Social Casework Processes: Study and Diagnosis (2024)

Social casework is an ongoing process of exploration (study), assessment (diagnosis), formulation of goals and treatment planning, intervention (treatment), evaluation and termination (disengagement). Fern Lowry (1936) described this process as similar in form to a rope woven of multiple strands. When one cuts the rope at any point, all the component strands are exposed.

In the same way, examination of social casework at any point of time reveals fact-finding, assessment (diagnosis) and intervention (treatment) taking place concurrently. The first three of the processes, viz., fact-finding (study), assessment and planning for intervention, represent simply the empirical methods of a science applied to a human problem in a social work context.

This method involves seeking and ordering information and determining the nature and strength of the evidence which supports it. The caseworker then makes inferences based on the information, theoretical knowledge, and the experience of himself and others.

Tentative hypotheses are formed, re-examined, accepted and revised, or eliminated in the light of further information. This is a continuous process which begins with the first encounter with the client (helpee), takes place in every interview, and extends over the entire contact.

It is fundamental to the formulation of researchable questions in social casework. Before study (exploration), as a process of social casework, it is better to discuss Intake (engagement), an administrative procedure followed in some welfare and medical agencies.

Intake:

As stated above, it is an administrative procedure, and not a process of social casework, to take in the person with problem, i.e., admit him or enroll him as a client of the agency. This starts with first encounter and ends with usually the second interview with the intake worker. This phase requires a very skillful probing into the client’s problem, mopping up all the relevant areas of the person-in-his-situation.

During one or two skillfully conducted interviews with the would-be client, the caseworker (sometimes called as intake worker) is able to assess (i) what are the needs/problems of applicant person, and (ii) how and where his needs can be best met.

This obviously requires that the caseworker finds out the nature of need, if it can be met in the present set-up of agency’s policies, procedures, services and personnel, and what sort of competence and provisions will be helpful and is required to tackle his problems.

How does the worker view the person and his problems diagnostically is also important to be mentioned. If his agency cannot serve the client’s needs, which agency and which type of service are required to tackle his problems, and the need for referral are also decided at this stage by the intake worker (caseworker).

Areas for probing are:

(i) The stage of the problem at which the person, through whom, and the reasons because of which, comes to this agency;

(ii) The nature of request and its relation to his problem, and the cause of his problem, as the client sees;

(iii) Does the request relate directly to his needs/problems;

(iv) His adjustment to his social functions in job, family, etc.;

(v) The state of his physical and mental health;

(vi) His appearance including dress etc. in the first meeting;

(vii) His personal and social resources including material and financial position;

(viii) Appropriateness and intensity of feelings;

(ix) Nature of defense mechanisms he frequently uses;

(x) Level of motivation, i.e., how quickly he wants to get rid of his problems, the efforts he did in the past to solve it, sufferings because of the problem he had to face, and what efforts he is thinking to undertake to solve his problems;

(xi) Nature of family, its status, values, relationship pattern within the family etc.; and

(xii) Reactions to the worker and seeking help from the agency and sex of caseworker who will be suitable to help the person.

Thus, these questions will give a broad picture of the person, his physical and social environments, and the nature of their interaction which have given birth to these problems. No detailed probing is required; all that is required is to have a global appreciation of the person-in-his-situation to decide feasibility of his treatment in the agency and if required, to refer him to a suitable agency.

Techniques are the same as described earlier but the approach has to be that of a short-term, in which focusing is on relevant issues. Intake interviews are different from the initial interviews in casework process because intake does not aim at treating (helping) the case; at the best, it clarifies certain issues necessary to seek effective help.

After intake, the case is usually referred to a particular caseworker or the intake caseworker himself/herself can continue with the case. Intake procedures are not followed in formal way in most of the welfare agencies.

Only a few employ intake caseworkers. Usually, the caseworker, who is assigned the case, continues with the client or may dispose of by referring the client to some other expert or agency. Intake procedures, if implemented properly, help the agency to avoid wastage of its services, frustration to client, and in utilising its resources more effectively.

Psycho-social Study:

According to Richmond (1917), the caseworker must secure all and every fact that taken together, through logical and inferential reasoning, would reveal the client’s personality and his situation for appropriate intervention (treatment).

An exhaustive collection of facts about the client and his situation is called study—the first step (process) in the continuum. (I will prefer to use the word ‘study’ because it communicates the real and complete nature of activities undertaken during this phase).

Psycho-social study is an ongoing process which begins with the first knowledge of the case, takes place in every interview, and extends over the entire contact. It may be defined as that part of the casework process which brings together the facts about a case and is distinctly different from the assessment of the meaning of the facts. Psycho-social study involves exploration, observation and documentation of both objective and subjective facts from a variety of sources.

In casework, the primary source of information is the client. One must learn when to go beyond personal report and seek data from collaterals, experts, significant others, documents (records), psychological tests, and so forth. One must be careful to carry out this search acting in full respect for the client, maintaining confidentiality, and without violating the right of the client to participate in, so far as it is possible.

Mutual engagement in the process is essential. It provides the caseworker with the client’s own view of the problem. It gives the client an opportunity to clarify the problem in its various aspects, permits him to air his feelings about his situation, and gives him a satisfaction that genuine efforts are being made to help him.

While fact-gathering proceeds until the case is closed, there is usually an emphasis on study at the time a case is opened. The extent and breadth of this study depends on the situation presented by the client, the purpose and goals in seeking help, the situation as perceived by the worker, the range of treatment modes available, treatment potential and motivation for treatment, and on the agency structure and function. One needs to learn to determine the kind of study to be carried out in relation to these factors.

Investing of more time in study has been found to be frustrating to the client who seeks immediate help with the presenting problem. In any case, facts are needed to plan the intervention (treatment). While collecting data, one must see that it is relevant, salient and individualised.

Relevant means facts “bearing upon or properly applying to the case in hand; of a nature to afford evidence tending to prove or disprove the matters in issue”. It then implies that the way, in which the problem is presented and defined, treatment modalities and resources available etc. will determine which data are relevant and which part needs more exploration and observation.

It follows then that study need not in every case cover each and every part of the person and situation. Salient implies prominence, i.e., anything which is conspicuous and noticeable. Similarly, individualised data mean that the data should be collected for a particular client having particular needs/ problems in a particular situation.

Facts required are either related to resources, structure of the organisation (system), e.g., family, agency, etc., communication, cultural practices, developmental stages, political situation, attitudes and behaviours of the client system, values and beliefs of individuals and groups, or to their multidimensional interaction with each other. These points have been elaborated in the section on assessment (diagnosis) to follow.

It must be emphasised that this conceptualisation of psycho-social study as a separate process is artificial and is used only to clarify and define the different types of activities involved in helping process. In practice, psycho-social study is carried out simultaneously with assessment and intervention.

It is carried out through interview with the client, home visits, consultation of records and collateral contacts. It is different from case history or interviewing for research purposes. Interviews are conducted with emphasis on knowing the client, his situation and the nature of their interaction and not as question-answer session.

Interviews are conducted in natural way with the help of interviewing techniques and the purpose in mind. It is the purpose which guides the interview. To collect relevant data, one requires theoretical knowledge of human behaviour usually from the social and behavioural sciences.

Psycho-social Diagnosis (Assessment):

Gardener while discussing the therapeutic process from the point of view of psycho-analytic theory says that “etiology, diagnosis and therapy are inseparably linked theoretically and practically in every approach to any of the disabilities of man”. Since social casework services are addressed to free the man from his psycho-social and socio-psychological disabilities, diagnosis (assessment) is the inseparable part of helping process.

The process of diagnosis in social casework, according to Lowry (1936), consists of:

(1) Shifting the relevant from irrelevant data,

(2) Organising the facts and getting them into relatedness,

(3) Grasping the way in which the facts fit together, and

(4) Perceiving the configuration of meaning as a whole.

Assessment (diagnosis) of facts is done by the caseworker in the light of his theoretical orientation and knowledge, and the methods of intervention available to him. Diagnosis (assessment), psycho-social in nature, emphasises an understanding of psychological, biological, social and environmental factors operating on the ‘person-in-his-situation’. This, in turn, affects the interview process and techniques used for further work with the client. This assessment gives a certain direction to the future work with the case.

Diagnosis may be viewed as a “fluid, constantly changing assessment of the client, their problems, life situations, and important relationships”. As such diagnosis in social casework is an ongoing process.

According to Perlman (1957), diagnosis process involves examining the part of a problem for their particular nature and organisation, for the interrelationships among “them, for the relation between them and the means to their solution. Thus, the diagnostic process, according to her, includes the conclusions this process leads to, stating what the trouble seems to be, how it is related to the goal, and what means the agency, caseworker and client himself can bring to bear upon the trouble.

According to Perlman (1957), casework diagnosis consists of the:

(1) Nature of the problem brought and the goals sought by the client in relationship to,

(2) Nature (personality) of the person who bears the problem, his social and psychological situation and functioning, and who seeks (or needs) help with his problem in relation to, and

(3) Nature and purpose of the agency and the kind of help it (agency) can offer and/or make available.

The diagnostic process, which is perceiving the situation in an organised way and deriving meaning from the available facts about the mentioned areas, starts at the first contact with the client and continues till termination of the casework services. The inferences or tentative conclusions derived from the facts in the light of theoretical knowledge (in other words, “what do the facts mean?”) lead to and form the psycho-social diagnosis.

These inferences or hypotheses should be stated in terms of theoretical concepts, constructs and models that currently explain human behaviour and social processes. Thus, the psycho-social diagnosis is to state as specifically as possible the physical, emotional and social causes of the problem and the appropriate treatment plan for the person-in-his-situation. Diagnosis based on a few facts is hazardous. It is not a separate phase of the casework process rather it goes concurrently with the study and intervention. No therapist can afford to wait for study and diagnosis to be completed before he takes up treatment.

Why Diagnosis:

The client seeks help to solve his problems. To solve problems, one must know the causes. The diagnostic process helps in organising these causative factors in one whole, thereby making it more meaningful. One can see the whole and its parts in relation to each other. How various factors are related to each other and to the problem become very much visible.

This gives a boundary and direction to the attempts of the helper in planning his helping process. This helps in (i) determining the focus of treatment, further collection of facts and discarding the irrelevant facts, and (ii) deciding the best course of action to solve the problem. Goals and techniques of treatment are accordingly decided on the basis of the diagnostic evaluation (assessment) of the facts.

Types of Diagnosis:

The person-in-his-situation can be understood and described from dynamic, etiological and clinical angles. Diagnosis, then, may be classified into three types, viz., clinical, etiological and dynamic (Perlman, 1957).

In the clinical diagnosis, the person is described by the nature of his illness, e.g., schizophrenic, psychopath, typhoid, etc. This type of description implicitly includes “nature of the problem and its relation to the person and the helping means and goal”.

The clinical diagnosis is the subject of medical practice. Its use in casework practice is minimum and no attempt is made in social casework to undertake clinical diagnosis as it is of little value in planning casework intervention (treatment).

However, the social workers working with medical and psychiatric patients need a fairly good understanding of various implications of clinical diagnosis (medical terms) useful while working in collaboration with medical and para-medical experts. In the recent past, psychiatric social workers in India have been encouraged to develop a capacity to diagnose patients clinically (though broadly only) because of the fact that they have to work very closely with psychiatrists in the treatment of the psychiatric patients (Nayyar, 1965).

The etiological diagnosis tries to delineate the causes and development of the presenting difficulty which may lie in the life situation or/and in the client’s personality. The present problem is seen in terms of past events and experiences. This is important to understand because it gives an idea of the duration, consistency and strength of the problem in the life history of the client or patient.

It also tells how far a particular disturbance has been affecting his social functioning, why his particular inappropriate behaviour has been persisting, how he has been coping with the problems, what are his personal strengths and how far these causative factors can be modified or altered.

However, etiological diagnosis has its own limitations. There are problems of current adjustment of individuals which cannot be explained fully on the basis of analysis of the life history of the person or problem. Its limitation has been very appropriately put in by Richmond (1922) when she quotes Jung: “A person is only half understood when one knows how everything in him came about. Only a dead man can be explained in terms of the past.” Hence dynamic diagnosis should be concurrently undertaken to supplement the understanding of the man as he is today.

Dynamic diagnosis seeks a proper evaluation of the client’s current problem as he is experiencing it now. It seeks to identify the various factors in active play in the current person-situation configuration. It is a cross-sectional view of the forces currently operating in the client’s problem.

The dynamic diagnosis seeks to establish what the trouble is, what role psychological, biological, social and environmental factors are playing in the causation of the problems, what effect it (the problem) has on the individual’s well-being (and that of others related with the client), what solution is sought, and what means exist within the client, his situation and the organised services and resources by which the problem may be affected.

In dynamic diagnosis, there is no attempt to dig the life history of the problem rather reasons for the problem are traced in the current situation. Thus dynamic approach focuses on the forces (instinctual needs) and their satisfaction, interaction of thinking and emotions and between the structural parts (id, ego, etc.) of personality which are currently operating within the client and on interaction between him and his social and physical situations.

In sum, diagnosis (assessment) includes “interpretation of the facts, evaluation of the several value systems, and the comparison of the validity and feasibility of various solutions and its results in operational predictions”. The diagnosis, a tentative conclusion subject to modification, is a continuing process, and as such a dynamic activity. The following outlines may prove quite useful for study and diagnostic purposes.

A Format for Psycho-social Study and Diagnosis:

Identifying Information:

Place clients in their current social reality, i.e., according to age, sex, race, religion, nationality, marital status, ordinal position in the family, and socio-economic class, occupation, current living situation, i.e., housing, other members in family etc. Observe affect, clothing, grooming, speech, gait, posture, muscular tension, facial expression, vasomotor responses in presence of, and interaction with, others. Changes in behaviour; reaction to social worker, etc.

Presenting Problem:

This includes problem for which client seeks help including source of and reason for referral, whether problem is of recent origin or of long standing, what precipitated client to seek help, client’s reaction to problem, his reacting to the referral source, and to the agency and worker as sources of help. It also includes what has been done about the problem. Significance of the problem to the client and significant others and how disturbing the problem is to them. Past therapeutic experience. Client’s expectations of help.

Assessment of Current Social Functioning and Immediate Social Situations:

(a) 1. Family relationships:

What is family’s style of functioning, goals, values, power structure, communication patterns, role patterns, joint and nuclear family arrangements, etc.

2. Interpersonal relationships:

What is occurring with significant others at work and recreation; nature of communication patterns, his reference groups, etc.

3. Adequacy of role performances in family, work and other situations.

(b) Personality structure and dynamics of functioning:

1. The efficiency of ego structure to deal with current inner forces, the current reality situations, and the interplay of both. Capacity of the client to observe self.

2. The nature and appropriateness of ego mechanisms in relation to social factors and influences of current exterior pressures. Indications of capacity to make modifications or the necessity of maintaining and strengthening existing defenses.

i. Prominent ego defenses (e.g., repression, denial, etc.).

ii. Super-ego (strength, rigidity and integration).

iii. Adaptive strengths (e.g., adequacy of reality testing, degree of synthesis within the ego, stress tolerance, amount of energy available for adaptive tasks).

3. Sense of self (e.g., body image, control vs. being influenced, etc.).

4. Psycho-social modalities (e.g., trust vs. mistrust, identity vs. role diffusion, etc.).

5. Prominent affects (e.g., depression, guilt, anxiety, hospitality etc.).

6. Nature and degree of problem (an etiological diagnosis and/or dynamic diagnosis should be used).

(c) Intellectual endowment (intellectual capacity).

(d) Health of client:

Observe and see the medical reports if available.

History:

Assessment of the nature of the client’s problem in the light of history. Tie together the significant factors in cause-effect relationship as seen from history. Includes psycho-dynamic, somatic and socio-cultural factors. If history does not contain sufficient information about a specific aspect, it is well to indicate that this is unclear, thus pointing up areas for further exploration and assessment.

A Brief Diagnostic Summary Statement Restate all relevant facts and inferences including clinical diagnosis. State the relative seriousness of each aspect and of all the possible causes and aspects in relation to each other. Also state prognosis. Assess the client’s motivation and capacity to use help. Specify short and long range goals.

Include the kind and amount of change to be expected. State all appropriate services needed. Specify casework techniques for accomplishing the goals. Also specify environmental factors which may help or hinder casework and any other recommended services. Are recommended services available in the community?

Diagnosis, Goals and Intervention Plan Need to be Re-evaluated in the Light of New Facts As a professional member of the agency staff, we should consider the following also:

(a) Nature, severity and frequency of problem:

i. Which groups are most likely affected by the problem,

ii. Observe shifts or changes in relation to problem.

(b) Evaluation of treatment facilities related to problem:

i. Appropriateness of agency services in light of the problem,

ii. Availability of, or gaps, in community resources in relation to problem,

iii. What broad social planning would prevent or mitigate development of such a problem?

(c) What is the appropriate channel for action at necessary level?

i. Agency,

ii. Community,

iii. Broad social planning.

Causative factors may also be identified and evaluated along several other dimensions.

They may be:

1. Lack of resources:

Sometimes lack of resources may cause or contribute to the development of the problem. Resources may be either financial, educational, health, recreational or housing etc.

2. Structural:

It is the very form of the system (organisation) working as a factor in causation or precipitation of the problem? (This includes the internal organisation of individuals, families, agencies and other relevant systems, and communities). For example:

i. The single-parent family;

ii. A very small house for a very large family;

iii. A lack of understanding regarding who makes decisions;

iv. Too much concentration of power in one person or sub-system;

v. Imbalance in the membership of a small group, or committee, or city council etc. Is the system an open or closed one?

3. Communication:

Is there dysfunctional (ineffective or contradictory or hostile) communication pattern? What can be the reasons for this?

4. Cultural:

Are there marked cultural or sub-cultural differences within the system (family or other units) or between the relevant systems? How do these contribute to the problem? What bearing do these have on communication patterns, decisions making, and on attitudes and behaviours of the client.

5. Development:

What is the relationship of the stage of development of the particular client (system) to the nature of the problem? How does it relate, for instance, to family structure and communication patterns? To what extent does the newness or the long existence of an organisation have a bearing on the flexibility or rigidity of the organisation? How do the significant events in the system’s past influence its current functioning?

6. Political:

To what extent do political forces have a bearing on the problem? To what extent do such factors as use of power, power struggles, competition, ability to tolerate and resolve conflict, needs to gain more power or to bring about changes in the location of power, etc., have a bearing on the problem?

7. Attitudes and behaviour:

To what extent are emotions and behaviours (per se, or in relation to the problem with which the client is struggling) dysfunctional (inappropriate or inadequate)? What is the system’s previous problem- solving history? For example, resourcefulness vs. hopelessness, resoluteness vs. indecision, concern vs. apathy, constructive action vs. protection of the status quo, etc. Are there internal forces (within personality) which tap the available energies for problem-solving? Are there external environmental stresses which impair the system’s problem-solving capacities?

8. Values and beliefs:

Are the problems related to different values and beliefs held by various individuals or sub-systems (components) of the system, and between the system and its environment? What are the influences, here, of cultural and sub-cultural background, and life aspirations? What is the history and what are the traditions? To what extent do these aspects have a bearing on the problem? How is the value and belief system of the social worker perceived by the client system and to what extent does this affect problem-solving efforts?

Social caseworker should use these guidelines for collection of data and prepare diagnosis based on the interpretation of the facts collected.

Intervention Plan and Goal Setting:

The purpose, for which social study and psycho-social assessment (diagnosis) are undertaken, is casework intervention (treatment). The first stage in intervention (treatment) involves planning. The questions to be answered by the worker at this stage are: “What kind of help (treatment) will best stabilise or improve the client’s functioning or better meet his needs?” “In terms of the kind of social adaptation or adjustment, which will be of most value to him?”

It is important to stress, however that each step in treatment must be taken jointly with the client since he is the person who will ultimately determine his engagement in this process. The aptitude, skills and knowledge of the individual worker may promote the treatment (helping) process or impede it.

It is also important to re-emphasise that the treatment plans are always conditioned by the age, health, culture, mores, values, opportunities, agency policy and community as well as broad societal forces. In addition, the caseworker has to be aware of his own norms and values and needs so that they are used constructively and do not interfere with the helping (treatment) process.

Long-range Objectives:

Treatment plans are clearly related to certain objectives.

Among these are the following:

1. To restore or improve social functioning and increase capacity for self-direction;

2. To prevent deterioration and conserve strength; and

3. To create opportunities for growth and development.

In summation, the long-range objectives are to make people’s life experiences more comfortable, compensating, satisfactory, productive and self-fulfilling.

Immediate Objectives:

Goals are not static. They are in a process of becoming. Some of the first steps taken to help a case may determine or even become initial or final goals. For example, in the case of an aged helpless person, securing old age pension may be the initial as well as final goal. Objectives are related to and emanate from every aspect of a case situation with which one deals. Goals can alternatively become prominent or receding.

Both long-range and immediate objectives relate to and are an outgrowth of the dynamic understanding of the case. One should plan his intervention in each case in terms of the considered immediate (short-term) objectives (priority-wise) in the determination of which the client participates.

In fact, these short-term (immediate) objectives lead to achieve the long-term objectives. The objectives initially undertaken should meet his needs quickly and be reassuring to him. Once the objectives are set, the specific methods, techniques, type of services required and the expected improvement and change is also to be calculated tentatively.

These objectives, needless to say, are based on realistic and sound assessment of the client’s social situation, needs and his priorities, motivations, capacities and resources available. Agency settings, modifiability of causative factors, time factor and caseworker’s competence, etc., also impose certain limitations on choosing the objectives. Objectives set should be specific, realistic and achievable within the time limit.

Once this planning is complete, one can move with the case to achieve the desired objectives. This planning should be a continuous process and not a periodical one. In some cases, in India, discussing the planning with the client may not be feasible either for time factor or overall socio-educational level of the client. In such cases, planning (how the problem will be solved) should at least be shared with him.

This may not be useful if it involves telling the client the process of therapy, i.e., what will be done and how it will solve his problems. Telling this to the client may weaken his motivation to seek help. This, to my experience, is quite true of majority of the Indian clients -who do not, by and large, appreciate the invisible therapeutic process.

Intervention (treatment/execution/action) is the fourth step in the social casework process after study (fact-finding), diagnosis (assessment) and planning for action, which aims at restoring, maintaining or enhancing social functioning of an individual in need of help.

All casework help intends (i) to improve the client’s psycho-social functioning and bring positive changes in his adaptive patterns, and/or (ii) to improve environmental conditions and resources, and to make them available to the client for his growth and development. Implied in these goals are prevention of deterioration in and conserving the strength of the client.

The approach to treatment, then, can be said to include either or any combination of the following services:

(a) The administration of concrete and practical services;

(b) Modification of environment, both social and physical;

(c) Strengthening capacities or clarifying, modifying and reinforcing attitudes, beliefs and values favourable to change and growth or to maintenance of the emotional equilibrium.

To achieve the desired goals, many practice theories (i.e., how and what to do in given situation to achieve the specified changes) are available in social casework literature.

This decision of the practitioner will be partly dependent upon:

(1) The unit of consideration: individual, couple, family;

(2) Length of treatment: long-term, short-term, referral, transfer;

(3) Nature of situation: crisis or non-crisis; and

(4) The nature of problem: interpersonal or economic, etc.

Intervention starts from the first contact with the client who seeks to solve his problems with the help of a social caseworker. In the initial phase, attempts are made to establish rapport and sustain the client’s interest in solving his problems.

Approach to intervention as described by Hollis (1972) is discussed below.

The author has chosen this approach because it describes the process in toto and encompasses the usual problems dealt with by the caseworkers. Interviewing skills and techniques are used to achieve the goals. Principles constantly guide the activities of the caseworker. Privacy is important for conducting casework interviews. Knowledge of human behaviour helps in focusing on relevant aspects of behaviour.

In another words, case work is carried out through interviewing (talking) techniques which help in achieving sub-goals (like perceiving the reality, developing understanding of the situation, insight into one’s a particular behaviour, locating resources, improving relationship with someone, etc.). While doing so, worker remembers values and assumptions and is guided by principles and knowledge of human behaviour. Hollis describes the processes in her approach as given below.

Sustaining Process (Initial Contact):

We all have experienced anxiety whensoever we had to ask for help from persons unknown or formally known to us. Similarly, questions about self from unknown or formally known persons also create anxiety in us. Apart from this, when the client approaches the caseworkers, he is naturally suffering from some anxiety caused by his problem/non-fulfillment of his needs.

The anxiety is tackled and the client’s interest in solving his problem is sustained. Sustaining process becomes more useful when anxiety is greater as it quickly reduces his anxiety, makes him comfortable and thus builds his confidence in caseworker.

Techniques used in sustaining process to maintain his/her current social functioning and interest in casework treatment are conveying acceptance, reassurance and encouragement. Acceptance is an attitude of warm goodwill towards the client, whether or not the client’s behaviour is socially acceptable and whether or not he is liked by the caseworker.

Conveying acceptance does not refrain the worker from communicating his evaluation of the client’s social functioning to him but the only condition is that it should be done out of goodwill. Sustaining process is useful when the client feels guilty having come to seek help from the agency, or when, for some reasons, he feels unworthy of the worker’s liking or respect.

The worker continues to convey a positive and understanding attitude towards the client. This attitude is not dependent upon the nature of action or behaviour of the client. It is a continued expression of goodwill or positive concern towards the client. The worker extends the required respect, listens to him interestingly and communicates to the client (through his facial expression, tone of voice, choice of words and body postures) that he likes the client.

The verbal and non-verbal communication of the worker should not be incongruent and contradictory. It should rather be supplementary to communicate acceptance. Acceptance can be communicated better only when the local norms and traditions for communicating respect are fully understood by the worker. Communication of acceptance is further facilitated by the worker’s understanding of client’s personal differences with the values of the group he belongs to, and the caseworker’s own values.

Awareness of one’s feeling to punish or seek return in lieu of services being given, moralistic attitude, etc., will help in exhibiting the deep concern for the client. The real method to express acceptance is to work hard for solution of the client’s problem.

The technique of reassurance brings relief to the client suffering from anxiety and guilt. Relief does not come from understanding but because the caseworker, in whom the client has placed confidence, has said in effect that it is not necessary to be so worried.

Sustaining process may require use of gift, patting and fondling when working with children. Home visits or solving the pressing concrete piece of problem, etc., will sustain the client’s interest in casework treatment and prevent further deterioration in his/her social functioning.

The process of direct influence deals with the different ways the worker uses to promote a specific kind of behaviour on the part of the client, i.e., he directly tries to bring a change in the client’s behaviour usually in the situation demanding specific behaviour like how to handle the child, how to deal with the employer, etc. This is achieved because of the client’s trust in the worker. The trust of the client in the worker is used as a vehicle for influencing his behaviour.

Hollis (1972) classifies the areas where direct influence is more useful:

1. Child-rearing matters.

2. Anxious people till they do not develop self-confidence.

3. Infantile personality.

4. Persons whose sense of reality is weak.

5. Compulsive patients.

The technique of direct influence should be used only when the worker knows that a particular (the suggested) course of action will be more useful and is perhaps the best in the situation for the client. This process should be used only when the client really needs it, i.e., when the situation of the client justifies use of this process. Many a time this process is used just because the workers in our settings are more anxious to give suggestions/advice, and sometimes, the client may ask for suggestions/advice only to please the worker.

According to Hollis (1972) the techniques of direct influence are:

1. Underlining:

This involves approving or emphasising a course of action, the client himself is contemplating upon. Here, the worker may use the sentences like, “I think this is realistic for you to…”, “I think you are doing the right thing and the action should be taken as quickly as possible”.

2. Suggestion:

Herein a solution is raised in the client’s mind by the worker and it is up to the client to accept or reject the idea. Since the worker is not emphatic on this suggestion, the client is free to reject the idea. For example, worker may say, “You can utilise this leisure time for painting or kitchen-garden etc.” In case the client uses his leisure time for walking or playing, he is free to do so without any fear of criticism from the worker.

3. Advice:

This involves stating an opinion or taking a stand concerning certain issues which must be acted upon by the client in his own interest and which if not taken will be harmful to the client’s interest. Physicians advise drugs which should be taken by the client if he wants to get cured. He does not suggest a drug when the patient is sick rather he advises. Similarly, the caseworker advises actions which should be adopted by the client to solve the problems.

4. Advocating:

This is one step beyond the advice, i.e., putting a certain urgency behind the advice offered. Advice is re-emphasised. It is offered in term of “it is essential and that it would be very unwise not to do so”. This is indicated when there is a chance of severe loss because of the client’s ill-considered or impulsive action or when enough time is not available for discussing consequences of the action being contemplated by the client.

Such situations may be like a mentally disturbed person sticking to the home, a person likely to commit suicide, or running away from home, etc. In all such situations, advocating becomes more useful because it saves the client from the big loss he may suffer because of his ill-considered action. However, no attempt should be made to create guilt in the client, when he fails, by telling him that “I told you so”.

5. Actual intervention:

Here in the caseworker takes action to prevent the client from taking inadequately considered action or sees that he acts in a particular (the desirable) way. Examples are removing the patient to a hospital, placing the child in a hostel, etc. Use of these technique demands that the worker be fully convinced that the step is factually justified and necessary community resources and support are available. His action should be firm and polite without communicating any anxiety to the people around.

Direct influence techniques should be avoided unless it is really justified and it should be, wherever possible, used in conjunction with the procedures for development of understanding. To start with, most gentle form of influence should be used. The caseworker has to be very cautious and conscious of his own needs while suggesting and offering advice.

Ventilation Process:

The process of ventilation (catharsis) is the process of helping the client to air his feelings freely and to provide him with an atmosphere which makes free expression of the feelings easier. It frees the individual from fears,” guilt feelings, and brings to light the hidden attitudes. The more intense the feelings, the better result through this process. This is usually used when the client is more tense or eager to come out with his inner feelings.

This technique may be used in certain unpleasant situations which might have arisen in between the interviews. Ventilation is not only therapeutic but also diagnostic. The therapist should explore intently and stimulate the client, by questioning or commenting, to tell more about his situation and its various aspects.

Only towards the end of session, the caseworker may use generalisation and logical discussion to lessen his guilt. In the initial stages one should not minimise the anxiety lest he stops coming out with relevant materials necessary to help him. The caseworker may choose either to be totally passive or actively participating and directing. The client must feel that the worker is uncritical, tolerant and is listening to him.

One should not permit ventilation when it is used as a defense mechanism to avoid further exploration. In such situations, it is better to divert his attention and help him to discuss the relevant matters concerning his problem.

It should be avoided or used with caution in case of psychotics etc. Ventilation is used sometimes by the client to seek attention and sympathy from the worker or a gratification from talking freely about self. The caseworker should be conscious in all such situations and direct the interviews accordingly.

Reflective Discussion of the Current Person-Situation Configuration:

As stated earlier, the psycho-social therapy views man in his situation and tries to understand the total man, i.e., inseparable from his environment. The procedure for reflective discussion, according to Hollis (1972), does not involve use of clarification or interpretation (utilised for developing insight).

She has classified the procedure for discussion of current person- situation configuration into four sub-categories:

(i) Perception and knowledge,

(ii) Decisions and consequences (reactions),

(iii) Inner awareness, responses and distortions, and

(iv) Reactions to the worker and treatment. These are described in the paragraphs that follow.

Perception and Knowledge:

In this category, caseworker is concerned with his/her client’s current situation which may consist of people, events and conditions related to economic, social, physical and educational spheres of life. The procedure in this sub-category deals partly with perception and partly with the question of knowledge.

Some of the clients see either distorted or only one-sided picture of the real situation around them. This happens because the clients see/hear what they anticipate or because their intense feeling lead them to ignore certain aspects of the real situation.

The feelings may also blot out important aspects of the reality. The worker may, in such situations, draws the attention of the client to the real facts of the situation which may in many cases correct his distorted perception of the situation. If this procedure does not work, the client may be helped to perceive the discrepancies between reality and his views of it, without going into the dynamics of his perceiving reality into a distorted way.

When we are angry with our friend or relative, we see his negative points only and interpret his good behaviour also from a negative angle only. His help is interpreted as motivated by selfish ends etc. In such cases, every movement of the friend/relative is interpreted in the same light and the reality gets totally ignored or blurred.

An individual’s response to a person may, sometimes, be because of little knowledge the individual has about normal responses of the concerned categories of persons like adolescents/aged/children etc. Explanations and information’s may develop understanding in the client leading him to tolerate normal reactions of the people. When an adolescent reacts angrily to the parents’ sermons for work/good behaviour, they should be helped to understand and appreciate the characteristic ways of behaviour of this age group.

In some situations the client may be hostile to others just because he is unable to imagine their feelings in the situation, or because of his failure to identify with the feelings of the person. A husband may not appreciate the difficulties of a university educated housewife, unable to manage household affairs effectively, simply because he fails to imagine the possible responses and feelings of such a housewife in such a situation. Similarly, a wife failing to appreciate the tiredness of her husband after he returns home from his work, may start murmuring the moment he enters the house.

Understanding of the external world can be increased if help (guidance) is extended in respect of various important life events like family budget, work situation, physical conditions, involvement in some social situation etc. If proper guidance is extended in these matters, e.g., how to prepare family budget, whom to approach for this or that work etc., the client will be able to handle his situation more effectively conducive to his growth and development.

Techniques like logical discussion, questioning, etc., which lead the client to think through is found to be more convincing and lasting in its affects. Explanation may not be very effective. Informing or use of bibliography can also be tried along-with other techniques in helping the client to reflect upon various aspects of his current situation.

Decisions and Consequences (Reactions):

In this procedure we consider the decisions and activities of the client and its effects in interaction with his environment. Over and again the worker strives to help the client think about the effect of his decisions and actions on others or its consequences for himself, e.g., advantages and disadvantages of moving to a new job, place, seeking divorce, quarreling with boss, and purchasing properties etc.

In any of these instances, the client tries imaginatively with the help of the caseworker to foresee the consequence of the plan for himself and for the other people whose lives are involved in his decision. The worker brings the client’s attention to those aspects of the situation which he may have overlooked, and this helps in right decisions. The decision should be taken after all possible facts have been gathered and the pros and cons of the alternative decisions have been considered.

At other times, an understanding of the effects of the client’s own behaviour or someone else involved in the situation is the focus of discussion. To quote Hollis (1972), a mother may not realise that hitting her son compels him to defy her to maintain his prestige before his peers.

If possible, avoid explaining the relationship between behaviour and consequences. It is preferable to lead the client to see sequence himself. Many times the client will draw his own correct conclusion once the two aspects of his behaviour are brought to his attention.

Inner Awareness, Responses and Distortions:

This part involves awareness of the so-called hidden feelings or reactions. There are many degree of hiddenness, according to Hollis (1972). The client may be perfectly aware of his reactions but afraid to speak of it because he is ashamed of it or fears ridicule or criticism, or has not recognised the significance of his feeling. At times, the client may be truly unaware of his feelings because they are not part of his conscious thoughts.

There are occasions when reading his thoughts is necessary, either because the client, unable to bring out his thoughts into open will feel relieved if the worker does so for him, or, because there is therapeutic justification for bringing them out even though this may make him uncomfortable.

Skill lies in finding Ways of enabling the client to bring out the hidden material himself. Where full awareness is present, this often occurs without any specific prompting as the client becomes more secure with the worker in response to a sustaining approach.

If, however, the client is struggling with the question of whether to speak something or not, the caseworker may handle this hesitation directly by commenting, “I understanding you want to talk about your relationship with”. At other times, when the worker is fairly sure of what the client is withholding, he may be able to make comments which refer tangentially to the anticipated content, thus inviting the client to talk about it but still not facing him with it directly, e.g., “You want to say that you want to leave the school”.

Often one can use the procedure of calling the attention of the client to the discrepancies between facts and feelings, to overemphasis, or to inconsistencies or inappropriateness one sees in the feelings. Sometimes this can be done merely by repeating the revealing statement in a questioning tone. For example, one can say, “You don’t like to meet your wife?”

When it is actually advisable to put the matter into words for the client, this can be done tentatively, making it possible for the client to maintain his defenses if he needs to do so. This also safeguards him from agreeing too readily to a possibly incorrect interpretations when the worker is not certain of his perception of the helpee’s thinking. Occasionally, a direct unqualified interpretation is helpful, but for this the worker should be very sure of his ground.

When the client’s attention is called to irrational or unproductive behaviour, he may on his own consider the consequences of his behaviour or the reasons for it, according to Mollis (1972). When feelings are brought to expression, the worker can adopt any of the technique—sustaining, discussion of genetic and dynamic matter or client’s current situations.

Reactions to the Worker and Treatment:

The client’s negative reactions to the worker’s performance, the treatment process, or to agency rules and regulations may block improvement in the client and may ultimately wean the client away from the agency and worker.

This may happen when the nature of the casework process, expected outcome, worker’s role and agency’s policies and regulation are not covered in the initial discussions between them. This may happen also because of transference and distorted perception of the process and of the worker’s efforts etc.

Techniques used in this procedure are demonstrating realities of interaction between client and caseworker and of his behaviour towards him, explaining the reasons for his certain behaviour giving knowledge and information, recognising and discussing the hurdles in the treatment, spacing the interview, exploring certain attitudes, accepting one’s feelings and reactions, etc.

Procedure for Reflective Consideration of Patterns of Personality and Behaviour, and their Dynamics:

This procedure is designed for those persons who cannot benefit adequately from the earlier procedure because of intrapsychic forces operating behind their patterns (tendencies) of behaviour. Consideration of patterns of personality and behaviour does not involve probing early life experiences.

It seeks “to pursue intrapsychic reasons” for the feelings, attitudes, ways of acting and thus the specific interaction between emotions and thoughts causing problems to the client. How the libidinal (sex urges) and aggressive drives are seeking satisfaction? Is their satisfaction creating anxiety in client?

In cases where the client is vaguely aware of his unrealistic or inappropriate behaviour, the caseworker may point out and draw his attention to it. If required, reality may be demonstrated along-with discussion of the feelings and thoughts involved in the said inappropriate behaviour.

Many a time, the client does not understand/realise that his behaviour is not conducive to his proper social functioning (i.e., it is ego-dystonic or ego-alien behaviour) and that he should change his pattern of behaviour so that it really becomes ego-syntonic, i.e., conducive to his development. A student who coerces his classmates to leave the class is indulging in ego-dystonic behaviour though he thinks it to be ego-systonic. To help such students (clients) one has to first help him to realise that his behaviour is, in fact, ego-dystonic, therefore, non-congenial to his proper social functioning.

Unconscious matters revealed through dreams etc., are utilised though no attempt is made to uncover this part of the mind. Too much of use of defense mechanisms speaks of poor capacity of ego to tolerate frustrations and consequent anxiety. In such cases, one may first bring these instances to his notice and slowly interpret it in dynamic terms, i.e., how and why he used it frequently or inappropriately.

Similarly, he may be helped to recognise his impulsive behaviour to learn to control such behaviours. Certain clients suffer from excessive guilt because of too strong superego. In such cases too one may first bring the facts to his notice (i.e., recognise it) and then, if required, may discuss its inappropriateness with reference to the social reality.

When the personality needs of dependence, narcissism, self-importance become excessive, these cause problems and hinder the client’s normal social functioning. Similarly, his unrealistic beliefs about caste, religion, etc., may also distort his perception and lead him to behave in socially unacceptable or undesirable way apart from inviting troubles from various quarters. All these get reflected in the client’s interaction with the caseworker or his description of current social interactions.

Insight into the current dynamics (interplay and interaction) of his feelings, responses, behaviour in his current interaction with others leads him to improvement. To develop insight one should try to understand the emotional process, their origin (may be dissatisfaction of drives) and defense mechanisms used. Techniques may be clarification and interpretation, confrontation and logical discussion etc.

An attempt is also made in this procedure to understand how a behaviour is continuing to exist in-spite of its being counter-productive. Reinforcing factors behind these counter-productive behaviours have to be located and tackled. Positive reinforcement is required to strengthen the newly learnt behaviour.

Procedures of Reflective Consideration of the Past Development and its Effect on Current Function This procedure considers the genetic material (early childhood experiences) operating in the client’s current behaviour patterns (response tendencies). Hollis (1972) pleads for use of this procedure only when the earlier procedures fail to yield desirable results (i.e., the desired change in the behaviour pattern of the client).

In certain cases, improvement in the desired direction does not occur because of deep influence of the client’s earlier life experiences in his current functioning. These influences block his efforts to change in the required direction. Therefore, it becomes imperative to help the client to see the links between his present personality characteristics and earlier life experiences.

Once the client is able to perceive how his earlier life experiences have shaped his certain current behaviour patterns (tendencies), he can be helped to review his earlier life experiences (if it can be recalled properly) and modify his reactions to these earlier experiences. These dysfunctional characteristics (or tendencies to behave in a particular style) cannot be overcome unless he develops insight into how these experiences have shaped his present dysfunctional behaviour patterns or tendencies.

This is based on Freudian concepts, according to which childhood experiences have permanent effect on personality functioning. However, it has been now realised that earlier life experiences get modified and the later experiences are as much valuable as the earlier ones.

This procedure does not seek to understand all the determinants of a particular behaviour pattern simply because it is not possible according to modern behavioural sciences and as implied in Indian philosophical concept of ‘anekantwad’. In this procedure also, positive reinforcers for a particular behaviour pattern are to be located and handled.

Earlier misconceptions or distorted generalisations get confirmed or reinforced by later experiences. To quote an example, a girl aged 20 years was unwilling to marry a college teacher because according to her, teachers have poor social life and status.

On enquiry, it was revealed by her that this was based on her experience of her father. Her distorted generalisation got reinforced from her experiences of her neighbours also. It may be mentioned that in such cases, clients perceive what they want to perceive and recognise only those experiences which confirm their ideas.

As opined earlier, no attempt is made to uncover the unconscious or retrace the infantile experiences, except those which can be easily recalled with normal probing. No technique of psycho-analysis to understand unconscious is used.

According to Hollis (1972), the client may talk about the past (1) for explaining his problem/disease, (2) for ventilating his feelings and pressure, (3) to justify his present feelings, attitudes and behaviour, and (4) because he thinks that the worker is interested in the history of the past. The caseworker may draw the attention of the client to the inconsistencies in his behaviour or examine his past experiences in the light of realities prevailing then.

In the case of a mother who does not allow her university educated girls for marketing, the caseworker can help to link her this behaviour with her own experience of moving along when unmarried. Sometimes this behaviour of mother may be because she learnt from her parents to restrict the movement of unmarried girls.

In such a case, the link between her present behaviour and her experience of parental restriction can be established and examined and re-evaluated (in terms of the realities existing then) to develop insight. However, re-evaluation of the past experiences should be taken up only when recognition of the past’s influence on current functioning fails to bring change in the client’s social functioning.

The phenomenon of transference occurring in the transactions between the caseworker and client may also be used to understand the past’s (i.e., genetic) influence in the current functioning of the client. To quote an example, the caseworker may comment, “You want me to accompany you to Red Cross as your father used to do”.

Here, the client’s dependence that he had developed on father is reflected in the relationship with caseworker and the client is thus transferring his experience with father onto the present interaction with the caseworker as he unconsciously identifies the caseworker with father (authority) figure.

It may be mentioned that before attempting dynamic or genetic (developmental) understanding, the caseworkers should use sustaining process and ventilation. Interpretations should always be in tentative terms unless one is dead sure of the meaning of the behaviour.

Dependence of the client on caseworker for self-understanding should be minimised and he should be encouraged to think more on himself. It is always better to lead the client to think on his own than giving him readymade answers or solutions, in other words, caseworker should work with the client and not for the client.

Under the indirect casework, the caseworker works with people other than the client because these people can be helpful to the improvement in the client’s social functioning. One may work, in the case of an industrial worker, with the immediate supervisor, labour officer, wife, etc. In the case of a school-going child, one may work with the parents and teachers.

The work with these people should be taken up only when one is satisfied that these people are affecting the client’s functioning and can be helpful to effect change in his social functioning. Apart from working with significant others, one may arrange for concrete services like admission to a hospital, widow or old age pension, money for purchase of some equipment’s/medicines, etc.

While arranging these protective services, the caseworker should assess if these services will be helpful to his social functioning, i.e., these should be used as a tool to help him to perform satisfactorily in his various roles. While serving the client, the caseworker can work in the role of a provider, locator, creator, interpreter, mediator and aggressive intervener (Hollis, 1972).

Thus, Hollis’ classification is broad enough to tackle and handle most of the problems one faces in social work settings. Concepts drawn from various other approaches can be used along-with this approach. These approaches can be used as supplementary to each other. While working with rural population and tradition-bound families, use of Indian concepts has been found quite useful.

Evaluation:

In recent years evaluation has assumed a significant place in our service programmes. It has been realised that no service or project can be effective unless we continuously and intermittently evaluate the outcomes of programmes and effectiveness of the methods used to deliver services. A lot of literature has, in the last decade, emerged on evaluation of welfare services.

In social casework practice too, we need to evaluate, at least empirically, the outcome of our efforts. The purpose of evaluation, as a process of casework, is to see if our efforts are yielding any result or not, if the techniques used are serving the purpose, and if the goals are being achieved.

This is not done from research point of view, because of which we do not use any rating scale etc. Like assessment (diagnosis), this too is a continuous process. Intermittently, evaluation of the approach and result should be taken up with the client so that the efforts are meaningfully utilised.

These evaluations may tell if the problem needs redefinition, if the objectives are to be reassessed and re-determined, and if the intervention approach and techniques need any change. This will further strengthen the relationship between the helper and helpees and motivate the client to work towards his goal.

At the end, i.e., termination, the worker should discuss the original as well as revised goals and objectives, achievements during the helping period, factors helpful or obstructive in achieving the objectives, and the efforts needed to maintain the level of achievement and the feelings aroused by disengagement.

Follow-up is done to help the client maintain the improvement. During follow-up, the client is helped to discuss the problems he faces in maintaining the improvement. Work is done with the people significant for his improved social functioning. If required, he is referred to the proper source for needed services and help.

An eclectic approach or choosing the most suitable approach according to the nature of the problem is necessary to achieve the desired result. Though literature available on choice of approach in various types of problems is plenty, experience is the only key to choose the right approach in each case.

Crisis Intervention, Motivating and Skills:

We have, so far, discussed the nature of casework and casework process. There are certain situations where knowledge of casework process and human behaviour do not suffice. Such situations in casework practice are crisis, and non-motivated clients who pose challenge to the practitioners. Dealing with such situations requires specialised knowledge and approach.

Crisis:

From our experience of life, we all know that every person is subjected to various stresses, both internal or/and external at different stages of life beginning from childhood. One’s ego develops only through learning to cope with such stresses and in this process one collects various coping devices and problem-solving techniques.

These devices and techniques are usually sufficient to deal with the usual tasks of daily life. The problem arises only when internal and/or external pressures increase or the coping ability of the individual diminishes and in such situations one fails to maintain homeostasis, resulting in disequilibrium.

According to Korner (1973), crisis may occur in two ways: exhaustion crisis, i.e., when the individual under prolonged stressful conditions suddenly reach a point where he fails to cope up any more with the stressful situation. Another is shock crisis which implies a sudden change in the environment resulting in excessive release of emotions that overwhelm his coping devices and render him incapable of perceiving, cognition and decision-making.

Caplan (1951) sees a crisis occurring when an individual faces an obstacle to achieving his important life goals, which is for the time being, insurmountable by means of customary methods of problem-solving. He, like Korner, also sees various types of crisis situations precipitated by changes in the normal course of living such as leaving of home for boarding school by the child, birth of a baby, marrying daughter, unwanted pregnancy, retirement, ageing, rustication etc., and the situations, arising out of accidental and hazardous events like accidents, sudden serious illness, dismissal of the breadwinner of the family from job etc.

Crises are seen usually as self-limiting and superimposed on normally functioning personalities. Intervention in these situations aims at “alleviation of the acute reactive condition without dealing with the underlying pathology”.

Crisis situations requiring crisis intervention:

(1) In psychiatric settings are severe difficulties expressed by patients in their current living, social and emotional problems of alcoholics, suicide cases, families of alcoholics and psychotics etc.;

(2) In medical settings, major surgery cases, acute and serious illnesses, families of such patients, etc.;

(3) In family and child welfare settings, family feuds and violence, desertion by one spouse, sudden stoppage of income, immoral sex, pregnancy of an unmarried daughter, rape, running away of son/daughter, unexpected big expenditure etc., and

(4) In community settings, disasters like flood, bombarding, storm, mass killings, mine blasts, dacoity, riots etc.

Crisis intervention has been the traditional concern of social caseworkers which is clear from the writings of Gordon Hamilton, Bertha C. Reynolds, Charlotte Towle, Helen Perlman, Max Siporin, etc. Traditional approach in casework and crisis intervention has something common as well as something different.

Similarities are:

(1) Enhancing the ability of the person to cope up with the current problems in living,

(2) Intervention is for the specific problems of interpersonal conflict, role dysfunction and provisions for life,

(3) It reaches only those conflicts which are either conscious or akin to conscious,

(4) Transference is recognised and handled, and

(5) Assessment of the client’s position in family and community.

The differences are:

(1) In crisis situations, unlike traditional casework approach, where social workers work very fast because of the urgency behind the problem, the client’s willingness to take risk for regaining the sense of mastery and control over his life, and

(2) Quick decisions and actions in the role of advocate and activists are called for.

Crisis situations involve either threat to the instinctual needs, sense of well-being and autonomy or a challenge to mastery, existence and growth of individual or loss in terms of status, person, capacity, etc. It causes disequilibrium and disorganisation of self, followed by reorganisation and equilibrium. This period may last between a week to a month or so.

During the reorganisation and reintegration period, ego picks up new adaptive styles and new techniques and becomes richer to tackle similar situations in future. This is usually possible with the help available from experts or experienced persons.

Ego’s self-confidence is fortified if it can tackle such situations effectively. The coping devices (the way people learn to adopt to and master internal and/or external pressure) learnt are new addition to its armamentarium.

It is recognised that, though anyone can come across with crisis situations, there is a population which is more vulnerable to such situations. Such a population is called “population at risk”. With the “population at risk”, public health approach, i.e., primary, secondary and tertiary intervention is advisable.

While the primary intervention seeks to check “a potential situation from developing into a crisis”, the secondary intervention aims at minimising the negative influence of the resultant equilibrium of the person experiencing crisis, and the tertiary intervention tries to check further deterioration and minimise the negative effects of the scars of the crisis.

Parad et al (1976) have suggested four basic steps in crisis intervention:

(1) Search for the precipitating event(s) and its meaning to the client,

(2) Search for coping means being utilised by the client,

(3) Search for alternate ways of coping that might better fit the current situation, and

(4) Review and support of client’s efforts to cope in new ways and evaluation of results. Golan has suggested the following steps: formulation and assessment of the present situation, implementation and termination.

The caseworker, while assessing, should understand the hazardous event (a specific stress producing event), the subjective reaction (termed as vulnerable state also) of the individual or family to the event, nature of precipitating factors which heighten the tension or worsen the situation for the client, the state of active crisis (the subjective condition like psychological and physical turmoil and disturbance of intellectual functioning and of mood, etc., in the individual when his homeostatic mechanisms have become non-operative and disequilibrium, has occurred) and finally also how disequilibrium in earlier crisis situations subsided and with what advantage and disadvantage to the client in terms of learning new coping devices. Attempts should be made to understand the available supportive systems and the capacity of the client to deal with such situations.

After assessment, treatment goals are determined.

These goals may be:

(1) Relief from symptoms and checking the influence of precipitating factors,

(2) Restoration to the optimal pre-crisis stage of social function, and

(3) Locating remedial measures within the reach of the client and his family for tackling the situation. One may try to initiate new models of perceiving, thinking, feeling and adopting new responses.

Though most of the techniques enlisted by Hollis (1972) and others are useful in helping the client, provision of protective (concrete) services and partialisation of the problem, involvement of the supportive social network and catharsis may prove more useful in crisis situations caused by sudden occurrence of hazardous events.

In the termination phase, one can review the tasks completed, new adaptive devices learnt, and the new mode of relating to persons and resources in the community. The caseworker in crisis situation has to be quite active, task-focused and committed to the client cause. He should remind the client about the time limit and the tasks completed after which the client has to move on the lead given by the worker.

Crisis situations in Indian settings are usually taken care of by the social network to which one belongs. People, as we know, are often recognised as groups based either on the lines of caste, religious sects or professions etc. The person in crisis is usually helped by the people of his own group. It has been observed that Indians by and large are more humane, probably because of their religion-dominated social life.

Though it has been observed and reported that our social ties are weakening, recent increase in exploitation of masses for votes along the caste line seems to have checked this erosion to a considerable extent. Apart from this, communities in general, even in metropolitan towns, help their people in crisis situations. Such systems, if any existing in the community to handle crisis situations, need to be strengthened.

Reach Out and Motivation:

One of the important problems not infrequently faced by social caseworkers in practice is to help a client lacking in motivation or exhibiting resistance to seek help. In such an instance of a hard-to-reach client, the caseworker in the interest of the client and society approaches (reaches out) the client with his help and services of the agency.

This is seen more often in psychiatric set-up where they resent being hospitalised or examined by psychiatrists. Resistance of this nature is also common with the clients in correctional settings. These clients see their ego- dystonic (alien) behaviour as ego-syntonic (conducive) because of which they reject all help to get rid of their non-productive and non-congenial approach to life.

In these cases of reaching out {aggressive casework) one uses advocating, persuasion, coercion and actual intervention or gifts (in terms of services offered by the agency) or social pressure to help the client to seek and use available services.

In many situations, some of these techniques may be considered either as unsuitable or undesirable. In such cases, motivating the client to utilise the services offered becomes very important.

Motivation or motive refers to the desire or emotion that moves one to act. Motives are the goals or objectives which we choose to pursue for our welfare and happiness. This impels us to act accordingly. These impelling forces may be either negative or positive. The positive ones are wants, needs, desires, etc., whereas the negative ones are fears, aversions, etc.

These needs or wants develop, according to Maslow (1954) in a sequence, i.e., (1) physiological needs (hunger, thirst etc.), (2) safety needs, (3) belongingness and love, affection etc., (4; esteem needs, i.e., prestige, self-respect, and (5) needs for self-actualisation. Goals are different from wants. Goals are selected by individuals depending on their cultural norms and values, physical capacity, personal experience, availability opportunities and resources. Wants and goals go on changing and developing which along-with fears and aversion initiate and sustain behaviour of an individual. These wants and fears are subsumed under the term motive or need.

Swanson and Woolson (1973) tested their assumptions (selectively quoted below) about unmotivated clients. They say that to understand an individual’s motivational pattern, one needs to know what rewards (or hope for rewards) have kept him behaving in the fashion he behaves. This can be discerned only when we note down his successes, satisfactions, failures, traumas, pains and the rewards he values more and his kinds of efforts to solve problems etc.

They have, after their long experience of work and research, proposed that motivation is likely to increase:

(1) If the patient can become actively engaged in setting his own goals for the outcome of therapy;

(2) If goals are definite, individualised and concrete rather than being vague, general and equally applicable to all humans. These goals should pertain to both the achievement of a new level of behaviour and of a new level of feeling by the patient;

(3) If we help the patient set priorities among his goals. This, of course, includes helping him set up a series of steps to be taken in a sequence. Also, it is often useful to help him distinguish between what he wants for his own comfort and survival as against what his family or intimate groups or community want from him;

(4) In proportion to the extent to which the patient believes he has a good chance of success (Maier, 1965). Review of his past satisfactions and successes helps caseworker formulate goals which have been within the reach of a person with his assets at one time, and presumably may be possible for him to achieve again.

There is evidence that psychiatric patients need more help other people in setting for themselves goals that are neither too high nor too low (Heckhausen, 1967). There is also research evidence from several sources which indicates that being encouraged to set fairly high goals for oneself results in more achievement than does setting low goals (Rosen and D’Andrade, 1959; Coopersmith, 1967).

(5) If we help the patient becomes as aware of his habits of pursuing rewards as of his habits of avoiding traumas;

(6) If the patient is encouraged to indulge in fantasy about himself as he wants to be at the conclusion of the therapy and fantasy about both how he will be able to behave and feel after therapy. These need to be encouraged and rewarded;

(7) For psychiatric patients, as it does for students or workers, if regular feedback on result is provided (Maier, 1965); and

(8) If we help the patient restates his insights about his dysfunction into goal-oriented statements which are accurate for his individual situation.

Types of questions that might be used in attempting to help a patient understand his own unconscious goals and sources of motivation are being quoted below.

These questions, according to Swanson and Woolson (1973), should not be used in direct, quick sequence but should be used gradually over a period of days after enough trust and rapport had been developed:

(1) What do you see as your main trouble now?

(2) Can you think for a few minutes about what have been the happiest times in your life? Will you describe these times to me and focus on your memories of some of them? What elements do you think have contributed to making these periods the most happy ones? How were these periods different from now?

(3) Of what are you most proud in your life, in yourself? List several. What is your job? How do you feel about it? What are the particular rewards and satisfactions of your kind of work? What are the particular disadvantages of this job? How do you feel about your employer, your immediate supervisor, if any? How do you feel about the attitude of your company (or organisation) towards you? The union?

(4) How do you feel about the people who work with you?

(5) What changes would you like to make in your work situation? What obstacles have prevented these changes? Which of these could you change? How secure is your job? Are you carrying more than on job? Why?

(6) Have you children? What do you enjoy most about your children? What problems do you have with any of your children? What changes would you like to see in any of them? Do you want your children lives to be different than yours? In what ways? This is often the most productive question in uncovering repressed goals if patient is in a reflective mood and taking his time to answer.

(7) What do you like about your father and mother? What do you like least about your father and mother?

(8) How satisfactory is your marriage? What do you see as the main good points in the way your wife/husband treats you? Also, the main bad points? What are your own good points in relation to your marriage? Also, bad points? What changes would you like to see in your wife/husband? What improvements would you like to make in your treatment of your wife/husband?

(9) What sexual experiences have been most satisfactory for you? Why these particular ones?

(10) Can you describe your life the way you would like it to be? Let your imagination go freely. In such an imaginary picture, how would you feel most of the time? In what way is that different from the way you feel now? What work would you be doing? Where would you live? How would your living conditions be different than they are now? How would your marriage be different? Describe the kind of father/mother you would be? Describe exactly how you would make each of these choices? What changes would you like to see most in yourself? And also in your way of living? In what ways would you like to change while you are in the hospital? Can you describe what kind of person you would like to be when you get out of the hospital (press for concrete details). If the answer is vague, i.e., I want to get well, one can point out that “getting well” means different things to different people. One may use examples from among patients on the ward, whom the client (patient) knows, in order to illustrate this, i.e. “for Mr. X getting well means being able to stop losing his temper and shouting at his children, for Mr. Y, it means feeling a lot more cheerful and active most of the time, and for Mr. Z it means being able to feel relaxed and happy without alcohol”. Exactly what does “getting well” mean to you? One needs to encourage patient to describe with as much concrete details as possible.

We have talked your goals. What do you think now are the goals of some of the other people who are most affected by your behaviour, e.g., your wife, family, employer, people who work with you, etc. How do their goals fit in with yours? Are there some points at which their goals conflict with yours? Should we think about working out these conflicts between your goals and theirs?

Think quietly about yourself and your feelings over the past few years. At what times have your feelings been most pleasant, and satisfying? Can you describe what these feelings were like? What caused them?

Think quietly about your own feelings for the last few years. Try to describe very accurately the most unpleasant feelings you have had during that period. What caused these feelings? What feelings would you like most to replace them? What steps might be taken to make this replacement?

About what, have you felt most fear or anxiety during these periods? Specify it in the several years, and in the recent weeks. Have you outgrown the need for it? With what feelings would you like to replace it? What could be done towards making this replacement? What things have made you most angry during the last few years? Was this a pleasant or unpleasant feeling to you? To what degree?

Have you ever really solved the problem that made you so angry or does it continue to recur? What steps might be taken to solve it instead of enduring its recurrence? How did you behave when you were angry? Can you think of any other behaviour that might have been more effective or preferable?

Social caseworker then considers these points and uses these questions to understand and enhance the client’s motivation to utilise available services for his real help. Effectiveness of casework services rests on the individual’s motivation, capacity and the opportunity he gets. To motivate him, his level of discomfort with the existing state of affairs will have to be increased by focusing on it, changing his values and definitions, creating fear of social criticism and loss, appealing to his family pride and assuring him of a better future along-with extra doses of acceptance.