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John Heron's Six Category Intervention Analysis
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John Heron offers his approach as a conceptual framework for understanding interpersonal relationships and as a means of analysing a range of possible therapeutic interactions between a client and a helper.
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'An intervention is an identifiable piece of verbal and/or nonverbal behaviour that is part of the practitioner's service to the client' (Heron 2001).
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Analysis, from Heron (2001) perspective places emphasis upon what the practitioner intended to achieve in the interaction/intervention, rather than on the actual effect.
Interventions and Non-Interventions
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An intervention must seek to address the current psychological needs of the client. If questions are asked of a client, solely for the practitioner's benefit - this is not an intervention and not worthy of analysis.
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If questions are asked of a client in order to address a client's needs and therefore, have an effect upon a client; i.e. enable, challenge, give, draw-out and/or encourage the client. This would be viewed as an appropriate intervention and be worthy of analysis.
Forms of Intervention (1)
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Therapeutic/Valid - an appropriate intervention which is delivered in the best interests of the client, with good intent and in a competent manner.
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Classes of Therapeutic Intervention
Authoritative Interventions
The practitioner takes a more dominant or assertive role, taking responsibility for and on behalf of the client.
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1). Prescriptive Intervention : the practitioner explicitly seeks to direct the behaviour of the client, by guiding his or her behaviour.
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2). Informative Intervention : the practitioner seeks to impart knowledge, information and meaning to the client, by giving instruction.
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3). Confronting Intervention : the practitioner seeks to raise the client’s awareness about some limiting attitude or behaviour of which they are relatively unaware, by challenging the client by direct feedback, but whilst not making a personal attack upon the client.
Facilitative Interventions
The practitioner seeks to enable clients to become more autonomous and take more responsibility for themselves
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4). Cathartic Intervention : the practitioner seeks to enable the client to abreact powerful emotions; primarily anxiety, grief and anger by helping to release emotional pain and tension.
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5). Catalytic Intervention : the practitioner seeks to enable the client to learn, develop and problem-solve by encouraging self-reflection, self-direction and self-discovery.
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6). Supporting Intervention : the practitioner seeks to affirm the worth and value of the client’s qualities, attitudes, beliefs and actions by approving the person.
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Forms of Intervention (2)
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Degenerate - an inappropriate intervention which is delivered in a misguided manner. ‘Degenerate interventions are rooted in lack of awareness, in lack of experience, lack of personal growth, lack of training’ (Heron 2001).
Types of Degenerate Interventions
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1). Unsolicited - inappropriate interventions where the formal relationship has not been established and a person appoints him or herself as the 'practitioner' without client consent; or when the manner of the intervention is overly intrusive or disrespectful, although solicited by the nature of the role-relationship.
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2). Manipulative - inappropriate interventions in which the practitioner is motivated by self-interest, or any interests other than those of the client. Being in control is the most obvious of the manipulative interventions, whereby the practitioner always wants to lead and never follow the client.
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3). Compulsive - inappropriate interventions in which the practitioner projects his or her unresolved psychological problems onto the client during the intervention. This may involve inappropriately attacking the client, colluding with client, or overlooking important aspects of the client's welfare.
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4). Unskilled - simply incompetent interventions because the practitioner has never had the training and has no real grasp of the quality, scope or suitability of the intervention.
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Degenerate classes of the six categories (examples)
Authoritative i). Prescriptive Degeneration
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Benevolent take-over:- creating dependency by giving advice to an insecure client who needs encouragement to be selfdirecting.
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Moralistic oppression:- creating rebelliousness by imposing authoritarian ‘shoulds’, ‘oughts’ and ‘musts’ on a client who may appreciate the rationality of the proposed behaviour but who feels impelled to reject the way in which it is presented. ii). Informative Degeneration
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Seductive over-teach:- the practitioner excels in excessive information giving, so that the client is seduced into excessive passivity and away from self-directed learning.
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Oppressive over-teach:- the practitioner goes on for too long giving out too much information, insensitive to the evidence of fatigue or the need of the client to contribute. The client is held back from self-direction. iii). Confronting Degeneration
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Sledgehammer:- the practitioner raises issues aggressively, displacing his or her anxiety into a punitive attack on the person, rather than on the attitude or the behaviour of the person.
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Smiling demolition (the smiler):- the practitioner says hurtful things to the client in a smiling, friendly or jocular way. The feedback is indirect and therefore, confusing to the client who may deny that they are hurting badly.
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Degenerate classes of the six categories (examples)
Facilitative iv). Cathartic Degeneration
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Encouraging dramatisation:- the practitioner mistakenly assumes dramatisation for catharsis and colludes and encourages a client to ‘act out’ in destructive and disruptive ways. The drama, which created the original hurt, is re-enacted rather than the release of hurtful emotions.
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Nut cracking (too deep too soon):- the practitioner takes the client’s defences by storm, making a steep intervention into deeply buried distress, which the client is not yet ready to handle. The client defends more intensely or dramatises in an uncontrolled way. v). Catalytic Degeneration
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Implicit take-over (the compulsive search for order):- the practitioner unwarily imposes some meaning and order onto the client’s talk or experience. The catalytic intervention centres on the practitioner's’, not the client’s search for meaning.
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Scraping the bowl:- the practitioner with discreet compulsion goes on beyond the point of productive enabling, trying to enable the client to find more to talk about in the same area.
(The facilitator becomes the ‘ferret’) vi). Supportive Degeneration
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Moral patronage (or your character is coming along nicely):- the practitioner handles the anxiety associated with true caring and sharing, by climbing into the pulpit in order to congratulate the client on his or her self-improvement. The client feels subtly insulted and put down.
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Qualified support:- the practitioner can only give support to a client if at the same time he or she discreetly reminds the client of the latter’s inadequacy in some respect.
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Forms of Intervention (3)
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Perverted - an inappropriate intervention which is deliberately malicious and intentionally seeks to do harm to the client. It leaves a client disabled, disadvantaged and in distress. A perverted intervention damages a client.
Perverted classes of the six categories (examples)
Authoritative
1). Perverted prescription – ‘the deliberate use of force, threat, pain, compulsion in constraining a person to act against that person’s needs and interests’ (Heron 2001).
2). Perverted information – ‘the deliberate use of misrepresentation, lies, calumny and slander to harm the person about whom they are put forth, or to whom they are addressed’ (Heron 2001).
3). Perverted confrontation – ‘deliberate, punitive psychological attack on a person to wound and incapacitate him or her emotionally. Torturing a person to tell the truth, or to ‘confess’ to things never said or done’ (Heron 2001).
Perverted classes of the six categories (examples)
Facilitative
4). Perverted catharsis – ‘deliberately producing cathartic collapse and disintegration through subjecting a person to extreme mental and physical stress and pain. The disintegrated person may then be re-integrated in terms of imposed suggestion and indoctrination
(Heron 2001).
5). Perverted catalysis – ‘deliberate and malicious seduction, both in the sexual and in the wider sense; intentionally leading a person on to his or her own undoing by eliciting self-indulgent and self-destructive tendencies’ (Heron 2001).
6). Perverted support – ‘affirming, supporting or encouraging the weak, distorted and corrupted behaviour of a person’ (Heron 2001).
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Reference
Heron, J. (2001) (5 th ed) Helping the Client – a creative practical guide .
SAGE publications, London.
Further Reading
Ashmore, R. (1999) Heron’s intervention framework: an introduction and critique. Mental Health Nursing , Vol.19, (1): 24-27.
Ashmore, R. & Banks, D. (2004) ‘Student nurses’ use of their interpersonal skills within clinical role-plays’. Nurse Education Today ,
Jan; 24, (1): 20-9.
Ashmore, R. & Banks, D. (1997) Student nurses’ perceptions of their interpersonal skills: A re-examination of Burnard & Morrison’s findings.
International Journal of Nursing Studies , Vol.34, (5): 335-345.
Burnard, P. & Morrison, P. (1991) Nurses’ interpersonal skills: a study of nurses’ perceptions.
Nurse Education Today , (11): 24-29.
Burnard, P. & Morrison, P. (1988) Nurses’ perceptions of their interpersonal skills: a descriptive study using Six Category Intervention
Analysis. Nurse Education Today , (8): 266-272.
Morrison, P. & Burnard, P. (1989) Students’ and trained nurses’ perceptions of their own interpersonal skills: a report and comparison.
Journal of Advanced Nursing , (14): 321-329.
Sloan, G & Watson, H (2001) ‘John Heron’s six-category intervention analysis: toward understanding interpersonal relations and progressing the delivery of clinical supervision for mental health nursing in the
United Kingdom’.
Journal of Advanced Nursing Oct; 36 (2): 206-14
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