By Calum Strathie
Date Posted: Sunday, 14 December 2008
Calum Strathie is the Video Interaction Development Officer for Dundee City Council Social Work Department. Callum welcomes people discussion who are interested in finding out more or in research about this method. He can be contacted at firstname.lastname@example.org
Parents who misuse drugs or drug users who have children?
A discussion about how professional perceptions and labels can influence the forms of intervention adopted with families where parental drugs or substance misuse is a key issue. The method of Video Interaction Guidance (VIG) will be considered as a means of actualising Social Work values and principles of change and empowerment in an age when the primacy of such values has been subsumed by defensive Social Work and the desire not to get things wrong for the profession and society rather than getting them right for the families we profess to support.
“If we believe people can move forward, they probably will – and if we believe that they can’t, they probably won’t.” (Merton, 1968)
This statement indicates the potential power of professional and personal belief systems to not only help and support people in making positive changes, but also to help them to stay ‘stuck’ because the professional can’t see a way out and only sees the ‘problem’. The belief of the professional can therefore be seen as a major factor influencing case work outcomes regardless of a person’s capacity to really change and move forward.
One of the most emotive areas of modern life is that of drugs misuse – the effects and impacts on families and communities, the associated criminal behaviour, and the reactive responses from government, police and other bodies with responsibility for maintaining the fabric of society. Equally strong emotions are aroused in the area of Child Protection. When these two areas are combined we then have a very powerful and potent mix that produces equally powerful and reactionary demands to “do something”. Parents who misuse drugs are, therefore, cast as a section of society who are demonised, particularly in the popular press when child fatalities at the hands of drug using parents gain great prominence. Everyone, it seems, gets caught up in a climate of fear.
When families come to the attention of the statutory authorities because of parental substance misuse and child protection concerns there is a natural inclination to put the needs and interests of the children first. The needs and interests of the parents then become very secondary and any power or control that they may have had is taken over by the professionals. While the children are still with parents in the family home there is often an immediate drive to draw up a care plan consisting of ‘packages of supports’ and interventions for the parents to help them make the changes defined for them by the professionals. Life for the parents changes as they enter a new and different relationship with the caring agencies. They have to get used to sometimes very intrusive home visits by Social Worker, Social Work Assistants, Family Support Workers, Health Visitors and others. Attendance at meetings becomes obligatory – Network Meetings, Children’s Hearings, Case Conferences and Reviews – with the outcomes often being a list of prescribed tasks to perform to the satisfaction of supervising professionals. Non-achievement of any task will be perceived as a failure of the parents and a sign of poor commitment rather than a professional failure to apply sound Social Work values.
The professional ‘concern’ and ‘supports’ to bring about change for troubled parents who are misusing substances can often be experienced by the parents as a lack of genuine warmth – a quality that many will not have felt throughout their lives. Drug users generally do not command warmth and respect, even less so if they are the parents of young children. They therefore present a challenge to the personal values and belief systems of some professionals whose practice is legitimised by an increasingly powerful and controlling system that seems less and less concerned with upholding Social Work values.
The experience of a young mother of two children whom I worked with illustrates well the counter-productive nature of professional overload on a person who already has much to contend with in her life. She was relating to me a discussion she had with her Social Worker who reminded her of how fortunate she was to have “all of these supports” from different workers and different agencies. I asked her if she felt supported. Her answer was – “No, I don’t feel supported. I only feel pressure.”
I’m sure that the worker, like many others, genuinely believed that the more ‘supports’ that are piled on, then the greater chance there is for a good outcome. What this young mother did not have was a chance to define what her goals were or what she would perceive as supportive intervention. If she didn’t understand the nature or demands of some of the supports, and if she felt overwhelmed by the volume of workers, tasks and meetings, it is little surprise that change was difficult to achieve, no matter how well meaning the professionals were. The words of Jane Addams in 1912 still ring true:
“May I warn you against doing good to people, and trying to make others good by law. One does good, if at all, with people, not to people.” (Addams in Lee, 2001)
Support or Control?
After many years working with families in a system where words like “support”-“empowerment” – “partnership” – “collaboration” – “cooperation” just trip off the tongue I start to question whether support and control are really one and the same thing? Similarly should we not be a bit more honest and talk about “compliance” instead of “cooperation”, or “collusion” instead of “collaboration”, or “controlling” instead of “empowering”?
Young parents, like the mother I described, are incredibly powerless and are rendered even more so by the power and authority ranged against them by people who assume that with their ‘professional’ training, knowledge and expertise they know exactly what the ‘problem’ is and the parent doesn’t! They, therefore, know best how to ‘fix it’ and the parent doesn’t. They know what has to change to make things better – and the parent doesn’t. Thus a dependency is often inadvertently created because the professionals know best when their training (and line management) should be telling them that this is not effective social work practice. Learned helplessness is an expression we often hear used to describe people who are not coping ( Seligman, 1990). If we believe in such a concept could we not, I wonder, also believe in the idea of learned hopefulness where we are the agents of hope?
Words and concepts such as empowerment become skewed and reinterpreted in a way that large social work organisations can make themselves believe that they really are practising the true values of Social Work when the experience of the ‘consumer’ of social work services can be quite the opposite –
“Empowerment also means inviting people to participate in decisions over which they have no control. Thus, for example, parents are said to be empowered by being invited to attend Child Protection Case Conferences; they thus become complicit in measures of state intervention in their family life decided on by professionals and the police. Too often, empowerment means reconciling people to being powerless.”
Social Work departments and other professional or statutory agencies wield great power over individuals and families. Power has to be used responsibly and appropriately and for helping bring about positive change. Most people wouldn’t disagree with that, but in the wrong hands that same power can be used in a very damaging and dangerous way. This is as true today as it ever was. In 1981 on the first day of my professional training our Head of School addressed us. He told us that out of the hundreds who had applied from all over the country we were extremely privileged to be the fifty selected. We were told that when we graduated we would be handed a “licence to kill”! In other words he was telling us that our qualification gave us power, authority and status, and to use it well for and with people – not against them.
Why then should Video Interaction Guidance be considered as a suitable method for working with parents who misuse drugs?
Life for some drug using parents (especially those living in impoverished circumstances) can be extremely difficult. The children of drug using parents can also find life full of uncertainty, anxiety and stress. Some can also function surprisingly well and can be as well cared for as some children of non-drug using parents. Drug using parents can carry around with them a heavy burden of sometimes a lifetime of damaging past events, damaging relationships with parents and families, and feelings of hopelessness. Because of what is perceived as irresponsible behaviour and poor parenting the burden can be added to by the difficulty in commanding any respect and warmth either as people or as parents. The climate for positive engagement between such parents and professional services can, therefore, be very gloomy unless the professionals are deliberately and consciously practicing from a very clear value and belief base, and unless the parents actually sense the genuineness and sincerity in the way those values and beliefs are applied.
The effective and successful delivery of the method of Video Interaction Guidance is wholly dependant on the conviction of VIG practitioners in applying a simple set of values and beliefs that are not unique to VIG . These can be expressed thus:
- People wish to communicate.
- People in troubled situations want to change.
- People care about each other
- Everybody is doing the best they can at the time.
- A crisis is an opportunity for change
- The power of change resides within the individual or situation itself
This is an essential starting point without which we can’t even begin to contemplate engaging successfully with parents. The VIG value base has strong echoes in the belief system underpinning the Tidal Model (Barker 2004) in which similar beliefs capture very well the essence of the VIG approach. Barker suggests that in order for professionals to begin the engagement process they have to believe:
- That recovery is possible.
- That change is inevitable – nothing lasts.
- That ultimately, people know what is best for them.
- That the person possesses all the resources needed to begin the recovery journey.
- That the person is the teacher and we, the helpers, are the pupils.
- That we need to be creatively curious to learn what needs to be done to help the person, now!
What both value and belief systems have in common is a complete conviction that the person and their strengths are the main focus and not their problems. There is an inherent belief that everyone is doing something successfully (however small that may be) and that they are capable of doing more of what works well for them and their families given the opportunity to discover and become aware of what is working. However, when the professional focus is mainly on everything that is problematic in a person’s life there is almost no chance that successes will be identified, let alone built upon and enhanced.
The challenge then for everyone in difficult situations is how to bring about positive and meaningful change. Who and what has to change, and in what way can that change be brought about? Crucially, who decides and defines what has to change?
Video Interaction Guidance is a method that has its roots in theories of empowerment, inter-subjectivity, and mediated learning. In this method interactions are studied in the context where change is sought. This means that the method has universal application across cultures, social classes, abilities and communications.
The aim of this method is to improve effective communication in the situation where it naturally occurs and to build on each individual’s unique and effective style by:
- Raising self-awareness.
- Increasing attuned responses to others.
- Activating people to solve their own problems.
- Reframing perceptions.
- Reducing stress and increasing self-confidence.
- Achieving collaborative relationships.
These aims are not unlike those of many other approaches where change is sought but sometimes very difficult to achieve. VIG offers an additional and very powerful dimension in the form of video and visual images. When used in conjunction with skilful and value based communication by the practitioner it becomes a very dynamic and interactive method that is open to many creative applications in different contexts.
The basic premise of VIG is that the key to future development and change lies primarily on the quality of interactions. All participants (professionals and service users) are involved in supported reflection through the analysis of themselves in video recorded interaction.
An essential part of the VIG approach is the concept of Self-Modelling. When we are analysing and selecting clips of successful interactions to feedback we are thinking about what we need to show people that will help them to change. We do this because self-modelling through viewing images of ourselves being successful in our interactions and communications with others allows us the rare opportunity to learn from ourselves. When we see our successful behaviour having a positive impact on our relationships we naturally want to do more, so we adapt our behaviour to replicate what we have just seen ourselves do well! Self-modelling then becomes a very powerful means of building self-confidence and creating self-motivation because the person can actually see and, therefore, believe in what they can do rather than being told by another person. If we are low in self-confidence or lacking in motivation we tend not to believe what others may say no matter how positive and encouraging they may try to be. However, when faced with strong and positive visual images of ourselves there is little room for argument and doubt.
Some professionals do find this a difficult concept to accept because of firmly held beliefs that only by showing people their inadequacies will they then adapt their behaviour. This may have an impact for a short while, but continued exposure to, and reminders of what we are doing wrong will only serve to reinforce those feelings of inadequacy, low confidence and lack of motivation to change. When this happens people will be more likely to stay ‘stuck’ in ‘the system’ for longer than need be.
So why is VIG successful in bringing about change and why, in particular, could it help drug using parents to move forward?
In many ways VIG stands conventional approaches on their heads. It is a very democratic way of working with people who have been rendered powerless to make positive changes that they want in their lives. VIG requires a high degree of expertise and commitment from the practitioner, yet does not require that person to be, or to act like, an expert. The emphasis is very much on working collaboratively with the client – exploring together, discovering together and eventually reaching shared understanding. Rather than being a method that allows the practitioner to (consciously or not) use their professional knowledge to define what needs fixed and to determine how it can be fixed, VIG becomes a great leveller. The power differential that exists between practitioner and client is dissolved and empowerment becomes possible.
Massive levels of money, thought, research and effort are committed in an effort to combat the impact that drugs usage has on individual families and on society as a whole, but the big question is “what will work?” We can safely say that none of the multifarious approaches will work unless the person who is using drugs wants the change to happen. And nothing will work unless the practitioner trusts the client and if the client feels trusted. So that is the first big challenge for the professional practitioner – i.e. how to engage with families where a drug-using parent is reluctant or not motivated to make change? – and how to establish and maintain a level of trust?
The natural inclination of Children’s Services is to protect children in the family, including the unborn child, which can lead to the safety and the needs of the child being used as a ‘lever’ to put pressure on drug using parents to motivate themselves to make the desired changes in their lifestyle. This type of pressure can be perceived by the parents as a threat to remove their children unless they make the changes defined for them rather than as an encouragement and motivation to make the changes that they want for themselves.
Undoubtedly logic and reason would dictate that, faced with the prospect of losing their children, most parents would do anything to stop that happening. However, for drug using parents logic and reason may be attributes that don’t feature large, so knowing what the consequences may be from continued drug use is not necessarily enough to motivate them. In other words, being told by a professional what the consequences will be and what they stand to lose is not always enough for some to bring about real and meaningful change.
Is that because of a lack of reason on the part of the parents, or a failure to communicate effectively by the practitioner?
What we can, therefore, also safely say is that without a constructive and truly collaborative relationship between professional and parent that is based on trust, a shared understanding, and a common agreed goal, meaningful change will not happen
It is possible that a paternalistic, controlling, even threatening approach may achieve short-term change. This may look like a successful outcome for the professional, but when the change is not sustained it becomes a failure on the part of the parent rather than a sign of ineffective or inappropriate interventions. The failure will almost always be seen as that of the client, otherwise the worker has to admit that they have run out of possible solutions, has become ‘stuck’ and starts to feel failure themselves. The difference with VIG is that it is collaborative. It is a ‘no blame’ approach in which neither client or worker hold each other liable when things go wrong. Instead of the conventional problem focus it is seen as a challenge and an opportunity to explore new ideas, solutions and possibilities for change, and to do this together – in partnership.
A comparison between conventional problem solving approaches and the solution building approach of VIG practitioners illustrates well the very fundamental differences in the belief systems and methodologies that have such an impact on outcomes.
Helping as problem solving
- The professional describes the problem and collect the data.
- The practitioner determines the seriousness of the problem and draws on professional knowledge and theories to make the assessment
- The practitioner and the client/carer worker agree intervention to solve or reduce the problem. This relies on the practititoner’s and the professional’s knowledge.
- To implement the intervention practitioner support nad referral becomes part of the intervention.
- Evaluation and follow up is carried out by the client/carer/worker monitoring the consequences and making adjustments.
There is a high dependence on practitioner support and expertise and there is a focus on problems and the client may become discouraged and feel they are victims of disease of dysfunction (De Jong & Kimberg, 2001). Problems are held together simply by being problems (De Shazer, 1998), while asking ‘Why?’ is not seen as useful. Analysing the causes of behaviour can be felt as confrontational and judgmental.
Helping as solution building
1. The parent’s goals are defined by the parent. The video recording of a situation is micro-analysed for clips that will help find evidence to reach the goal. For example, the mother wants the child to ‘behave better’. The clips show that the mother is dealing calmly with challenging behaviour.
2. There is an assessment of the communications and behaviour in the family. Video analysis is based on long established research findings on intersubjectivity. A comprehensive assessment is made using the Traject Plan (which looks at areas for change identified by both the practitioner and client).
3. The intervention planning involves the VIG practitioner and the client/carer entering upon a contract and relationship to develop shared understanding of communications and strategies that would help to reach the client’s goal. A stepped approach is used to reach this goal through coaching and scaffolding at the client’s ability and pace.
4. The intervention is implemented by having an agreed number of recordings, feedbacks and reviews. No referrals are made to other agencies unless the client requests it. The development of reflectiveness is encouraged as well as problem solving capacity within the client’s own culture and ability.
5. Evaluation is collaborative and review is continuous. The next goals are set at the end of each feedback session. This is part of a learning journey that goes at a pace and in the direction that the client wishes to take.
Solution building allows strengths to built on and increases motivation through an emphasis on strengths as the client defines them. The process of cooperative exploration between the client and the VIG practitioner is an empowering approach. The micro-analysis which takes place alleviates the temptation to judge or blame the person for their difficulties and helps to expose inner and environmental (home and family) resourcefulness even in the bleakest of circumstances (Deuchars, 2006).
The contrast between problem solving and solution building approaches is a stark one that is clearly recognised by the 21st Century Review Group in their Changing Lives report (2006). They have identified “a growing mismatch between the value base of Social Work and the experience of people who use services and of workers.”
The empowerment principles of a solution building (or VIG) approach are actively promoted by the review group – “People who use services should have their strengths, interests and aspirations built on by services and be active partners in finding solutions to problems.” This idea of partnership or collaborative working is further reinforced by the assertion that services designed around the needs of people require “participative and empowering assessments”.
Perhaps, however, the most powerful voices in support of an approach that recognises drug-using parents as people with strengths rather than as patients with problems are the parents themselves. And they do have something to say that is important but is very often not received.
The empowering and motivating characteristics of a solution building approach is evident from the comments of a second generation drug using parent who agreed to try Video Interaction Guidance after many years spent as a client of the Social Work Department.
“As the weeks went on I began to see things in the (video) feedbacks that hurt my heart – seeing the kids enjoying themselves, laughing, joking.
I kept asking to do more, because the more I did of it the more it made me feel confident, and the more I was able to go home that day feeling upbeat and happy, and carrying on whatever I’d been doing in the recording or feedback that day.
It’s made me a better mother. A better parent.”
In this paper I have discussed the question of whether drug-using parents should be defined by who and what they are (parents) or what they do (use drugs). I have also questioned if these definitions and perceptions determine professional approaches and interventions, and considered the use of Video Interaction Guidance as a means of bringing about meaningful and significant change.
You will easily detect my strong opinions that have developed as a result of my work as a VIG practitioner working with parents who misuse drugs. Much of what I write is based on first hand experience and opinion, but I am very much aware that this is an area that needs to be more rigorously researched.
In 2008 Maria Doria is undertaking a discourse analysis of the relationship development between professional and parents in Dundee during the first three video feedback sessions. Preliminary results are showing that parents do indeed become more active (i.e. empowered) as feedback sessions progress and that the quality of their statements become more deeply reflective and are more about positive change while they are also able to explore negative experiences. A full report of this will be available in due course and will add hard evidence to the hypotheses and ideas in this paper.
Barker,P. & Buchanan- Barker,P. ( 2004) The Tidal Model: A guide to mental Health professionals Brunner – Routledge
De Jong, P. & Kimberg, I. ( 2001) Learner’s workbook for Interviewing for Solutions Wadsworth
De Shazer, S. (1998) Clues: investigating Solutions in Brief Therapy Norton
Langan. M. (2002) Chapter 19 “Social Work: Themes, Issues and Critical Debates” in Editors: Adams.R; Dominelli.L; Payne.M. The Legacy of Radical Social Work Palgrave
Lee J.L.(2001) The empowerment Approach to Social Work Practice Columbia Press
McMahon, G. (1999) in Bayne, R. et al. A practical A-Z Guide to Professional and Clinical Practice Nelson Thornes
Merton, R.K. (1968) Social Theory and Social Structure McMillan
Seligman, M. ( 1990) Learned Optimism : How to change your mind and your life Free Press