Current Practice Approaches Flashcards

1
Q

What’re the Psychodynamic Theory-based Social Work Approaches?

A

psychosocial, problem-solving, crisis intervention, task-centered casework, planned short-term treatment

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2
Q

Where did Psychosocial theory originate?

A

Greatest influence was Sigmund Freud

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3
Q

What is Ego Psychology within Psychosocial Theory?

A

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

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4
Q

What’re Social Science Theories?

A

role, family and small group, impact of culture, communication theory, and systems theory

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5
Q

What’re Biological Theories?

A

ecological, homeostasis, behavioral genetics, health, and illness

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6
Q

What assumptions are made about human behavior within Psychosocial Theories?

A

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

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7
Q

What can be considered motivation for change in Psychosocial Theories?

A

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

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8
Q

What can be considered vehicles for change in Psychosocial Theories?

A

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

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9
Q

How does the role of the therapeutic relationship influence the therapeutic process based on Psychosocial Theory?

A

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

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10
Q

When should self-disclosure occur?

A

Purposefully and when it benefits that client

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11
Q

What can transference be used for in positive ways when engaging with clients?

A

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

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12
Q

What are way a that a therapist can create awareness of countertransference?

A

Have supervision and use consultation

Go to own therapy sessions

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13
Q

What’re assessments used for?

A

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

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14
Q

When are assessment done?

A

At the beginning of treatment

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15
Q

What’re the components of an assessment

A

Dynamic understanding, etiological understanding, clinical understanding

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16
Q

Dynamic understanding

A

How do different aspects of a client’s personality and his/her important relationships interact to produce or influence his/her total functioning?

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17
Q

Etiological understanding

A

What are the causative factors that produced the presenting problem and that influence the client’s attempt to deal with it?

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18
Q

Clinical understanding

A

Formulation of the client’s functioning (mental status, and accustomed defenses and coping style, including where pertinent, a clinical diagnosis)

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19
Q

Why are treatment plans important?

A

Focuses on key characteristics of the psychosocial approach is the development of a unique treatment plan based on the client’s situation

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20
Q

What do treatment plans consist of?

A

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

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21
Q

What is the focus of a treatment plan?

A

Changing the individual, the environment, or the interaction between the two

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22
Q

What’re the phases of treatment?

A

Engagement/assessment

Contracting/goal-setting

Ongoing treatment/interventions

Termination

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23
Q

Engagement/assessment

A

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

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24
Q

Contracting/goal-setting

A

Mutual understanding between client and worker about goals, treatment process, the nature of the relationship and roles, and the intended allotted time

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25
Ongoing treatment/interventions
Work to alleviate agreed upon problems and focus on current functioning and conscious experience Deal with ongoing resistance, transference, and countertransference
26
Termination
Potential for growth, recapitulation of major themes of treatment, experience feelings about ending the relationship
27
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
28
What social workers are associated with psychosocial approach?
Mary Richmond Gordon Hamilton Florence Hollis Francis Turner Mary Woods
29
Problem-Solving Approach
partially derived from psychosocial approach and partially derived from the functional approach
30
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)
31
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
32
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
33
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
34
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
35
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
36
Psychosocial Treatment: Problem-Solving Approach
based on the assessment of the problem and the client's motivation, capacity, and opportunities (MCO)
37
Functional Treatment: Problem-Solving Approach
based on the function of the agency as a boundary of service
38
Interagency Treatment: Problem-Solving Approach
uses resources of other agencies in network of services designed to aid the client
39
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
40
What're the four P's?
a person has a problem, comes to a place for help given through a process
41
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
42
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
43
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
44
What're the motivations for change in Crisis Intervention?
Disequilibrium brought on by stressful event or situation Energy made available by anxiety Supportive relationship
45
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
46
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
47
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
48
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
49
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
50
What're the Behavioral Theory-based Social Work Approaches?
Behavior Modification, Cognitive Therapy, Task-Centered
51
What is the theory base of Behavior Modification?
Early classical conditioning (Pavlov) Operant conditioning Social learning theory: observing, imitating, modeling
52
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
53
What're the motivations for change in Behavioral Modification?
Disequilibrium Anxiety Conscious wish to remove a symptom An agreement to follow behavior modification program
54
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
55
Operant (voluntary) behavior
Increased by positive or negative reinforcement Decreased (extinguished) by withholding reinforcement or punishment
56
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
57
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
58
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
59
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
60
How do you ensure that treatment is being implemented in behavior modification?
Examining obstacles to implementation Revising the program is obstacles cannot be overcome
61
What're the three types of treatment clusters in Behavior Modification?
operant, respondent, cognitive
62
What social workers are associated with Behavior Modification?
Edwin Thomas and Joel Fischer
63
What is the theory base for Cognitive Therapy?
Rational-emotive behavior therapy Cognitive therapy
64
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
65
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
66
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
67
What is the role of the therapeutic relationship in Cognitive Therapy?
Therapist is teacher, ally, coach; active, directive, didactic
68
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
69
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
70
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
71
What is the theory base for Task-Centered therapy?
Learning theory Cognitive and behavioral theory Research-based practice knowledge has high priority
72
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
73
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
74
What're the vehicles for change in Task-Centered therapy?
Problem clarification Steps taken to relieve or resolve problems Changes in the environment
75
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
76
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
77
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
78
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
79
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
80
What're Short-Term approaches?
Planned Short-Term Treatment Crisis Intervention Task-Centered Treatment Competency-Based Treatment
81
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
82
What is the theory base of Short-Term Approaches?
Psychodynamic, behavioral, cognitive, or a combination
83
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
84
What're the motivations for change in Short-Term Approaches?
Derives from anxiety or discomfort generated by acute situational or emotional problems
84
What're the vehicles for change in Short-Term Approaches?
Takes place through active engagement in problem-solving
84
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
84
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
85
What does assessment look like with Short-Term Approaches?
Brief Problem-Focused
86
What're the Meta-Theoretical Approaches?
Systems Ecological or Life Model Family Systems Theory
87
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"
87
Open and closed systems
Indicates whether the boundary between a system and its environment is open or closed
88
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
89
Subsystem
a subset of the whole system
90
Entropy
the randomness, disorder, or chaos in a system; can cause systems to lose energy faster than it creates or imports
90
Homeostasis
a system will make changes or adjustments to maintain an accustomed balance
91
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
92
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
93
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
94
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
95
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
96
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
97
What social workers are associated with Systems Theory?
Gordon Hearn, Max Siporin, Carol Meyer, Ann Hartman
98
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
99
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
100
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
101
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
102
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
103
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
104
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
105
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
106
What social workers are associated with Ecological or Life Model theory?
Carol Meyer, Carol Germaine, Alex Gitterman
107
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
108
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
109
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
110
Milan School
Assumes that symptoms serve a function within dysfunctional families in which a family member is sacrificed to maintain the family structure
111
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
112
Don Jackson
Known for his focus on power relationships and his theory "double-bind" communication in families
113
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
114
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
115
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
116
Concept of emotional cutoff
Person manages emotional issues with family members by cutting off emotional contact
117
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
118
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
119
What're the three subsystems in Family Systems Theory?
Marital relationship Parent-child relationship Sibling relationship
120
What're the vehicles for change in Family systems Theory?
The family is an interactional system is the primary vehicle of change
121
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
122
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?
123
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
124
What is the goal of Bowenian Family Therapy?
Differentiation of the self from the intense influence of the family
125
What treatment skills/techniques are required when using Family Systems Theory?
Structural Family Therapy Strategic Family Therapy Milan School Psychodynamic Bowen Satir
126
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
127
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
128
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
129
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
130
Treatment skills/techniques: Bowen
Emphasis on insight, not action
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Treatment skills/techniques: Satir
Typical techniques include family sculpting to dramatize roles and experience changes, reframing, and family reconstruction
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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
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Collaborative Therapy
A form of psychotherapy in which a separate therapist sees each spouse or member of the famiy
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Complementary Family Interaction
A form of family relationship in which members exhibit opposite behaviors that supply needs or lacks in the other
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Complementarity of Needs
Circular support system of a family system, in which there is reciprocity in meeting needs
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Double-Bind Communication
A communication in which two contradictory messages are transmitted simultaneously, leading to a no-win situation
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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)
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Family of Origin
The family into which one is born
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Family of Procreation
The family which one established with a mate and one's own children
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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)
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Identified Patient
The family member who is the "symptom-bearer"
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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
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Scapegoating
Irrational, unconscious selection of one family member for a negative, demeaned, or outsider role
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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
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What is the theory base of Narrative Therapy?
Draws on variety of individual and personality theoretical orientations as well as social psychological approaches
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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
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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
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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
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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
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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
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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
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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"
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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
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What is the theory base for Treatment of Children?
Normal Child Development Psychosocial Development Attachment Theory Object Relations Theory
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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
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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
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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
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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
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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
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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
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What is true about community-living elders?
Mental health risk for depression and suicidal ideation are lower
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What're the vehicles for change in Geriatric Social Work?
Individuals, couples, or family treatment Support groups or group therapy Recreation programs Education
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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
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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)
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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
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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
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Strengths-Based Perspective
Clinical Skills/Techniques used in various treatment modalities with adults
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What is the theory base for Practice with Maltreated Children?
Physical abuse: physical indicators and/or behavioral indicators Sexual Abuse Child Neglect
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Physical Abuse
extreme physical discipline that exceeds normative community standards
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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
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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
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Sexual Abuse
inappropriate sexual contact, molestation, rape
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Child Neglect
failure of the child's parent or caretaker to provide minimally adequate health care, nutrition, shelter, education, supervision, affection or attention
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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
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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
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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
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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
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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
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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)
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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
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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)
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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
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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
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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
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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
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DBT
teaches skills to cope with intense feelings, reduce symptoms of PTSD, and enhance respect for self and quality of life
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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