Theory And pratice Flashcards
What is a theory?
A theory is organized knowledge about a particular subject, in clinical social work is guided by theory, as well as principles,( Sommers Flannigan & Sommers Flannigan,2018)
What is a theory?
There are many different theoretical models of therapy available to help treat a wide range of issues and conditions. Some theoretical models are well known and have been systematically studied in the professional field, while others may be less well-known, or emerging to meet the needs of specific population.
The evolution of clinical theory
First wave: psychodynamic theory
Second wave: cognitive behavioral theories
Third wave: existential/humanistic theories
Fourth wave: feminist in multicultural theories
Fifth wave: postmodern: post, cultural, and constructivist theories
The evolution of clinical theory
Psychodynamic theory originated in the work of Sigmund Freud, and involves a comprehensive understanding of the interplay between an individuals internal and external world
First wave: psychodynamic theory
Object relations represents a natural bridge between the psychodynamic, perspective and theories of attachment, developmental, and social psychology, which posit that mental representations of significant people play an important role in shaping our behavior and social cognition
** object, relations theory has been described as the “ bridge”
First wave: psychodynamic theory
Relational theory, further builds on object relations, and self psychology, situating, intrapsychic conflict within the relational diet that is enacted between the therapist and the patient
Second wave: cognitive behavioral theories
Cognitive theory proposes that dysfunctional thinking is at the root of psychological disturbances.. the patient learns to look at their thoughts in a more rational way, which produces more rational, thinking
Second wave: cognitive behavioral theories
Behavioral therapy is based on the premise that all behaviors are learned, acquired through conditioning, and can be changed
Second wave: cognitive behavioral theories
Cognitive behavioral therapy is based on the premise that thoughts and beliefs, influence moves and behaviors.. the treatment goal is to change both a persons thinking and their behavior patterns
Third wave: existential/humanistic theories
 This approach is rooted in the European humanistic and existential, philosophy of self inquiry, struggle, and responsibility, and the American humanistic tradition of spontaneity optimism in practicality (Schneider & Krug, 2017)
Existential and humanistic approaches to therapy emphasize the same factors that research suggest make any therapy successful, such as therapeutic alliance, empathy, the provision of meaning, and hope, and and affective attunement
Fourth wave: feminist and multicultural theories
Feminist and multicultural theory suggest that earlier theoretical models are based on white male heterosexual norms that privilege western values (Corey, 2017)
Fifth wave: postmodern: post structural and constructivist theories
Fifth wave models emphasize the dialogic process that occurs between the client and therapist
Fifth wave: postmodern: post structural and constructivist theories
Postmodernism offers an ideological critique of the authority and certainty of the medical model with an emphasis on diagnosis (DSM) that is often embedded in the perspective of dominant social groups
Fifth wave: postmodern: post structural and constructivist theories
Post structuralism offers a method of understanding how meanings and subject matters are constructed and language
Integrative psychotherapy
Integrative therapy, combines different therapeutic tools, and approaches to fit the needs of the individual client
How to select a theory
Theory selection is a complicated and multifaceted process that depends on assessment, evidence, base research, and practice wisdom
** Theories provide the basis for treatment plans that attends to criteria that will be used to evaluate the effectiveness of the treatment
Evidence based practice: the science of psychotherapy
Evidence based practices and psychotherapy “ emphasize the best available research with clinical expertise in the context of the patient’s culture, individual characteristics, and personal preferences (Cook et al., 2017)
Evidence based practice: the science of psychotherapy
Another key goal of evidence based psychotherapy is to maximize patient choice, and to ensure that decisions are made collaboratively between the therapist and the patient
The therapeutic relationship: the art of psychotherapy
A key task in therapy is creating and maintaining an optimal therapeutic relationship which has to involve elements, such as empathy, positive regard and stealing hope, and exploring areas of change and making changes which can be challenging and painful (Baldwin& Imel, 2013)
The clinical interview-the first meeting
The bio psychosocial assessment is the product of that therapeutic process. Initially, the worker needs to gather information that forms the basis of the psychosocial assessment. The worker is also beginning to establish the working alliance.
Remember, the clinical interview is for the purpose of collecting data
Confidentiality
The health insurance, portability and accountability act of 1996 became effective on April 24, 2001, which set national standards for the protection of health information as applied to health plans, healthcare, clearing houses, and health providers who conduct transactions electronically
Self awareness
Self-awareness is an umbrella term.. it can be considered an understanding of the multiple dimensions of the workers identity, and how that interacts with the multiple dimensions of the clients identity
Why is the client here?
The best way to begin. The initial interview is bad learning why the client has come to see you.
Questions like what brings you here today or what is on your mind today?
Transference encounter transference
Transference was originally introduced by Freud, as the experience of feelings, drives, attitudes, fantasies, and defenses toward a person in the present, which are inappropriate to the person in our petition, a displacement of reactions originating with the significant person of early childhood
Countertransference
Countertransference is a controversial, subject and contemporary times. It was originally defined as a transference reaction of an analysis to a patient.
counter transference is now considered to be both the result of the therapist own unconscious processes and appropriate reaction by the therapist to the patient
Cultural countertransference
Cultural countertransference can be described as a complex and interacting set of culturally, derived personal life values; academically based theoretical/practice beliefs; emotionally driven biases about ethnic groups; and feelings about their own ethnic identity (Perez- Foster, 1998)
** clinicians have an ethical obligation to be mindful of cultural countertransference, especially in cross, cultural therapeutic relationships.
Motivational interviewing
Motivational interviewing is a counseling approach focused on helping clients explore and resolve ambivalence about making changes Arkowitz et al., 1995
TransTheoretical model: the stages of change.
Precontemplation
contemplation
Preparation
Action
Maintenance
 the middle stage of treatment
There are many reasons why therapy can get” stuck” in the middle phase. It is important to remember that it is normal for clients to be fearful of the unknown.
The end phases of treatment
In long-term treatment, termination is not necessarily agreed on before hand, but it is an outgrowth of the therapeutic process that has reached an end
Often sessions in before all goals are met , often times limited, internal and/or external resources can result in treatment ending earlier
A biopsychosocial model outline
Presenting problem
History of the problem
Human rights and social justice
Previous counseling experience
Family background
Personal history
Medical history
Educational/learning history
Social class
Cultural history
Spirituality/religion
Trauma
Substance use/abuse
Mental status, and client functioning
The mental status exam
The mental status exam
Appearance
Attitude
Motor activity
Affect
Mood
Speech
Thought processes
Thought content
Perception
Orientation
Cognitive functioning
Abstraction
Judgment
Insight
Establishing the diagnosis according to the DSM-5
When the clinician has a clear picture of the client from the mental status evaluation, they are ready to establish a diagnosis using the categories and codes describe in the DSM (American psychiatric Association, 2013)
Multicultural practice
The national Association of social workers provides standards for cultural competence that require social workers to examine their own cultural background and identities, while seeking out necessary knowledge, skills and values that can enhance the delivery of services to people with varying cultural experiences, associated with their race, ethnicity, gender, class, sexual orientation, religion, age, or disability, or other cultural factors (national Association of social workers, 2015)
Multicultural practice
Multicultural competence recognizes the importance of oppression and appreciation for social justice, when working with diverse clients
Multicultural, clinical practice and cultural competence
Multicultural counseling requires an understanding of the value systems of other cultures, and how those values influence the behavior of our clients
Object, relation theory-the internal object
Melanie Klein is considered to be the first to offer a complete object relations theory she introduced the concept of internal object which is the subjective experience of the infant based on the infants interactions with significant external objects in the environment
Splitting and projective identification
Klein introduced the concepts of projective, identification and splitting
Projective identification is motivated by the self need to be rid of unwanted or dangerous aspects
A part of the self split off and fantasize is being put into an external object(the other person)
** This translates into keeping part two contradictory feelings, such such as love and anger, and leads to an identification by projection; that is, the object becomes an extension of the self
Trauma bonding
Fairbairn’s work on the internalized bad object, laid the foundation for understanding the concept of trauma bonding.
A trauma bond is the internalized set of expectations and cues that a child develops when an adult, intermittently harasses, beats, threatens, or abuses the child (DeYoung & Lowery, 1992)
The internalized good object
Harry Guntrip elaborated on Fairbairn’s ideas focused on the importance of the object in ego development.. he felt the self was at the core of the individual, and at the center of Psychoanalytic theory. This self was thought to grow in the context of meaningful personal relationships.
The internal object(s) in interpersonal relationships
Winnicott (1965) a pediatrician, focused on the mother child relationship.. the mother in a state of primary maternal preoccupation provides a holding environment that enables a child’s psyche to grow
Attachment theory, and mentalizing
John Bowlby(1973, 1982) theorize that attachment occurs through an N8 structure that bonds the baby to the mother for the purposes of survival
Attachment theory, and mentalizing
Mary Ainsworth developed an assessment technique, called the strange situation classification to investigate. How attachments might vary among children.
**Consider the 4 attachment styles
The significance of the therapeutic relationship
Henry Stacks Sullivan reformulated the cycle, analytic concept of anxiety, by viewing it, not as the interest psychic process, but as a result of interactions between two people
Sullivan can also be credited as an early theorist and changing the conceptual framework of the therapeutic relationship, making it more collaborative interactional process
Self psychology
Heinz Kohut (1971,1977), A person sense of self and self esteem is described as dependent on the quality of relationships with parental figures that serve self object functions
A self object was originally considered a function provided by a caregiver and experience in psychically, as providing and enduring sense of availability to an infant however, it is evolved overtime, and some the is positive that Kohut’s Original conceptualization of the self object as a psychic function has shifted to personhood, placing it within the framework of personality ( Magid & Shane, 2017)
mentalization
The growth of a child’s capacity to understand interpersonal behavior in terms of mental states
Relational theory
Relational, social workers considers, an individuals, internalization of, and interaction with, the macro cultural, economic and political institutions of a larger society
Relational theory, and the third space
Benjamin (2004) has used the concept of the third space to describe the interactional field created when the subjective of the therapist and the patient come together
