Current Practice Approaches Flashcards
What’re the Psychodynamic Theory-based Social Work Approaches?
psychosocial, problem-solving, crisis intervention, task-centered casework, planned short-term treatment
Where did Psychosocial theory originate?
Greatest influence was Sigmund Freud
What is Ego Psychology within Psychosocial Theory?
Psychoanalytic base, with a specific base on ego functions and adaptation, defense mechanisms, adaptations to an average “expected” environment, ego mastery and development through the life cycle, separation/individuation
What’re Social Science Theories?
role, family and small group, impact of culture, communication theory, and systems theory
What’re Biological Theories?
ecological, homeostasis, behavioral genetics, health, and illness
What assumptions are made about human behavior within Psychosocial Theories?
Individuals are always seen within the context of their environment, interacting with family and/or other social systems, and influenced by earlier personal experiences
Conscious, unconscious, rational, and irrational motivations govern individual behavior
Individuals can change and grow under appropriate conditions throughout the life cycle
What can be considered motivation for change in Psychosocial Theories?
Disequilibrium evokes anxiety and release energy to change
Conscious and unconscious needs and wishes
Relationship with the clinician or group in a group treatment settings
What can be considered vehicles for change in Psychosocial Theories?
Development of insight and the resolution of emotional conflict
Corrective emotional experience in relationship with the worker
Changes in affective, cognitive, or behavioral patterns that evoke changes in interpersonal relationships
Changes in the environment
How does the role of the therapeutic relationship influence the therapeutic process based on Psychosocial Theory?
Conscious use of relationship can stimulate motivation and energy to change
Corrective emotional experience
Client and client’s needs are central
Client brings his/her own relationship history to treatment; these dynamics can interfere with treatment
Therapist needs to be aware of his/her own relationship history and of his/her responses to particular clients
Client not feeling empowered due to hierarchal issues
When should self-disclosure occur?
Purposefully and when it benefits that client
What can transference be used for in positive ways when engaging with clients?
Can be used as a potential vehicle for enhancing client self-understanding and then changing problematic interpersonal patterns; can be understood as values or cultural differences
What are way a that a therapist can create awareness of countertransference?
Have supervision and use consultation
Go to own therapy sessions
What’re assessments used for?
Delineates the client’s presenting problem, and the client’s internal and environmental resources for addressing it
Determines if match is appropriate between client and therapist regarding presenting problem and availability of services
When are assessment done?
At the beginning of treatment
What’re the components of an assessment
Dynamic understanding, etiological understanding, clinical understanding
Dynamic understanding
How do different aspects of a client’s personality and his/her important relationships interact to produce or influence his/her total functioning?
Etiological understanding
What are the causative factors that produced the presenting problem and that influence the client’s attempt to deal with it?
Clinical understanding
Formulation of the client’s functioning (mental status, and accustomed defenses and coping style, including where pertinent, a clinical diagnosis)
Why are treatment plans important?
Focuses on key characteristics of the psychosocial approach is the development of a unique treatment plan based on the client’s situation
What do treatment plans consist of?
Client goals and the feasibility of meeting them, given the client’s capabilities, strengths, and weaknesses, and the availability of relevant agency or community services
What is the focus of a treatment plan?
Changing the individual, the environment, or the interaction between the two
What’re the phases of treatment?
Engagement/assessment
Contracting/goal-setting
Ongoing treatment/interventions
Termination
Engagement/assessment
Transition from application to client, enhancing motivation, dealing with initial resistance, establishing relationship around the work to be accomplished
Establish informed consent regarding confidentiality, and client’s and worker’s roles, rights, and responsibilities
Contracting/goal-setting
Mutual understanding between client and worker about goals, treatment process, the nature of the relationship and roles, and the intended allotted time
Ongoing treatment/interventions
Work to alleviate agreed upon problems and focus on current functioning and conscious experience
Deal with ongoing resistance, transference, and countertransference
Termination
Potential for growth, recapitulation of major themes of treatment, experience feelings about ending the relationship
What treatment skills/techniques are required when doing Psychodynamic Theory-based Social Work Approaches?
sustainment; partialization; universalization; support; direct influence; ventilation; description and exploration; reflective consideration of current person-situation; reflective consideration of patterns of personality, behaviors, and their dynamics; reflective consideration of the past and relevance to current functioning
Work with significant others and social systems on behalf of the client
Cultural competence in working with various ethnic, racial, religious, immigrant, and economic groups
What social workers are associated with psychosocial approach?
Mary Richmond
Gordon Hamilton
Florence Hollis
Francis Turner
Mary Woods
Problem-Solving Approach
partially derived from psychosocial approach and partially derived from the functional approach
What is the theory base of Problem-Solving Approach?
Psychodynamic in its psychological theory base with major influence from ego psychologists: Erik Erikson (capacity for change throughout life), Robert White (coping, adaptation, and mastery of the environment), Heinz Hartmann (use of the conflict-free ego)
Social science theory: role theory, problem solving theory (John Dewey)
What’re assumptions about human behavior within the Problem-Solving Approach?
Individuals can change throughout their life and continue to adapt
Individual is seen as a whole person, but the focus is on the person in relation to a problem
Individuals have or can develop the motivation and capacity for change
Individual is not looked down upon but as someone needing help for resolve
There is z “reachable moment” at a point of disequilibrium when s/he can most effectively mobilize motivation and capacity
Individual’s cognitive processes can be engaged to solve problems, to achieve, and to grow emotionally
Individual has both rational and irrational, conscious and unconscious processes, but cognitive strengths can control irrationality
What’re the motivations for change in the Problem-Solving Approach?
Disequilibrium between what is and what the client whats
Conscious desire to achieve change
Positive expectations based on new life possibilities
The strength of a supportive relationship and positive expectations of the worker
What’re the vehicles for change within social work?
Improved skills in problem resolutions which may generate personality change or improved functioning in other areas, although this is secondary to problem resolution
Gratification, encouragement, and support resulting from the improvement in the problem situation, combined with the worker’s emotional reinforcement which enhances the possibility of change
Repetition and “drill” of problem-solving method increases capacity for replication of effective strategies in new situations
Insight, resolution of conflicts, and changes in feelings
Problem resolution involving changes in the person, the environment, and/or the interaction between the two
What is the role of the therapeutic relationship in the Problem-Solving Approach?
Conscious and sustained use of the supportive social work relationship to motivate clients to engage in problem-solving
The worker is an expert in problem-solving method and guides client through the steps of problem resolution further building on the therapeutic relationship
*Transference/countertransference is less likely to arise because it is focused on pragmatic problem solving
How is assessment done in the Problem-Solving Approach?
Focuses first on problem identification and those aspects of the person/environment that can be engaged in problem solving
Assesses motivation, capacity, and opportunity (MCO) of the client to solve the problem
Includes a statement of the problem, precipitating factors, and prior efforts to solve the problem
Assessment is a joint activity of worker and client
Psychosocial Treatment: Problem-Solving Approach
based on the assessment of the problem and the client’s motivation, capacity, and opportunities (MCO)
Functional Treatment: Problem-Solving Approach
based on the function of the agency as a boundary of service
Interagency Treatment: Problem-Solving Approach
uses resources of other agencies in network of services designed to aid the client
What treatment skills/techniques are needed in the Problem-Solving Approach?
Be able to release, energize, and give direction to client’s motivation for change
Make accessible the social and emotional resources client needs to solve problems
Rapid engagement in problem solving process
The four P’s
What’re the four P’s?
a person has a problem, comes to a place for help given through a process
Four P’s in the Problem-Solving Approach?
Clearly identify the problem and his/her subjective response to it
Select a part of the problem that has potential for resolution, identify possible solutions to the problem, and assess their feasibility in the light of MCO
Engage client’s ego capacities
Decide steps/actions to be taken by worker and client to solve or relieve the problem
Help client to carry out problem-solving activities and assess their effectiveness
Terminate treatment
What is the theory base of Crisis Intervention?
Psychodynamic, especially ego psychology, and Lindemann’s work on loss and grief
Intellectual Development
Social Science: stress theory, family structure, role theory
What assumptions can be made about human behavior when using Crisis Intervention?
Individuals have natural progressive growth tendencies that prevail over forces of regression
Stress in a crisis evokes disequilibrium and anxiety that allow therapeutic accessibility; crisis can provide opportunity for growth and can precipitate dysfunctional behavior
Crisis occurs when old coping skills do not resolve adequately and begins to impose a variety of affective, cognitive, and behavioral tasks while reactivating old problems
Those in crisis aren’t sick, but are dealing with challenges that come with the human condition and does not necessarily require a diagnosis
What’re the motivations for change in Crisis Intervention?
Disequilibrium brought on by stressful event or situation
Energy made available by anxiety
Supportive relationship
What’re the vehicles for change in Crisis Intervention?
Challenging established coping patterns and reorganization of coping skills
Growth occurring at the ego develops a larger repertoire of coping skills and organizes them into more complex patterns
What is the role of the therapeutic relationship in Crisis Intervention?
Crisis evokes a sense of helplessness which can make client develop intense attachment; relationship remains reality-based and regression is discouraged
Workers role is based on expertise, and is authoritative and directive
The client is encouraged to be active and reality-oriented, and to work toward finding new ways of coping with crisis
Use of relationship as a corrective experience is not emphasized; minimal focus on transference and countertransference
What does assessment look like in crisis intervention?
Explore what the stress-inducing event was and how the client responded to the stress as well as their response in the past to same stimuli
Characteristic signs and phases, patterns of adaptation and maladaptation to crisis (example is PTSD)
Necessity for quick action stimulates a highly focused assessment that emphasizes current current state of functioning, and internal and environmental supports and deficits
What’re the phases of treatment in Crisis Intervention?
Identify events that precipitated the crisis
Promote awareness of cognitive and emotional impact of crisis
Manage affect leading to tension discharge and mastery
Seek resources in individual, family, social network, and community
Identify specific tasks associated with healthy resolution of crisis
What treatment skills/techniques are required when using Crisis Intervention?
Brief treatment for crisis intervention, like a crisis, is by definition time-limited
Present-and future-oriented, but treatment can deal with the past to unlink/resolve old conflicts if they prevent work on the present crisis
Uses all psychosocial and problem-solving techniques, but reorders them; the clinician is very active, directive, and, at times, authoritative
What’re the Behavioral Theory-based Social Work Approaches?
Behavior Modification, Cognitive Therapy, Task-Centered
What is the theory base of Behavior Modification?
Early classical conditioning (Pavlov)
Operant conditioning
Social learning theory: observing, imitating, modeling
What assumptions about human behavior can be made when using Behavior Modification?
The person is knowable only through what is observable; no need for theory of the unconscious
The person is not viewed as having emotional illness, but rather, as having learned behaviors that are dysfunctional; no presumptions about psychiatric illness
Dysfunctional behavior is expressed in symptoms; symptoms may be labeled as deviant or problematic
Research and empirically-based knowledge and practice have high priority
What’re the motivations for change in Behavioral Modification?
Disequilibrium
Anxiety
Conscious wish to remove a symptom
An agreement to follow behavior modification program
What’re the vehicles for change in Behavior Modification?
Operant (voluntary) behavior
Respondent behavior (involuntary) increased or decreased by conditioning
Change is contingent upon environmental conditions or events that precede, are associated with, or follow the behavior
Modeling takes place as a result of observing and imitating in a social context; not learned via reward or punishment
Operant (voluntary) behavior
Increased by positive or negative reinforcement
Decreased (extinguished) by withholding reinforcement or punishment
What is the role of the therapeutic relationship in Behavior Modification?
Warm, empathetic, and facilitative; worker as teacher, ally, coach
Relationship is not the focus of attention or used as part of the treatment
How is assessment done in Behavior Modification?
Focuses on the problem behaviors or patterns of behavior, not on personality
Inventory of problem behaviors is created and antecedent consequences of problem behaviors are noted
What does treatment planning look like in behavior modification?
Priority problems are selected and their maintaining conditions are identified
The client is engaged in establishing targets for change
Baseline data are established about frequency of the behavior
A written or an oral contract is developed
What treatment skills/techniques are used in Behavior Modification?
Monitoring the frequency of the target behavior
Ensuring that the program is implemented
Three types of treatment clusters
How do you ensure that treatment is being implemented in behavior modification?
Examining obstacles to implementation
Revising the program is obstacles cannot be overcome
What’re the three types of treatment clusters in Behavior Modification?
operant, respondent, cognitive
What social workers are associated with Behavior Modification?
Edwin Thomas and Joel Fischer
What is the theory base for Cognitive Therapy?
Rational-emotive behavior therapy
Cognitive therapy
What assumptions about human behavior can be made in Cognitive Therapy?
Mental distress is not caused by upsetting events themselves, but by the maladaptive and rigid ways we construe these events
Activating events give rise to beliefs that trigger emotional consequences; thus negative automatic thoughts are generated by dysfunctional beliefs
Negative automatic thoughts, biases, and distortions precede negative affect and symptoms of psychological disorders
What’re the motivations for change in Cognitive Therapy?
Disequilibrium
Anxiety
Preference to live without a symptom
Agreement to work on changing a thought pattern
What’re the vehicles for change in Cognitive Therapy?
Structure sessions
Exploring and testing cognitive distortions and basic beliefs
Client has homework between sessions that helps client practice and challenge clients thinking in the natural environment where life situations occur
If client changes interpretations of events, it leads to changes in feelings and behaviors in the future
What is the role of the therapeutic relationship in Cognitive Therapy?
Therapist is teacher, ally, coach; active, directive, didactic
What does assessment look like in Cognitive Therapy?
Inventory the client’s distortions (catastrophizing, minimizing, negative predictions, mind-reading, overgeneralization, personalization)
Inventory the client’s negative automative thoughts and dysfunctional beliefs
What does treatment planning look like in Cognitive Therapy?
Establish baseline data: negative automatic thoughts, distortions, and dysfunctional beliefs; how often does the client think in these ways and in what circumstances?
Establish target goals for change and alternative ways of thinking
Agree to contract for goals, homework, time frame
What treatment skills/techniques are required in Cognitive Therapy?
Short-Term
Focus on symptoms reduction
Worker uses rational approach to focus on concrete tasks to work on in sessions and for homework
Albert Ellis: Be forcefully confrontative to reveal client’s philosophy, get client to see how the philosophy defeats him, and work hard to change thoughts that express that philosophy
Aaron Beck: Gentler, more collaborative; help people restructure their interpretation of events; use group therapy and milieu treatment
What is the theory base for Task-Centered therapy?
Learning theory
Cognitive and behavioral theory
Research-based practice knowledge has high priority
What assumptions can be made about human behavior in Task-Centered therapy?
The person is neither seen as influenced solely by internal unconscious drives, nor controlled only by environment forces
Usually, the client can identify own problems and goals
The client is a consumer of services and is the primary agent of change
The role of social worker is to help the client effect the changes that the client decides upon and is willing to work on
What’re the motivations for change in Task-Centered therapy?
Temporary breakdowns in coping that influence the client to seek help
Conscious wish for change
Reinforcement of self-esteem through accomplishing tasks
What’re the vehicles for change in Task-Centered therapy?
Problem clarification
Steps taken to relieve or resolve problems
Changes in the environment
What is the role of the therapeutic relationship in Task-Centered therapy?
Means of enhancing and supporting problem-solving actions, not an objective in itself; transference and countertransference are minimized
The worker provides acceptance, respect, and understanding and expects the client to work on mutually agreed upon tasks and activities to resolve problems
Relationship is collaborative
What does assessment look like in Task-Centered therapy?
Exploration and clarification of problems are a major activity; the problem has to be one that is concern to the client and amenable to treatment
Worker and client establish a rationale for problem resolution, and note the potential benefits of treatment
