Application of Human Development and Intervention Theories

Assignment two: critical application of theory. You will write a 3,500-word assignment in which you will apply the unit learning to your child observations and to your stage 1 practice placement. First, you will apply developmental theories to your observations and second, you will apply theories of intervention to a chosen case or scenario from your placement. In each case you will demonstrate your critical understanding of the theories you choose to write about and evaluate their relevance for evidence-informed and value-based practice. You will conclude by articulating your critical appreciation of the use of theory to inform professional social work practice based on your experience of doing this in two different contexts. The notes of your child observations, and a synopsis of your chosen case from your placement, will be included as appendices.

What is social work theory? Payne (2005) suggests that theories are organised statements about the world, whilst the dictionary of social work describes theory as XYZ. Social work theories can be broken down into two categories: theories that inform, and theories of intervention (Mathews, Simpson and Crawford, 2014). Theories and models are necessary in social work as they provide explanatory frameworks that guide effective interventions (Parker, 2010). In recent years there has been a call for social workers to possess a greater understanding of the practical application of theory to increase evidence-based practice (Humphreys 2011).

I will be applying theories of human development (theories that inform) to child observation, and applying theories of intervention (theories that guide practice) to a case study from placement.

Part One – Human Development Theory

Human behaviour is explained by observing the relationship between behaviour and the environment (Armstrong, 2014). Therefore, skilled observation is key to assessing human behaviour and development.  I was recently required to undertake a series of child observations and relate these to theories of human development. In part one of this assignment, I will contrast the ideas of two theorists: the cognitive development theory of constructivist Jean Piaget and behaviourist Albert Bandura’s social learning theory in relation to children’s learning through observational learning and modelling. In part two, I will discuss the application of theories of intervention to a case study from my placement. I will conclude by reflecting on my learning regarding the application of theory to social work and the implications for my practice.

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The context for my observation was a primary school in an affluent village in North Bedfordshire. The school has been rated as ‘Good’ by Ofsted since 2005. There are approximately fifty students in the school, with little diversity in race or socio-economic status. The school employs a monitor system, whereby the year six children acts as monitors and play a key role in nurturing the younger children. The year groups are merged on alternating years, so each year group is the youngest one year and the oldest the following year. This means that the students, according to which year they are in, are either the helpers or the helped in that year group. Despite year group, however, there is onus on each child to help all the younger children in the school.

My remit was to observe a child for five sessions of thirty minutes each. I based my observations upon the Tavistock model, recording my observations after the sessions. Central to the Tavistock approach is the psychoanalytical theory which acknowledges the need to understand the emotional impact on the observer (Bick 1964), therefore a short reflection is included with each observation, based on Rolfe et al’s 2001 model. To maintain the confidentiality of the child in accordance with the Health and Care Professions Council (HCPC, 2012) the observed child has been given the pseudonym ‘E’. ‘E’ is a four-year-old Afro-Caribbean boy – one of only two non-Caucasian children in the school – and has no recognised special educational needs.

I approached the theory selection as I would in direct practice; by considering the relevance of several theories and then deciding on which seemed the best fit for ‘E’. In his case, I decided on the theory of cognitive development due to the specific behaviours I witnessed. Cognitive Development Theory is the work of constructivist Jean Piaget (1896-1980). Constructivism is defined as a theory of learning in which individuals actively construct their own knowledge (Tracey and Morrow, 2006, p47). This frequently happens through play, which facilitates and transforms a child’s thought processes and helps them assimilate new information into existing mental structures, or schemas. Piaget believed that we are born with a rudimentary mental structure upon which all future learning and knowledge is based, and we move on to develop ‘schemas’ – building blocks of knowledge which are adapted and re-organized as we mature biologically and interact with our environment. This adaptation happens in a three-step process; assimilation – using an existing schema to deal with a new situation; accommodation – when the existing schema does not work and needs to be adjusted; and equilibrium – mastering the new challenge (Piaget, 1954). Learning ensues when individuals integrate new knowledge with existing knowledge, which in turn is dependent upon the learner’s active involvement in the learning process (Tracey and Morrow, 2006, p47).

Piaget developed a stage theory – four main stages of development which must be accomplished in the correct order for cognitive development to occur. These are the sensorimotor, pre-operational, concrete operational and the formal operational stages (Piaget, 1954). ‘E’ fell into the pre-operational stage for several reasons. He was using the symbolic representation of language but was unable to reach logical conclusions on several occasions (session 1, P2 and session 2, P3). He displayed centration (session 4, P1) – only being able to consider one aspect of a situation at a time and egocentrism – the inability to consider anyone else’s perspective (session 3, P2). ‘E’ mostly played in parallel play rather than playing with his peers and whilst doing so, talked about what he was doing but seemed disinterested in receiving a response or ensuring that he was being understood. He also displayed animism (session 3, P3) and a lack of understanding of reversibility (session 1, P2).

One example of ‘E’’s cognitive development from a Piagetian perspective relates to the concept of conservation (session 1, P2). ‘E’ was unable to make the logical judgement that it was the same volume of water in both containers, because Child A had ‘taller’ water. Piaget referred to this as ‘conservation’ and argued that this inability to see past one’s immediate perceptions and make logical inferences was a classic indicator that a child is in the pre-operational stage (Piaget, 1954). This was seen again later, where ‘E’ was unable to see that because Child B was ‘E’’s sister, that ‘E’ himself was the brother of Child B (session 2, P3).

In session four the children drew pictures of bugs that they found on their nature walk. ‘E’ drew a picture of a spider with six legs and was corrected by Child A, who declared that ‘spiders have eight legs!’. ‘E’ argued over this until the year six monitor entered the conversation, produced a book which depicted a spider with eight legs and proceeded to draw it. ‘E’ looked over the book quietly for a while, watched Child C drawing and then drew another spider, this time with eight legs. Piaget would argue that ‘E’ had experienced disequilibrium in this situation because the spider in the book did not match ‘E’’s existing schema of ‘spider’. ‘E’ went through the process of assimilation – using his existing schema on spiders to draw the first picture, then accommodation – adapting the existing schema of ‘spider’ to that of a more standard concept of ‘spider’, and then finally equilibration – balance was restored, and ‘E’’s learning was developed: ‘E’ now knew that spiders have eight legs. Piaget afforded pre-operational children an intuitive sense of unease that their existing schemas of the world were not always accurate, and I witnessed this in the spider picture incident (Piaget, 1954).

‘E’ displayed several examples of egocentrism, including giving his favourite blanket to a crying friend (‘if it soothes me, it will soothe him!’) in session 1 (P5), and failing to understand why he could see the squirrel but his friend could not (session 3, P2)

Therefore, an effective application of Piagetian theory to social work could be in the understanding of egocentrism in young adolescents who have not fully developed the ability to see things from another’s point of view or to empathise with them. Fink’s 1976 study showed that children who engage in role-playing develop more empathy and perspectivism (Fink, 1976). Therefore, young children who enter social care could participate in such role-playing activities with foster carers.

Moffatt (1996) argued that some human development theories are culturally biased as they do not account for race, class, gender or sexual orientation. Fellow constructivist Lev Vygotsky criticised Piaget’s stage theory for being too dismissive of culture and the impact of Western schooling upon children. (ref, Vygotsky) Piaget undertook much of his research in Geneva, where children were schooled in Western forms of thinking (Pass, 2004), and this was mirrored in my chosen school. In practice I would exercise caution when applying Piaget’s stage theory in a setting where it could be culturally inappropriate and at worst, oppressive. Whilst useful in explaining why ‘E’ displayed behaviours such as egocentrism and animism, it would not be useful in explaining XYZ. It omits any reference to the fact that children may be more likely to imitate a more capable peer if they share similarities, such as ‘E’ copying Child with spider.

Where Piaget’s cognitive theory was founded in understanding the subjective mental structures which build a child’s learning, Albert Bandura’s early work on social learning theory emphasised the importance of experimental methods and observable, measurable variables (Bandura, 1977). Social learning theory emphasises the role of social interaction in the development of knowledge (Tracey and Morrow, 2006). Although both theories can be applied to children in terms of their learning in a social capacity, social learning requires an environment where students can learn from each other. Therefore, whereas the core of constructivism is actively constructing knowledge, the core of social learning is the importance of observing and modelling behaviours (Tracey & Morrow, 2006).

Piaget gave little consideration to role models in terms of a child’s learning, however for Bandura this was a crucial factor. In Bandura’s observational theory the child observes a parent, teacher or more capable peer who models a desirable behaviour and may attempt to imitate it. Through observation, a child will observe peers either being punished or rewarded for certain behaviours which then either increases or decreases the likelihood of a child imitating that behaviour. Unlike Piaget, Bandura also believed in reciprocal determinism: a person’s behaviour affects their environment as much as the environment affects their behaviour (Bandura, 1977).

A good example of Bandura’s observational learning theory can be seen in session XYZ. ‘E’ was considering a new obstacle course which had been installed on the playing field which included a walk-over seesaw. An older child began to walk over the seesaw and ‘E’ shouted, ‘you’ll fall!’. A teacher called out to praise the older child’s efforts. By observing the older child’s success and the praise he received from the teacher, however, ‘E’ learned that it was indeed achievable. The next step was wondering whether perhaps he himself could achieve the same thing. ‘E’ tried, and succeeded. First ‘E’ needed to learn if it could be done, then he needed to learn whether he himself could do it.

Bandura argued that not only are role models important for children to develop, children are more likely to imitate a role model if they resemble themselves in some way. This might suggest that ‘E’’s imitation of Child A’s eight-legged spider was to do with an affinity to Child A’s ethnicity as she was the only other Afro-Caribbean child in the school besides ‘E’, and possibly also the fact that Child A was a school monitor – Bandura noted in his research that children are more likely to copy role models if they perceive them to be in a position of power (Bandura, 1977). These nuances of race and culture appear to have been largely ignored by Piaget.

How could social learning theory effect change in social work practice? Perhaps role models could be offered for young people demonstrating troubled behaviour at school, paying attention to cultural and ethnic sensitivities? Perhaps student social workers should be more educated on the importance of social learning in understanding patterns of behaviour in diverse cultures and ethnic groups?

SECOND HALF OF ASSIGNMENT

The National Institute for Health and Care Excellence (NICE) Mental Health Guidelines state that ‘self-harm is not a medical diagnosis but a heterogeneous set of behaviours that can have different meanings in different contexts’ (NICE, 2012). Considering that the purpose of ABC House is to reduce hospital admissions due to mental health factors, I considered whether a combination of psychodynamic therapy and cognitive behavioural therapy (CBT) would be appropriate for ‘A’ to reduce the harm inflicted by her self-injurious behaviour, with an emphasis on schema therapy.

Cognitive behavioural therapy is a theoretical framework that acknowledges the importance of thought patterns and behaviour and strives to make behavioural and emotional changes based on this (Teater, 2014). Underpinning this theory is the principle that it is our interpretation of external events that cause internal distress rather than the situation itself. (REF). Cognitive schemas created in childhood can be maladaptive – known as early maladaptive schemas (EMS) – and predispose individuals to unrealistic expectations, destructive patterns of thought and the risk of negative self-fulfilling prophecies (Dobson and Dobson, 2009). CBT – particularly schema therapy – in social work can help patients to challenge their own maladaptive schemas as well as teaching them how to modify damaging behaviours (Young, 1994).

There is evidence to suggest that psychodynamic therapy alongside CBT can have a reduction effect on the repetition of self-injurious behaviour. Several short-term (up to 6 months), interim (6-12 months) and long-term studies (over 12 months) involving patients who exhibited self-injurious behaviour using CBT and psychodynamic therapy have shown a reduction in self-harm in children and young people (Arensman, Garnefski, van der Leeden et al., 2008, NICE Guidelines, 2012).

Since CBT is a time-limited, structured approach to psychotherapy that is delivered collaboratively between workers and service users (Dobson & Dobson, 2009), work could be undertaken with ‘A’ to identify triggers, set goals and develop strategies for intervention. In a practical sense this could include completing an Automatic Thought Record (McLeod, 2015), which would allow ‘A’ to become more aware of her thoughts and assumptions based on her schemas, and work with her social worker or key worker to begin to challenge these. A further application of schema-focused cognitive therapy could be taking the patterns identified in the Automatic Thought Record and developing strategies for opposite action – a strategy used in dialectical behavioural therapy (DBT)

(Rizvi, S. L., & Linehan, M. M. 2005).

(https://mswcareers.com/cognitive-behavioral-therapy-socialwork/)

(R.. L. Leahy, Cognitive Therapy: Basic Principles and Applications. Jason Aronson Publishing Co., 1996.)

(NIDA Publication: A Cognitive Behavioral Approach: Treating Cocaine Addiction

Self-harm always serves a purpose to the client. Critical to understand what this purpose is and work on harm reduction rather than elimination and don’t try to remove their defence mechanism too quickly (defence mechanism=self harm) as this can be terrifying for patient. Help client to find other ways to meet those needs.

Outcome I’m trying to get to? Reduction of self-injurious behaviour and helping ‘A’ to identify other methods to meet her emotional needs.

Unconditional positive regard and use of self as social worker is forefront in my work with ‘A’, particularly relevant after experiencing severe bullying and emotional abuse from parents.

‘Donaldson D, Spirito A, Esposito-Smythers C. Treatment for adolescents following a suicide attempt: results of a pilot trial. Journal of the American Academy of Child & Adolescent Psychiatry. 2005;44:113–120.

Would a task-centred approach be appropriate? Enhancing social connectedness, participation in activities that ‘A’ identifies as meaningful,

Conclusion of final, whole essay

Social work practice involves interactions between people, which are influenced by each person’s life course and their experience and perceptions about their own life. As a student social worker I must possess an understanding of how people develop and place people’s life situations in the context of the expectations of normal life course development. This will enable me to appreciate that a person’s experience, their growth and life experiences have a direct impact on who they are and how they see their world. Understanding how people grow and develop is central to the role and task of a professional social worker. Crawford and Walker (2007)

Observation and the application of development theories go hand-in-hand. To apply theories accurately, the observation must be effective. It is not enough for social workers to passively observe a family or a child and assume that they have gathered adequate information to make decisions. The child must be heard, seen and have their interpretations of situations understood. Several recent serious case reviews have highlighted the need for social workers to observe children more closely. ‘The Voice of the Child’ (Ofsted, 2011) posits that too frequently, social workers fail to ensure that children are heard and understood and that social workers fail to interpret these observations correctly.

These observational skills are transferable to direct practice and will allow me to contribute to ethical anti-oppressive practice; in striving to work in an open-minded manner, suspend my own judgement, challenge my own assumptions and values. In doing so I may recognise the same assumptions and oppressive beliefs in others, allowing my observational skills to act as a safeguard in social work practice. In practice I will strive to use my observation skills to seek out power dynamics – including those between the observer and the observed, social worker and service user – before applying theories to avoid oppressive practice as much as possible. As I learned from writing my observation notes, there is power in creating written material based upon somebody else’s experiences. It will be important to be aware of this in the workplace – even nuances can be cleverly written to convey a point or make a case and if care isn’t taken, this could be oppressive. The observation process opened my eyes to the relative powerless of children both in school and family settings. I also became intensely aware that my personal views, upbringing, and professional standing can affect my perception.

Whilst it is imperative for social workers to possess an understanding of human development theories, all aspects of a person’s biological and social make-up should be considered whilst planning an intervention (Crawford and Walker). No theory alone can be applied prescriptively to explain a person’s development throughout their life or to singularly inform practice, such as in the case of ‘A’s care. One theory may be relevant to a service user at a moment in time, and prove irrelevant in another area of their life. As Crawford and Walker (2010) highlight, not everybody lives a ‘textbook life’. One theory may be useful in understanding a child’s development, but not useful in explaining growth and development in later life. Therefore, I will use theories should be used in an attempt to explain something, such as why a child takes his first steps at a certain age, or speaks her first word but not to ‘prove’ that someone isn’t meeting milestones etc. Service users are individuals and deserve the right to be treated as such; anything less would be an act of oppressive practice and counterproductive to the social work values of XYZ. Practitioners should draw on many resources and theories in order to truly meet service user’s needs (Beckett 2007).

Important for professional development. Reflective practice. tie it all together. Seek to understand what is happening in families.

Listening to children ties to children’s rights. RIghts and justice of PCF.

Social workers have a duty to promote knowledge-based practice. Outcomes of practice are shaped by the basis of what informs it (Jennifer Osmond & Ian O’Connor, 2006). Social work practice models describe how social workers can implement theories. Practice models provide social workers with a blueprint of how to help others based on the underlying social work theory. While a theory explains why something happens, a practice model shows how to use a theory to create change.

Found online, so re-write ”

I also learned that the method of observation recording is important: I practised with my own children and found that in making real-time detailed notes I was missing the action; it became perfunctory. Upon researching observation methods I discovered the Tavistock method and immediately noticed that I observed more and obtained a much richer observation in which the context of actions and words was noted. In practice I will be more aware that writing real-time notes can lead to nuances being missed; facial expressions, fleeting glances. Siraj-Blatchford (2009) argues that observation of a child cannot be reduced to its ‘component parts’, there is much more going on than meets the eye.

Understanding of social work theory is a requirement of the PCF – knowledge domain.

Link all the way through assignment to the values of the BASW code of ethics and PCF.  

The journal of social work Practice: find the article that talks about observation.

in observing behaviour, social workers can fall prey to pitfalls such as allowing judgement to be clouded by personal opinions and assumptions which can in turn lead to oppressive practice.

I would argue that theories, policies, procedures, law alone do not make a social worker. It is the interpretation and the use of self in the application of these which makes a social worker. I am the best tool available in social work practice?

What we know and how we know it = reflexive practice. Who holds enugh power to create a theory upon which practice is based?

In the case of ‘A’, several theories of intervention are applied and all are complex.

References

Armstrong, K.H. 2014. Evidence-Based Interventions for Children with Challenging Behavior, DOI 10.1007/978-1-4614-7807-2_2. Springer Science+Business Media New York 2014

Baldwin, M. 1994 Why Observe Children? Social Work Education, 13, 12, 74-85

Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York, NY: Guilford Press.

Cohen, D. 1983. Piaget: Critique and Reassessment. Croom Helm Ltd: Kent.

Bandura, A. 1977. Social Learning Theory. Prentice-Hall: New Jersey.

Dobson, D., & Dobson, K. S. (2009). Evidence-based practice of cognitive-behavioral therapy. New York, NY: Guilford Press.

D’Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107.

Edleson, J. A Piagetian approach to social work practice with children and adolescents Available at: http://0-eds.b.ebscohost.com.brum.beds.ac.uk/eds/pdfviewer/pdfviewer?vid=3&sid=e1e47bb5-1f93-4312-bb57-1b31396e8654%40sessionmgr102

Fawcett, M. & Watson, D. Learning through Child Observation,3rd ed, 2016, Jessica Kingsley Publishers, London.

Fink, R. S. The role of imaginative play in cognitive development. In M. K. Poulsen, J. F. Magary, and G. I. Lubin (Eds.), Piagetian theory and the helping professions: Proceedings of the fifth annual conference. Los Angeles: University of Southern California (UAP) 1976. Available at https://files.eric.ed.gov/fulltext/ED085612.pdf [accessed Feb 02 2018].

Guthrie E, Kapur N, Kway-Jones K, et al. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. British Medical Journal. 2001;323:135–138.

HCPC, 2012

Humphrey, C. 2011. Becoming a Social Worker: A Guide for Students. Sage, London.

Leahy, R.L. Cognitive Therapy: Basic Principles and Applications. Jason Aronson Publishing Co., 1996

Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press.

McLeod, S. A. (2015) Cognitive Behavioral Therapy.

Ofsted 2011 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/526981/The_voice_of_the_child.pdf (accessed2/2/18)

Moffatt (1996)

(National Collaborating Centre for Mental Health (UK). Self-Harm: Longer-Term Management. Leicester (UK): British Psychological Society; 2012. (NICE Clinical Guidelines, No. 133.) 7, PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK126779/)

NICE Guidelines. Self-Harm: The NICE Guideline on Longer-term Management (NICE Mental Health Guidelines)

NIDA Publication: A Cognitive Behavioral Approach: Treating Cocaine Addiction

Osmond, J. & O’Connor, I. Use of Theory and Research in Social Work Practice: Implications for Knowledge-Based Practice, Australian Social Work Vol. 59, No. 1, March 2006, pp. 5/19

Pass, S. Parallel Paths to Constructivism: Jean Piaget and Lev Vygotsky. 2004. Information Age Publishing: USA.

Piaget, J. 1926. The Language and Thought of the Child. Routledge: New York.

Piaget, J. 1972. Psychology of the Child. Basic Books: New York

Piaget, J. 1950. The Psychology of Intelligence. Routledge: New York

Piaget, J.  1954. The Construction of Reality in the Child. Basic Books: New York.

Teater, B. 2014. An Introduction to Applying Social Work Theories and Methods. Open University Press: Maidenhead.

Rizvi, S. L., & Linehan, M. M. (2005). The treatment of maladaptive shame in borderline personality disorder: A pilot study of “opposite action.” Cognitive and Behavioral Practice, 12(4), 437-447. Available at https://www.sciencedirect.com/science/article/pii/S1077722905800719?via%3Dihub Accessed on 23/2/18

Salkovskis PM, Atha C, Storer D. Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. British Journal of Psychiatry. 1990;157:871–876.

Stewart CD, Quinn A, Plever S, et al. Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high risk population. Suicide and Life-Threatening Behavior. 2009;39:538–547.

Tracey, D.H. & Morrow, L.M. 2006. Lenses on Reading: An Introduction to Theories and Models. New York, NY: Guilford Publications.

Vygotsky, L. REF

Walker, J and Crawford, K. 2014. Social Work and Human Development. Learning Matters: London

Young, J. E. (1994). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Press.

Bibliography

Atkinson, C. 1983. Making Sense of Piaget: The Philosophical Roots. Routledge & Paul: London.

Adams, R, Dominelli L & Payne, M. 1998. Social Work: Themes, Issues and Critical Debates. 3^rd ed. Palgrave Macmillan: London.

Baldwin, M (1994) Why Observe Children? Social Work Education, 13, 12.

Bee, H, & Boyd, D. Lifespan Development. 2015. Pearson Education Ltd: Harlow.

Banks, S. 2012. Ethics and Values in Social Work. Palgrave Macmillan: London

‘Cognitive–behavioural intervention for self-harm: randomised controlled trial’ The British Journal of Psychiatry (2008) 192, 202–211. doi: 10.1192/bjp.bp.107.037564

(Mary Fawcett and Debbie Watson, Learning through Child Observation,3rd ed, 2016, Jessica Kingsley Publishers, London.)

Le Riche, P and Tanner, K. Observation and Its Application to Social Work: Rather Like Breathing. 2006. Jessica Kingsley Publishers: London

Fink, R. S. The role of imaginative play in cognitive development. In M. K. Poulsen, J. F. Magary, and G. I. Lubin (Eds.),

Piagetian theory and the helping professions: Proceedings of the fifth annual conference.

Los Angeles: University of Southern California (UAP) 1976. Available at https://files.eric.ed.gov/fulltext/ED085612.pdf [accessed Feb 02 2018].

Edleson, J. A Piagetian approach to social work practice with children and adolescents (PDF Download Available). Available from: http://0-eds.b.ebscohost.com.brum.beds.ac.uk/eds/pdfviewer/pdfviewer?vid=3&sid=e1e47bb5-1f93-4312-bb57-1b31396e8654%40sessionmgr102

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https://www.bera.ac.uk/blog/observing-to-understand-using-the-tavistock-method-of-observation-to-support-reflective-practice

Observation Notes

Session 1

P1: I entered the classroom and took a chair in the reading corner where I pretended to be reading whilst observing their play and listening to their chatter. ‘E’ and his friend (Child A) came over and asked what I was doing in their classroom, and whose Mummy I was. I replied that I was nobody’s Mummy but that I had come to learn about how children play. I asked ‘E’ whether it was ok for me to watch him playing and he said ‘yes’ and ran off with Child A.

P2: ‘E’ and his friends were playing at the water table in the messy play area. ‘E’ played mostly with Child A. ‘E’ did not initially want to wear his apron and the teacher had to persist with him for around ten minutes to get him to wear it. Child A poured water into ‘E’’s water mill and ‘E’ cried and said it was ‘ruined’. ‘E’ then threw some water onto Child A, who cried and went to tell the teacher. ‘E’ cast his eyes down and his lip wobbled as the teacher reprimanded him for throwing water. The teacher made ‘E’ take a four-minute timeout from the water table. ‘E’ sat quietly in timeout with his arms crossed, staring at his feet.

P3: When timeout ended, he returned to the water table and began playing immediately with Child A. The children were filling different sized containers with water. ‘E’ took a cup, filled it to the top and poured the water into his container, which was large and shallow. He then took the same cup, filled it and poured it into Child A’s container, which was tall and very skinny. Child A declared ‘I have more water than you!’ to which ‘E’ replied ‘oh yeah!’.

P4: At the end of water play it was snack time. The children sat down at their table and the teacher brought over the fruit bowl. Each child was allowed one piece. ‘E’ could not choose and stated that he wanted both an orange and a banana, to which the teacher replied ‘no, choose one ‘E’’. ‘E’ tried to take the orange and the banana, and the teacher asked him to put one back. ‘E’ put back the banana, put the orange on the table and folded his arms, sticking his lower lip out. He refused to eat the orange at all and at the end of snack time the teacher put it back in the fruit bowl. ‘E’ cried and asked for the orange back and the teacher stated that snack time was now over and he should have eaten the orange when he had the chance. ‘E’ continued to cry that he wanted the orange.

P5: ‘E’ was distracted after around five minutes by the entrance of two of the school monitors, year six children who had come to read to them. As this was going to take place in the reading corner, I moved myself to the messy play area so as not to be part of the reading session. The children did not question my relocation.

P6: At playtime ‘E’ put on his coat and ran outside with Child A. I followed and sat on a bench in the corner of the playground. ‘E’ played football with Child A and several others. Another child fell and grazed her knee. ‘E’ ran over with the other children and expressed concern for her, asking ‘does it hurt?’ and shouting ‘there’s blood!’ and pointing at her knee as the teacher approached. The teacher ushered the girl back inside and ‘E’ followed, got his favourite ‘blankey’ (blanket) from his drawer and took it to her, saying ‘this will make you feel better’. The teacher said, ‘that was kind, thank you’ and ‘E’ ran back outside. He went back in around ten minutes later and retrieved the blanket from the floor and hung it back on his peg, then ran back outside and continued playing.

End of session.

Reflection of Session One

Tavistock: this worked as it removed the ‘what are you writing’ element that I had experienced in my trial run with my own children).

felt tense and de-skilled. uncertain. anxious. childrens expressions of strong feelings evoked an emotional reaction in myself. sad to witness crying and not intervene. child fell over and first reaction was to help but other child ran for teacher. felt glad i was inconspicious and guilty. Learning to be there but not do anything. stayed conscious of falling prey to my own discriminations and prejudices. anti oppresssive practice. observation turned out to be more complicated than I thought. many things to consider. felt skilled by the end. impossible to be objective though.

Session Two

P1: When I arrived, ‘E’ was engaging in parallel play with another child at the lego table. ‘E’ was talking aloud about what he was doing but not seeking to find out whether anybody was hearing or responding to him. He talked about what he was building, the colours of the bricks, imagining it was a police station. He talked about the ‘bad guy’ being caught by the police and going to ‘lego jail’.

P2: The children had just returned from their nature walk when I arrived. ‘E’ was clutching a small clear pot containing multiple bugs. He took his coat off and hung it up and came back to examine his pot. He cried out ‘where is my spider? My spider is gone!’. The teacher answered, ‘I don’t think you caught a spider ‘E’’ but ‘E’ spent a couple of minutes peering into his pot looking for the spider. The teacher sat the children down at the table and brought pencils and paper. Their remit was to draw some of the bugs that they had collected. ‘E’ drew a spider with six legs. Child A looked at the picture and said, ‘spiders have eight legs!’ to which ‘E’ replied ‘no they don’t, they have six!’. ‘E’ and Child A squabbled over this for some time. A year six monitor entered the classroom to sit with the younger children for drawing time. The year six monitor was the only other Afro-Caribbean child in the school. She sat with ‘E’ and showed him a picture of a spider in a book, confirming that it had eight legs. She then drew a spider with eight legs and ‘E’ watched quietly. He then drew another spider with eight legs, counting them aloud as he drew them. The teacher came over and praised ‘E’’s eight-legged spider, as did the monitor.

P3: After drawing time, ‘E’ ran off to the toilet and was gone for several minutes. Another yeargroup came into the class for story time. They merge year groups frequently and the older children help the younger ones. One of the older children began to read to the younger ones. Another child in ‘E’’s yeargroup said ‘your sister is reading, ‘E’!’. ‘E’ replied ‘she’s not my sister, I am her brother!’.

P4: When story time finished, the children prepared for snack time by washing their hands. ‘E’ did this with no problem and sat at the table with his hands folded. When the teacher brought the fruit bowl he took one piece of fruit without quibble.

End of session.

Session 3

P1: The children were putting wellies on for their nature walk when I arrived. They were bustling around and ‘E’ was talking aloud about his wellies, comparing them to his peers’ but not waiting for any response. He said to Child A, ‘your wellies are green, why are they green? Mine are red. I like red the most, it is my favourite’. He did not wait for a response from Child A, nor did Child A appear to hear him.

P2: I followed them into the woods at a safe distance, but within earshot. The children did not seem to care that I was in the woods with them and nobody paid me any attention. ‘E’ and Child A were holding hands. ‘E’ shouted ‘look, squirrel!’ and pointed up at a tree. Child A looked up but could not see the squirrel and replied, ‘no there’s not.’ ‘E’ could obviously see the squirrel and continued to point and shout ‘squirrel!’ but Child A was still unable to see it. ‘E’ became frustrated and shouted at Child A, ‘your eyes don’t work, they are broken!’. He snatched his hand away from Child A and walked off into the woods with his arms crossed over his chest, and did not play with Child A for the remainder of the walk.

P3: On the way back to the classroom, ‘E’ tripped over a bramble and grazed his elbow and hand. He began to cry and ask the teacher approached and asked what had happened, ‘E’ cried, ‘the branch tripped me up! Horrible branch!’. The teacher replied ‘ah, it was an accident ‘E’’ and ‘E’ responded, ‘no it was on purpose! You didn’t see!’. The teacher held ‘E’s hand on the walk back to the classroom.

P4: We returned to the classroom and ‘E’ and Child A went to wash their hands for snack time. When they returned to the table they were giggling, and I could not hear what they were talking about.

End of Session.

Session 4

P1: When I arrived, it was pouring with rain so the children were spending break time indoors, sorting wooden blocks into piles. Two monitors were helping. One of the monitors asked ‘E’ to sort all the square blocks into a pile. ‘E’ sorted all the red blocks into a pile, regardless of their shape. The monitor said, ‘no ‘E’, I want you to sort all the squares into a pile’. ‘E’ looked at the pile and replied, ‘oh ok’. He tried again but ended up just moving all the red blocks into different pile. The monitor laughed and said, ‘not all the red ones are square!’. ‘E’ looked at the pile of blocks again, then got up and walked away to the reading corner where the second monitor was reading a story to a small group of younger children.

P2: After break time the teacher asked the monitors to help her set up the tables for drawing time. The two monitors went to get the paper and pencils and the teacher brought in some wooden animals and placed them on the tables. ‘E’ drew a picture of a zebra in red and white. The monitor at his table said, ‘that’s a nice zebra, ‘E’’. ‘E’ did not answer but kept colouring the zebra in with red stripes. The monitor said, ‘I saw a zebra once in the zoo’. ‘E’ did not answer so Child A repeated his statement. Without looking up, ‘E’ said ‘I’ve seen a zebra too, there’ and pointed to his picture.

P3: ‘E’ drew quietly for around ten minutes. When drawing time was over the teacher asked the children to put their pencils back in the box. ‘E’ grabbed the box from the middle of the table and began to clear away all the children’s pencils. Several of the children cried out and tried to grab the box, wanting to clear away their own pencils. Some of the pencils fell out onto the table and ‘E’ said ‘you are silly!’ to which another child replied, ‘you are mean!’.

P4: ‘E’ spent several minutes washing his hands after drawing time. He played with the water in the sink until the teacher asked him to dry his hands and come to the corner for story time.

Session 5

P1: The children were playing outside when I arrived. A new obstacle course had been installed on the playing field which included a walk-over seesaw. An older child was attempting to walk over this seesaw and E was standing watching, one finger in his mouth and he appeared pensive as he watched. A teacher called to the older child ‘well done, Z, you can do it!’. ‘E’ shouted, ‘no, you’ll fall, Z!’. The older child walked successfully over the seesaw, with ‘E’ watching. A minute or two after Z completed this, ‘E’ gave it a go and succeeded, running away afterwards yelling to anyone and everyone ‘I did it! Did you see? I flew over the seesaw!’. He repeated this seesaw success several times over the next fifteen minutes.

P2: At the end of play time the children went back inside and took off their coats. ‘E’ threw his coat on the floor and the teacher asked him to pick it up and hang it on his peg, which he did. He then went and sat at his table and waited for snack time, chatting to Child C. The monitor came in and passed the fruit around and ‘E’ took an apple and ate it, talking aloud about his apple. The three other children at his table were also talking about their fruit as they ate, and though none appeared to hear what anyone else was saying there was laughter and much agreement amongst them over the fruit.

P3: I had already told ‘E’ that I would only come a few times to watch him play but as I was putting my coat on to leave, I reminded him that I wouldn’t be coming again. I had been unsure how ‘E’ would take this but he came over, hugged my leg, said ‘bye then’ and ran off to play in the home corner where Child C was cooking an imaginary breakfast for everyone, and did not look back. I thanked the staff for allowing me to undertake my observations at their school and left.

Reflection of Session Five

How did the Tavistock model work for me?

Case Vignette

The primary function of ‘ABC House’ is to prevent hospital admissions and to act as a step-down unit for those leaving more secure mental health wards.

Provision of services for self-injurious behaviour in the UK appears to be sporadic (Bennewith et al., 2004; Kapur et al., 1998)

‘A’ is a 20 year old female who has been in and out of mental health units (secure and open) since the age of 12 for persistent, chronic self-injurious behaviour, suicidal ideation and attempts. She has been resident at this mental health unit since mid-2017. She has a diagnosis of Unstable Emotional Disorder and PTSD in remission.

‘A’s case notes were a difficult read. An illness-ridden childhood resulting in frequent absences from school, sexual abuse at home and severe bullying during her high school years culminated in suicidal ideation beginning around the age of eleven. ‘A’ is currently residing at ‘ABC House’ on a Community Treatment Order for persistent, severe self-harm, mostly through the insertion of foreign objects into her body.

‘A’ first expressed suicidal ideation at the age of eleven due to severe bullying at school, this progressed very quickly to self-harm in the form of inserting foreign objects into body orifices and into wounds. ‘A’ has had greater than 20 surgeries to remove foreign objects from her arms including sewing needles, plastic tubes, cotton buds, twigs, cigarettes and on several occasions, her own faeces which she has inserted into her own PICC lines whilst in hospital for foreign object removal. This resulted in ‘A’ contracting sepsis following which she spent ten days on life support for sepsis and bilateral pneumonia.

The wounds that she receives from these surgeries then serve as new openings into which she inserts further objects.