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
What does treatment planning look like in Task-Centered therapy?
Contract is formal, oral, or written, but must state agreement on what is to be worked on, the client’s and the worker’s willingness to engage in the work, and the limits of the treatment; contract can be renegotiated
What treatment skills/techniques are used in Task-Centered therapy?
Task and resources are identified and expected obstacles are explored
Worker and client choose the actions necessary to accomplish task(s) and skills needed for task accomplishment; skills rehearsals take place in sessions and/or client carries out tasks in the environment between sessions
Client progress is reviewed, and tasks are changed if necessary
Termination is based on prior agreement on length of treatment; progress is reviewed and plans for the client’s continued work on the problem are developed before termination
Eclectic, drawing heavily on behavioral techniques, but techniques can be taken from almost any form of treatment
What is the range of application in Task-Centered treatment?
Appropriate for most clients except those how:
Are interested in life goals, existential issues, discussion of stressful events
Are unable or unwilling to use structured approach to tasks
Have problems not amenable to resolution or amelioration by problem-solving
Are involuntary, where treatment is mandated
What’re Short-Term approaches?
Planned Short-Term Treatment
Crisis Intervention
Task-Centered Treatment
Competency-Based Treatment
What is true of Cluster III Short-Term Approaches?
Used approaches use a limitation on time as a therapeutic component and are widely used in HMO and PPO treatment programs
What is the theory base of Short-Term Approaches?
Psychodynamic, behavioral, cognitive, or a combination
What assumptions can be made about human behavior in Short-Term Approaches?
Depend upon theoretical orientation; all place a major emphasis on the capacity of the individual to use ego capacities and cognitive strengths to resolve problems
What’re the motivations for change in Short-Term Approaches?
Derives from anxiety or discomfort generated by acute situational or emotional problems
What’re the vehicles for change in Short-Term Approaches?
Takes place through active engagement in problem-solving
What is the role of the therapists role in Short-Term Approaches?
Supportive relationship is important, but not the focus of treatment; dependency is discouraged
Transference is met with cognitive explanation
What does treatment planning look like with Short-Term Approaches?
Variety of psychodynamic, behavioral, or cognitive processes, all focused on the resolution of the identified problem
Incorporates the conscious use of time as a treatment tool
Specific number of sessions agreed upon by close assessment phase
What does assessment look like with Short-Term Approaches?
Brief
Problem-Focused
What’re the Meta-Theoretical Approaches?
Systems
Ecological or Life Model
Family Systems Theory
What is the theory base of Systems Theory?
Based on general systems theory applied and adapted to social work treatment
A conceptual framework that can be used with any of the practice approaches to help the client establish and maintain a “steady state”
Open and closed systems
Indicates whether the boundary between a system and its environment is open or closed
Boundary
the means of organization by which parts of a system can be differentiated from the environment in which the system exists and which differentiates subsystems from one another
Subsystem
a subset of the whole system
Entropy
the randomness, disorder, or chaos in a system; can cause systems to lose energy faster than it creates or imports
Homeostasis
a system will make changes or adjustments to maintain an accustomed balance
What assumptions can be made about human behavior in Systems Theory?
Individuals are active, problem-solving, and purposeful; potential for growth and adaptation throughout life
All individuals can be understood as open systems, interacting with other living systems and the nonliving environment
All systems are interdependent, so change in one system evokes changes in the others
What’re the motivations for change in Systems Theory?
Changes in the individual
Changes in the environment
Changes in the interaction between the individual and the environment
What is the therapists role in Systems Theory?
Since the worker may intervene on behalf of the client with individuals, the social support network, or the larger system, the relationship may be supportive, facilitative, collaborative, or adversarial depending on the problem and target of change
Feedback to client and other systems
What does assessment look like in Systems Theory?
Problems are not seen as belonging to the individual, but as the interaction of the behaviors or social conditions that create disequilibrium
What does treatment planning look like in Systems Theory?
Specific goals, their feasibility, and priority are established
In collaboration with the client, target systems for intervention are identified
The contrast is specific and may be developed with the client and/or with other systems that may be involved in change
What treatment skills/techniques are used in Social Theory?
Intervention strategies depend upon the target of change
Treatment techniques are eclectic; can use any applicable social work techniques
Termination: identify behaviors that help the client maintain treatment gains
What social workers are associated with Systems Theory?
Gordon Hearn, Max Siporin, Carol Meyer, Ann Hartman
What is the theory base of Ecologoical or Life Model?
Ecology
Systems Theory
Stress, coping, and adaptation theory
Psychodynamic, behavioral and cognitive theory
A conceptual framework that focuses on the interaction and interdependence of people and the environments and provides service to individuals, families, and groups within an organizational, community, and cultural environmentW
What assumptions can be made about human behavior when looking at Ecological or Life Model Theory?
Individuals are active, problem-solving, and purposeful; they have the potential for growth and adaptation throughout life; a positive model
Problems occur in three areas of life experience
Each client system is dependent upon or interdependent with other systems
What’re the three areas of life where problems arise?
Life transitions
Environmental pressures
Maladaptive lack of “fit” between the individual and the family or the larger environment
What’re the motivations for change in the Ecological or Life Model Theory?
changes desired by the individual in relation to him/herself, the environment, or the interaction between the two
What is the role of the relationship in the Ecological or Life Model Theory?
Relationship with clients is based on mutuality, trust, and authenticity
May be supportive, collaborative, or adversarial depending on the goal of the intervention
How is assessment done in Ecological or Life Model Theory?
Problems are not seen as belonging to the individual; rather the interaction of the behaviors or social conditions create disequilibrium
Client and worker seek to understand the problem, its impact, and meaning
What does treatment planning look like in the Ecological or Life Model Theory?
Specific goals are established in collaboration with the client; target systems for interventions are identified
The contract is specific and may be developed with the client and/or with other systems that may be involved in change
What treatment skills/techniques are required when using Ecological or Life Model Theory?
Worker mobilizes motivation, provides information, teaches problem-solving skills, strengthens social supports and social networks, and provide opportunities for practice of new problem-solving skills
On organizational level, worker locates organizational barriers resistant to change, develops alliances and supports, and influences formal and informal systems
Treatment techniques are eclectic, drawn from any appropriate approach
What social workers are associated with Ecological or Life Model theory?
Carol Meyer, Carol Germaine, Alex Gitterman
What is the theory base of Family Systems Theory and Therapy?
General Systems Theory
Structural Family Therapy
Strategic Family Therapy
Milan School – Systemic Family Therapy
Psychodynamic
Bowen Family System Theory
Experiential Family Therapy
Structural Family Therapy
strengthening family boundaries around the family subsystems when enmeshed or increasing flexibility when overly rigid
stresses family should be hierarchical with parents at the apex of the hierarchy
Strategic Family Therapy
Asks what function does the symptom serve in the family
Problem-focused behavioral change
Emphasizes parental power and hierarchical family relationships
Focus on the role of symptoms as a feature of family organization
Helplessness, incompetence, and illness provide power positions within the family
Milan School
Assumes that symptoms serve a function within dysfunctional families in which a family member is sacrificed to maintain the family structure
Psychodynamic within Family Systems Theory
Importance of family, multi-generational history
Previous family relations determine current family patterns
Unrealistic patterns of behavior that were produced that led to miscommunication and behavioral problems
Psychopathology results form interpersonal and intrapersonal conflict beneath apparent family unity
Heredity and environment affect social role functioning
Don Jackson
Known for his focus on power relationships and his theory “double-bind” communication in families
Bowen Family Systems Theory
Role of thinking versus feeling (reactivity) in relationship systems
Role of emotional triangles
Family issues that reappear over several generations
Undifferentiated family ego mass
Concept of emotional cutoff
Considering thoughts and feelings of each family member as well as understanding the family network
What is a Triangle?
Three-person systems that are seen as the smallest stable relationship system and are formed when a two-person system undergoes tension
What is undifferentiated family ego mass?
Refers to family’s lack of separateness, consisting of a fixed cluster of egos of individual family members as if they all have a common ego boundary
Concept of emotional cutoff
Person manages emotional issues with family members by cutting off emotional contact
What assumption can be made about human behavior in Family System Theories?
Change in one part of the family system evokes change in other parts of the system
The family provides unity, individuation, security, comfort, nurturance, warmth, affection, and reciprocal need satisfaction
Where family pathology exists, the individual is socially and individually disadvantaged
Behavioral problems are seen as a reflection of communication problems in the family system
The family unit is the focus of treatment, and changing family interactions are seen as the key to behavioral change
What’re the motivations for change in Family Systems Theory?
Disequilibrium of the accustomed family homeostasis; the family system is viewed as three subsystems and dysfunction within any one of these three subsystems if likely to produce dysfunction in others
What’re the three subsystems in Family Systems Theory?
Marital relationship
Parent-child relationship
Sibling relationship
What’re the vehicles for change in Family systems Theory?
The family is an interactional system is the primary vehicle of change
What is the role of the therapist in Family Systems Theory?
Expected to interact in the “here-and-now” with the family in relation to current problems
Consultant to the family
Structural: Dysfunctional family interaction is actively challenged
Strategic: Worker is very active
Systemic: Worker is very active
Milan School: Male and female clinicians act as co-therapists with observing team behind one-way mirror that consults to and directs the co-therapists
Psychodynamic: Facilitates self-reflection and understanding multi-generational dynamics and conflicts
Satir: Worker models caring, acceptance, compassion, love, and nurturance to help clients face their fears and increase openness
What does assessment look like in Family Systems Theory?
Dysfunction in the family system
Hierarchy
Are the boundaries around the subsystems and between the family and the larger environment permeable or impermeable? Flexible or rigid?
What function does the symptom serve in the family system?
What does treatment planning look like in Family Systems Theory?
The family worker establishes a mutually satisfactory contract with the family to establish the boundaries of the service
What is the goal of Bowenian Family Therapy?
Differentiation of the self from the intense influence of the family
What treatment skills/techniques are required when using Family Systems Theory?
Structural Family Therapy
Strategic Family Therapy
Milan School
Psychodynamic
Bowen
Satir
Treatment technique/skills: Structural Family Therapy
Active manipulation of family structure and hierarchy through enactments and re-structuring of family subsystems and boundaries during treatment sessions
Different family members may attend various sessions to introduce new dynamics in family discussions
Treatment skills/techniques: Strategic Family Therapy
Uses behavioral techniques to change family and dyadic interaction patterns
Worker prescribes the symptom, increasing the weight it contributes to the cost of symptom outweighing the gain of continuing it
Insight is necessary
Use of paradoxical interventions either to gain compliance with a directive and exaggerate the symptom until it no longer serves the family or to create defiance of the intervention and therefore change the symptom
Treatment skills/techniques: Milan School
Systemic co-therapists meet with the family
An observation team watches behind a one-way mirror, and interrupts sessions to meet with the therapists while the family waits
Co-therapists then deliver the team’s interventions
Reframing used not for insight, but to motivate compliance with treatment interventions
Change occurs as a result of therapeutic rituals and prescriptions, and as questions are asked of the family
Treatment lasts about 10 sessions
Treatment skills/techniques: Psychodynamic
Therapy consists of interpreting transference and insight that shows connections between current dysfunctional behavior, multi-generational themes, and unconscious behavior
Uncover family defenses to understand feelings, hopes, and desires
Treatment skills/techniques: Bowen
Emphasis on insight, not action
Treatment skills/techniques: Satir
Typical techniques include family sculpting to dramatize roles and experience changes, reframing, and family reconstruction
Boundaries Family Systems Theory
the means of organization by which the parts of a system can be differentiated from the environment in which the system exists and from each other
Serve to protect and enhance the differentiation and integrity of the family as a whole, the subsystem, and individual family members
Collaborative Therapy
A form of psychotherapy in which a separate therapist sees each spouse or member of the famiy
Complementary Family Interaction
A form of family relationship in which members exhibit opposite behaviors that supply needs or lacks in the other
Complementarity of Needs
Circular support system of a family system, in which there is reciprocity in meeting needs
Double-Bind Communication
A communication in which two contradictory messages are transmitted simultaneously, leading to a no-win situation
Enmeshment
The blurring of boundaries in which differentiation of family subsystems is lost, resulting in loss of individual autonomy
Characterized by mind-reading (one partner completes sentences for the other or related what the other is thinking or feeling)
Family of Origin
The family into which one is born
Family of Procreation
The family which one established with a mate and one’s own children
Homeostasis
The family is a unit having an internal ongoing interactional process and structure to maintain an accustomed systemic balance (of relationships, alliances, power, and authority)
Identified Patient
The family member who is the “symptom-bearer”
Multiple Family Group Therapy (MFT or MFGT)
Form of therapy in which three or more families gather as a group with one or more therapists to discuss common problems
Problems are universalized and group support is available
Scapegoating
Irrational, unconscious selection of one family member for a negative, demeaned, or outsider role
Narrative Therapy
A contemporary practice perspective that is receiving broad interest in the field
Apply the general approach to treatment of children, adults, and families
What is the theory base of Narrative Therapy?
Draws on variety of individual and personality theoretical orientations as well as social psychological approaches
What does Narrative Therapy focus on?
Stories people tell about their lives, interpreted through their subjective personal filters
Designed to reveal and reframe the way clients structure their perceptions of their experiences
What assumptions can you make about human behavior in Narrative Therapy?
Behaviors derive from interpretations of experience
Actions are influence by subjective meanings; the specifics of action are determined by meanings derived from interpretations of experience
Telling and re-telling of, the performance and re-performance of the preferred stories of people’s lives
What is the role of therapists relationship in Narrative Therapy?
Co-constructor of new narrative
A partnership that minimizes therapists as an authority; it does not use techniques that leave clients feeling coerced or manipulated
Agent of client empowerment
Worker guides therapeutic conversation to create new possibilities, fresh options, and opportunities to reframe client’s realities
Agent of Client Empowerment
The worker presents an optimistic future-oriented perspective that builds on client’s capacities and strengths in moving toward change, and emphasizes client’s possibilities, strengths, and resources
What does assessment look like in Narrative Therapy?
Mapping the influence of the problem in the client’s life and relationships
Mapping the influence of the person/family in the life of the problem: people begin to see themselves as authors, or at least co-authors, of their own stories
What does Treatment Planning look like in Narrative Therapy?
Client and worker together clearly establish goals for their work
Client and worker separate out and work on small goals that are specific and limited
Approach avoids disease and medical model that finds explanations for problems or attributes pathology to the family system
Rather than looking for weaknesses and deficits, the therapy builds on the strengths and competencies of families and individuals
What treatment skills/techniques are used in Narrative Therapy?
Helps individual or family generate alternative stories that are more affirming
Raises questions that deconstruct the client’s traditionally, usually negative, and deeply held perceptions about his/her life (the narrative) in a way that helps question and change the stories, and ultimately perceptions of his/her experiences
Looks for exceptions to the problem that tend to disprove the narrative and offer more positive interpretations
Emphasizes family strengths and areas where the family’s experience has been positive
Disrupts limiting mental sets and constructs a new perspective or point of view
Develops externalizing conversations, beginning by “externalizing the problem”
Raises outcome and account conversations
Offers unique redescription questions
Poses unique possibility questions
Uses unique circulation questions: inclusion of others in telling of story to develop alternative story
Raises experience questions: see themselves through the eyes of others
Offer questions which historicize unique outcomes: increases likelihood of alternative story being carried over
Poses questions concerning historical context of the problem
Uses preference questions
Refers to consultants’ questions: shift the status of a person from “client” to “consultant”
Treatment of Children
referred to therapy for symptoms or behavioral problems
in free expression, both verbal and through play, the child’s underlying conflicts can reveal themselves
play is the child’s form of symbolic communication, and emulation of the real world and the child’s psychological reality
What is the theory base for Treatment of Children?
Normal Child Development
Psychosocial Development
Attachment Theory
Object Relations Theory
What’re the motivations for change for Treatment of Children?
May be in placement alternative to being cared for by the family of origin which may define child’s behaviors as problematic and seek treatment interventions
Unhappy with peer relations, social immaturity
School adjustment
Conflict with parents
Feeling unhappy, angry
Self-destructive behaviors
What is the role of the therapeutic relationship in Treatment of Children?
Build upon strengths and focus on those areas where problems in functioning are found
Support adaptive behavior
Set realistic goals with emphasis upon those issues that directly affect child’s care
Clarifies length of time treatment might take with ongoing reevaluation
Building a relationship through management of concrete problems
What treatment modalities are use for Treatment of Children?
Individual Therapy
Parent-Child Interaction
Marital Treatment
Group Treatment
Family Treatment
Parent Guidance
Parent Aides and Educators
“Life Space” Interviews
What treatment skills/techniques are use when doing Treatment of Children?
Establishing and emotionally safe environment for the child
Engaging child in expressive play and understanding how to interpret its meaning
Cultural Competence in working with various ethnic, racial, religious, immigrant, and economic groups
What is the theory base of Geriatric Social Work?
Psychodynamic
Ego Psychology
Family Systems Theory
Life-Span Development Theory
Continuity Theory
Normal aging and demographics of the aging population
Impact of chronic illness, and physical and cognitive limitations
What assumptions can be made about human behavior in Geriatric Social Work?
Growth takes places across the life span, including during old age
Individuals are innately adaptive and capable of managing the disruptions, discontinuities, and losses that are inherent in old age
Difficulty accepting old age due to societal pressures
Care by the younger generation for the older may be experienced as role reversal challenging both generations
Aging in place with supportive services is preferable to institutional care whenever possible
Self-determination and confidentiality should not be compromised by ageist assumptions or because one lives in and institutional setting
There are individual differences in how people age
What is true about community-living elders?
Mental health risk for depression and suicidal ideation are lower
What’re the vehicles for change in Geriatric Social Work?
Individuals, couples, or family treatment
Support groups or group therapy
Recreation programs
Education
What is the role of relationship in Geriatric Social Work?
Therapist for individual, couple or multi-generational family
Case Manager
Advocate
Care Planning
Social Worker for institution (conflict could arise due to different view points of agency and social worker)
Guardian for older person who has been declared mentally incompetent by the court
Educator
Group leader or therapist
Program Planner
What does an assessment look like in Geriatric Social Work?
The presenting problem and the client’s personal and environmental resources for resolving it
If adult children are involved, assess intergenerational dynamics and resources, and the relevance and impact of family history on present functioning
Presence and impact of chronic illness, and physical and cognitive limitations
Home safety
Role of medications in influencing functioning or creating negative side effects
Need for supportive services or institutional care
Activities of Daily Living (ADL’s)
Instrumental Activities of Daily Living (IADL’s)
What does treatment planning look like in Geriatric Social Work?
Interventions and solutions that offer choice and support the older person’s highest level of functioning
Promote independence and aging in place by planning home modifications as result of home safety assessment and planning for assistive devices as result of assessing physical and cognitive limitations
What treatment skills/techniques are used in Geriatric Social Work?
Strengths-Based Perspective
Increase access to services
Cultural competence in working with various ethnic, racial, religious, immigrant, and economic groups
Strengths-Based Perspective
Clinical Skills/Techniques used in various treatment modalities with adults
What is the theory base for Practice with Maltreated Children?
Physical abuse: physical indicators and/or behavioral indicators
Sexual Abuse
Child Neglect
Physical Abuse
extreme physical discipline that exceeds normative community standards
Physical Indicators of Abuse
bruises or broken bones on any infant that are not adequately explained or in unusual places
lacerations
fractures
burns that take odd forms or patterns
head injuries
internal injuries
open sores
untreated wounds and illnesses
Behavioral Indicators of Abuse
overly compliant
passive
undemanding behavior
extremely aggressive
demanding
hostile behaviors
role reversal behavior or extremely dependent behavior in response to parental, emotional and even physical needs
developmental delays
Sexual Abuse
inappropriate sexual contact, molestation, rape
Child Neglect
failure of the child’s parent or caretaker to provide minimally adequate health care, nutrition, shelter, education, supervision, affection or attention
What’re indicators of child abuse?
Abandonment
Absence of Adult Supervision
Inadequate Clothing and Poor Hygiene
Lack of Adequate Medical and Dental Care
Inadequate Education
Inadequate Supervision
Inadequate Shelter
Consistent failure, unwillingness, or inability to correct the indicators above
What is the role of relationship in Maltreated Child Work?
Establish trust and a working relationship with the family, and build parental self-esteem
Parent may confuse role of social worker with the role of child protective services
Parents may confuse clinician as hostile link in a legal chain, rather than as a trusted clinical helper
Perception of coercion can inhibit communication and limit the effectiveness of treatment
Worker should inform the child’s caretaker of the implications of a report and the type of follow up they can expect
What is the first goal of the treatment plan in Maltreated Child Work?
Primary and overarching goal is protection of the child from further harm or sexual exploitation to halt further abuse, neglect, or sexual exploitation immediately and conclusively
What is the second goal of the treatment plan in Maltreated Child Work?
Create conditions insuring that abuse or neglect does not recur after protective supervision or treatment is terminated
May include prosecution or threat of prosecution or incarceration of the offending adult in severe cases
May also include exploration of the non-offending parents long-term capacity and motivation to protect and care for the child
What is the goal of treatment for parents in Maltreated Child Work?
Help them learn parenting and relational skills that can alter both the parent’s behavior and the child’s responses
What treatment skills/techniques are used in Maltreated Child Work?
Use outside resources
Specialized Treatment (used in sexual abuse cases for things like PTSD)
Emphasis is on helping families obtain access to needed resources (emphasis with neglectful families)
What is the theory base for Trauma-Related Treatment with Adults?
Trauma victims experiences a threat to his/her physical integrity or life which can make individuals feel fear and helplessness
Trauma may take form of one event of short duration or may be chronic and repeated
Many symptoms associated with PTSD and domestic violence are self-protective attempts at coping with realistic threats
What assumptions about human behavior can be made in Trauma-Related Treatment with Adults?
Most people experience the world as a basically safe place in which they themselves are worthy participants
Trauma can challenge or reverse these assumptions about the world and oneself
Resilience is an innate capacity to “self-right” after experiencing a stressor or a stressor so extreme as to be traumatic
Resilience can be drawn from both internal and environmental resources
Resilience can be more difficult to sustain (when perpetrator is caretaker or trusted protector)
What’re the motivations for change in Trauma-Related Treatment with Adults?
Reality-based fear and need for protection
Symptoms of depression, anxiety, dissociation, low self-esteem
What is the role of relationship in Trauma-Related Treatment with Adults?
PTSD: worker is a “protective presence” who guides the pace of treatment and provide a safe therapeutic space
Domestic Violence: worker may be therapist, case manager, court-based victim advocate, or broker to obtain resources
What does assessment look like in Trauma-Related Treatment with Adults?
PTSD: Nature of trauma; strengths and limitations that pre-existed the trauma; and the impact of trauma on the client’s emotional life, self-esteem, and functioning
Domestic Violence: Is the client safe? Legal reporting if children are involved
What does treatment planning look like for Trauma-Related Treatment with Adults?
PTSD: select individual treatment (EMDR or DBT)
Domestic Violence: Safety plan and other practical resources; individual clinical services
DBT
teaches skills to cope with intense feelings, reduce symptoms of PTSD, and enhance respect for self and quality of life
What treatment skills/techniques are used in Trauma-Related Treatment with Adults?
PTSD: Establish a safe environment in which to remember and process the trauma and address symptoms, taking care not to proceed too quickly or overwhelm the client with affect that would undermine his/her functioning
Domestic Violence: Use same therapeutic skills for PTSD; establish a therapeutic alliance; make and/or carry out safety plan
