Session five24/03/11

James Barber (1991) in his acclaimed book Beyond Casework, states;"Work with involuntary clients must begin with the recognition that the interaction between worker and client is based on conflict rather than cooperation, that social work with involuntary clients is a political, not a therapeutic process involving the socially sanctioned use of power." (p 45) 

Credit Bail Corrections Orders- community based

Community based Community based community work only Intensive Corrections Order Parole

Youth Justice Orders- community based Supervised Bail Supervised Deferral of Sentence Probation Youth Supervision Order Youth Attendance Order Youth Parole Order

• An involuntary treatment order is the basis for providing in-patient and out-patient treatment to involuntary patients under the Act. The criteria for making an involuntary treatment order are that:

– (a) the person appears to be mentally ill; and– (b) the person's mental illness requires immediate treatment and

that treatment can be– obtained by the person being subject to an involuntary treatment

order; and– (c) because of the person's mental illness, involuntary treatment of

the person is necessary for his or her health or safety (whether to prevent a deterioration in the person's physical or mental condition or otherwise) or for the protection of members of the public; and

– (d) the person has refused or is unable to consent to the necessary treatment for the mental illness; and

– (e) the person cannot receive adequate treatment for the mental illness in a manner less restrictive of his or her freedom of decision and action.

Family Court orders Child Protection orders

Has the client come of their own free will?

Is there a reward or punishment for attending or not attending for treatment? E.g. Has their partner threatened to leave if they don’t attend

Does the person want to address their problematic behaviours?

Even though a client is involuntary it does not mean that they cannot be engaged

Resistance and be transformed to participation and engagement

According to De Jong and Berg (2001), most clinicians view involuntary clients negatively. Likewise, R.G. Rappaport (1982) found that some involuntary clients, especially those in correctional settings, have negative views of rehabilitation programs. These negative views may adversely impact the therapeutic relationship and subsequently, treatment outcomes.

• Set the stage of negotiation by stating the statutory framework (including any court order) under which casework is being conducted (eg. protection of children, drug-relate offences, domestic violence, self-harm)

• Encourage the client to express their feelings and thoughts about the situation - the worker should use their reflective listening skills at this stage

• Worker express her/his thoughts and feelings about the constraints of the intervention while being respectful of the client

Worker inquires about the reasons for client resistance - ie what exactly does the client stand to loose by engaging in the change process or adhering to court orders? Notes are taken for use later.

Worker explains that they will subsequently negotiate a treatment plan which will aim to minimise these negative consequences.

• Reframe directives working towards meeting the conditions of attendance whilst working for the client’s best interest

• Client and worker both invited to question aspects of the bottom line and the worker should be prepared to negotiate where appropriate. For example, the worker needs to specify what is counted as an attendance (not a 5 minute drop in)

• Where there are risk issues, clear information should be provided regarding what will occur if there are concerns e.g. Mental health client not attending for treatment

• By the end of this step, both client and worker have agreed on bottom-line limits of intervention and the client has experienced a process of empowerment in their involvement of interpretation of the statutory issue or court order.

• Having agreed on the bottom-line, brainstorm a broad range of possible interventions and treatment goals which might meet the bottom line.

• While step three requires worker and client to be precise and pay attention to detail, step four calls for creativity and imagination. It may even be fun.

• E.g. Outreach appointments may be possible

• Negotiate a case plan taking into account the legitimate client interest, the bottom-line and the brainstorm of negotiable aspects of intervention. Keeping written notes from the former steps will be helpful here.

• Worker may express her/his legitimate interests (eg. amount of time for the case, availability of transport, etc.) to enable the fairest plan for both client and worker.

• Where there is ambivalence around choosing a particular course, the worker may use a modified motivational interviewing to help with decision making. In this modified version, both worker and client progress through the decisional balance of costs and benefits.

• The main points of an initial plan are drawn up while you are both there.

• Set a short-term goal with the client.

• Determine with client, answers to the following: How  will the treatment plan be monitored?

• How will worker and client know that the treatment plan is working

• What will happen if the client fails to comply with one or more of the terms?

• Document agreed criteria for monitoring and contingencies

When your client believes they do not need treatment?

Fails to attend as required or has sporadic attendance?

Is on medication which causes significant side effects causing issues with attendance?

When the service is not responsive to your client’s needs?

Samantha is a 17 year old young woman who attends your service as a result of a special condition of a Youth Supervision Order. During the intake appointment she is extremely abrupt and hostile. She has an extensive history with Child Protection and makes a point of telling you that she has had “hundreds of workers that have done nothing” for her in the past. You are required to provide feedback to Samantha’s Youth Justice worker in relation to her attendance and she can be breached if she fails to adhere to the special condition to attend your service.

What are some factors which may be influencing Sam’s resistance?

What strategies could you employ in an attempt to engage Sam in your service?

An introduction to..............

An approach that builds on the idea that people live their lives according to stories they construct about who they are, and what their lives are, (and can be) like. These stories can act like a lens, filtering out new and different stories which don't fit the main story.

Uses the stories people bring about themselves and their lives, to re-shape new lenses, new stories, new experiences and new futures

Narrative therapy seeks to be a respectful, non-blaming approach to counselling and community work, which centres people as the experts in their own lives.

It views problems as separate from people and assumes people have many skills, competencies, beliefs, values, commitments and abilities that will assist them to change their relationship with problems in their lives.

Curiosity and a willingness to ask questions to which we genuinely don’t know the answers are important principles of this work.

There are many possible directions that any conversation can take (there is no single correct direction).

The person consulting the therapist plays a significant part in determining the directions that are taken.

How does the presenting problem impact on the person’s life?

Counsellors assist clients to explore this and develop their stories in order for them to feel that the counsellor understands them

Example of a question – “When it is having it’s way with you, how do you see your future?”

Clients are encouraged to become the author or at least co-author of their story

Counsellors encourage them to identify how the characters may be feeling or what they would be feeling

The questioning used by the counsellor is integral to assisting the client to delve deeper into the story and uncover how their behaviours are linked with the themes in the story

These questions invite people to notice actions and intentions that contradict the dominant story

The theme of a story might relate to feeling too overwhelmed by responsibilities in one’s life

Given over-responsibility's encouragement of busyness, have there been any times when you have been able to rebel against it and satisfy some other of your desires? Did this bring you delight or pleasure?

• (If there have not been such times) Have there been times that you have thought -- even for a moment -- that you might take some time out?

• Did you give your responsibilies the slip to come here and indulge yourself in the luxury of this conversation?

• Can you imagine a time in the future that you might defy some responsibility and give yourself a break?

Unique account questions invite people to make sense of exceptions that may have not even registered as significant, and to hold them as part of an emerging coherent narrative.

Given having responsibility brings pleasure, how do you say no when it takes over?

When you have stood up to responsibility when it becomes too much, how did you do it and how did it react?

Was it easier than you thought?

Attempt to get the client to attach meaning to situations and events which have occurred and work towards re-describing themselves or others in the story

What does this tell you about yourself that you already didn’t know?

In taking some time out, who noticed and were they encouraging?

Used to get the client to start speculating about future possibilities, both situational and relational

When do you think you will feel more comfortable in saying no to taking on too many responsibilities in the future? How might this help your relationship with your children and partner?

Dominant views of addiction and mental health in our society are informed by the disease model that locates addiction within the individual, as a physiological, pharmacological or psychological deficit in the individual.

Addiction and mental health have underlying themes relating to the role of self and identity

Using a narrative approach aims to reduce stigma and assist the client to reconstruct their own identity separate from the substance or mental health issue