Clinical Practice 1

Secure Attachment

Describes infants whoa re comfortable relating to others, especially primary caretakers. Infants enjoy and thrive on interactions with others.

Interventions in EBPSW

- Activities aimed at solving specific problems, enhancing the client's psychological and behavioral capacity and modifying social-environmental contingencies to improve the client's psychological well-being

Client Focused Conceptulaization

- Derived primarily from the client's experience, needs, and expectations - This approach "constructs" a theory that fits the client or client system -This approach is compatible with social constructivists models such as Narrative approach -Client's develop their own conceptualization

Cognitive Targets of Assessment

- Formulate the case and create an initial cognitive conceptualization of the problem and client - Determine whether you will be an appropriate provider of services - Determine whether you can provide the appropriate "dose" of therapy - Determine whether adjunctive treatment or services may be indicated - Initiate therapeutic alliance with client - Begin to socialize the client into the structure and process of therapy - Identify important problems and set broad goals.

Evidence Based Practice

- Modeled after Evidence-based medicine - Focuses on using intervention approaches with demonstrated effectiveness for a client's particular presenting problem or condition in collaboration with the client - Linked to social work values, recognizing the ethical imperative to offer clients the best treatments proven to be effective

Process Dimension

- Must make perceptual shift away from the overt content and track the relational process of how two people are interacting well - Talk more directly with the client about their current interaction or interpersonal process and what may be going on between them at the moment

Theory Focused Case Conceptualizations

- Offer theoretical explanation for symptoms - Clinician's theoretical orientation serves as the basis for treatment goal setting and implementations. - "fitting" a specific theory to a client or client system -Answers the "why" by conceptualizing certain behaviors through the "prism" of a particular frame work - Limitation is primarily that the therapist centered and may not sufficiently reflect the client's own conceptualization

Pattern Analysis

- Premise is that specificity in understanding the What and Why of the client's or client's-system's situations which is essential in answering the How question -It is a process of examining the interrelationship among four factors: Precipitating factors, Perpetuating factors, and Presentation factors, and including Response factors.

Self Constancy

- The child is able to internalize a mental and emotional representation of the self. - This emotional ability develops through consistent, reliable, and positive interactions with primary caretakers and other key figures in the life of the child. - Under stress a child with self-constancy is able to retrieve positive self soothing images of the self.

Symptom Focused Case Conceptualization

-Medical and Behavioral Models - Favored by managed care -Emphasizes measurable objectives - The "What" and "How" are priority - Engender accountability and positive treatment outcomes

Assessment of Suicide Risk Factors

1.) It is unique to each person and includes biological, environmental, psychological, and cognitive factors as well as distal (ongoing) or proximal (acute). 2.) It is complex and challenging: passive vs. active 3.) It is an ongoing process. 4.) Errs on the side of caution due to: risk of false positive or a false negative 5.) It is collaborative: use a team approach whenever possible - Collaboration: including others - Corroboration: clarify risk w/ family or friends - Consultation: enhances both therapeutic core and legal protection 6.) Relies on Clinical Judgement 7.) Take all threats, risks factors, and warning signs seriously 8.) Ask the tough Questions 9.) The assessment is treatment 10.) Try to uncover the underlying message - Communication: may be a way for them to express their pain - Control: could be used as a method to control ones fate or the actions of others - Avoidance: believe it is the only solution when feeling overwhelmed or anticipate pain 11.) Done in a cultural context 12.) It is Documented!

Value

Service: Social worker's primary responsibility is to promote the well-being of clients

Prochaska's Transtheoretical Model of Assessment

Assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance

Anxious Attachment

Behave in ways that signal strong discomfort int heir interaction, and they are not easily soothed by their caretaker.

Attachment Theory

Bowlby 1969 - All human beings need a strong emotional bond with primary caretakers to establish a healthy emotional health - human beings learn how to regulate their emotions through this process - impacts capacity to form therapeutic relationship

ORT Therapeutic Alliance

Can help by providing a secure, consistent, and positive holding environment for a client with poor self or object constancy internalization.

Components of Case Conceptualization

Diagnostic formulation: a descriptive statement about the nature and severity of the individuals psychiatric presentation based on DSM Clinical Formulation: A description that attempts to offer a rationale for the development and maintenance of symptoms and dysfunctional life patterns. Treatment Formulation: Serves as the basis for developing a treatment intervention. Addresses the question, "how can it be changed?" by including goals, treatment plan, treatment interventions, and predictions about the course of treatment and it's potential outcomes

Object Constancy

Infant successfully established a mental representation of others that serve a self soothing function, allowing the child to feel safe when alone and able to self soothe.

Disorganized Attachment

Infants appear erratic and odd in their ability and interest in human interaction.

Avoidant Attachment

Infants do not appear interested in connecting with others, this type of behavior is usually connected to anxiety.

Object Relations Theory (ORT)

KLEIN 1964 Evolves from Psychoanalytic Ego and Psychology theory - the emotional self of a human being develops through the internalization of relational aspects with primary caretakers. Over time this internalization develops into relatively autonomous ability to self-soothe - The success of this internalizations in infancy dictates the ability of an adult to function autonomously and to manage the wide range of complex human emotions

Intersubjective Realm related to ORT (Transference/Counter Transference)

Klein: Projective Identification: an unconscious fantasy in which aspects of the self or an internal object are split off and attributed to an external object - It is a defense reaction through the relationship with the client both verbally and non verbally - only though understanding the unconscious meanings of this communication can the therapist be helpful to the client

Ethical Dilemma

Occur in situations where the SW must choose between two or more relevant but contradictory ethical directives, or when every alternative results in an undesirable outcome for one or more persons.

Readiness for Change Stages

Precontemplation (PC) Contemplation (C) Preparation (PR) Action (A) Maintenance (M)—in the adoption of healthy behaviors or cessation of unhealthy ones

Cognitive Behavioral Therapy

Primary focus is on the private, inner experience of the individual and that these are the core in the etiology, maintenance, and treatment of maladaptive behaviors. This interventions recognizes that thoughts, feelings, and behaviors all impact each other. Social Learning Theory with Classical Conditioning, Observational Learning and Operant Learning support this intervention.

Totalist View on Countertransference

Racker 1968 Argued there are personal influences (non-neurotic countertransference) which result from emotional conflicts -Concordant: emphatic feelings and responses toward clients - Complimentary: represents the compelling emotional reactions that result from the unconscious acceptance of the clients projective identification or therapist's negation of emotional representations from the past.

Model of Self and Other

Racker 1968: Clinicians must assess themselves to determine whether there are sources of emotional conflict stimulated by a client's material. Clinician must also understand client in regards to developmental history, emotional conflicts, attachment and object relations.

Corrective Emotional Experience

Real-life experience in the here-and-now relationship with the therapist.

Positionality

Refers to our location along the various axes of social group identities, which are interrelated, interconnected, and intersecting both our internal and external identities interact and influence each other and vary according to changing contexts and selectively carrying intrinsic privileges.

Multicultural Practice

Requires understanding of the value system of other cultures and how these values influence the behaviors of those with whom practitioners work. Understanding the worldview of the client - Native Oriented/Traditional-reflects patterns of culture rooted in past familiar and cultural experiences. -Bicultural/Multicultural- results from the client's experiences of two different ways of life-his or her own traditions versus that of the mainstream culture. -Acculturated/Assimilated-Refers to the acquisition of the beliefs, values and behaviors of a group that one is not a natural member. Assimilation is the end state of this process. -Transactional/Marginal-held by persons suspended between two cultures, their ethnic identity and mainstream culture- and who don't have a strong identification with either group.

Ethical Principle

Social worker's primary goal is to help people in need and to address social problems

Social Justice Frame

Social workers have an ethical responsibility to attend to the dynamics and consequences of oppression and to issues of social justice, given the close association between poverty, race, and ethnicity in the United States

Case Conceptualization/Pattern Analysis

Sperry 2005: Method and process of summarizing case information into a brief, coherent statement that indicates the client's pattern of behavior or problem -Clinician's theory of a particular case

Skills in EBPSW

Supportive and Facilitative Skills: - Listening and communication - Engendering Trust - Communicating empathy - Genuineness and positive regard - Enhancing client's confidence - Stimulating motivation to engage in the intervention Therapeutic Coping Skills: - Develop more effective ways of coping - Promoted and taught by practitioner - Usually combined with an overall strategy and implementation which is guided by outcome research and tailored to client's needs and expectations. Most are guided by social-cognitive theory. - Self Monitoring Skills - Psychoeducation - Stress Management Case Management Skills - Helps in assessment of social environmental factors that affect the client directly - Enhancing social supports which is associated with learning self-efficacy and social empowerment

Client Response Specificity

Therapists need to tailor their responses to fit the specific needs of each individual client

Cultural Sensitivity/Competence

Three primary components: 1.) therapists awareness of their own personal biases, assumptions, beliefs, (use a frame of intersectionality with regards to power) 2.) Understanding the world view of culturally diverse clients 3.) Developing appropriate intervention strategies and skills.

Critical Conciousness

a continuous self-reflexive process involving critical thinking in tandem with action whereby we challenge domination on three levels: personally, interpersonally, and structurally.

Conscientization

learning to perceive social, political and economic contradictions and to take action against the oppressive elements of reality.