SW 6140 Exam 2
What is meant by the term "deconstruction" and how and why do we do it?
"Deconstruction" is when narrative therapists help clients deconstruct unproductive stories in order to reconstruct new & more productive ones. The therapist spends time learning the family narrative & asks questions that add detail to the narrative. Once the narrative has been deconstructed, there's a chance that the narrative can be reconstructed to include elements that make problem solving possible (reframing ways in which clients might look at a person/situation; uncovering a person's positive qualities). Ex of how we do it: When a family member tells their narrative & another member disagrees with the narrative, we deconstruct the narrative so we can determine if there are certain parts of the narrative that are agreed upon. By finding areas of agreement, we can make the disagreement less powerful. Externalizing and effects questions can also be used to deconstruct a narrative.
What is meant by the term "deconstruction" and how and why do we do it?
"Deconstruction" is when narrative therapists help clients deconstruct unproductive stories in order to reconstruct new & more productive ones. The therapist spends time learning the family narrative & asks questions that add detail to the narrative. Once the narrative has been deconstructed, there's a chance that the narrative can be reconstructed to include elements that make problem solving possible (reframing ways in which clients might look at a person/situation; uncovering a person's positive qualities). Ex of how we do it: When a family member tells their narrative & another member disagrees with the narrative, we deconstruct the narrative so we can determine if there are certain parts of the narrative that are agreed upon. By finding areas of agreement, we can make the disagreement less powerful. Externalizing and effects questions can also be used to deconstruct a narrative.
What is meant by the term "unique outcomes" and how do we use them?
"Unique outcomes" or "sparkling events" are instances where the client resisted the problem or behaved in ways that contradicted the problem story. These unique outcomes become the building blocks of new, more preferred stories. They also make the problem seem more solvable. Therapist asks for elaboration on how the client was able to avoid the problem's effects: "Have there been times when your daughter didn't believe the lies Anorexia tells her about her body?"; "Can you remember a time when Anger tried to take you over, but you didn't let it? How did you do that?"
What are the underlying assumptions of the strengths perspective?
1. Humans have the capacity for growth and change. It is in line with the humanist approach. A person's life force or human power is the drive that continually transforms and heals. Families have the same capacity as individuals to grow. 2. Individuals and families all have many capabilities, abilities, and strengths. People are more than their problems, as each person has their own experiences, roles, characteristics, etc that make up a person. Families have traditions, rituals, and combined capabilities of all its members. Families also pull strengths from other systems in which they are involved, such as a neighborhood. This means that families are already or have the power to become competent. This relates back to individuals'/families' strengths, and strengths approach focuses on these to achieve client goals. 3. People have knowledge that is important in defining their situations--the problematic aspects as well as potential and actual solutions. Clients have survived in spite of great challenges, and that knowledge of their survival is useful in building a future. In recognizing a client's survival and perseverance, it affirms their abilities. This leads to clients describing their own situations with their "expert" opinion, which provides internal knowledge to the social worker. 4. Consumers of social work services often are oppressed by society and abused by other people. Keep in mind the strengths necessary to survive that abuse. 5. Humans are resilient or often able to survive and thrive despite risk factors for variou types of problems and dysfunction. Characteristics of resilient children are: social competence, autonomy, sense of purpose and future.
What did the authors write about regarding respecting the family structure?
1. There is considerable stress associated with immigration in the USA. Stressor events or challenges can include: finding employment, finances, and language barriers. The stressors must be assessed in therapy. 2. A family's national origin, depending on sociopolitical oppression and the danger at the time of migration, has been to found to relate to the immigration stress level, sometimes PTSD. 3. Foreign-born immigrants may have lower rates of mental illness than USA born Hispanics. If not USA born, the cultural practices of their original country may act as buffers for mental illness and substance abuse. EXAMPLE: Hispanics have the value of familismo and rely on extended family for emotional and monetary support. This is not as common in the US.
What does Wheeler say about pre-session change?
2/3 of people attending therapy for first two appointments reported progress/times when the problem did not happen. When parents report this, therapist can explore how this happened. Parents/children can identify the strategies that were used and may be able to resolve the problem based on them. EXAMPLE: Teenager is defiant. Mother used a reward system night before an appointment. System made it so the child listened more.
What did the authors say about assuming familiarity prematurely?
A. Don't call people by their first names initially. It is important to ask how family members would like to be addressed. Clients grow up in a society where overly familiar behavior has been the vehicle of disrespect. Err on the side of respect. By doing this it is another way of acknowledging their right to self-identify. Also ask about their ethnic self-identification (black, African-American, etc.)
Discuss McGoldrick's thoughts on race and racism presented in our reading
A. Racism is an issue of political oppression not a cultural or genetic one. It puts people into lower social status than other groups regardless of class or any other factor than skin color. Whites generally are unaware of the problems our society creates for people of color. Likewise, racism and poverty have dominated the lives of ethnic minorities, it has been one of the biggest dividers in the country. It is important to know that family therapy has been developed and conducted by white Americans for other white Americans without including people of color. Those who were seen as different based on skin color could not "pass" for other immigrants, leaving them "obligatory ethnic" regardless of their own thoughts or concerns. It has slightly improved in the past generation, but it still plagues American life. As moments of racism increase, it becomes more important for people to explore and understand their own ethnicity and overcome prejudice. It is essential to stop the feelings of anger and rage that come from racism by developing multicultural understanding. All white Americans have the invisible knapsack of privilege. Most white Americans don't acknowledge this institutionalized privilege that occurs between them and all other ethnicities. Most family therapy has been developed and conducted by White Americans for White Americans, which is why it is important that white therapists expand their knowledge to also benefit people of color. By appreciating cultural variability this leads to a radically new conceptual model of clinical intervention. By helping a person achieve a stronger sense of self may require resolving cultural conflicts within the family. Many families do not realize their racism until they are faced with it head on. This is how therapists can remain most effective with working with diverse clientele.
What did the authors ay about addressing the issue of racism and its effects?
A. The degree to which families have been affected by racism and see racism as impactful to their lives varies considerably. We do not assume racism is an important factor for the family, but we do know that it has affected many people in our society. Racism and discrimination remain widespread and powerful forces. Folks are affected by and/or see themselves as affected by it rather than their direct issues at the time. Loss of jobs, restricted opportunities, and hostile environment are real considerations as families make their way through life. You want to know what the family's experiences have been and what their beliefs are. Someone who has experienced racism by the larger society might have good reason to not trust the worker. Many families who have experienced racism on a large scale, let it affect their decisions in general. So, parental concerns about children's physical and psychological well-being in a racist society fan lead to parents to be overly restrictive when adolescents push for autonomy.
Pardasini & Band Findings-Client-staff communication
Black and Latino clients were less likely to report that it was "easy to talk to staff" when they called or walked into an agency than Caucasian clients. There was not a statistical difference when comparing the groups. Likewise, both Black and Latino groups were less likely to report that agency staff listened carefully when talking to them compared to the Caucasian clients. There were statistical differences found between the Caucasian and Black and Caucasian and Latino groups. Latino consumers were less likely to report that agency staff spoke the language that they typically spoke at home than the Caucasian and Black clients. There were statistically significant differences between the Caucasian and Black and Caucasian and Latino groups.
Pardasini & Band Findings-Trust
Black and Latino clients were less likely to report that they could trust the staff in social service agencies than Caucasian clients. There were significant differences between the Caucasian and Black and Caucasian and Latino groups.
Pardasini & Band Findings-Staff evaluation of clients based on ethnicity
Black and Latino consumers were more likely to report that agency staff thought less of them because of the colors of their skin compared to Caucasian clients. There were significant differences between Black and Caucasian and Latino and Caucasian groups. Latino clients were more likely to report that staff understood that not all people of their ethnicity were alike compared to Caucasian and Black clients. Significant differences between Black and Caucasian and Latino and Caucasian groups.
Pardasini & Band-Respect
Black and Latino were less likely to report that staff at agencies treated them with respect compared to Caucasian clients. There were significant differences between Caucasian and Black and Caucasian and Latino groups.
5. Describe the use of compliments. What are we trying to do and how do we do it?
Compliments can be used to highlight successful strategies & keep clients focused on those at work. Compliments are conveyed with questions, such as, "Wow! How did you do that?". This phrasing calls attention to the fact that the clients have already accomplished something. Invite the client to describe their successes, which helps foster self-confidence. Always seek to find out about decreases in problem levels, compliment them & find out how they did it. Compliments should point toward what to do more, not what to eliminate. Ex of how we do it (suggestions to client): do more of what works; try something different (may be able to interrupt a cycle that isn't working); go slow ("are there possible problems that might happen if you get your problems solved too quickly?"
Describe externalization of problems. What are we trying to do and how do we do it?
Externalization of the problem means that the person isn't having a problem or being a problem, but that they are struggling against a problem. If the problem is viewed as something that exists in the world that comes over the person & affects their functioning, it's more fixable than a problem defined as a personality characteristic. Externalizing conversations & externalizing questions are used throughout our interaction with clients to help them (and us) see the problem as something that is not part of them, but something that comes over them, & something that can be battled against. Externalizing questions may include "influence questions" (tell me about times when the problem has had more power or influence over you & tell me about times that it has had less influence over you—empowers client as it changes the family's narrative about the problem). Externalizing conversations may include personifying the problem, so that the problem is viewed as its own entity rather than a part of the client.
What are four examples of poor problem-solving skills from your text?
Four poor problem-solving skills would be: frequently changing the subject when discussing a problem, phrasing wishes and complaints in vague and critical ways when discussing a problem, responding to complaints with counter-complaints as a defense when discussing a problem, and phrasing alternative behaviors and wishes as complaints when discussing a problem.
Why do healthy families have strong reinforcement power?
Healthy families have strong reinforcement power because there are many opportunities for positive exchange between the members of the family. With few meaningful interactions or opportunities to discuss emotions, thoughts, behaviors, moments of reinforcement become powerless in comparison to the negative or lack of interaction. With more openings to discuss and modify concerning behaviors, the reinforcement provided has more of an influence in the family dynamic. With a couple, if they have few positive exchanges and limited reinforcement opportunities, their relationship will suffer. Increased reinforcement opportunities could involve varying their shared activities, developing new common interests, expanding their sexual repertoire and developing their communication to the point where they continue to interest one another.
Describe how we use the miracle question to help clients. Be thorough.
If you were to wake up tomorrow morning and everything was just the way you wanted it to be regarding the issue, what would it be like? The miracle question invites clients to envision positive outcomes and begins to activate a problem-solving mindset by giving them a mental picture of their goals in the same way that visualizing the perfect serve helps a tennis player. The miracle question also helps clients look beyond the problem to see that what they really want might not be the elimination of the problem per se but to be able to do the things that the problem has been obstructing. If the therapist can encourage the client to make strides despite the problem, it may not look so large in comparison. EXAMPLE: Mary says that if she weren't bulimic, she'd get closer to people and have more fun as an answer to the question. With encouragement, if Mary begins taking more risks and having fun, the bulimia may not seem so large and daunting.
Pardasini & Band Findings-Ethnic and Racial Disparity
In many caregiving settings, cultural competence is worked towards but not achieved because of the highly diverse cultures that each client may observe. In the study, they found that Latino clients reported that staff practices did not reflect their racial/ethnic background and views more often than any other client ethnic group. There were statistically high levels of difference found between each Latino, African American, and Caucasian groups.
Describe how we use exception finding to help clients. Be thorough.
In session, a client and therapist will probe for exceptions or moments when the client didn't have the problem to recognize times that some potential solutions may already be in their grasp. It involves asking exception questions. Exceptions in recent years are the most effective because the client can remember the outcome in greater detail. These questions allow client and therapist to explore and build on past successes. If there are not exceptions, the therapist will then ask coping questions. EXAMPLE: "When in the recent past might the problem have happened but didn't (or was less intense or more manageable)?"
What does Wheeler say about goal clarification and how SFT was used in his example?
In therapy, clients are encouraged to define their goals in measurable, concrete, and specific terms. They are used as the primary target for change. If the parents are overwhelmed and not thinking clearly, the goals are vague or described as a lack of the problem (the kid will stop being naughty). The therapist needs to encourage more a description if this occurs. A more detailed description allows the therapist to ask if any of the goal material has happened before. EXAMPLE: When asked what a 7-year-old child does when he is behaving better, parent said playing on his own/occupying himself. When asked if had happened before, sister said yes and gave examples.
Describe the use of scaling questions. What are we trying to do and how do we do it?
Introduced to help therapists and clients talk about vague topics topics such as depression and communication, where concrete changes are difficult to see. Helps the client to quantify their confidence and level of change. "On a scale of 1-10, how confident are you?" Scaling questions are a good tool to anticipate and stop resistance to change and backsliding and to encourage long-term commitment. It helps to recognize and nurture the small changes that are made. Trying to get a client to focus on the fact that a change was made and the circumstances that caused it. EX: Use scale in session each week and track change. Use change to initiate conversation on how change occurred and how to perpetuate it.
What did the authors say about addressing concerns about having a non-black therapist?
It is important for the therapist to open conversation about the family's feelings regarding have a therapist of a different ethnic group. It is importance to know that differences can affect family confidence in the therapist ability to understand the family's circumstances and challenges. The therapist needs to demonstrate their sensitivity to the differences and their willingness to discuss and understand the thoughts and feelings. There is not research backing discussing the difference when client and therapist are of different ethnicity, and there is no clear result on whether having a different ethnicity therapist will affect outcomes. It depends on the thoughts and feelings of the client. Non-African American therapist need to approach the subject carefully and cautiously to learn of family's feelings. New therapists should practice opening up about the subject to ensure comfort and focus on the family.
Pardasini & Band Findings-Staff willingness to provide ethnically sensitive treatment strategies
Latino clients were less likely to report that agency staff are willing to be flexible and provide alternate treatment approaches than Caucasian and Black clients. Statistically significant differences were found between Caucasian and Latino groups
Pardasini & Band Findings-Staff ability to acknowledge the importance of client cultural beliefs
Latino clients were less likely to report that staff acknowledged the importance of their culture in treatment than Black and Caucasian clients. There were statistically significant differences between Caucasian and Latino groups.
How do we reinforce the new story?
Narrative therapists believe that the self is constituted in social interaction, therefore they make a point of helping clients find audiences to support their progress in constructing new stories for themselves. Clients may be asked to contact people from their past who can authenticate their new story, or recruit people in their lives who will support their new story. Therapeutic letters (which convey a deep appreciation of what the client endured, the outline of a new story, and the therapist's confidence in the client's ability to continue to progress) can also be used
Describe how you would use the model from described in Corey chapter nine to help a parent learn to comment on appropriate behaviors by their kid.
Operant conditioning is a model/process used to modify specific behaviors. The goal could be to increase, decrease, or completely eradicate a behavior to implement an alternative. To do so, one must use functional behavior analysis to find out what could or is happen both before and after the undesired and desired behaviors or the contingencies of reinforcement. Those circumstances must be arranged by the adult to create a scenario when the desired behavior will occur. The steps are identify (A), model (B), teach (C), and reinforce (D). A-Name the unwanted behavior; B-Identify the alternative to said behavior; C-Identify what needs to be removed from the first behavior; D-Identify what needs to be done to implement the alternative behavior (setting the stage and reinforcement). By using this model, parents are able to encourage or discourage their children's specific behaviors and create an environment conducive to change. For example, A-The parent notices that child has temper tantrums when they do not get their way; B-The parent wants the child to listen to the parent; C-The parent notices that the child gets angry when they do not get what they want and that the parent gives in when the child's tantrum is prolonged. The giving in would be reinforcement of the child's negative behavior, which would keep it going; D-The parent needs to stop giving in when the child's tantrum is long and praise the child when they stop and do what is asked of them by the parent.
What does Wheeler say about problem saturation?
Parent often focus too much on the problems of their children. They feel that they have run out of effective strategies and are a lost cause in the future. The parent forgets the past successes of the child and solely focuses on the difficulties and the future with negativity. This thinking rubs off onto the children too. Noticing the negativity, their self-esteem and sense-of-self lower, and they feel little motivation to improve upon themselves. In parent-child relationship, negativity damages the attachment, which perpetuates more negativity. SFBT can be helpful in reversing the negative pattern within parents. EXAMPLE: With a mom and son, the mom is encouraged in therapy to envision a time when they would get along and have fun. Son is not used to hearing positive talk rather than complaints, so it could actually make more of an effect in their life.
What are the things we can do to make punishment ineffective?
Punishment can become ineffective, typically, when it is administered and used incorrectly. The following are several circumstances when this occurs: punish too long after the undesirable behavior occurred because the child will not understand why it is occurring, punish out anger because it meets the parents' needs not the child's needs, punish too big for the transgression because it overshadows the reason for the punishment, punish without reinforcing a more desirable alternative behavior because it does not create a more positive situation for the child, punish with too mild a transgression because it does not create a situation when the child would like to stop their behavior.
Describe the behavioral concept of shaping
Shaping involves rewarding and reinforcing someone when they make an effort to change an unwanted behavior, even if it is not perfect. It is the idea of reinforcing in small steps. When utilizing operant conditioning or another process to modify a behavior, kids are typically reinforced even if the behavior is not 100% perfect because it may take more than one time for the behavior to be done completely correctly. Reinforcement encourages even more effort and progress. Modifications could be broken into steps, creating a scenario when shaping is necessary to move to the next step in the change process. When a child first learns to do chores, it may be a process. They may not do it correctly the first time. Even when small progress is made, the parent should reward the child because it encourages the child to make even more progress, eventually leading to a 100% job.
Describe the use of the strengths perspective in the case example of Deanna Wilson and her son from the article
The SW focused on strengths of Deanna & Andy individually, as well as of the two of them as a family. The SW helped identify a number of strengths for the family to build on to facilitate successfully Andy's return home & to sustain an environment that would foster resilience & continuing efforts toward improvement. The SW & family developed a set of specific goals together using questions that targeted the aspirations of both Deanna & Andy. The SW helped them state their goals in a way that stressed the development of existing strengths. The SW provided information, completed tasks & role played with Deanna and Andy. The SW took advantage of the opportunity to model high expectations of what the family could accomplish & to reflect her appreciation of the family's strengths. While they worked together on tasks, the conversation often centered on how the family's situation was improving & the family's growing repertoire of strengths. The SW and Deanna also talked about various potential sources of social support.
Describe the use of coping questions. What are we trying to do and how do we do it?
The purpose of coping questions is to uncover solutions, and to discover what people do to not allow the problem to get worse. We want to know what things they have done to get through their difficult situation. Coping questions can help clients recognize that they are more resourceful than they realize. Ex of how it is done: "What keeps you going under such difficult circumstances?"; "What have you done to keep things from getting worse?"
What did the authors write about regarding respecting the family structure?
Therapists need to appreciate the wide range of family structures, relationships, and systems and not misinterpret them for a negative situation. EXAMPLE: Family may come in with an older child taking care of the other children instead of the parents. Do not misunderstand the situation because it may be normal with different cultures, as a power differential of that sort is normal in Hispanic cultures. However, if it becomes a negative situation for the sibling, the therapist could work with the family to outline duties and boundaries for the duty.
What did the authors write about regarding respecting the father figure?
This is rationalized through machismo, which is a common Hispanic value that describes the family with traditional gender roles in a patriarchal structure. Therapists should show respect to the father by meeting and addressing him first. They should also confront him less and consult on decision with him. Unless there is a strong reason to not, the therapist should approach the father as the head of the family because he would make decisions as the authority figure. Machismo can be seen as an obstacle but also a sense of commitment to the children and spouse by the father. Focusing on the positive can help to engage the man and get him involved in session.
Describe the type of time out that we do with kids
This time-out is used with kids to stop one behavior and start an alternative. It could be used with the operant conditioning model. It begins by telling the child when they do a particular, negative behavior and what an alternative, positive behavior would be, and the parent tells them that if they continue to do it, they will be put in time-out. The parent must tell them what exactly time-out entails. When the negative behavior occurs, the parent must ask the child if they can stop on their own or if they need a time-out, but the focus is to encourage the good choice because we want to encourage self-determination. If they cannot, a time-out is administered. They are told to go to time-out for a short period of time, a couple of minutes. But they can leave time out if they talk about the situation with the parent and tell them why they got the time-out and what they could have done differently. If they refuse the time out, the time increases in small increments. If it continues, the parent must take them to time out. If this is necessary, time-out will not start until the child is able to keep themself there without the parent's help. Time out must be separated from distractions and interactions. Even if the child attempts to hit or kick, take them to time out. Give them back control in small steps to ensure they are calm enough to sit there themself. Place a clock nearby, so the child can tell the parent when time out is over. In therapy, time-outs must be taught, discussed, and role-played to make sure the child understands the concept before they are implemented.
What did the authors say about the therapist's definition of family when working with black families?
When gathering information about who lives in the home and fulfills family roles, keep an open mind and assess the involvement of extended and non-blood-related family. African-American households are more likely to include extended family than other groups and the inclusion has shown better psychological functioning in men and women. There is no clinical support of the therapeutic validity but there is cultural relevance.
Describe the type of time outs we do with adults
With adults, the goal of time-outs is to interrupt cycles of negative behavior and escalating situations to create a more positive situation. In an escalating situation, it could involve adults physically giving the "T" (time-out) sign to stop the conversation, asking that they come back to the subject after both parties have calmed down and can talk civilly. It involves noticing the physical signs of being overwhelmed with emotion that will hinder productive conversation to resolve whatever issue is at hand. In therapy, a therapist would ask client to role play their escalated argument and give a time out. They would process their own emotions and discuss the implications of each other's emotions with one another. The practice would show them the effectiveness of using a time-out early on in the argument to keep it from reaching the breaking point. Next time that type of exchange begins to take place, hopefully, the couple would realize and take a break before it reached an escalating point.
