Principles of Practice

A client once compared our approach with the following saying,

"give a man a fish and he has food for a day, teach a man how to fish and he has food for life".

A reluctance to give out fish sums up our approach.

Our principles of practice are the social learning theory, the public health model and adult learning principles. These shape our approach and have been selected for two reasons. Firstly, we want to be as sure as we can that what we do works, and so we use scientific measures and methods that have been proved to be effective. The second reason is that these theories fit with our service philosophy. We agree with the view that health is a product of lifestyles and living conditions, and accept that lifestyles contain different patterns of behaviour that have both benefits and costs to the individual and the community.

We find that the social learning theory, a systematic study and theory of how humans learn to behave, think and feel, helps us to understand different patterns of behaviour. Through this theory we can appreciate the benefits as well as the costs of the behaviour for each client. Assuming that all behaviours are learnt in the same way, albeit at different levels, encourages us to be non-judgemental. It teaches us to view the behaviour as normal and functional, rather than abnormal and dysfunctional. We are therefore able to accept that clients have made rational choices based on the information they had at the time.

Providing clients with information about learning opens up opportunities for change and gives them the responsibility for their own well being. Recognizing where responsibility for change lies can be the greatest therapeutic insight that clients can have - it shows them that there are fish in the waters to be caught.

However, we expect that there will be a reluctance to give up a behaviour otherwise the person would probably already have done it. We accept that quite often the client does not have sufficient knowledge, skills or helpful beliefs to make changes at this stage. So, we use the technique of motivational interviewing, provide personalized information and offer skills training. Motivational interviewing aims to resolve ambivalence and reduce resistance. Through skilful reflective listening, some points are reinforced and others de-emphasized in order to create internal discomfort and discrepancy. By empathically highlighting how a person's current behaviour is inconsistent with their future goals, we can assist the client toward motivation for change through their own desire to resolve this discrepancy.

The task is to release potential and to facilitate the natural change processes. The counsellor does not present as an expert, as this tends to edge people into a passive role. He or she is treated as an ally, and no value judgements are used. Terms such as "well done" or "good" are avoided, as are various labels that may become barriers to change. The aim is to reinforce self-responsibility and show respect. Instead of labels or value judgements, the client's own perception of events is reflected. For example the counsellor may say, "you seem really pleased with how you are going". This technique displays unconditional positive regard for clients and therefore encourages a non-defensive view of their situation. When these techniques are used during an assessment, it allows clients to explore their experiences openly, and assists them, and us, to make sense of what is happening.

When clients have a clear picture of their position, then they are able, if they wish, to set goals and develop strategies for change. At this stage some clients are able to leave and implement their elected strategies. Others will have identified a need for more information or the development of specific skills, and so will return for further intervention.

Another way we demonstrate unconditional positive regard is to uphold our promise of confidentiality. We release no information whatsoever (except for issues requiring mandatory reporting) without prior written consent, even to the point that we will neither confirm no deny if a client has made an appointment at our agency. Due to this policy, we are sometimes unpopular with other services.

The use of adult learning principles ensures that information is provided to clients in a manner that will be most easily absorbed. It is important to firstly establish whether there is a need to learn, and then asking the client about their learning preferences so that material can be adapted to suit. It entails making the information relevant to the life context of the individual, and drawing upon the existing skills and life experience of the client as a resource for future learning. Using the fishing analogy, it is providing the rods, lures and bait, all essential tools to facilitate learning.

The public health model, which argues a systems approach, blends nicely with our philosophy, due to its emphasis on the interaction between the drug or activity, the individual, and the environment. In other words, the lifestyle or pattern of behaviour, the person, and their living conditions are considered. Explaining this model enables clients to understand that the existence of a particular behaviour may be the result of many influences. This knowledge assists them when developing strategies for change. It highlights that successful change of a behaviour may involve addressing the system in which their behaviour occurs, rather than focussing exclusively on the individual or the environment.

Ongoing evaluation of our service supports our overall approach. Evaluation has involved participation in a client outcome study, regular provision of evaluation questionnaires to clients, ongoing request for feedback from other agencies, and yearly review procedures as a part of staff development policy.