Pathways to Empowerment - Judith Wolf

Pathways to Empowerment

Methodically working on participation and self-direction

Judith Wolf

Pathways to Empowerment

‘Driven by knowledge, moved by people’

Pathways to Empowerment Methodically working on participation and self-direction

Judith Wolf

Translation of the Dutch revised second edition

bussum 2021

www.coutinho.nl/pathways You can start working with the online study materials accompanying this book. These materials consist of links, worksheets and an example of a safety plan.

© 2012/2016/2021 Impuls – Onderzoekscentrum maatschappelijke zorg, Radboudumc Nijmegen All rights reserved. No parts of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, storing in an information retrieval system or otherwise, without prior permission from the publisher, unless it is in accordance with the exemptions established in the Copyright Law of 1912. For reprographic reproduction as permitted on the basis of Article 16h of the Copyright Law of 1912, the legally required fee should be paid to Stichting Reprorecht (www.reprorecht.nl). Enquiries concerning the reader regulation should be made to Stichting UvO (publisher’s organisation for educational licenses, www.stichting-uvo.nl). For the use of copyright-protected material in newspaper cuttings, contact Stichting PRO (publication and reproduction rights organisation, www.stichting-pro.nl).

First edition (Dutch) 2012 Revised second edition (Dutch) 2016

Uitgeverij Coutinho P.O. Box 333 1400 AH Bussum info@coutinho.nl www.coutinho.nl

Cover: Jeanne design, Arnhem Icons Ten life areas: Deel 2 ontwerpers, Nijmegen Interior layout: Coutinho/az grafisch serviceburo bv, The Hague

Editor’s note Every effort has been made to trace copyright holders. Persons or organisations wishing to assert specific rights are kindly requested to contact the publisher.

ISBN: 978 90 469 0810 5 NUR: 752

Preface

Pathways to Empowerment is a strength-based methodology for providing social support to people in situations of disadvantage. The reason for developing this methodology was the desire of social support institutions to give new impetus to the method-based action of counsellors, with the aim of improving the quality of counselling given to people facing disadvantage. The initiative came from the institutions of the Academische werkplaats Opvang & Herstel (Academic Collaborative Center for Shelter and Recovery) and Impuls, the Netherlands Center for Social Care Research of the Radboud University Medical Center (Radboudumc Nijmegen) (www.impuls-onderzoekscentrum.nl). Pathways to Empowerment takes the individual strengths and potential for growth of its clients as the starting point and focus of its work. During the development of the strength- based approachby Impuls, in the period2008-2011, therewas intensive cooperation with clients, counsellors, policy officers, andmanagers of social support institutions. This cooperation resulted in a number of books and materials for the benefit of vulnerable people, such as homeless adults and young people (Wolf, 2012a, 2012b, 2012c), and women who have experienced violence (Wolf & Jansen, 2011; Bos, Reijmers, Scherpenisse, Jonker &Wolf, 2012). A process evaluation carried out in 2014 provides more information on the background and development of the strength-based methodology and the decision to give it the name Pathways to Empowerment (Krachtwerk®) (Wolf, Jonker & Jansen, 2015). Pathways to Empowerment has really taken off in recent years. Since 2010, more than 50 institutions throughout the Netherlands have chosen to implement this methodology in their organisations. Nearly 4000 counsellors have successfully completed basic Pathways to Empowerment training at the Impuls academy. In addition, policy officers and managers of the institutions took part in training days in order to have the tools needed for embedding and safeguarding the methodology in their organisations. Requests to use Pathways to Empowerment now also come from local authorities, for example, which are keen to apply the methodology in district social teams, addiction care, juvenile care and refugee shelters. There is also interest in Pathways to Empowerment from abroad. An important step in the development of Pathways to Empowerment was its formal recognition as being ‘well-founded’. On the basis of this recognition, Pathways to Empowerment has been included in the Effective Social Interventions Database of Dutch knowledge institute Movisie (www.movisie.nl/esi/krachtwerk). But possibly more important is the appreciation of clients for the counselling they receive with Pathways toEmpowerment to support their recovery. Clients recount feeling renewed courage, cherishing hopes for the future, experiencing their own strength and being

able to get to work on their personal goals. These responses strengthen our wish to use Pathways to Empowerment to give more clients prospects for a meaningful life. The immediate motive for this edition (i.e. the translation of the revised second edition inDutch) of the book about the basic strength-basedmethodology (Wolf, 2012a) was the desire of the social domain and sectors other than that of social support institutions to deploy Pathways to Empowerment, and the requests from universities to make it available for training students. Many individuals and institutions have made valuable contributions to the development of Pathways to Empowerment and this methodology book. The methodology would not be what it is today without the inspiration and support of the social support institutions in the Academic workplace and the involvement of Federatie Opvang, the sector organisation for social care, sheltered housing and women’s refuges. Also worthy of a special mention is the space that Charles Rapp and Rick Goscha gave us to apply and elaborate their strengths model (see Rapp & Goscha, 2012) in the Netherlands into a methodology for people in disadvantaged situations. Thanks are also due to Geert van der Laan, Sjef de Vries and Roel Bouwkamp: their valuable contributions to the professionalisation of method- based action in social work in the Netherlands have been integrated into the methodology in as recognisable a way as possible. In developing the methodology, we also drewon the accumulated body of knowledge of the recoverymovement and approaches to recovery for people with severe mental health conditions and addiction problems, with specific thanks toDirk denHollander, Jean PierreWilken, Wilma Boevink, Gert de Haan and Jaap van der Stel. The input from our Pathways to Empowerment trainers has also been of great value, especially that of Eric Albers. Important input for this edition (i.e. the revised second edition in Dutch) was provided by Carinda Jansen and members of a focus group: Yvonne Boersma and Rionne van de Laar (Higher Professional Education students, Social Work and Service Delivery (SW&SD)), Marjo Boer, Anja Gouwerok, Corinne Lenting- Eijkman and Inke Schaap (lecturers in social service professional education), Hans Aalders and Janne Baudoin (Pathways to Empowerment trainers), and Wytze Groen (manager of social support institution). Their feedback on the first edition of the book on thismethodology (Wolf, 2012a), together with their suggestions for case studies and assignments, prompted a thorough revision. From the Impuls academy, Irene Jonker, Nicoline Jansen and Milou Christians were always on hand with solicited and unsolicited advice, and they tested the correct use and the quality assessment of Pathways to Empowerment’s instruments. In addition, together with Manja van Wezep, they provided in-depth information on the central topics of Pathways to Empowerment. Many thanks are due to Ragna van Kesteren and Nicoline Jansen for putting the final touches to the book.

Judith Wolf Nijmegen, June 2016

Table of Contents

Introduction

15

Online study material

20

PART I Foundations of Pathways to Empowerment

1

Pathways to Empowerment

23

1.1 Hope and prospects in disadvantaged situations

23 24 25 25 26 26 28 28 29 30 30 31 31 32 32 37 40 40

1.1.1 Participation and personal control

1.2 People with a disadvantage

1.2.1 Emotional, physical, social and material challenges

1.2.2 On the defensive

1.3 Disruption in self-regulation 1.4 Improving the quality of daily life

1.4.1 Managing yourself and your existence 1.4.2 Building the conditions of your existence

1.5 A strength-based counselling programme

1.5.1 The client

1.5.2 The environment 1.5.3 Professionals

1.5.4 Counsellors

1.5.5 The programme: an iterative search process

1.6 Recovery-supporting and non-recovery-supporting practices

1.7 Implementation according to the model

Assignments

2

Cornerstones of participation and personal control

43

2.1 Cornerstones of participation and personal control

43 44 44 47 49 50

2.1.1 Hope

2.1.2 Self-regulation 2.1.3 Citizenship

2.2 Recovery, self and identity

2.2.1 The self and the individual identity

2.3 Forms of recovery 2.4 Recovery process

51 53 53 54 54 56 56 57 58 58 61 62 63 63 63 64 64 64 65 65 67 67 68 68 69 69 69 70 70 71 72 74 75 77 77 78 79 80 81 67

2.4.1 Personal recovery: unique and personal 2.4.2 Self-regulation as a mechanism for change

2.4.3 A range of developments

2.5 Sources and outcomes of recovery: resilience and compassion

2.5.1 Resilience 2.5.2 Compassion

2.6 Recovery in relation to others

2.7 Conditions for participation and personal control in society

2.8 Hope for a meaningful existence 2.9 What works: basic principles 2.9.2 Responsiveness principle 2.9.3 Balance principle 2.9.4 Integrity principle 2.9.5 Context principle 2.9.6 Continuity principle 2.9.7 Professionalism principle 2.9.1 Need principle

Assignments

3

The working relationship: respect and trust

3.1 The importance of a good working relationship 3.2 Critical elements of an effective working relationship

3.2.1 Confidence-building and loyalty 3.2.2 Goal-oriented and meaningful 3.2.3 Reciprocal and setting boundaries

3.2.4 Authentic

3.2.5 Strengthening and nourishing 3.3 Reciprocity and communication 3.3.1 Directing and being directed 3.3.2 Quality of the communication 3.4 Taking seriously through confrontation 3.4.1 Rules for careful confrontation

3.4.2 Confronting with complete messages

3.5 Pitfalls in the working relationship and reacting personally

3.5.1 Pitfalls in the working relationship

3.5.2 Reacting personally

3.6 Etiquette for counsellors

3.7 Boundaries of the working relationship

Assignments

PART II Strength-based counselling programme

4

Meeting and connecting

85

4.1 Importance of meeting and connecting 4.2 Clients also conduct an intake interview 4.3 Method-based tools for use when meeting 4.3.1 A guest in the client’s life 4.3.2 Begin where the client is 4.3.3 Meet basic needs 4.3.4 Help to guarantee safety 4.3.5 The client’s own narrative 4.3.6 Tuning in to the client 4.4 The power of the first meeting 4.5 Connecting with the client

85 85 86 87 87 87 87 87 88 89 92 92 93 93 94 95 95 95 95 96 97 97 99

4.5.1 Listening

4.5.2 Welcoming posture

4.6 Dealing carefully with available information

4.6.1 Assessment of available information and agreements

4.7 Asking the right questions and summarising

4.7.1 Asking for clarification

4.7.2 Open questions 4.7.3 Scale questions

4.7.4 Outcome questions and the miracle question

4.7.5 Summarising

4.8 Offering hope

Assignments

5

Making an inventory of strengths

103

5.1 The importance of an inventory of strengths

103 104 104 104 104 106

5.2 Curious about the client’s self

5.2.1 Empowerment 5.2.2 Slow process

5.2.3 Immersing oneself and spending time together 5.2.4 Including, estimating and evaluating as second nature

5.3 Forms of strength

108 108 108 109 109 109 109 113 113 113 114 115 116 119 120 121 121 123 123 124 125 125 126 127 131 134 135 136 137 140 141 121

5.3.1 Personal qualities 5.3.2 Talents and skills

5.3.3 Strengths and opportunities of the environment

5.3.4 Interests and aspirations 5.3.5 Knowledge and experience

5.4 Ecogram: insight into relationships and resources

5.5 The inventory of strengths

5.5.1 The inventory of strengths in brief 5.5.2 Examples of strength-based questions

5.5.3 Gleaning

5.5.4 The most important things in life and wishes for the future

5.5.5 Example of an inventory of strengths 5.6 Quality assessment of an inventory of strengths

Assignments

6

Evaluating self-regulation

6.1 The importance of evaluating self-regulation

6.2 Supporting reflectiveness

6.2.1 Clarifying without denying ownership 6.2.2 Reflection in relation to reference values

6.3 Suffering from life

6.3.1 Negative situations and normal transitions

6.3.2 Loss and grief

6.4 Cracks and fractures in an individual’s existence

6.4.1 Disadvantaged in ability to act, relationships and development

6.4.2 Part of a greater whole

6.5 Risk factors and protective factors

6.5.1 Risk factors of social exclusion

6.5.2 Strengthening factors of participation and personal control

6.6 Evaluating self-regulation

6.7 Coping questions and exception questions

Assignments

7

Setting goals and drawing up an action plan

143

7.1 The importance of goals

143 144 145 147

7.2 Where there’s smoke, there’s fire 7.3 ‘Producing’ motivation 7.4 Zone of proximal development

7.5 Personal action plan

148 148 149 151 151 154 155 156 157 157 159 160 160 160 161 161 162 162 163 167 168 168 169 172 177 180 180 183 188 188 191 193 159

7.5.1 Action plan as work agenda 7.5.2 Focus on the future: long-term goals 7.5.3 The difference is in the formulation 7.5.4 From long-term goals to achievable actions

7.5.5 Example of an action plan 7.5.6 Getting started on actions

7.6 Why goals are sometimes not achieved 7.7 Quality assessment of the action plan

Assignments

8

Supporting recovery

8.1 The importance of supporting recovery 8.2 Method-based tools for supporting recovery 8.2.1 Self-regulation as means and end

8.2.2 Be alert to problems

8.2.3 Active and responsible attitude

8.2.4 Mix of interventions

8.3 Strengthening one’s own regulation and development

8.3.1 Supporting reflectiveness

8.3.2 Self-care

8.3.3 Redefining yourself

8.3.4 Stages of personal recovery 8.4 A sense of belonging with others

8.4.1 Reciprocity and fairness in relationships 8.4.2 Finding, using and supporting social resources 8.4.3 Multiple bias and diverse frames of reference 8.5.1 Evaluation and re-evaluation of personal effectiveness 8.5.2 Regaining and strengthening competences 8.5 Strengthening the ability to act

8.6 Access to rights, resources and institutions

8.6.1 Gaining access to environments that support recovery

8.6.2 Working on exclusion mechanisms

Assignments

9

Evaluating and concluding

197

9.1 The importance of evaluating

197 198 198 198 199 201 202 204 204 205 205 206 206 208 208 209 209 209 210

9.2 Key points to consider when evaluating 9.3 Monitoring and adjusting, reflecting and learning

9.3.1 Monitoring and adjusting 9.3.2 Reflecting and learning 9.4 Looking back and looking ahead

9.5 How do you evaluate?

9.5.1 Evaluation report

9.6 The importance of concluding

9.7 Key points to consider when concluding 9.8 Finishing positively and saying goodbye

9.9 How should you conclude?

9.9.1 Exit interview

9.9.2 Safety plan or crisis card 9.9.3 Final evaluation and review 9.9.4 Network consultation

9.9.5 Final report

9.9.6 Concluding without contact

Assignments

PART III Conditions

10

Team strength meeting

215

10.1 The importance of the team strength meeting 10.2 Teams as vehicles of strength-based working 10.3 Carrying out the team strength meeting

215 216 216 219 220

10.4 Attention to quality

Assignment

11

Implementing and safeguarding strength-based working

221

11.1 The importance of implementing and safeguarding 11.2 Change process and model compliance as anchor

221 222 226 226 230

11.3 Working at various levels on a good fit with Pathways to Empowerment

11.3.1 Professionalism

11.3.2 Connections with the environment

11.3.3 Work processes

232 235 237 237 238 238 238 239 241

11.3.4 Management and policy

11.4 A learning organisation

11.4.1 Case-led 11.4.2 Focus

11.4.3 Reciprocal direction 11.4.4 Learning and reflecting

11.4.5 Professionalism

Assignments

Appendices

1 Ten life areas of Pathways to Empowerment: description and sample questions 2 Competences of counsellors using Pathways to Empowerment 3 The model compliance of Pathways to Empowerment: indicators and quality requirements 4 Mission and participants of the Academic Collaborative Center for Shelter and Recovery

245 264

266

270

References

273

Index

283

About the author

288

Introduction

Introduction

For people in disadvantaged situations who have lost control of their lives, Pathways to Empowerment offers an inviting prospect. This strength-based methodology supports such people in their recovery towards a quality of life that they wish to have, in which they, just as every other citizen, are allowed to participate in society, belong, have significance, and be who they are. Clients’ own strengths and potential for growth, and what they believe is most important for their future, form the starting point and the focus. Together with others around them, people actively set to work with the help of goals and action plans that they have chosen. ‘I’ve had all kinds of methodologys, but now for the first time it isn’t therapeutic. This is simple, effective and good; it has become more human. This isn’t forced on you because it comes from you.’ (Client) Addressing issues in the social domain Pathways to Empowerment provides tools for the challenges that social work is facing in today’s radically changing field of influence, in view of the policy focus on an individual’s own strength and self-reliance, and on support from society in the neighbourhood. There is a greater emphasis on the ability of people and their social networks to organise themselves, and only if these fall short is professional help brought in. Due to cutbacks, more help has to be provided with less money. The trend towards more extramural care (e.g. in care of the elderly and the disabled, and mental healthcare) and changes in the funding of long-term care also mean that vulnerable people continue to live independently for longer and that we can expect to see an increase in the number of people in the community who find it hard to cope in society. Pathways to Empowerment provides principles andmethod-based tools to equip professionals from various occupations better in order to meet the new requirements of working with diverse groups of vulnerable people. Pathways toEmpowerment is deployed to deal withmajor social issues, such as homelessness, domestic violence, addiction, release from prison, and refugee problems. Pathways to Empowerment: • lays a well-founded base under the professional method-based actions of counsellors and can ensure greater clarity within and between teams – including district teams – and organisations in method-based work and the development of a common language; • offers cornerstones and principles on the basis of which counsellors, volunteers, experts by experience, and employees of support services (receptionists, night staff, etc.) approach clients and support them, regardless of the setting and the nature and duration of the services provided;

15

Pathways to Empowerment

• provides insights and tools for creating an optimal working relationship with clients, increasing the chance of successful counselling; • offers instruments to assist clients in making an inventory of their strengths and resources, such as the inventory of strengths (IS); • provides insights and tools to assist clients in evaluating their self-regulation, specifically their way of dealing with setbacks; • provides an instrument to assist clients in setting their long-term goals and setting down actions in the form of personal action plans; • gives counsellors instructions for tapping into resources together with clients; • provides an instrument (a step-by-step plan for team strength meetings) for learning together inmultidisciplinary teams from ‘what works’ with clients and for strengthening and safeguarding the strength-based, recovery-supporting work of counsellors. Origins and further development As a methodology, Pathways to Empowerment is based on theoretical concepts and models (theoretically founded), scientific knowledge of what works (evidence-based), and relevant expertise from the field (practice-based). It is based on the strengths model developed by Charles Rapp and Rick Goscha at the University of Kansas in the United States at the end of the 1990s for people with severe mental health conditions, and adapted for use in social work by Dennis Saleebey (2006). The adaptation made use of work principles that had long been known in social work ( Jagt, 2008; Richmond, 1917; Saleebey, 2006; De Vries, 2008). These principles, such as the importance of ‘being there’ and ‘starting where the client is’ have actually existed for as long as people have been caring for one another (Van der Stel, 2013; Wolf, 2013). They have been elaborated in a multitude of methods, including the presence approach (Baart, 2001), the approaches focusing on empowerment and rehabilitation (Van Regenmortel, 2002; Korevaar & Dröes, 2016; Wilken & Den Hollander, 2012), and outreach (Van Doorn, 2004), active intervention (Lohuis & Schout, 2000), and Flexible Assertive Community Treatment (FACT; Mulder & Kroon, 2005). Theneweditionof thismethodologybookhasbeenseizeduponas anopportunity to broaden and deepen Pathways to Empowerment. The methodology is now more explicitly grafted onto the concepts of self-regulation and self-determination. Information from scientific research has been integrated into the methodology – research on self-regulation and self-determination, on contexts in which people experience happiness and manage to flourish, and on personal qualities and skills that contribute towards this blossoming (positive psychology; Bohlmeijer, Trompetter, Schotanus-Dijkstra & Drossaert, 2015). This connects with a broad concept of health – positive health – and with what is known about what works in health promotion and self-management.

16

Introduction

Strengths model proven to be effective International studies carried out with various target groups point to positive effects obtained through the application of the strengths model and similar interventions focused on empowerment (see Wolf et al., 2015). Most studies focus on vulnerable people with chronic mental health conditions who experience problems in various life areas, such as obtaining and retaining housing, work and social relationships. These studies booked positive results in health (including mental health) and hospitalisation (Björkman, Hansson & Sandlund, 2002; Macias, Kinney, Farley, Jackson & Vos, 1994; Macias, Farley, Jackson & Kinney, 1997; Modrcin, Rapp & Poertner, 1988), skills for independent living and daily activities (Macias et al., 1994; Modrcin et al., 1988), job training and income (Macias et al., 1997; Modrcin et al., 1988; Stanard, 1999), social support and behaviour (Macias et al., 1997; Modrcin et al., 1988), leisure activities (Modrcin et al., 1988), quality of life (Stanard, 1999), and satisfaction with the help given (Björkman et al., 2002). However, other target groups – people with addiction problems, women who have experienced violence, and young homeless people – also appear to benefit from a strength-based intervention (Rapp et al., 2008; Saewyc & Edinburgh, 2010; Song & Shih, 2010). This edition The desire of the social domain and sectors other than emergency and sheltered accommodation to deploy Pathways to Empowerment and the requests from universities to make Pathways to Empowerment available for training students were the incentive for a thorough revision of the methodology book on the basic strength-based methodology for vulnerable people (Wolf, 2012a). In fact, each chapter has been rewritten and new information and insights have been incorporated. The most important innovations, in addition to the consistent incorporation of the concepts of self-regulation and self-determination, are: • the three cornerstones of Pathways to Empowerment: hope, self-regulation and citizenship; • a deepening of the concept of recovery, in particular personal recovery, and the importance of resilience and self-compassion; • the forms of recovery – personal, social, functional and societal – that are also the starting point for supporting clients in their own individual recovery process; • strengthening the systemic approach of Pathways to Empowerment through the integration of the contextual approach; • practical tips for counsellors in carrying out the basic tasks of a strength-based counselling programme; • the conditions for participation and personal control in society: social empowerment, social cohesion, socio-economic security and social inclusion; • the description of the indicators and quality requirements of the model compliance of Pathways to Empowerment.

17

Pathways to Empowerment

Transfer: attitude, knowledge and insights This methodology book has been written for teaching, training and further professional training. It helps students and counsellors to master an attitude and acquire the competences needed to do strength-based work with clients and provides themwith specific tools to domethod-basedwork on client participation and personal control. You can increase your proficiency through practical exercises (at work or during an internship) and by linking the fundamental aspects of Pathways to Empowerment to the daily reality of counselling. The chapters provide practical insights (quotes from clients and counsellors, cases, references to film clips) and each chapter concludes with some assignments in order for the reader to process the knowledge and insights provided. Pathways to Empowerment sees counsellors as practitioners and it is only through practice and working with clients that they can really master the strength-based working methodology. By reading, actively internalising and applying the knowledge in this methodology book, you will: • become familiar with the cornerstones and principles of Pathways to Empowerment; • know which factors are connected with the quality of life of clients; • understand the meaning of recovery and know the forms and phases of recovery; • know why a good, respectful working relationship is necessary and how you can create it; • be able to help people recognise their strengths and opportunities; • be able to give people insight into the way they deal with challenges in life and with their own regulatory process; • have drawn up an inventory of strengths and an action plan, and you will know how to use it in practice with clients in achieving the goals they have chosen; • knowhowyou can use your position to support the recovery processes of clients; • know the conditions necessary to implement Pathways to Empowerment successfully and safeguard it. Hopefully Pathways to Empowerment will give an impetus to enhancing the quality of counsellors’ professional work and that it will support and strengthen disadvantaged people in their quest for a meaningful existence. Structure of this book This book about Pathways to Empowerment consists of 11 chapters divided into three parts, covering the foundations of Pathways to Empowerment, a strength- based counselling programme, and the conditions for implementing and safeguarding the methodology. At the end of the book there is a list of references and an index, as well as four appendices. Appendix 1 gives an explanation of the 10 life areas that are central to Pathways to Empowerment, with a number of sample questions for each area. Appendix 2 gives an overview of the strength-based

18

Introduction

competences of counsellors. Appendix 3 gives an overview of the indicators and quality requirements of Pathways to Empowerment’s model compliance, and Appendix 4 lists all the participants of the Academic Collaborative Center for Shelter andRecovery. This book is accompaniedby awebsite – www.coutinho.nl/- pathways – where you can find additional information. Part I begins with a characterisation of Pathways to Empowerment and the methodology’s target group: people in disadvantaged situations (Chapter 1). Chapter 2 gives an overview of the cornerstones of Pathways to Empowerment; addresses the concept of recovery and the relationship with the self and one’s own identity; describes the four forms of recovery and the recovery process; and deals with recovery in relation to others, together with the conditions for recovery in society. This first part concludes with Chapter 3, which centres on the working relationship as the foundation of work with clients. Part II gives an extensive description of the strength-based counselling programme. The successive chapters cover the seven basic tasks of this programme: meeting and connecting (Chapter 4), making an inventory of strengths (Chapter 5), evaluating self-regulation (Chapter 6), setting goals and drawing up an action plan (Chapter 7), supporting recovery (Chapter 8), and concluding (Chapter 9). Each of these chapters covers the importance of the basic task; goes into more detail about the subjects that are key to the basic task; and describes method-based tools and aids. Finally, tips and sample questions are given for counsellors to help in carrying out the basic task. Part III covers the conditions for successfully implementing and sustainably safeguarding Pathways to Empowerment. Chapter 10 explains the importance and the steps of the team strength meeting (a form of peer-to-peer reflection for the counsellors). Chapter 11 addresses the importance of implementing and safeguarding, and describes the characteristics of a comprehensive change process that is needed to embed Pathways to Empowerment in a team or organisation. There is also a discussion of what is important for a good connection between Pathways toEmpowerment and four levels of care (professionalismof counsellors, connections with the environment for the operational work with clients, work processes in a team or organisation, and management and policy). Finally, there is an outline of a learning organisation, because such an organisation offers favourable conditions for embedding Pathways to Empowerment.

19

Pathways to Empowerment

Online study material

On www.coutinho.nl/pathways you will find the online study material that goes with this book. This material consists of: • links • worksheets, for example of an inventory of strengths and of an action plan • example of a safety plan

In this book, references are made to the website using this icon:

See www.impuls-onderzoekscentrum.nl for more background information and in depth knowledge (in Dutch).

20

PART I Foundations of Pathways to Empowerment

21

22

1.1 Hope and prospects in disadvantaged situations

1

Pathways to Empowerment

Pathways to Empowerment provides principles and method-based tools for the social support of people in disadvantaged situations. This chapter begins with a characterisation of Pathways to Empowerment. It then describes how people fall behind and which factors play a role in this process. This provides points of reference for supporting clients in their recovery. We discuss a strength-based counselling programme, with an overview of the strength principles, the actors involved in the programme and the basic tasks and life areas of Pathways to Empowerment. We also describe the conditions for working on supporting recovery and the differences between practices that support recovery and those that do not. The chapter concludes with the importance of implementing Pathways to Empowerment in a way that is model-compliant.

1.1

Hope and prospects in disadvantaged situations

Pathways to Empowerment was developed to give new hope and prospects for a fulfilling life to people who have fallen behind in society. The principal cornerstone of Pathways to Empowerment can be found in the mission statement of this methodology for supporting recovery:

Supporting people in disadvantaged situations in their recovery process to become full members of society and to achieve the quality of life that they wish for.

Pathways to Empowerment takes the individual strengths and potential for growth of its clients as the starting point and focus of counselling. The basic principle is that even in the face of adversity and with limitations in their functioning, clients have the ability to recover, pick up their lives again and change. The ultimate limits of the potential for growth and change are not fixed in advance. The task of every counsellor in social work is to support clients in gaining an understanding of their personal situation and their values, in developing and achieving goals with the aim of living a meaningful existence, and in improving their self-regulation and resilience. Counsellors focus on using and

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1 Pathways to Empowerment

enhancing the client’s competences as much as possible, and on building a social support structure for informal support, using professional help as little as possible (Siegel et al., 1995). You can read more about these and other strength principles in the box in subsection 1.5.5. ‘My life hasn’t always been easy and I’ve had to deal with really unpleasant situations. I had a negative self-image. Over time, you start to believe what everyone says about you. Things are different now. I’m approached on the basis of my strengths and opportunities. I’ve discovered that I can stand up well for myself and that I’m very sociable. I now know that I can make my own choices and achieve things. I ask questions about what I want for my future and how I can make it happen. The intention of strength-based working is for you to use your own strength to pick up your life again.’ (Client) 1.1.1 Participation and personal control The things that give sense to the lives of people in disadvantaged situations and give them strength include secure conditions of existence (housing, income, activities, security, etc.); the opportunity to make their own choices and achieve their own goals; the acceptance of their situation but also the knowledge that they are accepted by others; meaningful and reciprocal relationships; meaningful experiences and activities; and pleasure and relaxation (Plantinga, Oliemeulen, Vleems, Jansen & Wolf, 2011; Al Shamma, Wewerinke, Boersma, Beijersbergen &Wolf, 2012). Pathways to Empowerment responds to these needs and wants to help fulfil them, mainly by strengthening the participation and personal control of clients. Participation means carrying out activities with others, with a view to achieving goals, and represents taking part in society in all its facets. This is all about being involved, belonging and having significance. It is connected with full citizenship, which is also one of Pathways to Empowerment’s major cornerstones. Participation gives structure and meaning to life, provides opportunities to learn or improve competences and obtain resources (income, accommodation, support, etc.), enables meaningful bonds with others, strengthens feelings of self-esteem, and is essential for developing a positive identity. Through participation, people also receive critical feedback from others, which gives them the chance to regulate themselves and their behaviour better (Wolf, 2015). Taking part and belonging both call for reciprocity in relationships, actively fighting stigma or self-stigma, and the courage to let go of the benefits and advantages associated with illness and disability (Wolf, 2015). Self-determination represents the principal value of respect (Donkers, 2015) and concerns the desire togain and exercise an influence on the quality of your life and the quality of care, and also the wish to withstand in the best way possible emotional, physical, social and material challenges in life. The aim is for less dependency, more autonomy and greater positive health (Huber, Van Vliet, Giezenberg & Knottnerus,

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1.2 People with a disadvantage

2013). The focus is on being able to choose relatively autonomously what you think is important (in various life areas and in care) and being able to achieve as much as possible the things that you prefer and that you wish for. We use the word ‘relatively’ here, because people are of course never totally free in their choices. People do not function in a vacuum, but in contexts that impose demands on their actions and also direct them, and, if necessary, restrict or limit their actions through pressure or coercion. Pathways to Empowerment assumes that it is only in interaction with their environment that clients can reach their full potential, develop competences and find their true selves to the best of their ability. The client is seen as a person who has a sense of belonging with others. Pathways to Empowerment therefore takes the interaction between the individual and the environment as the starting point for method-based actionand focuses stronglyon thepositionof clientswithin their social networks and society as a whole. In order to give direction and guidance to the method-based work of counsellors, an understanding is needed of the way in which people fall behind and the factors that influence this. This provides insight into the goals and intended outcomes, and offers points of reference for supporting clients. 1.2.1 Emotional, physical, social and material challenges Pathways to Empowerment is used for a variety of people who have problems – or combinations of problems – and are having difficulties participating wherever they find themselves – at home, in an institution or clinic, or on the street (Van Hemert & Wolf, 2011). Many kinds of circumstances or events can make it difficult for people to organise themselves and their lives. They may have little hold on themselves, experience problems in playing roles in society and move almost imperceptibly towards the fringes of society. In many cases, it is not exactly clear what is a cause and what is a consequence of disadvantage (Wolf, 2002). In the target group of Pathways to Empowerment, subpopulations can be distinguished in which one or more characteristics aremore pronounced, such as emotional and/or behavioural problems (fear, sadness, trouble controlling impulses), physical problems (illness and physical discomfort), social problems (relationship conflicts, parenting problems, loneliness, nuisance from neighbours) and material shortages (debts, inability to make ends meet). Intellectual or physical disabilities or mental health issues can be at the root of many problems. There can also be problems related to violence (child or parent abuse and/or violence against the partner). Age-related circumstances (e.g. becoming an adult, aging, the death of a partner, children leaving home) are sometimes too much of a challenge for clients. People with a disadvantage

1.2

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‘After my husband died, there came a point when I no longer knew how to cope with everything. Then I went to have a cup of coffee at the local community centre. A young man approached me for a chat. He asked me whether I would like to have a longer talk with somebody one day. Then Thea came to see me at home. Together we looked for solutions. That was nice, because when we thought about things together, I suddenly had all sorts of ideas for making life a bit more enjoyable. I don’t need any professionals to do that.’ (Client) 1.2.2 On the defensive Social exclusion is characterised by a lack of future prospects, combined with deficiencies in two dimensions ( Jehoel-Gijsbers, 2004; Hoff &Vrooman, 2011): 1 the sociocultural dimension: with deficiencies in social participation and insufficient cultural and normative integration; 2 the economic and structural dimension: with material deprivation relating to poverty and an unequal distribution of income and wealth, and limited access to basic social rights. A process of social exclusionmakes people fall even further behind in society. The problems they face can be so severe or can accumulate to such an extent that the burden becomes too great for them to bear. If protective factors are not sufficient, people experience a loss of control over their lives (Van Hemert & Wolf, 2011). This process and the factors that play a role in it are addressed in Chapter 6. The situation of the target group is often a chaotic and complex interplay of forces involving developments in society (structural), relationships between people and groups (relational), the functioning of our institutions (institutional) and people’s own ability for self-regulation (individual) (Edgar, 2010; Jehoel-Gijsbers, 2004; Wolf, 2002). Interventions and policy measures are necessary in all these areas to counter social exclusion and promote participation. The likelihood of social exclusion is greater for people with a lower level of education, a low income and a non-Western background, and for single people, older people and single-parent families (Hoff & Vrooman, 2011). People with these background characteristics also make greater than average use of social services (Bijl, Boelhouwer, Pommer & Andriessen, 2015).

1.3

Disruption in self-regulation

It is probable that a disadvantage at an individual level indicates disruptions in self-regulation. This is not the same as personal control. Self-regulation concerns ‘the regulation of the self ’ through psychological processes that enable people to take control of their own lives and to practise self-care (Van der Stel, 2013). Specifically, it is about the efforts people make to control and adjust their

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1.3 Disruption in self-regulation

emotions, cognitions, motivations and behaviours in order to achieve goals that are important to them (De Ridder & De Wit, 2006). Self-regulation is successful when the processes involved in having control of oneself, as well as the resources needed to achieve a goal, are in order. These inner processes are called executive functions. Examples are: the ability to think before acting, the ability to regulate emotions, the ability to organise and the ability to plan and to prioritise. Many major social and personal problems in the West are associated with inadequate self-regulation, such as addiction, violence and crime, debt, sexually transmitted diseases, unwanted pregnancy, obesity and gambling (Baumeister, Schmeichel & Vohs, 2007). Self-regulation is inadequate if regulation of the executive functions fails (Van der Stel, 2013). The inability to control one’s own impulses, that is to say a loss of self‑control, is sometimes cited as the cause of this lack of self-regulation (Baumeister et al., 2007). As a result, influencing emotions, cognitions,motivations andbehaviour also leaves something tobedesired. Examples of disruptions in self-regulation are fear, sadness, despair, unprocessed grief (emotions); limited intellectual capacity or cognitive damage, for example due to non-congenital brain damage or excessive use of alcohol and/or drugs or natural cognitive decline as a result of aging (cognitions); helplessness, a feeling of paralysis, a feeling of lethargy (motivation); a lack of impulse control, such as excessive drinking or an addiction to eating or shopping, and compulsive actions (behaviour). In a very simplified form, a situation of inadequate self-regulation occurs, for example, if someone spends structurally more than their income allows and cannot control their impulses in that area. This leads to accumulating rent arrears and other debts, so that the person can no longer think clearly due to the stress, continuallydelays dealingwith the problems and is overcome by panic and despair when an eviction letter arrives. The quotes below are from a study of eviction (Wewerinke, De Graaf, VanDoorn&Wolf, 2014). ‘I just let things slide a bit and spent the money on other things instead of the rent. (…) It can be a nice dress that I want to have, and then I think: the rent can wait a bit; I’ll pay it when I have money again. (…) In the Netherlands they’ve got such a great word for it: having a hole in your hand. I’ve really got that.’ ‘I can’t face it, I can’t even manage it physically, packing my stuff. I’m knackered; I can’t do it. I don’t want to leave; I just don’t want to leave! (…) I’ve even thought: my son’s a minor, should I have him rob a petrol station? (…) I try to do it in an honest way, but I’m really desperate.’ Inadequate self-regulation has a negative impact on people’s health andwell‑being. Peoplewho are in such a state are surrendered to their impulses and environmental conditions, as it were, and they lose control of their lives. Inadequate self‑regulation contributes towards underachievement, in the sense that people who have lost

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control have less perseverance in the face of setbacks, are less able to create environments in which they can perform well and flourish, are less able to set goals and to pursue them, and have less stamina to reach those goals (Baumeister et al., 2007). There can be many different causes for deficiencies in self-regulation (Wolf, 2002; Van der Stel, 2013). Some people have impairments from the outset, such as reduced intellectual capacity, a congenital brain defect, a mental health condition or a certain susceptibility to mental health issues. Other people have lived in disadvantaged situations all their lives (poverty, abuse, etc.), so that their executive functions have been less able to develop properly. In addition, there are people who are limited in their ability to self-regulate due to problems experienced in life (e.g. debt problems, inadequate support or ‘the wrong friends’). There is more about self-regulation in subsection 2.1.2. The overall objective of a counselling programme is an improved quality of daily life. The programme aims to create a life in which clients’ needs for participation and personal control are met as fully as possible. The model of social quality is important for a good understanding of people’s daily quality of life (Van der Maesen &Walker, 2005). The model explains this quality from the point of view of a larger whole or from a systemic perspective. If we unpack social quality, it concerns: • the extent to which citizens can participate in social, economic and cultural life • and in the development of their community • under conditions that are favourable to their well-being and self-realisation, • which in turn enables them to influence the conditions of their own lives. This model is based on the interaction between the individual as actor with a unique life story (micro level) and: • society and the societal structures and developments within it (macro level); • the informal relationships in the community (meso level); and • the formal relationships in institutions (meso level). 1.4.1 Managing yourself and your existence An essential prerequisite for participation and personal control is the proper functioning of the individual in their social and societal context(s). This functioning depends on a person’s ability to self-regulate. Pathways to Empowerment helps to strengthen this ability, principally by studying people’s intrinsicmotivations and by working on what is of value to them in their current and future existence. For a fair number of people, autonomous self-regulation will be too ambitious a goal. Pathways to Empowerment helps to provide these people with compensations, Improving the quality of daily life

1.4

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1.4 Improving the quality of daily life

including aids (medication, meals on wheels, etc.) and support structures (social support, buddy, etc.). The aim is to use these to redress the balance between burden and capacity, such that those close to themcontinue to feel well and do not become overburdened. Inspired by the concepts of self-regulation and positive health, Pathways to Empowerment defines recovery as follows:

People’s ability to regulate themselves and their lives and to take control in the face of life’s emotional, physical, social and material challenges.

This description shows clearly that people are themselves the most important drivers of changes focused on recovery (Van der Stel, 2013). In essence it is about personal recovery. See also Chapter 2 for information on the concept of recovery and its various forms. 1.4.2 Building the conditions of your existence By helping to strengthen clients’ participation and personal control, focusing on their functioning and on their personal recovery, the strength-based approach can give a major impetus to the quality of their daily lives. This is done by working with clients on improving four conditions of participation and personal control at individual level (Wolf, 2012a): 1 self-regulation 2 sense of belonging with others, i.e. social embedding 3 conditions of existence 4 access to rights, resources and institutions, i.e. having a place in society as a whole. Pathways to Empowerment’s broader focus on participation and personal control gives people a chance to increase their autonomy, once again make an active contribution to society and be of significance to others. Therefore, Pathways to Empowerment also has significance from the perspective of society, as clients regain the ability to do something for – or give something back to – society. This reciprocity benefits their well-being and self-realisation.

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