Social work practice has shown that understanding different psychological, sociological and biological theories can help in working effectively with families going through difficulties (Adams, Dominelli and Payne, 2009). This assignment will discuss relevant theories that would enable a social worker to better understand and assess this family’s circumstances and behaviour.
A brief history of Sam states that he was previously adopted by the family when he was 4 years old. One of the theories to consider within this case study is the Attachment theory. It has become more relevant in social work, especially when applying to adoption and fostering. Walker (2008) has highlighted the relevance of attachment theory to child protection in social work. Social work now understands the importance to assess the capacity of carers that would substitute the previous that would provide a secure base. Bowlby (1988) states that children would then develop and grow if they have this secure base. A possible problem would be that Sam has already entered the care system. He may have already experienced significant loss or trauma. This would affect his relationships with others. Children who have experienced significant loss or trauma will need help from their substitute carers to manage their feelings, which could be too strong for the child to manage alone. Therefore their carers need to have resolved any issues similar to the child’s in order to be affectionate and cognitively aware when the child remembers their experiences. (Walker, 2008)
Attachment was originally used to describe affectional bonds between children and their main care givers. The term has now been expanded to include other periods of development like adulthood. (Adams et al, 2009) The primary function of the attachment relationship is to ensure closeness to the caregiver for food and safety. (Brodzinsky and Schechter, 1990)
A large amount of research has found that attachment at infancy has a huge effect on the child’s psychological functioning. Researchers Hazen and Durrett (1982) found that toddlers more securely attached as infants are more willing to explore their environment, than those who were more anxiously attached to their caregivers. Other researchers have found that there is a continued link between behaviour from childhood when involving terms of attachment. (Brodzinsky et al, 1990)
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As Sam was adopted at a later developmental stage this would have an effect on his attachment. The foster home or placements before adoption is critical in that he needs support from the carers both psychologically and emotionally if he has experienced trauma or neglect. Children can have numerous attachments but according to Brodzinsky et al (1990) if they have suffered abuse or neglect in early infancy then this may affect their level of basic trust.
Bowlby described the attachment system simply. If the child perceived its attachment figure as accessible it will have confident behaviour. However if the child doesn’t believe this they will exhibit anxiety. This behaviour may have been produced by Sam up until he ‘gave up’. Sam may not believe his attached figure is still accessible as she’s caring for a newborn. Bowlby believed that after this time he may experience depression and despair.
Work by Tizzard (1977) found that children adopted from age’s two to four showed that on average demonstrated no more problems that those children living with their family. They were however more likely to be over friendly and have attention seeking behaviour. (Berryman, Smythe, Taylor, Lamont and Joiner, 2002)
Some researchers have found that there is an over dependence on using the attachment theory in adoption cases. Barth, Crea, John, Thoburn and Quinton (2005) found that the scientific base of attachment theory is limited when underpinning theory for future interventions. Barth (2005) did state that social workers needed to understand what works when using the attachment theory in adoption cases but to use what works and develop an intervention that has a more appropriate evidence based approach.
Applying Attachment theory to practice involves looking at the child’s present relationships, relationship history and the context of their life and concluding which particular stresses may affect their behaviour the most. In this case looking into Sam’s school life and financial problems the family may be having. Social workers work with families to provide support and psychotherapy. In this case they should help provide support in getting the family help regarding emotional support and financial. According to Payne (2005) understanding how attachment experiences can relate to difficulties they are currently facing is one of the therapeutic tasks Bowlby highlighted. A criticism highlighted by some psychologists is that the theory uses ideas from different theories. Bowlby didn’t set exact ideas of how to practice this theory, although Payne (2005) does recognise that the theory does have a good basis for explaining childhood problems.
When practicing this theory social workers must understand the importance of linking it to other theories as they support further work for example the cognitive behavioural supports the idea of using therapy as a learning tool much like what the Attachment theory describes.
Sam has shown a change in behaviour since his baby brother was born. He’s been rude to teachers, argues at home, he’s not eating properly and is withdrawn from his family. This change in behaviour may be because of a number of reasons however it is important to highlight that even though he displaying avoidant behaviour now he can still be securely attached. Avoidant behaviour means he is more likely to be withdrawn although still securely attached. However some of his behaviour shows signs of stronger avoidance. Sam is fighting at school, one example of avoidant of behaviour is bullying and focusing on those weaker than him, he has showed signs of this towards his baby brother which is a cause of concern. (Walker, 2008)
Social workers should be aware of this change in behaviour. Children who have experienced neglect or trauma will present challenging behaviour to their care givers, these carers then need to be more understanding as this behaviour may be due to past experiences and high levels of anxiety. (Berryman et al 2002)(Walker, 2008)
When working with Sam at assessment level its essential that the social workers use anti discriminatory practice they need to be non judgemental. It may be that they have seen cases like this several times, but to understand that each case is different and assessing Sam with no assumptions and treating him as an individual is an important attitude that the social workers would need to have.
The history given has shown that the parenting styles may have changed recently, as Sam has been more disruptive his parents have been firmer, sending him to his room. This authoritarian parenting style produces children that are anxious, aggressive and have low self esteem, all behaviour styles that Sam has presented. (Baumrind, 1966) This may not be the best way to deal with his behaviour, especially as he has become more withdrawn from the family and not eating. This may highlight an underlying problem for example an eating disorder or ADHD.
Research by Harris (1998) a major critic of the attachment theory found that Nature is an assumption. Society assumes that parents who are kind and honest will have kind and honest children. Harris believes that peers may have more of an effect on the child’s personality. Using the example of identical twins, she highlights that when living in different homes they will more likely have the same habits. She also highlights that children who live in high crime areas will be more susceptible to committing crime themselves. Personality also comes from genes, as shown in separated twin studies. In this case it’s important to investigate Sam’s friends at school and also his maternal mother to find out what could be influencing Sam’s behaviour.
Once more social workers when working with Sam would need to understand that although society can make assumptions social workers cannot. When working with Sam it’s also worth noting that the social workers must have controlled emotional involvement. Sam may explain situations which could be very emotional the social workers would need to have the capacity to be sensitive when working with him.
An additional theory that social workers should consider when assessing Sam is the Social Readjustment rating scale. Invented by Homes and Rahe (1967) the higher the number you have when counting the number of life events you have faced the more likely it is that you will have an illness. The scale denotes that if you have a score higher than 150 then you have faced mild life stress. Using the scale Sam’s social rating scale was 153. This scale is useful when considering the life events that Sam has faced in a relatively small space of time. However Lazarus and Folkman (1984) found that this approach is narrow and has the ability to ignore difference between individuals when considering their vulnerability to these life events. Lazarus et al also found that the Social readjustment rating scale ignores chronic stressors which may distress individuals greatly over a length of time.
An approach to understanding stress was produced by Lazarus, DeLongis, Folman and Gruen (1985) they consider stimulus and response, coping style and defence mechanisms. Called the Model of Adoption adjustment it focuses on two types of coping, problem focused and emotion focused. The emotion focused strategies can involve attempts to reduce the individuals stress with behaviour such as avoidance, distancing or selective attention. These changes in behaviour help in reappraising the life event and redefining it as less intimidating than the individual previously thought. This type of cognitive appraisal process and coping strategy Lazarus et al argues can be influenced by environment. Using this approach can help investigate other factors. This cognitive appraisal process provides the bases of highlighting differences between individuals and what their psychological stress reactions are in response. (Lazarus et al, 1985)
As Sam has faced so many life events it’s important for social workers to understand how much they can affect his psychological well being and behaviour and to understand the importance of recovery in these very traumatic situations. This approach can help expand the social workers understanding of how much these events could be part of the cause of his change in behaviour. Criticising different aspects of these similar theories can establish how useful it would be to individuals and how differently each individual responds to certain stressors.
Applying the Model of Adoption adjustment theory to practice would involve investigating Sam’s relationships and past history of emotional events to gain a better insight into how well he has used emotion focused or problem focused strategies and what his psychological reactions have been in response to the events he has faced.
Bronfenbrenners Ecological theory is another theory the social workers should consider when assessing this case study. This theory takes into account the relationship between the family, immediate environment and also the larger environment. It understands a structure of five layers. These layers involve different systems which would all affect Sam differently. The microsystem contains direct relationships and interactions of the child, the structures in the microsystem can be the family and school. Bronfenbrenner believed that the relationships between this system impact away and toward the child. For example the child affects the behaviour of the parent and the parent affects their behaviour onto the child. The mesosystem includes the child’s connections between the microsystem’s structures, e.g. Between Sam’s parents and their community neighbourhood. The exosystem identifies the child’s larger social system, although Sam will not directly function with it. For example Sam may not be directly involved with his father’s work hours but may be affected by its interaction within his system. The fourth layer, the macrosystem involves the wider society. (Payne, 2005) (Adams et al, 2009)
The ecological theory focuses on the unique influences of the service user and the relevance of the immediate environment as well as larger society. It focuses on the service user as the centre of the process.
Assessments use an ecological framework as a basis although in practice Francis et al (2006) argue that comprehensive assessment tools may affect crisis intervention assessments because this assessment is very time consuming. This theory provides a basis on which social workers can work from to consider the impact that these layers would have on Sam’s relationship and behaviour.
In this case it would be sensible to consider this theory. Sam has faced multiple life events each could affect his behaviour. This approach recognises that multiple factors could be affecting Sam’s behaviour. It provides a holistic framework to understand these factors, then analyses them and finds solutions. A major criticism involving social work using this approach is that as the assessment is so lengthy and needs a lot of organisation to produce a solution. Many social workers have shown a poor record of good quality assessments. (Petch, 2002) Some social workers seem to focus on the immediate future of the child rather than long term solutions. The GSCC (2004) have produced aims because of this to highlight that it is important that practitioners understand that it’s a central part of their core principles. It’s important to note the use of Anti discriminatory practice within the use of assessments using an ecological approach. Understanding that individuals all have different cultures, behaviours and history is essential especially when Sam is vulnerable both as a child and as a previous service user who may have experienced past neglect or trauma.
A brief history of Jan explained that she has previously used IVF treatment a number of times with no successful pregnancy. After realising the emotional and financial difficulties that may follow if they decided to carry on trying they applied for adoption. They were matched to Sam, who was four at the time and despite initial reservations he seemed like the ‘model child’. Jan then gave up work to care for him. At 24 weeks she found out she was pregnant which she was told by doctors would be virtually impossible. Jan has found motherhood a struggle and has stated she feels useless. Her Parenting style towards Sam has changed as she has been stricter because of his behaviour change. She is also worried about the health of her baby.
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Attachment is also an important theory to consider for this individual. Research on Attachment in adults focuses on the assumption that the same bonds between parents and children are responsible for the bonds between adults in personal relationships. (Bowlby, 1988) If this were the case then the relationship between these individuals should reflect how they attached when they were younger; younger children may have secure attachments. Therefore when they grew up have equally secure romantic attachments. However if they had less stable attachments when they were younger they may have less secure relationships when they reach adulthood. Similarly children who have secure attachments but have had inconsistent secure attachments as they grow up may well have a change in their attachment pattern.
Jan and her husband Tony seem to have some relationship problems. Tony isn’t able to provide the level of emotional support that she needs because of the increased hours he has to work. Jan may be slightly insecure about her relationship with Tony it’s important to explore this relationship at both an individual level and together to work out solutions together. To provide support and work out what each individual needs both emotionally and psychologically, especially as Jan seems to be becoming more upset about her situation and because she doesn’t seem to have anyone to turn to for help.
Jan’s relationship with her mother seems problematic. Firstly she seems over dependent on her mother, who she expected to help with the baby. The relationship she has with her mother may have consequences on how she attaches to future individuals affecting both her attachment with her husband, the attachment she has with her baby and with Sam.
As Jan didn’t realise she was pregnant until she was 24 weeks pregnant she didn’t have as much time to become emotionally and psychologically ready to prepare to have her baby. A paper by Bernstein, Lewis and Seibel (1994) found that women who were previously infertile have difficulty transitioning to parenthood some women may show high levels of anxiety, avoidance behaviour and problems with preparing for a newborn. They found that guidelines need to be developed to meet the needs of these women who have become pregnant after infertility. Not only could the attachment between her partner and mother be problematic but as these papers suggest the attachment between her and the newborn may be the most affected because of her infertility the effects it has on her emotionally, psychologically and biologically. Creating further levels of anxiety and producing negative behaviour.
Social workers assessing and working with Jan who have been involved in IVF or have experienced it themselves may be too embroiled in the situation as the social workers may unintentionally direct Jan into making decisions. It would be more responsive as a social worker to understand this and move away from this case.
The Spoilt identity theory is an important sociological theory to consider when understanding Jan’s behaviour. Goffman’s (1990) spoilt identity theory or social stigma explores behaviour and how certain behaviours or attributes can be socially shameful. The Collins dictionary describes stigma as distinguishing mark or social disgrace. Goffman (1990) refers to stigma as an attribute that is discrediting.
This theory is significant to this case as Jan has had to deal with a number of life events especially one that is socially discrediting. Stigma theory predicts that childless women deviate from ordinary and normal life courses and are deeply discredited by society. Jan had expectations before she got married that she would have children by birth and became increasingly obsessed with having a child because of the amount of IVF treatment she used. A recent paper by Whiteford and Gonzalez (1995) posed the question “Why do some women become consumed to give birth to a child, even to the detriment of their own health, marriage and financial status?” They found that society was the main cause that pressures women into having children. That the women used within their research suffered because they had internalised the norms within society and because of this described their selves as defective. As well as society it is also the mediatisation of intervention that has also affected women infertile. Media is constantly highlighting how many infertile women are now with child because of medical interventions what this does psychologically to the women still not able to become pregnant is even harder to comprehend.
When infertility does affect you the individual is then not living one’s life via the social “norms”. It affects women differently compared to other stigmas as infertility stigma is not a physical one like a limp. Looking at a woman who is infertile would not tell you that she is, it’s their own knowledge that has such a profound effect on their psychological wellbeing.
It can create stress and crisis to both the individual and family, affecting them financially, emotionally and physically. Jan and her husband have both been affected through this trauma and it may benefit both of them if they have counselling together, even though they have now become pregnant and had a child it is still affecting their relationship. The husband has to work long hours to be able to afford living costs because of the cost of treatment for the IVF.
Post natal depression may also be affecting Jan. Since she has had her baby she has become emotional and found motherhood a struggle feeling useless and low. Biologically speaking post natal depression is a form of depression. Depression usually develops within three or four weeks after childbirth it has the same symptoms is depressive disorder these include increased sleeping, lethargy and affected appetite. New mothers would also be anxious about the baby and have thoughts about her failure as a mother which Jan has showed signs of. Jan has faced a number of life events which may increase the risk of post natal depression.
Fortunately there are a lot of different types of diagnosis for post natal depression. The Edinburgh post natal depression scale and the Hamilton rating scale for depression which uses a point system to assess their level of depression.
There is a wide range of treatments for post natal depression the type the patient needs would be dependent upon the severity of their depression. Firstly support and advice is offered to give the family an understanding of how they can recover. Independent advice is given regarding any social problems that may be affecting their relationships. Antidepressants may be prescribed, these would then allow the body to function more normally. Although there are several types of side effects which may cause further problems.
Counselling and psychological treatments may be the best form of treatment as they look at the individual wholly and what within their lives could be affecting their depression. Cognitive behavioural therapy helps indentify thought patterns which could make the patient more depressed. It achieves changes in the way people think. Interpersonal therapy may also be useful to consider in this case as this therapy identifies problems within relationships and relates it to the individual’s depression. There will always be positives and negatives of using these different treatments post natal women may find it hard to commit to psychological therapy because of the time commitments and may find it easier to just use prescribed medication. The main criticism with this treatment is that it doesn’t look at the patient’s problems holistically if there are problems within the relationships facing them now and finding solutions rather than putting them off would be more beneficial in the long run. According to research by Dennis (2005) the most promising intervention is intensive professional post natal support.
Whilst working with Jan and her family it’s essential that the social workers give purposeful expression of feeling, giving them the chance to say what they want from the social workers and what they really need and feel about everything that’s affecting their relationships and what they want their goals to be.
Considering each type of theory for this case study then establishing how they all correlate to one another is the best way to understand how to find solutions for these individuals. Understanding biological, sociological and psychological theories and human growth and development plays an essential part in assessing and intervening in a positive way. The International Federation of Social Workers guideline states that “The social work profession draws upon theories of human development and behaviour and social systems to analyse complex situations and to facilitate individual, organisational, social and cultural changes.” (2000) Considering each type of theory gives a broader understanding of individual’s experiences and how social workers can find solutions when they are needed. Social workers need a broad knowledge base of professional experiences, evidence based research and service users experiences to gain the best understanding of that situation.
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