The intervention process

Techniques for harm reduction

A harm reduction approach refers to any program, policy, or intervention that seeks to reduce or minimize the adverse health and social consequences associated with an illness, condition, and/or behavior, such as substance use, without requiring a client to practice abstinence, discontinue use, or completely extinguish the behavior. This definition recognizes that many clients are unwilling or unable to abstain from behaviors or use at any given time and that there is a need to provide them with options that minimize the harm caused by their condition to themselves, to others, and to the community. Harm reduction complements prevention approaches because it is based on the acceptance that, despite best efforts, clients will engage in behaviors such as substance use, and are unable or unwilling to stop using substances at any given time. In addition, clients who use substances may prefer to use informal and nonclinical methods to reduce their consumption or reduce the risks associated with use. Harm reduction is practical, feasible, effective, safe, and cost-effective. Most harm reduction approaches are inexpensive, easy to implement, and have a high impact on individual and community health. Harm reduction acknowledges the significance of ANY positive change that clients make in their lives; these interventions are designed to "meet clients where they are" currently. Harm reduction recognizes that intervention can be seen as a continuum with the more feasible options at one end and less feasible, but desirable, ones at the other end. Though desirable, abstinence can be considered difficult to achieve. Thus, social workers should partner with clients to identify actions that can be taken to minimize impacts of their illnesses, conditions, and/or behaviors.

Steps and cognitive restructuring

Assist clients in: Accepting that their self-statements, assumptions, and beliefs determine or govern their emotional reaction to life's events Identifying dysfunctional beliefs and patterns of thoughts that underlie their problems Identifying situations that evoke dysfunctional cognitions Substituting functional self-statements in place of self-defeating thoughts Rewarding themselves for successful coping efforts Foundational to this treatment is client self-monitoring. Clients are encouraged to pay attention to any subtle shift in feelings. Clients frequently keep thought or emotion logs that include three components: (a) disturbing emotional states (b) the exact behaviors engaged in at the time of the emotional states and (c) thoughts that occurred when the emotions emerged. Homework is often done between sessions to record these encounters.

Methods to engage and motivate clients

A motivational approach aims to help clients realize what needs to change and to get them to talk about their daily lives, as well as their satisfaction with current situations. Social workers want to create doubt that everything is "OK" and help clients recognize consequences of current behaviors or conditions that contribute to dissatisfaction. It is much easier if clients believe goals can be achieved and life can be different. Sometimes clients are incapacitated by conditions that need to be addressed first (i.e., depression). Social workers can help clients think of a time when things were better or create a picture of what their lives could look like with fewer stresses. The role of a social worker is to create an atmosphere that is conducive to change and to increase a client's intrinsic motivation, so that change arises from within rather than being imposed from without. Motivation is a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. Some additional techniques include: Clearly identifying the problem or risk area Explaining why change is important Advocating for specific change Identifying barriers and working to remove them Finding the best course of action Setting goals Taking steps toward change Preventing relapse Empathy is a factor that increases motivation, lowers resistance, and fosters greater long-term behavioral change.

Client contracting

A social worker and client work together to develop a contract (intervention or service plan), including an agreement on its implementation or the activities used to help a client attain his or her goals. Modification of the contract may be required as new information about a client's situation emerges and/or as the situation changes. When clients seek to attain their goals, changes may need to be made to themselves, groups, families, and/or systems in the larger environment. This choice of targets is an even more complex issue than it first appears because the process of changing one system may bring about changes in others.

Crisis intervention and treatment approaches

A state of crisis is time limited. Brief intervention during a crisis usually provides maximum therapeutic effect. Crisis intervention is a process of actively influencing the psychosocial functioning of clients during a period of disequilibrium or crisis. A crisis does not need to be precipitated by a major life event. The goals are to alleviate stress and mobilize coping skills, psychological capabilities, and social resources. The goals of crisis intervention are to (a) relieve the impact of stress with emotional and social resources, (b) return a client to a previous level of functioning (regain equilibrium), (c) help strengthen coping mechanisms during the crisis period, and (d) develop adaptive coping strategies. Crisis intervention focuses on the here and now, is time limited (most crises last from 4 to 6 weeks), is directive, and requires high levels of activity and involvement from a social worker. A social worker sets specific goals and tasks in order to increase a client's sense of mastery and control.

Task centered approaches

A task-centered approach aims to quickly engage clients in the problem-solving process and to maximize their responsibility for treatment outcomes. In this modality, the duration of treatment is usually limited due to setting constraints, limitations imposed by third-party payers, or other reasons. Thus, at the outset, the expectation is that interventions from learning theory and behavior modification will be used to promote completion of a well-defined task to produce measurable outcomes. The focus is on the "here and now." This type of practice is often preferred by clients, as they are able to see more immediate results. The problem is partialized into clearly delineated tasks to be addressed consecutively (assessment leads to goals, which lead to tasks). A client must be able to identify a precise psychosocial problem and a solution confined to a specific change in behavior or a change of circumstances. A client must also be willing to work on the problem. It is essential that a social worker and client establish a strong working relationship quickly. A social worker's therapeutic style must be highly active, empathic, and sometimes directive in this approach. Assessment focuses on helping a client identify the primary problem and explore the circumstances surrounding the problem. Specific tasks are expected to evolve from this process. Consideration is given to how a client would ideally like to see the problem resolved. Termination, in this modality, begins almost immediately upon the onset of treatment.

Step 6: Termination and anticipation of future needs In termination

progress that has been achieved should be reviewed and supports anticipated to be needed in the future should be identified.

Individual psychology

Alfred Adler, a follower of Freud and a member of his inner circle, eventually broke away from Freud and developed his own school of thought, which he called "individual psychology." Adler believed that the main motivations for human behavior are not sexual or aggressive urges, but striving for perfection. He pointed out that children naturally feel weak and inadequate in comparison to adults. This normal feeling of inferiority drives them to adapt, develop skills, and master challenges. Adler used the term "compensation" to refer to the attempt to shed normal feelings of inferiority. However, some people suffer from an exaggerated sense of inferiority. Such people overcompensate, which means that, rather than try to master challenges, they try to cover up their sense of inferiority by focusing on outward signs of superiority such as status, wealth, and power. Healthy individuals have a broad social concern and want to contribute to the welfare of others. Unhealthy people are those who are overwhelmed by feelings of inferiority. The aim of therapy is to develop a more adaptive lifestyle by overcoming feelings of inferiority and self-centeredness and to contribute more toward the welfare of others.

Negative affects of anger problems

Although everyone gets angry, clients may come to social workers because they are not able to control their anger, causing problems. Anger can also increase risk for developing physical health problems, such as heart disease, stress-related illnesses, insomnia, digestive issues, and/or headaches. Social workers can assist clients to develop action or treatment plans to change these behaviors.

Contemplation

Ambivalence, conflicted emotion

Assertiveness training

Assertiveness training is when procedures are used to teach clients how to express their positive and negative feelings and to stand up for their rights in ways that will not alienate others. Assertiveness training typically begins with clients thinking about areas in their life in which they have difficulty asserting themselves. The next stage usually involves role plays designed to help clients practice clearer and more direct forms of communicating with others. Feedback is provided to improve responses, and the role play is repeated. Clients are asked to practice assertive techniques in everyday life. Assertiveness training promotes the use of "I" statements as a way to help clients express their feelings. "I" statements tell others how their actions may cause clients to be upset, but are in contrast with "you" statements, which are often seen as blaming or aggressive. Learning specific techniques and perspectives, such as self-observation skills, awareness of personal preferences, and assuming personal responsibility, are important components of the assertiveness training process.

micro level

At the micro level of intervention, social workers concentrate on helping clients solve their problems. These problems may relate to difficulties with partners/spouses, children, other family members, coworkers, and/or neighbors. At the micro level, social workers help clients to access needed services from other agencies, as well as provide direct support and counseling. This type of social work intervention is often the focus of clinical practice in social work and clients can include individuals, couples, and/or families.

Goalsetting techniques

Change Strategies Modify systems: The decision to help a client on a one-to-one basis or in the context of a larger system must take into consideration a client's preferences and previous experiences, as well as the degree to which a client's problem is a response to forces within the larger system and whether change can be readily attained by a change in the larger system. Modify individual thoughts: A social worker may teach how to problem solve, alter his or her self-concepts by modifying self-defeating statements, and/or make interpretations to increase a client's understanding about the relationship between events in his or her life. Modify individual actions: A social worker may use behavior modification techniques, such as reinforcement, punishment, modeling, role playing, and/or task assignments. Modeling and role modeling are very effective methods for teaching. They should be used whenever possible. Thoughts can be modified by feedback from others and behaviors can be modified through the actions of others in a system (by altering reinforcements). A social worker can also advocate for a client and seek to secure a change in a system on his or her behalf. A social worker can be a mediator by helping a client and another individual or system to negotiate with each other so that each may attain their respective goals.

Client self monitoring approaches

Clients are encouraged to pay attention to any subtle shift in feelings. Clients frequently keep thought or emotion logs that include three components: (a) disturbing emotional states, (b) the exact behaviors engaged in at the time of the emotional states, and (c) thoughts that occurred when the emotions emerged. In cognitive behavioral therapy (CBT), homework is often done between sessions to record these encounters. This homework involves client self-monitoring, which is central to this approach.

Limit setting or boundary techniques

Clients of all ages are frequently desperate for an environment with consistent boundaries. For this reason, it is helpful if social workers can learn limit-setting skills. Limit setting is facilitative as clients do not feel safe or accepted in a completely permissive environment. In addition, although compassion is important for a social worker, it is important to maintain a client-social worker relationship. Understanding boundaries and being able to maintain those boundaries with clients are essential.

The client role in the problem-solving process

Clients often tend to think of themselves and their problems as unique. A client may think his or her difficulties are so different from those of others that no one else could ever understand them. He or she may even enjoy this feeling of uniqueness. It may be a defense against the discomfort of exploring his or her fears of being like others. At this point, a client may not be ready to look at the problem. It is hard to admit difficulties, even to oneself. There may also be concerns as to whether social workers can really be trusted. Some people, because of unfortunate experiences in their childhoods, grow up with distrust of others. Furthermore, people are generally afraid of what others will think of them. A client may only be looking for sympathy, support, and/or empathy, rather than searching for a new way to solve his or her difficulties. A client may not see that change must occur. When a social worker points out some of the ways in which a client is contributing to his or her own problems, he or she stops listening. Solving the problem often requires a client to uncover some aspects of himself or herself that he or she has avoided thinking about in the past and wants to avoid thinking about in the future. A client may have struggled very hard to make himself or herself an independent person. The thought of depending on or receiving help from another individual seems to violate something. A client must constantly defend against a sense of weakness and may have difficulty listening to and using the assistance of another person. There are also many clients who have strong needs to lean on others. Some spend much of their lives looking for others on whom they can be dependent. In the helping situation, they may constantly and inappropriately seek to repeat this pattern.

CBT (cognitive behavioral therapy)

Cognitive behavioral therapy (CBT) is a hands-on, practical approach to problem solving. Its goal is to change patterns of thinking or behavior that are responsible for clients' difficulties, and so change the way they feel. CBT works by changing clients' attitudes and their behavior by focusing on the thoughts, images, beliefs, and attitudes that are held (cognitive processes) and how this relates to behavior, as a way of dealing with emotional problems. CBT can be thought of as a combination of psychotherapy and behavioral therapy. Psychotherapy emphasizes the importance of the personal meaning placed on things and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the relationship between problems, behaviors, and thoughts. This approach is active, collaborative, structured, time limited, goal oriented, and problem focused. This approach lends itself to the requirements posed by managed care companies, including brief treatment, well-delineated techniques, goal and problem oriented, and empirically supported evidence of its effectiveness.

When previous attempts to resolve a conflict have only escalated the conflict, a useful technique is to structure the interactions between the parties. Structuring techniques include:

Decreasing the amount of contact between the parties in the early stages of conflict resolution Decreasing the amount of time between problem-solving sessions Decreasing the formality of problem-solving sessions Limiting the scope of the issues that can be discussed Using a third-party mediator

relaxation exercises for anger management

Deep breathing Meditation or repeating calming words/phrases Guided imagery Yoga Stretching or physical exercise Assisting clients to practice these techniques regularly will result in using them automatically in tense situations.

Precontemplation

Denial, ignorance of the problem

Personalizing techniques

During the problem-solving process, a social worker may need to assist a client to break down problems or goals into less overwhelming and more manageable components. This is known as partialization and aims to break complex issues into simpler ones. Partialization is useful because it may assist a social worker and a client to identify the goals that are easier to achieve first, enabling a client to see results more quickly and gain some success in making harder changes. Partialization can also help individuals to order the problems or goals that need more immediate help from those that can be addressed later. A social worker can use Maslow's hierarchy of needs as one tool to assist in making decisions about more pressing needs. In addition, a client should be asked to prioritize his or her concerns or goals. When outlining the goals for treatment, it is important that the broad overarching aims of treatment are broken down by a social worker and client into smaller, more tangible items that must be achieved in order to reach the overall goal. Behavioral objectives are the smaller, observable, and measurable intermediate steps that lead to broader long-term goals. Behavioral objectives help a social worker and client understand whether the strategies they are using to achieve the goal are resulting in change or whether they need to modify their efforts to improve the likelihood of accomplishing the desired outcome.

Ego psychology

Ego psychology focuses on the rational, conscious processes of the ego. Ego psychology is based on an assessment of a client as presented in the present (here and now). Treatment focuses on the ego functioning of a client, because healthy behavior is under the control of the ego. It addresses: Behavior in varying situations Reality testing: perception of a situation Self Psychology Coping abilities: ego strengths Capacity for relating to others The goal is to maintain and enhance the ego's control and management of stress and its effects.

A social worker engages in the problem-solving process via the following steps:

Engaging Assessing (includes a focus on client strengths and not just weaknesses) Planning Intervening Evaluating Terminating

Preparation

Experimenting with small changes, collecting information about change

relapse

Feelings of frustration and failure

Psychosexual stages of development

Freud believed that personality solidifies during childhood, largely before age 5. He proposed five stages of psychosexual development: the oral stage, the anal stage, the phallic stage; the latency stage, and the genital stage. He believed that at each stage of development, children gain sexual gratification or sensual pleasure from a particular part of their bodies. Each stage has special conflicts, and children's ways of managing these conflicts influence their personalities. If a child's needs in a particular stage are gratified too much or frustrated too much, the child can become fixated at that stage of development. Fixation is an inability to progress normally from one stage into another. When the child becomes an adult, the fixation shows up as a tendency to focus on the needs that were overgratified or overfrustrated. Freud believed that the crucially important Oedipus complex also developed during the phallic stage. The Oedipus complex refers to a male child's sexual desire for his mother and hostility toward his father, whom he considers to be a rival for his mother's love. Freud thought that a male child who sees a naked girl for the first time believes that her penis has been cut off. The child fears that his own father will do the same to him for desiring his mother—a fear called castration anxiety. Because of this fear, the child represses his longing for his mother and begins to identify with his father. The child's acceptance of his father's authority results in the emergence of the superego. Stage Age Sources of pleasure Result of fixation Oral Birth to roughly 12 months Activities involving the mouth, such as sucking, biting, and chewing Excessive smoking, overeating, or dependence on others Anal Age 2, when the child is being toilet trained Bowel movements An overly controlling (anal-retentive) personality or an easily angered (anal-expulsive) personality Phallic Age 3-5 Genitals Guilt or anxiety about sex Latency Age 5 to puberty Sexuality is latent, or dormant, during this period No fixations at this stage Genital Begins at puberty The genitals; sexual urges return No fixations at this stage In psychoanalytic psychotherapy, the primary technique used is analysis (of dreams, resistances, transferences, and free associations).

There are several important elements of behavioral objectives:

Good behavioral objectives are client-oriented and place the emphasis upon what a client will need to do in order for change to occur. Good behavioral objectives are clear and understandable and contain a clearly stated verb that describes a definite action or behavior. Good behavioral objectives are observable and describe an action that results in observable products. Good behavioral objectives contain the behavior targeted for change, conditions under which a behavior will be performed, and the criteria for determining when the acceptable performance of the behavior occurs.

Group work techniques

Group work is a method of working with two or more people for personal growth, the enhancement of social functioning, and/or for the achievement of socially desirable goals. Social workers use their knowledge of group organization and functioning to affect the performance and adjustment of individuals. Individuals remain the focus of concern and the group is the vehicle of growth and change. When individual problems arise, they should be directed to the group for possible solutions as the group is the agent of change. Social workers must remind group members that confidentiality cannot be guaranteed—though seeing an agreement among group members concerning preserving the confidentiality of information shared should be an initial goal of any group process. Contraindications for group: client who is in crisis; suicidal; compulsively needy for attention; actively psychotic; and/or paranoid There are different kinds of groups. Open Versus Closed Open groups are those in which new members can join at any time. Closed groups are those in which all members begin the group at the same time. Short-Term Versus Long-Term Some groups have a very short duration, whereas others meet for a longer duration. A social worker takes on different roles throughout the group process, which has a beginning, middle, and end. Beginning A social worker identifies the purpose of the group and his or her role. This stage is characterized as a time to convene, to organize, and to set a plan. Members are likely to remain distant or removed until they have had time to develop relationships. Middle Almost all of the group's work will occur during this stage. Relationships are strengthened as a group so that the tasks can be worked on. Group leaders are usually less involved. End The group reviews its accomplishments. Feelings associated with the termination of the group are addressed.

Interviewing techniques

In social work, an interview is always purposeful and involves verbal and nonverbal communication between a social worker and client, during which ideas, attitudes, and feelings are exchanged. The actions of a social worker aim to gather important information and keep a client focused on the achievement of the goal. A social work interview is designed to serve the interest of a client; therefore, the actions of a social worker during the interview must be planned and focused. Questions in a social work interview should be tailored to the specifics of a client, not generic, "one size fits all" inquiries. The focus is on the uniqueness of a client and his or her unique situation. The purpose of the social work interview can be informational, diagnostic, or therapeutic. The same interview may serve more than one purpose. Communication during a social work interview is interactive and inter-relational. A social worker's questions will result in specific responses by a client that, in turn, lead to other inquiries. The message is formulated by a client, encoded, transmitted, received, processed, and decoded. The importance of words and messages may be implicit (implied) or explicit (evident). A social worker should listen, being nonjudgmental, throughout a social work interview.

Strategic family therapy

In strategic family therapy, a social worker initiates what happens during therapy, designs a specific approach for each person's presenting problem, and takes responsibility for directly influencing people. It has roots in structural family therapy and is built on communication theory. It is active, brief, directive, and task-centered. Strategic family therapy is more interested in creating change in behavior than change in understanding. Strategic family therapy is based on the assumption that families are flexible enough to modify solutions that do not work and adjust or develop. There is the assumption that all problems have multiple origins; a presenting problem is viewed as a symptom of and a response to current dysfunction in family interactions. Therapy focuses on problem resolution by altering the feedback cycle or loop that maintains the symptomatic behavior. The social worker's task is to formulate the problem in solvable, behavioral terms and to design an intervention plan to change the dysfunctional family pattern.

Maintenance

Maintaining a new behavior, avoiding temptation

Objects relation theory

Object relations theory, which was a focus of Margaret Mahler's work, is centered on relationships with others. According to this theory, lifelong relationship skills are strongly rooted in early attachments with parents, especially mothers. Objects refer to people, parts of people, or physical items that symbolically represent either a person or part of a person. Object relations, then, are relationships to those people or items. Age Phase Subphase Characteristics 0-1 month Normal autism First few weeks of life. The infant is detached and self-absorbed. Spends most of his or her time sleeping. Mahler later abandoned this phase, based on new findings from her infant research. 0-5 months Normal symbiotic The child is now aware of his or her mother, but there is not a sense of individuality. The infant and the mother are one, and there is a barrier between them and the rest of the world. 5-9 months Separation/Individuation Differentiation/Hatching The infant ceases to be ignorant of the differentiation between him or her and the mother. Increased alertness and interest for the outside world. Using the mother as a point of orientation. 9-15 months Practicing Brought about by the infant's ability to crawl and then walk freely; the infant begins to explore actively and becomes more distant from the mother. The child experiences himself or herself as one with his or her mother. 15-24 months Rapprochement The infant once again becomes close to the mother. The child realizes that his or her physical mobility demonstrates psychic separateness from his or her mother. The toddler may become tentative, wanting the mother to be in sight so that, through eye contact and action, he or she can explore his or her world. The risk is that the mother will misread this need and respond with impatience or unavailability. This can lead to an anxious fear of abandonment in the toddler. 24-38 months Object Constancy Describes the phase when the child understands that the mother has a separate identity and is truly a separate individual. Provides the child with an image that helps supply him or her with an unconscious level of guiding support and comfort. Deficiencies in positive internalization could possibly lead to a sense of insecurity and low selfesteem issues in adulthood.

Psychoeducation methods

One of the ways that social workers provide information to clients is through psychoeducation. This model allows a social worker to provide clients with information necessary to make informed decisions that will allow them to reach their respective goals. In addition to focusing on clients' education, it also provides support and coping skills development. Psychoeducation is delivered in many service settings and with many types of client populations. It is provided to those who are experiencing some sort of issue or problem with the rationale that, with a clear understanding of the problem, as well as self-knowledge of strengths, community resources, and coping skills, clients are better equipped to deal with problems and to contribute to their emotional well-being. The core psychoeducational principle is that education has a role in emotional and behavioral change. With an improved understanding of the causes and effects of problems, psychoeducation broadens clients' perception and interpretation of them, positively influencing clients' emotions and behavior. In other words, clients feel less helpless about the situation and more in control of themselves.

psychoanalytic theory

Originally developed by Sigmund Freud, a client is seen as the product of his past and treatment involves dealing with the repressed material in the unconscious. According to psychoanalytic theory, personalities arise because of attempts to resolve conflicts between unconscious sexual and aggressive impulses and societal demands to restrain these impulses. Freud believed that behavior and personality derive from the constant and unique interaction of conflicting psychological forces that operate at three different levels of awareness: the preconscious, the conscious, and the unconscious. The conscious contains all the information that a client is paying attention to at any given time. The preconscious contains all the information outside of a client's attention but readily available if needed—thoughts and feelings that can be brought into consciousness easily. The unconscious contains thoughts, feelings, desires, and memories of which clients have no awareness but that influence every aspect of their day-to-day lives. Freud proposed that personalities have three components: the id, the ego, and the superego. Id: A reservoir of instinctual energy that contains biological urges such as impulses toward survival, sex, and aggression. The id is unconscious and operates according to the pleasure principle, the drive to achieve pleasure and avoid pain. Ego: The component that manages the conflict between the id and the constraints of the real world. Some parts of the ego are unconscious, whereas others are preconscious or conscious. The ego operates according to the reality principle—the awareness that gratification of impulses has to be delayed in order to accommodate the demands of the real world. The ego's role is to prevent the id from gratifying its impulses in socially inappropriate ways. Ego-Syntonic/Ego-Dystonic: Syntonic = behaviors "insync" with the ego (no guilt) Dystonic = behavior "dis-n-sync" with the ego (guilt) The ego's job is to determine the best course of action based on information from the id, reality, and the superego. When the ego is comfortable with its conclusions and behaviors, a client is said to be ego-syntonic. However, if a client is bothered by some of his or her behaviors, he or she would be egodystonic (ego alien). Inability of the ego to reconcile the demands of the id, the superego, and reality produces conflict that leads to a state of psychic distress known as anxiety. Ego strength is the ability of the ego to effectively deal with the demands of the id, the superego, and reality. Those with little ego strength may feel torn between these competing demands, whereas those with too much ego strength can become too unyielding and rigid. Ego strength helps maintain emotional stability and cope with internal and external stress. Superego: The moral component of personality. It contains all the moral standards learned from parents and society. The superego forces the ego to conform not only to reality, but also to its ideals of morality. Hence, the superego causes clients to feel guilty when they go against society's rules.

permanency planning

Permanency planning is an approach to child welfare that is based on the belief that children need permanence to thrive. Child protection services should focus on getting children into, and maintaining, permanent homes. In permanency planning, the first goal is to get children back into their original homes. This can be achieved with a thorough investigation into child protection situations to determine if homes are safe and, if needed, exploring ideas for making them safer or more enriching for children. Supports can include getting caregivers services for meeting needs or providing education, if needed, to ensure adequate and quality care. If children cannot return to their original homes, steps need to be made so that they can get into permanent living situations as quickly as possible with adults with whom they have continuous and reciprocal relationships, including those made available through adoption. Family preservation helps keep families together and children out of foster care or other out-of-home placements. Efforts focus on family reunification or adoption if children are removed from homes. Plans for children involved in protection services must be reviewed regularly and "reasonable efforts" must be made to keep families together via prevention and family reunification services. There are often financial subsidies to assist with facilitating the adoption of children with complex needs or disabilities.

Concepts and techniques in strategic family therapy

Pretend technique—encourage family members to "pretend" and encourage voluntary control of behavior First-order changes—superficial behavioral changes within a system that do not change the structure of the system Second-order changes—changes to the systematic interaction pattern so the system is reorganized and functions more effectively Family homeostasis—families tend to preserve familiar organization and communication patterns; resistant to change Relabeling—changing the label attached to a person or problem from negative to positive so the situation can be perceived differently; it is hoped that new responses will evolve Paradoxical directive or instruction—prescribe the symptomatic behavior so a client realizes he or she can control it; uses the strength of the resistance to change in order to move a client toward goals

Healthy family roles

Provision of Resources The provision of resources is an instrumental role that fulfills the most basic needs of the family unit: having money, food, clothing, and shelter. Emotional Support Supporting other family members is primarily an affective role and includes providing comfort and support. Life Skills Development One of the functions of families is the physical, emotional, educational, and social development of children. This role ensures that life skills development of members occurs. Family System Management Decision making, handling finances, and maintaining appropriate boundaries and behavioral standards are critical to maintaining a healthy family dynamic. Intimate Relationship Maintenance Intimate relationships, including sexual ones, are critical between partners and couples. Ensuring that quality intimate relationships are maintained is essential to meeting the emotional needs of partners and spouses. In dysfunctional families, such as those with members who have substance use problems, members may assume codependent roles, including functioning as the Family Hero, the Scapegoat, the Mascot, and/or the Lost Child. The Family Hero, often the oldest child, devotes his or her time and attention to minimizing or masking problems. By overachieving and being successful in school or work, the Family Hero tries to make up for a dysfunctional home life. The Scapegoat is defiant, hostile, and angry, and gets in trouble at school or work. His or her behavior turns the focus away from dysfunction in the family. The Mascot tries to get people to laugh as a way of improving the atmosphere and drawing attention away from the dysfunctional household. The Lost Child becomes a loner or is very shy. He or she draws away from interactions with family members and becomes invisible in order to avoid adding to the dysfunction or stain. The following are some types of family therapy.

psychodynamic therapies overview

Psychodynamic theories explain the origin of the personality. Although many different psychodynamic theories exist, they all emphasize unconscious motives and desires, as well as the importance of childhood experiences in shaping personality. Psychodynamic approaches aim to help clients review emotions, thoughts, early life experiences, and beliefs in order to gain insight into their lives and their present-day problems. Recognizing recurring patterns helps clients see the ways in which they avoid distress and/or develop defense mechanisms as methods of coping so that they can take steps to change these patterns. In order to keep painful feelings, memories, and experiences in the unconscious, clients tend to develop defense mechanisms, such as denial, repression, rationalization, and others. Social workers using psychodynamic approaches encourage clients to speak freely about their emotions, desires, and fears in order to reveal vulnerable feelings that have been pushed out of conscious awareness. According to psychodynamic theory, behavior is influenced by unconscious thought; vulnerable or painful feelings are resolved by the use of defense mechanisms. The therapeutic relationship is central to psychodynamic approaches because it takes an intimate look at interpersonal relationships so that clients can see relationship patterns. It also empowers clients, through insight and self-awareness, to transform dysfunctional dynamics.

Psychotherapies

Psychotherapy aims to treat clients with mental disorders or problems by helping them understand their illness or situation. Social workers use verbal techniques to teach clients strategies to deal with stress, unhealthy thoughts, and dysfunctional behaviors. Psychotherapy helps clients manage their symptoms better and function optimally in everyday life. Sometimes, psychotherapy alone may be the best treatment for a client, depending on the illness and its severity. Other times, psychotherapy is combined with the use of medication or a psychopharmacological approach. There are many kinds of psychotherapy, so social workers must determine which is best to meet a client's need. A social worker should not use a "one size fits all approach" or a particular type of psychotherapy because it is more familiar or convenient. Some psychotherapies have been scientifically tested more than others for particular disorders. For example, cognitive behavioral therapy (CBT), a blend of cognitive and behavioral therapy, is used for depression, anxiety, and other disorders. Dialectical behavior therapy (DBT), a form of CBT developed by Marsha Linehan, was developed to treat people with suicidal thoughts and actions. It is now also used to treat people with Borderline Personality Disorder. A social worker assures a client that his or her feelings are valid and understandable, but coaches him or her to understand that they are unhealthy or disruptive and a balance must be achieved. A client understands that it is his or her personal responsibility to change the situation. Some psychotherapies are effective with children and adolescents and can also be used with families.

Indicators for clients readiness for termination

Readiness for termination may be marked when meetings between a social worker and client seem uneventful and the tone becomes one closer to cordiality rather than challenge, as well as when no new ground has been discovered for several sessions in a row. In termination, a social worker and client (a) evaluate the degree to which a client's goals have been attained, (b) acknowledge and address issues related to the ending of the relationship, and (c) plan for subsequent steps a client may take relevant to the problem that do not involve a social worker (such as seeking out new services, if necessary). The process of evaluation helps a client determine if his or her goals have been met and if the helping relationship was beneficial. As a result of the evaluation process, a social worker can become a more effective practitioner and provide better services. There must always be a method to evaluate the effectiveness of the services received. Evaluation measures, when compared with those taken at baseline, assist in determining the extent of progress and a client's readiness for termination. A social worker helps a client cope with the feelings associated with termination. This process may help a client cope with future terminations. By identifying the changes accomplished and planning how a client is going to cope with challenges in the future, a social worker helps a client maintain these changes.

Cognitive Techniques for anger management

Replacing destructive thoughts, such as "This is the end of the world" with healthy ones like "This is frustrating, but it will pass" Focusing on goals as a way of finding solutions to problems Using logic to get a more balanced perspective Not using an "all or nothing" approach Putting situations into perspective

Role modeling techniques

Role modeling emphasizes the importance of learning from observing and imitating and has been used successfully in helping clients acquire new skills, including those associated with assertiveness. Role modeling works well when it is combined with role play and reinforcement to produce lasting change. There are different types of modeling, including live modeling, symbolic modeling, participant modeling, or covert modeling. Models in any of these forms may be presented as either a coping or a mastery model. The coping model is shown as initially fearful or incompetent, and then is shown as gradually becoming comfortable and competent performing the feared behavior. The mastery model shows no fear and is competent from the beginning of the demonstration.

Techniques of role-playing

Role playing is a teaching strategy that offers several advantages. Role playing in social work practice may be seen between supervisor and supervisee or social worker and client. In all instances, role playing usually raises interest in a topic as clients are not passive recipients in the learning process. In addition, role playing teaches empathy and understanding of different perspectives as clients take on the role of another, learning and acting as that individual would in the specified setting. In role playing, participation helps embed concepts. Role playing gives clarity to information that may be abstract or difficult to understand. The use of role playing emphasizes personal concerns, problems, behavior, and active participation. It improves interpersonal and communication skills, and enhances communication. Role playing activities can be divided into four stages: Preparation and explanation of the activity Preparation of the activity Role playing Discussion or debriefing after the role play activity

family member roles overview

Roles are extremely important in family functioning, with the establishment of clear roles directly connected to family well-being and the ability to handle crises. Family members have both instrumental and affective functions that are essential for positive well-being. Instrumental functions are concerned with the provision of physical resources (i.e., food, clothing, and shelter) and decision making. Affective functions involve the provision of emotional support to family members. In order for families to maintain emotional and physical health, family members must fulfill essential roles. Sometimes these roles are assumed by multiple family members; in other instances, separate family members may meet each of these needs. Often individuals have multiple roles within family units.

Secondary Prevention

Secondary prevention occurs after a disease, injury, or illness has occurred. It aims to slow the progression or limit the long-term impacts. It is often implemented when asymptomatic, but risk factors are present. Secondary prevention also may focus on preventing reinjury. Examples: Telling those with heart conditions to take daily, low-dose aspirin Screenings for those with risk factors for illness Modifying work assignments for injured workers

Communication Skills for anger management

Slowing down speech to avoid saying something not meant or that one will regret Listening to what others are saying Thinking about what to say before speaking Avoiding defensiveness Using humor to lighten the situation

Methods to teach coping and other self-care skills

Social workers assist clients in realizing how their lives can improve and/or how they can learn from mistakes that they have made. The techniques that social workers employ are a form of informal or didactic teaching. For example, social workers may help clients see: How their histories have shaped them Needs associated with medical and/or behavioral health conditions Developmental issues related to various phases across the lifespan The workings of systems in which they operate Ways of coping in various situations A social worker must use the problem-solving process to teach clients skills needed to make changes in their lives. In addition, social workers may collaborate with or inform clients of colleagues who may also assist with more formal teaching, such as learning to read, obtaining a driver's license, and so on.

Mindfulness and complementary therapeutic approaches

Social workers continue to provide the bulk of mental health services. A significant number of persons seek services expecting providers to be aware and knowledgeable about alternatives and complements to Western medical approaches for symptom relief and healing when their medical or behavioral health is disrupted and/or compromised. An ever increasing number of people are seeking complementary and alternative medicine (CAM) or integrated health care (IHC) to address health/behavioral health issues. Not only are clients receptive to the use of complementary approaches, they often request diverse approaches that go beyond medications and psychotherapy to address their overall concerns. Thus, social workers must have knowledge of mindfulness and complementary therapeutic approaches. Interventions and remedies that some cultures and populations consider conventional, others view as alternative, and what some clients assess as successful outcomes, some professionals may not concur. Mindfulness is the practice of paying close attention to what is being experienced in the present, both inside the body and mind and in the external world. It is a conscious effort to be with whatever is going on right now, without judging or criticizing what we find. In each moment, mindfulness invites being awake, aware, and accepting of ourselves. The practice of mindfulness is integral to efforts to reduce stress and to increase capacity to cope. Mindfulness can stand alone as a treatment tool or may be incorporated with other treatment modalities. Most settings where social workers practice would be conducive to mindfulness practice. Social workers and other health/behavioral health providers are increasingly including the practice of mindfulness as a useful tool, not only in building a self-care routine, but also in addressing the needs of their clients. The multitude of complementary approaches to maintaining health are vast and it is unrealistic for social workers to be informed and knowledgeable about all of them, but it is expected that social workers will be aware of the predominant practices and methods being used among the populations they are serving. Just as important, social workers need to be instilled with a respect for clients' authority in determining the best method to treat their problems when there are no indications of harm to self and/or others. Knowing how to integrate empirically tested and validated medical interventions, along with indigenous approaches preserved for generations, is essential to ensuring culturally competent, holistic treatment.

Management of conflict entails four steps:

The recognition of an existing or potential conflict An assessment of the conflict situation The selection of an appropriate strategy Intervention

Methods to engage and work with involuntary clients

Social workers often find themselves providing services to those who did not choose to receive them, but instead have to do so as mandated by law, including families in the child protection system, people in the criminal justice system, and so on. Working with involuntary clients can be challenging because they may want to have no contact or may only participate because they feel that they have no other choice. Often these situations require social workers to receive peer support or supervision to process struggles encountered, as well as reassert their professionalism, because clients may try to test and exhibit anger at social workers, who represent the mandates placed upon them. Some methods that can be helpful in working with involuntary clients include: Acknowledging clients' circumstances and understanding how they came about given clients' histories Listening to clients' experiences in order to try to understand how they feel about intervention Engaging in clear communication because involuntary clients struggle to understand what is happening to them Making clear what the purpose of the intervention is, what clients have control over and what they do not, what is going to happen next, and what the likely consequences will be if they do not participate Assisting at an appropriate pace as progress may be slow Building trust, even on the smallest scale, by consistently being honest and up-front about the situation and why a social worker is involved Giving clients practical assistance when needed to help them fight for their rights Paying attention to what is positive in clients' behavior and celebrating achievements Showing empathy and viewing clients as more than the problems that brought them into services

Methods to create implement and evaluate policies and procedures that minimize risk

Social workers should create, implement, and evaluate policies that minimize risk for clients, workers, and practice settings. One critical feature of implementing a comprehensive risk management strategy is conducting a comprehensive ethics audit. An ethics audit entails examining risks through the following steps: Appointing a committee or task force of concerned and informed staff and colleagues Gathering information from agency documents, interviews with staff and clients, accreditation reports, and other sources to assess risks associated with client rights; confidentiality and privacy; informed consent; service delivery; boundary issues; conflicts of interest; documentation; client records; supervision; staff development and training; consultation; client referral; fraud; termination of services; professional impairment; misconduct, or incompetence; and so on Reviewing all collected information Determining whether there is no risk, minimal risk, moderate risk, or high risk in each area Preparing action plans to address each risk, paying particular attention to policies that need to be created to prevent risk in the future and steps needed to mitigate existing risk Monitoring policy implementation and progress made toward reducing existing risk, as well as ensuring that procedures adhere to social work's core ethical principles Risk management is an ongoing process and must consist of preventive strategies as well as corrective actions that result from audits done routinely or in response to particular concerns or complaints.

Mezzo or Meso Level

The second level of intervention for social workers is mezzo (also known as meso). Mezzo interventions apply to larger groups or communities. At the mezzo intervention level, social workers attempt to make connections between the micro and macro levels.

Stress management

Stress is a psychological and/or physical reaction to life events, with most people experiencing it regularly in their own lives. When a life event is seen as a threat, it signals the release of hormones aimed at generating a response. This process has been labeled the "fight-or-flight" response. Once the threat is gone, clients should return to typical relaxed states, but this may not happen if other threats are presented immediately thereafter. Thus, stress management is important because it provides tools to deal with threats and minimize the impacts of psychological and/or physical reactions. The first step in stress management is for clients to monitor their stress levels and identify their stress triggers. These can be major life events, but also those associated with day-to-day life, such as job pressures, relationship problems, or financial difficulties. Positive life events, such as getting a job promotion, getting married, or having children, also can be stressful. The second step in stress management is to assist clients in identifying what aspects of a situation they can control. Clients can make these changes, as well as benefit from stress-reduction techniques, such as deep breathing, exercise, massage, tai chi, or yoga, to manage those aspects of a situation that cannot be altered. Maintaining a healthy lifestyle is essential to helping manage stress. Stress will always be a part of life, but assisting clients to manage it can increase their ability to cope with challenges and enhance their psychological and/or physical well-being.

Action

Taking direct action toward achieving a goal

Primary Prevention

The goal is to protect people from developing a disease, experiencing an injury, or engaging in a behavior in the first place. Examples: Immunizations against disease Education promoting the use of automobile passenger restraints and bicycle helmets Screenings for the general public to identify risk factors for illness Controlling hazards in the workplace and home Regular exercise and good nutrition Counseling about the dangers of tobacco and other drugs Since successful primary prevention helps avoid the disease, injury, or behavior and its associated suffering, cost, and burden, it is typically considered the most cost-effective

Short term interventions

The growing need for time-limited treatment, fueled by the widening influence of managed care in the behavioral health field, has produced a renewed focus on short-term therapy. Short-term interventions vary greatly in their duration. Research has suggested that a social worker's and client's views on the time of treatment are more important than the duration of treatment itself. Sometimes these approaches are used because of organizational or financial constraints. In other instances, clients are choosing them over open-ended approaches. Although some have been wary of the effectiveness of these techniques to instill long-lasting change, they are being used more broadly than ever before. Some short-term interventions include a crisis intervention model and a cognitive behavioral model. Although psychoanalysis is often thought of as long term, this was not the case with Freud's early work, and psychoanalysis did not start out this way. A number of short-term psychodynamic approaches focus on the belief that childhood experiences are the root of adult dysfunction.

Self psychology

This approach defines the self as the central organizing and motivating force in personality. As a result of receiving empathic responses from early caretakers (self-objects), a child's needs are met and the child develops a strong sense of selfhood. "Empathic failures" by caretakers result in a lack of self-cohesion. The objective of self psychology is to help a client develop a greater sense of self-cohesion. Through therapeutic regression, a client reexperiences frustrated self-object needs. Three self-object needs are: Mirroring: behavior validates the child's sense of a perfect self Idealization: child borrows strength from others and identifies with someone more capable Twinship/Twinning: child needs an alter ego for a sense of belonging

Impacts of out of home placement

The homes in which clients live are part of their self-definition. They are decorated to reflect likes or dislikes, telling others about their occupants and accommodating interests such as gardening, cooking, and others. Homes are seen as extensions of their residents and distinguish people from each other. Behavior is also cued by the physical environment. Homes remind inhabitants of experiences which took place in the past, as well as what to do in the future. Homes are familiar and are often viewed as safe havens where clients can behave without being judged. Thus, involuntary displacement outside the home due to hospitalization, incarceration, needed safety, or long-term care needs can be traumatic for many reasons. First, such movement may be associated with losses such as those due to health issues, financial concerns, or safety problems. These losses alone can cause depression, anxiety, confusion, and/or other emotional reactions, which are compounded from having to move from the communities or homes in which clients live. In out-of-home placements, clients may have changes in roles, causing them to develop poor self-image. For example, the roles of neighbor, community leader, gardener, and so on, which provided fulfillment and recognition, may be lost and no longer possible. Since there is also status attached to these roles, their loss can negatively affect self-image. There also may be a loss of possessions associated with displacement. Precious items that represent a lifetime of memories may have been destroyed, such as by a natural disaster, or sold/given away as there may be no room to keep them in the new settings—especially if they are shared with others. There also may be a cost associated with involuntary displacement. For example, long-term care can drain client assets and make clients feel guilty about spending money on themselves or fearful about running out of funds for sustained care and housing. Out-of-home displacement also often accompanies loss of relationships. Relatives and friends who interfaced with clients in their homes may find it inconvenient or impossible to see them in the new settings. Sometimes the lack of private space in which to visit puts up barriers. Visitors may also be intimidated by the sights and sounds of hospitals, jails, or nursing homes. Clients frequently do not have the same freedom or control that they had when they were at home. In congregate settings, meals, activities, room cleaning, and bathing may be overseen and scheduled for the sake of organization and efficiency, and there are usually numerous rules, policies, and procedures to follow with less individual autonomy and choice.

Strength based empowerment

The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty (NASW Code of Ethics, 2018—Preamble). Empowerment aims to ensure a sense of control over well-being and that change is possible. A social worker can help to empower individuals, groups, communities, and institutions. On an individual level, social workers can engage in a process with a client aimed at strengthening his or her self-worth by making a change in life that is based on his or her desires (self-determination). To facilitate empowerment, a social worker should: Establish a relationship aimed at meeting a client's needs and wishes such as access to social services and benefits or to other sources of information Educate a client to improve his or her skills, thereby increasing the ability for self-help Help a client to secure resources, such as those from other organizations or agencies, as well as natural support networks, to meet needs Unite a client with others who are experiencing the same issues when needed to enable social and political action Social workers should also use an empowerment process with groups, communities, and institutions so they may gain or regain the capacity to meet human needs, enhance overall well-being and potential, and provide individuals control over their lives to the extent possible. A social worker needs many skills that focus on the activation of resources, the creation of alliances, and the expansion of opportunities in order to facilitate empowerment.

Techniques used for follow up

The standard of practice is that social workers must involve clients and their families (when appropriate) in making their own decisions about follow-up services or aftercare. Involvement must include, at a minimum, discussion of client and family preferences (when appropriate). Follow-up meetings are often important to ensure change maintenance. Many clients continue to progress after termination and follow-up meetings provide opportunities to acknowledge these gains and encourage continuation of such efforts. Follow-up meetings also provide valuable interactions which can mitigate any unanticipated difficulties. Follow-up meetings provide clients with reassurance that they are not alone as they implement what they have learned. They allow for longitudinal evaluation of practice effectiveness. It is important that social workers explain to clients that follow-up meetings may be important in the problem-solving process. Social workers must not be intrusive or send messages that clients cannot function on their own. Clients who have difficulty terminating may use follow-up meetings as ways to prolong social worker-client relationships beyond what is needed. Social workers must set clear boundaries and treat follow-up meetings with professionalism—having clearly stated goals for these sessions. Clients who tell social workers during follow-up about new problems that have arisen should be seen for assessment. Social workers who have already assisted clients resolve issues are often the first ones to which clients disclose new problems which have emerged.

macro level

The third level of intervention for social workers is macro. This level stresses the importance of economic, historical, sociopolitical, and environmental influences on client well-being and functioning. Social workers determine how these factors can facilitate growth and/or create problems for clients. Social workers are charged with making systems-level changes that can lead to opportunities and/or reduce barriers. Macro interventions can include creating or changing policies, procedures, regulations, and laws. They are aimed at not only assisting individual clients, but others who are experiencing the same difficulties. The focus of social work to engage in broader macro-level changes is what distinguishes it from other allied professions.

Couples interventions in treatment approaches

There are often reasons that couples experience problems including, but not limited to: Retriggering emotional trauma and not repairing it An inability to bond or reconnect after hurting or doing damage to one another Lack of skills or knowledge Many treatment techniques are used with individuals that can be adapted in work with couples, including: Behavior modification—Successful couples counseling methods will address and attempt to modify any dysfunctional behavior so that couples can change the way each individual behaves with the other. Insight-oriented psychotherapy—A good deal of time is spent studying interactions between individuals in order to develop a hypothesis concerning what caused individuals to react to each other in the way they do. There are also specific couples therapy approaches, including the Gottman Method, which is based on the notion that healthy relationships are ones in which individuals know each other's stresses and worries, share fondness and admiration, maintain a sense of positiveness, manage conflicts, trust one another, and are committed to one another. The Gottman Method focuses on conflicting verbal communication in order to increase intimacy, respect, and affection; removes barriers that create a feeling of stagnancy in conflicting situations; and creates a heightened sense of empathy and understanding within relationships. With all approaches, there are actions that a social worker can take to facilitate effective couples' treatment. For example, when developing a collaborative alliance with each person, a social worker should validate the experience of each and explore each person's reservations about engaging in couples therapy. In addition, when developing an alliance with the couple as a unit, a social worker can reframe individual problems in relationship terms and support each person's sense of himself or herself as being part of a unit, as well as a separate individual.

Structural family therapy

This approach stresses the importance of family organization for the functioning of the group and the well-being of its members. A social worker "joins" (engages) the family in an effort to restructure it. Family structure is defined as the invisible set of functional demands organizing interaction among family members. Boundaries and rules determining who does what, where, and when are crucial in three ways. Interpersonal boundaries define individual family members and promote their differentiation and autonomous, yet interdependent, functioning. Dysfunctional families tend to be characterized by either a pattern of rigid enmeshment or disengagement. Boundaries with the outside world define the family unit, but boundaries must be permeable enough to maintain a well-functioning open system, allowing contact and reciprocal exchanges with the social world. Hierarchical organization in families of all cultures is maintained by generational boundaries, the rules differentiating parent and child roles, rights, and obligations. Restructuring is based on observing and manipulating interactions within therapy sessions, often by enactments of situations as a way to understand and diagnose the structure and provide an opportunity for restructuring.

Time management approaches

Time management is planning and consciously controlling the amount of time spent on specific activities, especially to increase effectiveness, efficiency, or productivity. Though time management initially focused on business or work activities, it is now increasingly used to control personal activities as well. Most time management approaches focus on creating conducive or effective environments, modifying behaviors, setting priorities, and/or reducing time spent on nonpriorities. The approaches to time management have evolved. Initially, approaches consisted of checklists and notes to recognize the demands on time. These then evolved into calendars and appointment books that focused on looking ahead to anticipate future events. The third approach, often used today, examines efficiency with the focus on prioritizing, planning, controlling, and taking steps toward a goal. The last approach requires the categorization of daily activities by importance and urgency. Those activities that are urgent and important can be stressful and require immediate action; those who deal with these exclusively will think they are just "putting out fires." Activities that are not urgent or important require little or no attention, and time spent on these activities will result in feelings of disengagement. Activities that are urgent but not important often take up a lot of attention but tend to yield little difference or progress. The last grouping—those things that are important but not urgent—are likely to be put aside yet are critical to personal fulfillment. Time management should include minimizing time spent on activities that are not important and ensuring those that are not urgent but are important, such as building relationships, recreation and leisure, and so on, are also prioritized.

participant modeling

an individual models anxiety-evoking behaviors for a client and then prompts the client to engage in the behavior.

Bowenian Family Therapy

Unlike other models of family therapy, the goal of this approach is not symptom reduction. Rather, a Bowenian-trained social worker is interested in improving the intergenerational transmission process. Thus, the focus within this approach is consistent whether a social worker is working with an individual, a couple, or the entire family. It is assumed that improvement in overall functioning will ultimately reduce a family member's symptomatology. Eight major theoretical constructs are essential to understanding Bowen's approach. These concepts are differentiation, emotional fusion, multigenerational transmission, emotional triangle, nuclear family, family projection process, sibling position, and societal regression. These constructs are interconnected. Differentiation is the core concept of this approach. The more differentiated, the more a client can be an individual while in emotional contact with the family. This allows a client to think through a situation without being drawn to act by either internal or external emotional pressures. Emotional fusion is the counterpart of differentiation and refers to the tendency for family members to share an emotional response. This is the result of poor interpersonal boundaries between family members. In a fused family, there is little room for emotional autonomy. If a member makes a move toward autonomy, it is experienced as abandonment by other members of the family. Multigenerational transmission stresses the connection of current generations to past generations as a natural process. Multigenerational transmission gives the present a context in history. This context can focus a social worker on the differentiation in the system and on the transmission process. An emotional triangle is the network of relationships among three people. Bowen's theory states that a relationship can remain stable until anxiety is introduced. However, when anxiety is introduced into the dyad, a third party is recruited into a triangle to reduce the overall anxiety. It is almost impossible for two people to interact without triangulation. The nuclear family is the most basic unit in society and there is a concern over the degree to which emotional fusion can occur in a family system. Clients forming relationships outside of the nuclear family tend to pick mates with the same level of differentiation. Family projection process describes the primary way parents transmit their emotional problems to children. The projection process can impair child functioning and increase vulnerability to clinical symptoms. Sibling position is a factor in determining personality. Where a client is in birth order has an influence on how he or she relates to parents and siblings. Birth order determines the triangles that clients grow up in. Societal regression, in contrast to progression, is manifested by problems such as the depletion of natural resources. Bowen's theory can be used to explain societal anxieties and social problems, because Bowen viewed society as a family—an emotional system complete with its own multigenerational transmission, chronic anxiety, emotional triangles, cutoffs, projection processes, and fusion/differentiation struggles.

Environmental Change for anger management

Walking away or leaving situation Avoiding people or situations in the future that evoke anger Not starting conversations or entering situations that may cause anger when tired or rushed

Step 1: Engagement with client, group, or community In engagement

a social worker should be actively involved in determining why change is sought, what has precipitated the desire to change now, and the parameters of the helping relationship, including defining the roles of a social worker and the expectations for treatment (what will occur and when it will happen).

Methods to develop and evaluate Measurable objectives for clients

When social workers are creating intervention or service plans, it is essential that goals are written in observable and measurable terms. In order to achieve this aim, the following should be included in each goal contained in the intervention or service plan. Criteria: What behavior must be exhibited, how often, over what period of time, and under what conditions to demonstrate achievement of the goal? Method for evaluation: How will progress be measured? Schedule for evaluation: When, how often, and on what dates or intervals of time will progress be measured? There may also be benchmarks or the intermediate knowledge, skills, and/or behaviors that must be learned/achieved in order for a client to reach his or her ultimate goal. Objectives break down the goals into discrete components or subparts, which are steps toward the final desired outcome.

Working with families

Working with families has always been central to social work practice. Family interventions require treating not just an individual but all those within a family unit, with the focus of assessment and intervention directed at the interaction of family members. In order to work effectively with families, social workers must: Understand the development of, as well as the historical, conceptual, and contextual issues influencing, family functioning Have awareness of the impact of diversity in working with families, particularly race, class, culture, ethnicity, gender, sexual preference, aging, and disabilities Understand the impact of a social worker's family of origin, current family structure, and its influence on a social worker's interventions with families Be aware of the needs of families experiencing unique family problems (domestic violence, blended families, trauma and loss, adoptive families, etc.) Social workers use a variety of techniques to work with families. Family therapy treats the family as a unified whole—a system of interacting parts in which change in any part affects the functioning of the overall system. The family is the unit of attention for diagnosis and treatment. Social roles and interpersonal interaction are the focus of treatment. Real behaviors and communication that affect current life situations are addressed. The goal is to interrupt the circular pattern of pathological communication and behaviors and replace it with a new pattern that will sustain itself without the dysfunctional aspects of the original pattern. Key clinical issues include: Establishing a contract with the family Examining alliances within the family Identifying where power resides Determining the relationship of each family member to the problem Seeing how the family relates to the outside world Assessing influence of family history on current family interactions Ascertaining communication patterns Identifying family rules that regulate patterns of interaction Determining meaning of presenting symptom in maintaining family homeostasis Examining flexibility of structure and accessibility of alternative action patterns Finding out about sources of external stress and support

Step 3: Planning or design of intervention In planning

an understanding of the problem is developed. Goals are developed from this understanding in order to provide a direction to help or assist. Specific action plans are developed and agreed upon in order to specify who will do what, what resources will be needed and how they will be used, and timelines for implementation and review.

Confrontation

calling attention to something

covert modeling

clients are asked to use their imagination, visualizing a particular behavior as another describes the imaginary situation in detail.

Step 2: Assessment of strengths and needs In assessment

essential information is collected upon which to define the problem and solutions, as well as identify collateral contacts from which gaps in data can be collected.

tertiary prevention

focuses on managing complicated, long-term diseases, injuries, or illnesses. The goal is to prevent further deterioration and maximize quality of life because disease is now established and primary prevention activities have been unsuccessful. However, early detection through secondary prevention may have minimized the impact of the disease. Examples: Pain management groups Rehabilitation programs Support groups

Summarization

identifying key ideas and themes regarding client problems to provide focus and continuity to an interview

Symbolic modeling

includes filmed or videotaped models demonstrating the desired behavior. Self-modeling is another form of symbolic modeling in which clients are videotaped performing the target behavior.

Social planning

is defined as the process by which a group or community decides its goals and strategies relating to societal issues. It is not an activity limited to government, but includes activities of the private sector, social movements, professions, and other organizations focused specifically on social objectives. Models of social planning in social work practice include those that are based on community participation. Rather than planning "for" communities, social workers as planners engage "with" community members. Social planning does not merely examine sociological problems that exist, but also includes the physical and economic factors that relate to societal issues. All issues confronting those who are served by social workers are really human or social issues. Social workers can help facilitate the process of planning through all stages: organizing community members; data gathering related to the issue—including identifying economic, political, and social causes; problem identification; weighing of alternatives; policy/program implementation; and evaluation of effectiveness.

Community organizing

is focused on harnessing the collective power of communities to tackle issues of shared concern. It challenges government, corporations, and other power-holding institutions in an effort to tip the power balance more in favor of communities. It is essential for social workers to understand sources of power in order to access them for the betterment of the community. Organizing members to focus these sources of power on the problem(s) and mobilizing resources to assist is critical. Community organization enhances participatory skills of local citizens by working with and not for them, thus developing leadership with particular emphasis on the ability to conceptualize and act on problems. It strengthens communities so they can better deal with future problems; community members can develop the capacity to resolve problems.

Interpretation

pulling together patterns of behavior to get a new understanding

Live modeling

refers to watching a real person perform the desired behavior.

Clarification

reformulate problem in a client's words to make sure that the social worker is on the same wavelength

Reframing and relabeling

stating problem in a different way so a client can see possible solutions

Step 5: Evaluation of efforts In evaluation

subjective reports, in conjunction with objective indicators of progress, should be used to determine when goals and objectives have been met and whether new goals or objectives should be set.

Universalization

the generalization or normalization of behavior

Step 4: Intervention aimed at making change In intervention

there is active involvement to realize continued progress and sustainable change. Issues that may threaten goal attainment must be addressed. Progress must be tracked and plans and timelines adjusted accordingly.