Clinical Practice Flashcards
What does clinical practice seek to do?
Alleviate the internalized negative effects of environmental factors such as stress from health, vocational, family, and interpersonal problems
What is the workers role in clinical practice?
Helps individuals, couples, and families to modify attitudes, feelings, and coping behaviors that interfere with optimal social functioning
Where is clinical practice done?
Agencies or Private Practice Settings
What is assessment for in clinical practice?
Focused on the person-in-environment, with the goal of enhancing social functioning
What theoretical approaches are used in clinical practice?
Psychosocial
Problem-Solving
Behavior Modification
Cognitive Therapy
Crisis Intervention
Family Therapy
Group Therapy
Narrative Therapy
Ecological or Life Model
Task-Centered
Psychosocial
focuses on intrapsychic and interpersonal change; based on psychoanalytic theory, ego psychology, role, and systems theory
Problem-Solving
to solve discrete problems, based on psychosocial and functional approaches
Behavior Modification
for symptom reduction of problem behaviors and learning alternative positive behaviors
Cognitive Therapy
for symptom reduction of negative thoughts, distorted thinking, and dysfunctional beliefs
Crisis Intervention
Brief treatment of reactions to crisis situations to reestablish the client’s equilibrium
Family Therapy
treats the whole family system and sees the individual symptom bearer as indicative of a problem in the family as a whole
Group Therapy
a practice model in which group members can help and be helped by others with similar problems, get validation for their own experiences, and test new social identities and roles
Narrative Therapy
Uses the stories that people tell about their lives to reveal how they structure perceptions of their experiences; therapist co-constructs alternative, more affirming stories with the client
Ecological or Life Model
Focuses on life transitions, environmental pressures, and the maladaptive fit between individual and family or the larger environment; focuses on the interaction and interdependence of people and environments
Task-Centered
Focuses on accomplishing tasks to reinforce self-esteem and reestablish usual capacity for coping
What’re the assumptions and knowledge base used in clinical practice?
Individual growth, development, and behavior result from complex interaction of psychological and environmental factors
Theories of personality development
Systems Theory
DSM-5
Sociocultural factors are a significant influence, including ethnicity, immigration status, occupation, race, gender, sexual orientation, and socioeconomic class
What does the Ongoing Clinical Process Include?
Problem Assessment
Planning for Change
Determining the Intervention Locus
Evaluating Change
Problem Assessment
Identify forces that contribute to or maintain the problem
What is included in Problem Assessment?
Stresses that may impair functioning can originate in the individual, the individual’s system, or the system’s environment
DSM-5
Done to evaluate client’s strengths, to appraise the client-system’s strengths and weaknesses, and to identify supports or constraints that may influence change possibilites
What’s included in Planning for Change?
Criteria for Intervention Strategies
What is the criteria for Intervention Strategies?
Should be consistent with objectives
Should be evidence that strategy is effective
Must be consistent with professional values
What is included in Determining the Intervention Locus?
Behavioral: modify actions
Affective: modify feelings
Cognitive: modify thoughts or thought patterns
What is included in evaluating change?
Assess progress in achieving treatment goals
Assess effectiveness of treatment interventions
Determine areas still needing work
What’re the stages of clinical practice?
Beginning Stage
Middle Stage
Ending Stage
What is included in the beginning stages of clinical practice?
Assessment
Establishing a positive therapeutic relationship
Contracting or goal setting
Connecting with resistance clients
What is included during the assessment at the beginning stages of clinical practice?
Presenting problem
Match between presenting problem and available services
Understanding of the client’s problems and how that largely depends on data collected in early interviews that is expanded as treatment progresses
Worker’s Role
Other Sources of Data
Clinical Diagnosing
Beginning Stage: Presenting problem
What are the client’s concerns and problems?
How does the client describe the problems?
Can the client clearly articulate what is disturbing?
What factors contribute to the client’s problem?
What strengths does the client show in relation to the presenting problem?
Is the client’s affect appropriate and his expectations realistic?
What does the client hope to achieve?
Beginning Stage: Match Between Presenting Problem and Available Services
Does the agency or private practice setting offer the appropriate services and have the needed skills to address the client’s presenting problem effectively?
Should the client remain with this worker or agency, or be referred elsewhere?
Beginning Stage: Worker’s Role
Ask leading questions
Ask the client to elaborate and describe the situation in detail; the worker also observes the client’s behavior and affect in the treatment situation; worker organizes data to formulate a meaningful, dynamic psychosocial or diganostic assessment
Beginning Stage: Other Sources of Data
Interviewing Other Family Members
Home Visits
Collateral Contacts with Teachers
Clergy
Doctors
Social Agencies
Friends
Beginning Stage: Establishing a Positive Therapeutic Relationship
Characteristic of the Worker
Needs of the Client
Establishing a Therapeutic Relationship: Characteristics of the Worker
Nonpossessive warmth and concern
Genuineness
Appropriate empathy
Nonjudgemental Acceptance
Optimism about the Possibilities for Change
Objectivity Regarding the Client and the Client’s Situation
Professional Knowledge and Competence
Capacity to Communicate with the Client
Self-Awareness
Establishing a Positive Therapeutic Relationship: Needs of the Client
Hope and courage to engage in the change process
Motivation to change
Trust in the worker’s interest and skill to help
Be dealt with as an individual rather than a case
Personality type
To express self
To be accepted as a person of worth
Make one’s choices
Change one’s own pace
Contracting or Goal Setting: The Contract in Theory
Compatible with various models of social work practice; not limited to an initial working agreement, but part of the total social work process
Helpful in facilitating client’s activity in problem solving, maintaining a focus, and continuing in therapy
Contracting or Goal Setting
an explicit agreement between the worker and client regarding target problems, goals, and strategies of social work intervention, and differentiating the roles and tasks of the client and worker
Contracting or Goal Setting: Mutual Agreement
Determined in a reciprocal process between client and worker
Must be stablished at the beginning and monitored throughout to avoid hidden agendas
Contracting or Goal Setting: Differentiated Participation
Worker is responsible for delineating unique aspects of his/her participation at each phase of the process
Contracting or Goal Setting: Reciprocal Accountability
The client and the worker are each accountable to the other for fulfilling upon work toward agreed upon goals
Contracting or Goal Setting: Explicitness
Work is specific, clear, and open
No implicit or covert contracts, or discrepant client-worker expectations
Contracting or Goal Setting: Realistic Agreement
Within the capacities of client and worker
Contracting or Goal Setting: Flexibility
To guard against rigidity, includes provisions for renegotiation by mutual consent
Beginning Stage: Contracting with Resistant Clients
The worker recognizes, accepts, and addresses his/her own resistance if present
The worker recognizes and accepts client’s resistance, whether due to negative experiences with professionals, fear of worker’s authority, or fear of change
Client resistance may be expressed passively or through open hostility
The worker clarifies role and purpose
The worker explores client reactions (resistance) and strategizes on how to work with them
Limitations
Contracting with Resistant Clients: Limitations
Difficult to contract with involuntary clients who do not acknowledge or recognize problems, or who see the worker as marginal or unhelpful, and with very severely distrubed or mentally retarded clients
Acknowledge openly the difficulty for both worker and client inherent in mandatory treatment and to negotiate a contract within those realities
Middle Stage: Worker Interventions Definition
Continue the work of the beginning stage with more emphasis on helping the client resolve problems and make changes in feelings, behavior, or ways of thinking
Middle Stage: Worker Interventions
Supporting or Sustaining
Direct Influence
Exploration
Worker encourages the client’s reflections and responds to enhance the client’s insight; focus on current and recent experiences
Encourages the client’s reflection on pattern-dynamics and underlying personality dynamics adversely affecting current adaptation; focus on conscious and preconscious, rather than unconscious material
Confrontation
Clarification
Interpretation
Partilization
Universalization
Ventilation
Catharsis
Worker Interventions: Supporting or Sustaining
Reduce the client’s feelings of anxiety, poor self-esteem, and low self confidence, the worker expresses confidence in or esteem for the client, interest in and acceptance of the client, and a desire to help
Expressed through interest, sympathetic listening, acceptance of client, honest reassurance, and encouragement
Worker Interventions: Direct Influence
Worker gives advice or suggestions to influence client
Worker Interventions: Exploration
Workers continued effort to understand the client’s view of self and his/her situation
Worker Interventions: Confrontation
The worker finds ways to challenge the client to think about discrepancies in what s/he says or does, other maladaptive behavior behavior, or about resistance to treatment or to change
Worker Interventions: Clarification
Accomplished through questions, and repeating or rephrasing material the client brings up
Requires sensitivity to the client’s defensiveness
Worker Interventions: Interpretation
Used with clients who are not emotionally fragile
Worker suggest psychodynamic meaning of the client’s thoughts, feelings and fantasises, especially about the origins or problem behaviors
Aims at enhancing the client’s insight and working through conflictual material by deepening and extending the client’s conscious understanding
What may interpretation involve?
Uncovering repressed (unconscious process) or suppressed (conscious process) material
Connecting the present to the past so the client can see present distortions more clearly
Integrating material from various sources so the client gains a more realistic perspective on his/her situation
Worker Interventions: Partialization
To facilitate the client feeling less overwhelmed and more empowered to problem solve and break down problems or goals into smaller, more manageable components
Prioritize the components into a hierarchy of importance to the client or those that are more manageable to address first
Worker Interventions: Ventilation
The client airs feelings associated with the data presented about oneself and the situation
The release of emotions may help reduce the intensity of the client’s feelings, the feeling that they are unspeakable or that the client must be alone with them
Worker may need to distinguish between times when ventilation is useful to reduce the intensity and when it “feeds the fire”
Worker Interventions: Catharsis
Reliving and consciously examining repressed, early life, or traumatic experiences in treatment to achieve abreaction, the release of tension or anxiety that was caused by the conflict and its repression
Middle Stage: Special Considerations in Treatment
Resistance
Transference
Countertransference
Special Considerations in Treatment: Resistance
In psychodynamic terms, resistance is an unconscious defense against painful or repressed material
It can be expressed through silence, evasiveness, balking at the worker’s suggestions, or a premature desire to end treatment
The worker should recognize and understand resistance as an opportunity to learn more about the client and then work empathically with the client to face resistance and understand when and how to use it effectively
Special Considerations in Treatment: Transference
Client’s unconscious attempts to recapitulate with the worker the conflicts attached to a relationship experienced with significant persons in the past
The worker needs to help the client understand dynamics of transference, how it related to past relationships, and how it contributes to present relationship difficulties
The worker must be aware of self, reality of clinical situation and relationship, and of the client’s conflicts that are revealed through transference
Special Considerations in Treatment: Countertransference
The therapist’s unconscious distorted perceptions and responses to the client based on emotional conflicts regarding a significant person from the social worker’s past
Worker needs to understand countertransference reactions, be aware of their presence and consequences, and use supervisory help or therapy to understand them and not impose them on the client
Stages of Clinical Practice: Ending Stage
Used the termination phase of treatment
