Interventions With Clients/ Client Systems; Psychotherapy & CM

Question 1

Intervention Process & Techniques, what does it entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 1

Working with CTs.
Direct practice is multifaceted. Also known as micro or clinical practice, direct practice refers to working with individuals, couples, families, and groups. SW provides professional therapeutic services, which include psychotherapy, education, advocacy, referral, mediation, and social action.
Indirect practice or macro practice is defined as program planning and development, policy analysis, administration, and program evaluation.

Question 2

What are the Guidelines for Working with CTs? Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 2

• Begin where the CT is.
• Goals must have the potential to benefit the CT.
• The CT and SW should work in partnership to identify treatment goals.
• When difficult situations arise in practice, it is generally appropriate to be honest and direct. Talking through an issue can be beneficial to the CT, not only in addressing the difficult situation, but also in viewing the talking- through process as a model of behavior the CT can use with other difficult situations.
• When there are cultural differences between the CT and SW, it is important that the SW acknowledge these differences and provide a culturally competent assessment of the CT’s situation, as well as culturally competent interventions.
• SWs should assess the Communication skills of each CT, including the CT’s language. When possible, CTs should be assigned a SW who speaks the language with which the CT is most comfortable. When this is not possible, the services of a translator may be needed.
• SWs should not try to “reality test” with a delusional CT. Instead, a SW should deal with the CT’s anxiety and thoughts in a calm, empathic manner and arrange for the CT to obtain a psychiatric evaluation as soon as possible.
  (The ability to distinguish between reality and fiction in one’s own thoughts is an important aspect of development. Errors in thinking can influence behavior and lead to anxiety. Reality testing highlights the importance of recognizing common errors in one’s thinking and correcting them.)
• SWs should always be aware of transference and countertransference situations.
• In the profession of SW, there is agreement that Evidence- Based Practice (EBP) is a process of asking an answerable question based on a CT or organizational need, locating the best available evidence to answer the question, evaluating the quality of the evidence and its applicability, and evaluating the effectiveness and efficiency of the intervention. SW should utilize well- researched interventions in balance with their clinical experience, ethics, CT preferences, and culture to inform the delivery of treatments and service. SWs must also assess whether a specific Evidence- Based practice or Evidence Based Treatment is adaptable for their CTs and specific situations.

While SWs in most states can have CTs committed (i.e. hospitalized against their will), the criteria for involuntary hospitalization differ among states. Laws typically require the recommendation of at least one person before admission is possible. Specific CT rights and treatment guidelines have been identified in the mental health realm and these have been recognized in different forms. *Remember the ASWB exam is used in US and abroad, therefore, you should not answer questions based exclusively on the laws in your geographic area, with exception of those related to harm to self and others.

Question 3

What do Communication Skills entail?
Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 3

SW need a variety of communication skills in their work with CTs. Two major types of communication skills are:

• Verbal/ Focusing Skills
  
  • Furthering Responses encourages the CT to talk, as well as demonstrate to the CT that the SW is carefully listening. Furthering responses include minimal prompts (e.g. brief verbal responses such as “But?” and nonverbal responses such as head nodding) that communicate a SW’s tracking and interest.
  • Paraphrasing refers to the SW restating the CT’s message *succinctly in his or her own words. This technique focuses on the content of the message rather than underlying feelings. Paraphrasing allows the SW to check out the accuracy of his understanding of the CT’s statement, which demonstrates that the SW is listening and tracking.
    (Succinctly a brief and clearly expressed manner.)
  • Seeking Concreteness helps CT to discuss their experiences using explicit rather than abstract or general terms. Responses by the SW that help CT achieve concreteness in their communication include exploring perceptions, clarifying terms that are unfamiliar or vague, asking the CTs to share their rationale for conclusions they draw and helping CTs “personalize” their communications (e.g. using “I” and “me” when the CT is talking about his or her experience/ thoughts/ emotions.) Seeking concrete information assists CTs in identifying their specific feelings, focusing on the here-and-now, and expressing the detail of their experience.

Question 4

What do Communication Skills entail?
Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 4

• Summarizing provides the CT with a condensed version of a segment of an interview. The SW highlights the CT’s main ideas and theme. Summarizing is useful as a method of organizing interview data, providing an opportunity for CT verification of content, and differentiating between relevant and irrelevant content.
  
  • Empathic Responding is achieved by the SW when he/she is able to accurately perceive the CT’s feelings and communicate understanding of those feelings through accurate reflection. Effective empathic responding leads to better therapeutic outcomes.
  • Questioning is an important component of successful therapy and satisfying relationships. Different types of questioning are used to achieve different goals.
    • Questions that have utility in practice:
      
      • Closed- ended questions- can be answered with few words and are used to obtain specific information such as, “How old are you?” or “What is your name?”
      • Open- ended questions invite the CT to express him/herself freely by asking questions such as, “What was it like for you to hear from your son after two years of no contact?” Open- ended questions enable the SW to gather a large amount of information w/o bombarding the CT with questions.
      • Questions that should not be used in practice:
        
        • Stacked questions are those that are asked in quick succession, (as opposed to a single question), for which the person has little or no time to respond. As a result, little information can be obtained from the responses.
        • Leading questions involve asking questions that have an underlying goal of obtaining CT agreement w/ the SW such as, “ You don’t really want to hurt yourself, do you?”

Question 5

What do Communication Skills entail?
Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 5

Other Communication Skills
- Active (Reflective) Listening is a set of listening skills used in problem resolution. The listener rephrases the message (verbal and non-verbal components) sent by the communicator. Only when the communicator confirms that the listener has correctly understood his/her message does the listener seek to communicate his/her views. Active (Reflective) listening also involves being aware of and identifying the communicator’s feelings. This technique does not involve advising, judging and criticizing.

• Confrontation is a method of helping a CT to become more self-aware of components of the thoughts, feelings or behavior of which the CT is unaware. Confrontation may involve, among other things, identifying incongruities between between a CT’s beliefs and his/her behavior, identifying problems in communication, addressing self-defeating patterns of behavior, and identifying CT strength. Caring confrontation can strengthen the therapeutic relationship and help CTs achieve a higher level of functioning.
  (Incongruities the state of being incongruous or out of keeping- incongruous in harmony or keeping with the surroundings or other aspects of something.)
• Components of Effective Confrontation
  • Effective confrontation my support the goals of therapy and meet the CT’s needs.
  • Confrontation is effective if it is appropriately timed, (typically immediately following the event that is addresses), and when there is adequate time left in the session to deal with the consequences. The therapeutic relationship must be strong enough to support confrontation by the SW.
  • Effective confrontation must be specific in nature, rather than general or unclear.
  • Effective Confrontation must be CT- bases, not an opportunity for the SW to vent hostility.

Question 6

What do Communication Skills entail?
Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 6

• Barriers to Communication
  Barriers to effective communication may occur if the CT is fearful of what the SW’s response may be to his/her situation, or to the disclosure of certain personal information. CTs may use denial or may minimize their problems, which is a barrier to dealing with the real problems that the CT is facing. CT’s especially those who have been abused, may feel that they will lose control if they about the abuse, so they refrain from discussing their real issue. A common barrier to communication occurs when the CTs feel responsible for their situation and therefore are hesitant to express themselves freely. Sometimes CTs who have experienced discrimination or negative interactions with people in the past, may project their feelings on to their SW, thus creating another barrier to effective communication.

Other barriers occur when the SW’s behavior interferes. A passive SW who does not direct the therapy session may decrease the likelihood that the CT will divulge all necessary information. Conversely, a SW who is too aggressive or who behaves in a threatening or hostile manner will create a barrier to communication. Excessive interruptions during the therapeutic session may convey to the CT that the SW is more interested in things other than the session or the CT. SWs who provide premature assurance to the CT or who give untimely advice may cause the CT to stop talking before adequate depth of therapy has been achieved. Potentially agitating choices of wording by the SW, such as repeating the CT’s exact words, sarcastic comments, inappropriate humor, guilt-producing language, etc., are barriers to effective communication. The SW’s non-verbal communication (e.g. looking at his or her watch, making facial grimaces, gazing out the window, yawning), may be interpreted by the CT as directed at him or her, even if there are other reasons for the behavior.

Occasionally transference and counter-transference issues come up in the therapeutic relationship and become barriers to communication and therefore must be dealt with.

* Transference is the emotional reaction that an individual has toward another person based on the individual's previous experiences with a different person.  For example, transference may occur between a CT and SW if the CT displaces feelings that he/she has for someone else on to the SW. These feelings can be positive, such as the CT having romantic feelings toward the SW, or they can be negative, such as the CT treating the SW in a hostile manner for no apparent reason.     * Counter- transference refers to the range of reaction and responses that the SW has toward the CTs' including the CT's transference reactions, based on the SW's own background.

Question 7

What is The Helping Process?-
Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 7

When utilizing any type of treatment, always remember to consider the CT’s cultural differences. The helping process resembles a problem- solving model but is more *strength(s)- based and is made up of the following stages:
- Stage 1: Relationship- Building, Exploration, Engagement, Assessment and Planning- this stage provides a basis for intervention. This procedure consists of the collection of data via the interview process with the CT and identification of the primary problem(s) and external contributing factors. The steps in this process include the development of rapport with the CT; the completion of a multidimensional assessment; the identification of mutually agreed- upon treatment goals; the formulation of a treatment contract; and referral to other entities when the CT has needs that the SW is unable to meet.
Relationship- building skills by the SW include the use of empathy, unconditional positive regard, congruence, authenticity, and relating assertively when warranted by the situation. The SW needs to maintain focus, interrupt dysfunctional processes, teach facilitative behaviors to the CT, and make firm and decisive requests using assertive language. The SW should address the CT’s anger and complaints in a direct manner and * set limits when necessary.

- Stage 2: Implementation and Goal Attainment- this stage also referred to as the "action- oriented" or "change- oriented" stage, where the treatment plan is put into action. This stage often involves breaking goals down into specific tasks to accomplished.  * Partializing techniques may be utilized, in which the SW temporarily views a CT's interconnected problems as separate issues in order to make the solutions more manageable. The SW and CT establish priorities, focusing first on problems that need immediate attention and then moving to those issues that can be postponed until later.     - Stage 3: Termination, Planning Maintenance Strategies, and Evaluation- termination occurs when treatment goals have been met. It is important for the SW to assist the CT in processing any negative emotional reactions that he or she has regarding termination. There should be an evaluation showing the extent to which treatment goals were met. A plan that the CT will follow to maintain the progress that was made in therapy should be developed. A follow-up visit may be scheduled to evaluate the extent to which the CT has been able to maintain gains from treatment, to adjust maintenance strategies based on the CT's experience since the last visit, and to communicate the SW's continued interest in the welfare of the CT.

Question 8

What is Systems Theory?
Intervention Process & Techniques
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 8

• Refers to the relationship of the parts of a system to one another and the effects of those relationship on the system. SWs use systems theory in all aspects of their work.
  In research, SW examine the dynamic interrelations of individuals, families, societies, and institutions. They identify the functioning of each system and examine the negative impact that certain aspects of the system have on individuals. Then, the SW attempts to create needed changes in functioning that will produce positive results.
  On the Micro level, SWs use system theory to view families in terms of roles, relationships, and family dynamics to determine the effect those factors have on individual family members.
  On the Macro level, SWs use systems theory in understanding the interrelated social structure of communities, and then use policy and advocacy to improve the welfare of society and communities.

Question 9

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 9

• Critical Incident Stress Management (CISM)
  Critical incidents are traumatic events that create powerful emotional reactions in the individuals who have been exposed to those events (e.g. multiple- causality, line of duty, workplace violence). CISM was created by Jeffrey T. Mitchell, Ph.D in response to traumatic events and the psychological effects on first responders. The model has been adapted to meet the needs of a variety of populations (e.g. corporate settings) who have experienced a traumatic event.

The premise of this model is that most stress-related symptoms are transitory (not permanent) with no long-term detrimental effects. However, if some symptoms are delayed, problems might occur at a later date (e.g. declining work performance, deterioration of family relationships, and increased health problems). The model has both counseling and educational components. Critical Incident Stress Management begins with on-scene management (defusing) where observes watch for signs of stress in first responders and take action to help mitigate the stress. Formal Critical Incident Stress Debriefing (CISD) is a specific, 7- phase, small group, crisis intervention process that is conducted 24-72 hrs after the incident in which participants talk about their experience and the positive and negative emotions associated with the incident. The group leader then normalizes reactions and teaches stress responses strategies. If individual participants need additional help, then these individuals are referred to mental health professionals.

Since 9/11, research studies have been critical in CISD as having either no effect or increasing trauma symptoms. However, many of the studies did not implement CISD with properly trained professionals and homogenous groups. Therefore, further research is still needed on the effectiveness of CISD.

Question 10

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 10

• Task- Centered Treatment is a short- term approach to treatment based on learning and cognitive theories. It can use intervention and strategies from many models of therapy in the task- centered framework to achieve concrete goals.
  
  • Engagement
  • Problem- centered assessment
  • The development of problem- solving tasks or planning implementation
  • Performing problem- solving tasks
  • At the beginning of each session, reviewing progress in achieving a task
  • SW and CT planning a new task or dealing with obstacles through task completion
  • Evaluation
  • Termination

Learning Theory describes how students absorb, process, and retain knowledge during learning. Cognitive, emotional, and environmental influences, as well as prior experience, all play a part in how understanding, or a world view, is acquired or changed and knowledge and skills retained.
Cognitive theory is an approach to psychology that attempts to explain human behavior by understanding your thought processes. For example, a therapist is using principles of cognitive theory when she teaches you how to identify maladaptive thought patterns and transform them into constructive ones.

Question 11

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 11

Behavioral Therapy
* Classical Conditioning involves helping the CT unlearn maladaptive responses to environmental stimuli (e.g. fear of riding in a car following an accident). Treatment based on counter conditioning by Wolpe focus on the technique of reciprocal inhibition. Classical conditioning entails conditioning an individual to associate pleasant feelings with a stimulus that has been anxiety- producing (e.g. learning to feel relaxed rather than anxious when flying).

• Systematic Desensitization is a counter- conditioning intervention frequently used in treating phobias that utilizes relaxation training, construction of the anxiety hierarchy, and desensitization in imagination (pairing of relaxation and mental images of items from the least to the most anxiety- producing image until the person can visualize all images w/o becoming anxious).
• In Vivo Desensitization involves the pairing of relaxation and real- life experience with an anxiety- producing stimulus until the person no longer responds to the experience with anxiety.
• Assertiveness Training involves training an individual to communicate his/her feelings in a direct and honest manner. Behavioral rehearsal is an important component of assertiveness training.

Question 12

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 12

Behavioral Therapy
* Sensate Focus and Nondemand Pleasuring (in Sex Therapy) is used in the treatment of performance anxiety or spectator role. It initially involves having couples focus on pleasuring each other using sensual massage, hugging, and kissing while refraining from having intercouse or caressing genitals or breast and, overtime, gradually rebuilding their sexual repertoire while continuing to focus on sensual pleasure rather than on achieving an erection or orgasm.

• Operant Conditioning focuses on behaviors that operate or act on the environment (operants) with the goal of obtaining some response (i.e. reinforcing behavior so it will be repeated and withholding reinforcement so a behavior will not be repeated).
• Reinforcer is a consequence that increases the likelihood that a preceding behavior will be repeated. The reinforcer needs to immediately follow the target behavior.
• Primary Reinforcer refers to stimuli required to sustain life or to satisfy physiological needs. Primary reinforcers are naturally reinforcing (e.g. water, food, sleep)
• Secondary Reinforcer is a stimulus that the organism learns to value.

Question 13

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 13

Behavioral Therapy
* Positive Reinforcement is the repetition of a behavior because the behavior is followed by a pleasant stimulus.

• Negative Reinforcement is the repetition of a behavior because of the behavior’s power to turn off negative stimuli.
• Premack Principle involves using a high- probability behavior (video game) to reinforce a low-probability behavior in order to increase the frequency of the low- probability (homework) behavior (e.g. allowing a child to play a video game for 30 mins after finishing his/her homework)
• Differential Reinforcement for Alternative Behaviors (DRA) means that alternative behaviors are reinforced while the target behaviors are not.
• Shaping is a technique of reinforcing successive approximations to the desired behavior.

Question 14

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 14

• Schedules of Reinforcement
• Continuous refers to reinforcing every occurrence of the target behavior. Continuous reinforcements is useful early in the learning process.
• Intermittent is reinforcement of only some occurrences of the target behavior. This is useful in maintaining behavior.
• Fixed Interval refers to providing reinforcement after a specific time period has elapsed following the occurrence of the desired behavior.
• Variable Interval refers to reinforcement occurring at varying times after occurrences of the desired behavior. For example checking your email multiple times per day is likely to result in a random reinforcement (e.g. at random times a person would get an email)

Question 15

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 15

• Schedules of Reinforcement
  
  • Fixed Ratio refers to reinforcement that is given after a specified number of responses. Getting a prize after every five successes is an example of a fixed ratio.
  • Variable Ratio is reinforcement that is given on an unpredictable or varied basis. This reinforcement schedule creates a high steady rate of responding. Gambling and lottery games are good examples of a reward based on a variable ratio schedule.
  • Punishment is following a behavior with an aversive stimulus (e.g. spanking a child for misbehaving). The use of punishment often creates resentment towards the punisher and does not teach appropriate behavior.
  • Extinction refers to failing to reinforce the target behavior, which results in the disappearance of the behavior.

Question 16

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 16

• Schedules of Reinforcement
  
  • Response Cost is withdrawing a specific positive reinforcer each time an undesirable behavior is performed (e.g. the child loses a token earned previously for appropriate behavior)
  • Verbal Clarification and Prompts are helpful aids in the development of a new behavior.
  • Modifying Behavior with Contingency Contracts and Token Economies
    Contingency Contract is a treatment contract that makes a specified consequence, pleasant or unpleasant, contingent (subject to change) on a specific behavior or behaviors.
    Token Economy is a widely- used approach for reinforcing desirable behaviors that involves rewarding these behaviors with token that can be redeemed for reinforcers (e.g. special one-on-one time with the teacher). This approach is commonly used with children.

Question 17

What does Individual Theories and Types of Psychotherapy entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 17

Reality Therapy (William Glasser)
Glasser was influenced by Control theory, which asserts that all human behavior is purposeful and originates from within the person and that the individual is responsible for his/her behavior. 

Reality Therapy personality theory states that individuals have a number of innate (inborn; natural) needs, including four psychological needs (i.e. belonging, power, freedom, and fun). The brain is a control system, and a control system acts on the external world in an effort to fulfil the inherent (essential) needs needs or purposes of the system (i.e. the person). Psychological disorders represent failures to act upon the world in a manner that brings about the responsible satisfaction of needs. Responsible behavior is moral behavior according to this theory.

The goal of this type of therapy is to enable the CT to take better control of his or her life. Reality Therapy rejects the medical model and the concept of mental illness. It focuses on current behaviors and beliefs rather than past behaviors, feelings, attitudes, and experiences. Transference is viewed as detrimental to the therapy process. Reality Therapy stresses conscious rather than unconscious processes and helps CTs understand that our choice of behavior reflects our effort to fulfill our basic needs. The therapy seeks to teach CTs to evaluate their behavior in terms of whether the behavior is enabling them to satisfy needs without interfering with the satisfaction of the needs of others (responsible behavior).

Question 18

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 18

• Cognitive- Behavioral Therapies is that our thoughts and beliefs control how we feel and behave. There is strong evidence that Cognitive- Behavior Therapy is the treatment of choice for depression (in combination with drug therapy). It is an integration of three schools of thoughts: 1. Behavior therapy (This form of therapy seeks to identify and help change potentially self-destructive or unhealthy behaviors. It functions on the idea that all behaviors are learned and that unhealthy behaviors can be changed); 2. Cognitive therapy (A relatively short-term form of psychotherapy based on the concept that the way we think about things affects how we feel emotionally. Cognitive therapy focuses on present thinking, behavior, and communication rather than on past experiences and is oriented toward problem solving); 3. Cognitive and Social psychology (Social psychology is largely about dealing with how people react to the behavior patterns of others during interactive situations. … As for cognitive psychology, the study would cover the thought processes that people consider when faced with any given situation).

These are the three cognitive- behavioral perspectives:
1. Aaron Beck’s Cognitive Therapy
He was trained in psychoanalysis, and believed that depression was a bias of negative thoughts and that most mental illnesses were based on pervasive negative thoughts. For example, depression is a negative view of one’s self; anxiety disorder is a send of psychological or physical danger, etc. Beck identified the following common thinking errors:
* All-or-nothing thinking and Black-and-white (or dichotomous*) thinking is the belief that it is either one way or another, but there is no gray area. (Di-chot-o-mous- a division or contrast between two things that are or are represented as being opposed or entirely different.)

• Emotional reasoning refers to an individual’s belief that something is true because the individual feels strongly about it and ignores evidence to the contrary.
• Overgeneralization occurs when an individual arrives at board principles derived from minimal information.
• Magnification and Minimization refers to an individual magnifying the negative and minimizing the positive in evaluations of himself or herself and others.
• Personalization is the thinking error that occurs when person “A” erroneously* believes that the negative behavior of person “B” is the result of something that person “A” has done. (er·ro·ne·ous·ly- in a mistaken way; incorrectly.)
• Catastrophizing is assuming that the worst will happen.
• Mind reading takes place when an individual assumes that he or she knows another person’s thoughts on an issue.

Question 19

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 19

In characterizing Beck’s Cognitive Therapy, the patient’s problems are continually defined in cognitive terms. Therapy requires the formation and maintenance of a good therapeutic alliance, where therapy is a collaborative effort between the SW and patient. Therapy is goal-oriented and problem-focused. The focus is primarily on the present and has a large educational component. Cognitive Therapy is time-limited, adheres to a relatively strict structure, and emphasizes relapse prevention. The patient is taught how to identify, evaluate, and change dysfunctional thoughts and beliefs. Cognitive Therapy uses techniques from a number of different theoretical orientations (e.g. Behavior therapy, Gestalt, etc.).

- Cognitive Methods include:
   * Collaborative Empiricism is a method during which the CT and SW work in tandem to test the validity of the CT's beliefs. 
  * Socratic Dialogue is the use of questions to lead the individual to discover a reality. 
  * Guided Discovery is a process whereby interventions are structured, including the use of a progression of questions, to enable CTs to discover inaccuracies in their thinking. 
 * Decatastrophizing is a technique to help CTs see that events are really not the end of the world, even if they are relatively difficult. 
 * Reattribution Training involves the identification of cognitive errors and distortions in thinking followed by the consideration of alternative beliefs. 
 * Decentering involves helping the CT to break his/her pattern of seeing self as the reference point for all life events.

Question 20

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 20

These are the three cognitive- behavioral perspectives:
2. Albert Ellis’ Rational Emotive Behavior Therapy
He was originally trained in psychoanalysis, but came to believe that irrational beliefs, not unconscious conflicts from early childhood, were at the root of neurotic behavior. In therapy, Ellis directly attacks the CT’s belief system and encourages the CT to challenge his/her own beliefs, unlike Beck.

Ellis’s Explanation for Personality
A= Activating Events
B= Belief System of Individual
C= Consequent Emotion of A & B
D= Disputing Irrational Thoughts and Beliefs
E= Emotional and Cognitive Effects of Revised Beliefs

Ellis believes that an activating event does not cause a person to feel a certain way, but the feelings are the consequences of the individual’s belief about the event. Beliefs can be rational or irrational, and irrational beliefs lead to unnecessary painful emotions and maladaptive behavior. Emotional health results from the rational or logical processing of activating events.

Rational Emotive Behavior Therapy identifies common irrational beliefs, which are a series of demands and absolutes. Examples of these beliefs are:

• Sexual, and other basic human desires, are needs rather than desires
• We cannot “stand” specific events that we can, in fact, handle.
• Our worth is based on things like our IQ, our wealth, our successes, and our failures.
• We must have the approval of significant others.
• Life should treat us fairly.
• People we judge to be wicked should be punished.
• It is awful when things do not work out as we wish.
• Harmful behaviors, such as substance abuse, are justified because we are in pain.
• Life circumstances determine a person’s happiness.

In Rational Emotive Behavior Therapy, the SW educates the CT about the principles of REBT (i.e. about the cognitive underpinnings of much emotional distress). The SW challenges the rationality of the CT’s beliefs and assists the CT in learning how to challenge his/her own beliefs. The SW and CT work together to dispute (D) the irrational beliefs that result in distressing negative consequences. The CT’s homework includes reading relevant books and critiquing tapes of his therapy sessions in an effort to increase awareness of his irrational beliefs.

Question 21

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 21

These are the three cognitive- behavioral perspectives:
3. Donald Meichenbaum’s Self- Instruction Training (Cooper and Lesser, 2002)
In Self-Instruction Training the focus is on the CT’s self-statement. Maladaptive self- statements often underlie problems. Important elements of Self- Instruction Training include training relative to the source of our problems, modeling, and practicing of behavioral and cognitive skills. The three phases of Self- Instruction Training include:
1. The SW and CT make an assessment of the CT’s self- statements and a conceptualization of the problem.
2. The CT is instructed to imagine a difficult situation and to identify to the SW the concomitant* self- statements. The CT and SW discuss the self- statements in terms of their impact on the CT’s behavior. The CT is directed to self-monitor (i.e. listen to self- talk). (con·com·i·tant- naturally accompanying or associated).
3. The CT and SW works in tandem to develop self- statements that result in greater enjoyment of life.

Question 22

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 22

Dialectical Behavioral Therapy
It is a treatment approach developed by Marsha Linehan and its used primarily with CTs who have been diagnosed with Borderline Personality Disorder (characterized by instability in relationships, self-image and affect, as well as impulsive behavior; common in females). This treatment is a combination of behavioral therapy and cognitive therapy, incorporating mindfulness practice as an essential part of the therapy. The two required parts of Dialectical Behavior Therapy include:
(1) an individual component between SW and CT that is focused on skill- building
(2) weekly group therapy.
The four modules of Dialectical Behavioral Therapy include:
* Mindfulness comes from the Buddhist tradition and involves the skills of observing, describing, and participating. CTs are taught to practice mindfulness skills non-judgmentally, one-mindfully and effectively.
* Interpersonal effectiveness refers to the teaching and learning of skills that allow an individual to be assertive in asking for another person to do something (e.g. requesting a change) or effectively problem- solving with another person w/o damaging the relationship or the person’s self-esteem (e.g. being able to say “no”).
* Distress tolerance refers to the CT’s ability to accept the reality of circumstances that cannot be changed, find meaning in the situation, and tolerate the distress. Distress tolerance behaviors include distracting, self-soothing, improving the moment, and identifying positives and negatives. Acceptance behaviors include fundamental acceptance, attitude adjustment, and willingness rather than willfulness- “deliberate” or “stubborn.
* Emotion regulation is a necessary skill for CTs who have diagnosed with Borderline Personality Disorder, as these individuals are usually emotionally labile-liable to change; easily altered. The focus on this part of therapy involves identifying and labeling emotions, removing barriers to changing emotions, increasing positive emotional situations, becoming mindful of current emotions, reducing vulnerability and taking positive action, and utilizing distress tolerance techniques.

Question 23

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 23

Solution- Focused Therapy
It is a therapeutic approach developed in part from behavioral and cognitive therapy. This approach is based on a short-term, strengths-based treatment model that emphasizes an empowerment strategy to allow the CT to take action for himself or herself.

The founders were Steve de Shazer and Insoo Kim Berg of the Brief Family Therapy Center in Milwaukee. This approach moved therapy from a problem-centered orientation to a focus on the construction of solutions by the SW- CT team.

The components of Solution- Focused Therapy include:

• describing the problem (though this is not the focus of treatment)
• developing well-formulated goals
• working cooperatively to identify solutions to problems
• end of session feedback
• evaluation of CT progress

Techniques used in Solution-Focused Therapy include:
* The Miracle Question is used to help the CT start to envision what he wants to be different in his life (e.g. If you were to wake up tomorrow morning to find that things were better because a miracle had occurred while you were asleep, what would be the signs that a miracle had indeed occurred? What would be different?).

• Exception-Finding Questions help the CT to identify what has previously worked concerning the problem with which he/she was confronted and to engage in more of the effective action or behavior.
• Presuppositional questions help the CT conceptualize goal attainment (the who, what, how, why and where). For instance, the SW many ask, “How will your relationship with Bill be different?” (Pre-sup-po-si-tional)
• Compliments are used by the SW to compliment the CT on successful problem-solving or coping strategies used in the past.
• Listening skills include furthering responses, reflective listening and summarizing.
• Empathy is the ability to understand and then demonstrate an understanding of the communicator’s message, including underlying feelings.
• Scaling Questions are used to obtain a quantitative measure from the CT on different issues and progress at different points in therapy. For instance, a SW may ask, “On a scale of 1 to 10, how would you rate your problem? How confident are you that you can solve the problem?”

Question 24

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 24

Neo-Freudians
Typically downplay the importance of instinctual forces in personality and emphasize interpersonal and social influences. The leading theorists are Karen Horney, Harry Stack Sullivan, and Erich Fromm.

Karen Horney agreed with Freud that the basis of neurosis is anxiety but differed in that she did not believe that conflicts between instinctual drives and the moral platitudes* of the superego were at the root of anxiety.
(platitude- a remark or statement, especially one with a moral content, that has been used too often to be interesting or thoughtful.) She believed that certain parental behaviors such as indifference, overprotectiveness, or rejection can create anxiety in a child. Horney believed that the child may seek to alleviate anxiety in one of three ways:
(1) by becoming compliant and moving toward people
(2) by becoming detached and moving away from people
(3) by becoming aggressive and moving against people.
She identified that children have two basic needs:
(1) to be protected from pain, danger, and fear
(2) to have their biological needs met.

Question 25

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 25

Neo-Freudians
Harry Stack Sullivan placed an emphasis on the importance of relationships over the lifespan. He believed that personality consists of the relationships that contributed to its formation along with the dynamisms (the quality of being characterized by vigorous activity and progress), or reciprocal patterns, that resulted from these relationships. Sullivan recognized the role of cognitive factors in personality development and proposed three modes of cognitive experience:
1. Prototaxic mode in which Sullivan believed that the first few months of life are related to a discreet series of momentary states.

2. Parataxic mode entails seeing causal connections between events that occur at about the same time but are actually unrelated. Sullivan believed maladaptive behavior is attributable as “parataxic distortions” (misperceptions that involve responding to a person as though he/she is a significant person from the past), which are due to arrest in the Parataxic mode.
3. Syntaxic mode occurs at the end of the first year of life and is characterized by logical, sequential, internally- consistent, and modifiable thinking.

Sullivan was the founder of the Interpersonal School of Psychotherapy. He viewed the SW as both participant and observer and expert in interpersonal relationships.

Question 26

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 26

Neo-Freudians
Erich Fromm was considered to be a Humanistic psychoanalyst*. His theoretical ideas represent a blending, in part, of Marx’s societal Determinism (the individual is determined by the economic system) and Freud’s biological determinism. Fromm went beyond Freud and Marx in that he believed that the individual could transcend biological and societal factors. Fromm saw freedom as the core feature of human nature, believing that we can “… find principles of action and decision making which replace the principles of instincts.” He believed that human beings are individuals, with their own thoughts, feelings and a sense of what is right and wrong, and that they are ultimately responsible for their behavior. He further believed that human beings have characteristic ways of trying to escape their individual identity (i.e. their freedom) which results in self-alienation. Fromm stated that an important determinant of which escape mechanism we choose is the nature of our family of origin. Fromm identified two “unproductive” type of families:
(1). The Symbiotic Family is one in which members are enmeshed and devoid of individual personalities.

(2). The Withdrawing Family is a family in which members exhibit indifference toward each other. Punishment may be ritualistic, without feeling or involve guilt-loading and withdrawal of affection. An alternative form is a permissive approach that leaves children without appropriate adult guidance. Children derive their values from the media and members of their peer group.
(Humanistic psychoanalyst- looks at people from a historical and cultural perspective rather than a strictly psychological one. It is more concerned with those characteristics common to a culture).

Erich Fromm identified Five Personality Types or “orientations” which are described in economic terms, four of which are unhealthy orientations.
1. Receptive orientation-They receive satisfaction from outside factors, and thus they passively wait for others to provide them with things that they need. For example, they want someone to provide them with love and attention.

2. The Exploitative orientation-people aggressively take what they want rather than passively receiving it. These types of people do whatever they can to get what they want; even if it includes stealing, or snatching something away from somebody else just to get it.
3. Hoarding-oriented- people save what they already have obtained, including their opinions, feelings, and material possessions. It may be love, power, or someone’s time.
4. Marketing orientation- People who are marketing orientated see themselves as commodities and value themselves against the criterion of their ability to sell themselves. They have fewer positive qualities than the other orientations because they are essentially empty.
5. Productive orientation- the healthy personality. “the person without a mask”- a person who understands hie or her biological and social nature while accepting responsibility and embracing personal freedom.

A healthy, productive family is one in which parents appropriately assume the responsibility of teaching their children rationality and providing a loving environment. In these families, children are treated as individuals and are not expected to simply conform to the wishes of parents. The reason is valued above rules.

Question 27

What do Individual Theories and Types of Psychotherapy cover?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 27

Jungian Psychotherapy
Associated with Carl Jung, libido is defined as a general psychic energy, and it is believed that behavior is determined by past events as well as future goals and aspirations. Jungian Personality Theory states that personality is the consequence of both conscious and unconscious factors.
The Conscious personality is oriented toward the external world.
The Unconscious personality consists of two parts: the personal unconscious and the collective unconscious.
The personal unconscious contains experiences that were once conscious but are now repressed or forgotten (or unconsciously perceived). The collective unconscious is the repository (a place, building, or receptacle where things are or may be stored.) of latent memory traces and primordial images that causes people to understand certain phenomena in the same way (archetypes). Archetypes of particular importance to personality development include the self, which represents a striving for a unity of the different parts of the personality; the persona or public mask; the shadow or dark side of the personality; the anima or feminine archetype; and the animus (hostility or ill-feeling.) or masculine archetype.

Carl Jung believed that personality consists of two attitudes (i.e. extroversion and introversion) and four basic functions (i.e. thinking, feeling, sensing, and intuiting). The focus of therapy is to rebridge the gap between the conscious and the personal and collective unconscious via interpretations, dreamwork, etc.

Jung also considered the psychotherapeutic use of abreaction, a type of catharsis. Abreaction refers to the process ridding oneself of the intense feelings associated with a previously painful or traumatic experience. Jung later decided that the release of the pent-up feelings was not as important in the healing process as was the SW-CT relationship.

Question 28

What is Psychoanalytic Psychotherapy/ Psychodynamic/ Ego Psychology?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 28

Leading theorists include Anna Freud, Heinz Hartman, Ernest Kris, David Rapaport, and Erik Erikson. The believed that the SW does not simply allow the therapy to be free-flowing, as it the case with classical analysis. Since psychoanalytic psychotherapy is briefer, the SW is more active and more directive (e.g. giving advice and making suggestions). Psychoanalytic psychotherapy is more individualized. Compared to traditional psychoanalysis, psychoanalytic psychotherapy is more:

• brief (weekly rather than daily sessions)
• direct ( less free association and more face to face discussions)
• reliant on positive transference to facilitate progress
• focused on the present

The patient and SW may sit face-to-face. A free association may not be used in favor of direct conversation between the SW and CT. A transference neurosis will likely not be allowed to develop. The CT may be seen less frequently than on a daily or almost daily basis. The SW may rely more on a positive transference to facilitate progress. Interpretations may be limited to present situations. Providing the patient with a “corrective emotional experience” is given greater emphasis than “consciousness-raising”.

Question 29

What does Psychoanalytic Psychotherapy/ Psychodynamic/ Ego Psychology entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 29

In describing Autonomous Ego Functions, Heinz Hartman, an Ego psychologist, disagreed with Freud’s contention ( assertion) that the ego develops out of the id and that the capacities of the ego are dependent on the instinctual drives. He maintained that the capacity for ego and id is present at birth, having evolved in the human species as part of the process of adaption. He saw the ego as having its own independent source of energy and as developing independently of instinctual drives and internal conflicts. He saw the ego as having purposes beyond intrapersonal (is the communication with oneself, and so only one person is involved in it.) conflict. He believed that the ego strives for adaption, competence, and mastery. Some ego functions that Hartmann identified as conflict-free and autonomous from instinctual drives include perception, memory, intelligence, thought processes, motor activity, and reality testing. He believed that humans experienced pleasure when they exercise these ego functions.

Question 30

What does Psychoanalytic Psychotherapy/ Psychodynamic/ Ego Psychology entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 30

Ego Psychology theorists identified Defense Mechanisms, such as repression, regression, projection, reaction formation, displacement, sublimation, denial, introjection, rationalization, undoing- Human Behavior and Development in the Environment. When conflict arises between id and superego, the individual experiences anxiety. This anxiety is a signal to the individual (to the ego) to do something to alleviate the anxiety such as to utilize a defense mechanism. As a result, anxiety is alleviated and the disturbing impulse is kept at bay. Sigmund Freud’s theories include defense mechanisms with the primary focus on repression. Anna Freud more broadly identified other defense mechanisms.

Development Theory- (Human Behavior and Development in the Environment) Developmental theories explain the biological, psychological, social, and emotional development as stages over a portion (childhood, adolescence, adulthood, old age) or the whole of the life span. Developmental theories influence social work practice by providing a basis for assessing and understanding a client’s physiological, psychological, and emotional development. Such theories are primarily used in the assessment stage of social work practice where a social worker assesses the current level of development and functioning and uses this information to assist in explaining the client’s situation, to determine the most appropriate form of intervention, and to hypothesize about future outcomes. Developmental theories are also useful during the evaluation and ending stages to determine any shifts or changes in levels of development.

Question 31

What does Psychoanalytic Psychotherapy/ Psychodynamic/ Ego Psychology entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 31

Ego- Oriented Approaches to Treatment place greater emphasis on the present than the past and attempts to increase awareness of and conscious control over behavior. Assessment is holistic, focusing on environmental stressors, accessibility to needed resources, trauma, developmental difficulties, and deficits in ego functioning. Two categories of intervention include:
1. Ego- supportive interventions restore, maintain and enhance adaptive functioning (ego mastery or the ability to mediate between basic primal needs of an individual and the higher moral standard). Psychologically- based interventions are helpful. In addition, environmentally-based interventions can be useful as the CT works to change his environment to alter his behavior (i.e. removing cookies from the pantry to avoid binge eating). The treatment focus is on conscious thoughts and feelings. Interventions are more directive and structured, and treatment can be either short-term or long-term. Ego- supportive interventions are used with CTs who have deficits in ego strength, low tolerance for anxiety and poor impulse control.

  2.  Ego- modifying interventions involve modification of basic personality patterns. These interventions are psychologically based and are long term. Treatment focuses on the past and the present, as well as the conscious, preconscious, and unconscious. SWs seek to help CTs use increased insight and conflict resolution. SWs use positive and negative transference as a tool in therapy. The therapeutic interventions are nondirective and use interpretation. Ego-modifying interventions are typically used with those having good ego strength to address maladaptive patterns. The intervention may also be used with individuals with ego deficits and severely dysfunctional patterns. 

Ego psychology is probably the most significant mode for SW and clinical expertise in that it deals with mastering stages of development, emphasizes the development of coping behaviors, and integrates psychological and social realms.

Question 32

What does Psychoanalytic Psychotherapy/ Psychodynamic/ Ego Psychology entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 32

Object Relations Models came from classical psychoanalytic theory and Ego psychology. Since Feud’s theory of human development had its basis almost exclusively in his work with adult patients, some psychoanalytic thinkers, notably Melanie Klein, Ronald Fairbairn, Margaret Mahler (the British School of objects relations theory), Otto Kernberg, Heinz Hohut, and James Masterson (American contributors) questioned its validity.

Objection Relations Therapy is a psychodynamic approach* to therapy. The focus is on early childhood experiences and relationships with significant others in childhood, in particular, Mother, as well as the resulting personality structure. The therapeutic process also looks at the impact of unconscious fantasies and impulses. Therapy is focused on childhood relationships and experiences that influenced personality development.
*(Psychodynamic approach-includes all the theories in psychology that see human functioning based upon the interaction of drives and forces within the person, particularly unconscious, and between the different structures of the personality.)

Intervention strategies include encouraging the CT to talk about childhood experiences, interpretation of the impact of the childhood experiences on present functioning and relationships, dream analysis of transference or resistance, and provision of a therapeutic environment that supports adjustments in the individual’s sense of self, in his or her psychological functioning, and in the nature of his or her relationships. Brief forms of psychodynamic therapy have been developed in recent years that appear to hold promise for working with individuals with substance abuse problems and depressions.

Question 33

What does Psychoanalytic Psychotherapy/ Psychodynamic/ Ego Psychology entail?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 33

Melaine Klein
a psychoanalytic writer who based her theorizing about human development specifically on her work with children saw the internal world of the child-focused more on relationships with others than on instincts and drives.

According to Object Relations theorists, infants are innately- naturally relationship (object) seeking. The infant’s relationship with the mother provides the basis for the development of the infant’s sense of self and a pattern for all subsequent relationships. The infant internalizes (introjects) qualities of the mother and, subsequently, splits these introjects into positive and negative aspects. The infant initially experiences the mother as good or bad, depending on whether the mother is fulfilling or frustrating his or her needs at the moment. Over time, the child typically becomes aware that the same person can have both positive and negative qualities. This is referred to as “splitting”, as an important step in developmental tasks of childhood. Splitting can also be seen as a defense mechanism in older individuals. In order to relate to significant others, an individual, may “split” the significant other into two parts, good and bad, in an effort to cope with the painful feelings associated with that person. For example, a child who has an abusive parent may use splitting as a defense mechanism, thus separating the “good” parent (loving) from the “bad” parent abusive.

The child may form either a secure or insecure attachment to the mother.
Secure attachment- is formed when the mother and child relationship has been predominately positive.

Insecure attachment- is formed when the relationship has been predominantly negative.

Human behavior reflects the nature of early experiences with the mother (or primary caregiver) and, to a lesser degree, with other significant individuals (e.g. father, grandparents).

Question 34

What are Humanistic/ Existential Theories and Models?(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 34

Characteristics of humanistic models include an emphasis on the uniqueness and wholeness of the individual, a belief in the individual’s inherent striving for self-determination and self-actualization, and a focus on current behavior. Humanistic/ Existential models also have a view of therapy as involving an authentic, collaborative, and *egalitarian relationship between SW and CT. There is a belief that to understand a person, one must understand his/her subjective experience. This model rejects traditional assessment techniques and diagnostic labels. The leading theorists of the Humanistic/ Existential movement include Carl Rogers, Fritz Perls, and Eric Berne.
(Egalitarian- *social value- relating to or believing in the principle that all people are equal and deserve equal rights and opportunities.)
(Social value-is the quantification of the relative importance that people place on the changes they experience in their lives. E.g.Respect. Justice/Fairness. Honesty. Service/Giving Back/Contribution. Responsibility. Family. Community.)

Question 35

Who is part of Humanistic/ Existential Theories and Models and what therapy is offered?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 35

Person-Centered Therapy (Carl Rogers)
This theory includes the belief that human beings have an inherent tendency towards self-actualization (i.e. achievement of their full potential). People will naturally grow and self-actualize in a warm, caring, authentic, nonjudgmental, empathic, and understanding environment. Maladaptive behavior results when the person experiences conditions of worth (i.e. significant others communicate to the child that their love and acceptance of him or her is contingent on conformity to their standards). The child then internalizes some of these conditions and comes to define an experience as positive or negative based on the internalized conditions of worth rather than on the capacity of the experience to enhance the person. There is a belief that individuals’ defense block awareness of the organization processes that would naturally propel them in a direction of growth.

The critical component of this therapy is the experiential relationship between SW and CT (i.e. the therapeutic alliance). The SW is non-directive (i.e. respectful of the self-directing capacity of the CT). The SW’s attitudes, rather than technical skills or a specific knowledge base, are the critical ingredients, the CT is free to experience all elements of self and to reclaim parts of previously disowned because of conditions of worth.

Question 36

Who is part of Humanistic/ Existential Theories and Models and what therapy is offered?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 36

Gestalt (Fritz Perls)
The major concept of this therapy includes the belief that human beings are constantly discovering and reconstructing who they are. A person’s behavior represents a whole, not differing pieces. Behavior can be fully understood only in the context of the present. An increased awareness of the here-and-now experience allows the individual to choose and to make a greater sense of his/her existence.

This therapy is based on the theory that personality consists of the self and the self-image. The self is the creative aspect of the personality that promotes the individual’s inherent tendency for *self-actualization. Self-image is seen as the darker side of the personality that can hinder growth and self-actualization by imposing external standards. The child’s early interactions with the environment often determine which aspect dominates.
(Self-actualization- Person-Centered Therapy achievement of their full potential, especially considered as a drive or need present in everyone).

Question 37

Who is part of Humanistic/ Existential Theories and Models and what therapy is offered?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 37

Gestalt (Fritz Perls)
Neurotic behavior is considered a developmental disorder resulting from early experience. It involves the abandonment of the self in favor of the self-image and results in an inability to see oneself as a whole person. Neurotic behavior stems from a disturbance in the boundary between the self and the external environment.

There are four major boundary disturbances identified in Gestalt therapy:
1. Introjection occurs when the person believes the external perception of the whole. The person has difficulty distinguishing between “me” and “not me” and may be overly compliant.

2. Projection refers to disowning aspects of the self by assigning them to other people. For example, if you extremely dislike an individual, a form of projection would be for you to portray the scenario that he or she dislikes you instead. Paranoia is an extreme form of projection.
3. Retroflection is described as doing to oneself what one wants to do to others. It involves redirecting anger one has for another person inward. This can be exhibited in extreme self-blame in response to appropriate feedback given to a person. Rather than expressing anger with the person, that anger is expressed inward and becomes self-blame.
4. Confluence is the absence of a boundary between the self and the environment. This causes intolerance of any differences between oneself and others and often underlies feelings of guilt and resentment.

Gestalt therapy focuses on increasing awareness and clarity of the experience of the moment for both the CT and the SW. Interpretations are seen as less valuable or reliable than the individual’s perceptions and feelings. Through dialogue and structured experiences or experiments, discrepancies between the SW’s and the CT’s experiences are explored in an effort to increase the CT’s awareness of what he is doing and how he is doing it. The CT is also assisted in learning to accept himself fully.

Question 38

Who is part of Humanistic/ Existential Theories and Models and what therapy is offered?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 38

Gestalt (Fritz Perls)
The goal of therapy is to help the CT achieve integration of the various aspects of the self in order to become a unified whole. The SW avoids the use of diagnostic labels. The CT’s history is seen as relevant only as it impinges (have an effect or impact, especially a negative one) on the here-and-now. The SW-CT relationship is referred to as an I-Thou dialogue relationship reflecting caring, warmth, acceptance, and authenticity. Gestalt therapy utilizes the following focusing techniques:
1. Directed awareness is a technique whereby the SW helps the CT become aware of his/her immediate experience.

2. “No questions” is a technique that places the focus on increasing one’s own awareness of his/her experience in the here-and-now.
3. “I language” is a technique that involves the SW’s use of “I” statements rather than making impersonal interpretations. The SW will often share his/her experience of the here-and-now (e.g. what the SW sees and hears).
4. Enactment is a technique, which involves asking the CT to act out feelings or thoughts to increase awareness (e.g. empty chair, role-playing, psychodrama, exaggerating a feeling, thought or motion).
5. Guided fantasy visualization is a technique that involves having the CT create a mental image of an experience.
6. Loosening/ Integrating techniques involves encouraging the CT to think in a new way (e.g. asking the CT to imagine believing the opposite of what he/she believes about something; having the CT locate where in his or her body-specific emotion of located).
7. Body techniques are techniques used for increasing the CT’s awareness of their bodies and helping them to learn new ways of using their bodies to create additional self-awareness and to engage in meaningful contact with others.
8. Dreamwork is a technique, which focuses on recurring dreams.
9. “Stay with it”/ “Feel it out” is a technique that involves encouraging the CT to allow himself to continue to feel the emotion of the moment. This technique increases the CT’s capacity to experience his or her feelings fully.

Question 39

Who is part of Humanistic/ Existential Theories and Models and what therapy is offered?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 39

Transactional Analysis (Eric Berne)
Berne incorporates elements of psychoanalysis, Gestalt psychology, Rational Emotive Behavior Therapy, psychodrama, and behavior therapy. Transactional Analysis is often used in group settings and teaches individuals to trust one another. 

The psychological theory of Transactional Analysis includes the following concepts:
* Ego States are specific patterns of thoughts, feelings, and behaviors.

* The Adult is the rational part of the personality. 
* The Parent is the critical or nurturing part of the personality. 
* The Child is the creative, intuitive- instinct, and emotional part of the personality, rebellious or conforming. 
* Life Position refers to the four possible life positions. The "I'm ok, you're ok" is considered a healthy life position. The other three positions (i.e. "I'm ok, you're not ok," "I'm not ok, you're ok", and "I'm not ok, you're not ok") are considered unhealthy.     * Lifescript is the life plan a person creates during childhood, which forms the core of the person's identity and his or her destiny. This theory is based on beliefs about self and others.     * Environmental Conditions, especially parenting, affect all individuals.    * Recognition is viewed as an existing innate (inborn; natural) need of individuals.

Question 40

Who is part of Humanistic/ Existential Theories and Models and what therapy is offered?
(Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 40

Transactional Analysis (Eric Berne)
Transactional Analysis therapy consists of the following concepts and techniques:
   * The role of the SW is to be a facilitator of change and growth.

• The SW completes a structured analysis of the individual’s ego states (Critical Parent or Nurturing Parent: Adult: Free Child or Adapted Child) using an Egogram (i.e. a graph of the relative energy of the different ego states.) The SW may assist the CT in changing the energy balance of these states.
• Certain structures are associated with personality pathology (i.e. ego states with overlapping boundaries.)
• Transactional analysis involves an examination of the interactions between the ego states of two individuals. The types of transactions are identified as the following:
• Social interactions are observable transactions.
• Psychological interactions are covert, often discernible thorough examination of body language.
• The SW does an analysis of the “stereotyped games” (i.e. dishonest interpersonal interactions) people play in their relationships. These games reinforce the individual’s belief system. Individuals vary in terms of the games they participate in with others (e.g. when the SW and the CT alternate between playing the role of the victim, rescuers, and persecutor). Understanding the self-perpetuating role one plays in the relationship will enlighten the CTs, brining a clearer picture of their relationship patterns.
• The SW creates a script analysis of crucial transactions between parents and the child in the early years. The script analysis reveals why the individual chooses to play the specific games that he/she plays. This provides important information in coming to an understanding of the individual’s personality development.

Question 41

What is Play Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 41

It is often used with children instead of talk therapy alone. With preverbal (not able to speak) children, play therapy may be the sole form of therapy. The basic premises are that children’s emotional conflicts are manifested in their play (assessment) and that the reenactment, in play therapy, of those experiences and situations that underline emotional conflict con facilitate the healing process (intervention). Play therapy also lessens children’s self-consciousness while simultaneously talking about difficult subjects, such as abuse, and facilitating overall communication.

Question 42

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 42

Group Composition
There is considerable controversy relative to whether groups should be heterogeneous (variable in characteristics) or homogeneous (similar in characteristics). There is a general agreement that group members should have approximately the same level of intelligence. Groups should typically be homogeneous in terms of the developmental level of members.

Rudolf Dreikurs believed members should be matched by age, particularly in children’s groups, and that there should be no more than two years difference between the oldest and the youngest. With adolescents, group leaders should consider chronological age as well as the developmental level (e.g. young teens who have not resolved the identity issues arising in this developmental period should not be placed in a group with more mature teens or young adults). In general, the inclusion of both genders in groups of children is not recommended; although, some adolescents can handle mixed groups. Mixed groups traditionally have the most lasting effects on adults.

There is controversy about whether group members, in treatment groups, should have the same problem.
Yalom (Irvin David Yalom is an American existential psychiatrist) believes it is best to have heterogeneity for conflict areas and homogeneity for ego strength.
Glaver and Gavin maintain that a group that is too homogeneous, in terms of undesirable characteristics (deviant behavior), will lead to the reinforcement of these traits.
Garvin, Reid, and Epstein believe that similarities among members of task-oriented groups are important as these groups are more effective when the members share common goals.
Homogeneous groups tend to gel faster, become more cohesive, offer more immediate support to the group members, have better attendance and less conflict, and provide more symptomatic relief. Homogenous groups can, however, remain superficial and are ineffective for altering character structure. Group therapy is not indicated for children younger than 8yrs.

Question 43

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 43

Closed group (new members not added after a cut-off period) are most effective for short-term, task-oriented therapy. 
Open groups (new members may be added at any time) offer members fresh input and allow them to benefit from the success of graduates; however, they can often impede the development of trust, acceptance, and cohesiveness. 

Assimilation of new members is another concern in group work. A new person’s assimilation into a group depends on the following factors:

1. the size of the group- large group are less affected by a new member
2. the age of the group-if a group is fairly young, it typically accepts a new member with relative ease. When a group has been meeting for a long period of time and is fairly cohesive, the members may treat a new person with some resentment. Some groups are simply more flexible and accepting than others.

Group Size influences the effectiveness of treatment. Treatment groups are usually most effective when they include between seven and ten members. Having fewer than seven members limits opportunities for learning while including more than ten members limits the opportunity for individuals participation. Groups with three to six members can function effectively if the number of participants remains more or less constant.

Question 44

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 44

Stages of Group Development
Despite variation in the number and naming of stages put forward by the various models of group development, commonalities can be discerned-perceive or recognize (something) (Wheelan et al., 2003). A general description of a five-stage sequence follows, with reference to the models of Tuckman (1965), Garland et al., (1973), and Weelan et al., (2003).

1. At the outset (start/ beginning of something) of its life, the group is in a “forming” (Tuckman, 1965) or “preaffiliation” (Garland et al., 1973) stage. The members will experience anxiety, seek guidance from the group leader(s) on appropriate behaviors, and engage in tentative self-disclosures and sharing.
2. Once established, the group will enter a stage characterized by a “storming” stage (Tuckman, 1965) or “counterdependency and flight” (Wheelan et al. 2003), defined by struggles around issues of “power and control” (Garland et al. 1973). Competition and conflict among the members, anxiety about the safety of the group, and the authority of the leader are common concerns. Confrontation s of the leader reinforce member solidarity and openness. Many theories of group development hold that these struggles over authority and status are essential for the emergence of genuine cohesion and cooperation.
3. In a third stage of “norming” (Tuckman, 1965) or “intimacy” (Garland et al. 1973), a consensus on the group tasks and a working process emerge. The group begins to demonstrate “trust and structure” (Wheelan 2005), cohesion and openness.

Question 45

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 45

Stages of Group Development
4. A fourth stage of “performing” (Tuckman, 1965), “work” (Wheelan et al. 2003) or “differentiation” (Garland et al. 1973), is characterized by a mature and productive group process and the expression of individual differences. The group has the capacity for focusing on the task of therapeutic work and the members engage in an open exchange of feedback. If the group has a time-limited format or certain members prepare to “graduate” during this stage, elements of disillusionment and disappointment can emerge.

5. The finale stage addresses the issue of termination, whether of individual members or the group as a whole. Concerns associated with “adjourning” (Tuckman, 1965) and “separation” (Garland et al. 1973) prompt the emergence of painful effects and *oscillations between conflict and defensiveness and mature work. The members’ appreciation for each other and the group experience, along with efforts at prepping the group members to be more independent in future group activities, are goals in this termination stage.
   (os·cil·la·tion-movement back and forth at regular speed)

Group members benefit from group therapy in a number of ways. Yalom considers the group to be a *microcosm of the real world and believes that it provides members with the following: hope, universality, *altruism, learning, self-understanding and insight, existential learning, family re-enactment, guidance, *catharsis, group membership, and identification. Research indicates that group components such as interpersonal input, catharsis, self-understanding, and cohesiveness may be viewed by members as the most important factors. The importance of these factors is a function of the type of group and of the characteristics of individual members. Higher functioning CTs rate interpersonal learning and universality as most important, while lower- functioning CTs rate *instillation of hope most important.
(mi·cro·cosm-a community, place, or situation regarded as encapsulating in miniature the characteristic qualities or features of something much larger.)
(al·tru·ism-the belief in or practice of disinterested and selfless concern for the well-being of others.)
(ca·thar·sis- the process of releasing, and thereby providing relief from, strong or repressed emotions.)
(instillation is a noun. It is related to the verb instill, which means to impart knowledge gradually or to put droplets of liquid into something.)

Question 46

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 46

The 11 “Curative (able to cure) Factors” in Group Therapy proposed by Irvin Yalom:
1. Altruism can result when group members help each other. The experience of being able to give something to another person can lift a member’s self-esteem. Group members can develop more adaptive coping styles and interpersonal skills by receiving help from others.

2. Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion; members tell their story to a supportive audience, resulting in relief from chronic feelings of shame and guilt.
3. Existential Factors are defined as the process of learning that one has to take responsibility for one’s own life and the consequences of one’s decisions.
4. Cohesiveness is an important and foundational factor in therapeutic outcomes. Human beings instinctually desire group acceptance and belonging Personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.
5. Imparting Information (A.K.A. Guidance) refers to learning factual information from other members in the group (e.g. learning about treatment options or services)

Question 47

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 47

The 11 “Curative (able to cure) Factors” in Group Therapy proposed by Irvin Yalom:
6. Imitative Behavior (A.K.A. Identification) refers to group members developing social skills through the modeling process, observation, and imitating the SW and other group members (e.g. sharing personal feelings, showing concern).

7. Instillation of Hope occurs when group members are inspired and encouraged by another member who has overcome the problems with which they are still struggling.
8. Interpersonal Learning (A.K.A. Interpersonal Input) refers to group members achieving a greater level of self-awareness through interaction and feedback from others. The stage of “Self- Understanding” or “Insight” often falls into this category.
9. Development of Socializing Techniques (A.K.A. Interpersonal Output) refers to the group setting that provides a safe and supportive environment in which members can take risks by extending their repertoire of interpersonal behavior and improving their social skills.
10. Corrective recapitulation of the primary family experience refers to when members unconsciously identify the group worker and other group members with their own parents and siblings, which is a form of transference specific to group psychotherapy. The SW’s interpretations can help group members gain an understanding of the impact of childhood experiences on their personality and they may, in turn, learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships.
11. Universality is the recognizing of shared experiences and feelings among group members and acknowledging that the “problems” may be widespread or be universal human concerns. There are reduced feelings of isolation, validation or experiences, and increased self-esteem.

Question 48

What does Group Work Techniques and Approaches entail?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 48

The Group Social Worker’s Role includes the creation and maintenance of the group, illumination of the here-and-now (group process), and creating a group culture and a sense of safety. Other Issues Relative to Groups include Co-leadership, which can be very helpful in group therapy if the co-leaders are not in competition. Working with a co-leader makes it easier to monitor individual members of the group. Co-leadership is helpful if an individual group member goes into crisis; one leader can tend to the crisis while the other continues to facilitate the group. It is important for co-leaders to meet before group therapy to prepare and after the group to debrief.

Another issue is Concurrent Group and Individual Therapy. Yalom does not believe that concurrent group and individual therapy is necessary or beneficial. He believes that individual therapy can drain off affect from the group. Some SWs; however, believe it is helpful if there is ongoing communication between the group SW and individual SWs. Some predictors of a group member’s premature termination include high use differences between that group member and other members of the group.

Three types of transference can occur in the group setting:

1. transference to the SW (parental figure)
2. transference to other group members (siblings)
3. transference to the group itself (mother-womb symbol)

Johari Window is a graphic model of interpersonal behavior that can be applied to many different theories of group interaction and is useful in evaluating interpersonal interaction and group effectiveness. This model is more likely to be successful if individual group members have been prepared for the group experience. Groups high on cohesiveness are associated with better outcomes.

Question 49

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 49

Family Systems Theory (Murray Bowen)
It extends general systems theory beyond the nuclear family. The goal of therapy is the achievement of a higher level of differentiation of self on the part of each family member. Therapy often involves working with one family member, with the premise that when one family member changes, others will follow. Each family member is guided by the SW to take responsibility for his or her own role for the problematic issue. In order to keep the tension between family members at a minimum, each family member directs his or her comments to the SW.

The eight interlocking concepts in Family Systems Theory include:
1. Differentiation of Self is described as family members’ ability to discriminate between their identities and experiences and that of other family members (rather than having fused identities).

2. Nuclear Family Emotional System (formerly called Undifferentiated Family Ego Mass) has reference to a family in which members’ identities are fused.
3. Triangles is a term that denotes that relationships have periods of closeness and periods of distance. Triangulation occurs during periods of distance-an “outsider” takes sides with one person in the relationship (e.g. a wife is irritated with her husband, shares this information with their daughter, and the daughter bands with the mother). Family problems are typically triangular.
4. Societal Emotional Process is a term used to denote that the emotional system governs behavior on a societal level, similar to that found in a family, promoting both progressive and regressive periods in society.

Question 50

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 50

5. Emotional Cutoff is an unhealthy way of dealing with intergenerational differentiation (e.g. a young adult may sever ties with parents).
6. Sibling Position is often associated with the development of specific personality traits.
7. Family Projection Process is the process thought which parents transmit their lack of differentiation onto their offsprings.
8. Multigenerational Transmission Process has reference to the transmission, through the generations, of the family’s emotional process.

Question 51

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 51

Therapeutic Techniques include the following:
The Therapeutic Triangle refers to an SW “joining” or engaging in work with a couple. The SW, through avoidance of triangulation, helps the couple address, with each other, the difficulties they are experiencing.

A Genogram is a graphic representation of family relationships that includes a minimum of three generations. Circles represent females, squares represent males, and marriage is represented with a solid line. The genogram often includes important information about family members, including, but not limited to, birth and death dates, occupations, and the nature of relationships between different family members.

Questioning uses process questions to explore the dynamics of family relationships. The purpose of these questions is to shift the focus of family members from how others are causing them grief to what they are doing to contribute to family difficulties.

Detriangulation is a process in which the SW avoids taking sides with partners and encourages each of them to take responsibility for their part in the family problems.

Coaching is a technique whereby the SW helps the family along each step of the way so they know exactly what they are to do.

• Communication/ Experiential Family Therapy came out of the Mental Research Insitute in Palo Alto in the 1960s with Gregory Bateson, Don Jackson, Virginia Satir, and Jay Haley. It saw the primary purpose of symptoms as being the maintenance of homeostasis in the family. Pathological families were seen as stuck in strong dysfunctional communication patterns and viewed any change as a threat to the integrity of the system. The primary goal of therapy is to alter the interactional patterns that maintain the presenting symptoms.

Question 52

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 52

Communication/ Experiential Family Therapy includes the following basic principles:
All communication has both a report and a command level or function. Reusch and Bateson (1951) labeled the information or content portion of a message the report. They labeled the relationship defining aspects of the message the command. The command aspect of a message suggests how the sender views him or herself, how the sender views the receiver and how the sender imagines the receiver views the sender, etc. Watzlawick, et al. (1967) suggested that often the relationship aspects of the communication are sent and received without the full awareness of either sender or receiver.

Relationships are either symmetrical or complementary (not a value judgment).
Symmetrical relationships are egalitarian relationships, in which roles are mirror images. (egalitarian-relating to or believing in the principle that all people are equal and deserve equal rights and opportunities)
Complementary relationships are relationships that involves a fit between different roles.

The Principle of Equifinality in Communications/ Experimental Therapy means that the same results can be obtained via different means. The Circular Model of Causality refers to behaviors of different subsystems that reciprocally impact each other.

Question 53

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 53

Forms of dysfunctional communication include the following:
* blaming and criticizing

• mind-reading (when a family member represents his or her interpretations of the beliefs or feelings of other family members as reality.)
• making incomplete statements
• making statements that imply that events are unalterable when they are not
• over-generalizing
• double-bind communication: communication that involves contradictory demands; the recipient of the communication cannot comment on the contradictions in the communication and is unable to escape the inevitable consequences of only being able to meet one of the demands.
• denying that one is communicating
• disqualification of the communication of another member of the family

Question 54

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 54

Virginia Satir
Utilized a communications approach that increasingly emphasized the feelings and self-esteem of individual family members. Her approach used a more humanistic model in clarifying family communications. Satir joined the family to facilitate a family process that promoted the well-being of family members. The family was seen as a system seeking balance. Satir looked at the cost to each member of the family of maintaining the present balance in the family. She saw a symptom in a member of a family as evidence of a blockage in growth in the family. Satir saw explicit and implicit family rules as coming out of the parents’ approach to their own self-esteem; these rules create the atmosphere of the family or the context for the development of the children’s self-esteem. In therapy, Satir assisted each family member to become as whole as possible through deliberate efforts to build self-esteem and self-worth and through the correction of dysfunctional communication patterns. Satir identified five Styles of Communication (also referred to as poses). Four of these styles serve to protect family members from revealing who they really are; one is functional.

Question 55

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 55

Satir identified five Styles of Communication (also referred to as poses).
1. The Placater is a communication style that is characterized by agreement, apologizing, and/or efforts to please.

2. The Blamer accuses, criticizes and dominates.
3. The Super-reasonable family member maintains an outward appearance of calm and coolness and is emotionally detached.
4. The Irrelevant family member seeks to distract others and seemingly has difficulty relating to what is going on in the moment.
5. The Congruent Communicator sends clear, straightforward messages and is genuine.

Satir taught family members how to communicate congruently via assisting them to use their senses fully, to get connected with their true feelings, and to be accepting of their feelings. She saw this as the mechanism through which self-esteem is built, and saw self-esteem as providing people with the basis to change dysfunctional relationships. Satir identified a Healthy Family as one in which family members can directly request what they need, get their needs met, and where individuality is supported and encouraged.

The SW is a model for the changes the family needs to make. He/she must be congruent and demonstrate how to change dysfunctional communication patterns. The SW teaches family members how to connect with their own feelings, how to listen, and how to verify one’s understanding of another member’s communication.

Question 56

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 56

Structural Family Theory (Salvador Minuchin) is based on the premise that all families have an underlying organization, which may be adaptive or maladaptive. Maladaptive patterns of interaction underlie symptoms observed in individual family members. Through observation of family interactions, Structural Family Therapy identifies the maladaptive structural elements that underlie maladaptive family interactions, as well as relationships between the family and nonfamily entities, and then makes changes in these structural elements. Important concepts of Structural Family Theory include:

Alignments are coalitions between subsystems in the family that serve a specific purpose.

Power hierarchies is a term that refers to the distribution of power in the family.

Subsystems are some part of the family (e.g. the parents)

Interpersonal boundaries are rules that control the amount of involvement family members have with each other and with others who are not a part of the family.

Disengagement occurs when family members and subsystems of the family are isolated from each other emotionally and in terms of their interaction.

Enmeshment occurs when family members and subsystems of the family are overly involved and concerned with each other resulting in minimal autonomy in functioning.

Complementarity refers to the extent to which different family roles (e.g. husband-wife patterns of providing support to each other) are in harmony with each other.

Inflexible family structures are rigid structures that do not lend themselves to being changed in the face of changing family circumstances (e.g. environmental and developmental crises).

Question 57

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 57

Techniques of Structural Family Theory include:
Joining has reference to the SW’s entrance into the family’s interactional system. It includes forming a strong bond with family members, acknowledging the various perspectives of members, and accommodating the family’s organization and patterns. Joining is more central to Minuchin’s approach.

Evaluating family structure refers to the mapping of underlying structures of the family (structural diagnosis, or the identification of the problem and its structural dynamics).

Restructuring the family involves changing the family structure via enactment (the process of passing legislation/ acting something out), spontaneous behavior sequences and reframing (e.g. increasing the involvement of an uninvolved father and decreasing the involvement of an overly-involved mother).

Enactment means that the SW has the family or a subsystem of the family act out, in session, how they typically deal with a specific type of problem. The enactments are defined and directed by the SW. When the enactment creates a problem, the SW may push family members to continue in the vein they are going or, alternatively, he or she will comment on the problem.

Spontaneous behaviors sequences occur when the SW highlights an interaction that is naturally occurring in the moment and assists the family in modifying problem sequences.

Reframing means redefining the family’s perspective on problems (i.e that they are the problems of individual family members or caused by the environment) as problems with the structure of the family.

Question 58

What is Family Theory and Therapy?

Interventions with CTs/ CT systems; Psychotherapy & Case management

Answer 58

Strategic Family Therapy (Jay Haley) emphasizes change techniques over theory. Strategic Family Therapy is consistent with the influence of Milton Erickson’s work. Strategic family SWs believe in the possibility of rapid change and use resistance of family members in the services of change. Communication is seen as defining relationships. Every relationship involves a struggle for power; that is, a struggle for who defines the relationship. Symptoms are tactics to control; they define the relationship. The SW is very directive and relieves symptoms by helping patents find alternatives ways of defining relationships. This type of therapy is especially useful with change-resistant families.