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VALUE-BASED INTERVENTIONS IN THE COMMUNITY : FOUNDATIONS AND APPLICATIONSIsaac Prilleltensky, Ph.D

Before you reply with enthusiasm to our plea for help, you should consider whether you are not merely engaged as magicians to avoid the crisis in the center of the ring. In considering our motives for offering you a role, I think you would do well to consider how much less expensive it is to hire a thousand psychologists than to make even a miniscule change in the social and economic structure ( Judge Bazelon, in the 60s, addressing a group of forensic psychologists).WHAT IS VALUE-BASED PRACTICE?Value-based practice is concerned with the promotion of psychological theories and practices that reflect a cogent set of moral principles.

Value-based practice is concerned not only with what IS but also with what SHOULD BE, and with the contributions psychology can make towards that end. ORDER OF PRESENTATIONRATIONALEPROPOSALFOUNDATIONSAPPLICATIONSCHALLENGESRATIONALEPsychology is concerned with describing and predicting behaviorPsychology has shied away from explicitly prescribing behavior

However, we are, in effect, involved in creating culture and in prescribing behavior. Even if we dont want to assume that responsibility, we make value judgments all the time. Hence, its better to be explicit about our values.

Psychology is concerned with what ISPsychology has shied away from SHOULD

If no one is concerned with how individuals SHOULD lead their lives, and how governments and societies SHOULD treat their citizens, then we are stuck with the status quo. Hence, psychology can and should contribute to creating a better society.

Value based psychology is concerned with creating

A good lifeA good society

PROPOSAL(What the SHOULD is all about)

THREE TYPES OF WELLNESSPersonal WellnessRelational WellnessCollective Wellness

A Matter of BalanceForeground and backgroundPersonal well-beingCollective well-beingRelational well-beingFOUNDATIONSEmpirical research

Asking people what values are important in life

Historical and philosophical analysis

Examining what combination of values promotes wellness under what conditionsBasic Values for the Promotion of Well-Being

APPLICATIONSMental health practice (therapy and counselling)Programs and policies Psychological consultationApplications in Practice

Effects of Values

Effects of Assumptions

Effects of Practices

AND NOW WHAT? WE APPLY THESE TOOLS TO DIVERSE SETTINGS

CLINICAL AND COUNSELLING SETTINGS

HEALTH SETTINGS

EDUCATIONAL SETTINGS

WORK SETTINGS

COMMUNITY SETTINGSCycle of PraxisPhilosophyWhat should be?ActionWhat can be done?NeedsWhat is missing?ContextWhat is?Guidelines for practice include voice of clientconsider role of social oppressionavoid pursuit of pathologyavoid blaming the victimconsider multiple levels of analysis

The psychotherapist, social worker or social reformer, concerned only with his own clients and their grievance against society, perhaps takes a view comparable to the private citizen of Venice who concerns himself only with the safety of his own dwelling and his own ability to get about the city. But if the entire republic is slowly being submerged, individual citizens cannot afford to ignore their collective fate, because, in the end, they all drown together if nothing is done; and again, as with Venice, what needs to be done is far beyond the powers of any one individual. In such circumstancesthe therapist can no longer afford the luxury of ignoring everything that is going on outside the consulting room.

Even when people do successfully change their high risk behaviors, new people continue to enter the at-risk population to take their place. For example, every time we finally helped a man in the MRFIT project to stop smoking, it is probable that, on that day, one or two children in a school yard somewhere were for the first time taking their first tentative puffs on a cigarette. So, even when we do help high risk people to lower their risk, we do nothing to change the distribution of disease in the population becausewe have done nothing to influence those forces in the society that caused the problem in the first place. (Syme, 96, p. 22)

CHALLENGES1.Axiological Angst

2.Cognitive fallacies

3.Implementation barriersAXIOLOGICAL ANGSTAnxiety produced when mental health workers are asked to articulate the set of values underpinning their theoretical, investigative, and applied work.

When pressed to articulate their values, and asked what to do when their values conflict with the values of others (students, clients, etc), workers revert to relativismCOGNITIVE FALLACIES1.Naturalistic fallacyFrom is (research) to ought (prescription)Corollary: Psychology is not enough

2.Philosophical fallacyFrom what should be to what is feasibleCorollary: Philosophy is not enoughIMPLEMENTATION BARRIERS1.Political barriersPressures, conflicting interests, power differentials, etc.

2.Cultural barriersCulture of indulgence and hedonism.Disdain for communitarian values and fears of dogmatism when a set of values is proposed.CHALLENGES FOR AGENT OF CHANGE1. Congruence between values and actions

2.Commitment but no support

3.Commitment but no strategyTAKE HOME MESSAGEValues out of balance, out of context, and out of controlThree values for public policyLIBERTYEQUALITYFRATERNITYThree values for psychologyPERSONAL WELLNESSCOLLECTIVE WELLNESSRELATIONAL WELLNESS

TAKE HOME MESSAGEIDENTIFY ONE SETTING WHERE YOU WANT TO BE AN AGENT OF CHANGEUSE CYCLE OF PRAXIS TO GUIDE EFFORTSIDENTIFY A SMALL TASK FROM GUIDELINES WHERE YOU CAN EXPERIENCE SUCCESSPARTNER WITH OTHERS IN PROCESS OF CHANGESUPPORT EACH OTHERCALL A MEETING TOMORROW

PERSONAL WELLNESSRELATIONAL

WELLNESSCOLLECTIVE WELLNESS

HealthRespect for diversitySocial justice

Self determinationCollaboration and democratic participationSupport for social structures

Caring and compassionSupport for

the

environment

Values for Personal WellnessNeeds Addressed

Caring and protection of healthEmpathy, nurturance, emotional and physical well-being

Education and personal developmentCognitive, emotional, physical, and spiritual growth; autonomy

Self-determinationMastery, control, self-efficacy, voice, choice

Values for Collective WellnessNeeds Addressed

Social justice in provision of resources

Economic security, shelter, clothing, nutrition, access to vital health and social services

Support for strong community structures Sense of community, cohesion, formal support

Values for Relational WellnessNeeds Addressed

Respect for human diversityIdentity, dignity, self-respect, self-esteem, acceptance

Collaboration and respect for the communitySolidarity, mutuality, peace, involvement, participation, belonging

Domain

ValuesQuestions

Caring and compassionDoes it promote the expression of care, empathy, and concern for the physical and emotional wellbeing of other human beings?

Self-determinationDoes it promote the ability of individuals to pursue their chosen goals without excessive frustration and in consideration of other peoples needs?

Human diversityDoes it promote respect and appreciation for diverse social identities?

ParticipationDoes it promote a peaceful, respectful, and equitable process whereby citizens have meaningful input into decisions affecting their lives?

Distributive justiceDoes it promote the fair and equitable allocation of bargaining powers, resources and obligations in society?

VALUESOPPRESSIVEEMANCIP.

PersonalBlameEmpowerment

RelationalMask powerVoice

CollectiveConformityJustice

Domain

Assumptions AboutQuestions

KnowledgeTo what end is knowledge used? Is knowledge subordinate to morality or independent from it?

The good lifeWhat conceptions of the good life are promoted? Are these based on self-interest or cooperation?

The good societyWhat conceptions of the good society are promoted? Are these based on the pursuit of equality or personal gain at the expense of others?

Power in relationshipsWho has more power in relationships? Are there attempts to share power?

ASSUMPT.OPPRESSIVEEMANCIP.

Good lifeMeritInterdepend.

Good societyCompetitionCohesion

Power NeglectedAcknowledg.

Domain

Practices regardingQuestions

Problem definitionWhat factors are included and excluded from problem definition? Are psychological as well as sociological and economic factors taken into account?

Role of clientIs client active or passive? To what extent does client participate in decisions affecting his or her wellbeing?

Role of helperIs helper a true collaborator or a removed expert imparting advice?

Type of interventionDoes intervention focus exclusively on intrapsychic factors, or does it include systems affecting clients?

Time of interventionIs intervention reactive or proactive? Does psychologist wait until victims of unhealthy environments seek help or does he/she try to prevent problems?

PRACTICESOPPRESSIVEEMANCIP.

Prob def.PathologizeDeblame

ClientPassive Active

Psychol. Arrog. PowerShares power

Interven.IntrapsychSocially sens.