consciousness of one’s feelings and thoughts) and behaviour. Thus, the cognitive behavioural therapeutic tradition can have the best of both worlds, claiming both to influence behaviour and empower the ‘client’ by involving him or her in selecting goals and engaging in therapeutic programmes to achieve them.

Chapter 43

Therapeutic approaches in the medical area tend towards complementary health and professions allied to medicine, whilst in social work their typical representatives are brief therapy, which has a link with cognitive behavioural therapy, and family therapy, which combines elements of existential (a ‘the present is everything’ philosophical perspective) philosophy and group therapy in the psychodynamic tradition. Around these there are vast numbers of different therapies. Some owe more to Western psychology and psychoanalysis, whilst others are rooted in Eastern philosophies and religious traditions. Some ideas are more controversial than others. In Appendix 3, we give brief details of some of the complementary health approaches more commonly known and used in Western countries. This Appendix gives some idea of the wealth of diverse knowledges, theories, values and approaches.

We should be aware that most of these theories are quite comfortable with the focus on the individual of the biologically based ‘clinical’ medical model. The relevance of this comment will be apparent when we come to the next chapter.

Chapter 44

Systems theory is a sociological theory, probably born in the work of nineteenth century biologists and scientists such as Charles Darwin and Herbert Spencer, whereas psychodynamic therapies referred to in the previous chapter are psychological in origin. Systems theory has tended to challenge the limitations of psychodynamic theories, as though it was a demonstration of their lack of success at dealing with the social factors affecting human activity and problems. Systems theorists are able to show off their ability to encompass the wider environment and social setting of the individual with whose problems the health and social care practitioner is working. The context of the wider system of the family, located in the wider social system of the neighbourhood, located in the wider social system of the town, is one which leads to the approach being regarded as comprehensive and integrated.

Chapter 45

Counselling has its origins in psychological understandings of individual human development and behaviour and group interaction. Some counselling approaches owe much to research and expertise in social skills training and practice. Others use experiential (based on the assumption that what you experience in the here and now is of paramount importance, in learning expertise and practising) methods. Others again are based on cognitive behavioural theories.

All of these approaches and methods tend to be psychological and social psychological. There is little in counselling which takes us into the context of social and sociological ideas. The counselling interview tends to be a one-to-one encounter. Other people may enter the room, but only in the sense that they are introduced into the talk between counsellor and ‘client’.

Chapter 46

Emergency work relates to that part of acute medicine which belongs in accident and emergency departments of the hospital. Its context is the textbooks on resuscitation and other life-restorative treatments, such as tourniquets, bandages and dressings.

Despite any assumed similarity, the contextual knowledge base of crisis work bears no actual resemblance to emergency work. Crisis work relates to those branches of psychology which feed directly into psychiatry. Its origins lie, if anything therefore, in mental health. The theories informing it are psychodynamic. However, there is also a sense in which the ideas informing crisis work as well are on the social rather than the medical and clinical side of psychiatry, being about preventive psychiatry and trying to establish networks as a means of enabling a person with mental health problems to lift themselves out of their condition.

We need to exercise just as much caution when putting task-centred or task-based work alongside crisis work, because there are some significant differences between them. In some ways, the theoretical context of task-centred work is much closer to cognitive behavioural therapy than crisis work ever could be.

Part VII

This part of the book deals with the wider context of multi-disciplinary and multi-professional work, in which health and social care practice is rooted. We tackle this in four ways.

1. Chapter 47 relates to the wider literature on teams and team working.

2. Chapters 48 and 49 deal in turn with some of the complexities of practice, using detailed practice studies.

3. Chapter 50 takes one profession allied to healthcare - occupational therapy - to illustrate multi-disciplinary and multi-professional practice.

4. Chapter 51 explores the area of decision-making in a way which can relate to any area discussed above.

Chapter 47

We find in the literature on teams and team working a great richness of theories and approaches, largely but not exclusively drawn from psychology and social psychology in particular. There is a concentration on the social psychology of the work group, the task group and the team and the purpose is to find out what makes for effective teamwork. A good deal of attention has been devoted to research into the chemistry of good teamwork. Some mystique has built up around the preferred style of team leadership which contributes best to the team’s effectiveness.

Chapter 48

This chapter has its roots in the legal and policy contexts of health and social care work with adults. However, this is only the beginning. As the chapter traces the process of the work through any typical case, it touches on every other contextual area: the philosophical dimension of discussions about ethical aspects; the sociological aspects of divisions and inequalities affecting and affected by the race, gender, age of the patient, service user or carer; the psychological basis of examination of the stage of the life course the person has reached; this also affects decisions about implementing treatments and care plans; it affects also the organisational aspects, informed by psychological and sociological knowledge of organisations, of how members of the staff multidisciplinary team go about their work.

Chapter 49

This chapter relates to very similar contexts to the previous one. There is an additional dimension, brought to the foreground by the fact that the government has produced (DoH, 2000) a Framework for the Assessment of Children in Need and their Families, which goes further than the single assessment framework for adults in emphasising the triangle of assessment tasks: the development of the child, the parenting capacity of the adults and the family and environmental factors which have a bearing on the situation. This means that in the assessment process the sociological and anthropological contexts are more explicitly required, especially where ethnic, cultural and faith diversity is an aspect of the child’s situation.

Chapter 50

Occupational therapy forms the setting for this chapter, but its main contexts are theories and research about occupational therapy practice and frameworks for work in multi-disciplinary teams.

The former of these is rooted in biological, physiological, psychological and sociological disciplines and the latter relates to organisational psychology and sociology. This gives occupational therapists a broad, holistic perspective on people’s needs and how they may be met.